We study the dispersion properties of electron plasma waves, or plasmons, which can be excited in quantum plasmas in the nonlinear regime. In order to describe nonlinear electron response to finite amplitude plasmons, we apply the Volkov approach to nonrelativistic electrons. For that purpose, we use the Schrödinger equation and describe the electron population of a quantum plasma as a mixture of quantum states. Within the kinetic framework that we are able to derive from the Volkov solutions, we discuss the role of the wave amplitude on the nonlinear plasma response. Finally, we focus on the quantum properties of nonlinear Landau damping and study the contributions of multiplasmon absorption and emission processes.
OBJECTIVE: This study focuses on the evolution of treatment techniques for aortic coarctation in children and assesses long-term morbidity. METHODS: This retrospective cohort study evaluates patients treated for native aortic coarctation, with at least 7 years of follow-up. To assess time-related changes, three time periods were distinguished according to year of primary intervention (era 1, 2 and 3). Operative and long-term follow-up data were collected by patient record reviews. RESULTS: The study population consisted of 206 patients (177 surgical and 29 catheter-based interventions), with a median follow-up of 151 months. Anterior approach with simultaneous repair of aortic arch and associated cardiac lesions was more common in the most recent era. Median age at intervention did not change over time. Reintervention was necessary in one third of the cohort with an event-free survival of 74% at 5year and 68% at 10-year follow-up. Reintervention rates were significantly higher after catheter-based interventions compared with surgical interventions (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.04-3.00, pâ¯= 0.04) and in patients treated before 3 months of age (HR 2.1, 95% CI 1.27-3.55, pâ¯= 0.003). Hypertension was present in one out of five patients. CONCLUSION: Nowadays, complex patients with associated cardiac defects and arch hypoplasia are being treated surgically on bypass, whereas catheter-based intervention is introduced for non-complex patients. Reintervention is common and more frequent after catheter-based intervention and in surgery under 3 months of age. One fifth of the 206 patients remained hypertensive.
PURPOSE: Despite the increasing use of telemanipulators in colorectal surgery, an additional benefit in terms of improved perioperative results is not proven. The aim of the study was to compare clinical, oncological, and functional results of Da Vinci (Xi)-assisted versus conventional laparoscopic (low) anterior resection for rectal cancer. METHODS: Monocenter, prospective, controlled cohort study with a 12-month follow-up of bladder and sexual function using the validated questionnaires International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index. RESULTS: Fifty-one patients were included (18, Da Vinci (Xi) assisted; 33, conventional laparoscopy). Conversion to an open approach was more common in the Da Vinci cohort (p = 0.012). In addition, surgery and resumption of a normal diet took longer in the robotic group (p = 0.005; p = 0.042). Surgical morbidity and oncological quality did not differ. There was no difference in most functional domains, except for worsened ability to orgasm (p = 0.047) and sexual satisfaction (p = 0.034) in women after conventional laparoscopy. Moreover, we found a higher rate of improved bladder function in the conventional laparoscopy group (p = 0.023) and less painful sexual intercourse among women in the robot-assisted group (p = 0.049). CONCLUSION: In contrast to the ROLARR trial, a higher conversion rate was found in the robotic cohort, which may in part be explained by a learning curve effect. Nevertheless, the Da Vinci-assisted approach showed favorable results regarding sexual function.
Laparoscopy , Rectal Neoplasms/surgery , Robotic Surgical Procedures , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Care , Prospective Studies , Rectal Neoplasms/pathology , Treatment Outcome
In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.
Musculoskeletal Diseases , Rheumatic Diseases , Rheumatology , Early Diagnosis , Germany , Humans , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/therapy , Referral and Consultation , Rheumatic Diseases/diagnosis , Rheumatic Diseases/therapy , Rheumatology/methods
Understanding the transport properties of charged particle beams is important not only from a fundamental point of view but also due to its relevance in a variety of applications. A theoretical model is established in this article, to model the interaction of a tenuous positively charged ion beam with an ultradense quantum electron-ion plasma, by employing a rigorous relativistic quantum-hydrodynamic (fluid plasma) electrostatic model proposed in McKerr et al. [M. McKerr, F. Haas, and I. Kourakis, Phys. Rev. E 90, 033112 (2014)PLEEE81539-375510.1103/PhysRevE.90.033112]. A nonlinear analysis is carried out to elucidate the propagation characteristics and the existence conditions of large amplitude electrostatic solitary waves propagating in the plasma in the presence of the beam. Anticipating stationary profile excitations, a pseudomechanical energy balance formalism is adopted to reduce the fluid evolution equation to an ordinary differential equation. Exact solutions are thus obtained numerically, predicting localized excitations (pulses) for all of the plasma state variables, in response to an electrostatic potential disturbance. An ambipolar electric field form is also obtained. Thorough analysis of the reality conditions for all variables is undertaken in order to determine the range of allowed values for the solitonic pulse speed and how it varies as a function of the beam characteristics (beam velocity and density).
The dynamics of linear and nonlinear ionic-scale electrostatic excitations propagating in a magnetized relativistic quantum plasma is studied. A quantum-hydrodynamic model is adopted and degenerate statistics for the electrons is taken into account. The dispersion properties of linear ion acoustic waves are examined in detail. A modified characteristic charge screening length and "sound speed" are introduced, for relativistic quantum plasmas. By employing the reductive perturbation technique, a Zakharov-Kuznetzov-type equation is derived. Using the small-k expansion method, the stability profile of weakly nonlinear slightly supersonic electrostatic pulses is also discussed. The effect of electron degeneracy on the basic characteristics of electrostatic excitations is investigated. The entire analysis is valid in a three-dimensional as well as in two-dimensional geometry. A brief discussion of possible applications in laboratory and space plasmas is included.
BACKGROUND: Research in postoperative mortality is scarce. Insight into mortality and cause of death might improve and innovate perioperative care. The objective for this study was to report the 24-hour and 30-day overall, and surgery and anaesthesia-related, in-hospital mortality at a tertiary paediatric hospital. METHODS: All patients <18 yr old who underwent anaesthesia with or without surgery between January 1, 2006, and December 31, 2012, at the Wilhelmina Children's Hospital, Utrecht, The Netherlands, were included in this retrospective cohort study. Causes of death within 30 days were identified and tabulated into four major categories according to principal cause. RESULTS: A total of 45,182 anaesthetics were administered during this 7-yr period. The all-cause 24-hour hospital mortality was 13.1 per 10,000 anaesthetics (95% CI: 9.9-16.8) and the all-cause 30-day in-hospital mortality was 41.6 per 10,000 anaesthetics (95% CI: 35.9-48.0). In total five patients were partially contributable to anaesthesia (30-day mortality: 1.1/10,000, 95% CI: 0.4-2.6) and four patients were partially contributable to surgery (30-day mortality: 0.9/10,000, 95% CI: 0.2-2.3). Mortality was higher in neonates and infants, children with ASA physical status III and IV, and emergency- and cardiothoracic surgery. CONCLUSIONS: Neonates and infants, children with ASA physical status III or poorer, and emergency- and cardiothoracic surgery are associated with a higher postoperative mortality. Anaesthesia- or surgery-related complications contribute to mortality in only a small amount of the deaths, indicating the relative safety of paediatric surgical and anaesthetic procedures.
Anesthesia/statistics & numerical data , Hospital Mortality , Hospitals, Pediatric/statistics & numerical data , Perioperative Period/statistics & numerical data , Tertiary Care Centers/statistics & numerical data , Adolescent , Age Factors , Anesthesia/adverse effects , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Male , Netherlands , Retrospective Studies
The magnetotransport of GaAs/InAs core/shell nanowires contacted by two superconducting Nb electrodes is investigated, where the InAs shell forms a tube-like conductive channel around the highly resistive GaAs core. By applying a magnetic field along the nanowire axis, regular magnetoconductance oscillations with an amplitude in the order of e(2)/h are observed. The oscillation amplitude is found to be larger by 2 orders of magnitude compared to the measurements of a reference sample with normal metal contacts. For the Nb-contacted core/shell nanowire the oscillation period corresponds to half a flux quantum Φ0/2 = h/2e in contrast to the period of Φ0 of the reference sample. The strongly enhanced magnetoconductance oscillations are explained by phase-coherent resonant Andreev reflections at the Nb-core/shell nanowire interface.
An excitation function of one- and two-neutron transfer channels for the ^{60}Ni+^{116}Sn system has been measured with the magnetic spectrometer PRISMA in a wide energy range, from the Coulomb barrier to far below it. The experimental transfer probabilities are well reproduced, for the first time with heavy ions, in absolute values and in slope by microscopic calculations which incorporate nucleon-nucleon pairing correlations.
Measurements of the excitation function for the fusion of (24)Mg+(30)Si (Q=17.89 MeV)have been extended toward lower energies with respect to previous experimental data. The S-factor maximum observed in this large, positive-Q-value system is the most pronounced among such systems studied thus far. The significance and the systematics of an S-factor maximum in systems with positive fusion Q values are discussed. This result would strongly impact the extrapolated cross sections and reaction rates in the carbon and oxygen burnings and, thus, the study of the history of stellar evolution.
The influence of localized water currents on the nonlinear dynamics and stability of large amplitude, statistically distributed gravity waves is investigated theoretically and numerically by means of an evolution equation for a Wigner function governing the spectrum of waves. It is shown that water waves propagating in the opposite direction of a localized current channel can be trapped in the channel, which can lead to the amplification of the wave intensity. Under certain conditions the wave intensity can be further localized due to a self-focusing (Benjamin-Feir) instability. The localized amplification of the wave intensity may increase the probability of extreme events in the form of freak waves, which have been observed in connection with ocean currents.
Gravitation , Models, Chemical , Nonlinear Dynamics , Rheology/methods , Water Movements , Water/chemistry , Computer Simulation
We report on the technology and growth optimization of GaAs/InAs core/shell nanowires. The GaAs nanowire cores were grown selectively by metal organic vapor phase epitaxy (SA-MOVPE) on SiO(2) masked GaAs (111)B templates. These were structured by a complete thermal nanoimprint lithography process, which is presented in detail. The influence of the subsequent InAs shell growth temperature on the shell morphology and crystal structure was investigated by scanning and transmission electron microscopy in order to obtain the desired homogeneous and uniform InAs overgrowth. At the optimal growth temperature, the InAs shell adopted the morphology and crystal structure of the underlying GaAs core and was perfectly uniform.
We investigated the transport properties of GaAs/InAs core/shell nanowires grown by molecular beam epitaxy. Owing to the band alignment between GaAs and InAs, electrons are accumulated in the InAs shell as long as the shell thickness exceeds 12 nm. By performing simulations using a Schrödinger-Poisson solver, it is confirmed that confined states are present in the InAs shell, which are depleted if the shell thickness is below a threshold value. The existence of a tubular-shaped conductor is proved by performing magnetoconductance measurements at low temperatures. Here, flux periodic conductance oscillations are observed which can be attributed to transport in one-dimensional channels based on angular momentum states.
The quantum relativistic Buneman instability is investigated theoretically using a collective Klein-Gordon model for the electrons and a cold fluid model for the ions. The growth rate and unstable wave spectrum is investigated in different parameter regimes corresponding to various degrees of relativistic and quantum effects. The results may be important for streaming instabilities involving ion dynamics in very dense plasmas.
Models, Chemical , Plasma Gases/chemistry , Quantum Theory , Computer Simulation
Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised.
A multistream model for spinless electrons in a relativistic quantum plasma is introduced by means of a suitable fluidlike version of the Klein-Gordon-Maxwell system. The one- and two-stream cases are treated in detail. A new linear instability condition for two-stream quantum plasmas is obtained, generalizing the previously known nonrelativistic results. In both the one- and two-stream cases, steady-state solutions reduce the model to a set of coupled nonlinear ordinary differential equations, which can be numerically solved, yielding a manifold of nonlinear periodic and soliton structures. The validity conditions for the applicability of the model are addressed.
PURPOSE: The purpose of this study was to determine potential effects of isometric non-machine-based training on the cross-sectional area (CSA) of the paravertebral muscles in volunteers who were participants in a prevention program. An increase in the CSA of back muscles after various machine-based exercises have been reported but non-machine-based training programs have not been adressed before. MATERIALS AND METHODS: In the study 14 volunteers, who were participants of a company internal prevention program, underwent a magnetic resonance (MR) examination before and after a 3 months training program to improve back muscle strength. The MRI protocol consisted of T1-weighted and T2-weighted images aligned to the intervertebral disc spaces. The CSAs of the erector spinae and quadratus lumborum muscles were assessed twice by 2 operators at the levels L3/4, L4/5 and L5/S1. RESULTS: Out of 14 subjects 11 completed the training. The recorded CSA values exhibited an intrarater and intrarater correlation coefficient ranging from 0.949 to 0.989. There was an increase in CSA in all subjects after the training period (mean increase 8%). CONCLUSIONS: A 3-month isometric training program is sufficient to effect measurable increases in back muscles volume. The study demonstrated the usefulness of MRI to quantify such changes as a measure of training efficacy and compliance into the training program. These results represent a rationale for further studies to determine the effect of different training methods on the CSA of back muscles and to correlate structural changes with clinical symptoms in chronic low back pain syndrome.
Exercise Therapy/methods , Image Interpretation, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Isometric Contraction , Muscle, Skeletal/pathology , Muscle, Skeletal/physiopathology , Anatomy, Cross-Sectional/methods , Back/pathology , Back/physiopathology , Exercise Therapy/instrumentation , Humans , Image Enhancement/methods , Male , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Treatment Outcome
BACKGROUND: The Norwood procedure consists of three palliative operations, performed in neonates with hypoplastic left heart syndrome. Especially the first stage (Norwood I) is associated with the highest mortality rates in paediatric cardiac surgery (up to 25%). During surgery, the aorta is reconstructed and a systemic-to-pulmonary shunt is applied. Originally the modified Blalock-Taussig shunt was used, but recently the right-ventricle-to-pulmonary-artery shunt is increasingly being employed. We reviewed the results of our operative strategy, where an individualised choice of shunt is made. Furthermore, attempts to reduce interstage mortality (between Norwood I and II) were assessed. METHODS: All neonates who underwent Norwood stage I palliation from August 2004 until November 2010 were included in this retrospective analysis. Mortality rates and management strategies were compared. RESULTS: Thirty-six patients were available for analysis. Overall 30-day mortality was 5.6% (2 patients) and interstage mortality after discharge was 14% (5 patients). In 2006, a novel clinical protocol was introduced, aimed at reduction of mortality during the interstage period. This resulted in reduction of interstage mortality from 23% to 9% (3 of 13 infants, versus 2 of 23), with a cumulative survival of 82% (maximum follow-up 4 years). CONCLUSION: Early surgical results following the Norwood procedure using an individualised shunt choice are favourable.
