Charging capacitors from thermal fluctuations using diodes.

We theoretically consider a graphene ripple as a Brownian particle coupled to an energy storage circuit. When circuit and particle are at the same temperature, the second law forbids harvesting energy from the thermal motion of the Brownian particle, even if the circuit contains a rectifying diode. However, when the circuit contains a junction followed by two diodes wired in opposition, the approach to equilibrium may become ultraslow. Detailed balance is temporarily broken as current flows between the two diodes and charges storage capacitors. The energy harvested by each capacitor comes from the thermal bath of the diodes while the system obeys the first and second laws of thermodynamics.

Evolution of magnetic surfboards and spin glass behavior in (Fe1-pGap)2TiO5.

The unusual anisotropy of the spin glass (SG) transition in the pseudobrookite system Fe2TiO5has been interpreted as arising from an induced, van der Waals-like, interaction among magnetic clusters. Here we present susceptibility (χ) and specific heat data (C) for Fe2TiO5diluted with non-magnetic Ga, (Fe1-pGap)2TiO5, for disorder parameterp= 0, 0.11, and 0.42, and elastic neutron scattering data forp= 0.20. A uniform suppression ofTgis observed upon increasingp, along with a value ofχTgthat increases asTgdecreases, i.e.dχ(Tg)/dTg<0We also observeCT∝T2in the low temperature limit. The observed behavior places (Fe1-pGap)2TiO5in the category of a strongly geometrically frustrated SG.

Assessing Nontrivial Topology in Weyl Semimetals by Dichroic Photoemission.

The electronic structure of Weyl semimetals features Berry flux monopoles in the bulk and Fermi arcs at the surface. While angle-resolved photoelectron spectroscopy (ARPES) is successfully used to map the bulk and surface bands, it remains a challenge to explicitly resolve and pinpoint these topological features. Here we combine state-of-the-art photoemission theory and experiments over a wide range of excitation energies for the Weyl semimetals TaAs and TaP. Our results show that simple surface-band-counting schemes, proposed previously to identify nonzero Chern numbers, are ambiguous due to pronounced momentum-dependent spectral weight variations and the pronounced surface-bulk hybridization. Instead, our findings indicate that dichroic ARPES provides an improved approach to identify Fermi arcs but requires an accurate description of the photoelectron final state.

Genetic aspects for the behaviour of lactating sows towards humans.

With the keeping of lactating sows in loose housing systems, ensuring work safety for stockpersons is gaining importance. Aim of the present study was to develop tests characterising the behaviour of lactating sows in farrowing environments with more freedom to move. The behaviour towards humans in different management procedures was examined. Emphasis was given to integrate tests into daily routines. The study was conducted in a nucleus herd with 771 purebred Landrace sows. Data were collected from October 2016 until December 2018. Sows were kept in individual indoor pens with movable farrowing crates in which the animals were restrained from 7 days antepartum (ap) to an average of 7 days postpartum (pp). The Dummy Arm Test (DAT; 1444 observations) was used to assess the sows' reaction towards a stockperson handling the piglets around day 4 pp (closed crates). With the Towel Test (TT; 2846 observations), the reaction of sows to a novel object and an unexpected situation was assessed. The Trough Cleaning Test (TCT; 2805 observations) described the sows' response to common procedures such as trough cleaning. TT and TCT were conducted on days 3 pp (closed crates) and 10 pp (open crates). Variance components of behavioural traits were estimated univariately with a linear animal model, and genetic correlations between traits were derived using a multivariate animal model in ASreml 3.0. Most sows showed no or only a slight reaction to human interactions without attempting to attack them. However, a strong defensive reaction of sows was recorded in 4.0% (TCT), 4.5% (TT), and 10.7% (DAT) of observations. This behaviour of sows was observed more frequently in the open than in the closed pen system. Estimates of heritabilities (h2 ± SE) were h2 = 0.17 ± 0.05 for behaviour of sows towards humans (DAT), h2 = 0.19 ± 0.04 for response of sows towards unexpected situations (TT), and h2 = 0.13 ± 0.04 for reactions of animals to TCT. Genetic correlations (rg ± SE) ranged from rg = 0.59 ± 0.37 between TT and TCT to rg = 0.77 ± 0.30 between TT and DAT. Our results show that the developed tests are suitable for assessing the behaviour of sows towards humans. Behavioural traits derived from these tests could be used as new phenotypes for the genetic selection of gentle and easy-to-handle sows. The genetic correlations of all tests studied were positive indicating related reaction patterns.

Momentum-space signatures of Berry flux monopoles in the Weyl semimetal TaAs.

Since the early days of Dirac flux quantization, magnetic monopoles have been sought after as a potential corollary of quantized electric charge. As opposed to magnetic monopoles embedded into the theory of electromagnetism, Weyl semimetals (WSM) exhibit Berry flux monopoles in reciprocal parameter space. As a function of crystal momentum, such monopoles locate at the crossing point of spin-polarized bands forming the Weyl cone. Here, we report momentum-resolved spectroscopic signatures of Berry flux monopoles in TaAs as a paradigmatic WSM. We carried out angle-resolved photoelectron spectroscopy at bulk-sensitive soft X-ray energies (SX-ARPES) combined with photoelectron spin detection and circular dichroism. The experiments reveal large spin- and orbital-angular-momentum (SAM and OAM) polarizations of the Weyl-fermion states, resulting from the broken crystalline inversion symmetry in TaAs. Supported by first-principles calculations, our measurements image signatures of a topologically non-trivial winding of the OAM at the Weyl nodes and unveil a chirality-dependent SAM of the Weyl bands. Our results provide directly bulk-sensitive spectroscopic support for the non-trivial band topology in the WSM TaAs, promising to have profound implications for the study of quantum-geometric effects in solids.

Implementation and evaluation of a nurse-led decision-coaching program for healthy breast cancer susceptibility gene (BRCA1/2) mutation carriers: a study protocol for the randomized controlled EDCP-BRCA study.

BACKGROUND: Female BRCA mutation carriers have an increased lifetime risk for breast and ovarian cancer compared to the general population. Women who carry this mutation have several options to deal with their cancer risk, such as risk-reducing surgeries or intensified breast cancer screening. Previous research has shown that preferences in this scenario are highly dependent on affected women's personalities and value systems. To support these women in the decision-making process, a structured decision support consisting of decision coaching combined with a decision aid might be helpful. METHODS/DESIGN: A randomized controlled trial will be conducted in order to compare usual care with structured decision support alongside usual care. The decision support program entails nurse-led decision coaching as well as an evidence-based patient decision aid. Nurses are qualified by a 4-day training program in informed decision-making and decision coaching. Six centers for Familial Breast and Ovarian Cancer in Germany will be included in the study, with a planned sample size of 398 women. The primary outcome is the congruence between the preferred and the actual played role in the decision-making process as measured by the Control Preferences Scale. It is hypothesized that the structured decision support will enable women to play the preferred role in the decision-making process. Secondary outcomes include the knowledge and attitudes about preventive options, decisional conflict, depression and anxiety, coping self-efficacy, impact of event, and self-concept. A process evaluation will accompany the study. DISCUSSION: The EDCP-BRCA study is the first study to implement and evaluate decision coaching combined with a decision aid for healthy BRCA mutation carriers worldwide. TRIAL REGISTRATION {2A}: DRKS-ID: DRKS00015527. Registered 30 October 2019.

[Epidemiology of severe visual impairment and blindness of old people in Germany]. / Epidemiologie hochgradiger Sehbehinderungen und Blindheit älterer Menschen in Deutschland.

Approximately 500,000 blind and 1 million visually impaired persons live in Germany, which lacks a national blind registry. Therefore data from social welfare agencies and population-based studies are used to estimate prevalence and incidence. Main causes for severe visual impairment and blindness are age-related macular degeneration, glaucoma and diabetic eye diseases. We observed a relative decline of the incidence of severe visual impairment and blindness over the last decades, which is primarily due to improved ophthalmic care and better treatment options. However, the absolute number of subjects with severe visual impairment and blindness increases due to population ageing. This will cause significant social and economic challenges in the future.

Necrotizing enterocolitis comes in different forms: Historical perspectives and defining the disease.

The specific cause of what is commonly referred to as necrotizing enterocolitis (NEC) disease has been elusive largely because it is becoming clear that this entity represents more than one disease with multifactorial pathogenic mechanisms. Furthermore, finding clear and consistent diagnostic biomarkers will be difficult until the different subsets of what we are calling this disease are better delineated. In this introductory chapter, we discuss different disease entities that are frequently termed "NEC" in the newborn infant. We hope this will set the stage for more focused research and development of preventative measures for at least the most common forms of this disease.

Playing with Pearson's concept: orthogonally functionalized 1,4-diaza-1,3-butadienes leading to heterobinuclear complexes.

By reacting 1,2-diketones and ortho- diphenylphosphinoyl aniline in the presence of zinc(ii) as a templating agent, cationic zinc(ii) complexes of novel phosphine oxide functionalized 1,4-diaza-1,3-butadiene ligands are acessible. Herein the zinc(ii) site is bound to all four donor atoms of the ligand. Depending on the flexibility of the 1,4-diaza-1,3-butadiene backbone, the bonds to zinc(ii) from the 1,4-diaza-1,3-butadiene donors can be broken. Reaction with oxalate cleaves the zinc(ii) coordination completely and makes accessible the free ligands possessing orthogonal (N,N: soft; O,O: hard) sets of donor sites. This allows for the specific coordination of soft and hard Lewis acids and thus for the generation of heterobimetallic complexes, here exemplarily shown for the combination of palladium(ii) (soft) and zinc(ii) (hard) centres.

[Self-reported vision in (gerontological) health services research and practice-an opening plea]. / Selbstberichtetes Sehvermögen in der (gerontologischen) Versorgungsforschung und -praxis ­ ein Plädoyer zur Öffnung.

The use of self-reported vision is an integral part of most population surveys and is primarily used for healthcare monitoring. Since the patient's assessment is not always consistent with the objectively measured clinical parameters, the majority of the literature looks critically at the adequacy of self-reported vision, particularly with respect to answering epidemiological questions; however, it is often misunderstood that self-reported vision measures far more than the directly derived information show. This article shows the complexity of self-reported vision and discusses the importance of health services research and practice, with a special focus on the topic of vision in old age. From the explanations it becomes clear that the self-estimation of vision by a person is determined by various factors apart from the pure organ function and that the need for action and diagnostic conclusions can only be derived from self-reports. This is essential if vision is to be understood as a multifactorial condition and empirically practiced using different survey instruments. The article shows that self-reported vision is a good indicator of the quality of care in its entirety.

Cost-utility of a six-month programmed sports therapy (PST) in patients with haemophilia.

INTRODUCTION: Recurrent musculoskeletal haemorrhages in people with haemophilia (PwH) lead to restrictions in the locomotor system and, as a result, in physical performance, too. Due to its physical and psychological benefits, sport is increasingly re-commended for haemophilic patients. Evidence on the cost-effectiveness of sports therapy is still lacking. AIM: The aim of this study was to determine the cost-effectiveness of a 6-month programmed sports therapy (PST). METHODS: The cost-effectiveness of the 6-month PST was assessed from a societal perspective alongside a RCT using cost-utility analysis. The analysis included 50 PwH with moderate-to-severe haemophilia A and B and a training period over 6 months. The health-related quality of life was measured with the EuroQoL-domain questionnaire. Resource utilization was assessed by questionnaire before and after the intervention. A cost-effectiveness acceptability curve was constructed, and sensitivity analyses were performed. RESULTS: During the 6-month study period, mean adjusted total healthcare costs were lower (mean difference: -22 805 EUR; 95%-CI: -73 944-48 463; P = .59) and the number of QALYs was higher in the intervention group (mean difference: 0.3733; 95%-CI: 0.0014-0.0573; P = .04). The probability of an incremental cost-effectiveness ratio <50 000 EUR per QALY was 71%. The performed sensitivity analysis confirmed these results. CONCLUSION: Results showed that the PST is effective in terms of a significant gain of QALYs. Furthermore, results weakly indicate the potential of the PST to reduce healthcare costs. Future studies should expand the observation period to have a closer look at the influence of PST on lifetime costs.

Maternal milk feedings reduce sepsis, necrotizing enterocolitis and improve outcomes of premature infants.

OBJECTIVE: Human milk (donor milk (DM) and/or maternal milk (MM)) feedings protect against late onset sepsis (LOS), necrotizing enterocolitis (NEC) and death. However, DM lacks many anti-infective components of MM. Therefore, we studied exclusive MM feedings to evaluate the full effect of human milk on infectious and other outcomes in premature infants. STUDY DESIGN: All infants born before 33 weeks postmenstrual age (PMA) who received exclusive (>95%) MM or exclusive preterm formula (PF) were included in this prospective investigation. RESULTS: Sixty-three infants (53%) received MM and 55 infants (47%) received PF. Both groups had similar baseline characteristics. Infants in the MM group achieved full enteral nutrition sooner (14±8 vs 19±15 days, P<0.03) and required a shorter duration of central venous lines (14±10 vs 22±21, P<0.005). Fewer infants in the MM group developed LOS (9 vs 19, P<0.05) and pneumonia (8 vs 16, P<0.05) than PF infants. Only one MM and five PF infants developed NEC (Bell stage ⩾II). Logistic regression analysis using PMA and prolonged rupture of membranes as covariates demonstrated an increased rate of NEC (odds ratio=8.85, CI=1.01 to 25.17, P=0.048) in PF infants. Periventricular leukomalacia (PVL) was more common in PF (4 vs 0, P=0.04) than in MM infants. CONCLUSION: Feedings of MM advanced more rapidly and were associated with fewer infections than PF. A possible protective effect of MM against PVL, not previously described, may be related to its immune and anti-inflammatory components.

[Omitted spinal X-ray examination after a fall from a height of 3 m]. / Keine Röntgenuntersuchung der Wirbelsäule nach Sturz aus 3 m Höhe.

A 59-year-old patient with right-sided chest pains after a fall from a height of 3 m was referred to hospital by an emergency physician. The chest x-rays showed fractures of the third and seventh ribs on the right side. Inpatient analgesic therapy was initiated and after 3 days the patient was discharged from hospital for further outpatient treatment. As the pain persisted the patient consulted a surgeon 5 weeks later and the first X-ray examination of the spine was carried out which revealed the formation of several wedge-shaped thoracolumbar vertebral bodies. Further magnetic resonance imaging (MRI) diagnostics also revealed alterations to T10, T12, L1 and L3 as well as radiological signs of Scheuermann's disease; however, a definite statement differentiating these findings from older spinal fractures as a result of the accident was no longer possible. The patient claimed that the hospital failed to perform spinal X-ray investigations leading to prolonged pain and limitations in the quality of life. An external expert stated that the distracting injury of the ribs and the pain medication might have veiled the additional vertebral fractures. Thus, an earlier diagnosis of the apparently stable vertebral fractures would not have changed the conservative therapy approach. The decision of the arbitration board differed from the expert opinion as additional imaging techniques of the spine should have been initially performed due to the mechanism of injury. Although no irreversible damage to health resulted an earlier targeted treatment could have reduced the overall length of therapy.

[Bilateral vocal cord paresis after total thyroidectomy]. / Bilaterale Stimmlippenparese nach totaler Thyreoidektomie.

A 66-year-old female patient complained of hoarseness and dyspnea under exertion following total thyroidectomy. Due to a faulty operating technique both nerves to the vocal cords were damaged. From the operation report it emerged that the dissection was carried out by protecting the border lamellae but the recurrent laryngeal nerve could not be found on both sides. This article presents the external expert opinion, the decision of the arbitration board and the assessment of the case by two specialist physicians.

[Acute compartment syndrome after a bowling game]. / Kompartmentsyndrom nach Bowlingspiel.

A 28-year-old male patient was initially conservatively treated by a general physician for muscle strain of the right calf after a bowling game. Due to increasing pain and swelling of the lower leg 5 days later, the differential diagnosis of a deep vein thrombosis was considered. Furthermore, the onset of neurological deficits and problems with raising the foot prompted inclusion of compartment syndrome in the differential diagnosis for the first time. Admission to hospital for surgical intervention was scheduled for the following day. At this point in time the laboratory results showed a negative d-dimer value and greatly increased C-reactive protein level. On day 6 a dermatofasciotomy was performed which revealed extensive muscular necrosis with complete palsy of the peroneal nerve. In the following lawsuit the patient accused the surgeon of having misdiagnosed the slow-onset compartment syndrome and thus delaying correct and mandatory treatment. The arbitration board ruled that the surgeon should have performed fasciotomy immediately on day 5 at the patient's consultation. The clinical presentation of progressive pain, swelling of the lower leg in combination with peroneal palsy must lead to the differential diagnosis of compartment syndrome resulting in adequate therapy. The delay of immediate surgery, therefore, was assessed to be faulty as this knowledge is to be expected of a surgeon.

[Complicated course of a laparoscopic cholecystectomy]. / Komplizierter Verlauf einer laparoskopischen Cholezystektomie.

The case presented deals with the complicated course of a laparoscopic cholecystectomy in a 45-year-old female patient due to cholecystolithiasis. The patient complained that during the operation an injury to the small intestine occurred, which was only operatively treated at midday of the despite massive pain and insufficient pain treatment. The intervention was claimed to have resulted in mental and physical suffering. The case is assessed by two independent experts in the sense of a "scientifically founded comment" with respect to the decision of the arbitration board and taking the surgical standards into consideration.

[Operation well performed but insufficiently documented and not indicated]. / Operation lege artis, jedoch mangelhaft dokumentiert und nicht indiziert.

A 50-year-old patient presented with a lump in the main joint of the fourth finger of the left hand, which was suspected of being malignant, for an operation. Following surgery the lump was still present and, furthermore, the patient reported a wound resulting from surgery on the third finger accompanied by swelling, pain and a loss of mobility. The patient accused the physician of performing surgery without indications on the wrong finger together with failure to remove the lump. The surgeon stated that lysis had been performed on the flexor tendon in the area of the lump. An external expert admonished the cursory surgery report; however, the expert stated that removal of the lump at the tendon would have been medically indicated and the operation was performed according to professional surgical standards. The decision of the arbitration board differed from the expert opinion as the insufficient documentation presented at first could have been understood to mean that a tendon node on the fourth finger was to be removed which was not the case. Furthermore, the operation performed would only have been indicated if a "trigger finger" were present; therefore, the surgery as well as the resulting afflictions and follow-up treatment were to be assessed as faulty. The handwritten surgery report had several shortcomings as well and led to a reversal of the burden of proof.

The value of routine evaluation of gastric residuals in very low birth weight infants.

OBJECTIVE: Little information exists regarding gastric residual (GR) evaluation prior to feedings in premature infants. The purpose of this study was to compare the amount of feedings at 2 and 3 weeks of age, number of days to full feedings, growth and incidence of complications between infants who underwent RGR (routine evaluation of GR) evaluation versus those who did not. STUDY DESIGN: Sixty-one premature infants were randomized to one of two groups. Group 1 received RGR evaluation prior to feeds and Group 2 did not. RESULT: There was no difference in amount of feeding at 2 (P=0.66) or 3 (P=0.41) weeks of age, growth, days on parenteral nutrition or complications. Although not statistically significant, infants without RGR evaluation reached feeds of 150 ml kg(-1) per day 6 days earlier and had 6 fewer days with central venous access. CONCLUSION: RESULTs suggest RGR evaluation may not improve nutritional outcomes in premature infants.

[High-pressure injection injury of the hand. Underestimation of injury severity]. / Hochdruckinjektionsverletzung an der Hand. Unterschätzung der Verletzungsschwere.

A 44-year-old man sustained a high-pressure injection injury of the left index finger with hot hydraulic oil in an occupational accident. On presentation to the occupational physician 4 h later the wound was irrigated and cleaned. At this time X-ray diagnostics, wound revision, administration of antibiotics and immobilization were not performed. The following day the patient presented to a hospital with painful swelling and reddening of the left index finger where an emergency surgical wound revision, administration of antibiotics and immobilization of the finger were performed due to a phlegmon of the flexor tendon. Despite subsequent revision operations, necrosis of the flexor tendon sheath occurred with a skin subcutis defect necessitating a full thickness skin transplantation and ultimately operative fusion of the distal interphalangeal joint of the index finger. After a total period of treatment of 9 months the patient still presented with local soft tissue swelling and paresthesia as well as a limited range of motion of the proximal interphalangeal joint. The patient filed a complaint for wrong treatment of the high-pressure injection injury in terms of an inaccurate examination and lack of administration of antibiotics at the first presentation. The expert opinion of the arbitration board ascertained medical malpractice at the first presentation. An emergency surgical wound revision had already been indicated at the first presentation and the revision procedures would have been less extensive and it was highly probability that surgical fusion of the distal interphalangeal joint could have been avoided. The arbitration furthermore concluded that iatrogenic maltreatment led to a phlegmon of the flexor tendon with the need for subsequent revision operations including surgical fusion of the distal interphalangeal joint which resulted in an affected grip control. The delay in surgical treatment must be considered as the reason for the much worse initial situation that finally led to the functional impairment of the left index finger.