Juice Powder Concentrate and Systemic Blood Pressure, Progression of Coronary Artery Calcium and Antioxidant Status in Hypertensive Subjects: A Pilot Study

Because micronutrients from plants may have beneficial cardiovascular effects, the hypothesis that an encapsulated juice powder concentrate might affect several measures of vascular health was tested in free living adults at low cardiovascular risk. Blood pressure, vascular compliance, lipid and antioxidant markers, and serial electron beam tomography (to calculate a coronary artery calcium score as a measure of atherosclerosis burden), were monitored in 51 pre-hypertensive and hypertensive subjects over 2 years. By the end of follow-up, systolic and diastolic blood pressure decreased significantly (−2.4 ± 1.0 mmHg, P < 0.05 and −2.2 ± 0.6 mmHg, P < 0.001), and large artery compliance improved significantly (1.9 ± 0.6 ml mmHg−1 × 100, P < 0.01). The progression of coronary artery calcium score was smaller than expected compared with a historical database (P < 0.001). Laboratory testing showed a significant decrease in homocysteine (P = 0.05), HDL cholesterol (P = 0.025) and Apo A (P = 0.004), as well as a significant increase in β-carotene, folate, Co-Q10 and α-tocopherol (all P < 0.001). The phytonutrient concentrate we utilized induced several favorable modifications of markers of vascular health in the subjects. This study supports the notion that plant nutrients are important components of a heart healthy diet

Low-Temperature Growth of Graphene on a Semiconductor

The industrial realization of graphene has so far been limited by challenges related to the quality, reproducibility, and high process temperatures required to manufacture graphene on suitable substrates. We demonstrate that epitaxial graphene can be grown on transition-metal-treated 6H-SiC(0001) surfaces, with an onset of graphitization starting around 450–500 °C. From the chemical reaction between SiC and thin films of Fe or Ru, sp3 carbon is liberated from the SiC crystal and converted to sp2 carbon at the surface. The quality of the graphene is demonstrated by using angle-resolved photoemission spectroscopy and low-energy electron diffraction. Furthermore, the orientation and placement of the graphene layers relative to the SiC substrate are verified by using angle-resolved absorption spectroscopy and energy-dependent photoelectron spectroscopy, respectively. With subsequent thermal treatments to higher temperatures, a steerable diffusion of the metal layers into the bulk SiC is achieved. The result is graphene supported on magnetic silicide or optionally, directly on semiconductor, at temperatures ideal for further large-scale processing into graphene-based device structures

Diamond (111) surface reconstruction and epitaxial graphene interface

The evolution of the diamond (111) surface as it undergoes reconstruction and subsequent graphene formation is investigated with angle-resolved photoemission spectroscopy, low energy electron diffraction, and complementary density functional theory calculations. The process is examined starting at the C(111)-(2x1) surface reconstruction that occurs following detachment of the surface adatoms at 920 {\deg}C, and continues through to the liberation of the reconstructed surface atoms into a free-standing monolayer of epitaxial graphene at temperatures above 1000 {\deg}C. Our results show that the C(111)-(2x1) surface is metallic as it has electronic states that intersect the Fermi-level. This is in strong agreement with a symmetrically {\pi}-bonded chain model and should contribute to resolving the controversies that exist in the literature surrounding the electronic nature of this surface. The graphene formed at higher temperatures exists above a newly formed C(111)-(2\times1) surface and appears to have little substrate interaction as the Dirac-point is observed at the Fermi-level. Finally, we demonstrate that it is possible to hydrogen terminate the underlying diamond surface by means of plasma processing without removing the graphene layer, forming a graphene-semiconductor interface. This could have particular relevance for doping the graphene formed on the diamond (111)surface via tuneable substrate interactions as a result of changing the terminating species at the diamond-graphene interface by plasma processing.Comment: 10 pages, 4 figure

Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool

Background: Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic, neuropathic-like and ischaemic pain. However, the heterogeneity of patients in daily clinical practice makes it often challenging to determine which patients are eligible for this treatment, resulting in undesirable practice variations. This study aimed to establish patient-specific recommendations for referral and selection of SCS in chronic pain. Methods: A multidisciplinary European panel used the RAND/UCLA Appropriateness Method (RUAM) to assess the appropriateness of (referral for) SCS for 386 clinical scenarios in four pain areas: chronic low back pain and/or leg pain, complex regional pain syndrome, neuropathic pain syndromes and ischaemic pain syndromes. In addition, the panel identified a set of psychosocial factors that are relevant to the decision for SCS treatment. Results: Appropriateness of SCS was strongly determined by the neuropathic or neuropathic-like pain component, location and spread of pain, anatomic abnormalities and previous response to therapies targeting pain processing (e.g. nerve block). Psychosocial factors considered relevant for SCS selection were as follows: lack of engagement, dysfunctional coping, unrealistic expectations, inadequate daily activity level, problematic social support, secondary gain, psychological distress and unwillingness to reduce high-dose opioids. An educational e-health tool was developed that combines clinical and psychosocial factors into an advice on referral/selection for SCS. Conclusions: The RUAM was useful to establish a consensus on patient-specific criteria for referral/selection for SCS in chronic pain. The e-health tool may help physicians learn to apply an integrated approach of clinical and psychosocial factors. Significance: Determining the eligibility of SCS in patients with chronic pain requires careful consideration of a variety of clinical and psychosocial factors. Using a systematic approach to combine evidence from clinical studies and expert opinion, a multidisciplinary European expert panel developed detailed recommendations to support appropriate referral and selection for SCS in chronic pain. These recommendations are available as an educational e-health tool (https://www.scstool.org/)

The effects of customer equity drivers on loyalty across services industries and firms

Customer equity drivers (CEDs)—value equity, brand equity, and relationship equity—positively affect loyalty intentions, but this effect varies across industries and firms. We empirically examine potential industry and firm characteristics that explain why the CEDs–loyalty link varies across services industries and firms in the Netherlands. The results show that (1) some previously assumed industry and firm characteristics have moderating effects while others do not and (2) firm-level advertising expenditures constitute the most crucial moderator because they influence all three loyalty strategies (significant for value equity and brand equity; marginally significant for relationship equity), while three industry contexts (i.e., innovative markets, visibility to others, and complexity of purchase decisions) each influence two of the three loyalty strategies. Our results clearly show that specific industry and firm characteristics affect the effectiveness of specific loyalty strategies

A Longitudinal Analysis of Customer Satisfaction, Relationship Commitment Dimensions, and Triggers on Share of Wallet

The overwhelming majority of research in marketing has treated commitment as a one or two dimensional construct and largely disregarded temporal effects when investigating the relationship between satisfaction, commitment and customer loyalty. This under-specification of the commitment construct and cross-sectional nature of studies has the potential to misrepresent these relationships. This research uses a three-component model of commitment (affective, calculative, normative) and situational triggers to examine their impact on customers’ share of wallet (SOW). The data consists of 269 households whose banking relationships were tracked for two years. The results showed that changes in affective, calculative and normative commitment each have a significant positive association with change in share of wallet when one adjusts for the effects of customer characteristics such as age and tenure with company. The baseline level of calculative commitment, and changes in affective commitment provide the best explanations for changes in SOW, and when this information on commitment is used, contemporaneous changes in satisfaction has no significant incremental value as a predictor for changes in SOW. Finally the analysis reveals a two-segment customer model which demonstrates how managers can be misled if they assume that everyone will react to satisfaction and commitment improvement efforts similarly.Customer Satisfaction, Affective Commitment, Calculative Commitment, Normative Commitment, Share-of-Wallet

A longitudinal examination of customer commitment and loyalty

Purpose - This study aims to provide the first longitudinal examination of the relationship between affective, calculative, normative commitment and customer loyalty by using longitudinal panel survey data. Design/methodology/approach - Repeated measures for 269 customers of a large financial services provider are employed. Two types of segmentation methods are compared: predefined classes and latent class models and predictive power of different models contrasted. Findings - The results reveal that the impact that different dimensions of commitment have on share development varies across segments. A two-segment latent class model and a managerially relevant predefined two-segment customer model are identified. In addition, the results demonstrate the benefits of using panel survey data in models that are designed to study how loyalty develops over time. Practical implications - This study illustrates the benefits of including both baseline level information and changes in the dimensions of commitment in models that try to understand how loyalty unfolds over time. It also demonstrates how managers can be misled by assuming that everyone will react to commitment improvement efforts similarly. This study also shows how different segmentation schemes can be employed and reveals that the most sophisticated ones are not necessarily the best. Originality/value - This research provides the first examination of models for change in customer loyalty by employing survey panel data on the three-component model of customer commitment (affective, calculative, and normative) and considers alternative segmentation methods