Spin texture and magnetoroton excitations at nu=1/3

Neutral spin texture (ST) excitations at nu=1/3 are directly observed for the first time by resonant inelastic light scattering. They are determined to involve two simultaneous spin flips. At low magnetic fields, the ST energy is below that of the magnetoroton minimum. With increasing in-plane magnetic field these mode energies cross at a critical ratio of the Zeeman and Coulomb energies of eta(c)=0.020 +/- 0.001. Surprisingly, the intensity of the ST mode grows with temperature in the range in which the magnetoroton modes collapse. The temperature dependence is interpreted in terms of a competition between coexisting phases supporting different excitations. We consider the role of the ST excitations in activated transport at nu=1/3

Supergravity Higgs Inflation and Shift Symmetry in Electroweak Theory

We present a model of inflation in a supergravity framework in the Einstein frame where the Higgs field of the next to minimal supersymmetric standard model (NMSSM) plays the role of the inflaton. Previous attempts which assumed non-minimal coupling to gravity failed due to a tachyonic instability of the singlet field during inflation. A canonical K\"{a}hler potential with \textit{minimal coupling} to gravity can resolve the tachyonic instability but runs into the $\eta$-problem. We suggest a model which is free of the $\eta$-problem due to an additional coupling in the K\"{a}hler potential which is allowed by the Standard Model gauge group. This induces directions in the potential which we call K-flat. For a certain value of the new coupling in the (N)MSSM, the K\"{a}hler potential is special, because it can be associated with a certain shift symmetry for the Higgs doublets, a generalization of the shift symmetry for singlets in earlier models. We find that K-flat direction has $H_u^0=-H_d^{0*}.$ This shift symmetry is broken by interactions coming from the superpotential and gauge fields. This direction fails to produce successful inflation in the MSSM but produces a viable model in the NMSSM. The model is specifically interesting in the Peccei-Quinn (PQ) limit of the NMSSM. In this limit the model can be confirmed or ruled-out not just by cosmic microwave background observations but also by axion searches.Comment: matches the published version at JCA

Using Computer Simulation for Reducing the Appointment Lead-Time in a Public Pediatric Outpatient Department

Pediatric outpatient departments aim to provide a pleasant, effective and continuing care to children. However, a problem in these units is the long waiting time for children to receive an appointment. Prolonged appointment lead-time remains a global challenge since it results in delayed diagnosis and treatment causing increased morbidity and dissatisfaction. Additionally, it leads to an increased number of hospitalization and emergency department visits which augments the financial burden faced by healthcare systems. Despite these considerations, the studies directly concentrating on the reduction of appointment lead-time in these departments are largely limited. Therefore, this paper proposes the application of Discrete-event Simulation (DES) approach to evaluate potential improvement strategies aiming at reducing average appointment lead-time. Initially, the outpatient department is characterized to effectively identify the main activities, process variables, interactions, and system constraints. After data collection, input analysis is conducted through intra-variable independence, homogeneity and goodness-of-fit tests followed by the creation of a simulation model representing the real pediatric outpatient department. Then, Mann-Whitney tests are used to prove whether the model was statistically comparable with the real-world system. After this, the outpatient department performance is assessed in terms of average appointment lead-time and resource utilization. Finally, three improvement scenarios are assessed technically and financially, to determine if they are viable for implementation. A case study of a mixed-patient type environment in a public pediatric outpatient department has been explored to validate the proposed methodology. Statistical tests demonstrate that appointment lead-time in pediatric outpatient departments may be meaningfully minimized using this approach. © 2019, Springer Nature Switzerland AG

IL11 stimulates ERK/P90RSK to inhibit LKB1/AMPK and activate mTOR initiating a mesenchymal program in stromal, epithelial, and cancer cells

IL11 initiates fibroblast activation but also causes epithelial cell dysfunction. The mechanisms underlying these processes are not known. We report that IL11-stimulated ERK/P90RSK activity causes the phosphorylation of LKB1 at S325 and S428, leading to its inactivation. This inhibits AMPK and activates mTOR across cell types. In stromal cells, IL11-stimulated ERK activity inhibits LKB1/AMPK which is associated with mTOR activation, ⍺SMA expression, and myofibroblast transformation. In hepatocytes and epithelial cells, IL11/ERK activity inhibits LKB1/AMPK leading to mTOR activation, SNAI1 expression, and cell dysfunction. Across cells, IL11-induced phenotypes were inhibited by metformin stimulated AMPK activation. In mice, genetic or pharmacologic manipulation of IL11 activity revealed a critical role of IL11/ERK signaling for LKB1/AMPK inhibition and mTOR activation in fatty liver disease. These data identify the IL11/mTOR axis as a signaling commonality in stromal, epithelial, and cancer cells and reveal a shared IL11-driven mesenchymal program across cell types

A systematic review of treatment for patients with burning mouth syndrome.

BACKGROUND: Burning mouth syndrome is a chronic idiopathic intractable intraoral dysaesthesia that remains a challenge to clinicians due to its poorly understood pathogenesis and inconsistent response to various treatments. AIM: This review aimed to study the short- (≤3 months) and long-term (>3 months) effectiveness and sustainable benefit of different burning mouth syndrome treatment strategies and the associated side effects. MATERIALS AND METHODS: Randomised controlled trials of burning mouth syndrome treatment compared with placebo or other interventions with a minimum follow up of 2 months were searched from the PubMed, Embase and Cochrane database (published to July 2020). RESULTS: Twenty-two studies were selected based on the inclusion and exclusion criteria and analysed. Nine categories of burning mouth syndrome treatment were identified: Anticonvulsant and antidepressant agents, phytomedicine and alpha lipoic acid supplements, low-level laser therapy, saliva substitute, transcranial magnetic stimulation, and cognitive behaviour therapy. Cognitive behaviour therapy, topical capsaicin and clonazepam, and laser therapy demonstrated favourable outcome in both short- and long-term assessment. Phytomedicines reported a short-term benefit in pain score reduction. The pooled effect of alpha lipoic acid (ALA) pain score improvement was low, but its positive effects increased in long term assessment. CONCLUSION: A more significant volume in terms of sample size, multi-centres, and multi-arm comparison of therapeutic agents with placebo and longitudinal follow-up studies is recommended to establish a standardised burning mouth syndrome treatment protocol. Further studies are required to assess the analgesic benefits of topical clonazepam and capsaicin, alternative medicines with neurodegenerative prevention capability and psychology support in treating burning mouth syndrome and reducing systemic adverse drug reactions.Registration International Prospective Register of Systematic Reviews (PROSPERO):Protocol ID - CRD42020160892

Accidental blood exposure: risk and prevention in interventional radiology

There is a growing concern about the transmission of bloodborne pathogens during medical procedures among health care workers and patients. Over the last three decades, radiological services have undergone many changes with the introduction of new modalities. One of these new disciplines is interventional radiology (IR) which deals with procedures such as arteriography, image-guided biopsies, intravascular catheter insertions, angioplasty and stent placements. Despite these developments, the potential for accidental blood exposure and exposure to other infectious material continues to exist. Therefore, it is important for all radiologists who perform invasive procedures to observe specific recommendations for infection control. In this review, we look at the different policies for protection and universal standards on infection control

Germline polymorphisms as modulators of cancer phenotypes

Identifying the complete repertoire of genes and genetic variants that regulate the pathogenesis and progression of human disease is a central goal of post-genomic biomedical research. In cancer, recent studies have shown that genome-wide association studies can be successfully used to identify germline polymorphisms associated with an individual's susceptibility to malignancy. In parallel to these reports, substantial work has also shown that patterns of somatic alterations in human tumors can be successfully employed to predict disease prognosis and treatment response. A paper by Van Ness et al. published this month in BMC Medicine reports the initial results of a multi-institutional consortium for multiple myeloma designed to evaluate the role of germline polymorphisms in influencing multiple myeloma clinical outcome. Applying a custom-designed single nucleotide polymorphism microarray to two separate patient cohorts, the investigators successfully identified specific combinations of germline polymorphisms significantly associated with early clinical relapse. These results raise the exciting possibility that besides somatically acquired alterations, germline genetic background may also exert an important influence on cancer patient prognosis and outcome. Future 'personalized medicine' strategies for cancer may thus require incorporating genomic information from both tumor cells and the non-malignant patient genome