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Abstract Background Erenumab, the first-in-class fully human monoclonal antibody targeting the calcitonin gene-related peptide receptor, was shown to be efficacious and safe for the prophylactic treatment of migraine in adults in randomized clinical trials. Large-scale, real-world evidence in multi-centre settings is still needed to confirm these results. Erenumab patient profiles outside clinical trials and physicians’ treatment patterns, as well as data from patients treated in Germany, a severely impacted population, are not published yet. Methods TELESCOPE was a multi-centre survey gathering real-world data from 45 German headache centres between July 2019 and December 2019. The project consisted of two parts. In the first part, treating physicians shared their experiences on current erenumab treatment with regard to patient profiles, treatment patterns and treatment responses. In the second part, a retrospective chart review was conducted of 542 migraine patients treated with erenumab for at least three months. Treatment responses focused on various aspects of patients’ quality of life. Results The analysis of 542 patients’ charts revealed that three-month treatment with erenumab significantly reduced monthly headaches, migraine and acute medication days. Furthermore, headache intensity and frequency were reduced in over 75 % and accompanying aura in 35 % of patients. The clinical global impression scale revealed a general improvement in 91 % of patients. According to the treating physicians’ professional judgement, 83 % of patients responded to erenumab and 80 % were satisfied with the treatment. Physicians evaluated restricted quality of life, the number of monthly migraine days and previous, prophylactic treatments as the main components of the current patient profile for monoclonal antibody recipients. Based on the assessment of physicians, erenumab reduced migraine symptoms in 65 % and increased quality of life in more than 75 % of their patients. Conclusions TELESCOPE confirms positive treatment responses with erenumab shown in clinical trials in a real-world multi-centre setting. The results show consistently positive experiences of physicians utilizing erenumab in clinical practice and underline that therapy with this monoclonal antibody is effective in migraine patients, particular in those, who have failed several prophylactic therapies.

The electric solar wind sail, or E-sail, is a novel deep space propulsion concept which has not been demonstrated in space yet. While the solar wind is the authentic operational environment of the electric sail, its fundamentals can be demonstrated in the ionosphere where the E-sail can be used as a plasma brake for deorbiting. Two missions to be launched in 2023, Foresail-1p and ESTCube-2, will attempt to demonstrate Coulomb drag propulsion (an umbrella term for the E-sail and plasma brake) in low Earth orbit. This paper presents the next step of bringing the E-sail to deep space—we provide the initial modelling and trajectory analysis of demonstrating the E-sail in solar wind. The preliminary analysis assumes a six-unit cubesat being inserted in the lunar orbit where it deploys several hundred meters of the E-sail tether and charges the tether at 10–20 kV. The spacecraft will experience acceleration due to the solar wind particles being deflected by the electrostatic sheath around the charged tether. The paper includes two new concepts: the software architecture of a new mission design tool, the Electric Sail Mission Expeditor (ESME), and the initial E-sail experiment design for the lunar orbit. Our solar-wind simulation places the Electric Sail Test Cube (ESTCube) lunar cubesat with the E-sail tether in average solar wind conditions and we estimate a force of 1.51×10−4 N produced by the Coulomb drag on a 2 km tether charged to 20 kV. Our trajectory analysis takes the 15 kg cubesat from the lunar back to the Earth orbit in under three years assuming a 2 km long tether and 20 kV. The results of this paper are used to set scientific requirements for the conceptional ESTCube lunar nanospacecraft mission design to be published subsequently in the Special Issue “Advances in CubeSat Sails and Tethers”.

We present a novel rocket-borne ion mass spectrometer named ROMARA (ROcket-borne MAss spectrometer for Research in the Atmosphere) for measuring atmospheric positive and negative ions (atomic, molecular and cluster ions) and positively and negatively charged meteor smoke particles. Our ROMARA instrument has, compared to previous rocket-borne ion mass spectrometers, a markedly larger mass range of up to m/z 2000 and a larger sensitivity, particularly for meteor smoke particle detection. The major objectives of this first ROMARA flight included the following: a functional test of the ROMARA instrument, measurements between 55 and 121 km in the mass range of atmospheric positive and negative ions, a first attempt to conduct mass spectrometric measurements in the mass range of meteor smoke particles with mass-to-charge ratios up to m/z 2000, and measurements inside a polar mesospheric winter echo layer as detected by ground-based radar. Our ROMARA measurements took place on the Arctic island of Andøya, Norway, at around noon in April 2018 and represented an integral part of the polar mesospheric winter radar echo (PMWE) rocket campaign. During the rocket flight, ROMARA was operated in a measurement mode, offering maximum sensitivity and the ability to qualitatively detect total ion signatures even beyond its mass-resolving mass range. On this first ROMARA flight we were able to meet all of our objectives. We detected atmospheric species including positive atomic, molecular and cluster ions along with negative molecular ions up to about m/z 100. Above m/z 2000, ROMARA measured strong negative-ion signatures, which are likely due to negatively charged meteor smoke particles.

The electric and magnetic field instrument suite FIELDS on board the NASA Parker Solar Probe and the radio and plasma waves instrument RPW on the ESA Solar Orbiter mission that explore the inner heliosphere are sensitive to signals generated by dust impacts. Dust impacts have been observed using electric field antennas on spacecraft since the 1980s and the method was recently used with a number of space missions to derive dust fluxes. Here, we consider the details of dust impacts, subsequent development of the impact generated plasma and how it produces the measured signals. We describe empirical approaches to characterise the signals and compare these in a qualitative discussion of laboratory simulations to predict signal shapes for spacecraft measurements in the inner solar system. While the amount of charge production from a dust impact will be higher near the Sun than observed in the interplanetary medium before, the amplitude of pulses is determined by the recovery behaviour that is different near the Sun since it varies with the plasma environment.

Abstract Background Increased cortical excitability has been hypothesized to play a critical role in various neurological disorders, such as restless legs syndrome, epilepsy and migraine. Particularly for migraine, local hyperexcitability has been reported. Levels of regional excitatory and inhibitory neurotransmitters are related to cortical excitability and hence may play a role in the origin of the disease. Consequently, a mismatch of the excitatory-inhibitory neurotransmitter network might contribute to local hyperexcitability and the onset of migraine attacks. In this study we sought to assess local levels of glutamate / glutamine (GLX) and gamma-aminobutyric acid (GABA) in the occipital cortex and right thalamus of migraineurs and healthy subjects. Methods We measured interictally local biochemical concentrations in the occipital lobe and the right thalamus in patients with migraine (without aura) and healthy controls (HCs) using proton magnetic resonance spectroscopy at 3 T. GLX levels were acquired using PRESS and GABA levels using the GABA-sensitive editing sequence MEGA-PRESS. Regional GLX and GABA levels were compared between groups. Results Statistical analyses revealed significantly increased GLX levels in both the primary occipital cortex and thalamus. However, we found no group differences in GABA levels for these two regions. Correlation analyses within the migraine group revealed no significant correlations between pain intensity and levels of GLX or GABA in either of the two brain regions. Conclusions Further research is needed to investigate the role of GABA/GLX ratios in greater depth and to measure changes in neurotransmitter levels over time, i.e. during migraine attacks and interictally.

Abstract Background Cluster headache (CH) is a disabling primary headache disorder characterized by severe periorbital pain. A subset of patients does not respond to established pharmacological therapy. This study examines outcomes of a cohort of mainly chronic CH patients treated with sphenopalatine ganglion (SPG) stimulation. Methods Patients were followed in an open-label prospective study for 12 months. Ninety-seven CH patients (88 chronic, 9 episodic) underwent trans-oral insertion of a microstimulator targeting the SPG. Patients recorded stimulation effect prospectively for individual attacks. Frequency, use of preventive and acute medications, headache impact (HIT-6) and quality of life measures (SF-36v2) were monitored at clinic visits. Per protocol, frequency responders experienced ≥ 50% reduction in attack frequency and acute responders treated ≥ 50% of attacks. HIT-6 responders experienced an improvement ≥ 2.3 units and SF-36 responders ≥ 4 units vs. baseline. Results Eighty-five patients (78 chronic, 7 episodic) remained implanted and were evaluated for effectiveness at 12 months. In total, 68% of all patients were responders, 55% of chronic patients were frequency responders and 32% of all patients were acute responders. 67% of patients using acute treatments were able to reduce the use of these by 52% and 74% of chronic patients were able to stop, reduce or remain off all preventive medications. 59% of all patients were HIT-6 responders, 67% were SF-36 responders. Conclusions This open-label registry corroborates that SPG stimulation is an effective therapy for CH patients providing therapeutic benefits and improvements in use of medication as well as headache impact and quality of life.

An instrument was designed to assess the current state of faculty governance at those institutions of higher learning that are members of the Coalition of Christian Colleges and Universities (CCCU). The purpose was to arrive at a clearer understanding of the variety and range of governance systems that are currently in place among CCCU schools. In addition, the identification of faculty concerns was assessed. The goal of the authors is to provide a tool for the faculty at these particular campuses to help improve the faculty governance systems. By determining the different structures and systems in place, the faculty and the administration will be in a better position to ascertain if the current systems at institutions are meeting their designed purpose. The results indicate that there is truly a wide range of systems currently being utilized. Size appears to be a large factor in determining the particular organizational alignment in place; 26 institutions reported that all faculty are part of the main faculty governing body (MFGB). MFGB size was deemed appropriate in the majority of institutions (90.6%); however, respondents also indicated that the optimal size would be smaller. An average of 6.43 committees/councils report to the MFGB, the top three being: educational policies, professional development, and faculty reviews. Salaries, workload, and budget issues rank the highest in concern for the faculty, and decision making for these fell within the "effective" range. (Contains 6 tables.)

This article discussed the relation between ethical standards for counselors and the legal principles of our society as it affects the client-counselor relationship. The concepts of client confidentiality and counselor liability are defined. A client-counselor situation is outlined, with suggested counselor responses to the ethical/legal issues involved. (Author)