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An interview with Johannes Jan Pauen, Managing Partner at KopfHerzHand, and Sebastian Vetter, Network Partner at KopfHerzHand is presented. They argues that service design, while focusing on stakeholders, often fails to adequately address the complexity within organizations. They discusses how organizations are social systems, and understanding the behaviors and decisions of members is crucial for inspiring and influencing change.

Objectives: Previous studies have observed an increase in low frequency diastolic heart sounds in patients with coronary artery disease (CAD). The aim was to develop and validate a diagnostic, computerized acoustic CAD-score based on heart sounds for the non-invasive detection of CAD. Methods: Prospective study enrolling 463 patients referred for elective coronary angiography. Pre-procedure non-invasive recordings of heart sounds were obtained using a novel acoustic sensor. A CAD-score was defined as the power ratio between the 10–90 Hz frequency spectrum and the 90–300 Hz frequency spectrum of the mid-diastolic heart sound. Quantitative coronary angiography analysis was performed by a blinded core laboratory and patients grouped according to the results: obstructive CAD defined by the presence of at least one ≥ 50% stenosis, non-obstructive CAD as patients with a maximal stenosis in the 25–50% interval and non-CAD as no coronary lesions exceeding 25%. We excluded patients with potential confounders or incomplete data (n = 245). To avoid over-fitting the final cohort of 218 patients was randomly divided into to a training group for development (n = 127) and a validation group (n = 91). Results: In both the training and the validation group the CAD-score was significantly increased in CAD patients compared to non-CAD patients (p < 0.0001). In the validation group the area under the receiver-operating curve was 77% (95% CI 63–91%). Sensitivity was 71% (95% CI 59–82%) and specificity 64% (95% CI 45–83%). Conclusion: The acoustic CAD-score is a new, inexpensive, non-invasive method to detect CAD, which may supplement clinical risk stratification and reduce the need for subsequent non-invasive and invasive testing. [ABSTRACT FROM AUTHOR]

Regardless of the several measures implemented by the South African government to curb food insecurity, the majority of rural households are still experiencing food insecurity at a provincial level, particularly in Limpopo Province. This could be because of the high unemployment rate that is becoming worse in the province. Even though many members of rural households have obtained tertiary education, most individuals still find it difficult to secure jobs. This results in many rural households depending on social grants to make a living, and it is acknowledged that these social grants are not enough to provide for a household's food needs. This study was conducted in the Mopani district municipality. A multistage sampling procedure was used, and villages were selected based on probability proportionate to size, making a total of 173 rural households. The objectives of the study were to profile the socio-economic characteristics of rural households, to identify the food security status of these households, and to determine the factors that influence food security among them. To analyse the data, the Household Food Insecurity Access Scale, descriptive statistics and the multinomial logistic regression model were used. From the findings of the study, the results revealed that the majority of rural households in the Mopani district municipality were found to be moderately to severely food insecure as per logistic regression estimates. [ABSTRACT FROM AUTHOR]

This study is a gender analysis of access to formal credit by both male and female small-scale farmers in Greater Letaba Municipality. The study precisely identified and described the socio-economic characteristics of female and male small-scale farmers, analysed and compared factors influencing access to formal credit by these farmers, and determined the perceptions of female small-scale farmers towards the credit system. In collecting the primary data, structured questionnaires were administered to 140 respondents (70 females and 70 males) using the stratified random technique. The study employed descriptive statistics, principal component analysis and a probit model to analyse the data collected. The probit regression model discovered that farm size, land ownership, gender, age, collateral and extension services had a significant positive influence on small-scale farmers formal credit access. Based on the study findings, a set of recommendations for achieving equitable formal credit access by female and male small-scale farmers was put forward. [ABSTRACT FROM AUTHOR]

This paper analysed the economic efficiency of small-scale tomato farmers in the Greater Letaba municipality of South Africa's Limpopo Province. Primary data were collected from 68 tomato farmers based on structured questionnaires and using convenience and purposive sampling procedures. The Cobb-Douglas production function was used to analyse the level of economic efficiency. The study utilised the output approach, where the output achieved by the farmers is compared to the maximum output attainable using the given inputs. The empirical results reveal that mean technical, allocative, and economic efficiency levels are at 0.95, 0.41 and 0.39, respectively. The study also found that land (farm size), seedlings, labour, pesticides and water have a positively significant relationship with the production of tomatoes in the study area. Therefore, it is recommended that the Department of Agriculture, Land Reform and Rural Development provide farmers with enough extension services by employing more extension personnel. Government programmes such as the Comprehensive Agricultural Support Programme should be intensified - through the pillar of training and capacity building - to reach the small-scale farmers in the municipality, whereby farmers should be provided with training on the recommended minimum and maximum application of inputs like pesticides, fertilisers, seedlings and water in tomato production. [ABSTRACT FROM AUTHOR]

This study aims to empirically estimate the relationship between economic growth and the unemployment rate in the Limpopo Province of South Africa. The analysis used quarterly data covering the 2008-2018 period, which was obtained from Statistics South Africa. For data analysis, the study employed the difference model, the dynamic model and the Granger causality test to consider the potential short term and long term relationships. Based on the difference model estimation, the Okun's coefficient was determined to be -0.22. The Granger causality test showed that a causal relationship between these two variables does not exist, which means that a change in the growth rate of the real Gross Domestic Product (GDP) does not cause a change in the rate of unemployment and vice-versa. The impossibility of applying Okun's law indicates that a cyclical recovery will not be accompanied by a decrease in unemployment. Furthermore, this might reflect the sizable structural and/or frictional component of unemployment in the Limpopo Province. Lastly, South Africa's economic policies have not been suitable for fostering development that can reduce unemployment and this could be due to an improper structure of the public and private sectors. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the correlation between the seismocardiogram and cardiorespiratory fitness. Cardiorespiratory fitness can be estimated as VO2 max using non-exercise algorithms, but the results can be inaccurate. Healthy subjects were recruited for this study. Seismocardiogram and electrocardiogram were recorded at rest. VO2 max was measured during a maximal effort cycle ergometer test. Amplitudes and timing intervals were extracted from the seismocardiogram and used in combination with demographic data in a non-exercise prediction model for VO2 max. 26 subjects were included, 17 females. Mean age: 38.3±9.1 years. The amplitude following the aortic valve closure derived from the seismocardiogram had a significant correlation of 0.80 (p<0.001) to VO2 max. This feature combined with age, sex and BMI in the prediction model, yields a correlation to VO2 max of 0.90 (p<0.001, 95% CI: 0.83–0.94) and a standard error of the estimate of 3.21 mL·kg−1 ·min−1. The seismocardiogram carries information about the cardiorespiratory fitness. When comparing to other non-exercise models the proposed model performs better, even after cross validation. The model is limited when tracking changes in VO2 max. The method could be used in the clinic for a more accurate estimation of VO2 max compared to current non-exercise methods. [ABSTRACT FROM AUTHOR]

Given observations from a circular random variable contaminated by an additive measurement error, we consider the problem of minimax optimal goodness-of-fit testing in a non-asymptotic framework. We propose direct and indirect testing procedures using a projection approach. The structure of the optimal tests depends on regularity and ill-posedness parameters of the model, which are unknown in practice. Therefore, adaptive testing strategies that perform optimally over a wide range of regularity and ill-posedness classes simultaneously are investigated. Considering a multiple testing procedure, we obtain adaptive i.e. assumption-free procedures and analyse their performance. Compared with the non-adaptive tests, their radii of testing face a deterioration by a log-factor. We show that for testing of uniformity this loss is unavoidable by providing a lower bound. The results are illustrated considering Sobolev spaces and ordinary or super smooth error densities. [ABSTRACT FROM AUTHOR]

Plants manipulate their rhizosphere community in a species and even a plant life stage-dependent manner. In essence plants select, promote and (de)activate directly the local bacterial and fungal community, and indirectly representatives of the next trophic level, protists and nematodes. By doing so, plants enlarge the pool of bioavailable nutrients and maximize local disease suppressiveness within the boundaries set by the nature of the local microbial community. MiSeq sequencing of specific variable regions of the 16S or 18S ribosomal DNA (rDNA) is widely used to map microbial shifts. As current RNA extraction procedures are time-consuming and expensive, the rRNA-based characterization of the active microbial community is taken along less frequently. Recently, we developed a relatively fast and affordable protocol for the simultaneous extraction of rDNA and rRNA from soil. Here, we investigated the long-term impact of three type of soil management, two conventional and an organic regime, on soil biota in fields naturally infested with the Columbian root-knot nematode Meloidogyne chitwoodi with pea (Pisum sativum) as the main crop. For all soil samples, large differences were observed between resident (rDNA) and active (rRNA) microbial communities. Among the four organismal group under investigation, the bacterial community was most affected by the main crop, and unweighted and weighted UniFrac analyses (explaining respectively 16.4% and 51.3% of the observed variation) pointed at a quantitative rather than a qualitative shift. LEfSe analyses were employed for each of the four organismal groups to taxonomically pinpoint the effects of soil management. Concentrating on the bacterial community in the pea rhizosphere, organic soil management resulted in a remarkable activation of members of the Burkholderiaceae, Enterobacteriaceae, and Pseudomonadaceae. Prolonged organic soil management was also accompanied by significantly higher densities of bacterivorous nematodes, whereas levels of M. chitwoodi had dropped drastically. Though present and active in the fields under investigation Orbiliaceae, a family harboring numerous nematophagous fungi, was not associated with the M. chitwoodi decline. A closer look revealed that a local accumulation and activation of Pseudomonas, a genus that includes a number of nematode-suppressive species, paralleled the lower M. chitwoodi densities. This study underlines the relevance of taking along both resident and active fractions of multiple organismal groups while mapping the impact of e.g. crops and soil management regimes. [ABSTRACT FROM AUTHOR]

This study aims to estimate sorghum supply elasticity in South Africa. The study used time series data spanning from 1998 to 2016, obtained from the abstracts of agricultural statistics. The Variance Error Correction Model was employed; the study used two dependent variables, these being area and yield response functions. The results have shown that the area response function was found to be a robust model as most of the variables were significant, responsive and elastic. Maize price, as a competing crop for sorghum, negatively influenced the area allocation; however, the remaining variables had a positive impact on area allocation in the long-run. The yield response function was found not to be robust and hence not adopted. It was therefore concluded that the area response function is more robust than the yield response function, hence sorghum production has shown more response to area allocation than yield. The findings further indicated that the error correction term for area and for the yield response function was –1.55 and –1.30, respectively. This indicated that the two models were able to revert to equilibrium. Based on the findings, the study recommends that amongst other methods to enhance sorghum output, producers could use improved varieties or hybrids, as this action would result in allocation of more land to sorghum production, following price change. [ABSTRACT FROM AUTHOR]

Objective: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD.Methods: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography. If significant obstruction was suspected in any coronary segment, patients were referred to invasive angiography and fractional flow reserve (FFR) assessment. Heart sound analysis was performed in all patients. A predefined acoustic CAD-score algorithm was evaluated; subsequently, we developed and validated an updated CAD-score algorithm that included both acoustic features and clinical risk factors. Low risk is indicated by a CAD-score value ≤20.Results: Haemodynamically significant CAD assessed from FFR was present in 145 (10.0%) patients. In the entire cohort, the predefined CAD-score had a sensitivity of 63% and a specificity of 44%. In total, 50% had an updated CAD-score value ≤20. At this cut-off, sensitivity was 81% (95% CI 73% to 87%), specificity 53% (95% CI 50% to 56%), positive predictive value 16% (95% CI 13% to 18%) and negative predictive value 96% (95% CI 95% to 98%) for diagnosing haemodynamically significant CAD.Conclusion: Sound-based detection of CAD enables risk stratification superior to clinical risk scores. With a negative predictive value of 96%, this new acoustic rule-out system could potentially supplement clinical assessment to guide decisions on the need for further diagnostic investigation.Trial Registration Number: ClinicalTrials.gov identifier NCT02264717; Results. [ABSTRACT FROM AUTHOR]

We consider nonparametric estimation problems in the presence of dependent data, notably nonparametric regression with random design and nonparametric density estimation. The proposed estimation procedure is based on a dimension reduction. The minimax optimal rate of convergence of the estimator is derived assuming a sufficiently weak dependence characterised by fast decreasing mixing coefficients. We illustrate these results by considering classical smoothness assumptions. However, the proposed estimator requires an optimal choice of a dimension parameter depending on certain characteristics of the function of interest, which are not known in practice. The main issue addressed in our work is an adaptive choice of this dimension parameter combining model selection and Lepski's method. It is inspired by the recent work of Goldenshluger and Lepski [(2011), ‘Bandwidth Selection in Kernel Density Estimation: Oracle Inequalities and Adaptive Minimax Optimality’,The Annals of Statistics, 39, 1608–1632]. We show that this data-driven estimator can attain the lower risk bound up to a constant provided a fast decay of the mixing coefficients. [ABSTRACT FROM PUBLISHER]

We consider the problem of estimating the value ℓ(ϕ) of a linear functional, where the structural function ϕ models a nonparametric relationship in presence of instrumental variables. We propose a plug-in estimator which is based on a dimension reduction technique and additional thresholding. It is shown that this estimator is consistent and can attain the minimax optimal rate of convergence under additional regularity conditions. This, however, requires an optimal choice of the dimension parameter m depending on certain characteristics of the structural function ϕ and the joint distribution of the regressor and the instrument, which are unknown in practice. We propose a fully data driven choice of m which combines model selection and Lepski’s method. We show that the adaptive estimator attains the optimal rate of convergence up to a logarithmic factor. The theory in this paper is illustrated by considering classical smoothness assumptions and we discuss examples such as pointwise estimation or estimation of averages of the structural function ϕ. [ABSTRACT FROM AUTHOR]

Optimizing risk assessment may reduce use of advanced diagnostic testing in patients with symptoms suggestive of stable coronary artery disease (CAD). Detection of diastolic murmurs from post-stenotic coronary turbulence with an acoustic sensor placed on the chest wall can serve as an easy, safe, and low-cost supplement to assist in the diagnosis of CAD. The aim of this study was to evaluate the diagnostic accuracy of an acoustic test (CAD-score) to detect CAD and compare it to clinical risk stratification and coronary artery calcium score (CACS). We prospectively enrolled patients with symptoms of CAD referred to either coronary computed tomography or invasive coronary angiography (ICA). All patients were tested with the CAD-score system. Obstructive CAD was defined as more than 50 % diameter stenosis diagnosed by quantitative analysis of the ICA. In total, 255 patients were included and obstructive CAD was diagnosed in 63 patients (28 %). Diagnostic accuracy evaluated by receiver operating characteristic curves was 72 % for the CAD-score, which was similar to the Diamond-Forrester clinical risk stratification score, 79 % (p = 0.12), but lower than CACS, 86 % (p < 0.01). Combining the CAD-score and Diamond-Forrester score, AUC increased to 82 %, which was significantly higher than the standalone CAD-score (p < 0.01) and Diamond-Forrester score (p < 0.05). Addition of the CAD-score to the Diamond-Forrester score increased correct reclassification, categorical net-reclassification index = 0.31 (p < 0.01). This study demonstrates the potential use of an acoustic system to identify CAD. The combination of clinical risk scores and an acoustic test seems to optimize patient selection for diagnostic investigation. [ABSTRACT FROM AUTHOR]

Long Pulses in LV Pacing Introduction Phrenic nerve stimulation is a major obstacle in cardiac resynchronization therapy (CRT). Activation characteristics of the heart and phrenic nerve are different with higher chronaxie for the heart. Therefore, longer pulse durations could be beneficial in preventing phrenic nerve stimulation during CRT due to a decreased threshold for the heart compared with the phrenic nerve. We investigated if long pulse durations decreased left ventricular (LV) thresholds relatively to phrenic nerve thresholds in humans. Methods and Results Eleven patients, with indication for CRT and phrenic nerve stimulation at the intended pacing site, underwent determination of thresholds for the heart and phrenic nerve at different pulse durations (0.3-2.9 milliseconds). The resulting strength duration curves were analyzed by determining chronaxie and rheobase. Comparisons for those parameters were made between the heart and phrenic nerve, and between the models of Weiss and Lapicque as well. In 9 of 11 cases, the thresholds decreased faster for the LV than for the phrenic nerve with increasing pulse duration. In 3 cases, the thresholds changed from unfavorable for LV stimulation to more than a factor 2 in favor of the LV. The greatest change occurred for pulse durations up to 1.5 milliseconds. The chronaxie of the heart was significantly higher than the chronaxie of the phrenic nerve (0.47 milliseconds vs. 0.22 milliseconds [P = 0.029, Lapicque] and 0.79 milliseconds vs. 0.27 milliseconds [P = 0.033, Weiss]). Conclusion Long pulse durations lead to a decreased threshold of the heart relatively to the phrenic nerve and may prevent stimulation of the phrenic nerve in a clinical setting. [ABSTRACT FROM AUTHOR]

We consider the estimation of the slope function in functional linear regression, where a scalar response Y is modelled in dependence of a random function X, when Y and only a panel Z,..., Z of noisy measurements of X are observable. Assuming an i.i.d. sample of ( Y, Z,..., Z) of size n we propose an estimator of the slope which is based on a dimension reduction technique and additional thresholding. We derive in terms of both the sample size n and the panel size L a lower bound of a maximal weighted risk over a certain ellipsoid of slope functions and a certain class of covariance operators associated with the regressor X. It is shown that the proposed estimator attains this lower bound up to a constant and hence it is minimax-optimal. The results are illustrated considering different configurations which cover in particular the estimation of the slope as well as its derivatives. [ABSTRACT FROM AUTHOR]

This work deals with the ill-posed inverse problem of reconstructing a function f given implicitly as the solution of g = Aƒ, where A is a compact linear operator with unknown singular values and known eigenfunctions. We observe the function g and the singular vahles of the operator subject to Gaussian white noise with respective noise levels ε and σ. We develop a minimax theory in terms of both noise levels and propose an orthogonal series estimator attaining the minimax rates. This estimator requires the optimal choice of a dimension parameter depending on certain characteristics off and A. This work addresses the fully data-driven choice of the dimension parameter combining model selection with Lepski's method. We show that the fidly data-driven estimator preserves minimax optimality over a wide range of classes for ƒ and A and noise levels ε and σ. The results are illustrated considering Sobolev spaces and mildly and severely ill-posed inverse problems. [ABSTRACT FROM AUTHOR]

We consider the semi-parametric regression model Y = Xt + ∅(Z) where β and ∅(.) are unknown slope coefficient vector and function, and where the variables (X, Z) are endogenous. We propose necessary and sufficient conditions for the identification of the parameters in the presence of instrumental variables. We also focus on the estimation of β. It is known that the presence of ∅ may lead to a slow rate of convergence for the estimator of β. An additional complication in the fully endogenous model is that the solution of the equation necessitates the inversion of a compact operator that has to be estimated non-parametrically. In general this inversion is not stable, thus the estimation of β is ill-posed. In this paper, a √n-consistent estimator for β is derived in this setting under mild assumptions. One of these assumptions is given by the so-called source condition that is explicitly interpreted in the paper. Monte Carlo simulations demonstrate the reasonable performance of the estimation procedure on finite samples. [ABSTRACT FROM AUTHOR]

In this paper, we consider nonparametric estimation for dependent data, where the observations do not necessarily come from a linear process. We study density estimation and also discuss associated problems in nonparametric regression, using the 2-mixing dependence measure. We compare the results under the 2-mixing with those derived under the assumption that the process is linear. [ABSTRACT FROM AUTHOR]

This paper studies the estimation of a nonparametric function ϕ from the inverse problem r = Tϕ given estimates of the function r and of the linear transform T. We show that rates of convergence of the estimator are driven by two types of assumptions expressed in a single Hilbert scale. The two assumptions quantify the prior regularity of ϕ and the prior link existing between T and the Hilbert scale. The approach provides a unified framework that allows us to compare various sets of structural assumptions found in the econometric literature. Moreover, general upper bounds are also derived for the risk of the estimator of the structural function ϕ as well as that of its derivatives. It is shown that the bounds cover and extend known results given in the literature. Two important applications are also studied. The first is the blind nonparametric deconvolution on the real line, and the second is the estimation of the derivatives of the nonparametric instrumental regression function via an iterative Tikhonov regularization scheme. [ABSTRACT FROM AUTHOR]

The nonparametric estimation of a regression function from conditional moment restrictions involving instrumental variables is considered. The rate of convergence of penalized estimators is studied in the case where the regression function is not identified from the conditional moment restriction. We also study the gain of modifying the penalty in the estimation, considering derivatives in the penalty. We analyze the effect of this modification on the identification of the regression function and the rate of convergence of its estimator. [ABSTRACT FROM AUTHOR]

Multivariate statistics are used to investigate sensitivity of the tropical atmospheric circulation to scenario-based global land cover change (LCC), with the largest changes occurring in the tropics. Three simulations performed with the fully coupled Parallel Climate Model (PCM) are compared: (1) a present day control run; (2) a simulation with present day land cover and Intergovernmental Panel on Climate Change (IPCC) Special Report on Emission Scenarios (SRES) A2 greenhouse gas (GHG) projections; and (3) a simulation with SRES A2 land cover and GHG projections. Dimensionality of PCM data is reduced by projection onto a priori specified eigenvectors, consisting of Rossby and Kelvin waves produced by a linearized, reduced gravity model of the tropical circulation. A Hotelling T test is performed on projection amplitudes. Effects of LCC evaluated by this method are limited to diabatic heating. A statistically significant and recurrent signal is detected for 33% of all tests performed for various combinations of parameters. Taking into account uncertainties and limitations of the present methodology, this signal can be interpreted as a Rossby wave response to prescribed LCC. The Rossby waves are shallow, large-scale motions, trapped at the equator and most pronounced in boreal summer. Differences in mass and flow fields indicate a shift of the tropical Walker circulation patterns with an anomalous subsidence over tropical South America. [ABSTRACT FROM AUTHOR]

A rare case of repeated granulomatous inflammation after silicone injection laryngoplasty for vocal fold immobility as well as its treatment by endoscopic approach is reported. The patient presented a right-sided vocal fold immobility after laryngeal trauma and remained dysphonic despite of logopedic voice therapy because of severe glottal insufficiency. An endoscopic transoral intrafold silicone injection was applied to improve the vocal function. Silicone granuloma inflammation was observed 8 days after the vocal fold augmentation. Oral broad-spectrum antibiotics and corticosteroids did not improve the inflammation. A cordotomy was performed to remove the silicone implant. After 3 months, a second endoscopic surgical intervention was necessary to remove a recurrent silicone granuloma. Eight months after the second surgical intervention, the inflammation had disappeared. An autologous fat injection to restore the glottal closure was performed successfully. Type IV contact allergy was excluded with an epicutaneous patch and scratch test with components of the silicone implant. Clinical and treatment observations are reported and the literature on complications of intrafold injected silicone for vocal fold augmentation is reviewed. [ABSTRACT FROM AUTHOR]

A definition of selfinformative Bayes carriers or limits is given as a description of an approach to non-informative Bayes estimation in non- and semiparametric models. It takes the posterior w.r.t. a prior as a new prior and repeats this procedure again and again. A main objective of this article is to clarify the relation between selfinformative carriers or limits and maximum likelihood estimates (MLEs). For a model with dominated probability distributions, we state sufficient conditions under which the set of MLEs is a selfinformative carrier or in the case of a unique MLE its selfinformative limit property. Mixture models are covered. The result on carriers is extended to more general models without dominating measure. Selfinformative limits, in the case of estimation, of hazard functions based in censored observations and in the case of normal linear models with possibly non-identifiable parameters are shown to be identical to the generalized MLEs in the sense of Gill [Gill, R.D., 1989, Non- and semi-parametric maximum likelihood estimators and the von Mises method. I. Scandinanian Journal of Statistics , 16(2), 97–128.] and Kiefer and Wolfowitz [Kiefer, J. and Wolfowitz, J., 1956, Consistency of the maximum likelihood estimator in the presence of infinitely many incidental parameters. Annals of Mathematical Statistics , 27, 887–906.]. Selfinformative limits are given for semiparametric linear models. For a location model, they are identical to generalized MLEs, while this is not true in general. [ABSTRACT FROM AUTHOR]

Background: A reduction in duration of antibiotic therapy is crucial in minimizing the development of antimicrobial resistance, drug-related side effects and health care costs. The minimal effective duration of antimicrobial therapy for febrile urinary tract infections (fUTI) remains a topic of uncertainty, especially in male patients, those of older age or with comorbidities. Biomarkers have the potential to objectively identify the optimal moment for cessation of therapy.Methods: A secondary analysis of a randomized placebo-controlled trial among 35 primary care centers and 7 emergency departments of regional hospitals in the Netherlands. Women and men aged ≥18 years with a diagnosis of fUTI were randomly assigned to receive antibiotic treatment for 7 or 14 days. Patients indicated to receive antimicrobial treatment for more than 14 days were excluded from randomization. The biomarkers procalcitonin (PCT), mid-regional proadrenomedullin (MR-proADM), and C-reactive protein (CRP) were compared in their ability to predict clinical cure or failure through the 10-18 day post-treatment visit.Results: Biomarker concentrations were measured in 249 patients, with a clinical cure rate of 94% in the 165 randomized and 88% in the 84 non-randomized patients. PCT, MR-proADM and CRP concentrations did not differ between patients with clinical cure and treatment failure, and did not predict treatment outcome, irrespective of 7 or 14 day treatment duration (ROCAUC 0.521; 0.515; 0.512, respectively). PCT concentrations at presentation were positively correlated with bacteraemia (τ = 0.33, p < 0.001) and presence of shaking chills (τ = 0.25, p < 0.001), and MR-proADM levels with length of hospital stay (τ = 0.40, p < 0.001), bacteraemia (τ = 0.33, p < 0.001), initial intravenous treatment (τ = 0.22, p < 0.001) and time to defervescence (τ = 0.21, p < 0.001). CRP did not display any correlation to relevant clinical parameters.Conclusions: Although the biomarkers PCT and MR-proADM were correlated to clinical parameters indicating disease severity, they did not predict treatment outcome in patients with community acquired febrile urinary tract infection who were treated for either 7 or 14 days. CRP had no added value in the management of patients with fUTI.Trial Registration: The study was registered at ClinicalTrials.gov [ NCT00809913 ; December 16, 2008] and trialregister.nl [ NTR1583 ; December 19, 2008]. [ABSTRACT FROM AUTHOR]

This observational study investigated digital auscultation for the purpose of assessing the clinical feasibility of monitoring vascular sounds in pregnancy. The study was performed at the Regional Hospital Viborg, Denmark, and included 29 pregnant women, 10 non-pregnant women and 10 male participants. Digital auscultation was performed with an electronic stethoscope bilaterally near the uterine arteries and correlated to the clinical diagnosis of preeclampsia (PE), intrauterine growth restriction (IUGR) or normal pregnancy in the group of pregnant participants. In the group of non-pregnant participants, digital auscultation was performed as control measurements in the same anatomical positions. The auscultations displayed pulse waveforms comprising systolic and diastolic periods in 20 of the 29 pregnant participants. However, in the non-pregnant and male participants, the pulse waveforms were absent. The pulsatile patterns are thus likely to originate from the arteries in relation to the pregnant uterus. In the participants displaying pulse waveforms, the presence of a dicrotic notch appeared with a sensitivity of 89% and a specificity of 100% in the discrimination of normal pregnancies (n  =  11) from pregnancies with PE or IUGR (n  =  9), (p  <  0.001). This preliminary study shows the potential of identifying vascular complications during pregnancy such as preeclampsia and intrauterine growth restriction. The morphology of the derived pulse contour should be investigated and could be further developed to identify pathophysiology. [ABSTRACT FROM AUTHOR]