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Autoimmune limbic encephalitis (ALE) presents with new-onset mesial temporal lobe seizures, progressive memory disturbance, and other behavioral and cognitive changes. CD8 T cells are considered to play a key role in those cases where autoantibodies (ABs) target intracellular antigens or no ABs were found. Assessment of such patients presents a clinical challenge, and novel noninvasive imaging biomarkers are urgently needed. Here, we demonstrate that visualization of the translocator protein (TSPO) with [18F]DPA-714-PET-MRI reveals pronounced microglia activation and reactive gliosis in the hippocampus and amygdala of patients suspected with CD8 T cell ALE, which correlates with FLAIR-MRI and EEG alterations. Back-translation into a preclinical mouse model of neuronal antigen-specific CD8 T cell-mediated ALE allowed us to corroborate our preliminary clinical findings. These translational data underline the potential of [18F]DPA-714-PET-MRI as a clinical molecular imaging method for the direct assessment of innate immunity in CD8 T cell-mediated ALE.

Industrial systems are increasingly threatened by cyberattackswith potentially disastrous consequences. To counter suchattacks, industrial intrusion detection systems strive to timelyuncover even the most sophisticated breaches. Due to its criticality for society, this fast-growing field attracts researchersfrom diverse backgrounds, resulting in 130 new detectionapproaches in 2021 alone. This huge momentum facilitatesthe exploration of diverse promising paths but likewise risksfragmenting the research landscape and burying promisingprogress. Consequently, it needs sound and comprehensibleevaluations to mitigate this risk and catalyze efforts into sustainable scientific progress with real-world applicability. Inthis paper, we therefore systematically analyze the evaluationmethodologies of this field to understand the current stateof industrial intrusion detection research. Our analysis of609 publications shows that the rapid growth of this researchfield has positive and negative consequences. While we observe an increased use of public datasets, publications stillonly evaluate 1.3 datasets on average, and frequently usedbenchmarking metrics are ambiguous. At the same time, theadoption of newly developed benchmarking metrics sees littleadvancement. Finally, our systematic analysis enables us toprovide actionable recommendations for all actors involvedand thus bring the entire research field forward.

Industrial systems are increasingly threatened by cyberattacks with potentially disastrous consequences. To counter such attacks, industrial intrusion detection systems strive to timely uncover even the most sophisticated breaches. Due to its criticality for society, this fast-growing field attracts researchers from diverse backgrounds, resulting in 130 new detection approaches in 2021 alone. This huge momentum facilitates the exploration of diverse promising paths but likewise risks fragmenting the research landscape and burying promising progress. Consequently, it needs sound and comprehensible evaluations to mitigate this risk and catalyze efforts into sustainable scientific progress with real-world applicability. In this paper, we therefore systematically analyze the evaluation methodologies of this field to understand the current state of industrial intrusion detection research. Our analysis of 609 publications shows that the rapid growth of this research field has positive and negative consequences. While we observe an increased use of public datasets, publications still only evaluate 1.3 datasets on average, and frequently used benchmarking metrics are ambiguous. At the same time, the adoption of newly developed benchmarking metrics sees little advancement. Finally, our systematic analysis enables us to provide actionable recommendations for all actors involved and thus bring the entire research field forward.

People making food choices are often exposed to different cues that can activate relevant goals that influence the choice outcome. Hedonic goals are frequently primed by advertising while health policy enlists primes that activate health goals in the moment of food decision-making - e.g., healthy food labels. However, little is known about the effect of such goal-priming cues on the population level and how people respond when exposed to both types of primes simultaneously. The results of this study, based on a large, representative sample (N = 1200), show no effect of health-goal priming on healthy food choices. Being exposed to a sole hedonic prime, however, reduces healthy choices by 3%. This effect completely disappeared when both primes were presented at the same time. All effects remained insensitive to people's gender, hunger status, level of dietary restraint, and BMI. These findings cast doubt over the effectiveness of health goal primes as a tool to increase healthy food choices but suggest a protective effect against competing hedonic primes and could thereby prevent less healthy choices.

Latent Profile Analysis (LPA) is a method to extract homogeneous clusters characterized by a common response profile. Previous works employing LPA to human value segmentation tend to select a small number of moderately homogeneous clusters based on model selection criteria such as Akaike information criterion, Bayesian information criterion and Entropy. The question is whether a small number of clusters is all that can be gleaned from the data. While some studies have carefully compared different statistical model selection criteria, there is currently no established criteria to assess if an increased number of clusters generates meaningful theoretical insights. This article examines the content and meaningfulness of the clusters extracted using two algorithms: Variational Bayesian LPA and Maximum Likelihood LPA. For both methods, our results point towards eight as the optimal number of clusters for characterizing distinctive Schwartz value typologies that generate meaningful insights and predict several external variables.

Sweet foods are commonly used as rewards for desirable behavior, specifically among children. This study examines whether such practice may contribute to reinforce the valuation of these foods. Two experiments were conducted, one with children, the other with rats. The first study, conducted with first graders (n = 214), shows that children who receive a food reward for performing a cognitive task subsequently value the food more compared to a control group who received the same food without performing any task. The second study, conducted on rats (n = 64), shows that rewarding with food also translates into higher calorie intake over a 24-hour period. These results suggest that the common practice of rewarding children with calorie-dense sweet foods is a plausible contributing factor to obesity and might therefore be ill advised. © 2021 This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Latent Profile Analysis (LPA) is a method to extract homogeneous clusters characterized by a common response profile. Previous works employing LPA to human value segmentation tend to select a small number of moderately homogeneous clusters based on model selection criteria such as Akaike information criterion, Bayesian information criterion and Entropy. The question is whether a small number of clusters is all that can be gleaned from the data. While some studies have carefully compared different statistical model selection criteria, there is currently no established criteria to assess if an increased number of clusters generates meaningful theoretical insights. This article examines the content and meaningfulness of the clusters extracted using two algorithms: Variational Bayesian LPA and Maximum Likelihood LPA. For both methods, our results point towards eight as the optimal number of clusters for characterizing distinctive Schwartz value typologies that generate meaningful insights and predict several external variables.

Objectives This study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA. Participants 3296 emergency medical stations in Germany. Setting Rural areas in Germany. Primary and secondary outcome measures Three UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS. Results Current EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158). Conclusion These results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

Latent Profile Analysis (LPA) is a method to extract homogeneous clusters characterized by a common response profile. Previous works employing LPA to human value segmentation tend to select a small number of moderately homogeneous clusters based on model selection criteria such as Akaike information criterion, Bayesian information criterion and Entropy. The question is whether a small number of clusters is all that can be gleaned from the data. While some studies have carefully compared different statistical model selection criteria, there is currently no established criteria to assess if an increased number of clusters generates meaningful theoretical insights. This article examines the content and meaningfulness of the clusters extracted using two algorithms: Variational Bayesian LPA and Maximum Likelihood LPA. For both methods, our results point towards eight as the optimal number of clusters for characterizing distinctive Schwartz value typologies that generate meaningful insights and predict several external variables.

Message authentication guarantees the integrity of messages exchanged over untrusted channels. However, to achieve this goal, message authentication considerably expands packet sizes, which is especially problematic in constrained wireless environments. To address this issue, progressive message authentication provides initially reduced integrity protection that is often sufficient to process messages upon reception. This reduced security is then successively improved with subsequent messages to uphold the strong guarantees of traditional integrity protection. However, contrary to previous claims, we show in this paper that existing progressive message authentication schemes are highly susceptible to packet loss induced by poor channel conditions or jamming attacks. Thus, we consider it imperative to rethink how authentication tags depend on the successful reception of surrounding packets. To this end, we propose R2-D2, which uses randomized dependencies with parameterized security guarantees to increase the resilience of progressive authentication against packet loss. To deploy our approach to resource-constrained devices, we introduce SP-MAC, which implements R2-D2 using efficient XOR operations. Our evaluation shows that SP-MAC is resilient to sophisticated network-level attacks and operates as resources-conscious and fast as existing, yet insecure, progressive message authentication schemes., Comment: ACM WiSec'22

Latent Profile Analysis (LPA) is a method to extract homogeneous clusters characterized by a common response profile. Previous works employing LPA to human value segmentation tend to select a small number of moderately homogeneous clusters based on model selection criteria such as Akaike information criterion, Bayesian information criterion and Entropy. The question is whether a small number of clusters is all that can be gleaned from the data. While some studies have carefully compared different statistical model selection criteria, there is currently no established criteria to assess if an increased number of clusters generates meaningful theoretical insights. This article examines the content and meaningfulness of the clusters extracted using two algorithms: Variational Bayesian LPA and Maximum Likelihood LPA. For both methods, our results point towards eight as the optimal number of clusters for characterizing distinctive Schwartz value typologies that generate meaningful insights and predict several external variables.

Improving spatial accessibility to hospitals is a major task for health care systems which can be facilitated using recent methodological improvements of spatial accessibility measures. We used the integrated floating catchment area (iFCA) method to analyze spatial accessibility of general inpatient care (internal medicine, surgery and neurology) on national level in Germany determining an accessibility index (AI) by integrating distances, hospital beds and morbidity data. The analysis of 358 million distances between hospitals and population locations revealed clusters of lower accessibility indices in areas in north east Germany. There was a correlation of urbanity and accessibility up to r = 0.31 (p < 0.001). Furthermore, 10% of the population lived in areas with significant clusters of low spatial accessibility for internal medicine and surgery (neurology: 20%). The analysis revealed the highest accessibility for heart failure (AI = 7.33) and the lowest accessibility for stroke (AI = 0.69). The method applied proofed to reveal important aspects of spatial accessibility i.e. geographic variations that need to be addressed. However, for the majority of the German population, accessibility of general inpatient care was either high or at least not significantly low, which suggests rather adequate allocation of hospital resources for most parts of Germany.

Purpose: The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). Methods: We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The cross-sectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. Results: We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = − 0.57; p < 0.001). Conclusion: Geographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving

URPOSE: Today, the majority of medical graduates in countries such as the UK, the US or Germany are female. This poses a major problem for workforce planning especially in urology. We here use first the first time the previously established Brüggmann Groneberg (BG) index to assess if female academic career options advance in urology. METHODS: Different operating parameters (student population, urology specialist population, urology chair female:male (f:m) ratio) were collected from the Federal Office of Statistics, the Federal Chamber of Physicians and the medical faculties of 36 German universities. Four time points were monitored (2000, 2005, 2010 and 2015). From these data, female to male (f:m) ratios and the recently established career advancement (BG) index have been calculated. RESULTS: The German hospital urology specialists' f:m ratios were 0.257 (499 female vs. 1944 male) for 2015, 0.195 for 2010, 0.133 for 2005 and 0.12 for 2000. The career advancement (BG) index was 0.0007 for 2000, 0,0005 for 2005, 0.094 for 2010 and 0.073 for 2015. The decrease from 2010 to 2015 was due to an increase in the f:m ratio of hospital urologists and female medical students. CONCLUSION: The BG index clearly illustrated that there is an urgent need for special academic career funding programs to counteract gender problems in urology. The BG index has been shown to be an excellent tool to assess female academic career options and will be very helpful to assess and document positive or negative changes in the next decades.

Systematic reviews represent the core and backbone of evidence-based medicine (EBM) strategies in all fields of medicine. In order to depict a first global sketch of the international efforts in the Cochrane database systematic reviews (CDSR), we analyzed the systematic reviews of the Cochrane database. Our global maps of systematic reviewing offer intriguing structural insights into the world of EBM strategies. They demonstrate that for the CDSR, the UK and Commonwealth countries take the lead position. Since patients, care providers and health systems all over the world benefit from systematic reviewing, institutions in other countries should increase their commitment.

The quality of visual input is very important for both human and machine perception. Consequently many processing techniques exist that deal with different distortions. Usually image processing is applied freely and lacks redundancy regarding safety. We propose a novel image comparison method called the Combined Distances of Contrast Distributions (CD2) to protect against errors that arise during processing. Based on the distribution of image contrasts a new reduced-reference image quality assessment (IQA) method is introduced. By combining various distance functions excellent performance on IQA benchmarks is achieved with only a small data and computation overhead.

Background: Immigration has a strong impact on the development of health systems, medicine and science worldwide. Therefore, this article provides a descriptive study on the overall research output. Methods: Utilizing the scientific database Web of Science, data research was performed. The gathered bibliometric data was analyzed using the established platform NewQIS, a benchmarking system to visualize research quantity and quality indices. Findings: Between 1900 and 2016 a total of 6763 articles on immigration were retrieved and analyzed. 86 different countries participated in the publications. Quantitatively the United States followed by Canada and Spain were prominent regarding the article numbers. On comparing by additionally taking the population size into account, Israel followed by Sweden and Norway showed the highest performance. The main releasing journals are the Public Health Reports, the Journal of Immigrant and Minority Health and Social Science & Medicine. Over the decades, an increasing number of Public, Environmental & Occupational Health articles can be recognized which finally forms the mainly used subject area. Conclusion: Considerably increasing scientific work on immigration cannot only be explained by the general increase of scientific work but is also owed to the latest development with increased mobility, worldwide crises and the need of flight and migration. Especially countries with a good economic situation are highly affected by immigrants and prominent in their publication output on immigration, since the countries’ publication effort is connected with the appointed expenditures for research and development. Remarkable numbers of immigrants throughout Europe compel medical professionals to consider neglected diseases, requires the public health system to restructure itself and finally promotes science.

Background: Ever since it was discovered that zoophilic vectors can transmit malaria, zooprophylaxis has been used to prevent the disease. However, zoopotentiation has also been observed. Thus, the presence of livestock has been widely accepted as an important variable for the prevalence and risk of malaria, but the effectiveness of zooprophylaxis remained subject to debate. This study aims to critically analyse the effects of the presence of livestock on malaria prevalence using a large dataset from Indonesia. Methods: This study is based on data from the Indonesia Basic Health Research ("Riskesdas") cross-sectional survey of 2007 organized by the National Institute of Health Research and Development of Indonesia’s Ministry of Health. The subset of data used in the present study included 259,885 research participants who reside in the rural areas of 176 regencies throughout the 15 provinces of Indonesia where the prevalence of malaria is higher than the national average. The variable "existence of livestock" and other independent demographic, social and behavioural variables were tested as potential determinants for malaria prevalence by multivariate logistic regressions. Results: Raising medium-sized animals in the house was a significant predictor of malaria prevalence (OR = 2.980; 95% CI 2.348–3.782, P < 0.001) when compared to keeping such animals outside of the house (OR = 1.713; 95% CI 1.515–1.937, P < 0.001). After adjusting for gender, age, access to community health facility, sewage canal condition, use of mosquito nets and insecticide-treated bed nets, the participants who raised medium-sized animals inside their homes were 2.8 times more likely to contract malaria than respondents who did not (adjusted odds ratio = 2.809; 95% CI 2.207–3.575; P < 0.001). Conclusions: The results of this study highlight the importance of livestock for malaria transmission, suggesting that keeping livestock in the house contributes to malaria risk rather than prophylaxis in

Zielsetzung: Sowohl für Knochenmineraldichte (BMD) als auch für Knochenstrukturparameter ist bekannt, dass Sie mit der Versagenslast eines Wirbelkörpers korrelieren, jedoch ist noch weitgehend unerforscht ob die mittels MDCT in vivo verfügbare Bildqualität ausreicht diese valide zu bestimmen. Ergebnisse: Wir konnten Korrelationen mit der Versagenslast von bis zu r = 0.80 (p < 0,001) für die normalisierte BMD, bis zu r = 0.87 (p < 0,001) für die HR-pQCT Knochenstrukturparameter und bis zu r = 0,89 (p < 0,001) für die MDCT Knochenstrukturparameter erzielen. Schlussfolgerung: Sowohl niedrigdosis MDCT BMD als auch MDCT Knochenstrukturparameter sind geeignete Parameter zur Abschätzung der Versagenslast des Wirbelkörpers; Die zur Verfügung stehende räumliche Auflösung ist hierzu ausreichend., Purpose: It was reported previously that bone mineral density (BMD) and trabecular bone structure parameters can both predict bone strength. However still little is know whether image quality of in vivo MDCT is sufficient to get valid results for those parameters. Results: Correlations between trabecular bone structure parameters and failure load amounted up to r = 0.80 (p < 0.001) using BMD, up to r = 0.87 (p < 0.05) using the HR-pQCT images, and up to r = 0.89 (p < 0.05) using the MDCT images. Both low-dose MDCT BMD and trabecular bone structure parameters obtained with clinically available whole-body MDCT scanners can predict vertebral bone strength; the spatial resolution available is sufficient.

Die Quantifizierung von Fettgewebe ist mittels der Magnetresonanztomographie gut möglich, stellt aber bei Säuglingen eine Herausforderung dar. In dieser Arbeit wurde die PROPELLER-Sequenz (periodically rotated overlapping parallel lines with enhanced reconstruction) als neue Methode zur Unterdrückung von Bewegungsartefakten im Vergleich mit der konventionellen turbo spin echo-Sequenz untersucht. Die Genauigkeit und Reproduzierbarkeit der MRT-Sequenzen wurden mit einem eigens hergestellten Phantom und wiederholter Messungen bestimmt und zeigten gute Ergebnisse. Zudem wurde die Korrelation der MRT-Sequenzenz mit anderen Methoden wie der Hautfalten- und Ultraschallmessung berechnet. Unterschiede der Fettgewebsmasse zwischen Säuglingen mit und ohne Supplementierung der Mütter mit Omega-3-Fettsäuren während der Schwangerschaft wurden nicht gefunden., Quantification of adipose tissue by MRI is possible, but difficult in young infants. In this study a comparison between the PROPELLER-sequence (periodically rotated overlapping parallel lines with enhanced reconstruction) as a new method for elimination of movement artefacts and the turbo spin echo sequence was made. Accurancy and reproducibility were analyzed by a self-made phantom and repeated measurements. Additionally the correlation between MRI and skinfoldthickness and ultrasound were evaluated. There was no difference in adipose tissue mass between infants with or without supplementation of the mothers with omega-3 fatty acids during pregnancy found.

Background: Health care accessibility is known to differ geographically. With this study we focused on analysing accessibility of general and specialized obstetric units in England and Germany with regard to urbanity, area deprivation and neonatal outcome using routine data. Methods: We used a floating catchment area method to measure obstetric care accessibility, the degree of urbanization (DEGURBA) to measure urbanity and the index of multiple deprivation to measure area deprivation. Results: Accessibility of general obstetric units was significantly higher in Germany compared to England (accessibility index of 16.2 vs. 11.6; p < 0.001), whereas accessibility of specialized obstetric units was higher in England (accessibility index for highest level of care of 0.235 vs. 0.002; p < 0.001). We further demonstrated higher obstetric accessibility for people living in less deprived areas in Germany (r = − 0.31; p < 0.001) whereas no correlation was present in England. There were also urban–rural disparities present, with higher accessibility in urban areas in both countries (r = 0.37–0.39; p < 0.001). The analysis did not show that accessibility affected neonatal outcomes. Finally, our computer generated model for obstetric care provider demand in terms of birth counts showed a very strong correlation with actual birth counts at obstetric units (r = 0.91–0.95; p < 0.001). Conclusion: In Germany the focus of obstetric care seemed to be put on general obstetric units leading to higher accessibility compared to England. Regarding specialized obstetric care the focus in Germany was put on high level units whereas in England obstetric care seems to be more balanced between the different levels of care with larger units on average leading to higher accessibility.

Objective: Worldwide, the respiratory syncytial virus (RSV) represents the predominant viral agent causing bronchiolitis and pneumonia in children. To conduct research and tackle existing healthcare disparities, RSV-related research activities around the globe need to be described. Hence, we assessed the associated scientific output (represented by research articles) by geographical, chronological and socioeconomic criteria and analysed the authors publishing in the field by gender. Also, the 15 most cited articles and the most prolific journals were identified for RSV research. Design: Retrospective, descriptive study. Setting: The NewQIS (New Quality and Quantity Indices in Science) platform was employed to identify RSV-related articles published in the Web of Science until 2013. We performed a numerical analysis of all articles, and examined citation-based aspects (eg, citation rates); results were visualised by density equalising mapping tools. Results: We identified 4600 RSV-related articles. The USA led the field; US-American authors published 2139 articles (46.5%% of all identified articles), which have been cited 83 000 times. When output was related to socioeconomic benchmarks such as gross domestic product or Research and Development expenditures, Guinea-Bissau, The Gambia and Chile were ranked in leading positions. A total of 614 articles on RSV (13.34% of all articles) were attributed to scientific collaborations. These were primarily established between high-income countries. The gender analysis indicated that male scientists dominated in all countries except Brazil. Conclusions: The majority of RSV-related research articles originated from high-income countries whereas developing nations showed only minimal publication productivity and were barely part of any collaborative networks. Hence, research capacity in these nations should be increased in order to assist in addressing inequities in resource allocation and the clinical burden of RSV in these cou

In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the "official degree of care provision". However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.

Because the value of preschool child care is under intensive debate among both policy - makers and society in general,this paper analyzes the relation between preschool care and the well-being of children and adolescents in Germany. It also examines differences in outcomes based on child socioeconomic background by focusing on the heterogeneous effects for migrant children. Our findings, based on data from the German Health Interview and Examination Survey of Children and Adolescents, suggest that children who have experienced child care have a slightly lower well-being overall. For migrant children, however, the outcomes indicate a positive relation.

BACKGROUND: Geographical variation of the general practitioner (GP) workforce is known between rural and urban areas. However, data about the variation between and within urban areas are lacking. METHOD: We analyzed distribution patterns of GP full time equivalents (FTE) in German cities with a population size of more than 500,000. We correlated their distribution with area measures of social deprivation in order to analyze preferences within neighborhood characteristics. For this purpose, we developed two area measures of deprivation: Geodemographic Index (GDI) and Cultureeconomic Index (CEI). RESULTS: In total n = 9034.75 FTE were included in n = 14 cities with n = 171 districts. FTE were distributed equally on inter-city level (mean: 6.49; range: 5.12-7.20; SD: 0.51). However, on intra-city level, GP distribution was skewed (mean: 6.54; range: 1.80-43.98; SD: 3.62). Distribution patterns of FTE per 10^4 residents were significantly correlated with GDI (r = -0.49; p < 0.001) and CEI (r = -0.22; p = 0.005). Therefore, location choices of GPs were mainly positively correlated with 1) central location (r = -0.50; p < 0.001), 2) small household size of population (r = -0.50; p < 0.001) and 3) population density (r = 0.35; p < 0.001). CONCLUSION: Intra-city distribution of GPs was skewed, which could affect the equality of access for the urban population. Furthermore, health services planners should be aware of GP location preferences. This could be helpful to better understand and plan delivery of health services. Within this process the presented Geodemographic Index (GDI) could be of use.

Zielsetzung: Sowohl für Knochenmineraldichte (BMD) als auch für Knochenstrukturparameter ist bekannt, dass Sie mit der Versagenslast eines Wirbelkörpers korrelieren, jedoch ist noch weitgehend unerforscht ob die mittels MDCT in vivo verfügbare Bildqualität ausreicht diese valide zu bestimmen. Ergebnisse: Wir konnten Korrelationen mit der Versagenslast von bis zu r = 0.80 (p < 0,001) für die normalisierte BMD, bis zu r = 0.87 (p < 0,001) für die HR-pQCT Knochenstrukturparameter und bis zu r = 0,89 (p < 0,001) für die MDCT Knochenstrukturparameter erzielen. Schlussfolgerung: Sowohl niedrigdosis MDCT BMD als auch MDCT Knochenstrukturparameter sind geeignete Parameter zur Abschätzung der Versagenslast des Wirbelkörpers; Die zur Verfügung stehende räumliche Auflösung ist hierzu ausreichend., Purpose: It was reported previously that bone mineral density (BMD) and trabecular bone structure parameters can both predict bone strength. However still little is know whether image quality of in vivo MDCT is sufficient to get valid results for those parameters. Results: Correlations between trabecular bone structure parameters and failure load amounted up to r = 0.80 (p < 0.001) using BMD, up to r = 0.87 (p < 0.05) using the HR-pQCT images, and up to r = 0.89 (p < 0.05) using the MDCT images. Both low-dose MDCT BMD and trabecular bone structure parameters obtained with clinically available whole-body MDCT scanners can predict vertebral bone strength; the spatial resolution available is sufficient.

Subjects with indolent systemic mastocytosis (ISM) have an increased risk for osteoporosis. It has been demonstrated that trabecular bone microstructure analysis improves the prediction of bone strength beyond dual-energy X-ray absorptiometry-based bone mineral density. The purpose of this study was to obtain Magnetic Resonance (MR)-based trabecular bone microstructure parameters as advanced imaging biomarkers in subjects with ISM (n=18) and compare them with those of normal controls (n=18). Trabecular bone microstructure parameters were not significantly (P>.05) different between subjects with ISM and controls. These findings revealed important pathophysiological information about ISM-associated osteoporosis and may limit the use of trabecular bone microstructure analysis in this clinical setting. (C) 2015 Elsevier Inc. All rights reserved.

Subjects with indolent systemic mastocytosis (ISM) have an increased risk for osteoporosis. It has been demonstrated that trabecular bone microstructure analysis improves the prediction of bone strength beyond dual-energy X-ray absorptiometry-based bone mineral density. The purpose of this study was to obtain Magnetic Resonance (MR)-based trabecular bone microstructure parameters as advanced imaging biomarkers in subjects with ISM (n=18) and compare them with those of normal controls (n=18). Trabecular bone microstructure parameters were not significantly (P>.05) different between subjects with ISM and controls. These findings revealed important pathophysiological information about ISM-associated osteoporosis and may limit the use of trabecular bone microstructure analysis in this clinical setting. (C) 2015 Elsevier Inc. All rights reserved.

Rasmussens encephalitis is a rare chronic neurological disorder, characterised by unilateral inflammation of the cerebral cortex, drug-resistant epilepsy, and progressive neurological and cognitive deterioration. Neuropathological and immunological studies support the notion that Rasmussens encephalitis is probably driven by a T-cell response to one or more antigenic epitopes, with potential additional contribution by autoantibodies. Careful analysis of the association between histopathology and clinical presentation suggests that initial damage to the brain is mediated by T cells and microglia, suggesting a window for treatment if Rasmussens encephalitis can be diagnosed early. Advances in neuroimaging suggest that progression of the inflammatory process seen with MRI might be a good biomarker in Rasmussens encephalitis. For many patients, families, and doctors, choosing the right time to move from medical management to surgery is a real therapeutic dilemma. Cerebral hemispherectomy remains the only cure for seizures, but there are inevitable functional compromises. Decisions of whether or when surgery should be undertaken are challenging in the absence of a dense neurological deficit, and vary by institutional experience. Further, the optimum time for surgery, to give the best language and cognitive outcome, is not yet well understood. Immunomodulatory treatments seem to slow rather than halt disease progression in Rasmussens encephalitis, without changing the eventual outcome.

Rasmussen's encephalitis is a rare chronic neurological disorder, characterised by unilateral inflammation of the cerebral cortex, drug-resistant epilepsy, and progressive neurological and cognitive deterioration. Neuropathological and immunological studies support the notion that Rasmussen's encephalitis is probably driven by a T-cell response to one or more antigenic epitopes, with potential additional contribution by autoantibodies. Careful analysis of the association between histopathology and clinical presentation suggests that initial damage to the brain is mediated by T cells and microglia, suggesting a window for treatment if Rasmussen's encephalitis can be diagnosed early. Advances in neuroimaging suggest that progression of the inflammatory process seen with MRI might be a good biomarker in Rasmussen's encephalitis. For many patients, families, and doctors, choosing the right time to move from medical management to surgery is a real therapeutic dilemma. Cerebral hemispherectomy remains the only cure for seizures, but there are inevitable functional compromises. Decisions of whether or when surgery should be undertaken are challenging in the absence of a dense neurological deficit, and vary by institutional experience. Further, the optimum time for surgery, to give the best language and cognitive outcome, is not yet well understood. Immunomodulatory treatments seem to slow rather than halt disease progression in Rasmussen's encephalitis, without changing the eventual outcome.

Objectives: Finite-element-models (FEM) are a promising technology to predict bone strength and fracture risk. Usually, the highest spatial resolution technically available is used, but this requires excessive computation time and memory in numerical simulations of large volumes. Thus, FEM were compared at decreasing resolutions with respect to local strain distribution and prediction of failure load to (1) validate MDCT-based FEM and to (2) optimize spatial resolution to save computation time. Materials and methods: 20 cylindrical trabecular bone specimens (diameter 12 mm, length 15-20 mm) were harvested from elderly formalin-fixed human thoracic spines. All specimens were examined by micro-CT (isotropic resolution 30 pm) and whole-body multi-row-detector computed tomography (MDCT, 250 mu m x 250 mu m x 500 mu m). The resolution of all datasets was lowered in eight steps to similar to 2000 mu m x 2000 mu m x 500 mu m and FEM were calculated at all resolutions. Failure load was determined by biomechanical testing. Probability density functions of local micro-strains were compared in all datasets and correlations between FEM-based and biomechanically measured failure loads were determined. Results: The distribution of local micro-strains was similar for micro-CT and MDCT at comparable resolutions and showed a shift toward higher average values with decreasing resolution, corresponding to the increasing apparent trabecular thickness. Small micro-strains (epsilon(eff) < 0.005) could be calculated down to 250 mu m x 250 mu m x 500 mu m. Biomechanically determined failure load showed significant correlations with all FEM, up to r= 0.85 and did not significantly change with lower resolution but decreased with high thresholds, due to loss of trabecular connectivity. Conclusion: When choosing connectivity-preserving thresholds, both micro-CT- and MDCT-based finiteelement-models well predicted failure load and still accurately revealed the distribution of local microstrains

BACKGROUND: The growth and rupture of cerebral aneurysms is intrinsically related to the hemodynamics prevailing in the diseased area. Therefore, a better understanding of intra-aneurysmal hemodynamics is essential for developing effective treatment methods. OBJECTIVE: The intention of this study was to evaluate the intra-aneurysmal flow and flow reduction induced by flow diverters in a true-to-scale elastic aneurysm model, obtained from real patient data. METHODS: Based on the computed tomography angiography (CTA) data of a fusiform aneurysm of a 34 year old patient, an elastic silicon rubber model of the aneurysm was produced. A physiologic pulsatile flow was created with a circulatory experimental set-up, and a non-Newtonian perfusion fluid was used as a substitute for human blood. Hemodynamics were measured by LDA before and after flow diverter implantation. RESULTS: Implantation of a flow diverter device resulted in a reduction of intra-aneurysmal maximum flow velocities of 97.8% at the inflow zone, 89.1% in the dome and 89.3% at the outflow zone, when compared to the native model. A significant reduction of 94% in the mean intra-aneurysmal velocity was found. CONCLUSIONS: This promising methodology can optimize patient treatment and will correlate with computational simulations to evaluate their reliability.

Die Quantifizierung von Fettgewebe ist mittels der Magnetresonanztomographie gut möglich, stellt aber bei Säuglingen eine Herausforderung dar. In dieser Arbeit wurde die PROPELLER-Sequenz (periodically rotated overlapping parallel lines with enhanced reconstruction) als neue Methode zur Unterdrückung von Bewegungsartefakten im Vergleich mit der konventionellen turbo spin echo-Sequenz untersucht. Die Genauigkeit und Reproduzierbarkeit der MRT-Sequenzen wurden mit einem eigens hergestellten Phantom und wiederholter Messungen bestimmt und zeigten gute Ergebnisse. Zudem wurde die Korrelation der MRT-Sequenzenz mit anderen Methoden wie der Hautfalten- und Ultraschallmessung berechnet. Unterschiede der Fettgewebsmasse zwischen Säuglingen mit und ohne Supplementierung der Mütter mit Omega-3-Fettsäuren während der Schwangerschaft wurden nicht gefunden., Quantification of adipose tissue by MRI is possible, but difficult in young infants. In this study a comparison between the PROPELLER-sequence (periodically rotated overlapping parallel lines with enhanced reconstruction) as a new method for elimination of movement artefacts and the turbo spin echo sequence was made. Accurancy and reproducibility were analyzed by a self-made phantom and repeated measurements. Additionally the correlation between MRI and skinfoldthickness and ultrasound were evaluated. There was no difference in adipose tissue mass between infants with or without supplementation of the mothers with omega-3 fatty acids during pregnancy found.

In der vorliegenden Studie wurde die Reproduzierbarkeit zweidimensionaler und dreidimensionaler Strukturparameter des spongiösen Knochens untersucht. Dazu wurden Untersuchungen am distalen Radius im 1,5-Tesla und 3-Tesla MRT wiederholt durchgeführt. Anschließend wurden die Bilder manuell oder automatisch nachbearbeitet, um ein bestmögliches Ergebnis der Reproduzierbarkeit zu erzielen. Dabei zeigte sich, dass die Reproduzierbarkeit vor allem durch die Anzahl der Schnittbilder und die Art der Segmentierung des Knochens beeinflusst wird, und weniger durch Auflösung, Feldstärke oder Signal-zu-Rausch-Verhältnis., In this study reproducibility of two-dimensional and three-dimensional parameters of trabecular bone structure were examined. Therefore the distal radius was scanned repeatedly using 1.5 Tesla and 3 Tesla MR imaging. Subsequently the images were reprocessed by hand or automatically in order to improve reproducibility. The results showed that reproducibility was highly influenced by the number of scanned images and the percentage of segmentation, whereas the quality of MR imaging and signal-to-noise-ratio were less important.

In dieser Arbeit sollte geprüft werden, ob man mittels hochauflösender MRT bessere Aussagen über die Beschaffenheit von trabekulärem Knochen perimenopausaler Frauen treffen kann, als nur mit der Knochendichtemessung mittels qCT. Untersucht wurden 126 Frauen. Es konnte kein Vorteil durch Messung der Knochenstrukturparameter zur Beschreibung der Beschaffenheit von trabekulärem Knochen gegenüber der Bestimmung der Knochendichte in der Analyse von trabekulärem Knochen nachgewiesen werden., This study analyzed whether it is possible to have better evidence about the constitution of trabecular bone structure using high resolution magnetic resonance tomography than by quantitative computed tomography. 126 perimenopausal women were examind. It was not possible to make superior conclusions about trabecular bone constitution with bone structure parameters by hr-MRT to measuring bone mineral density with qCT.

Rasmussen's encephalitis is a rare chronic neurological disorder, characterised by unilateral inflammation of the cerebral cortex, drug-resistant epilepsy, and progressive neurological and cognitive deterioration. Neuropathological and immunological studies support the notion that Rasmussen's encephalitis is probably driven by a T-cell response to one or more antigenic epitopes, with potential additional contribution by autoantibodies. Careful analysis of the association between histopathology and clinical presentation suggests that initial damage to the brain is mediated by T cells and microglia, suggesting a window for treatment if Rasmussen's encephalitis can be diagnosed early. Advances in neuroimaging suggest that progression of the inflammatory process seen with MRI might be a good biomarker in Rasmussen's encephalitis. For many patients, families, and doctors, choosing the right time to move from medical management to surgery is a real therapeutic dilemma. Cerebral hemispherectomy remains the only cure for seizures, but there are inevitable functional compromises. Decisions of whether or when surgery should be undertaken are challenging in the absence of a dense neurological deficit, and vary by institutional experience. Further, the optimum time for surgery, to give the best language and cognitive outcome, is not yet well understood. Immunomodulatory treatments seem to slow rather than halt disease progression in Rasmussen's encephalitis, without changing the eventual outcome.

We investigate the use of different trabecular bone descriptors and advanced machine learning tech niques to complement standard bone mineral density (BMD) measures derived from dual-energy x-ray absorptiometry (DXA) for improving clinical assessment of osteoporotic fracture risk. For this purpose, volumes of interest were extracted from the head, neck, and trochanter of 146 ex vivo proximal femur specimens on multidetector computer tomography. The trabecular bone captured was characterized with (1) statistical moments of the BMD distribution, (2) geometrical features derived from the scaling index method (SIM), and (3) morphometric parameters, such as bone fraction, trabecular thickness, etc. Feature sets comprising DXA BMD and such supplemental features were used to predict the failure load (FL) of the specimens, previously determined through biomechanical testing, with multiregression and support vector regression. Prediction performance was measured by the root mean square error (RMSE); correlation with measured FL was evaluated using the coefficient of determination R2. The best prediction performance was achieved by a combination of DXA BMD and SIM-derived geometric features derived from the femoral head (RMSE: 0.869 ± 0.121, R2: 0.68 ± 0.079), which was significantly better than DXA BMD alone (RMSE: 0.948 ± 0.119, R2: 0.61 ± 0.101) (p < 10-4). For multivariate feature sets, SVR outperformed multiregression (p < 0.05). These results suggest that supplementing standard DXA BMD measurements with sophisticated femoral trabecular bone characterization and supervised learning techniques can significantly improve biomechanical strength prediction in proximal femur specimens.

Objectives: Finite-element-models (FEM) are a promising technology to predict bone strength and fracture risk. Usually, the highest spatial resolution technically available is used, but this requires excessive computation time and memory in numerical simulations of large volumes. Thus, FEM were compared at decreasing resolutions with respect to local strain distribution and prediction of failure load to (1) validate MDCT-based FEM and to (2) optimize spatial resolution to save computation time. Materials and methods: 20 cylindrical trabecular bone specimens (diameter 12 mm, length 15-20 mm) were harvested from elderly formalin-fixed human thoracic spines. All specimens were examined by micro-CT (isotropic resolution 30 pm) and whole-body multi-row-detector computed tomography (MDCT, 250 mu m x 250 mu m x 500 mu m). The resolution of all datasets was lowered in eight steps to similar to 2000 mu m x 2000 mu m x 500 mu m and FEM were calculated at all resolutions. Failure load was determined by biomechanical testing. Probability density functions of local micro-strains were compared in all datasets and correlations between FEM-based and biomechanically measured failure loads were determined. Results: The distribution of local micro-strains was similar for micro-CT and MDCT at comparable resolutions and showed a shift toward higher average values with decreasing resolution, corresponding to the increasing apparent trabecular thickness. Small micro-strains (epsilon(eff) < 0.005) could be calculated down to 250 mu m x 250 mu m x 500 mu m. Biomechanically determined failure load showed significant correlations with all FEM, up to r= 0.85 and did not significantly change with lower resolution but decreased with high thresholds, due to loss of trabecular connectivity. Conclusion: When choosing connectivity-preserving thresholds, both micro-CT- and MDCT-based finiteelement-models well predicted failure load and still accurately revealed the distribution of local microstrains

BACKGROUND: The growth and rupture of cerebral aneurysms is intrinsically related to the hemodynamics prevailing in the diseased area. Therefore, a better understanding of intra-aneurysmal hemodynamics is essential for developing effective treatment methods. OBJECTIVE: The intention of this study was to evaluate the intra-aneurysmal flow and flow reduction induced by flow diverters in a true-to-scale elastic aneurysm model, obtained from real patient data. METHODS: Based on the computed tomography angiography (CTA) data of a fusiform aneurysm of a 34 year old patient, an elastic silicon rubber model of the aneurysm was produced. A physiologic pulsatile flow was created with a circulatory experimental set-up, and a non-Newtonian perfusion fluid was used as a substitute for human blood. Hemodynamics were measured by LDA before and after flow diverter implantation. RESULTS: Implantation of a flow diverter device resulted in a reduction of intra-aneurysmal maximum flow velocities of 97.8% at the inflow zone, 89.1% in the dome and 89.3% at the outflow zone, when compared to the native model. A significant reduction of 94% in the mean intra-aneurysmal velocity was found. CONCLUSIONS: This promising methodology can optimize patient treatment and will correlate with computational simulations to evaluate their reliability.

In der vorliegenden Studie wurde die Reproduzierbarkeit zweidimensionaler und dreidimensionaler Strukturparameter des spongiösen Knochens untersucht. Dazu wurden Untersuchungen am distalen Radius im 1,5-Tesla und 3-Tesla MRT wiederholt durchgeführt. Anschließend wurden die Bilder manuell oder automatisch nachbearbeitet, um ein bestmögliches Ergebnis der Reproduzierbarkeit zu erzielen. Dabei zeigte sich, dass die Reproduzierbarkeit vor allem durch die Anzahl der Schnittbilder und die Art der Segmentierung des Knochens beeinflusst wird, und weniger durch Auflösung, Feldstärke oder Signal-zu-Rausch-Verhältnis., In this study reproducibility of two-dimensional and three-dimensional parameters of trabecular bone structure were examined. Therefore the distal radius was scanned repeatedly using 1.5 Tesla and 3 Tesla MR imaging. Subsequently the images were reprocessed by hand or automatically in order to improve reproducibility. The results showed that reproducibility was highly influenced by the number of scanned images and the percentage of segmentation, whereas the quality of MR imaging and signal-to-noise-ratio were less important.

In dieser Arbeit sollte geprüft werden, ob man mittels hochauflösender MRT bessere Aussagen über die Beschaffenheit von trabekulärem Knochen perimenopausaler Frauen treffen kann, als nur mit der Knochendichtemessung mittels qCT. Untersucht wurden 126 Frauen. Es konnte kein Vorteil durch Messung der Knochenstrukturparameter zur Beschreibung der Beschaffenheit von trabekulärem Knochen gegenüber der Bestimmung der Knochendichte in der Analyse von trabekulärem Knochen nachgewiesen werden., This study analyzed whether it is possible to have better evidence about the constitution of trabecular bone structure using high resolution magnetic resonance tomography than by quantitative computed tomography. 126 perimenopausal women were examind. It was not possible to make superior conclusions about trabecular bone constitution with bone structure parameters by hr-MRT to measuring bone mineral density with qCT.

Background: The students' perception of working conditions in hospitals hasn't been subject of research in Germany so far. However the perception plays an important role talking about the sustainability of working conditions. The iCept Study wants to examine the perception of medical students compared to the perception of practicing physicians. Methods: The perception will be investigated with a redesigned questionnaire based upon two established and validated questionnaires. The two samples built for this study (students and physician) will be chosen from members of the labor union Marburger Bund. The iCept-Study is designed as an anonymized online-survey. Discussion: The iCept-Study is thought to be the basis of ongoing further investigations regarding the perception of working conditions in hospitals. The results shall serve the facilitation of improving working conditions.

Multislice-Computertomographie (MSCT)-Datensätze des proximalen Femurs wurden automatisch segmentiert und “volumes of interest“ (VOIs) im trabekulären Knochen platziert. In den VOIs wurden trabekuläre Strukturparameter, Knochenmineralgehalt (BMC) und Knochenmineraldichte (BMD) berechnet. Die mittels DXA, der gegenwärtigen Osteoporose-Standarddiagnostik, bestimmte BMC und BMD wurden mit diesen Parametern hinsichtlich einer Verbesserung der Vorhersage der biomechanischen Bruchlast des Femurs verglichen. Die entwickelten automatisierten Segmentierungs- und Platzierungstechniken führten im Vergleich zu manuellen Techniken zu einer bedeutsamen Zeitersparnis und geringeren Präzisionsfehlern. Die trabekulären Struktur- und Knochendichteparameter konnten die Bruchlast des Femurs gut vorhersagen. Die Kombination aus trabekulären Strukturparametern und bestem DXA Parameter konnte die Bruchlast signifikant besser vorhersagen als der beste DXA Parameter alleine., An automated segmentation and volume of interest (VOI) fitting algorithm was applied to multislice computed tomography (MSCT)-datasets of the proximal femur, to analyse trabecular bone structure as well as trabecular bone mineral content (BMC) and density (BMD) within the fitted VOIs and to investigate whether trabecular structure parameters and trabecular BMC and BMD improve the prediction of the biomechanical strength of the femur compared to BMC and BMD determined with dual X-ray absorptiometry (DXA) as the standard osteoporosis diagnostic technique. The applied automated segmentation and fitting algorithm showed better precision and timesaving compared to manual techniques. Trabecular BMC, BMD and structure parameters predicted the biomechanical strength of the femur well. The biomechanical strength of the femur could be significantly better predicted by the combination of trabecular structure parameters and best DXA parameter than by the best DXA parameter alone.

The photovoltaic applications spreads in these days fast, therefore they also undergo great development. Because the amount of the energy obtained from the panel depends on the surrounding conditions, as intensity of the sun exposure or the temperature of the solar array, the converter must be connected to the panel output. The Solar system equipped with inverter can supply small loads like notebooks, mobile chargers etc. in the places where the supplying network is not present. Or the system can be used as a generator and it shall deliver energy to the supply network. Each type of the application has different requirements on the converter and its control algorithm. But for all of them the one thing is common – the maximal efficiency. The paper focuses on design and simulation of the low power inverter that acts as output part of the whole converter. In the paper the design of the control algorithm of the inverter for both types of inverter application – for islanding mode and for operation on the supply grid – is discussed. Attention is also paid to the design of the output filter that should reduce negative side effects of the converter on the supply network.