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Brain edema; Intracranial hemorrhage; Serum biomarker Edema cerebral; Hemorragia intracraneal; Biomarcador sérico Edema cerebral; Hemorràgia intracranial; Biomarcador sèric Background: Early identification of patients developing symptomatic intracranial hemorrhage and symptomatic brain edema after acute ischemic stroke is essential for clinical decision-making. Astroglial protein S-100B is a marker of blood-brain barrier disruption, which plays an important role in the formation of intracranial hemorrhage and brain edema. In this study, we assessed the prognostic value of serum S-100B for the development of these complications. Methods: Serum S-100B levels were measured within 24 h from symptom onset in 1749 consecutive acute ischemic stroke patients from the prospective, observational, multicenter BIOSIGNAL cohort study (mean age 72.0 years, 58.3% male). To determine symptomatic intracranial hemorrhage or symptomatic brain edema, follow-up neuroimaging was performed in all patients receiving reperfusion therapy or experiencing clinical worsening with an NIHSS increase of ⩾4. Results: Forty six patients (2.6%) developed symptomatic intracranial hemorrhage and 90 patients (5.2%) developed symptomatic brain edema. After adjustment for established risk factors, log10S-100B levels remained independently associated with both symptomatic intracranial hemorrhage (OR 3.41, 95% CI 1.7–6.9, p = 0.001) and symptomatic brain edema (OR 4.08, 95% CI 2.3–7.1, p

Flexible changes in behavior can involve changes in the processing of external information (i.e., shifts in attention between different stimuli) or internal information (i.e., shifts in task rules stored in memory). However, it is unclear if different types of flexible change rely on separate, domain-specific neural processes or on a domain-general system, which enables flexible actions independent of the type of change needed. In the current study, participants performed a task switching procedure while we measured neural oscillations via EEG. Importantly, we independently manipulated the need to switch attention between 2 types of stimuli, as well as the need to switch between two sets of stimuli–response rules stored in memory. Both attentional and rule switches significantly increased error rates and RTs. On a neural level, both types of changes were associated with a widespread decrease in alpha power, predominantly over the parietal cortex. Attentional switches and rule switches showed a subadditive interaction effect on both participants' performance as well as on their alpha power reactivity. This indicates that implementing both changes at the same time was more efficient than implementing each individual change separately. Independent of the presence or absence of either attentional or rule switches, higher frontal theta power and lower parietal/posterior alpha power predicted faster responses on correct trials. Our study suggests that flexible behavior relies on domain-general frontal and parietal oscillatory dynamics, which enable efficient implementation of goal-directed actions independent of which aspects of the task change.

William Alphonso Murrill was an American mycologist of the early 20th century. He described 1453 new species of Agaricales, Boletales, and Polyporales. Within these were 44 taxa that he described as Hebeloma or that he recombined into Hebeloma. Additionally, there are five species, of which we are aware, that Murrill described within other genera that should be referred to the genus Hebeloma. A further three species described from northern America by J. P. F. C. Montagne, and transferred to Hebeloma by Saccardo, were commented on by Murrill and not accepted within the genus. These 52 taxa are analyzed here, both morphologically and molecularly, as far as possible. For 18 of his types, internal transcribed spacer (ITS) sequences were generated. For two species (H. harperi and H. subfastibile), which were mixed collections, lectotypes are designated. Twenty-three of the taxa analyzed are Hebeloma, as the genus is recognized today, and six of these (H. australe, H. harperi, H. paludicola, H. subaustrale, H. subfastibile, and H. viscidissimum) are regarded as current, i.e., they are names that should be accepted and used. Hebeloma paludicola is an earlier name for H. hygrophilum, described from Europe. Gymnopilus viscidissimus is synonymous with H. amarellum but has priority and is here recombined into Hebeloma. The remaining 17 Hebeloma taxa are synonymized with other species that have priority. The remaining 29 species belong to a range of genera; molecularly supported were Agrocybe, Cortinarius, Inocybe, Inosperma, Phlegmacium, Pholiota, Pseudosperma, and Pyrrhulomyces. Recombinations and synonymizations are made as appropriate and necessary. The names H. alachuanum and H. vatricosum, respectively Inocybe vatricosa, are considered doubtful and should be avoided.

Artikel in mehreren Sprachen: Deutsch und Englisch Aim: This revised guideline was coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). It aims to improve the prediction, prevention, and management of preterm birth, based on evidence from the current literature, the experience of members of the guidelines commission, and the viewpoint of self-help organizations. Methods: The members of the contributing professional societies and organizations developed recommendations and statements based on international literature. The recommendations and statements were presented and adopted using a formal process (structured consensus conferences with neutral moderation, written Delphi vote). Recommendations: Part 1 of this short version of the guideline presents statements and recommendations on the epidemiology, etiology, prediction, and primary and secondary prevention of preterm birth. Ziel: Überarbeitete Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) und der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Ziel der Leitlinie ist es, die Prädiktion, die Prävention und das Management der Frühgeburt anhand der aktuellen Literatur, der Erfahrung der Mitglieder der Leitlinienkommission einschließlich der Sicht der Selbsthilfe evidenzbasiert zu verbessern. Methoden: Anhand der internationalen Literatur entwickelten die Mitglieder der beteiligten Fachgesellschaften und Organisationen zahlreiche Empfehlungen und Statements. Diese wurden in einem formalen Prozess (strukturierte Konsensuskonferenzen mit neutraler Moderation, schriftliche Delphi-Abstimmung) verabschiedet. Empfehlungen: Der Teil 1 dieser Kurzversion der Leitlinie zeigt Statements und Empfehlungen zur Epidemiologie, Ätiologie, der Prädiktion sowie der primären und sekundären Prävention der Frühgeburt.

International audience; This article proposes a first synthesis of ancient funerary practices in western Normandy based on a corpus of 29 sites selected from a very dense documentation of uneven quality. Most of them are unpublished, some have been partially published. This corpus illustrates a wide range of funerary practices identified at regional level and covers a vast chronological range from the 1st century BC to the 5th century AC.The cremation of corpses largely dominates the Lower Normandy funerary landscape since the Conquest and throughout the Early Roman Empire. This practice gradually gave way to that of inhumations, which in turn became predominant in the 2nd century. However, numerous sites prove that these two rites coexisted for a long time. Beyond these considerations, the ancient funerary sites of western Normandy reflect a variety of occupations from the isolated tomb to the family mausoleum, via the community necropolis. Only the urban necropolises remain undocumented to this day.; Le dernier bilan de la recherche archéologique portant sur le fait funéraire antique en Normandie a été mené entre 2004 et 2010. Il a mis en évidence un fort potentiel d'étude avec pas moins de 41 indices. En quelques années, ce chiffre a triplé du fait de l'essor de l'archéologie préventive sur le territoire normand. Fin 2015, ce sont pas moins de 158 sites funéraires recensés dont 50 % des découvertes, soit près de 80 sites, sont postérieures à 1984. Parallèlement, peu de publications ont vu le jour ces trois dernières décennies. L'atelier "funéraire" du PCR Arbano s'est donné comme objectif de prendre en compte la totalité des découvertes anciennes (études complémentaires) comme récentes (sites inédits) et de dresser un premier état des connaissances sur le fait funéraire antique en Normandie occidentale.

This dataset contains all data on which the following publication below is based. Paper Citation: Risch Anita C., Zimmermann, Stefan, Schütz, Martin, Borer, Elizabeth T., Broadbent, Arthur A.D., Caldeira, Maria C., Davies, Kendi F., Eisenhauer, Nico, Eskelinen, Anu, Fay, Philip A., Hagedorn, Frank, Knops, Johannes M.H., Lembrechts, Jonas, J., MacDougall, Andrew S., McCulley, Rebecca L., Melbourne, Brett A., Moore, Joslin L., Power, Sally A., Seabloom, Eric W., Silveira, Maria L., Virtanen, Risto, Yahdjian, Laura, Ochoa-Hueso, Raul (accepted). Drivers of the microbial metabolic quotient across global grasslands. Global Ecology and Biogeography Please cite this paper together with the citation for the datafile. The microbial metabolic quotient (MMQ; mg CO2-C mg MBC-1 h-1), defined as the amount of microbial CO2 respired (MR; mg CO2-C kg soil-1 h-1) per unit of microbial biomass C (MBC; mg C kg soil-1), is a key parameter for understanding the microbial regulation of the carbon (C) cycle, including soil C sequestration. Here, we experimentally tested hypotheses about the individual and interactive effects of multiple nutrient addition (NPK+micronutrients) and herbivore exclusion on MR, MBC, and MMQ across 23 sites (5 continents). Our sites encompassed a wide range of edaphoclimatic conditions, thus we assessed which edaphoclimatic variables affected MMQ the most and how they interacted with our treatments. Soils were collected in plots with established experimental treatments. MR was assessed in a five-week laboratory incubation without glucose addition, MBC via substrate-induced respiration. MMQ was calculated as MR/MBC and corrected for soil temperatures (MMQsoil). Using LMMs and SEMs, we analysed how edaphoclimatic characteristics and treatments interactively affected MMQsoil. MMQsoil was higher in locations with higher mean annual temperature, lower water holding capacity, and soil organic C concentration, but did not respond to our treatments across sites as neither MR nor MBC changed. We attributed this relative homeostasis to our treatments to the modulating influence of edaphoclimatic variables. For example, herbivore exclusion, regardless of fertilization, led to greater MMQsoil only at sites with lower soil organic C (-1.7%). Our results pinpoint the main variables related to MMQsoil across grasslands and emphasize the importance of the local edaphoclimatic conditions in controlling the response of the C cycle to anthropogenic stressors. By testing hypotheses about MMQsoil across global edaphoclimatic gradients, this work also helps to align the conflicting results of prior studies.

Invisibilizarão ou caracterizações que inferiorizam personagens negros são idiossincrasias presentes na literatura infantojuvenil desde seu advento. Este cenário é influenciado sobretudo por uma estrutura social que coloca os corpos negros como inferiores, o racismo. Este é um problema histórico e social, que pode ser expresso de diversas formas, explícita ou velada, em diversos contextos, como na literatura. Embora nas últimas décadas tenham ocorrido modificações lentas nesse panorama, em especial em relação a meninas negras, ainda há amplo acesso de crianças e adolescentes a obras literárias que inferiorizam pessoas negras. Devido a isso, o interesse do presente artigo é analisar o livro “Dito, o negrinho da flauta”, de Pedro Bloch (1983), disponível a alunos de uma escola particular localizada no município de Vitória, Espírito Santo, cujo personagem principal é Dito, um garoto negro. Identificamos uma construção problemática do personagem, em que lhe são atribuídas caracterizações definidoras de raça, como neguinho, embora não seja escravizado, é tratado com um, dentre outras atribuições. O acesso de crianças e adolescentes a obras de conteúdo racista podem perpetuar estereótipos e preconceito, afetando a autoestima e identidade de pessoas negras.

Item does not contain fulltext How well can social scientists predict societal change, and what processes underlie their predictions? To answer these questions, we ran two forecasting tournaments testing the accuracy of predictions of societal change in domains commonly studied in the social sciences: ideological preferences, political polarization, life satisfaction, sentiment on social media, and gender–career and racial bias. After we provided them with historical trend data on the relevant domain, social scientists submitted pre-registered monthly forecasts for a year (Tournament 1; N = 86 teams and 359 forecasts), with an opportunity to update forecasts on the basis of new data six months later (Tournament 2; N = 120 teams and 546 forecasts). Benchmarking forecasting accuracy revealed that social scientists' forecasts were on average no more accurate than those of simple statistical models (historical means, random walks or linear regressions) or the aggregate forecasts of a sample from the general public (N = 802). However, scientists were more accurate if they had scientific expertise in a prediction domain, were interdisciplinary, used simpler models and based predictions on prior data. 18 p.

Zusammenfassung: Der INWORK (Integrity in work-related situations) ist ein Situational Judgment Test (SJT) zur Erfassung der beruflichen Integrität. Der INWORK besteht aus 23 Beschreibungen konfliktbehafteter Arbeitssituationen mit jeweils 4 Handlungsoptionen, die mehr oder weniger kontraproduktive Verhaltensweisen beinhalten. Testpersonen sollen diejenige Option wählen, die ihr typisches Verhalten in der beschriebenen Situation am besten widerspiegelt. Objektivität bei Testdurchführung und -auswertung ist gegeben. Reliabilität ist in Teilen gegeben und Hinweise auf Validität liegen vor. Allerdings sind weitere Studien mit Fremdurteilen sowie eine Normstichprobe, bestehend aus Bewerber_innen, notwendig.

The aim of the current systematic review and meta-analysis was to examine the prevalence and incidence of somatoform symptoms and disorders (also referred to as medically unexplained symptoms, psychosomatic symptoms, functional syndromes, somatization disorder, or somatic symptom disorder) in childhood and adolescence. The PRISMA guidelines were followed, and the review was registered prior to initiation (PROSPERO CRD42022339735). Fitting search terms were entered in Web of Science, Scopus, and PubMed in June, 2022. Included were articles, reports, book chapters, and conference papers that reported on the prevalence or incidence rates of somatoform symptoms and disorder in under-18-year-olds with empirical primary data; these needed to be published in English or German. Publications were excluded if they focused on abuse, trauma, serious illness, or hypochondria, as well as if they had a qualitative or experimental (intervention) study design. To be included in the meta-analysis, studies needed to report values suitable to calculate a pooled prevalence or incidence rate. After the full-text screening, 33 articles remained, of which 29 were used for the meta-analysis. The quality evaluation criteria proposed by Loney and colleagues (1998) were utilized for quality assessment. The pooled global prevalence rate was 31.0% for somatoform symptoms and 3.3% for somatoform disorders, yet heterogeneity remained high. The noteworthy prevalence rates have important implications for healthcare professionals, as well as school nurses and counselors.

Introduction: The goal of breast conserving surgery (BCS) for early breast cancer (EBC) is to remove the tumor in toto and preserving as much of the normal breast tissue as possible. In 20-50% of cases a re-excision is necessary because of involved margins. Repeat surgeries are not only a burden to patients physically but also psychologically and can delay recommended adjuvant therapies. Accurate determination of tumor margins during surgery is therefore a critical need. Breast cancer tissue produces significantly higher amounts of VEGF-A than healthy tissue. VEGF-A stimulates tumor angiogenesis and is therefore a target for molecular imaging techniques. The fluorescence imaging agent bevacizumab-IRDye800CW (Beva800) is a conjugate of bevacizumab and IRDye800CW and binds specifically to VEGF-A. Beva800 provides a potentially efficacious approach to imaging specimen and cavity margins during BCS. We are presenting a phase II study that combined Beva800 with the SurgVision Explorer Air camera for intraoperative margin assessment during BCS for EBC. Methods: MARGIN II is a multicenter open-label single arm prospective clinical trial aimed at evaluating Beva800 for assessment of tumor margins in women with EBC scheduled for BCS. The study was a within-patient comparison of positive tumor margin rates using BCS standard of care margin assessment compared to intraoperative assessment with 4.5 mg Beva800 and fluorescence imaging with the SurgVision Explorer Air camera. All patients received an i.-v. bolus injection of 4.5 mg of Beva800 three days before surgery. The fluorescent signal was visualized during surgery using NIR fluorescence imaging (700–1000 nm). Standard of care margin assessment was defined as visual inspection, palpation and, in cases of pre-operative wire marking, specimen sonography or mammography. Beva800 efficacy was determined as the number of patients in which a pathology-confirmed positive margin was identified by fluorescence-guided surgery using Beva800 but not by standard of care BCS. Results: 49 patients were included in 5 centers. 4 training cases were only included in the safety analysis, 45 patients were evaluable for the efficacy analysis. 8 patients (17.8%) had involved margins after standard of care BCS, 4 of which were detected by molecular fluorescence intraoperatively resulting in the reduction of patients with positive margins by 50% (95% CI: 15.7%, 84.3%). 4 patients (8.9%; 95% CI: 2.5%, 21.1%) needed a re-excision because of involved margins. In 27 patients (60.0%) the additional molecular fluorescence guided cavity shaving did not change the resection status from positive to negative (false positive). Adverse events were reported by 16 of 49 patients (32.7%), but only 3 (6.1%) were related to Beva800 (syncope, hot flush, hypertensive crisis). One patient experienced a treatment related SAE (hypertensive crisis). No anti-Beva800 antibodies were detected. Conclusion: In our analysis the rate of necessary second operations was reduced by 50% using Beva800 and the SurgVision Explorer Air camera. The safety analysis confirmed the positive safety profile of Beva800 found in previous studies. Molecular fluorescence-guided surgery may have the potential to change the practice of breast conserving surgery by reducing unnecessary re-excisions. Future studies will have to address the high false positive rates. Citation Format: Hans-Christian Kolberg, Carmen Röhm, Angrit Stachs, Florian Schütz, Jens-Uwe Blohmer, Sarah Wetzig, Steffi Hartmann, Jörg Heil, Markus Hahn. MOLECULAR FLUORESCENCE-GUIDED SURGERY USING BEVA800 FOR THE ASSESSMENT OF TUMOR MARGINS DURING BREAST CONSERVING SURGERY OF PATIENTS WITH PRIMARY BREAST CANCER (MARGIN-II) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-01.

ZusammenfassungUnter dem Post-COVID-Syndrom (PCS) versteht man eine länger als 12 Wochen anhaltende Symptomatik mit Fatigue, Kurzatmigkeit, eingeschränkter Leistungsfähigkeit u. a., die bei rund 15% der Patienten nach einer akuten Infektion mit SARS-CoV-2 auftritt. Als Ursache werden Veränderungen im Mikrobiom und Störungen des Tryptophanstoffwechsels diskutiert, welche zu einer vermehrten Umwandlung von Tryptophan in prooxidativ und proinflammatorisch wirkende Abbauprodukte führen. Nach aktuellen Studien können infolge der Infektion latente Viren wie Epstein-Barr-, Cytomegalie- und Varizella-Zoster-Virus reaktiviert werden und PCS-typische Symptome auslösen. Eine überschießende Entzündungsreaktion bei COVID-19 führt zur Bildung von Autoantikörpern, die durch Einschränkung der Immunantwort die Virusbekämpfung erschweren. Therapeutisch kann eine Supplementierung von Mikronährstoffen wie Vitamin C, D, E, B6, B12, ω-3-Fettsäuren und Coenzym Q10 sinnvoll sein.

ZusammenfassungFür die Behandlung von Patientinnen mit fortgeschrittenem HER2-negativem, hormonrezeptorpositivem Mammakarzinom sind in den letzten Jahren einige Substanzen in die Praxis eingeführt worden. Zusätzlich sind weitere Medikamente in der Entwicklung. Im letzten Jahr sind einige Studien veröffentlicht worden, die entweder einen Vorteil für das progressionsfreie Überleben oder aber auch für das Gesamtüberleben gezeigt haben. Diese Übersichtsarbeit fasst die neuesten Ergebnisse, welche auf aktuellen Kongressen oder in Fachzeitschriften veröffentlicht wurden, zusammen und ordnet sie in den klinischen Behandlungskontext ein. Insbesondere wird auf den Stellenwert einer Therapie mit CDK4/6 Inhibitoren, Trastuzumab-Deruxtecan, Sacituzumab-Govitecan und Capivasertib eingegangen. Für Trastuzumab-Deruxtecan wurde in der Destiny-Breast-04-Studie ein Gesamtüberlebensvorteil bei HER2-negativem Mammakarzinom mit einer niedrigen HER2-Expression (HER2-low expression) berichtet. Ebenso konnte ein Gesamtüberlebensvorteil in der FAKTION-Studie mit Capivasertib verzeichnet werden. Nach dem fehlenden Gesamtüberlebensvorteil für Palbociclib in der 1. Therapielinie stellt sich hier die Frage nach der klinischen Einordnung.

ZusammenfassungDie Empfehlungen der AGO-Kommission Mamma zur operativen Therapie des Mammakarzinoms wurden zuletzt im März 2022 aktualisiert (www.ago-online.de). Da die operative Therapie einen von mehreren Teilschritten bei der Behandlung des Mammakarzinoms darstellt, sind eine umfangreiche diagnostische und onkologische Expertise eines Brustoperateurs und eine gute interdisziplinäre Zusammenarbeit mit den diagnostischen Radiologen von großer Bedeutung. Die wichtigsten Änderungen betreffen die Lokalisationstechniken, die Resektionsränder, das axilläre Management im neoadjuvanten Setting und die Bewertung der Netze in der rekonstruktiven Chirurgie. Aufgrund von Metanaanalysen randomisierter Studien wurde der Empfehlungsgrad der intraoperativen Mammasonografie zur Lokalisation nicht palpabler Befunde auf „++“ erhöht. Somit wird die Technik als gleichwertig zur Drahtlokalisation angesehen, vorausgesetzt, es handelt sich um eine sonografisch gut darstellbare Läsion, der Operateur verfügt über umfangreiche Kenntnisse in der Mammasonografie und hat Zugang zu einem geeigneten Ultraschallgerät während der Operation. Beim invasiven Mammakarzinom wird das Erreichen von negativen Resektionsrändern („no tumor on ink“) angestrebt, unabhängig davon, ob eine extensive intraduktale Komponente vorliegt oder nicht. Onkoplastische Operationen können durch die Vielzahl der existierenden Techniken in ausgewählten Fällen auch eine Mastektomie ersetzen und sind im Vergleich zu einer regulären Segmentresektion hinsichtlich der onkologischen Sicherheit bei vergleichbaren Komplikationsraten gleichwertig. Patientinnen mit cN0-Status, die eine neoadjuvante Chemotherapie erhalten, wird eine Sentinel-Node-Exzision nach Abschluss der Chemotherapie empfohlen. Bei initial suspekten Lymphknoten wird die minimalinvasive Sicherung empfohlen. Nach der neoadjuvanten Chemotherapie stehen Patientinnen mit initial 1–3 suspekten Lymphknoten und gutem Ansprechen (ycN0) die „Targeted axillary Dissection“ und die Axilladissektion als gleichwertige Optionen zur Verfügung.

Background Pseudomonas aeruginosa (Pa) continues to affect disease progression in cystic fibrosis (CF). However, the best eradication regimen remains unclear. This work compares three different antibiotic eradication regimens in pediatric CF: an administration according to a standard-operating procedure (SOP) order vs. administration outside of this order (ooSOP). Methods This observational study includes all CF patients Results Performed according to SOP order, Hi-TOBI showed the greatest efficacy, followed by lo-Tobra/IV and finally COL/Cip, while ooSOP lo-Tobra/IV was most successful, followed by COL/Cip and Hi-TOBI. Previous Pa-infections and Pa-therapies along with age at CF diagnosis were risk factors for eradication failure. Conclusion Antibiotic treatment in SOP-based pre-defined order leads to significantly better eradication rates than individual modifications of the order of administration. A short course of inhalational high-dose Tobramycin is most successful at the first attempt. Prolonged antibiotic therapy seems to improve eradication after failed initial attempts.

The long-term outcomes of solid organ transplantation remain suboptimal. Therefore, appropriate biomarkers are needed in addition to immunosuppressive drugs and other traditional approaches for graft monitoring to achieve personalized immunosuppression and reduce premature graft loss.Donor-derived cell-free DNA (dd-cfDNA) is a minimally invasive biomarker of cell death due to graft injury. It can be quantified using droplet digital polymerase chain reaction and next-generation sequencing. Fractional dd-cfDNA determination can be affected by changes in recipient cfDNA, such as those caused by leukopenia or infection, leading to false positive or negative results, respectively. Absolute quantification of dd-cfDNA helps in overcoming this limitation.Overall, there is sufficient evidence of the clinical validity of dd-cfDNA. It detects rejection episodes early at an actionable stage and reflects the severity of graft injury without being rejection-specific. Owing to its high negative predictive value, dd-cfDNA is very useful for ruling out graft injury. Dd-cfDNA complements histological findings and can help in avoiding unnecessary biopsies. It indicates a response to rejection treatment and detects under-immunosuppression.Monitoring changes in dd-cfDNA over time may be helpful in adapting immunosuppression to prevent graft rejection. Moreover, serial dd-cfDNA determination may increase the effectiveness of transplant recipient surveillance and facilitate personalized immunosuppression when combined with other relevant clinical and diagnostic findings.

Urban sound management often amounts to reducing sound levels with the underlying assumption of sound/noise as a nuisance. However, a reduction in sound level does not necessarily lead to a more pleasant auditory experience, especially in urban public spaces where vibrancy can be sought after. A proactive design approach that accounts for the human experience of sound environment is needed to improve the quality of urban spaces. Recent studies in soundscape research suggest that added sound and particularly sound art installations can have a positive influence on public space evaluations. Yet, the role of added sounds in urban context remains understudied and there is no existing method to date to inform sound art composition in public space through soundscape simulation. We present here a research-creation collaboration around the design of a permanent sound installation in an urban public space in Paris: Nadine Schütz's Niches Acoustiques. We report on a series of listening tests involving High-Order Ambisonic soundscape simulations of different prototypes to inform the sound artist's composition in order to optimize the quality of public space experience in the presence of the sound installation.

Abstract. The authentic and hubristic pride (A&HP) model is the domineering paradigm in pride research. Authentic pride (AP) comprises feelings of accomplishment and self-worth, whereas hubristic pride (HP) includes conceit and arrogance. We provide a German version of the A&HP scale ( Tracy & Robins, 2007 ), the GAHPS. We found a good fit for a two-factor solution. Internal consistencies were high. Nomological validity was supported for personality, self-esteem, and narcissism (Study 1, N = 569), status (Study 2, N = 565), and other emotions (Study 3, N = 204). In Study 4 ( N = 184), AP and HP had different associations with prosocial and antisocial behavior. We found high self-other agreement (109 dyads) for AP but not for HP. Further, people used different words to describe AP and HP when they described themselves and peers, thus suggesting that the two forms are associated with different linguistic styles. Finally, using an Ant Colony Optimization algorithm, we derived a short form for the scale. Researchers are advised to choose the standard or short scale, depending on the research purpose. This research broadens the validity testing of the A&HP model and, for the first time, provides linguistic correlates of the two forms of pride.

ZusammenfassungDiese Leitlinie repräsentiert die Empfehlungen der Österreichischen Diabetes Gesellschaft (ÖDG) zur Nutzung von Diabetes-Technologie (Insulinpumpentherapie; kontinuierliche Glukosemesssysteme, CGM; Hybrid Closed Loop Systeme, HCL; Automated Insulin Delivery Systeme, AID, Diabetes-Apps) und den Zugang zu diesen technologischen Innovationen für Menschen mit Diabetes mellitus. Die Leitlinie wurde basierend auf aktueller wissenschaftlicher Evidenz erstellt.

In articulated vehicles steering is accomplished by adjusting the articulation angle. Commonly a steering actuator is used to pivot the two vehicle sections. This actuator can be dispensed with if the pivoting is controlled by selective distribution of the drive torques to the individually driven wheels instead. Since steering is a safety-critical function, it must be ensured even if one of the drive motors fails. For this purpose, we propose a control method for a fault-tolerant four wheel independently driven articulated vehicle. The control method was developed and tested in a simulation environment and validated on a 1:5 scale demonstrator vehicle. The proposed method with constrained control allocation maintains the desired velocity and articulation angle by distributing the driving torques to the four wheels considering the current actuator limits. Both the simulation and the vehicle tests show that the control method meets the control objectives even when a sudden actuator limit occurs during critical driving scenarios like cornering. Thus, the vehicle can keep its maneuverability in the event of a detected failure of a drive motor. Together with reliable failure detection, the proposed approach provides a basis for further development towards innovative fault-tolerant electric articulated vehicles that meet the requirements of functional safety.

Purpose: CDK4/6 inhibitors (CDK4/6i) combined with endocrine therapy are considered standard-of-care for first-line therapy of patients with hormone receptor positive, HER2 negative, advanced breast cancer (HR+/HER2- ABC). Superiority of combination therapy over endocrine monotherapy has been demonstrated in a multitude of randomized controlled trials (RCTs) in phase III and IV. However, RCTs reflect clinical reality only to a limited extent, as narrow inclusion criteria lead to a selected patient collective. Here, we present real-world data (RWD) on CDK4/6i treatment in patients with HR+/HER2- ABC at four certified German university breast cancer centers. Methods: Patients diagnosed with HR+/HER2- ABC who were treated in clinical routine with CDK4/6i between November 2016 and December 2020 at four certified German university breast cancer centers (Saarland University Medical Center, University Medical Center Charité Berlin, University Medical Center Bonn, and University Medical Center Hospital Schleswig-Holstein, Campus Kiel) were identified and enrolled in this retrospective study. Clinicopathological characteristics and clinical outcomes were recorded with particular emphasis on CDK4/6i therapy course [progression-free survival (PFS) following treatment initiation, toxicity, dose reduction, therapy discontinuation, prior and subsequent therapy line]. Results: Data from n = 448 patients were evaluated. The mean patient age was 63 (±12) years. Of these patients, n = 165 (36.8%) were primarily metastasized, and n = 283 (63.2%) had secondary metastatic disease. N = 319 patients (71.3%) received palbociclib, n = 114 patients (25.4%) received ribociclib, and n = 15 patients (3.3%) received abemaciclib, respectively. Dose reduction was performed in n = 132 cases (29.5%). N = 57 patients (12.7%) discontinued the treatment with CDK4/6i due to side effects. N = 196 patients (43.8%) experienced disease progression under CDK4/6i treatment. The median PFS was 17 months. Presence of hepatic metastases and prior therapy lines were associated with shorter PFS, whereas estrogen positivity and dose reduction due to toxicity were positively associated with PFS. Presence of bone and lung metastases, progesterone positivity, Ki67 index, grading, BRCA1/2 and PIK3CA mutation status, adjuvant endocrine resistance, and age did not significantly impact on PFS. Conclusion: Our RWD analysis on CDK4/6i treatment in Germany supports data from RCTs regarding both treatment efficacy and safety of CDK4/6i for treatment of patients with HR+/HER2- ABC. In comparison to data from the pivotal RCTs, median PFS was lower but within the expected range for RWD, which could result from inclusion of patients with more advanced diseases (i.e., higher therapy lines) to our dataset.

ZusammenfassungIn dieser Übersichtsarbeit werden neueste Entwicklungen in der Prävention von Brustkrebs und Behandlung von Patientinnen mit frühen Krankheitsstadien mit Mammakarzinom zusammengefasst. Die Ermittlung von individuellen Erkrankungsrisiken nach molekularen Subtypen wurde in einer großen epidemiologischen Studie untersucht. Im Bereich der Behandlung gibt es neue Daten zur Langzeitnachbeobachtung der Aphinity-Studie ebenso wie neue Daten zur neoadjuvanten Therapie von HER2-positiven Patientinnen mit Atezolizumab. Biomarker wie Residual Cancer Burden wurden im Zusammenhang mit einer Pembrolizumab-Therapie untersucht. Eine Untersuchung des Genomic-Grade-Indexes bei älteren Patientinnen reiht sich ein in die Gruppe von Studien, die versucht, durch moderne Multigentests Patientinnen zu identifizieren, bei denen eine Chemotherapie vermieden werden kann, weil diese eine exzellente Prognose haben. Diese und weitere Aspekte der neuesten Entwicklungen bei der Diagnostik und Therapie des Mammakarzinoms werden in dieser Übersichtsarbeit beschrieben.

OBJECTIVE The management of asymptomatic intracranial meningiomas is controversial. Through the assessment of growth predictors, the authors aimed to create the basis for practicable clinical pathways for the management of these tumors. METHODS The authors volumetrically analyzed meningiomas radiologically diagnosed at their institution between 2003 and 2015. The primary endpoint was growth of tumor volume. The authors used significant variables from the multivariable regression model to construct a decision tree based on the exhaustive Chi-Square Automatic Interaction Detection (CHAID) algorithm. RESULTS Of 240 meningiomas, 159 (66.3%) demonstrated growth during a mean observation period of 46.9 months. On multivariable logistic regression analysis, older age (OR 0.979 [95% CI 0.958–1.000], p = 0.048) and presence of calcification (OR 0.442 [95% CI 0.224–0.872], p = 0.019) had a negative predictive value for tumor growth, while T2-signal iso-/hyperintensity (OR 4.415 [95% CI 2.056–9.479], p < 0.001) had a positive predictive value. A decision tree model yielded three growth risk groups based on T2 signal intensity and presence of calcifications. The median tumor volume doubling time (Td) was 185.7 months in the low-risk, 100.1 months in the intermediate-risk, and 51.7 months in the high-risk group (p < 0.001). Whereas 0% of meningiomas in the low- and intermediate-risk groups had a Td of ≤ 12 months, the percentage was 8.9% in the high-risk group (p = 0.021). CONCLUSIONS Most meningiomas demonstrated growth during follow-up. The absence of calcifications and iso-/hyperintensity on T2-weighted imaging offer a practical way of stratifying meningiomas as low, intermediate, or high risk. Small tumors in the low- or intermediate-risk categories can be monitored with longer follow-up intervals.

ZusammenfassungFür Patientinnen mit einem fortgeschrittenen Mammakarzinom sind in den letzten Jahren mit den CDK4/6‑Inhibitoren, den Immuncheckpoint-Inhibitoren, den PARP-Inhibitoren, dem Alpelisib, Tucatinib und Trastuzumab-Deruxtecan sowie Sacituzumab-Govitecan einige Therapien neu etabliert worden, welche die Therapielandschaft von Patientinnen mit einem fortgeschrittenen Mammakarzinom deutlich verändert bzw. erweitert haben. Einige dieser Substanzen sind mittlerweile auch bei frühen Krankheitsstadien zugelassen bzw. eine Zulassung ist in naher Zukunft wahrscheinlich, sodass sich die Therapielandschaft abermals ändern wird. Die Einführung neuer Substanzen und das Verständnis der Progressions- und Effektivitätsmechanismen für diese Substanzen steht deswegen im Fokus der aktuellen wissenschaftlichen Bemühungen. In dieser Übersichtsarbeit werden die neuen Entwicklungen basierend auf aktuellen Publikationen und Kongressen zusammengefasst. Erkenntnisse zur Behandlung von Patientinnen mit einem HER2-positiven Mammakarzinom und Hirnmetastasen werden ebenso dargestellt wie eine Reihe von Studien, die sich mit Biomarkern bei Patientinnen mit HER2-negativem, hormonrezeptorpositivem Mammakarzinom beschäftigen. Insbesondere die Einführung der oralen, selektiven Östrogenrezeptor-Degradierer birgt neue Chancen, eine biomarkerbasierte Therapie zu etablieren. Die molekulare Diagnostik etabliert sich als diagnostischer Marker und Verlaufsparameter.

The debate on the cyclical adjustment procedure of the debt brake has focused on problems with regards to potential output. The second key determinant of the cyclical budget component, however, has been neglected: the semi-elasticity of the budget balance, which measures the response of federal revenues and expenditures to the business cycle. We analyse the sensitivity of estimates of the semi-elasticity with respect to data inputs and model specifications. Our results highlight estimation uncertainties that affect how much the federal government is allowed to borrow under the debt brake.

To interact with one’s environment, relevant objects have to be selected as targets for saccadic eye movements. Previous studies have demonstrated that factors such as visual saliency and reward influence saccade target selection, and that humans can dynamically trade off these factors to maximize expected value during visual search. However, expected value in everyday situations not only depends on saliency and reward, but also on the required time to find objects, and the likelihood of a successful object-interaction after search. Here we studied whether search costs and the accuracy to discriminate an object feature can be traded off to maximize expected value. We designed a combined visual search and perceptual discrimination task, where participants chose whether to search for an easy- or difficult-to-discriminate target in search displays populated by distractors that shared features with either the easy or the difficult target. Participants received a monetary reward for correct discriminations and were given limited time to complete as many trials as they could. We found that participants considered their discrimination performance and the search costs when choosing targets and, by this, maximized expected value. However, the accumulated reward was constrained by noise in both the choice of which target to search for, and which elements to fixate during search. We conclude that humans take into account the prospective search time and the likelihood of successful a object-interaction, when deciding what to search for. However, search performance is constrained by noise in decisions about what to search for and how to search for it.

BackgroundPaediatric community-acquired pneumonia (CAP) is a leading cause of paediatric morbidity. However, particularly for outpatients with paediatric CAP, data on aetiology and management are scarce.MethodsThe prospective pedCAPNETZ study multicentrically enrols children and adolescents with outpatient-treated or hospitalised paediatric CAP in Germany. Blood and respiratory specimens were collected systematically, and comprehensive analyses of pathogen spectra were conducted. Follow-up evaluations were performed until day 90 after enrolment.ResultsBetween December 2014 and August 2020, we enrolled 486 children with paediatric CAP at eight study sites, 437 (89.9%) of whom had radiographic evidence of paediatric CAP. Median (interquartile range) age was 4.5 (1.6–6.6) years, and 345 (78.9%) children were hospitalised. The most prevalent symptoms at enrolment were cough (91.8%), fever (89.2%) and tachypnoea (62.0%). Outpatients were significantly older, displayed significantly lower C-reactive protein levels and were significantly more likely to be symptom-free at follow-up days 14 and 90. Pathogens were detected in 90.3% of all patients (one or more viral pathogens in 68.1%; one or more bacterial strains in 18.7%; combined bacterial/viral pathogens in 4.1%). Parainfluenza virus andMycoplasma pneumoniaewere significantly more frequent in outpatients. The proportion of patients with antibiotic therapy was comparably high in both groups (92.4% of outpatientsversus86.2% of hospitalised patients).ConclusionWe present first data on paediatric CAP with comprehensive analyses in outpatients and hospitalised cases and demonstrate high detection rates of viral pathogens in both groups. Particularly in young paediatric CAP patients with outpatient care, antibiotic therapy needs to be critically debated.

A educação especial na perspectiva inclusiva é uma modalidade da educação que está respaldada por marcos jurídicos que visam promover a inclusão das pessoas com necessidades educacionais especiais. Contudo, a exclusão social gerada pelo capitalismo impõe diversas barreiras para a efetivação da inclusão deste público, cria expressões de uma exclusão específica que se materializam sob a forma de limites impostos às pessoas com necessidades educacionais especiais ao longo da vida. Nesse sentido, entendemos que a educação na perspectiva inclusiva pode ser pensada a partir do horizonte de uma utopia concreta; significa que, embora haja condições materiais e históricas para a eliminação das barreiras à inclusão, é devido à lógica de organização do Estado como instrumento de dominação da classe burguesa e pela apropriação privada dos meios de produção pelos capitalistas, que a inclusão deste público é precária e incipiente. Por fim, a educação inclusiva pensada enquanto utopia concreta, se apresenta como uma possibilidade real de efetivação da inclusão das pessoas com necessidades educacionais especiais, para tanto, viável por meio da superação do capitalismo.

The LNG-ADP problem is a tactical planning problem for creating an annual delivery program (ADP) for a liquefied natural gas (LNG) producer. An ADP specifies the departure dates of the LNG carriers as well as the delivery dates at the different customers for a period of 12–18 months. The problem can be formulated as maritime inventory routing problem, as it is an important requirement to plan the deliveries such that inventory levels are kept within minimum and maximum limits at the customers as well as the LNG production facility. Inspired by the case of Yamal LNG, we propose a novel discrete-time formulation for the LNG-ADP problem with transshipment and intermediate storage. Our formulation also allows for waiting at the unloading ports. The problem is solved using a rolling horizon heuristic (RHH) for a case based on the Yamal LNG project. We study the impact of different RHH configurations on run time and solution quality. The results show that using a central period that is shorter than the forecast period provides the best objective function, whereas a central period that is longer than the forecast period improves run time. We also explore the effect of allowing waiting at the unloading ports. Waiting does not necessarily improve the objective function value, despite increasing the solution space. However, we observe a reduction in run time for instances where waiting is allowed.

In Organisation for Economic Co-operation and Development (OECD) countries, the number of pets and pet owners has been increasing in recent years. The experiences people have with pets might impact their relationships with animals in general and especially attitudes towards animal protection and use. However, research on the impact of pet ownership on values and attitudes towards animals is relatively scarce. We analyse associations of pet ownership with different values and attitudes towards animals. We derived seven attitude constructs towards animals from three different datasets using Principal Component Analyses. Data were collected using standardised online surveys with German residents (dataset 1 = 1,049 respondents; dataset 2 = 414 respondents; dataset 3 = 1,048 respondents). All three samples are non-probability quota samples. The seven attitudinal constructs represent values and attitudes towards animals ranging from general values and attitudes towards, eg animal protection, to more specific attitudes towards, eg eating animals. We analysed the relationship of pet ownership, sex, and age with these constructs using ANOVA. Our results show that effect sizes are small to medium. Pet ownership has the strongest association with more general values and attitudes towards animals, with pet owners being, eg more involved in animal protection and more in favour of awarding fundamental rights to animals. In contrast, we found that more specific attitudes, such as the evaluation of current pig farming systems or attitudes towards eating meat, were more related to sex than pet ownership. Our findings indicate that having pets relates to their owners’ attitudes towards animals, but that this association varies depending on the specificity of attitudes.

This paper studies the existence of pure Nash equilibria in atomic congestion games with different user classes where the cost of each resource depends on the aggregated demand of each class. A set of cost functions is called consistent for this class if all games with cost functions from the set have a pure Nash equilibrium. We give a complete characterization of consistent sets of cost functions showing that the only consistent sets of cost functions are sets of certain affine functions and sets of certain exponential functions. This characterization is also extended to a larger class of games where each atomic player may control flow that belongs to different classes.

Objective: This study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis at two hospitals in southern Brazil. Methods: Patients aged < 18 years were evaluated retrospectively. The patients’ medical and epidemiological history, tuberculin skin test results, radiological and pathological findings, and pleural fluid analysis results were retrieved. Results: Ninety-two patients with pleural tuberculosis were identified. The mean age was 10.9 years old. Twenty-one percent were children aged six years or less. The most common symptoms were fever (88%), cough (72%), and chest pain (70%). Unilateral pleural effusion was observed in 96% of the cases. Lymphocyte predominance was found in 90% of the pleural fluid samples. The adenosine deaminase activity of the pleural fluid was greater than 40 U/L in 85% of patients. A diagnosis of community-acquired pneumonia with antibiotic prescriptions was observed in 76% of the study population. Conclusions: Tuberculosis etiology must be considered in unilateral pleural effusion in a child with contact with a case of tuberculosis. Pleural fluid biomarkers contribute to the diagnosis of pleural tuberculosis in children and adolescents.