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Background The use of image guidance systems has gained widespread acceptance as an adjunctive tool for endoscopic sinus surgery. However, the accessibility and usage of this technology is variable across hospitals in Canada. Study objective The aim of this study is to investigate the availability, usage, and related issues surrounding the use of image guidance systems in endoscopic sinus surgery across Canadian otolaryngology practice settings. Methods An online survey was electronically distributed to practicing otolaryngologists across Canada. The survey contained 27 questions pertaining to the availability, usage, barriers and overall experience of image guidance systems. Results The survey was electronically sent to a total of 654 Canadian otolaryngologists of which 158 responded (response rate 24.2%). Image guidance was available to 56.3% of respondents. Of the respondents without access to IGS, 85.5% indicated they would use it if it was available. Financial (capital cost) was identified as the most important barrier in obtaining IGS by 76.3% of respondents. Conclusion Over half of Canadian otolaryngologists have access to IGS with over 85% of those without access interested in using it if it was made available. A multitude of different factors contribute to this disparity. We hope that the results of this study will help support Canadian otolaryngologists to access IGS. Graphical Abstract

We generate circularly-polarized soft X-rays from a laser-driven plasma source by a magnetic thin-film polarizer. This enables first lab-based X-ray magnetic circular dichroism experiments at the Fe L edges with picosecond time resolution.

ObjectiveThis mixed-methods study examines the feasibility of art museum tours (Art Rx) as an intervention for individuals with chronic pain.MethodsArt Rx provided 1-hour docent-led tours in an art museum to individuals with chronic pain. Survey data were collected pre-tour, immediately post-tour, and at three weeks post-tour. Pain intensity and unpleasantness were measured with a 0-10 numerical rating scale. Social disconnection was measured with a 12-item social disconnection scale. Participants also reported percent pain relief during the tour and program satisfaction in the post-tour survey. Change in pain and social disconnection was analyzed with paired t tests, bias-corrected and accelerated bootstrap confidence intervals (BCa CIs), and Cohen's d. Thematic analysis of semistructured interviews with participants explored the feasibility and perceived impact of the program.ResultsFifty-four individuals participated in this study (mean age [SD] = 59 [14.5] years, 64.8% female), and 14 were interviewed. Fifty-seven percent of participants reported pain relief during the tour, with an average pain relief (SD) of 47% (34.61%). Participants reported decreased social disconnection and pain unpleasantness pre- to post-tour (3.65, BCa 95% CI = 1.70-5.73, P

Objective To design a module that students reacted favorably to on diabetes mellitus medications that increases student retention of medication names (including brand and generic), mechanism of action, indications, side-effects (Black Box Warnings), route (and dose), and aids them in their ability to apply that knowledge to "real-world" patient cases. Design A graduated series of quizzes was created at three different levels based on Bloom's Taxonomy. Each quiz was opened once for students, followed by in-class feedback, and then re-opened for mastery. Assessment Students were surveyed and interviewed to better understand their use of and reactions to the graduated quizzes. Quiz and exam scores were also collected and analyzed. Conclusions Students responded favorably to this method of quiz taking. While there was no direct correlation between exam score and number or duration of quiz attempts in the population under study, nearly all students (about 95%) took the quizzes until they received a perfect score and many (about 36%) continued to use the quizzes as study guides. Culminating exam scores were compared between two student populations: students in the present study, who were given the graduated quizzes, were compared with students from the previous year, who were not given the mastery quizzes. The t -test showed a difference at the significance level of 0.05 in the scores for those who were given the graduated quizzes ( M = 84.24, SD=9.94), as compared to those who took the class before the graduated quizzes were instituted ( M = 82.58, SD=10.44), p = 0.05.

Background: Even though there is an increasing number of studies on the efficacy of Internet-based interventions (IBI) for depression, experimental trials on the benefits of added guidance by clinicians are scarce and inconsistent. This study compared the efficacy of semistandardized feedback provided by psychologists with fully standardized feedback in IBI. Methods: Participants with mild-to-moderate depression (n = 1,089, 66% female) from the client pool of a health insurance company participated in a cognitive-behavioral IBI targeting depression over 6 weeks. Individuals were randomized to weekly semistandardized e-mail feedback from psychologists (individual counseling; IC) or to automated, standardized feedback where a psychologist could be contacted on demand (CoD). The contents and tasks were identical across conditions. The primary outcome was depression; secondary outcomes included anxiety, rumination, and well-being. Outcomes were assessed before and after the intervention and 3, 6, and 12 months later. Changes in outcomes were evaluated using latent change score modeling. Results: Both interventions yielded large pre-post effects on depression (Beck Depression Inventory-II: dIC = 1.53, dCoD = 1.37; Patient Health Questionnaire-9: dIC = 1.20, dCoD = 1.04), as well as significant improvements of all other outcome measures. The effects remained significant after 3, 6, and 12 months. The groups differed with regard to attrition (IC: 17.3%, CoD: 25.8%, p = 0.001). Between-group effects were statistically nonsignificant across outcomes and measurement occasions. Conclusion: Adding semistandardized guidance in IBI for depression did not prove to be more effective than fully standardized feedback on primary and secondary outcomes, but it had positive effects on attrition.

Security architectures such as Intel SGX need protection against rollback attacks, where the adversary violates the integrity of a protected application state by re-playing old persistently stored data or by starting multiple application instances. Successful rollback attack shave serious consequences on applications such as financial services. In this paper, we propose a new approach for rollback protection on SGX. The intuition behind our approach is simple. A single platform cannot efficiently prevent rollback, but in many practical scenarios, multiple processors can be enrolled to assist each other. We design and implement a rollback protection system called ROTE that realizes integrity protection as a distributed system. We construct a model that captures adversarial ability to schedule enclave execution and show that our solution achieves a strong security property: the only way to violate integrity is to reset all participating platforms to their initial state. We implement ROTE and demonstrate that distributed rollback protection can provide significantly better performance than previously known solutions based on local non-volatile memory.

With almost 30 million individuals predicted to be diagnosed by the year 2025, type 2 diabetes mellitus (T2DM) has become one of the most prevalent diseases in the United States. Because of the progressive dysfunction of the pancreatic β-cells and increasing insulin resistance over time, the need for treatments with different mechanisms or addition of medications to a regimen is becoming commonplace. Because of this, developing new medications to treat T2DM has been the focus of a lot of recent research and drug development. Molecular substrates such as glucagon-like peptide-1 (GLP-1), dipeptidyl peptidase-4 (DPP-4), and the sodium glucose transporter-2 (SGLT2) have all become new therapeutic targets. GLP-1 agonists and DPP-4 inhibitors are 2 of the newest classes of Food and Drug Administration–approved medications for diabetes. By increasing GLP-1 to supraphysiologic levels (GLP-1 agonists) and delaying endogenous GLP-1 degradation (DPP-4 inhibitors), these drugs increase insulin secretion and decrease glucagon production. SGLT2 inhibitors, the newest antihyperglycemic class, promote glycosuria by inhibiting sodium and glucose reabsorption in the proximal tubule of the renal nephron. Other novel agents for the treatment of diabetes include the use of the dopamine agonist bromocriptine, the cholesterol medication colesevelam, and a new form of inhaled insulin.

Pricing counterparty credit risk, although being in the focus for almost a decade by now, is far from being resolved. It is highly controversial if any valuation adjustment besides the basic CVA should be taken into account, and if so, for what purpose. Even today, the handling of CVA, DVA, FVA, … differs between the regulatory, the accounting, and the economic point of view. Eventually, if an agreement is reached that CVA has to be taken into account, it remains unclear if CVA can be modelled linearly, or if nonlinear models need to be resorted to. Finally, industry practice and implementation differ in several aspects. Hence, a unified theory and treatment of FVA and alike is not yet tangible. The conference Challenges in Derivatives Markets, held at Technische Universität München in March/April 2015, featured a panel discussion with panelists representing different points of view: John Hull, who argues that FVA might not exist at all; in contrast to Christian Fries, who sees the need of all relevant costs to be covered within valuation but not within adjustments. Damiano Brigo emphasises the nonlinearity of (most) valuation adjustments and is concerned about overlapping adjustments and double-counting. Finally, Daniel Sommer puts the exit price in the focus. The following (mildly edited) record of the panel discussion repeats the main arguments of the discussants—ultimately culminating in the awareness that if everybody charges an electricity bill valuation adjustment, it has to become part of any quoted price.

29th European Photovoltaic Solar Energy Conference and Exhibition; 1208-1211, More or less all proposed highly efficient solar cell concepts use quite successfully laterally selective boron doping. However, quality control regarding achieved doping level, lateral extension, etc. on real devices or precursors gets more and more complicated with these small structures as the typical characterisation techniques simply do not work well on small scale. High resolution mapping confocal Raman spectroscopy is considered a possible technique to tackle this challenge. In this contribution it is demonstrated on IBC precursor structures that the contrast in local doping level can be finely resolved via mapping Raman spectroscopy, even though the determined absolute value is found to be too small. It is discussed on the basis of a few fundamental calculations that the depth sensitivity is accountable for this drawback

Although reports are rare, lactose-containing medications may cause patient discomfort and subsequently affect medication adherence.

Unity is Strength – this was the core statement made by Syrian freemasons already in 1876 when spreading their ideas all over the Syrian lands. With this phrase in mind, in this book Dorothe Sommer analyses early masonic lodges that existed in the late Ottoman Empire showing how Syrian freemasons used the lodges to reach out to other Syrians. Freemasons in Syria wanted to form a sense of unity inside Ottoman Syria; a unity that could act as a bridge to span religious cleavages and to ultimately help to produce inter-confessional sociability. European freemasonry, outside of the Western sphere of direct influence, developed a life of its own and paradoxically promoted a new sense of self-perception among Ottoman Syrians. Consequently, this analysis directly contradicts previous research carried out in the field of colonial freemasonry, according to which the lodges served as vanguard for Western purposes of occupation and domination. Additionally, freemasonry during Ottoman times was the first and by then the only institution that overcame religious cleavages outside Beirut and attracted more participants than any other society or fraternity. In this, it was unique and warrants an in-depth study.

Introduction Results from preclinical and clinical trials indicate that combination of the Epidermal Growth Factor Receptor (EGFR) specific antibody Cetuximab (C225) with classical radiotherapy improves local tumor control and overall survival of patients with head and neck cancers1-4. First results of Meller et al. showed a synergistic effect of 131I-labelled C225 in combination with external irradiation in vitro5. These data indicate that the combination of internal radiation dose delivered by radiolabelled C225 plus the therapeutic effect of C225 in combination with radiotherapy might significantly lower the overall external dose applied to patients, reducing undesired side effects on healthy tissue. Thus, bimodal cancer therapy seems a promising approach. This encouraged us to investigate the combined effect of 90Y[Y]-CHX-A"-DTPA-Cetuximab (90Y-C225) and radiation dose delivered by external beam irradiation in vitro and in vivo in our joint project. Materials and Methods CHX-A´´-DTPA was conjugated to C225 via thiourea bridging. Radiolabelling was performed under mild conditions using [90Y]YCl3. Binding affinity of 90Y-C225 was studied by flow cytometric analysis as well as by competitive binding assays using cells in 2D and 3D culture or cell membrane preparations. Distribution in spheroids (FaDu) was studied in a concentration- and time-dependent manner. Cellular uptake, EGFR binding specificity and kinetics, retention of 90Y-C225 as well as clonogenic activity of 90Y-C225 treated cells in combination with external irradiation were studied. The capacity of 90Y-C225 to induce DNA double-strand breaks (DSBs) was assessed through the Gamma-H2AX/53BP1 foci technique and cell survival by colony formation. Ex vivo autoradiography was performed with 90Y-C225. Biodistribution and in vivo kinetics were measured with PET using 86Y as radiolabel. FaDu tumour bearing nude mice were treated with 90Y-C225 (2.8 MBq 13 μg C225 / mouse, i.v.) and external beam irradiation (20 Gy single dose, 1.1 Gy/min). Experimental endpoints are the tumour growth delay and the local tumour control after 180 d. Results Radiolabelling of the conjugate resulted in specific activities up to 9 GBq/mg. For the present study, a labelling protocol to achieve a reproducible specific activity of 1.2 GBq/mg was established. in vitro: Flow cytometric analysis showed that affinity of 90Y-C225 is not significantly reduced compared to native C225. A Ki of 0.4 nM vs 0.22 nM for native C225 was determined by a competitive binding assay. Saturation of FaDu spheroids with 90Y-C225 was achieved after 24 h of incubation at 5 μg/ml. A saturation test showed that the optimal concentration to block all EGFR (SAS and UT5 cells) by C225 in monolayer culture is about 3-5 nM. No unspecific binding on an EGFR-negative CHO cell line was observed. Binding 90Y-C225 to EGFR in HNSCC cells occurred time dependently with a maximum after 24 h. 24 h after treatment approximately 10% of bound activity was found in the supernatant. Conjugation of CHX-A"-DTPA to C225 does not alter the cellular and biological function of C225. Combination of single doses of 2 or 4 Gy with 90Y-C225 reduced clonogenic survival in the UT5 and SAS cell lines. For UT5 cells the D37 value for non-treated control cells was 3.7 Gy with X-rays. Treatment with C225 reduced D37 of UT5 cells to 2.7 Gy. When 90Y-C225 was combined with X-rays, the D37 of UT5 cells dropped to 1.8 Gy. Thus, in comparison to C225, a decrease of D37 by about 33 % was observed in cells treated with 90Y-C225. D37 of untreated cells was only reduced from 3.9 Gy to 3.7 Gy after incubation with native C225. A D37 of 3.3 Gy resulted upon treatment with 90Y-C225 which reflects only a reduction of about 11%, compared to C225. Induction of DNA DSBs by 90Y-C225 in cell lines with varying EGFR expression showed that the amount of 90Y-C225 binding and the number of induced DSBs is proportional to the EGFR on the cell membrane and that the cytotoxicity is dependent on the number of residual DSB (clonogenic survival). in vivo: Autoradiography revealed high tumour accumulation 48 h p.i., also PET showed an increasing accumulation of activity in the tumour, which was abundant after 24 h p.i. The combined treatment was well tolerated by all mice and no histological alterations in organs were found. A clear dose-dependent effect of the external irradiation was observed. A significant improvement of the local tumour control after X-ray irradiation with 20 Gy was achieved after application of 13 μg of 90Y-C225 compared to native C225 or to the treatment by external irradiation alone. Conclusion The results from in depth investigations of the effects of 90Y-C225 on various EGFR expressing cell lines validate it as a powerful tool for in vivo studies. The combined treatment of tumours in our experimental mouse model permits a reduction of the external radiation dose of 12 Gy. Our in-vivo data support the concept that bimodal cancer treatment results in a potentially relevant improvement of local tumour control. This encourages us to follow this promising scientific concept. Research Support: The Bundesministerium für Bildung und Forschung (grant 02NUK006, framework “Kompetenzverbund Strahlenforschung” (KVSF)) is gratefully acknowledged for the financial support. References 1 Bonner JA, Harari PM, Giralt J et al. [2010] Lancet Oncol.; 11: 21-8. 2 Bonner JA, Harari PM, Giralt J et al. [2006] N Engl J Med.; 354: 567-78. 3 Curran D, Giralt J, Harari PM et al. [2007] J Clin Oncol.; 25: 2191-7. 4 Zhang N, Erjala K, Kulmala J et al. [2009] Radiother Oncol.; 92: 388-92. 5 Meller B, Rades D, Wolff C et al. [2009] IJROBP 75: 1226-1231.

Adequate caloric intake is associated with improved outcome in neurocritical illness, but factors influencing the provision of enteral nutrition (EN) have not been systematically evaluated. The primary goal of the study was to determine the EN intake of neurosurgical intensive care unit (ICU) patients within the first week of illness and investigate the factors contributing to achieving caloric goals. A retrospective cohort of adult patients admitted to the neurosurgery service (NS) during August 2005–August 2006 were randomly selected and stratified into three groups based on their ICU-admission Glasgow Coma Scale Score (GCS) (GCS > 11, GCS 8–11, GCS 4–7). Daily EN intake, GCS, and other clinical data were collected. A total of 71 patients were included (GCS > 11 = 23, GCS 8–11 = 23, GCS 4–7 = 25). Admitting diagnoses included traumatic brain injury (TBI) (32%), subarachnoid hemorrhage (SAH) (32%), and intracerebral hemorrhage (17%). The overall in-hospital mortality was 23.9%. Overall, the maximum daily mean calories provided was 1,100 kcal (mean of 55% of caloric goal on hospital day 6). The median time to feeding was approximately 3 days in each group. GCS did not appear to significantly affect the mean % of caloric goal administered in patients with a minimum daily GCS ≤ 11 (P = 0.053). Multivariate analysis revealed that clinical care factors, such as time to EN orders and enteral access confirmation, were significant impediments to EN provision (P = 0.001). System-based clinical care factors appear to have great impact on the successful provision of EN in the first week of neurocritical illness.

Two DNA markers, a random DNA fragment 754 and the cDNA sequence encoding the gene for ornithine transcarbamylase (OTC) have been studied in kindreds segregating for Duchenne muscular dystrophy. 754 and OTC are located close physically to the mutation in the region Xp21 below the breakpoints in two Duchenne females. The genetic distance was found to be approximately 10cM between 754 and DMD (two crossovers in 26 meioses) and to be approximately 10cM between OTC and DMD (two crossovers in 26 meioses). Physical data suggest the order DMD-754-OTC. The frequency of recombination compared to physical distance between these markers and DMD suggests that there may be a hot spot of recombination. The relevance of these observations for the isolation of the DMD mutation and clinical use of these probes is discussed.

Blood flow is an important parameter of cardiac performance and can be determined by measuring circulation times (1). For that purpose, usually an Anger-Type gamma-camera is used to register the first pass of a radioactive tracer of blood flow through the heart. The acquired data are processed by a suitable computer program yielding time-activity curves for sequential heart segments, which are selected by the region of interest technique. Appropriate smoothing of the curves facilitates theevaluation of data and also the automatic detection of activityarrival (2,3,4). Sequential activity arrivals describe thefastest flow or minimal transit time.

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This paper presents parallel concatenated turbo codes that employ a non-uniform constellation to achieve shaping gain. The output signal approximates the Gaussian distribution by using equally likely signals with unequal spacing (a non-uniform constellation). The small distance of points near the center of the constellation may lead to a small overall free distance and thus a high error floor for turbo codes. We avoid this situation by a two-step design procedure, that first creates an interleaver, and then identifies the constituent encoders that maximize the turbo code free distance. Simulation results for 4 bits/sec/Hz show that this use of shaping can offer an improvement of approximately 0.2 dB for turbo codes.

Businesses make use of data routinely for daily operations, including sensitive and/or personal data. Personal data and information are, inter alia, seen as means towards customization of services for employees and for customers. Some elements of this processing of personal information and some practices have come under increasing scrutiny due to privacy concerns. There is undoubtedly a call for better privacy management in organisations, and a tendency to strengthen privacy regulations and policies up to the point where some of the current processes may even become impossible to execute or become outlawed. However, a basic fact is that even if users want maxmium privacy in business dealings, unless organisations can support these privacy requests, the users will not get their wish.