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A dynamic element matching (DEM) decoder with integrated mismatch calibration control for high-speed current-steering digital-to-analog converters (CS-DACs) and CSDAC- based direct digital frequency synthesizers (DDFSs) is studied and presented. The DEM algorithm achieves very good averaging of mismatch-induced errors in the succeeding CS-DAC. It features a minimum element transition rate, therefore opimizing the power dissipation and ensuring minimal glitch energy at the output. Due to the chosen network-based architecture, with only a few modifications of the hardware, the decoder allows the integration of a comprehensive current source mismatch calibration that can be fully operated in the background and even in parallel to the regular DEM operation. A proof-ofconcept hardware implementation of the presented decoder was fabricated in a 22-nm FD-SOI CMOS process and characterized in a high-speed DDFS system with a sampling rate of 5 GHz. Measurements reveal a significant improvement in the spurious free dynamic range (SFDR) and signal-to-noise-and-distortion ratio (SNDR) when the calibration and DEM are enabled. Compared to the state-of-the-art (SoA), the presented DDFS achieves one of the best figures of merit.

Statins are the cornerstone treatment for patients with heterozygous familial hypercholesterolaemia but research suggests it could increase the risk of type 2 diabetes in the general population. A low prevalence of type 2 diabetes was reported in some familial hypercholesterolaemia cohorts, raising the question of whether these patients are protected against type 2 diabetes. Obesity is a well known risk factor for the development of type 2 diabetes. We aimed to investigate the associations of known key determinants of type 2 diabetes with its prevalence in people with heterozygous familial hypercholesterolaemia.

This article presents a novel framework that combines the hazard and operability analysis with generative AI to support a safety expert in identifying safety hazards, their causes and consequences, and to propose mitigation strategies.

In this research, we employed the alchemical double-decoupling method alongside restraining potentials, coupled with the FEPMD method, to ascertain the standard binding free energy of a drug-like molecule termed BHQ and three analogous compounds engineered with progressive addition of bulky para-alkyl groups binding to SERCA (Ca2+-ATPase of skeletal muscle sarcoplasmic reticulum). Integral transmembrane proteins represent crucial drug targets in numerous therapeutic interventions, presenting computational challenges due to their considerable system sizes. Our approach integrated the generalized born potential method and the spherical solvent boundary potential method, allowing us to explicitly focus on the active binding site while treating the remainder of the system implicitly. We evaluated contributions to the standard binding free energy from distinct interaction potentials: electrostatic, repulsive, dispersive, and restraining potentials, computed separately. The resulting absolute binding free energy of BHQ (11.63 kcal/mol) closely aligns with experimental measurements (10.56 kcal/mol). Notably, an accurate estimation of the absolute binding free energy was achieved for the simplest analog, created with the addition of a single para-methyl group. However, the analog with two para-methyl groups exhibited the highest binding free energy, which disagreed with experimental results. Determining the binding free energy of the BHQ analog engineered with three para-methyl groups presented challenges in convergence and resulted in the lowest free energy among the three.

Spousal bereavement is associated with health declines and increased mortality risk, but its specific impact on physical and cognitive capabilities is less studied. A historical cohort study design was applied including married Tromsø study participants (N=5739) aged 50–70 years with baseline self-reported overall health and health-related factors and measured capability (grip strength, finger tapping, digit symbol coding, and short-term recall) at follow-up. Participants had data from Tromsø4 (1994–1995) and Tromsø5 (2001), or Tromsø6 (2007–2008) and Tromsø7 (2015–2016). Propensity score matching, adjusted for baseline confounders (and baseline capability in a subset), was used to investigate whether spousal bereavement was associated with poorer subsequent capability. Spousal bereavement occurred for 6.2% on average 3.7 years (SD 2.0) before the capability assessment. There were no significant bereavement effects on subsequent grip strength, immediate recall, or finger-tapping speed. Without adjustment for baseline digit symbol coding test performance, there was a negative significant effect on the digit symbol coding test (ATT −1.33; 95% confidence interval −2.57, −0.10), but when baseline digit symbol coding test performance was taken into account in a smaller subsample, using the same set of matching confounders, there was no longer any association (in the subsample ATT changed from −1.29 (95% CI −3.38, 0.80) to −0.04 (95% CI −1.83, 1.75). The results in our study suggest that spousal bereavement does not have long-term effects on the intrinsic capacity components physical or cognition capability to a notable degree.

Patients with psychosis and patients with depression exhibit widespread neurobiological abnormalities. The analysis of dynamic functional connectivity (dFC) allows for the detection of changes in complex brain activity patterns, providing insights into common and unique processes underlying these disorders.

This article explores the financial challenges that seniors are currently facing, including increasing debt and financial crises. It draws attention to the historical Townsend Plan, a movement that fought for seniors' rights during the Great Depression, and suggests that it could offer a potential solution to the current crisis. The article also examines the limitations and inequalities of the Social Security Act, which was intended to provide a safety net for aging Americans but has left many seniors in debt. It concludes by questioning whether a new movement similar to the Townsend Plan is necessary to address the current challenges faced by seniors. [Extracted from the article]

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Inflammation is gradually compartmentalized and restricted to specific tissue niches such as the lesion rim. However, the precise cell type composition of such niches, their interactions and changes between chronic active and inactive stages are incompletely understood. We used single-nucleus and spatial transcriptomics from subcortical MS and corresponding control tissues to map cell types and associated pathways to lesion and nonlesion areas. We identified niches such as perivascular spaces, the inflamed lesion rim or the lesion core that are associated with the glial scar and a cilia-forming astrocyte subtype. Focusing on the inflamed rim of chronic active lesions, we uncovered cell–cell communication events between myeloid, endothelial and glial cell types. Our results provide insight into the cellular composition, multicellular programs and intercellular communication in tissue niches along the conversion from a homeostatic to a dysfunctional state underlying lesion progression in MS.

Inline monitoring is already an essential part of laser material processing. Due to the ongoing technological improvements as well as the development of new sensor technology, new fields of application emerge. In this regard, optical microphones are a promising alternative to conventional microphones as the membrane-free measuring principle allows them to cover a significantly wider frequency spectrum and, thus, enable new possibilities for process observation. Simultaneously to the development in sensor technology, ultrashort-pulse laser beam sources are being further commercialized, which results in a gradual enlargement of their fields of application due to the improved economic efficiency. In order to increase the productivity of ultrashort-pulse laser beam sources, high pulse repetition rates in the upper kilohertz or even in the megahertz region are often used. Together with the emitted pulses exhibiting durations in the picosecond or femtosecond range, the inline process observation is challenging. In this work, the diffusion media for polymer electrolyte membrane fuel cells, consisting of a carbon black particle-based microporous layer and a carbon fiber-based substrate layer, were structured with a laser beam source emitting pulses in the picosecond range. An optical microphone was used for process monitoring in combination with dedicated data processing methods. It was shown that acoustic data can be used to determine the focus position as well as the material transitions during ultrashort-pulsed laser material processing. Additionally, information about the ablation volume and the presence of surface defects can be drawn from the data.

A strictly time-domain. formulation of the log-sensitivity of the error signal to structured plant uncertainty is presented and analyzed through simple but representative classical and quantum systems. Results demonstrate that across a wide range of physical systems, maximization of performance (minimization of the error signal) asymptotically or at a specific time comes at the cost of increased log-sensitivity, implying a time-domain constraint analogous to the frequency-domain identity $\mathbf {S(s) + T(s) = I}$. While of limited value in classical problems based on asymptotic stabilization or tracking, such a time-domain formulation is valuable in assessing the reduced robustness cost concomitant with high-fidelity quantum control schemes predicated on time-based performance measures.

IMPORTANCE: Despite efforts to promote diversity within the neurosurgical workforce, individuals from underrepresented groups face significant challenges. OBJECTIVE: To compare practice metrics and earning potential between female and male neurosurgeons and investigate factors associated with gender disparity in Medicare reimbursement. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used publicly accessible Medicare data on reimbursements to female and male neurosurgeons for procedural and evaluation and management services delivered in both inpatient and outpatient settings between January 1, 2013, and December 31, 2020. Data were analyzed from December 9, 2021, to December 5, 2022. MAIN OUTCOMES AND MEASURES: The primary outcome was the mean annual payments received and charges submitted by female and male neurosurgeons for services rendered between 2013 and 2020. Secondary outcomes included the total number and types of services rendered each year and the number of beneficiaries treated. Univariate and multivariable analyses quantified differences in payment, practice volume, and composition. RESULTS: A total of 6052 neurosurgeons (5540 men [91.54%]; 512 women [8.46%]) served the Medicare fee-for-service patient population. Female neurosurgeons billed for lesser Medicare charges (mean [SE], $395 851.62 [$19 449.39] vs $766 006.80 [$11 751.66]; P < .001) and were reimbursed substantially less (mean [SE], $69 520.89 [$2701.30] vs $124 324.64 [$1467.93]; P < .001). Multivariable regression controlling for practice volume metrics revealed a persistent reimbursement gap (−$24 885.29 [95% CI, −$27 964.72 to −$21 805.85]; P < .001). Females were reimbursed $24.61 less per service than males even after matching services by code (P = .02). CONCLUSIONS AND RELEVANCE: This study found significant gender-based variation in practice patterns and reimbursement among neurosurgeons serving the Medicare fee-for-service population. Female surgeons were reimbursed less than male surgeons when both performed the same primary procedure. Lower mean reimbursement per service may represent divergence in billing and coding practices among females and males that could be the focus of future research or educational initiatives.

Abstract: Introduction: An increasing number of women are entering the field of general surgery. Because surgical devices have traditionally been targeted at men, we hypothesized that, due to smaller hand size, female general surgery residents would have significantly more difficulty utilizing the “one size fits all” handles of disposable laparoscopic (lap) devices when compared with male residents. Methods: General surgery residents were anonymously surveyed at four university general surgery training programs. Participants were asked to describe their use of four disposable lap instruments: the lap stapler, lap Harmonic scalpel® (Ethicon, Inc., Somerville, New Jersey), lap LigaSure™ (Valleylab, Boulder, Colorado), and lap retrieval bag. Data were tabulated and analyzed, comparing male with female residents for each instrument as well as according to glove size. Results: A total of 120 residents were asked to participate with 65 anonymous responses (28 women and 37 men). Women’s median glove size was significantly smaller than men’s (6.5 vs. 7.5, p < 0.0001), whereas the clinical year and number of lap cases were not significantly different. Women reported the following devices more awkward than their male counterparts: lap stapler, lap Harmonic scalpel®, and the lap LigaSure™. Women were more likely to use two hands and describe these devices as “always awkward.” When results were analyzed by glove size independently of gender we found that, with increasing glove size, residents were more likely to describe these devices as easy to use and used these devices with only one hand. Conclusions: Current disposable lap devices are not designed for individuals with small hands. Women have significantly smaller hands than their male counterparts and have difficulty with the “one size fits all” lap device handles. With the increasing number of women entering general surgery programs, this problem will likely persist until devices are designed for surgeons with small hand sizes.

Climate change threatens the role of European forests as a long-term carbon sink. Assisted migration aims to increase the resilience of forest tree populations to climate change, using species-specific climatic limits and local adaptations through transferring seed provenances. We modelled assisted migration scenarios for seven main European tree species and analysed the effects of species and seed provenance selection, accounting for environmental and genetic variations, on the annual above-ground carbon sink of regrowing juvenile forests. To increase forest resilience, coniferous trees need to be replaced by deciduous species over large parts of their distribution. If local seed provenances are used, this would result in a decrease of the current carbon sink (40 TgC yr−1) by 34–41% by 2061–2080. However, if seed provenances adapted to future climates are used, current sinks could be maintained or even increased to 48–60 TgC yr−1.

IntroductionLow socioeconomic status (SES) is associated with poor mental health and cognitive function. Individual-level SES and area-level SES (ASES) may affect mental health and cognitive function through lifestyle. We aimed to quantify the associations of ASES with mental health and cognitive function and examine the mediating role of lifestyle behaviours independent of individual-level SES in a Norwegian population.MethodsIn this cross-sectional study, we included 7211 participants (54% women) from the seventh survey of the Tromsø Study (2015–2016) (Tromsø7). The exposure variable ASES was created by aggregating individual-level SES variables (education, income, housing ownership) from Statistics Norway at the geographical subdivision level. Tromsø7 data were used as mediators (smoking, snuff, alcohol, physical activity, diet) and outcomes (cognitive function, anxiety, depression, insomnia). Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex.ResultsHigher ASES was associated with better cognitive function and fewer depression and insomnia symptoms, independent of individual-level SES. These associations were mediated by smoking and physical activity. Alcohol was a mediator for depression and cognitive function in women. Age was a significant moderator of the association between ASES and global cognitive function in women. The largest total indirect effect of ASES was found for depression, with the joint effect of the mediators accounting for 36% of the total effect.ConclusionsPeople living in areas with lower ASES are at higher risk of poor mental health, such as depression and insomnia, and have lower cognitive function possibly due to unhealthy lifestyle (smoking, alcohol and physical inactivity).

BackgroundEarly clinical trials validating endovascular therapy (EVT) for emergent large vessel occlusion (ELVO) ischemic stroke in the anterior circulation initially focused on patients with small or absent completed infarctions (ischemic cores) to maximize the probability of detecting a clinically meaningful and statistically significant benefit of EVT. Subsequently, real-world experience suggested that patients with large core ischemic strokes (LCS) at presentation may also benefit from EVT. Several large, retrospective, and prospective randomized clinical trials have recently been published that further validate this approach. These guidelines aim to provide an update for endovascular treatment of LCS.MethodsA structured literature review of LCS studies available since 2019 and grading the strength and quality of the evidence was performed. Recommendations were made based on these new data by consensus of the authors, with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors.ResultsThe management of ELVO strokes with large ischemic cores continues to evolve. The expert panel agreed on several recommendations: Recommendation 1: In patients with anterior circulation ELVO who present within 24 hours of last known normal with large infarct core (70–149 mL or ASPECTS 3–5) and meet other criteria of RESCUE-Japan LIMIT, SELECT2, ANGEL-ASPECT, TESLA, TENSION, or LASTE trials, thrombectomy is indicated (Class I, Level A). Recommendations 2–7 flow directly from recommendation 1. Recommendation 2: EVT in patients with LCS aged 18–85 years is beneficial (Class I, Level A). Recommendation 3: EVT in patients with LCS >85 years of age may be beneficial (Class I, Level B-R). Recommendation 4: Patients with LCS and NIHSS score 6–30 benefit from EVT in LCS (Class I, Level A). Recommendation 5: Patients with LCS and NIHSS score <6 and >30 may benefit from EVT in LCS (Class IIa, Level A). Recommendation 6: Patients with LCS and low baseline mRS (0–1) benefit from EVT (Class I, Level A). Recommendation 7: Patients with LCS and time of last known well 0–24 hours benefit from EVT (Class I, Level A). Recommendation 8: It is recommended that patients with ELVO LCS who also meet the criteria for on-label or guideline-directed use of IV thrombolysis receive IV thrombolysis, irrespective of whether endovascular treatments are being considered (Class I, Level B-NR).ConclusionsThe indications for endovascular treatment of ELVO strokes continue to expand and now include patients with large ischemic cores on presentation. Further prospective randomized studies, including follow-up to assess the population-based efficacy of treating patients with LCS, are warranted.

BackgroundEndovascular therapy (EVT) dramatically improves clinical outcomes for patients with anterior circulation emergent large vessel occlusion (ELVO) strokes. With recent publication of two randomized controlled trials in favor of EVT for basilar artery occlusions, the Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee provides this focused update for the existing SNIS guideline, ‘Current endovascular strategies for posterior circulation large vessel occlusion stroke.’MethodsA structured literature review and analysis of studies related to posterior circulation large vessel occlusion (basilar or vertebral artery) strokes treated by EVT was performed. Based on the strength and quality of the evidence, recommendations were made by consensus of the writing committee, with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors.ResultsBased on the results of the most recent randomized, controlled trials on EVT for basilar or vertebral artery occlusion, the expert panel agreed on the following recommendations. For patients presenting with an acute ischemic stroke due to an acute basilar or vertebral artery occlusion confirmed on CT angiography, National Institutes of Health Stroke Scale (NIHSS) score of ≥6, posterior circulation Alberta Stroke Program Early CT Score (PC-ASPECTS) ≥6, and age 18–89 years: (1) thrombectomy is indicated within 12 hours since last known well (class I, level B-R); (2) thrombectomy is reasonable within 12–24 hours from the last known well (class IIa, level B-R); (3) thrombectomy may be considered on a case by case basis for patients presenting beyond 24 hours since last known well (class IIb, level C-EO). In addition, thrombectomy may be considered on a case by case basis for patients aged <18 years or >89 years on a case by case basis (class IIb, level C-EO).ConclusionsThe indications for EVT of ELVO strokes continue to expand and now include patients with basilar artery occlusion. Further prospective, randomized controlled trials are warranted to elucidate the efficacy and safety of EVT in populations not included in this set of recommendations, and to confirm long term outcomes.

BackgroundMechanical thrombectomy (MT) is the standard of care for patients with a stroke and large vessel occlusion. Clot composition is not routinely assessed in clinical practice as no specific diagnostic value is attributed to it, and MT is performed in a standardized ‘non-personalized’ approach. Whether different clot compositions are associated with intrinsic likelihoods of recanalization success or treatment outcome is unknown.MethodsWe performed a prospective, non-randomized, single-center study and analyzed the clot composition in 60 consecutive patients with ischemic stroke undergoing MT. Clots were assessed by ex vivo multiparametric MRI at 9.4 T (MR microscopy), cone beam CT, and histopathology. Clot imaging was correlated with preinterventional CT and clinical data.ResultsMR microscopy showed red blood cell (RBC)-rich (21.7%), platelet-rich (white,38.3%) or mixed clots (40.0%) as distinct morphological entities, and MR microscopy had high accuracy of 95.4% to differentiate clots. Clot composition could be further stratified on preinterventional non-contrast head CT by quantification of the hyperdense artery sign. During MT, white clots required more passes to achieve final recanalization and were not amenable to contact aspiration compared with mixed and RBC-rich clots (maneuvers: 4.7 vs 3.1 and 1.2 passes, P<0.05 and P<0.001, respectively), whereas RBC-rich clots showed higher probability of first pass recanalization (76.9%) compared with white clots (17.4%). White clots were associated with poorer clinical outcome at discharge and 90 days after MT.ConclusionOur study introduces MR microscopy to show that the hyperdense artery sign or MR relaxometry could guide interventional strategy. This could enable a personalized treatment approach to improve outcome of patients undergoing MT.

Hexahydrocannabinol (HHC) is a cannabinoid that has been known since 1940 but has only recently found its way into recreational use as a psychoactive drug. HHC has been used as a legal alternative to tetrahydrocannabinol (THC) in many countries, but first countries already placed it under their narcotic substances law. Our aim was to evaluate a reliable analytical method for the proof of HHC consumption by LC-MS/MS and GC-MS. We identified the two epimers of HHC and metabolites after HHC consumption by two volunteers (inhalation by use of a vaporizer and oral intake). LC-HR-MS/MS, LC-MS/MS and GC-MS with literature data (EI-MS spectra of derivatives) and reference compounds - as far as commercially available - were used for metabolite identification. Phase-II-metabolites (glucuronides) of HHC and OH-HHC were found in urine samples with LC-HR-MS/MS and LC-MS/MS. The main metabolite was tentatively identified with GC-MS as 4'OH-HHC (stereochemistry on C9 and C4' unknown). Another major side-chain hydroxylated metabolite found by LC-MS/MS could not be unambiguously identified. Both epimers of 11-OH-HHC were found in considerable amounts in urine. (8R, 9R)-8-OH-HHC was identified as a minor metabolite with GC-MS and LC-MS/MS. While (9S)-HHC was found in urine after oral intake and inhalation of HHC, the more psychoactive epimer (9R)-HHC was only found in urine after inhalation. Several other minor metabolites were detected but not structurally identified. We found that after oral or inhalative consumption the urinary main metabolites of a diastereomeric mixture of HHC are different from the respective, major Δ9-THC metabolites (11-OH-Δ9-THC and 11-nor-9-carboxy-Δ9-THC). Although a sensitive LC-MS/MS and GC-SIM-MS method were set-up for the reference compounds (9R)-11-nor-9-carboxy-HHC and (9S)-11-nor-9-carboxy-HHC, these oxidation products were not detected in urine with these techniques. To further increase sensitivity, a GC-MS/MS method was developed, and the 11-nor-9-carboxy metabolites of HHC were confirmed to be present as minor metabolites.

El síndrome de Poland es una malformación infrecuente (un caso por cada 30.000 nacimientos) que combina, en diversos grados, anomalías del tórax y del miembro superior homolateral. La anomalía constante es la agenesia de los fascículos esternocostales y esternoclaviculares del pectoral mayor. Con frecuencia hay asimetría mamaria, con hipoplasia de una mama y del complejo areolomamilar homolateral. Las malformaciones de la mano, presentes en alrededor del 20% de los casos, son numerosas y varían en gravedad, pero la más frecuente es la braquimesofalangia. Este cuadro clínico es más frecuente en los varones (proporción por sexos de 3/2) y más a menudo en el hemitórax derecho. La etiopatogenia está a favor de una anomalía vascular subclavia embrionaria (6.ª semana). Nunca hay consecuencias funcionales en caso de afectación torácica, incluso de la mano, sólo molestias estéticas. Una clasificación reciente, basada en la experiencia de 151 pacientes intervenidos, permite orientar las opciones terapéuticas. En los últimos años, la cirugía reconstructiva se ha beneficiado de la tecnología digital, con implantes torácicos de elastómero de silicona hechos a medida mediante diseño y fabricación asistidos por ordenador, a partir de una tomografía computarizada. También pueden utilizarse como complemento otras técnicas que combinan implantes mamarios e injertos de grasa, según los casos. El colgajo clásico del músculo dorsal ancho rara vez se utiliza. En función de la edad, el sexo y la gravedad de las anomalías toracomamarias, puede proponerse una estrategia terapéutica adaptada a cada caso de síndrome de Poland.

Forty years ago, it was proposed that gas-phase organic chemistry in the interstellar medium can be initiated by the methyl cation CH3+(refs. 1–3), but so far it has not been observed outside the Solar System4,5. Alternative routes involving processes on grain surfaces have been invoked6,7. Here we report James Webb Space Telescope observations of CH3+in a protoplanetary disk in the Orion star-forming region. We find that gas-phase organic chemistry is activated by ultraviolet irradiation.

AbstractThis article analyzes class formation of the Milwaukee Teachers’ Education Association (MTEA). In 2011, Wisconsin curtailed public-sector union collective bargaining, causing Wisconsin unions’ membership and political power to plummet. This article puts the 2011 collapse into historical perspective, by considering the development of Milwaukee teachers’ labor organizing over the course of the twentieth century. In part I, I chronicle the formation of the MTEA, including its early contest with the Milwaukee Teachers Union (MTU) and the gendered fault lines of the teachers’ collective vision. In part II, I discuss the consequences of teachers’ rhetorical contradictions, especially their lack of collaboration with the civil rights movement in Milwaukee. This article challenges the notion that class movements are preordained with unified interests and aims, and instead shows that unions themselves build and assemble people’s political ideas, either to expand solidarity or to narrow it.

Food processing conditions affect the structure, solubility, and therefore accurate detection of gluten proteins. We investigated the influence of dough, bread, and pretzel making on the composition of different wheat protein fractions obtained by Osborne fractionation. The albumin/globulin, gliadin, and glutenin fractions from flour, dough, crispbread, bread, and pretzel were analyzed using RP-HPLC, SDS-PAGE, and untargeted nanoLC-MS/MS. This approach enabled an in-depth profiling of the fractionated proteomes and related compositional changes to processing conditions (mixing, heat, and alkali treatment). Overall, heat treatment demonstrated the most pronounced effect. Label-free quantitation revealed significant changes in the relative abundances of 82 proteins within the fractions of bread crumb and crust in comparison to flour. Certain gluten proteins showed shifts or reductions in particular fractions, indicating their incorporation into the gluten network through SS and non-SS cross-links. Other gluten proteins were enriched, suggesting their limited involvement in the gluten network formation.

Die Diagnose der Spondyloarthritis (SpA) wird auch heute noch mit einer Verzögerung von mehr als 6 Jahren gestellt. Aus diesem Grund ist es wichtig, die Symptome der Spondyloarthritis früh zu erkennen, um die Diagnosestellung einzuleiten. Vor allem die Bildgebung spielt dafür neben der ausführlichen Anamnese und Untersuchung eine wichtige Rolle. Therapieziel der nichtmedikamentösen und der medikamentösen Therapieansätze ist die Remission oder zumindest eine niedrige Krankheitsaktivität der SpAs. Regelmäßiges Monitoring hilft, die Versorgungsqualität zu sichern.