Search

In computer-mediated communication, small graphical icons (emojis) can be used to compensate for the lack of nonverbal cues such as facial expressions or hand gestures. Accordingly, literature suggests that the use of emojis may also be subject to social norms—similar to nonverbal behavior in face-to-face interactions. However, actual empirical investigations into this assumption remain lacking. To remedy this research gap, I explored whether traditional norms of appropriate emotional intensity and reciprocity also apply to emoji usage. A first online experiment (N = 188) revealed that excessive emoji use in a first-contact scenario leads to diminished interpersonal outcomes, corresponding to the drawbacks of overly intense nonverbal displays in natural interactions. Proceeding to a different communicative stage, Experiment 2 (N = 242) explored nonverbal reciprocity with acquainted interaction partners. Inviting participants to reply to fictitious text messages (at varying levels of interpersonal intimacy), it was observed that stimulus messages containing more emojis also evoke stronger emoji use in return—indicating that principles of nonverbal attunement are in full effect during text-based online interactions.

When interacting with sophisticated digital technologies, people often fall back on the same interaction scripts they apply to the communication with other humans—especially if the technology in question provides strong anthropomorphic cues (e.g., a human-like embodiment). Accordingly, research indicates that observers tend to interpret the body language of social robots in the same way as they would with another human being. Backed by initial evidence, we assumed that a humanoid robot will be considered as more dominant and competent, but also as more eerie and threatening once it strikes a so-called power pose. Moreover, we pursued the research question whether these effects might be accentuated by the robot’s body size. To this end, the current study presented 204 participants with pictures of the robot NAO in different poses (expansive vs. constrictive), while also manipulating its height (child-sized vs. adult-sized). Our results show that NAO’s posture indeed exerted strong effects on perceptions of dominance and competence. Conversely, participants’ threat and eeriness ratings remained statistically independent of the robot’s depicted body language. Further, we found that the machine’s size did not affect any of the measured interpersonal perceptions in a notable way. The study findings are discussed considering limitations and future research directions.

Meal-concurrent media use has been linked to several problematic outcomes, including higher caloric intake and an increased risk for obesity. Nevertheless, the sociocultural and dispositional predictors of using media while eating are not yet well-understood, including potential cross-cultural differences. Inspired by the recent emergence of a new food-related media phenomenon called “mukbang”—digital eating broadcasts that have become immensely popular throughout East and Southeast Asia—we inquire 296 participants from two cultures (Germany and South Korea) about their meal-concurrent media use. Our results suggest that South Koreans tend to use media more frequently during meals than Germans, especially for social purposes. Meanwhile, younger age only predicts meal-concurrent media use in the German sample. Apart from that, however, many other examined predictors (e.g., gender, living situation, body-esteem, the Big Five) remain statistically insignificant, indicating notable universality for the behavior in question. In the second part of our study, we then put special focus on the emerging mukbang trend and conduct a theory-driven exploration of its gratifications. Doing so, we find that participants' parasocial and social experiences during eating broadcasts significantly predict their enjoyment of the genre.

Faced with the ongoing diversification and commercial success of highly immersive media technologies (e.g., VR headsets), both content producers and scientific scholars have become highly invested in understanding the psychological consequences of experiencing media in these new and lifelike ways. While many studies underscore positive effects of high media immersivity—such as increased enjoyment or persuasive success—others warn about the intense cognitive load that technologies such as VR might put on their users. In a laboratory experiment with N = 121 participants, we compare the cognitive load experienced while watching a 360° video on a laptop screen or via an immersive VR head-mounted display. Furthermore, we scrutinize two prominent explanations for the additional cognitive load in immersive media settings, i.e., the role of spatial presence and cybersickness. As expected, the VR condition results in higher cognitive load, spatial presence, and cybersickness than the 2D condition. However, by means of a parallel mediation model, we observe that only cybersickness emerges as a meaningful mediator of participants’ strained cognitive capacity; spatial presence, on the other hand, remains statistically irrelevant in this regard. We discuss our findings considering implications for media producers and future research.

Pain is a frequent problem faced by emergency medical services (EMS) in pre-hospital settings. This large observational study aims to assess the prevalence of sufficiently provided analgesia and to analyze the efficacy of different analgesics. Moreover, we evaluated if quality of analgesia changed with an emergency physician on scene or depended on paramedics' gender.This is a retrospective analysis of all pre-hospital medical charts from adults and adolescents treated by the municipal EMS SchutzRettung Zürich over a period of 4 years from 2013 to 2016. Inclusion criteria were age ≥16 years, initial GCS 13, NACA score ≥I and ≤V, an initial numeric rating scale (NRS) ≥ I and a documented NRS at hospital admission. 20,978 out of 142,484 missions fulfilled the inclusion criteria and therefore underwent further investigation. Descriptive, univariate and multivariate analyses were applied.Initial NRS on scene was on average 5.2 ± 3.0. Mean NRS reduction after treatment was 2.2 ± 2.5 leading to a NRS at hospital admission of 3.0 ± 1.9. This resulted in sufficient analgesia for 77% of included patients. Among analgesics, the highest odds ratio for sufficient analgesia was observed for ketamine (OR 4.7, 95%CI 2.2-10.4, p 0.001) followed by fentanyl (OR 1.4, 95%CI 1.1-1.7, p = 0.004). Female paramedics provided better analgesia (OR 1.2, 95%CI 1.1-1.2; p 0.001). Patient's sex had no influence on analgesia. In patients with a NACA score 2, the presence of an emergency physician on scene improved the quality of analgesia significantly.Pre-hospital analgesia is mostly adequate, especially when done with ketamine or fentanyl. Female paramedics provided better analgesia and in selected patients, an emergency physician on scene improved quality of analgesia in critical patients.

The harassment of researchers working in the social sciences—not rarely an organized effort targeting members of marginalized groups—is most alarming. Its implications reach from severe personal consequences to the risk of scientific self-censorship. We invite readers to engage in a much-needed discourse about this worrisome phenomenon.

BACKGROUND: Approximately every third surgical patient is anemic. The most common form, iron deficiency anemia, results from persisting iron-deficient erythropoiesis (IDE). Zinc protoporphyrin (ZnPP) is a promising parameter for diagnosing IDE, hitherto requiring blood drawing and laboratory workup. STUDY DESIGN AND METHODS: Noninvasive ZnPP (ZnPP-NI) measurements are compared to ZnPP reference determination of the ZnPP/heme ratio by high-performance liquid chromatography (ZnPP-HPLC) and the analytical performance in detecting IDE is evaluated against traditional iron status parameters (ferritin, transferrin saturation [TSAT], soluble transferrin receptor-ferritin index [sTfR-F], soluble transferrin receptor [sTfR]), likewise measured in blood. The study was conducted at the University Hospitals of Frankfurt and Zurich. RESULTS: Limits of agreement between ZnPP-NI and ZnPP-HPLC measurements for 584 cardiac and noncardiac surgical patients equaled 19.7 μmol/mol heme (95% confidence interval, 18.0-21.3; acceptance criteria, 23.2 μmol/mol heme; absolute bias, 0 μmol/mol heme). Analytical performance for detecting IDE (inferred from area under the curve receiver operating characteristics) of parameters measured in blood was: ZnPP-HPLC (0.95), sTfR (0.92), sTfR-F (0.89), TSAT (0.87), and ferritin (0.67). Noninvasively measured ZnPP-NI yielded results of 0.90. CONCLUSION: ZnPP-NI appears well suited for an initial IDE screening, informing on the state of erythropoiesis at the point of care without blood drawing and laboratory analysis. Comparison with a multiparameter IDE test revealed that ZnPP-NI values of 40 μmol/mol heme or less allows exclusion of IDE, whereas for 65 μmol/mol heme or greater, IDE is very likely if other causes of increased values are excluded. In these cases (77% of our patients) ZnPP-NI may suffice for a diagnosis, while values in between require analyses of additional iron status parameters.

BACKGROUND This study investigates the impact of preoperative calculated rivaroxaban (RXA) plasma concentration on perioperative red blood cell (RBC) loss. STUDY DESIGN AND METHODS In this retrospective single-center study, we identified patients with RXA intake according to a preoperative determination of RXA levels within 96 hours before surgery. RXA plasma concentration at the beginning of surgery was then calculated from the last RXA intake using a single-compartment pharmacokinetic model with four categories of RXA concentration (≤20, 21-50, 51-100, and >100 μg/L). Patients were classified into surgery with high (≥500 mL) or low (

As artificial intelligence advances towards unprecedented levels of competence, people's acceptance of autonomous technology has become a hot topic among psychology and HCI scholars. Previous studies suggest that threat perceptions—regarding observers' immediate physical safety (proximal) as well as their more abstract concepts of human uniqueness (distal)—impede the positive reception of self-controlled digital systems. Developing a Model of Autonomous Technology Threat, we propose both of these threat forms as common antecedents of users' general threat experience, which ultimately predicts reduced technology acceptance. In a laboratory study, 125 participants were invited to interact with a virtual reality agent, assuming it to be the embodiment of a fully autonomous personality assessment system. In a path analysis, we found correlational support for the proposed model, as both situational control and human uniqueness attitudes predicted threat experience, which in turn connected to stronger aversion against the presented system. Other potential state and trait influences are discussed.

Smartphone use while walking (i.e., being a smartphone zombie) has become a prevalent phenomenon in many cities worldwide. Previous research shows that many pedestrians choose to interact with their phones as they walk around in cities, despite being aware that their behavior might be dangerous. To investigate potential reasons for the prevalence of distracted walking, the current study explores the construct Fear of Missing Out (FoMO) as a potential antecedent of pedestrians' smartphone use while walking. Hierarchical OLS and logistic regression analyses show that FoMO predicts distracted walking, the tendency to engage in virtual social interactions while walking, and dangerous traffic incidents—irrespective of participants’ age and gender. Virtual communication might serve as a compensation for real-world company, thus sidelining the need to traverse safely.

Social networking sites such as Instagram provide users with numerous social comparison cues, potentially leading to envy and lower self-esteem. We conducted two experiments, examining whether such negative consequences could be mitigated by brief cognitive interventions. In Experiment 1 (N = 391), we reminded users of the unrealistic nature of most Instagram posts in a 2 (intervention: disclaimer vs. control) × 2 (Instagram profile: upward vs. downward comparison standard) between-subjects design. Positive and negative affect, envy, self-esteem, and well-being served as dependent variables. Experiment 2 (N = 184) explored whether slightly longer cognitive interventions (“cognitive bias” vs. “growth mindset” vs. control) could improve participants’ experience of upward comparisons, shielding them against envy or the loss of self-esteem. Both experiments included social comparison orientation (SCO) as a potential moderator. Results show that eliciting upward comparisons indeed evoked more envy, with SCO moderating the effect. We further observed indirect effects of the shown Instagram profiles on positive affect, envy, self-esteem, and well-being via participants’ social comparison experience. Concerning the cognitive interventions, however, we report that neither an authoritative disclaimer, nor educating users about cognitive biases or mindsets significantly reduced the negative consequences of social comparisons.

Postpartum hemorrhage is the major cause of maternal mortality worldwide. Retained placenta accounts for nearly 20% of severe cases. We investigated the influence of the time factor and retained placenta etiology on postpartum hemorrhage dynamics.Our retrospective study analyzed a single-center cohort of 296 women with retained placenta. Blood loss was measured using a validated and accurate technique based on calibrated blood collection bags, backed by the post- vs pre-partum decrease in hemoglobin. We evaluated the relationship between these two blood loss parameters and the duration of the third stage of labor using Spearman rank correlation, followed by subgroup analysis stratified by third stage duration and retained placenta etiology.Correlation analysis revealed no association between third stage duration and measured blood loss or decrease in hemoglobin. A shorter third stage ( 60 min) was associated with significantly increased uterine atony (p = 0.001) and need for blood transfusion (p = 0.006). Uterine atony was significantly associated with greater decrease in hemoglobin (p 0.001), higher measured blood loss (p 0.001), postpartum hemorrhage (p = 0.048), and need for blood transfusion (p 0.001).Postpartum blood loss does not correlate with third stage duration in women with retained placenta. Our results suggest that there is neither a safe time window preceding postpartum hemorrhage, nor justification for an early cut-off for manual removal of the placenta. The prompt detection of uterine atony and immediate prerequisites for manual removal of the placenta are key factors in the management of postpartum hemorrhage.

Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.

In recent years, China and Germany have become invaluable partners in business, politics, and science. However, psychological research indicates that the countries’ large-scale affinity does not tr...

Fueled by tragic incidents worldwide, many studies have investigated dispositional factors that lead to virtual abuse and cyberbullying. In contrast to this, less extreme forms of uncivil online behavior have received only little attention. The current paper strives to overcome this research gap by focusing on uncivil commenting intentions in public Facebook discussions. We presented controversial online comments to a convenient student sample of 256 Facebook users asking them to consider their likely response on several scales ranging from a functional to an uncivil style of reasoning. Users' intended commenting was then linked to several personality traits (Big Five, Dark Triad, sensation seeking, and impulsivity) and their Facebook intensity. Analyses revealed openness, agreeableness, and experience seeking as negative predictors of participants' intention to comment uncivilly, whereas attentional impulsivity, boredom susceptibility as well as intense Facebook use emerged as positive predictors. No connections were found for the Dark Triad. Possible explanations for these effects are discussed.

Zusammenfassung. Das Patient Blood Management ist ein multidisziplinäres Behandlungskonzept, das vorrangig die Behandlung von Anämie und Eisenmangel, die Minimierung von Blutverlusten und die Erhöhung der Anämietoleranz beinhaltet. Die Anwendung des Patient Blood Management Konzeptes ist nicht nur für die perioperative Phase, sondern für alle Bereiche der Medizin indiziert, die sich mit der Behandlung mit Blut und Blutprodukten auseinandersetzen. Eine Vielzahl von Studien mit bis zu 605’000 Patienten haben die Sicherheit und Effektivität dieses Konzepts geprüft. Dabei konnten Fremdbluttransfusionen reduziert, finanzielle Ressourcen geschont und klinische, patientenbezogene Outcomeparameter, inklusive Morbidität und Mortalität, verbessert werden. Patient Blood Management ist daher zu einem Standard der Patientenversorgung geworden.

Bei den Installationsarbeiten der Grundungspfahle des Offshore-Windparks (OWP) Amrumbank West kam zur Rammschallminderung neben dem einfachen und doppelten Grosen Blasenschleier das neu entwickelte Schallminderungssystem Hydro Sound Damper (HSD) zum Einsatz. Zur Untersuchung der Schallwellenausbreitung und der Wirksamkeit verschiedener Schallminderungssysteme wurden durch das Institut fur Grundbau und Bodenmechanik der Technischen Universitat Braunschweig (IGB-TUBS) umfangreiche Offshore-Messkampagnen durchgefuhrt. Eine dichte Matrix aus Hydrophonen in verschiedenen Wassertiefen und einer Reihe von Geophonen auf dem Meeresboden in Entfernungen zwischen 25 m und 1.500 m vom Pfahl wurde wahrend der Rammarbeiten mit verschiedenen Kombinationen von Schallminderungssystemen eingesetzt. Zudem wurde der Pfahl selbst mit Dehnungs- und Beschleunigungssensoren instrumentiert. Aufbauend auf diesen Messungen wird die Wellenausbreitung im System Pfahl, Wasser und Boden untersucht, sowie die Wirkung der Schallminderungssysteme in verschiedenen Abstanden zum Pfahl und uber den bei Rammarbeiten masgeblichen Frequenzbereich bestimmt. Die Wirksamkeit der eingesetzten Schallminderungssysteme in verschiedenen Frequenzbereichen konnte bestimmt werden. Aus der gemeinsamen Betrachtung von Hydroschallmessungen mit Messungen am Pfahl bzw. am Boden konnte die Schallabstrahlung des Pfahls und des Bodens in das Wasser gezeigt werden.

Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid. The incidence of massive transfusion (≥ 10 units of red blood cells from emergency department arrival until intensive care unit admission) was compared with the predicted incidence according to the trauma associated severe haemorrhage score. All adult (≥ 16 years) trauma patients primarily admitted to the University Hospital Zürich with an injury severity score ≥ 16 were included. In 2005-2007, the observed and trauma associated severe haemorrhage score that predicted the incidence of massive transfusion were identical, whereas in 2012-2014 the observed incidence was less than half that predicted (3.7% vs. 7.5%). Compared to 2005-2007, the proportion of patients transfused with red blood cells and fresh frozen plasma was significantly lower in 2012-2014 in both the emergency department (43% vs. 17%; 31% vs. 6%, respectively), and after 24 h (53% vs. 27%; 37% vs. 16%, respectively). The use of tranexamic acid and coagulation factor XIII also increased significantly in the 2012-2014 time period. Implementation of a revised trauma management strategy, which included goal-directed coagulation management, was associated with a reduced incidence of massive transfusion and a reduction in the transfusion of red blood cells and fresh frozen plasma.

Trauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate–based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome.

Introduction Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. Material and methods In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed. Only descriptive statistics were applied. Results In a 6-year period 24 of 2261 (1.1%) trauma patients had prehospital chest decompression. Seventeen patients had NT, six patients TT, one patient NT as well as TT, and no patients had LT. Prehospital successful release of a tension pneumothorax was reported by the paramedics in 83% (5/6) with TT, whereas NT was effective in 18% only (3/17). In five CT scans all thoracocentesis needles were either removed or extrapleural, one patient had a tension pneumothorax, and two patients had no pneumothorax. No NT or TT related complications were reported during hospitalization. Conclusion Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission.

The increasing demand for lightweight design requires the use of multi materials such as metal-polymer-metal composites. These so-called sandwich panels offer a good stiffness-to-weight ratio. Production technologies like shear cutting have to be adapted for these materials. For a targeted adaption, a comprehensive knowledge about the cutting phases of the shear cutting process of sandwich panels is essential. Therefore, within this paper, the shear cutting process of sandwich panels is studied in detail. The conducted experimental studies indicate that the shear cutting process can be divided into five stages. Based on these findings, a new analytic model is introduced to predict the force displacement curves of sandwich panels. The quality of the new model is proven by comparison with existing analytic models for monolithic materials as well as with the experimental data.

Background Considering the significant morbidity and mortality of out-of-hospital cardiac arrest, only little data on survival or quality of life after successful resuscitation is available in Europe. Additionally, economic aspects of such events are poorly studied. The purpose of this study is to provide data for survival, quality of life and costs directly related to the cardiac arrest for a region of Switzerland served by one emergency medical service (EMS). Methods Eighty eight patients older than 18 years of age that were resuscitated by the EMS Winterthur in the year 2013 were included and retrospective analysis of EMS-protocols was performed. For patients alive at follow-up, 2 years after the event, a structured interview with quality of life questionnaires was conducted. This study was accepted by the local Ethics Committee. Results Thirty five percent (n = 31) of resuscitated patients were admitted alive to the hospital following out-of-hospital cardiac arrest. This incidence was as high as 60%, if the patients had a shockable rhythm as first rhythm. Survival to follow-up was 16% (n = 14). These patients had an excellent quality of life overall, with little to no limitations in daily life. There was no significant difference in survival for patients in outlying regions with comparatively longer timespans until arrival of EMS. Median EMS-costs for deceased patients were CHF 1731 (inter-quartile range 346), for survivors CHF 2′169 (inter-quartile range CHF 444) and median hospital-costs were CHF 27′707 (inter-quartile range CHF 62′783). Conclusion Quality of care for patients with out-of-hospital cardiac arrest in the region of Winterthur is high, including patients in outlying regions. The associated costs are similar to other European countries. Trial registration This trial was registered with www.clinicaltrials.gov under NCT02625883.

Background While mainly larger hospitals have introduced routine anti-Xa assays for rivaroxaban (RXA), these are not readily available to smaller hospitals often relying on routine coagulation tests such as prothrombin time (PT) and activated partial thromboplastin time (aPTT). The aim of our study was to investigate the effect of RXA plasma concentration on the standard coagulation tests PT (Quick test and INR) and aPTT in a large group of real-life patients. We further assessed whether normal results of these standard coagulation assays are sufficient to exclude surgically relevant RXA plasma concentration, defined as > 50 mcg/l. Methods This retrospective study included all patients between 2012 and 2016 where anti-Xa (calibrated for RXA), PT (Quick test and INR), and/or aPTT were determined from the same sample. PT is expressed as Quick value (% of normal plasma pool). In total, 1027 measurements in 622 patients were eligible for analysis: 752 measurements of 505 patients for Quick/INR and 594 measurements of 417 patients for aPTT. Results A moderate correlation of PT/Quick (Pearson's correlation coefficient − 0.59; p < 0.001), INR (Pearson's correlation coefficient 0.5; p < 0.001), and aPTT (Pearson's correlation coefficient 0.53; p < 0.001) with RXA plasma concentration was observed. However, in 50% of all samples with a normal PT/Quick, in 25% of all samples with a normal INR and in 80% of all samples with a normal aPTT residual RXA plasma concentration was surgically relevant. Conclusion Although a moderate correlation of RXA plasma concentration with PT/Quick, INR, and aPTT was observed, standard coagulation assays are not sufficient to exclude surgically relevant RXA plasma concentrations.

Digital technologies are advancing rapidly, growing to be more human-like and intelligent by the day. However, research shows that a machine's resemblance to humans can reach a critical level, which makes it seem uncanny to observers. While scholars have discussed this effect in terms of both human-like appearances and mental abilities, a potential interaction between the two aspects has hardly been addressed in literature. We designed a two-factorial experiment to overcome the identified research gap, introducing participants to digital agents with varying embodiment (text interface/human rendering) and mental capacity (simple algorithms/complex artificial intelligence). Our results show that the interaction of both factors indeed affects participants’ experience in a crucial way: Whereas an agent based on simple algorithms only evokes discomfort when embedded in a human-like body, the artificial intelligence is always perceived as eerie, regardless of its embodiment. Yet, additional findings raise doubts on the unidimensionality of participants’ affective response.

Anaemia and iron deficiency are frequent in patients scheduled for cardiac surgery. This study assessed whether immediate preoperative treatment could result in reduced perioperative red blood cell (RBC) transfusions and improved outcome.In this single-centre, randomised, double-blind, parallel-group controlled study, patients undergoing elective cardiac surgery with anaemia (n=253; haemoglobin concentration (Hb)120 g/L in women and Hb130 g/L in men) or isolated iron deficiency (n=252; ferritin100 mcg/L, no anaemia) were enrolled. Participants were randomly assigned (1:1) with the use of a computer-generated range minimisation (allocation probability 0·8) to receive either placebo or combination treatment consisting of a slow infusion of 20 mg/kg ferric carboxymaltose, 40 000 U subcutaneous erythropoietin alpha, 1 mg subcutaneous vitamin B12, and 5 mg oral folic acid or placebo on the day before surgery. Primary outcome was the number of RBC transfusions during the first 7 days. This trial is registered with ClinicalTrials.gov, number NCT02031289.Between Jan 9, 2014, and July 19, 2017, 1006 patients were enrolled; 505 with anaemia or isolated iron deficiency and 501 in the registry. The combination treatment significantly reduced RBC transfusions from a median of one unit in the placebo group (IQR 0-3) to zero units in the treatment group (0-2, during the first 7 days (odds ratio 0·70 [95% CI 0·50-0·98] for each threshold of number of RBC transfusions, p=0·036) and until postoperative day 90 (p=0·018). Despite fewer RBC units transfused, patients in the treatment group had a higher haemoglobin concentration, higher reticulocyte count, and a higher reticulocyte haemoglobin content during the first 7 days (p≤0·001). Combined allogeneic transfusions were less in the treatment group (0 [IQR 0-2]) versus the placebo group (1 [0-3]) during the first 7 days (p=0·038) and until postoperative day 90 (p=0·019). 73 (30%) serious adverse events were reported in the treatment group group versus 79 (33%) in the placebo group.An ultra-short-term combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12, and oral folic acid reduced RBC and total allogeneic blood product transfusions in patients with preoperative anaemia or isolated iron deficiency undergoing elective cardiac surgery.Vifor Pharma and Swiss Foundation for Anaesthesia Research.

The German offshore wind industry has historically grown since the first offshore wind farm (OWF) “alpha ventus” was completed in 2010. Since the end of 2017 a total number of 18 OWF with a capacity of about 5 GW have been operating in the German Exclusive Economic Zone (EEZ) [1]. While the majority of the population and the industry focus on new projects, it appears the life cycle observation and especially the decommissioning phase remain largely unattended. This narrow view can lead to unexpected and expensive consequences in the future. The decommissioning of a complex structure as an offshore wind turbine (OWT) needs to be planned well in advance. There are numerous aspects that make the decommissioning a challenge, such as the federal regulations, the marine environment and the technical limitations of offshore operations. This article gives an overview of the problematic matter of dealing with monopiles after the predicted lifetime, the geotechnical condition, analyses of the current decommissioning options and identification of issues in regards to the decommissioning method. Furthermore, other promising decommissioning methods for a complete removal of offshore monopiles, such as vibratory extraction, internal dredging, external jet drilling and the use of buoyancy force, are presented and compared concerning a possible combination. Some of the presented methods are highly experimental, others are commonly used in other industries.

Monopiles installed by impact driving are the preferred system for the foundation of offshore wind turbines in water depths up to 40 m. The vibration technique as alternative installation method has big advantages regarding piling noise and installation time. Much experience exists for the design and installation of impact driven piles. Within the research project ZykLaMP, the lack of experience concerning vibrated monopiles shall be faced by means of large-scaled model investigations regarding the lateral load-bearing behavior. Therefore, open ended steel pipe piles (L = 2.4 m, Dpile = 0.6 m) are installed into dense sand by means of impact and vibratory pile driving and then subjected to cyclic lateral loading. This paper focusses on pile driving predictions and measurements during the installation process. Pile driving post-predictions were carried out based on a simple force equilibrium approach. Model piles were installed using two different vibro hammers with different eccentric moments and one impact hammer. Measurements of strains and accelerations were carried out to investigate dynamic movements during pile driving. Earth pressure transducers were used to investigate the development of soil stresses due to the installation process. Measurements show that even at high acceleration amplitudes a refusal to vibratory driving may occur at a certain penetration depth. Soil stresses in the vicinity of the pile decrease to about 50 % due to vibratory driving which is one reason for the friction fatigue phenomenon. Drivability studies using the force equilibrium model give rough predictions about whether or not a pile can be driven to a certain penetration depth but are quite sensitive to input parameters. For the model tests, post-predictions gave reasonable results.

Introduction Rivaroxaban (RXA) is a direct oral factor Xa (Xa) antagonist with a short half-life and a fast onset and offset of effect. Before elective surgery, discontinuation is recommended with an interval of at least > 24 hours. In clinical practice, this is, however, not always sufficient to achieve a residual RXA plasma concentration deemed appropriate for surgery, defined as ≤ 50 mcg/L. Our study aimed at identifying factors associated with a higher-than-expected residual RXA plasma concentration in a large group of real-life patients. Materials and Methods This retrospective single-centre study included all patients taking RXA between 2012 and 2016 where RXA plasma concentration was determined by pharmacodynamic anti-Xa assay (518 measurements in 368 patients). Medical records were reviewed. Residual RXA plasma concentrations were then compared with expected values according to a pharmacokinetic model. Results Residual RXA plasma concentration was significantly higher-than-expected in patients with atrial fibrillation, impaired kidney function (glomerular filtration rate [GFR] 50 mcg/L at 24 to 48 hours after the last RXA intake. Conclusion In our group of real-life patients, impaired kidney function (GFR

Hochfeste Tiefziehstähle und kurze Produktzyklen erfordern immer kürzere Amortisationszeiten der Werkzeuge. Daher wurden in den letzten Jahren neue Technologien zur automatisierten Oberflächenbearbeitung entwickelt. In den vorliegenden Untersuchungen wurde das Optimierungspotenzial einer Kombination aus automatisierter Oberflächenbearbeitung und lastangepasstem Werkstoff, sogenanntem Austempered Ductile Iron (ADI), ermittelt. High-strength steel for deep-drawn products as well as brief product cycles require short time-to-values of tools. Thus, new technologies for automated surface treatments have been developed in the last years. Within the scope of the presented investigations, the potential for optimization of a combination of automated surface treatment and load-adjusted materials such as Austempered Ductile Iron (ADI) is examined.

Continually increasing exhaust emission standards for automobiles and an increasing environmental awareness push design engineers to develop new constructive and material concepts. So-called sandwich panels, consisting of stiff facings and light-weight cores, offer the possibility to combine properties of different materials synergistically. When processing large quantities, as is the case in the automotive industry commonly used manufacturing processes for cutting sandwich panels, like sawing or milling, are not applicable. A common manufacturing process to cut metal sheets in high quantities is shear cutting. However, pre-trials of shear cutting of sandwich panels have shown that it is not possible to achieve flawless cutting surfaces with current process layouts. Characteristic types of failure like high bending of the facings, delamination effects, burr formation and an undefined cracking of the core material were ascertained. Thus, in this study, the influence of cutting parameters, such as the clearance and the punch diameter, on these types of failure is examined. Five different clearances between 0.025 mm and 0.4 mm with two punch diameters, 8 mm and 32 mm, were investigated. In order to compare the influence of different materials, three commercially available sandwich panels were studied. The chosen sandwich panels differ both in the face sheet thickness and the core material. Finally, the shear cutting force is measured to identify a possible correlation between the cutting force and the face bending. As a result, optimal clearances to minimize the face bending are derived. Additionally, the influence of the core stiffness on the cutting force is determined.

Vorstellung der Kasuistik eines 60-jahrigen Patienten mit Verletzung durch einen schweren Gegenstand am zervikothorakalen Ubergang. Bei progredienter Dyspnoe infolge einer entstandenen Paraplegie erfolgte die Intubation mittels Larynxtubus bei schwierigem Atemweg. Bergungstechnisch wurde die Indikation zur Windenbergung des Patienten mittels Rettungshelikopter im unwegsamen Baustellengelande gestellt. Diskussion der folgenden Punkte: praklinischer schwieriger Atemweg und Windenbergung eines beatmeten Patienten.

Background At the University Hospital Zurich (USZ) and the Cantonal Hospital of Lucerne (LUKS) an individualized goal-directed coagulation and transfusion algorithm was introduced and implemented before 2012 (Coagulation algorithm of the USZ: USZ-Alg; of the LUKS: LUKS-Alg). Main differences between both algorithms are: 1) A target haematocrit-range of 0.21–0.24 (USZ-Alg) vs. a lower haematocrit limit only (LUKS-Alg). 2) Blind coagulation-package in selected cases (LUKS-Alg only). 3) Factor XIII substitution is considered earlier according to the USZ-Alg. The Aim of this study was to analyse the impact of two different coagulation algorithms on the administration of allogeneic blood products, coagulation factors, the frequency of point of care measurements and haemoglobin level during resuscitation in trauma patients. Methods This retrospective, multicentre, observational study included all adult trauma patients with an injury severity score (ISS) ≥ 16 primarily admitted to the USZ or the LUKS in the period of 2012 to 2014. Referred patients and patients with missing/incomplete records of the initial treatment at the emergency department (ED) were excluded. Two propensity score matched groups were created using a non-parsimonious logistic regression to account for potential differences in patient and trauma epidemiology. Results A total of 632 patients meeting the inclusion criteria were admitted to the two hospitals: 428 to the USZ and 204 to the LUKS. Two Propensity score matched groups (n = 172 per group) were created. Treatment with USZ-Alg compared with LUKS-Alg resulted in a lower number of patients receiving RBC transfusion (11.6% vs. 29.7%, OR 3.2, 95% CI 1.8–5.7, p

The tetradymite compound BiSbTeSe$_2$, is one of the most bulk-insulating three-dimensional topological insulators, which makes it important in the topological insulator research. It is a member of the solid-solution system Bi$_{2-x}$Sb$_x$Te$_{3-y}$Se$_y$, for which the local crystal structure, such as the occupation probabilities of each atomic site, is not well understood. We have investigated the temperature and polarization dependent spontaneous Raman scattering in BiSbTeSe$_2$, revealing a much higher number of lattice vibrational modes than predicted by group theoretical considerations for the space group R$\bar{3}$m corresponding to an ideally random solid-solution situation. The density functional calculations of phonon frequencies show a very good agreement with experimental data for parent material Bi$_2$Te$_3$, where no disorder effects were found. In comparison to Bi$_2$Te$_3$ the stacking disorder in BiSbTeSe$_2$, causes a discrepancy between theory and experiment. Combined analysis of experimental Raman spectra and DFT calculated phonon spectra for different types of atomic orders showed coexistence of different sequences of layers in the material and that those with Se in the center and a local order of Se-Bi-Se-Sb-Te, are the most favored., Comment: 6 pages, 4 figures, 2 tables

In the last years it has become evident that the use of blood products should be reduced whenever possible. There is increasing evidence regarding serious adverse events, including higher mortality and morbidity, related to transfusions. The use of point of care (POC) devices integrated in algorithms is one of the important mechanisms to limit blood product exposure. Any type of algorithm, especially the POC-based ones, allows goal-directed transfusions of blood products and even better targeted factor concentrate substitutions. Different types of algorithms in different surgical settings (cardiac surgery, trauma, liver surgery etc.) have been established with growing interest in their use as they offer objective therapy for management and reduction of blood product use. The use of POC devices with evidence-based algorithms is important in the bleeding patient independent of its origin (traumatic vs. surgical). The use of factor concentrates compared to the classical blood products can be cost-saving, beneficial for the patient, and in agreement with the WHO-requested standard of care. The empiric and uncontrolled use of blood products such as fresh frozen plasma, red blood cells, and platelets without POC monitoring should no longer be followed with regard to actual evidence in literature. Furthermore, the use of factor concentrates may provide better outcomes and potential for cost saving.

There is limited data on prehospital administration of tranexamic acid (TXA) in civilian trauma. The aim of this study was to evaluate changes in coagulation after severe trauma from on-scene to the hospital after TXA application in comparison to a previous study without TXA.The study protocol was registered at ClinicalTrials.gov (NCT02354885). A prospective, multicenter, observational study investigating coagulation status in 70 trauma patients receiving TXA (1 g intravenously) on-scene versus a control group of 38 patients previously published without TXA. To account for potential differences in patient and trauma epidemiology, crystalloid and colloidal resuscitation fluid, 2 propensity score matched groups (n = 24 per group) were created. Measurements included ROTEM, standard coagulation tests and blood gas analyses on-scene and emergency department admission. Presented values are mean and [standard deviation], and difference in means and 95% confidence intervals.Patient epidemiology was not different between groups. Coagulation assays on-scene were comparable between the TXA and C. Prehospital hyperfibrinolysis was blunted in all 4 patients in the TXA group. Viscoelastic FIBTEM maximum clot firmness (MCF), representing functional fibrinogen levels, did not change from on-scene to the emergency department in the TXA group, whereas MCF decreased -3.7 [1.8] mm in the control group. Decrease of MCF was significantly reduced in the TXA group in EXTEM by 9.2 (7.2-11.2) mm (P.001) and INTEM by 6.8 (4.7-9.0) mm (P.001) in favor of the TXA group. Production of fibrinogen fragments (represented by D-dimers) was significantly lower in the TXA group compared to group C.Early prehospital administration of TXA leads to clot stabilization and a reduction of fibrinolytic activity, causing a decrease in fibrin degradation products buildup (D-dimer).

Tranexamic acid is used both pre-hospital and in-hospital as an antifibrinolytic drug to treat or prevent hyperfibrinolysis in trauma patients; dosing, however, remains empirical. We aimed to measure plasma levels of tranexamic acid in patients receiving pre-hospital anti-hyperfibrinolytic therapy and to build a population pharmacokinetic model to propose an optimised dosing regimen. Seventy-three trauma patients were enrolled and each received tranexamic acid 1 g intravenously pre-hospital. A blood sample was drawn after arrival in the emergency department, and we measured the plasma tranexamic acid concentration using liquid chromatography-mass spectrometry, and modelled the data using non-linear mixed effect modelling. Tranexamic acid was administered at a median (IQR [range]) time of 43 (30-55 [5-135]) min after trauma. Plasma tranexamic acid levels were determined on arrival at hospital, 57 (43-70 [20-148]) min after pre-hospital administration of the drug. The measured concentration was 28.7 (21.5-38.5 [8.7-89.0]) μg.ml-1 . Our subjects had sustained severe trauma; injury severity score 20 (16-29 [5-75]), including penetrating injury in 2.8% and isolated traumatic brain injury in 19.7%. The pharmacokinetics were ascribed a two-compartment open model with body-weight as the main covariate. As tranexamic acid concentrations may fall below therapeutic levels during initial hospital treatment, we propose additional dosing schemes to maintain a specific target blood concentration for as long as required. This is the first study to investigate plasma level and pharmacokinetics of tranexamic acid after pre-hospital administration in trauma patients. Our proposed dosing regimen could be used in subsequent clinical trials to better study efficacy and tolerance profiles with controlled blood concentrations.