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Introduction: Allergic diseases represent a broad spectrum of high-prevalence, chronic conditions that remain underdiagnosed and undertreated. The aims of this interdisciplinary, questionnaire-based, non-interventional study were to identify and analyze potential barriers to clinical allergological care in Germany. Methods: All hospitals listed in the German hospital register involved in the treatment of allergological patients (n = 899) were invited to participate. The study yielded a response rate of 52.1% (n = 468). Results: Overall, 88.5% of clinics agreed that allergological care in Germany needs improvement, especially in terms of reimbursement for diagnostics and therapy. More than 80% of participating clinics reported that the decreased availability of test substances and the time-intensity of allergological testing represent relevant barriers. For dermatology and pulmonology, the former is the strongest barrier, while for pediatric and ENT clinics, time-intensity is regarded as the strongest barrier. The availability of good therapy and appropriate guidelines present no barriers to allergological care. Regarding the use of digital healthcare concepts, a very large majority of clinics (n = 352; 91.4%) do not offer video consultations or the use of health applications in patient care. Conclusion: In conclusion, we have identified several structural barriers to allergological care in Germany. Reimbursement and the use of digital healthcare concepts in German clinics providing allergological care need improvement. Based on the results of this study, there is an urgent need for researchers and policymakers to further investigate and support allergology departments in their clinical work and in their implementation of digital healthcare concepts.

Secondary rhinoplasty is a challenging procedure, requiring a precise preoperative diagnosis of nasal deformities before correcting them. As there is currently no accepted outcome measurement tool available to assess unilateral cleft lip and palate (UCLP) nose sequelae before secondary rhinoplasty. The goal of this retrospective study is to identify the nose deformities and rate them in an evaluation scale that allows collecting and analyzing cleft nose data. Our retrospective cohort is composed of 29 patients with UCLP, who underwent secondary rhinoplasty between 2010 and 2021 in a cleft center, with a mean age of 23years old. Evaluation of deformities is made from preoperative two-dimensional photography. The assessment photographic tool is a custom-designed scale of 16 items. A binary scoring system is used by two experts to assess nasolabial deformities. The most encountered sequelaes are the alar foot displacement (93%), the enlarged tip (90%) and the nostril horizontalization (86%). The inter-examiner ICC for total rating was calculated at 0.911 and indicated a strong level of reliability that was highly significant (P0.05). The simplicity, reliability and reproducibility of the proposed assessment system could be interesting for clinicians, in order to diagnose the nasal deformities before surgery, but also to assess postoperative success of a secondary rhinoplasty and thus to compare several surgical techniques.

Objective The Latina(o)/Hispanic (L/H) population represents the largest and fastest-growing ethnic group in the United States. Migration patterns have evolved and greater diversity (i.e., country of origin) is evident, highlighting the ever-changing heterogeneity of this community and the need for the field of neuropsychology to ensure equitable care for linguistically and culturally diverse communities. This paper aims to provide a flexible protocol of neuropsychological instruments appropriate for primarily Spanish-speaking adults residing in the United States. Method Spanish measures were selected based on availability, translations/cultural modifications, accompanying normative data sets, and clinician experience/acumen. Bilingual/bicultural providers of neuropsychological services to Spanish speakers across the training spectrum working at U.S.-based medical centers implemented a multimodal approach (i.e., literature search, clinical practice parameters, and focus groups) in the development of a multi-domain primary protocol that includes core and supplemental measures that are appropriate for individuals with varying linguistic proficiency and sociocultural demographic characteristics. Results A multi-domain, evidence-based, flexible neuropsychological protocol is presented. Recommendations for test selection based on sociocultural demographic factors and examples of clinical assessment practices are provided via a case illustration. Most instruments included may be applied across cultural and regional backgrounds. Conclusion Provision of neuropsychological services to primarily Spanish-speaking adults presents unique challenges. Existing Spanish measures and accompanying data rarely capture the heterogeneity of L/H individuals. Although Spanish has the largest number of neurocognitive instruments, relative to other languages, robust and representative norms continue to be scarce. Future studies should prioritize collecting normative data from educationally and geographically diverse samples.

In this article, the Greek temple is set into a larger historical and cultural context, comparing it with Near Eastern and especially Syrian temples. The author argues that the Syrian temple in antis played a significant role in the development of the Greek prostyle temple. This is demonstrated by briefly highlighting the mostly overlooked aspects of Oriental or Syrian building traditions, which, in addition to other traditions in the Mediterranean, could have played an influential role in the conception of the Greek temple cella.

Artificial intelligence (AI) and convolutional neural networks (CNNs) represent rising trends in modern medicine. However, comprehensive data on the performance of AI practices in clinical dermatologic images are non-existent. Furthermore, the role of professional data selection for training remains unknown.The aims of this study were to develop AI applications for outlier detection of dermatological pathologies, to evaluate CNN architectures' performance on dermatological images, and to investigate the role of professional pre-processing of the training data, serving as one of the first anchor points regarding data selection criteria in dermatological AI-based binary classification tasks of non-melanoma pathologies.Six state-of-the-art CNN architectures were evaluated for their accuracy, sensitivity, and specificity for five dermatological diseases and using five data subsets, including data selected by two dermatologists, one with five and the other with eleven years of clinical experience.Overall, 150 CNNs were evaluated on up to 4051 clinical images. The best accuracy was reached for onychomycosis (accuracy=1.000), followed by bullous pemphigoid (accuracy=0.951) and lupus erythematosus (accuracy=0.912). The CNNs InceptionV3, Xception, and ResNet50 achieved the best accuracy in 9, 8, and 6 out of 25 datasets, respectively (36.0%, 32.0%, and 24.0%). On average, the dataset provided by the senior physician and the dataset provided in accordance with both dermatologists performed the best (accuracy=0.910).This AI approach for the detection of outliers in dermatological diagnoses represents one of the first studies to evaluate the performance of different CNNs for binary decisions in clinical non-dermatoscopic images of a variety of dermatological diseases other than melanoma. The selection of images by an experienced dermatologist during pre-processing had substantial benefits for the performance of the CNNs. These comparative results might guide future AI approaches to dermatology diagnostics, and the evaluated CNNs might be applicable for the future training of dermatology residents.

BACKGROUND: A stringent systematic review of population-based observational studies focusing on the physical health of self-employed individuals as a basis for the development of targeted prevention strategies is lacking. OBJECTIVE: We aimed to systematically evaluate all the studies of good quality that compared the occurrence of chronic physical disorders in self-employed individuals with that of employees. METHODS: We searched three major medical databases (MEDLINE, Web of Science, Embase) following the Cochrane guidelines. The quality of the studies was rated based on the slightly modified validated assessment tool that was developed by Hoy et al. RESULTS: We included 16 population-based studies of good quality, with data from 15,369,964 participants in total. The two longitudinal evaluations of Swedish national registers with the longest follow-up periods showed increased cardiovascular mortality and incidence estimates of cardiovascular disease in self-employed individuals compared with those of white-collar (i.e., nonmanual) employees but decreased risk estimates compared with those of blue-collar (i.e., manual) workers. The results of the shorter cohort studies were heterogeneous. In cross-sectional studies, prevalence estimates for musculoskeletal, respiratory and malignant diseases were higher among self-employed individuals than among employees. CONCLUSION: The long-term cardiovascular disease risk and mortality of self-employed individuals seemed to be higher than those of white-collar employees but lower than those of blue-collar employees. As a basis for targeted prevention strategies, further longitudinal studies in different settings are required to better understand the development of physical health disorders for specific self-employment categories such as sole proprietors, small entrepreneurs, family businesses and others.

Axial spondyloarthritis (axSpA) is an underdiagnosed condition with a high disease burden. Due to delayed diagnosis and limited access to specialist care, conventional health data might not sufficiently capture the perspective of affected individuals. The aim of this study was to assess public interest, unmet needs, and disease burden of axSpA in Germany through the analysis of thematic, geographic, and temporal patterns in national web search data. Google Ads Keyword Planner was used to identify axSpA-related keywords and their monthly search volume in Germany between January 2017 and December 2020. Identified keywords were qualitatively categorized into six categories. Overall, 265 axSpA-related keywords with a search volume of 3,881,490 queries were identified. Nearly 81% of the total search volume was assigned to the category terms and definition, while 19% referred to either outcomes, symptoms, diagnosis, management, or causes. In the category outcomes, prognostic outcomes like “life expectancy” generated more searches than physical manifestations like “pain”. Less populated cities showed significantly more searches per 100,000 inhabitants than larger cities. Searches were seasonally stable with a Germany-wide peak in July 2017. This study provides an overview of public interest in axSpA based on web search data in Germany. The identified search patterns could be used to guide public health campaigns and optimize axSpA management in Germany.

Zusammenfassung. Vorgestellt wird die Entwicklung und testpsychologische Evaluation des Multidimensionalen Düsseldorfer Trauminventars (MDTI), eines Fragebogens zur Erfassung des Traumerlebens unabhängig vom Trauminhalt. Dazu wurde eine Vorläuferversion, das Düsseldorfer Trauminventar (DTI; 51 Items), einer Stichprobe aus N = 715 vorgelegt, welche über E-Mail-Verteiler an Universitäten, sozialen Netzwerke sowie Medizin- und Traumforen rekrutiert und zu einem digitalen Fragebogenformular weitergeleitet wurden. Die Stichprobe bestand aus n = 444 weiblichen (62 %) und n = 270 männlichen (38 %) Teilnehmenden. Ihr Alter lag zwischen 15 und 73 Jahren. Das mittlere Alter betrug M = 30.03 Jahre ( SD = 10.36). Die Items wurden einer Hauptkomponentenanalyse mit obliquer Rotation unterzogen, um anschließend die reliabelsten und validesten Items herauszufiltern. Die Faktorenanalyse ergab eine eindeutige 5-faktorielle Struktur des Fragebogens mit sehr guten Reliabilitäten der Subskalen. Die verbliebenen 27 Items bilden nun die 5 Skalen des als Multidimensionales Düsseldorfer Trauminventar (MDTI) bezeichneten Fragebogens: (1) Inkorporation von Tagesereignissen, (2) Angenehme Trauminhalte, (3) Traumerinnerung, (4) Aversive Trauminhalte und (5) Persönliche Bedeutsamkeit der Träume. Mit dem MDTI ist es möglich, das Traumerleben unabhängig vom Trauminhalt zu erfassen.

Simulation of absorbed dose deposition in a detector is one of the key tasks of Monte Carlo (MC) dosimetry methodology. Recent publications (Hartmann and Zink, 2018; Hartmann and Zink, 2019; Hartmann et al., 2021) have shown that knowledge of the charged particle fluence differential in energy contributing to absorbed dose is useful to provide enhanced insight on how response depends on detector properties. While some EGSnrc MC codes provide output of charged particle spectra, they are often restricted in setup options or limited in calculation efficiency. For detector simulations, a promising approach is to upgrade the EGSnrc code egs_chamber which so far does not offer charged particle calculations.Since the user code cavity offers charged particle fluence calculation, the underlying algorithm was embedded in egs_chamber. The modified code was tested against two EGSnrc applications and DOSXYZnrc which was modified accordingly by one of the authors. Furthermore, the gain in efficiency achieved by photon cross section enhancement was determined quantitatively.Electron and positron fluence spectra and restricted cema calculated by egs_chamber agreed well with the compared applications thus demonstrating the feasibility of the new code. Additionally, variance reduction techniques are now applicable also for fluence calculations. Depending on the simulation setup, considerable gains in efficiency were obtained by photon cross section enhancement.The enhanced egs_chamber code represents a valuable tool to investigate the response of detectors with respect to absorbed dose and fluence distribution and the perturbation caused by the detector in a reasonable computation time. By using intermediate phase space scoring, egs_chamber offers parallel calculation of charged particle fluence spectra for different detector configurations in one single run.

For decades, most prehospital clinicians have only been armed with needle thoracostomy to treat a tension pneumothorax, which has a significant failure rate. Following recent changes by the US military, more ground and air transport agencies are adopting simple thoracostomy, also commonly referred to as finger thoracostomy, as a successful alternative. However, surgical procedures performed by prehospital clinicians remain uncommon, intimidating, and challenging. Therefore, it is imperative to adopt a training strategy that is comprehensive, concise, and memorable to best reduce cognitive load on clinicians while in a high-acuity, low-frequency situation. We suggest the following mnemonic to aid in learning and retention of the key procedural steps: FINGER (Find landmarks; Inject lidocaine/pain medicine; No infection allowed; Generous incision; Enter pleural space; Reach in with finger, sweep, reassess). This teaching aid may help develop and maintain competence in the simple thoracostomy procedure, leading to successful treatment of both a tension pneumothorax and hemothorax.

The number of publications of prospective surgical residents has steadily increased over the past decade as the emphasis on research output has become paramount. However, the reported data from the National Resident Matching Program (NRMP) does not discriminate amongst impact, author position, and region of matched residents. This study aimed to evaluate categorical general surgery postgraduate year 1 (PGY-1) residents' research productivity by programs' research impact and region of the United States and support the need for additional public data on research metrics of accepted applicants. We hypothesize that residents accepted to top quartile schools will have more total and first author publications and higher h-index compared to residents in the other quartiles, and research metrics would not differ amongst the regions.The Doximity Residency Navigator was used to sort general surgery programs based on research output, which was determined by the average h-index of residents. All 2021 matriculating PGY-1 categorical residents from the top two programs from each region and quartile that met study criteria were included in the analysis. Web of Science (WoS) citation database was used to collect prior to residency and current total publications, and the first, last, and corresponding author positions of these publications. Residents' h-index and various research metrics reported by WoS were recorded. Descriptive statistics were used to examine the association between quartile and region.Categorical general surgery residency programs throughout the United States.Categorical PGY-1 general surgery residents.The median total number of publications prior to residency was 1 (IQR = 0-5). The median total number of first-author publications prior to residency was 0 (IQR = 0-1), and the current h-index was 0 (IQR = 0-2). The top quartile had more total and first author publications prior to residency, while the other quartiles had similar metrics. Each region had similar total publications and h-index.Research output is significant for applicants applying to top-quartile research programs compared to the other 3 quartiles and is relatively similar throughout all regions of the United States. Public data is limited to future applicants.