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Objective: To describe how a partnered evaluation of the Whole Health (WH) system of care-comprised of the WH pathway, clinical care, and well-being programs--produced patient outcomes findings, which informed Veterans Health Administration (VA) policy and system change. Data Sources: Electronic health records (EHR)-based cohort of 1,368,413 patients and a longitudinal survey of Veterans receiving care at 18 WH pilot medical centers. Study Design: In partnership with VA operations, we focused the evaluation on the impact of WH services utilization on Veterans' (1) use of opioids and (2) care experiences, care engagement, and well-being. Outcomes were compared between Veterans who did and did not use WH services identified from the EHR. Data Collection: Pharmacy records and WH service data were obtained from the VA EHR, including WH coaching, peer-led groups, personal health planning, and complementary, integrative health therapies. We surveyed veterans at baseline and 6 months to measure patient-reported outcomes. Principal Findings: Opioid use decreased 23% (31.5-6.5) to 38% (60.3-14.4) among WH users depending on level of WH use compared to a secular 11% (12.0-9.9) decrease among Veterans using Conventional Care. Compared to Conventional Care users, WH users reported greater improvements in perceptions of care (SMD = 0.138), engagement in health care (SMD = 0.118) and self-care (SMD = 0.1), life meaning and purpose (SMD = 0.152), pain (SMD = 0,025), and perceived stress (SMD = 0.191). Conclusions: Evidence developed through this partnership yielded key VA policy changes to increase Veteran access to WH services. Findings formed the foundation of a congressionally mandated report in response to the Comprehensive Addiction and Recovery Act, highlighting the value of WH and complementary, integrative health and well-being programs for Veterans with pain. Findings subsequently informed issuance of an Executive Decision Memo mandating the integration of WH into mental health and primary care across VA, now one lane of modernization for VA. KEYWORDS *evaluation design and research, health care organizations and systems, health policy/politics/law/regulation, patient assessment/satisfaction, VA health care system What is known on this topic * Policy decisions regarding large-scale system changes often cannot wait for research results to inform policy. * The Veterans Health Administration (VA) has been working on the implementation of the Whole Health System (WHS) of Care, an approach to health care that focuses on what matters most to patients to empower and equip them to take charge of their health and well-being. * Little is known about the impact of VA's implementation of the WHS on important Veteran outcomes. What this study adds * Collaboration between researchers and operational partners informed the structure and relevant outcomes for timely evaluation. * Use of WHS services resulted in improvements in patient-reported outcomes and reductions in opioid use for Veterans with chronic pain. * Findings presented to key stakeholders led to policy changes to expand the implementation of the WHS., 1 | INTRODUCTION The United States Veterans Health Administration (VA) is the nation's second largest integrated health care system, serving approximately 8.9 million military Veterans. Since the landmark 2001 Institute [...]

In this paper, we investigate the possibility of performing Gaussian elimination for arbitrary binary matrices on hardware. In particular, we presented a generic approach for hardware-based Gaussian elimination, which is able to process both non-singular and singular matrices. Previous works on hardware-based Gaussian elimination can only process non-singular ones. However, a plethora of cryptosystems, for instance, quantum-safe key encapsulation mechanisms based on rank-metric codes, ROLLO and RQC, which are among NIST post-quantum cryptography standardization round-2 candidates, require performing Gaussian elimination for random matrices regardless of the singularity. We accordingly implemented an optimized and parameterized Gaussian eliminator for (singular) matrices over binary fields, making the intense computation of linear algebra feasible and efficient on hardware. To the best of our knowledge, this work solves for the first time eliminating a singular matrix on reconfigurable hardware and also describes the a generic hardware architecture for rank-code based cryptographic schemes. The experimental results suggest hardware-based Gaussian elimination can be done in linear time regardless of the matrix type.

Genotype-limited plant regeneration is one of the main obstacles to the broader use of genetic transformation in barley breeding. Thus, developing new approaches that might improve responses of in vitro recalcitrant genotypes remains at the center of barley biotechnology. Here, we analyzed different barley genotypes, including “Golden Promise,” a genotype commonly used in the genetic transformation, and four malting barley cultivars of poor regenerative potential. The expression of hormone-related transcription factor (TF) genes with documented roles in plant regeneration was analyzed in genotypes with various plant-regenerating capacities. The results indicated differential expression of auxin-related TFgenes between the barley genotypes in both the explants and the derived cultures. In support of the role of auxin in barley regeneration, distinct differences in the accumulation of free and oxidized auxin were observed in explants and explant-derived callus cultures of barley genotypes. Following the assumption that modifying gene expression might improve plant regeneration in barley, we treated the barley explants with trichostatin A (TSA), which affects histone acetylation. The effects of TSA were genotype-dependent as TSA treatment improved plant regeneration in two barley cultivars. TSA-induced changes in plant regeneration were associated with the increased expression of auxin biosynthesis-involved TFs. The study demonstrated that explant treatment with chromatin modifiers such as TSA might provide a new and effective epigenetic approach to improving plant regeneration in recalcitrant barley genotypes.

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Our aim was to evaluate health-related quality-of-life (HRQoL) of the patients with critical illness neuropathy and/or myopathy after severe COVID-19 during their rehabilitation. The prospective cohort study included 157 patients (median age 64 years) admitted to rehabilitation. HRQoL was assessed the using European Quality 5-Dimensions questionnaire [EQ-5Dindex, range 0(or exceptionally less) to 1, and Visual Analogue Scale (VAS), range 0–100], which was completed by the patients at admission and discharge. Additionally, they were assessed with the de Morton Mobility Index (DEMMI), the 6-Minute Walk Test (6MWT), and the Functional Independence Measure (FIM). Median EQ-5Dindexwas 0.32 and median EQ VAS was 48 at admission, and median EQ-5Dindexwas 0.61 and median EQ VAS 80 at discharge. Some or extreme problems were reported by 154 (98%) patients regarding the mobility dimension, 151 (96%) regarding usual activities, 136 (87%) regarding self-care, 84 (54%) regarding pain or discomfort dimension, and 52 patients (34%) regarding anxiety or depression at admission. At discharge, some or extreme problems were still reported by 96 patients (61%) regarding mobility, 95 (61%) regarding usual activities, 70 patients (45%) regarding pain or discomfort, 46 (29%) regarding self-care, and 19 patients (12%) regarding anxiety or depression. At the same time, the patients exhibited significant improvements in the DEMMI (median increased from 41 to 67 points), 6MWT (from 60 to 293 m) and motor FIM (from 56 to 84 points). The improvement of the self-reported HRQoL was, thus, paralleled by the improvements in clinician-assessed mobility, walking endurance and functional independence.

Post-Quantum Cryptography (PQC) has emerged as a response of the cryptographic community to the danger of attacks performed using quantum computers. All PQC schemes can be implemented in software and hardware using conventional (non-quantum) computing systems. PQC is the biggest revolution in cryptography since the invention of public-key schemes in the mid-1970 s. Lattice-based key exchange schemes have emerged as leading candidates in the NIST PQC standardization process due to their relatively short public keys and ciphertexts. This paper presents novel high-speed hardware architectures for four lattice-based Key Encapsulation Mechanisms (KEMs) representing three NIST PQC finalists: NTRU (with two distinct variants, NTRU-HPS and NTRU-HRSS), CRYSTALS-Kyber, and Saber. We benchmark these candidates in terms of their performance and resource utilization in today's FPGAs. Our best architectures outperform the best designs from other groups reported to date in terms of the area-time product by factors ranging from 1.01 to 2.88, depending on the algorithm and security level. Additionally, our study demonstrates that CRYSTALS-Kyber and Saber have very similar hardware performance. Both outperform NTRU in terms of execution time by a factor 36-62 for key generation and 3-7 for decapsulation, assuming the same security level.

In this paper, we investigate the practical performance of rank-code based cryptography on FPGA platforms by presenting a case study on the quantum-safe KEM scheme based on LRPC codes called ROLLO, which was among NIST post-quantum cryptography standardization round-2 candidates. Specifically, we present an FPGA implementation of the encapsulation and decapsulation operations of the ROLLO KEM scheme with some variations to the original specification. The design is fully parameterized, using code-generation scripts to support a wide range of parameter choices for security levels specified in ROLLO. At the core of the ROLLO hardware, we presented a generic approach for hardware-based Gaussian elimination, which can process both non-singular and singular matrices. Previous works on hardware-based Gaussian elimination can only process non-singular ones. However, a plethora of cryptosystems, for instance, quantum-safe key encapsulation mechanisms based on rank-metric codes, ROLLO and RQC, which are among NIST post-quantum cryptography standardization round-2 candidates, require performing Gaussian elimination for random matrices regardless of the singularity. To the best of our knowledge, this work is the first hardware implementation for rank-code-based cryptographic schemes. The experimental results suggest rank-code-based schemes can be highly efficient.

CRISPR technology has demonstrated broad utility for controlling target gene expression; however, there remains a need for strategies capable of modulating expression via the precise editing of non-coding regulatory elements. Here, we demonstrate that CRISPR base editors, a class of gene-modifying proteins capable of creating single-base substitutions in DNA, can be used to perturb gene expression via their targeted mutagenesis of cis-acting sequences. Using the promoter region of the human huntingtin (HTT) gene as an initial target, we show that editing of the binding site for the transcription factor NF-κB led to a marked reduction in HTT gene expression in base-edited cell populations. We found that these gene perturbations were persistent and specific, as a transcriptome-wide RNA analysis revealed minimal off-target effects resulting from the action of the base editor protein. We further demonstrate that this base-editing platform could influence gene expression in vivoas its delivery to a mouse model of Huntington’s disease led to a potent decrease in HTT mRNA in striatal neurons. Finally, to illustrate the applicability of this concept, we target the amyloid precursor protein, showing that multiplex editing of its promoter region significantly perturbed its expression. These findings demonstrate the potential for base editors to regulate target gene expression.

A fracture in the thoracolumbal junction may cause complete or incomplete damage to the spinal cord, conus medullaris or cauda equina and result in an isolated or mixed lesion of the upper and lower motor neurons causing leg weakness and urinary/bowel/sexual dysfunction. In this retrospective cross-sectional study, we aimed to describe electrodiagnostic and urodynamic findings after thoracolumbal fractures and determine potential discriminating factors. We identified 74 cases (mean age 42 years, range 16–79 years, 55 men) admitted to our institution between 2008 and 2018 for Th12, L1 or L2 vertebral fractures, and retrieved from their medical records available demographic, clinical, electrodiagnostic and urodynamic data. The most common electrodiagnostic findings in the lower limbs (n= 40) were moderate-to-severe L3–S1 (35%) and L5–S1 (40%) lesions. As to the external anal sphincter (n= 33), the most frequent findings were an incomplete cauda equina (39%) or conus medullaris (15%) lesion, followed by the combined upper and lower motor neuron lesion (12%). Only the fracture level (with peripheral damage) was statistically significantly associated with electromyography findings. Detrusor overactivity or underactivity was each present in 37 (50%) cases. Those with Th12 versus L1–L2 fractures had higher odds of exhibiting detrusor overactivity; men had higher odds of using clean intermittent catheterization for bladder emptying than women. In summary, detrusor overactivity is common after fractures at the thoracolumbal junction and urodynamic findings are essential for proper diagnosis and selection of therapeutic approach. Combining urodynamic and electrodiagnostic studies is especially valuable in the presence of L1 fracture and lower urinary tract symptoms.

The objective of this study was to examine life satisfaction and athletic identity among para-alpine skiers and explore their associations with sociodemographic, sports practice, and disability-related characteristics of the participants. The respondents to the on-site survey were 129 para-alpine ski racers with acquired disability from 33 countries on all five continents who competed in the Paralympic games in Sochi (aged 16–53 years, mean and median 30 years, 100 men). Two self-developed assessment instruments were used – a 7-point Likert-type life-satisfaction questionnaire probing seven domains (health, family, education, freedom, friends, travelling, and self) and the Athletic Identity Scale (AIS; possible score range 17–85). The independence between life-satisfaction items was confirmed by low interitem correlations (largest absolute value <0.25, 15 of 21, and <0.15). The estimated internal-consistency reliability (Guttman lambda-2) of AIS was 0.65. The reported life satisfaction was very high (median of 6 for all domains except education, where it was 5). Like life-satisfaction ratings, the AIS scores were also very high on average (mean and median score 81). In general, the level of life satisfaction and athletic identity were not notably associated with sociodemographic, sports practice, and disability characteristics of the participants. The likely reason is high average and, hence, low variability of life-satisfaction ratings, as well as imperfect metric characteristics of the AIS. Nonetheless, the overall findings encourage further research into factors that drive the participation of disabled athletes in (winter) Paralympic games and the possible role of the rehabilitation process in this regard.

With a population of about 250,000 the city of Lausanne, in Switzerland, is unusually small to have its own subway line, particularly a fully-automatic one. The goal of this ambitious [...]

The tremendous growth in communication and media technology and the wide availability of cheaper end using devices have made 3D video communication very popular due to its immersive experience. It has been observed that a 3D video can be produced either by direct accusation using a 3D camera (say real 3D video) or by rendering from a set of 2D images (say fake 3D video). There are several occasions where it is required to distinguish between such real and fake 3D video sequences. In this paper, an algorithm is proposed which can distinguish the real 3D video from the fake one. A set of distinguishing features has been identified which are primarily based on the vertical parallax and sharpness peculiarities of object edges due to 3D acquisition process and rendering. Finally, two different supervised learning classifiers (Support Vector Machines and Linear discriminant analysis), are being trained using these features to detect the fake 3D video sequences. A comprehensive set of experiments has been carried out to justify the applicability of the proposed detection scheme over the recent existing scheme.

Identification of genetic factors leading to increased risk of suicide death is critical to combat rising suicide rates, however, only a fraction of the genetic variation influencing risk has been accounted for. To address this limitation, we conducted the first comprehensive analysis of rare genetic variation in suicide death leveraging the largest suicide death biobank, the Utah Suicide Genetic Risk Study (USGRS). We conducted a single‐variant association analysis of rare (minor allele frequency <1%) putatively functional single‐nucleotide polymorphisms (SNPs) present on the Illumina PsychArray genotyping array in 2,672 USGRS suicide deaths of non‐Finnish European (NFE) ancestry and 51,583 NFE controls from the Genome Aggregation Database. Secondary analyses used an independent control sample of 21,324 NFE controls from the Psychiatric Genomics Consortium. Five novel, high‐impact, rare SNPs were identified with significant associations with suicide death (SNAPC1, rs75418419; TNKS1BP1, rs143883793; ADGRF5, rs149197213; PER1, rs145053802; and ESS2, rs62223875). 119 suicide decedents carried these high‐impact SNPs. Both PER1and SNAPC1have other supporting gene‐level evidence of suicide risk, and psychiatric associations exist for PER1(bipolar disorder, schizophrenia), and for TNKS1BP1and ESS2(schizophrenia). Three of the genes (PER1, TNKS1BP1, and ADGRF5), together with additional genes implicated by genome‐wide association studies on suicidal behavior, showed significant enrichment in immune system, homeostatic and signal transduction processes. No specific diagnostic phenotypes were associated with the subset of suicide deaths with the identified rare variants. These findings suggest an important role for rare variants in suicide risk and implicate genes and gene pathways for targeted replication.

The assets of any employee benefits plan, including a 401(k) plan, are, unless subject to an exception, to be held in trust. Exceptions to ERISA's trust requirement are to be found in three sections of the law. In the spr of 1995, the Department of Labor started enforcement activity because sponsors of some 401(k) plans failed to use the trust or other approved funding vehicle. This enforcement activity continues, and employers should review their policy on holding plan assets of employee benefit plans in trust.

The cryogenic distribution system (CDS) at the European Spallation Source (ESS) connects the refrigeration plant with the linear accelerator, consisting in 13 spoke and 30 elliptical cryomodules that are cooled at 2K via multi-transfer lines, individual valveboxes for every cryomodule and an endbox. The designed control system monitors and controls the cooling helium flow through the CDS. The controls architecture for the CDS is based on one Programmable Logic Controller (PLC) per valvebox and another one for the endbox, which are integrated into EPICS through the Controls Network and takes care of the process functions, making it a total of 44 PLCs. This type of integration allows for the remote operation of the CDS from the control room and the necessary interaction of the control system with other related systems and EPICS services like archiving, alarms and save-and-restore. Pre-commissioning activities like loop checks, temperature curve validation, pressure sensor calibration and valve initialization started in summer 2022. Eventually, the system was ready for commissioning and a first cooldown was performed in December 2022. The paper describes the design, development and commissioning of the control system and diverse challenges during the deployment and commissioning activities. Future activities are discussed including the implementation of a sequencer for automatic cooldown and warmup, integration with the cryomodule controls and a master PLC to handle the helium management.

ABSTRACTObjectives: Suprascapular neuropathy is more frequent in volleyball as compared to other overhead sports. This study aims to report the actual prevalence of suprascapular neuropathy among elite volleyball players. The hypothesis is that becoming jump topspin serves the most common serving technique, suprascapular neuropathy reduced its frequency.Methods: A total of 82 professional players were enrolled in the study. The presence of symptoms and the type of serve preferably performed were investigated. The strength and trophicity of the supraspinatus and infraspinatus muscles were evaluated. Patients with positive clinical findings underwent MRI of the shoulder.Results: The jump topspin serve was found to be the most popular type of serve both in males and females. At physical examination, 9% of the males and 12% of the females presented with infraspinatus muscle hypotrophy. Each case was accompanied by external rotation weakness. None of them complained of pain or reduced performance when they played. MRI confirmed infraspinatus muscle atrophy in all subjects.Conclusion: A lower prevalence of suprascapular neuropathy was found as compared with that previously reported in the 1980s and 1990s. A reduction in the popularity of the float serve seems to be a possible explanation. Thus, the jump topspin serve could be safe for suprascapular neuropathy and associated injuries in volleyball. The findings of this study should be considered by athletes and coaches for the prevention of activity-related injuries.

It is often difficult for the clinician to choose the most appropriate balance-assessment measure. We wanted to facilitate this decision based on the stroke patient’s functional abilities. The aim of our study was to compare three established scales [Berg Balance Scale (BBS), mini-BESTest (MBT) and Functional Gait Assessment (FGA)] in terms of responsiveness, floor and ceiling effects at different levels of ambulation as defined by the Functional Ambulation Classification (FAC). The 18-month prospective study included 88 patients after cerebral stroke, who were able to walk independently or with assistance of one person (FAC 2–6). BBS showed the highest relative gain in the FAC 2–3 group (17% of maximum scale score); in the other two groups (FAC 4–5 and FAC 6), MBT showed the highest relative gain (16 and 13%, respectively), followed by FGA (11 and 10%, respectively). Among the patients with initial FAC 2–3, a floor effect occurred with FGA, while a ceiling effect occurred with BBS among patients with initial FAC 6. Gain in FGA correlated slightly more with improvement detected by MBT (r= 0.60) than with BBS (r= 0.50). We can conclude that BBS seems to be suitable for stroke patients with initial FAC 2–5, whereas MBT and FGA for those with FAC 4–6.

The Measure of Processes of Care for professionals (MPOC-SP) is valid and reliable a self-administered questionnaire for paediatric service providers engaged in care for chronically ill children. Our aim was to evaluate internal consistency reliability, one-year stability and some aspects of validity of its Slovene translation. Sixty-seven service providers from seven professional groups of several hospitals and health centres participated in the study. MPOC-SP mean scores for all four subscales were high; their ranking order was the same as in other MPOC-SP studies. All subscales exhibited sufficient internal consistency (Cronbach alpha from 0.69 to 0.86, adequate corrected item-total correlations). None of the mean subscale scores changed significantly after one year (Pvalues from 0.11 to 0.80). The Slovene translation of the MPOC-SP can therefore be considered a reliable instrument that shows good stability over a period of one year, and as such it can be adopted in clinical practice.

World demography is changing as the population ages and there are more people with disabilities having problems to stay independently at home. Innovative technologies could help extend the independence of older people living at home. As part of a collaborative project, we investigated ownership and use of information and communication technologies (ICT) among older people with lower limb loss (LLL) using questionnaires and retrospective analysis. Our aim was to analyse factors associated with ICT use among people with LLL. We identified age as the main factor that limits ownership and use of ICT among older people with LLL in Slovenia. Cause of amputation also appears to be relevant, whereby those who had amputation because of peripheral vascular disease are more likely to use a personal or tablet computer, social networks, messaging apps, email and internet than those who had amputation because of diabetes. In addition, those living in the suburbs are more likely to use a health monitoring device than those living in the countryside.

Amyotrophic lateral sclerosis (ALS) is a debilitating and fatal disorder that can be caused by mutations in the superoxide dismutase 1 (SOD1) gene. Although ALS is currently incurable, CRISPR base editors hold the potential to treat the disease through their ability to create nonsense mutations that can permanently disable the expression of the mutant SOD1 gene. However, the restrictive carrying capacity of adeno-associated virus (AAV) vectors has limited their therapeutic application. In this study, we establish an intein-mediated trans-splicing system that enables in vivodelivery of cytidine base editors (CBEs) consisting of the widely used Cas9 protein from Streptococcus pyogenes.We show that intrathecal injection of dual AAV particles encoding a split-intein CBE engineered to trans-splice and introduce a nonsense-coding substitution into a mutant SOD1 gene prolonged survival and markedly slowed the progression of disease in the G93A-SOD1 mouse model of ALS. Adult animals treated by this split-intein CRISPR base editor had a reduced rate of muscle atrophy, decreased muscle denervation, improved neuromuscular function, and up to 40% fewer SOD1 immunoreactive inclusions at end-stage mice compared to control mice. This work expands the capabilities of single-base editors and demonstrates their potential for gene therapy.

Patients after ACL have a high risk of developing post-traumatic osteoarthritis (PTOA) regardless surgical reconstruction (ACLR). However, long-term soft tissue degeneration after ACLR and their relationship with patient pain development are largely unknown.

•Novel real-world evidence strategy for rapid data collection urothelial carcinoma.•Fibroblast growth factor receptor alterations did not predict outcomes in overall cohort in first-line setting.•High progression rate in fibroblast growth factor receptor alteration patients post immune checkpoint inhibition.•This understanding may allow physicians to optimize treatment strategy and response.

Low donor heart availability underscores the need to identify all potentially transplantable organs. We sought to determine whether pre-emptive administration of pangenotypic direct-acting antiviral therapy can safely prevent the development of chronic hepatitis C virus (HCV) infection in uninfected recipients of HCV-infected donor hearts.

We examined whether driving-related reaction times differ between 26 healthy adults (university students) and 26 patients after stroke, and how distractors and leg-dominance affect reaction time and correctness of reactions of healthy adults. Reaction times were measured with the Fiat Mediatester driving simulator using 18-lamps reaction test (simple reaction time measurement) and choice reaction test (scored as reaction time and number of correct reactions). There was no statistically significant difference between the groups in simple reaction time. As expected, choice reaction times of the healthy adults were shorter on average and their reactions more accurate than those of the patients. Under the influence of distractors, healthy adults had statistically significantly longer choice and simple reaction times and made fewer correct choices compared to normal conditions. Leg dominance statistically significantly affected choice reaction times and correctness of reactions, but not simple reaction times. Our results confirm validity and usefulness of the Fiat Mediatester driving simulator for research purposes.

Effects of rehabilitation on knee function, activity and health-related quality of life after soft-tissue knee injury have been widely studied in clinical trials, but there is still a lack of data on the relation between knee muscle strength and athlete’s perceived performance to identify sports-risk modifiers. We performed a prospective observational clinical study of knee muscle strength and self-reported health during rehabilitation after unilateral knee soft-tissue injury in recreational sports. Forty-three patients performed isokinetic dynamometry and filled in the Short form Health Survey (SF-36) and the Oxford Knee Score questionnaires before and after 4 months of instructed home strengthening program. We observed significant improvement in peak torque deficit between two limbs during concentric extension (PTDE) and flexion, dynamic control ratio of the involved knee, most of the SF-36 subscales and the Oxford Knee Score values (P≤ 0.001). Dynamic control ratio of the uninvolved knee values remained below referential values and unchanged. Improvement of PTDEcorrelated positively with improvement of the bodily pain subscale of SF-36 score (r= 0.51, P < 0.001). Receiver operating characteristic analysis indicated that reduction of pain by at least nine points predicts at least 10% reduction in PTDE, whereby the bodily pain change achieved poor (56%) sensitivity and good (86%) specificity as a rehabilitation success measure for recreational athletes after knee injury. Primary inferior eccentric strength of noninjured knee hamstrings might indicate increased risk of knee injury. Diminished perceived pain predicts strength improvement of the injured knee extensors with poor sensitivity and good specificity.

ABSTRACTIntroduction: Recently, a new minimally invasive single bundle technique for anatomic ACL reconstruction has been described, called the ‘All-Inside graft-link technique’. One of the advantages of this procedure is the reduced morbidity at the donor site as the graft choice is the quadrupled semitendinosus, thus sparing the gracilis tendon. The aim of this study was to evaluate isokinetic flexion strength recovery in patients who underwent a gracilis sparing technique compared to those with a full-tibial tunnel technique using a doubled gracilis and semitendinosus tendons (DGST) graft.Methods: Patients were divided into two groups: Group A (22 patients) who underwent ACL reconstruction performed with an All-Inside graft-link technique; Group B (22 patients) who underwent ACL reconstruction with an Out-In technique and DGST graft. At a mean follow-up of 13 months, quadriceps and hamstring isokinetic peak torque deficits were recorded.Results: In group A, the mean side to side peak torque flexion difference between the operated and non-operated limbs was −3% and the mean torque at 30° was −7.5% at high angular velocity (180°/sec); the mean peak flexion torque was 7.2% and the mean torque at 30° was 3.1% at low angular velocity (60°/sec).In group B, the mean side to side peak flexion torque was −3.5% and the mean torque at 30° was −7.6% at high angular velocity (180°/sec); the mean peak flexion torque was −7.2% and the mean torque at 30° was −11% at low angular velocity (60°/sec).A statistically significant difference was found between the two groups at lower angular velocity both for the mean peak flexion torque and the mean torque at 30° (p = 0.009), with better results in the study group.Discussion/conclusion: Gracilis sparing technique is a minimally invasive technique for ACL reconstruction and yielded a significantly better flexion strength recovery at lower angular velocity compared to a full tibial tunnel technique with DGST for ACL reconstruction.

In physical and rehabilitation medicine, there are few reports on the effects of therapeutic low-frequency electrical stimulation on the immune response of the organism, even though electrical stimulation is used widely in clinical practice and sports medicine. The aim of our study was to examine the possible immunological consequences of moderate transcutaneous neuromuscular electrical stimulation (NMES) for quadriceps muscle strengthening in healthy individuals. The study included twelve healthy male adult volunteers (mean age 42 years) without contraindications for electrical stimulation. At the beginning and immediately after a 20-min session of NMES of quadriceps muscles, peripheral blood was collected to analyse the biochemical blood components (creatinine, creatine kinase, estimated glomerular filtration rate, cortisol), differential white blood cell count and immunological parameters. The intensity of NMES was set at maximum tolerance, eliciting on average about one-sixth of the maximum voluntary isometric contraction of the same leg. No statistically significant differences in the average group level were found in any of the measured biochemical blood components, white blood cell count or immunological parameters after the NMES session. On an individual level, the changes in creatine kinase, estimated glomerular filtration rate, basophils and some immunological parameters correlated with changes in the cortisol level. We can conclude that moderate transcutaneous low-frequency electrical stimulation for quadriceps muscle strengthening used in our study did not induce essential changes in immune status in healthy men.

Inside wire supporting voice, data and video telecommunications is not one of the more dominating topics on the minds of hotel owners and managers. That agreed, the following should ignite [...]

The new isotope module in HYDRUS‐1D can be used to infer the origin of root water uptake (RWU), a suitable dynamic indicator for agriculture and forest water management. However, evidence shows that the equilibrium fractionation between liquid water and water vapor within the soil is affected not only by soil temperature but also by soil tension. How soil tension affects isotope transport modeling and interpretations of the RWU origin is still unknown. In this study, we evaluated three fractionation scenarios on model performance for a field data set from Langeoog Island: (a) no fractionation (Non_Frac), (b) the soil temperature control on equilibrium fractionation as described by the standard Craig‐Gordon equation (CG_Frac), and (c) CG_Frac plus the soil tension control on equilibrium fractionation (CGT_Frac). The model simulations showed that CGT_Frac led to more depleted isotopic compositions of surface soil water than CG_Frac. The vertical origin of RWU was estimated using the water balance (WB) calculations and the Bayesian mixing model (SIAR). While the former directly used water flow outputs, the latter used as input simulated isotopic compositions (using different fractionation scenarios) of RWU and soil water. Both methods provided similar variation trends with time and depth in different soil layers' contributions to RWU. The contributions of all soil layers interpreted by the CGT_Frac scenario were always between Non_Frac and CG_Frac. The temporal origin of RWU was deduced from particle tracking (PT, releasing one hypothetical particle for individual precipitation event and tracking its movement based on the water balance between particles) and a virtual tracer experiment (VTE, assigning a known isotope composition to individual precipitation event and tracking its movement based on the cumulative isotope flux). Both methods revealed similar variation trends with time in drainage and root zone (RZ) travel times. The interpreted drainage and RZ travel times were generally ranked as Non_Frac > CGT_Frac > CG_Frac. Overall, the factors considered in the standard CG equation dominated isotope fractionation, transport, and interpretations of the RWU origin. Isotope transport‐based methods (SIAR, VTE) were more computationally demanding than water flow‐based methods (WB, PT). While factors in the Craig‐Gordon equation dominate evaporation fractionation, soil tension effects deplete isotopic composition of surface soil waterRoot water uptake origin interpreted by considering tension effects is between no fractionation and Craig‐Gordon fractionation scenariosUsing the Bayesian isotope mixing model or the virtual tracer experiment is more demanding than water balance or particle tracking methods While factors in the Craig‐Gordon equation dominate evaporation fractionation, soil tension effects deplete isotopic composition of surface soil water Root water uptake origin interpreted by considering tension effects is between no fractionation and Craig‐Gordon fractionation scenarios Using the Bayesian isotope mixing model or the virtual tracer experiment is more demanding than water balance or particle tracking methods

Background: An adequate iodine supply in utero and shortly after birth is known to be crucial to an individual's physical and mental development. The question of whether iodine supplementation later in life can exert a favorable influence on the mental performance of iodine-deficient populations was addressed in various studies, but with contradictory results. Objective: The aim of this study was to examine the effect of an improvement in iodine status on mental and psychomotor performance of schoolchildren (7-11 y) who were moderately to severely iodine deficient. Design: The study, which was originally planned as a double-blind, randomized, placebo-controlled intervention, was carried out in an iodine-deficient population of schoolchildren (n = 196) in northern Benin. As the population began to have access to iodized salt during the 1-y intervention period, the study population was split post hoc--on the basis of urinary iodine concentrations--into a group with improved iodine status and a group with unchanged iodine status. Changes in mental and psychomotor performance over the intervention period were compared. Results: Children with increased urinary iodine concentrations had a significantly greater increase in performance on the combination of mental tests than did the group with no change in urinary iodine concentrations. Conclusions: An improvement in iodine status, rather than iodine status itself, determined mental performance in this population, which was initially iodine deficient. These findings suggest a 'catch-up' effect in terms of mental performance. Am J Clin Nutr 2000;72:1179-85. KEY WORDS Iodine deficiency, mental performance, schoolchildren, urinary iodine concentration, Benin, West Africa

The Ritz-Carlton Hotel Co. was dealing with a situation in which all of its hotels were taking requests from guests and meeting planners for an ever-increasing amount of telecommunications' services. [...]

Background: To gain more insight into the relation between vegetable consumption and the risk of chronic diseases, it is important to determine the bioavailability of carotenoids from vegetables and the effect of vegetable consumption on selected biomarkers of chronic diseases. Objective: To assess the bioavailability of [Beta]-carotene and lutein from vegetables and the effect of increased vegetable consumption on the ex vivo oxidizability of LDL. Design: Over 4 wk, 22 healthy adult subjects consumed a high-vegetable diet (490 g/d), 22 consumed a low-vegetable diet (130 g/d), and 10 consumed a low-vegetable diet supplemented with pure [Beta]-carotene (6 mg/d) and lutein (9 mg/d). Results: Plasma concentrations of vitamin C and carotenoids (ie, a-carotene, [Beta]-carotene, lutein, zeaxanthin, and [Beta]-cryptoxanthin) were significantly higher after the high-vegetable diet than after the low-vegetable diet. In addition to an increase in plasma [Beta]-carotene and lutein, the pure carotenoid-supplemented diet induced a significant decrease in plasma lycopene concentration of -0.11 [micro]mol/L (95% CI: -0.21, -0.0061). The responses of plasma [Beta]-carotene and lutein to the high-vegetable diet were 14% and 67%, respectively, of those to the pure carotenoid-supplemented diet. Conversion of [Beta]-carotene to retinol may have attenuated its plasma response compared with that of lutein. There was no significant effect on the resistance of LDL to oxidation ex vivo. Conclusions: Increased vegetable consumption enhances plasma vitamin C and carotenoid concentrations, but not resistance of LDL to oxidation. The relative bioavailability of lutein from vegetables is higher than that of [Beta]-carotene.

ABSTRACTThis article deals with the extensive signals surveillance program operated by the Wehrmacht and directed at their most dangerous enemy in the Balkans, the Yugoslav Partisans. This subject has so far received surprisingly little attention in academic circles despite the fact that it was one of the crucial pillars of the entire Axis counter-insurgency effort in Yugoslavia and that it was one of the most successful actions of its kind conducted by the German intelligence. Based largely osn previously unpublished primary sources, as well as post-war literature, this article will outline the workings of the program during its heyday in the years 1943–1944 and seek to establish its impact on the battlefield. As such, it will hopefully prove to be useful to both students of wartime events in the Western Balkans and to researchers of intelligence services during the Second World War in general.

There are many prosthetic feet (Pfeet) on the market, and those in the same category do not necessarily have the same properties. We assessed three different Pfeet in terms of gait patterns on various terrains, balance and walking speed in a randomized double-blind controlled single-subject multiple-rater clinical trial. The patient was a 43-year old man who was an active prosthesis user and was amputated at transtibial level because of injury 17 years ago. One Solid Ankle Cushion Heel and two Dynamic Elastic Response (DER) Pfeet were tried six times in random order. The patient walked on flat, uneven, sloped terrain and stairs. Gait pattern was rated in comparison with the patient’s previous prosthetic foot (Pfoot) by a physiatrist, physiotherapist, prosthetist and the patient; one-leg standing test on the prosthesis and 10-m walking test were also performed. The ratings differed significantly between the raters on each terrain, and there was no agreement among the raters regarding the ranking order of the Pfeet. All the Pfeet were generally rated as worse than the patient’s previous one. The patient gave lower ratings on average than the professionals and recognized the order of the tested Pfeet. The results of one-leg standing test with one DER and the Solid Ankle Cushion Heel Pfoot were statistically significant better than with the other DER and the patient’s previous Pfoot. Our study therefore indicates that rehabilitation professionals, when blinded, cannot always reliably observe differences in walking on different terrains with different Pfeet. The patient may feel the differences, but those may not match what the manufacturers declare.

Quantum phase transitions, transitions between many-body ground states, are of extensive interest in research ranging from condensed-matter physics to cosmology1–4 . Key features of the phase transitions include a stage with rapidly growing new order, called inflation in cosmology5 , followed by the formation of topological defects6–8 . How inflation is initiated and evolves into topological defects remains a hot topic of debate. Ultracold atomic gas offers a pristine and tunable platform to investigate quantum critical dynamics9–21 . We report the observation of coherent inflationary dynamics across a quantum critical point in driven Bose–Einstein condensates. The inflation manifests in the exponential growth of density waves and populations in well-resolved momentum states. After the inflation stage, extended coherent dynamics is evident in both real and momentum space. We present an intuitive description of the quantum critical dynamics in our system and demonstrate the essential role of phase fluctuations in the formation of topological defects. An ultracold quantum gas experiment shows that, when it crosses the many-body phase transition, the original ground state can evolve coherently into the new emergent phase, reflecting the initial global coherence presented in the system.

Background: The bulk production of Gold Nanoparticles (AuNPs) and their concentrated ink, with desirable properties such as morphology, purity, stability and final Au concentration, remains a challenge. Objective: (i) Synthesis of AuNPs through Ultrasonic Spray Pyrolysis (USP) from different precursors. (ii) Preparation of their concentrated ink and (iii) Test their feasibility for ink jet printing onto a glossy paper substrate. Method: Initially, two different start materials were used - precursor: Gold Chloride with its nanoparticles as C-AuNPs, and Gold Acetate with its nanoparticles as A-AuNPs stabilised with PVP40 in deionised water. The concentrated ink was prepared from both AuNPs, and filtered up to the [Au] of 1000 ppm. Ink-jet printing was performed, and the obtained patterns were analysed through SEM. Results: The [Au] in the obtained solutions, determined through ICP-OES analysis, was, for CAuNPs, about 100 ppm, and 150 ppm for A-AuNPs. In the case of C-AuNPs the solution was rose, and for A-AuNPs violet. TEM investigation revealed that C-AuNPs dominated in a circular shape with size about 18 nm; contrary to this, A-AuNPs were mostly in ellipsoid shape, with size in the longitudinal direction of about 36 nm. EDX analyses detected 99.9 wt. % of Au in both AuNPs, which is evidence that these were of high purity. Due to different AuNPs` sizes and [Au], the colloidal solutions showed maximum absorbance wavelength of 532 nm for C-AuNPs and 528 nm for A-AuNPs. SEM results showed that A-AuNPs were significantly better for printing on the paper substrate than C-AuNPs, due to their ellipsoidal shape, as the flow behaviour had been much smoother through the nozzle as compared to the circular shape. The printed area with A-AuNPs reflected in better incorporation of nanoparticles on the paper surface and high-density connectivity among AuNPs. Conclusions: C-AuNPs and A-AuNPs were synthesised successfully under optimum parameters of evaporation temperature, reaction temperature and gas flow rates. The spherical shape of C-AuNPs as compared to the ellipsoidal nature of A-AuNPs was due to the rapid sintering of Gold Chloride at a higher temperature of 300ºC as compared to Gold Acetate.

Scattering is used to probe matter and its interactions in all areas of physics. In ultracold atomic gases, control over pairwise interactions enables us to investigate scattering in quantum many-body systems. Previous experiments on colliding Bose–Einstein condensates have revealed matter–wave interference, haloes of scattered atoms, four-wave mixing and correlations between counter-propagating pairs. However, a regime with strong stimulation of spontaneous collisions analogous to superradiance has proved elusive. In this regime, the collisions rapidly produce highly correlated states with macroscopic population. Here we find that runaway stimulated collisions in Bose–Einstein condensates with periodically modulated interaction strength cause the collective emission of matter-wave jets that resemble fireworks. Jets appear only above a threshold modulation amplitude and their correlations are invariant even when the number of ejected atoms grows exponentially. Hence, we show that the structures and atom occupancies of the jets stem from the quantum fluctuations of the condensate. Our findings demonstrate the conditions required for runaway stimulated collisions and reveal the quantum nature of matter-wave emission.

English-language historiography has paid scant attention to the events in Yugoslavia in spring 1945, despite the fact that the combined strength of the armies pitted against each other amounted to around 800,000 men, and that it was the only front in Europe which was held independently by a junior member of the anti-Hitler coalition. This article provides an analysis of both the capitulation of the German Army Group E, and the widely diverging descriptions of the same event offered by German and Yugoslav authors. The main argument presented here is that the Yugoslav leadership, prompted by both internal and foreign policy considerations, did not shirk from using less-than-honourable methods to achieve its aims. In doing this, the article will also provide insights into the functioning of the historiography of the socialist era when dealing with potentially embarrassing issues.

In traumatic brain injury (TBI) and stroke rehabilitation, the question of reintegration of the driver into traffic is faced very often. Driving is an important domain and for some patients, return to driving represents a crucial event for community inclusion. The aim of our study was to examine the utility of Glasgow Coma Scale within the first 24 h of injury and the Functional Independence Measure (FIM) at rehabilitation admission for predicting the return to driving. We included 72 patients after TBI or stroke. Driving outcome was assessed in terms of being allowed to drive without restrictions as opposed to failing the test or being allowed to drive with restrictions. We examined two samples: the TBI patients only and the entire sample including patients after stroke. The results indicate that for TBI patients, Glasgow Coma Scale and motor FIM could be predictors of driving outcome; in the entire sample, the unrestricted driving outcome was also associated with a high score on the FIM motor scale. Early prediction of return to driving after TBI and stroke is important for the patients, their families and the rehabilitation teams to set realistic goals that enable the best possible reintegration after rehabilitation.