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Cationic tantalum oxide nanoparticles (Ta 2 O 5 -cNPs), as a newly introduced contrast agent for computed tomography of cartilage, offer quantitative evaluation of proteoglycan (PG) content and biomechanical properties. However, knowledge on the depth-wise impact of cartilage constituents on nanoparticle diffusion, particularly the influence of the collagen network, is lacking. In this study, we aim to establish the depth-dependent relationship between Ta 2 O 5 -cNP diffusion and cartilage constituents (PG content, collagen content and network architecture). Osteochondral samples (n = 30) were harvested from healthy equine stifle joints (N = 15) and the diffusion of 2.55 nm diameter cationic Ta 2 O 5 -cNPs into the cartilage was followed with micro computed tomography (µCT) imaging for up to 96 hours. The diffusion-related parameters, Ta 2 O 5 -cNP maximum partition (P max) and diffusion time constant, were compared against biomechanical and depth-wise structural properties. Biomechanics were assessed using stress-relaxation and sinusoidal loading protocols, whereas PG content, collagen content and collagen network architecture were determined using digital densitometry, Fourier-transform infrared spectroscopy and polarized light microscopy, respectively. The P max correlates with the depth-wise distribution of PGs (bulk Spearman's ρ = 0.87, p < 0.001). More open collagen network architecture at the superficial zone enhances intake of Ta 2 O 5 -cNPs, but collagen content overall decreases the intake. The P max values correlate with the equilibrium modulus (ρ = 0.80, p < 0.001) of articular cartilage. This study establishes the feasibility of Ta 2 O 5 -cNPs for the precise and comprehensive identification of biomechanical and structural changes in articular cartilage via contrast-enhanced µCT. [ABSTRACT FROM AUTHOR]

• A comprehensive testing process for AI applications in radiology was developed. • Systematic testing helps to identify biases, pitfalls, and unacceptable deviations. • A form template for AI evaluation was developed by our multidisciplinary team. • The described process is based on our experience with several clinical AI algorithms. • Systematic testing of radiology AI applications ultimately benefits patient care. Artificial intelligence (AI) applications are becoming increasingly common in radiology. However, ensuring reliable operation and expected clinical benefits remains a challenge. A systematic testing process aims to facilitate clinical deployment by confirming software applicability to local patient populations, practises, adherence to regulatory and safety requirements, and compatibility with existing systems. In this work, we present our testing process developed based on practical experience. First, a survey and pre-evaluation is conducted, where information requests are sent for potential products, and the specifications are evaluated against predetermined requirements. In the second phase, data collection, testing, and analysis are conducted. In the retrospective stage, the application undergoes testing with a pre selected dataset and is evaluated against specified key performance indicators (KPIs). In the prospective stage, the application is integrated into the clinical workflow and evaluated with additional process-specific KPIs. In the final phase, the results are evaluated in terms of safety, effectiveness, productivity, and integration. The final report summarises the results and includes a procurement/deployment or rejection recommendation. The process allows termination at any phase if the application fails to meet essential criteria. In addition, we present practical remarks from our experiences in AI testing and provide forms to guide and document the testing process. The established AI testing process facilitates a systematic evaluation and documentation of new technologies ensuring that each application undergoes equal and sufficient validation. Testing with local data is crucial for identifying biases and pitfalls of AI algorithms to improve the quality and safety, ultimately benefiting patient care. [ABSTRACT FROM AUTHOR]

Extrusion-based 3D printing methods have great potential for manufacturing of personalized polymer-based drug-releasing systems. However, traditional melt-based extrusion techniques are often unsuitable for processing thermally labile molecules. Consequently, methods that utilize the extrusion of semi-solid inks under mild conditions are frequently employed. The rheological properties of the semi-solid inks have a substantial impact on the 3D printability, making it necessary to evaluate and tailor these properties. Here, we report a novel semi-solid extrusion 3D printing method based on utilization of a Carbopol gel matrix containing various concentrations of polymeric microspheres. We also demonstrate the use of a solvent vapor-based post-processing method for enhancing the mechanical strength of the printed objects. As our approach enables room-temperature processing of polymers typically used in the pharmaceutical industry, it may also facilitate the broader application of 3D printing and microsphere technologies in preparation of personalized medicine. [Display omitted] • Extrudable inks were formulated from Carbopol gel and PLLGA microspheres. • Rheological characterization revealed potential for 3D printing. • Thermoplastic objects could be 3D printed at ambient conditions. • Solvent vapor sintering enhanced the mechanical strength of the printed objects. • Sintering enabled tailoring of the porosity of the printed objects. [ABSTRACT FROM AUTHOR]

We studied the short- and long-term effects of imatinib in hospitalized COVID-19 patients. Participants were randomized to receive standard of care (SoC) or SoC with imatinib. Imatinib dosage was 400 mg daily until discharge (max 14 days). Primary outcomes were mortality at 30 days and 1 year. Secondary outcomes included recovery, quality of life and long COVID symptoms at 1 year. We also performed a systematic review and meta-analysis of randomized trials studying imatinib for 30-day mortality in hospitalized COVID-19 patients. We randomized 156 patients (73 in SoC and 83 in imatinib). Among patients on imatinib, 7.2% had died at 30 days and 13.3% at 1 year, and in SoC, 4.1% and 8.2% (adjusted HR 1.35, 95% CI 0.47–3.90). At 1 year, self-reported recovery occurred in 79.0% in imatinib and in 88.5% in SoC (RR 0.91, 0.78–1.06). We found no convincing difference in quality of life or symptoms. Fatigue (24%) and sleep issues (20%) frequently bothered patients at one year. In the meta-analysis, imatinib was associated with a mortality risk ratio of 0.73 (0.32–1.63; low certainty evidence). The evidence raises doubts regarding benefit of imatinib in reducing mortality, improving recovery and preventing long COVID symptoms in hospitalized COVID-19 patients. • We found no short or long-term benefit from imatinib in hospitalized COVID-19. • Pooled evidence raises doubts regarding benefit of imatinib in reducing mortality. • Fatigue and sleeping problems common at 1 year after hospitalized COVID-19. [ABSTRACT FROM AUTHOR]

Both rising interest rates and tighter credit constraints decrease investors' funding positions in a given currency and cause the currency to appreciate. I extend the Gabaix and Maggiori (2015) global multi-country currency and bond model and show that the policy interventions have opposite effects on the value of an alternative funding currency through investor positioning. Rising interest rates encourage investors to shift their positioning and cause the alternative currency to depreciate. Tightening credit conditions have the contrasting effect and prompt appreciation for both currencies. Empirical evidence on Japanese Yen returns is consistent with the model. • Both rate hikes and credit constraints cause currency appreciation by reducing funding positions. • Extending Gabaix and Maggiori (2015), I show divergent policy effects on alternative funding currencies. • Rate hikes depreciate the alternative currency; tighter credit constraints appreciate both. • Evidence on Japanese Yen returns aligns with the model's propositions. [ABSTRACT FROM AUTHOR]

Inappropriately reported or conducted studies may decrease the quality of care due to under- or overestimation of the benefits or harms of interventions. Our aim was to evaluate how often hand surgical randomized controlled trials (RCTs) use and report adequate methods to ensure internal validity, and whether inadequate reporting or methods are associated with the magnitude of treatment effect estimates. Data Sources were the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases until November 2020. We included published RCTs investigating the effects of any surgical intervention in the hand and wrist region. We assessed internal validity using the Cochrane Risk of Bias (RoB) tool for 6 domains: selection, performance, detection, attrition, selective reporting, and "other" bias. We extracted the primary outcome and calculated the effect size for each study. We used mixed-effect meta-regression to assess whether the RoB modified the magnitude of the effects. For 207 assessed trials, the RoB was unclear or high for 72% in selection, 93% in performance, 88% in detection, 25% in attrition, 22% in selective reporting, and 34% in the "other" bias domain. Trials with a high or unclear risk of selection bias yielded 0.28 standardized mean difference (95% confidence interval, 0.02–0.55) larger effect sizes compared to studies with a low risk. Risks of bias for other domains did not modify the intervention effects. The risk for selection bias declined over time: the odds ratio for a high or unclear RoB was 0.90 (95% confidence interval, 0.85–0.95) per additional year of publication The internal validity and credibility of hand surgical RCTs can be improved by using established methods to achieve true randomization, blinding of the participants and study personnel, publishing the trial protocol and avoiding selective reporting of the outcomes, and reporting the trial as recommended in the Consolidated Standards of Reporting Trials statement. Clinicians should be aware that RCTs that do not use or report proper randomization and allocation concealment may overestimate the treatment effects. [ABSTRACT FROM AUTHOR]

Transcranial magnetic stimulation (TMS) allows non-invasive stimulation of the cortex. In multi-locus TMS (mTMS), the stimulating electric field (E-field) is controlled electronically without coil movement by adjusting currents in the coils of a transducer. To develop an mTMS system that allows adjusting the location and orientation of the E-field maximum within a cortical region. We designed and manufactured a planar 5-coil mTMS transducer to allow controlling the maximum of the induced E-field within a cortical region approximately 30 mm in diameter. We developed electronics with a design consisting of independently controlled H-bridge circuits to drive up to six TMS coils. To control the hardware, we programmed software that runs on a field-programmable gate array and a computer. To induce the desired E-field in the cortex, we developed an optimization method to calculate the currents needed in the coils. We characterized the mTMS system and conducted a proof-of-concept motor-mapping experiment on a healthy volunteer. In the motor mapping, we kept the transducer placement fixed while electronically shifting the E-field maximum on the precentral gyrus and measuring electromyography from the contralateral hand. The transducer consists of an oval coil, two figure-of-eight coils, and two four-leaf-clover coils stacked on top of each other. The technical characterization indicated that the mTMS system performs as designed. The measured motor evoked potential amplitudes varied consistently as a function of the location of the E-field maximum. The developed mTMS system enables electronically targeted brain stimulation within a cortical region. • Multi-locus TMS system with six independent H-bridge channels. • 5-coil transducer to control the electric field within a 30-mm-diameter cortical region. • Algorithm for targeting the electric field. • Automatic motor mapping without physical coil movement. [ABSTRACT FROM AUTHOR]

Background: Rates and predictors of major bleeding in patients with peripheral artery disease (PAD) treated with antiplatelets have not been well studied. This post hoc analysis of EUCLID aimed to determine the incidence of major/minor bleeding, predictors of major bleeding, and risk of major adverse cardiovascular events (MACE) following major bleeding events.Methods: EUCLID, a multicenter randomized controlled trial of 13,885 patients with symptomatic PAD, compared ticagrelor with clopidogrel for the prevention of MACE. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. Baseline characteristics were used to develop a multivariable model to determine factors associated with TIMI major bleeding. The occurrence and timing of MACE relative to a first major bleeding event were determined.Results: TIMI major bleeding occurred in 2.3% of participants overall (0.94 event/100 patient-years). There was no significant difference in major bleeding rates by treatment assignment. Factors associated with TIMI major bleeding included older age, geographic region, Rutherford class, and β-blocker use. Patients with TIMI major bleeding postrandomization had an increased risk of MACE (hazard ratio [HR] 4.46; 95% CI 3.40-5.84; P < .0001) compared with those without major bleeding; the association was strongest within 30 days after a bleeding event.Conclusions: In patients with symptomatic PAD, 0.94 major bleeding event/100 patient-years was observed and associated with older age, residing in North America, disease severity, and β-blocker use. Patients who had a major bleeding event were significantly more likely to experience MACE, especially within the first 30 days, when compared with patients who did not have major bleeding. [ABSTRACT FROM AUTHOR]

Assessment plays a crucial role in student learning in higher education. Until rather recently, the role of assessment in relation to inclusion has been unexplored. In this study, we conduct a research synthesis of 42 studies published between 2010 and 2022, including 868 student participants, to map the assessment experiences of students with disabilities in higher education. Specifically, we conduct a meta-ethnographic review to synthesise qualitative studies and capture the participants' lived experiences of assessment. Our analysis considers how these experiences reflect both inclusion and exclusion. We theorise these elusive terms through the ideas of access and participation. Most of the studies considered the students' imminent physical, perceptual and social access to assessment, such as in the cases of inaccessible examination halls or digital assessment systems. A smaller subset of the studies considered inclusion/exclusion as a matter of students' social participation as fully accepted members of academia. In these studies, assessment was described as providing the students with opportunities to belong to academia, whereas experiences of exclusion portrayed assessment as a mechanism for social segregation and discrimination. Overall, our review shows that assessment is a primary barrier to the inclusion of students with disabilities in higher education. We propose that the predominant discourse of inclusion in assessment needs to widen from considering immediate access to assessment into considering how assessment regulates the full participation of diverse students in higher education. We discuss the implications of inaccessible assessment for all students and suggest that, ultimately, both access and participation are matters of student identity. Our review has important practical implications for the design of inclusive assessment in the current higher education contexts in which student cohorts are becoming increasingly diverse. • We synthesise the assessment experiences of higher education students with disabilities. • 42 empirical, qualitative studies are analysed in our meta-ethnographic review. • The students largely reported experiences of exclusion in assessment. • We emphasise assessment not only as a matter of learning, but as a matter of inclusion. • In mass higher education, assessment must be designed with student diversity in mind. [ABSTRACT FROM AUTHOR]

In an effort to strengthen health care professionals' ability to anticipate and address multiple trauma patients' needs, this study aims to explore the experience of suffering from multiple trauma. This is a qualitative descriptive study. Nine interviews were analysed using content analysis. The study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma. The analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with 'dead ends' during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care. A shared understanding is essential in order to define a person's needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients' needs and address them with supportive guidance. [ABSTRACT FROM AUTHOR]

• Diffusion determinants and population density follow a concentric spatial pattern. • The Finnish spectrum policy encouraged MNOs to satisfy USOs without subsidies. • Lack of investment triggered the emergence of fiber cooperatives in rural areas. • NRAs shall allocate 3.5 GHz and higher bands partly through local light licensing. This article analyzes the role of Finnish regulation in achieving the broadband penetration goals defined by the National Regulatory Authority. It is well known that in the absence of regulatory mitigation the population density has a positive effect on broadband diffusion. Hence, we measure the effect of the population density on the determinants of broadband diffusion throughout the postal codes of Finland via Geographically Weighted Regression. We suggest that the main determinants of broadband diffusion and the population density follow a spatial pattern that is either concentric with a weak/medium/strong strength or non-concentric convex/concave. Based on 10 patterns, we argue that the Finnish spectrum policy encouraged Mobile Network Operators to satisfy ambitious Universal Service Obligations without the need for a Universal Service Fund. Spectrum auctions facilitated infrastructure-based competition via equitable spectrum allocation and coverage obligation delivery via low-fee licenses. However, state subsidies for fiber deployment did not attract investment from nationwide operators due to mobile preference. These subsidies encouraged demand-driven investment, leading to the emergence of fiber consumer cooperatives. To explain this emergence, we show that when population density decreases, the level of mobile service quality decreases and community commitment increases. Hence, we recommend regulators implementing market-driven strategies for 5G to stimulate local investment. For example, by allocating the 3.5 GHz and higher bands partly through local light licensing. [ABSTRACT FROM AUTHOR]

Scedosporium species are fungal opportunistic pathogens frequently seen in chronic lung diseases such as in cystic fibrosis (CF). They can cause a wide spectrum of diseases mainly in immunodeficient patients. Invasive, disseminated infections with poor prognosis have been described after lung transplantation. We present a CF-patient with disseminated Scedosporium apiospermum infection after lung transplantation. The patient had skin, surgical wound, spinal cord, and brain involvements. She recovered fully after prolonged course of voriconazole treatment. [ABSTRACT FROM AUTHOR]

Highlights • Births before arrival are rare, and stressful for the ambulance nurses. • BBA arouses mixed feelings of fright and exhilaration among ambulance nurses. • Ambulance nurses need more education and scenario training about BBA. • The prehospital care environment imposes challenges regarding safety and security. Abstract Background Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards. Aim This study describes the experiences of specialist ambulance nurses with BBA. Method A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis. Findings The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education. Conclusion Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training. [ABSTRACT FROM AUTHOR]

Performance of meso-scale numerical weather prediction model HARMONIE-AROME was assessed for a summer-time heatwave in a high-latitude coastal city of Turku in SW Finland. Representativeness of the model's ECOCLIMAP-SG based physiographic land cover specification with a resolution of 750 m was assessed against the 20 m resolution CORINE Land Cover (CLC) dataset. Moreover, the modelled 2 m air temperatures were compared with temperature observations recorded at 74 sites of the local climate observation network. Correlation analysis between the model's physiographic data (PGD) and CLC shows a statistically significant (p ≤ 0.01) match between the datasets in 76% of the land cover types, indicating mainly a good representativeness of the HARMONIE-AROME's land cover parameterization in the study area. The cases of mismatch are mostly related to the differences in ECOCLIMAP-SG and CLC classification principles and/or resolution, and thus can not be considered to indicate poor representativeness of the ECOCLIMAP-SG classification in the area. The HARMONIE-AROME modelled temperatures were on average slightly higher than the observed temperatures, and the difference was largest for daily minimum temperatures. Heterogeneity of land cover and topography inside a 750 m grid cell was related to larger difference between the modelled and observed temperature. • The T modelled by HARMONIE-AROME was accurate; only 0.8 °C warmer than the observed T. • The largest site-specific differences were 2.1 °C / 0.4 °C (same/opposite direction). • Diurnally, the difference between the modelled and observed T was largest at night. • ECOCLIMAP-SG reflects well the land cover (CLC) in the study area. • The best correspondence between ECOCLIMAP-SG and CLC was on natural uninhabited areas. [ABSTRACT FROM AUTHOR]

• Noise is an important image quality feature in computed tomography. • Deep learning can be used for noise mapping from clinical images. • Image quality control using clinical data instead of phantom scans is desirable. • Our model was trained with phantom data and tested with clinical data. • The developed tool allows objective and tissue-specific protocol optimization. This study aimed to develop a deep learning (DL) method for noise quantification for clinical chest computed tomography (CT) images without the need for repeated scanning or homogeneous tissue regions. A comprehensive phantom CT dataset (three dose levels, six reconstruction methods, amounting to 9240 slices) was acquired and used to train a convolutional neural network (CNN) to output an estimate of local image noise standard deviations (SD) from a single CT scan input. The CNN model consisting of seven convolutional layers was trained on the phantom image dataset representing a range of scan parameters and was tested with phantom images acquired in a variety of different scan conditions, as well as publicly available chest CT images to produce clinical noise SD maps. Noise SD maps predicted by the CNN agreed well with the ground truth both visually and numerically in the phantom dataset (errors of < 5 HU for most scan parameter combinations). In addition, the noise SD estimates obtained from clinical chest CT images were similar to running-average based reference estimates in areas without prominent tissue interfaces. Predicting local noise magnitudes without the need for repeated scans is feasible using DL. Our implementation trained with phantom data was successfully applied to open-source clinical data with heterogeneous tissue borders and textures. We suggest that automatic DL noise mapping from clinical patient images could be used as a tool for objective CT image quality estimation and protocol optimization. [ABSTRACT FROM AUTHOR]

The wearable industry is growing and diverse. However, despite the variety in device producers and served purposes, many wearables include biosensors that can measure health parameters, such as heart rate. This makes them potentially useful or even disruptive for healthcare; particularly, for its remote delivery mode that is referred to as telehealth. Wearables and consumer technologies can bring changes to the current value network of telehealth industry by creating new business roles and attracting new stakeholders. However, traditionally regulated telehealth industry may be reluctant to accept unregulated non-medical devices. Furthermore, apart from the potential impact of wearables, the future of the industry is affected by other factors, which need to be understood. This article analyzes a potential evolution of the telehealth value network. For that, we first identified the current trends in the evolution of telehealth technologies and products based on the quantitative analysis and review of three different types of literature – scientific publications, patents, and press releases. Furthermore, we discussed the actors that can drive the future telehealth industry by taking a key role in its value network. The study indicates that technologies and products brought by consumer companies will be used in telehealth for the self-management of chronic diseases and wellness. To facilitate the interaction of the previously separated unregulated consumer and regulated medical domains of telehealth, a new health data aggregation role may emerge and take a central position in the value network. While several candidates for this role can be identified, currently, none of them has the full required expertise. [ABSTRACT FROM AUTHOR]

Objectives Critical limb ischaemia (CLI) implies an increased risk of cardiovascular morbidity and mortality, and the optimal antithrombotic treatment is not established. Design, Materials, Methods The EUCLID trial investigated the effect of monotherapy with ticagrelor versus clopidogrel in 13,885 patients with peripheral artery disease (PAD); the primary endpoint was cardiovascular death, myocardial infarction, or ischaemic stroke. Patients planned for revascularisation or amputation within 3 months, were excluded. This analysis focuses on the subgroup with CLI, defined by rest pain (58.8%), major (9.0%) or minor (32.2%) tissue loss. Results In EUCLID, 643 patients (4.6%) had CLI at baseline. Diabetes mellitus was more common in the CLI group, while coronary disease, carotid disease, and hypertension were more common in the non-CLI group. A majority of CLI patients (62.1%) had only lower extremity PAD. In patients enrolled on the ankle brachial index (ABI) criteria, ABI was 0.55 ± 0.21 (mean ± SD) for those with CLI versus 0.63 ± 0.15 for those without CLI. The primary efficacy endpoint significantly increased among patients with CLI compared with those without CLI with a rate of 8.85 versus 4.28/100 patient years (adjusted for baseline characteristics hazard ratio [HR] 1.43 [95% CI 1.16–1.76]; p = 0.0009). When acute limb ischaemia requiring hospitalisation was added to the model, significant differences remained (adjusted HR 1.38, [95% CI 1.13–1.69]; p = 0.0016). The 1 year mortality was 8.9%. A trend towards increased lower limb revascularisation among those with CLI was observed. Bleeding (TIMI major, fatal, intracranial) did not differ between those with and without CLI. Conclusions Nearly 5% of patients enrolled in EUCLID had CLI at baseline. Milder forms of CLI dominated, a result of the trial design. Patients with CLI had a significantly higher rate of cardiovascular mortality and morbidity versus those without CLI. Further efforts are required to reduce the risk of cardiovascular events in PAD, especially in patients with CLI. ClinicalTrials.gov NCT01732822 . [ABSTRACT FROM AUTHOR]

Objectives: To investigate the independent and combined associations of objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with reading and arithmetic skills.Design: Cross-sectional/prospective.Methods: Participants were 89 boys and 69 girls aged 6-8 years. MVPA and ST were measured using a combined heart rate and movement sensor and body fat percentage by dual-energy X-ray absorptiometry in Grade 1. Reading fluency, reading comprehension, and arithmetic skills were assessed using standardized tests in Grades 1-3. The data were analyzed using linear regression analyses and analyses of covariance with repeated measures.Results: In boys, MVPA was directly and ST inversely associated with reading fluency in Grades 1-3 and arithmetic skills in Grade 1 (P<0.05). Higher levels of MVPA were also related to better reading comprehension in Grade 1 (P<0.05). Most of the associations of MVPA and ST with reading and arithmetic skills attenuated after mutual adjustment for MVPA or ST. Furthermore, boys with a combination of lower levels of MVPA and higher levels of ST had consistently poorer reading fluency (P=0.002) and reading comprehension (P=0.027) across Grades 1-3 than other boys. In girls, ST was directly associated with arithmetic skills in Grade 2 (P<0.05). However, this relationship of ST with arithmetic skills was no longer significant after adjustment for body fat percentage.Conclusions: Lower levels of MVPA and higher levels of ST and particularly their combination were related to poorer reading skills in boys. In girls, higher levels of ST were related to better arithmetic skills. [ABSTRACT FROM AUTHOR]

Introduction When emergency medical services (EMS) are needed, the choice of transport depends on several factors. These may include the patient’s medical condition, transport accessibility to the accident site and the receiving hospital’s resources. Emergency care research is advancing, but little is known about the patient’s perspective of helicopter emergency medical services (HEMS). Aim The aim of this study was to describe trauma patients’ experiences of HEMS. Method Thirteen persons (ages 21–76) were interviewed using an interview guide. Data were analyzed using qualitative content analysis. Findings The analysis resulted in three themes: Being distraught and dazed by the event – patients experienced shock and tension, as well as feelings of curiosity and excitement. Being comforted by the caregivers – as the caregivers were present and attentive, they had no need for relatives in the helicopter. Being safe in a restricted environment – the participants’ injuries were taken seriously and the caregivers displayed effective teamwork. Conclusion For trauma patients to be taken seriously and treated as ‘worst cases’ enables them to trust their caregivers and ‘hand themselves over’ to their care. HEMS provide additional advantageous circumstances, such as being the sole patient and having proximity to a small, professional team. [ABSTRACT FROM AUTHOR]

Settings and objectives: A midsize hospital in the north of Sweden with a high-tech intensive care unit and space for up to 10 patients, with an attached postoperative ward for up to 15 patients. The wards are manned by critical care nurses who are also responsible for carrying a trauma pager. When the alarm goes off, the critical care nurse leaves her/his duties and joins a trauma team. The aim of the study was to describe critical care nurse's experiences of nursing patients suffering from trauma. Method: A qualitative descriptive design was used. Data were collected through four focus group discussions with 15 critical care nurses analysed using qualitative content analysis. Findings: One theme: Preparing for the unexpected with four subthemes: (1) Feeling competent, but sometimes inadequate; (2) Feeling unsatisfied with the care environment; (3) Feeling satisfied with well-functioning communication; and (4) Feeling a need to reflect when affected. Conclusions: Nursing trauma patients require critical care nurses to be prepared for the unexpected. Two aspects of trauma care must be improved in order to fully address the challenges it poses: First, formal preparation and adequate resources must be invested to ensure delivery of quality trauma care. Secondly, follow-ups are needed to evaluate care measures and to give members of the trauma team the opportunity to address feelings of distress or concern. [ABSTRACT FROM AUTHOR]

Unlabelled: We investigated the cross-sectional associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat content with pain conditions in prepubertal children. The participants were a population sample of 439 children aged 6 to 8 years. Sedentary behavior, physical activity, and pain conditions were assessed using questionnaires, cardiorespiratory fitness using maximal cycle ergometer test, and body fat percentage using dual-energy X-ray absorptiometry. The associations of sedentary behavior, physical activity, cardiorespiratory fitness, and body fat percentage with the risk of pain conditions were analyzed using multivariate logistic regression. Children in the highest sex-specific third of sedentary behavior had 1.95 (95% confidence interval [CI], 1.20-3.17; P = .007 for trend across thirds) times higher odds of any pain than children in the lowest third. Children in the highest sex-specific third of cardiorespiratory fitness had 46% (odds ratio [OR] = .54; 95% CI, .32-.91; P = .019) lower odds of any pain and 50% (OR = .50; 95% CI, .28-.87; P = .015) lower odds of headache than children in the lowest third. Children in the highest sex-specific third of body fat percentage had 44% (OR = .56; 95% CI, .34-.93; P = .023) lower odds of any pain, 49% (OR = .51; 95% CI, .30-.86; P = .011) lower risk of multiple pain, and 48% (OR = .52; 95% CI, .31-.86; P = .010) lower odds of lower limb pain than children in the lowest third. Physical activity was not associated with pain conditions. These findings suggest that prepubertal children with high levels of sedentary behavior, low levels of cardiorespiratory fitness, and low body fat content have increased likelihood of various pain conditions. This information could be used to develop strategies to prevent chronic pain in childhood.Perspective: Our findings suggest that low cardiorespiratory fitness, high levels of sedentary behavior, and low body fat content are associated with increased likelihood of various pain conditions among prepubertal children. This information could be used to develop strategies to prevent chronic pain in childhood. [ABSTRACT FROM AUTHOR]

Background: Despite overwhelming data demonstrating the efficacy of antiplatelet therapy in heart disease and stroke, data in peripheral artery disease (PAD) are less compelling. Aspirin has modest evidence supporting a reduction in cardiovascular events in patients with PAD, whereas clopidogrel monotherapy may be more effective in PAD. Ticagrelor, a potent, reversibly binding P2Y12 receptor antagonist, is beneficial in patients with acute coronary syndrome and prior myocardial infarction. The EUCLID trial is designed to address the need for effective antiplatelet therapy in PAD to decrease the risk of cardiovascular events.Study Design: EUCLID is a randomized, double-blind, parallel-group, multinational clinical trial designed to evaluate the efficacy and safety of ticagrelor compared with clopidogrel for the prevention of major adverse cardiovascular events in subjects with symptomatic PAD. Subjects with established PAD will be randomized in a 1:1 fashion to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily. The primary end point is a composite of cardiovascular death, myocardial infarction, or ischemic stroke. Other end points address limb events including acute leg ischemia, need for revascularization, disease progression by ankle-brachial index, and quality of life. The primary safety objective is Thrombolysis in Myocardial Infarction-defined major bleeding. Recruitment began in December 2012 and was completed in March 2014; 13,887 patients were randomized. The trial will continue until at least 1,364 adjudicated primary end points occur.Conclusions: The EUCLID study is investigating whether treatment with ticagrelor versus clopidogrel, given as antiplatelet monotherapy, will reduce the incidence of cardiovascular and limb-specific events in patients with symptomatic PAD. [ABSTRACT FROM AUTHOR]

Modeling the sales and replacements of technology products is typically carried out at the aggregate product category level. However, with maturing markets and especially with high-technology products, the ever-increasing variety of differentiating product features calls for more detailed analysis. This article presents evidence on the effect of price, popularity, and technological sophistication on unit replacement and lifetimes of mobile handsets. The analysis is conducted with a unique device model specific dataset from the Finnish market, with monthly mobile handset unit sales from 2003 to 2009 and annual installed bases from 2005 to 2012. The results show that median unit lifetimes decreased during the second half of the study period, indicating a structural change in the mobile handset market. Furthermore, handset models with higher technological sophistication were shown to have explanatory power on unit lifetimes. During the first half of the study period, more popular handset models were also associated with longer unit lifetimes and models with complex flip design with shorter lifetimes. [ABSTRACT FROM AUTHOR]

There is a growing interest in fostering breakthrough technologies that offer exceptionally high value to society. However, when starting technology projects, it is impossible to know which of them have the potential to lead to breakthroughs. Therefore, organizations have adopted funding policies in which on-going projects are subjected to interim evaluations based on which some projects may be abandoned to release resources for seizing new opportunities. In this paper, we study which funding policies are optimal when the objective is either (i) to maximize the expected value of the project portfolio, or (ii) to maximize the expected number of exceptionally excellent projects that may lead to breakthrough technologies. We show that the optimal policy for funding exceptionally excellent projects is to start a large number of projects and abandon a high proportion of them later, whereas the optimal policy for maximizing the expected value of the project portfolio is to grant long-term funding to a smaller set of projects based on initial evaluation. Furthermore, we show how the trade-off between these two objectives depends on the initial project evaluation accuracy and the rate at which this accuracy improves. Our results suggest that this trade-off is particularly significant when the initial project evaluations are very uncertain but become more accurate soon after the projects have been launched. In such a setting, policies that seek to maximize the expected portfolio value may fail to promote breakthrough technologies. [ABSTRACT FROM AUTHOR]

Abstract: Bright light therapy (BLT) is widely accepted as first-line treatment of seasonal affective disorder (SAD). However, the mechanism of action of BLT is still widely unknown. On the other hand, in mammals, light penetrates the skull bone and reaches the brain, and extra ocular transcranial phototransduction has physiological influences such as changed reproductive cycles and increased brain serotonin levels. Therefore, we challenged the existing conceptual framework that light therapy would only be mediated through the eyes. Consequently, we run a pilot study on the putative effect of transcranial bright light in the treatment of SAD. The light was produced using light-emitting diodes (LEDs), which were attached to earplugs. The amount of photic energy was 6.0–8.5lumens in both ear canals, and the length of treatment was 8 or 12min five times a week during a four-week study period. Subjects were recruited through advertisements in the city of Oulu, Finland (latitude 65°01′N) during 14 January 2009–03 February 2009. The final patient series consisted of 13 (aged 37.1±7.2years) physically healthy indoor workers suffering from SAD according to DSM-IV-TR criteria. Severity of depressive symptoms was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17) and Beck Depression Inventory (BDI)-21. Furthermore, severity of anxiety symptoms was measured by the 14-item Hamilton Anxiety Rating Scale (HAMA). The HAMD-17 mean sum score at screening was 23.1±1.6. Ten out of 13 SAD patients (76.9%) achieved full remission (i.e., HAMD-17 sum score ⩽7), and 92.3% (12/13) at least 50% reduction in HAMD-17 sum scores at “Week 4”. By using a mixed regression model of repeated measures (AR-1) controlling for age, gender, and HAMD-17 mean sum score at screening, significant differences were found comparing the HAMD-17 mean sum scores of “Week 0” with the corresponding scores at the “Week 3” (t =−2.05, p =0.045) and “Week 4” visit (t =−2.77, p =0.008). Correspondingly, significant differences were found comparing the BDI-21 mean sum scores (15.2±6.7) of “Week 0” with the corresponding scores at the “Week 3” (t =−2.37, p =0.021) and “Week 4” visit (t =−3.65, p <0.001). The HAMA mean sum score at screening was 20.5±5.4. During the study period, 12 out of 13 (92.3%) patients achieved at least 50% reduction in their HAMA sum scores, and in 10 out of 13 patients (76.9%), the HAMA sum score was <7. In conclusion, it is hard to believe that our findings could be explained solely by placebo effect. Consequently, the basic assumptions underlying extraocular photoreception in humans deserve to be reconsidered. Given that a proper placebo treatment can be implemented via ear canals, further investigations with randomized placebo-controlled and/or dose-finding study designs regarding the extraocular transcranial bright light in the treatment of SAD are called for. [Copyright &y& Elsevier]

Abstract: The evolution of technology products can be analysed on multiple levels. Product categories go through continuous evolution determined by the cumulative changes in the features of new product models. This is manifested in the diffusion of new product features and in the increasingly vague boundaries between different product generations. This article develops an approach for planning and forecasting technology product evolution and the diffusion of new product features. This is achieved by isolating the phenomena underlying the evolution process, and formulating the process at the product category, product feature, and product model levels. The approach is derived from these formulations combining the primarily demand-driven product category diffusion and product unit replacement behaviour, and the more supply-driven product feature dissemination. The approach enables meaningful sensitivity analysis including the analysis of discontinuities. The developed approach is applied to characterise the evolution of an example product category of mobile handsets and to forecast the diffusion of mobile handset features using extensive longitudinal and cross-sectional data collected from Finland. In consequence, the process of technology product evolution and the phenomenon of product feature dissemination are suggested as extensions to research on product category diffusion and replacement. [Copyright &y& Elsevier]

Amputation remains a frequent and feared outcome in patients with peripheral artery disease (PAD). Although typically characterized as major or minor on the extent of tissue loss, the etiologies and outcomes after amputation by extent are not well-understood. In addition, emerging data suggest that the drivers and outcomes of amputation in patients with PAD may differ in those with and without diabetes mellitus (DM). The EUCLID trial randomized 13,885 patients with symptomatic PAD, including 5345 with concomitant diabetes, to ticagrelor or clopidogrel and followed them for long-term outcomes. Amputations were prospectively reported by trial investigators. Their primary and contributing drivers were adjudicated using safety data, including infection, ischemia, or multifactorial etiologies. Outcomes following major and minor amputations were analyzed, including recurrent amputation, major adverse limb events, adverse cardiovascular events, and mortality. Multivariable logistic regression models were used to identify independent predictors of minor amputations. Analyses were performed overall and stratified by the presence or absence of DM at baseline. Of the patients randomized, 398 (2.9%) underwent at least one lower extremity nontraumatic amputation, for a total of 511 amputations (255 major and 256 minor) over a median of 30 months. A history of minor amputation was the strongest independent predictor for a subsequent minor amputation (odds ratio, 7.29; 95% confidence interval, 5.17-10.30; P <.001) followed by comorbid DM (odds ratio, 4.60; 95% confidence interval, 3.16-6.69; P <.001). Compared with patients who had a major amputation, those with a minor amputation had similar rates of subsequent major amputation (12.2% vs 13.6%), major adverse limb events (15.1% vs 14.9%), and major adverse cardiovascular events (17.6% vs 16.3%). Ischemia alone was the primary driver of amputation (51%), followed by infection alone (27%), and multifactorial etiologies (22%); however, infection was the most frequent driver in those with DM (58%) but not in those without DM (15%). Outcomes after amputation remain poor regardless of whether they are categorized as major or minor. The pattern of amputation drivers in PAD differs by history of DM, with infection being the dominant etiology in those with DM and ischemia in those without DM. Greater focus is needed on the prognostic importance of minor amputation and of the multifactorial etiologies of amputation in PAD. Nomenclature with anatomical description of amputations and eliminating terms "major" or "minor" would seem appropriate. [ABSTRACT FROM AUTHOR]

• On all occasions, 'pain/discomfort' was the most frequently reported problem. • Problems with 'pain/discomfort' decreased the least between 3 and 6 months. • Problems with 'mobility' increased between 6 and 12 months. • When hospitalized and after discharge, 'interaction with caregivers' needs to be improved. [ABSTRACT FROM AUTHOR]