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The life cycles of information technology (IT) components are notably distinct in both duration and nature when compared to their physical counterparts, commonly referred to as operational technology (OT). However, OT is increasingly getting converged with IT technologies. To ensure effective oversight of these converged IT/OT assets throughout their life spans, it is imperative to align the various stakeholders. Critical areas for achieving this alignment in the context of IT/OT converged assets encompass cybersecurity and the management of maintenance processes. This paper presents a design for a "Maintenance Management Game". The purpose of this game is to educate maintenance professionals managing IT/OT converged assets. As part of the game mechanics, the players must make decisions trading off the different objectives and needs of a fictional railway company. The game mechanics are developed using design science research and employ the iterative process of participatory prototyping. The initial findings indicate that the game is an engaging approach to learn about managing and maintaining digitized railway assets. [ABSTRACT FROM AUTHOR]

• "ClearSight" system underestimated standard NIBP in patients with PAD. • Bland-Altman analysis: mean bias of 13 mmHg with 95% LOA from -17 to 42 mmHg. • No influence of phenylephrine or dobutamine on the measurement differences. [Display omitted] To investigate the agreement between continuous noninvasive blood pressure measurement with the ClearSight system (cNIBP-CS) and standard intermittent noninvasive blood pressure measurement (iNIBP) in patients with peripheral arterial disease (PAD). Additionally, the influence of vasoactive medication on potential measurement differences was assessed. A secondary analysis of a randomized controlled trial. At a university hospital. Thirty-four patients with PAD undergoing percutaneous transluminal angioplasty of the lower limbs. None. Continuous noninvasive blood pressures were measured with the "ClearSight" system and compared to standard iNIBPs. Bland-Altman analysis revealed a mean bias of 13 mmHg (±15) between cNIBP-CS and iNIBP, with 95% limits of agreement (LOA) ranging from −17 to 42 mmHg. When comparing both medication groups, a similar mean bias was found for phenylephrine and dobutamine (12 mmHg [±13] and 13 mmHg [±13], respectively). In this study, in patients with PAD, cNIBP-CS showed an underestimation of blood pressure compared to iNIBP in phenylephrine- and dobutamine-treated patients. Compared to previous studies, a larger bias and wider 95% LOA were found. [ABSTRACT FROM AUTHOR]

Practitioners in the field of voice are often faced with patients who are 'dysphonic', but who do not have identifiable abnormalities of the vocal tract structures or any neural or hormonal alteration affecting the phonatory function. For lack of better nomenclature describing the origin of the disorder, this group of patients has been labeled as having 'non-organic' or 'functional' dysphonia. 'Non-organic' only states what the dysphonia is not, and 'functional' does not have any etiological implication. Hence 'functional disorder' as a determination of the origin is at best vague, imprecise and often misleading. In truth, the terms "functional" and 'non-organic' are by now so muddled and confused in everyday clinical usage and parlance that it is unclear what they mean in any given clinical setting or for any particular clinical case. Thus, the UEP Voice Committee (VC) has come to the conclusion that it is best to adopt a new term that is clearly defined, universally agreed to, and indicative of a different and more useful perspective. We have reviewed the literature relating to terminology of these phonatory disorders. We now propose replacement of the phrase 'functional dysphonia' with 'malregulative dysphonia', since the indication of faulty regulation represents an etiological connotation. We also propose a restructuring of the etiological terminology of phonation disorders. We believe this to be a biologically clearer framework for the labeling of 'non-organic' phonatory disorders, and hope that its routine use will allow for more clarity of presentation and discussion in the future. [ABSTRACT FROM AUTHOR]

Non-invasive near-infrared spectroscopy is gaining popularity in the detection of spinal cord ischemia following aortic aneurysm repair. However, practical recommendations are lacking. This review focuses on the physiological and anatomical background, as well as on the clinical implementations of near-infrared spectroscopy as a tool for monitoring ischemia of the spinal cord. Clinical recommendations based on the currently available evidence are rendered. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the mechanical properties and energy absorption characteristics of the gyroid, dual-lattice and spinodoid structures, as biomimetic lattices, through finite element analysis and experimental characterisation. As part of the study, gyroid and dual-lattice structures at 10% volume fraction were 3D-printed using an elastic resin, and mechanically tested under uniaxial compression. Computational models were calibrated to the observed experimental data and the response of higher volume fraction structures were simulated in an explicit finite element solver. Stress-strain data of groups of lattices at different volume fractions were studied and energy absorption parameters including total energy absorbed per unit volume, energy absorption efficiency and onset of densification strain were calculated. Also, the structures were characterized into bending-dominant and stretch-dominant structures, according to their nodal connectivity and Gibson-and-Ashby's law. The results of the study showed that the dual-lattice is capable of absorbing more energy at each volume fraction cohort. However, gyroid structures showed higher energy absorption efficiency and the onset of densification at higher strains. The spinodoid structure was found to be the poorest structure in terms of energy absorption, specifically at low volume fractions. Also, the results showed that the dual-lattice was a stretch dominated structure, while the gyroid structure was a bending dominated structure, which may be a reason that it is a better candidate for energy absorption applications. [ABSTRACT FROM AUTHOR]

Around the turn of the century, a better understanding of the complex physiology of cerebral blood flow (CBF) regulation has emerged. It is now acknowledged that cerebral autoregulation is much more complicated than we previously thought it was, with the shape of the autoregulation curve and limits of autoregulation that may vary enormously and unpredictably, both within and between patients. The consequence is that to safeguard the cerebral circulation, the dogma that an empirically chosen blood pressure guarantees adequate CBF in any individual patient has to be abandoned. Integration of cerebral autoregulation monitoring in daily perioperative patient care offers the opportunity to guide blood pressure management to the individual patient's need. The most common approach tests the effect of changes in blood pressure on an estimate of CBF. However, a "gold standard" to assess cerebral autoregulation is not yet available, and the literature shows considerable disparity of methods and criteria. [ABSTRACT FROM AUTHOR]

Abstract Industrial wireless sensor and actuator networks (WSANs) are being used to improve the efficiency, productivity and safety of industrial processes. One open standard that is commonly used in such cases is IEEE 802.15.4e. Its Time-Slotted Channel Hopping (TSCH) mode employs a time synchronized based medium access control (MAC) scheme together with channel hopping to alleviate the impact of channel fading and interference. Until now, most of the industrial WSANs have been designed to only support static nodes and are not able to deal with mobility. In this paper, we show how a single-hop, multi-gateway IEEE 802.15.4e TSCH network architecture can tackle the mobility problem. We introduce the Virtual Grand Master (VGM) concept that moves the synchronization point from separated Backbone Border Routers (BBRs) towards the backbone network. With time synchronization of all BBRs, mobile nodes can roam from one BBR to another without time desynchronization. In addition to time synchronization, we introduce a mechanism to synchronize the schedules between BBRs to support fast handover of mobile nodes. We show that with the proposed network architecture handovers happen instantly without any packet losses, while the handover time can be up to tens of seconds without any time synchronization between BBRs. The solution is evaluated in a testbed setting as well as in a real industrial environment. [ABSTRACT FROM AUTHOR]

Abstract To cope with the diversity of Internet of Things (IoT) requirements, a large number of Medium Access Control (MAC) protocols have been proposed in scientific literature, many of which are designed for specific application domains. However, for most of these MAC protocols, no multi-platform software implementation is available. In fact, the path from conceptual MAC protocol proposed in theoretical papers, towards an actual working implementation is rife with pitfalls. (i) A first problem is the timing bugs, frequently encountered in MAC implementations. (ii) Furthermore, once implemented, many MAC protocols are strongly optimized for specific hardware, thereby limiting the potential of software reuse or modifications. (iii) Finally, in real-life conditions, the performance of the MAC protocol varies strongly depending on the actual underlying radio chip. As a result, the same MAC protocol implementation acts differently per platform, resulting in unpredictable/asymmetrical behavior when multiple platforms are combined in the same network. This paper describes in detail the challenges related to multi-platform MAC development, and experimentally quantifies how the above issues impact the MAC protocol performance when running MAC protocols on multiple radio chips. Finally, an overall methodology is proposed to avoid the previously mentioned cross-platform compatibility issues. [ABSTRACT FROM AUTHOR]

Indoor localization solutions are key enablers for next-generation indoor navigation and track and tracing solutions. As a result, an increasing number of different localization algorithms have been proposed and evaluated in scientific literature. However, many of these publications do not accurately substantiate the used evaluation methods. In particular, many authors utilize a different number of evaluation points, but they do not (i) analyze if the number of used evaluation points is sufficient to accurately evaluate the performance of their solutions and (ii) report on the uncertainty of the published results. To remedy this, this paper evaluates the influence of the selection of evaluation points. Based on statistical parameters such as the standard error of the mean value, an estimator is defined that can be used to quantitatively analyze the impact of the number of used evaluation points on the confidence interval of the mean value of the obtained results. This estimator is used to estimate the uncertainty of the presented accuracy results, and can be used to identify if more evaluations are required. To validate the proposed estimator, two different localization algorithms are evaluated in different testbeds and using different types of technology, showing that the number of required evaluation points does indeed vary significantly depending on the evaluated solution. [ABSTRACT FROM AUTHOR]

In this study, we evaluate the performance of three algorithms as computational models of trabecular bone architecture, through systematic evaluation of morphometric, topological, and mechanical properties. Here, we consider the widely-used gyroid lattice structure, the recently-developed spinodoid structure and a structure similar to Voronoi lattices introduced here as the dual-lattice. While all computational models were calibrated to recreate the trabecular tissue volume (e.g. BV/TV), it was found that both the gyroid- and spinodoid-based structures showed substantial differences in many other morphometric and topological parameters and, in turn, showed lower effective mechanical properties compared to trabecular bone. The newly-developed dual-lattice structures better captured both morphometric parameters and mechanical properties, despite certain differences being evident their topological configuration compared to trabecular bone. Still, these computational algorithms provide useful platforms to investigate trabecular bone mechanics and for designing biomimetic structures, which could be produced through additive manufacturing for applications that include bone substitutes, scaffolds and porous implants. Furthermore, the software for the creation of the structures has been added to the open source toolbox GIBBON and is therefore freely available to the community. [ABSTRACT FROM AUTHOR]

Finite element analysis (FEA) can be used to evaluate applied interface pressures and internal tissue strains for computational prosthetic socket design. This type of framework requires realistic patient-specific limb geometry and constitutive properties. In recent studies, indentations and inverse FEA with MRI-derived 3D patient geometries were used for constitutive parameter identification. However, long computational times and use of specialized equipment presents challenges for clinical, deployment. In this study, we present a novel approach for constitutive parameter identification using a combination of FEA, ultrasound indentation, and shear wave elastography. Local shear modulus measurement using elastography during an ultrasound indentation experiment has particular significance for biomechanical modeling of the residual limb since there are known regional dependencies of soft tissue properties such as varying levels of scarring and atrophy. Beyond prosthesis design, this work has broader implications to the fields of muscle health and monitoring of disease progression. [ABSTRACT FROM AUTHOR]

Very little is known about the structure and properties of peri-prosthetic fibrous tissue that is found around loose orthopaedic implants. We describe a method for characterizing the structural organisation (histology, confocal microscopy) as well as the nano- and micro-scale mechanical behaviour (atomic force microscopy, nanoindentation) of peri-prosthetic fibrous tissue. The tissue was collected from 11 patients undergoing revision surgery due to aseptic loosening. Sirius Red and Movat histological staining procedures indicated that the tissue mainly consists of collagen fibres and ground substance. However, large inter- and intra-patient variations in the relative proportions of these tissue components were found, as well as in collagen fibre orientation and possibly also maturation. The nano-scale Young׳s moduli ranged from 0–950 kPa, but showed large inter-patient variability. When the results per sample were presented in a probability density function, we could roughly discriminate one peak in the 0–100 kPa range and/or one peak in the 100–500 Pa range. These nano-scale moduli seem to respectively present the mechanical properties of glycosaminoglycan (GAG) and collagen molecules. The majority of the micro-scale Young׳s moduli ranged between 0.5 and 2.0 kPa for all samples. This explorative study provides new insights in (the variations of) structural organisation and mechanical properties of peri-prosthetic tissue. [ABSTRACT FROM AUTHOR]

Summary Objectives/Hypothesis Inhaling singing is a recently developed singing technique explored by the soprano singer Françoise Vanhecke. It is based on an inspiratory airflow instead of an expiratory airflow. This article describes the anatomical structural differences of the vocal tract between inhaling and exhaling singing. We hypothesize that the vocal tract alters significantly in inhaling singing, especially concerning the configuration of the anatomical structures in the oral cavity and the subglottal region. Study Design This is a prospective study. Methods A professional singer (F.V.) performed sustained tones from F5 chromatically rising up to Bb5 on the vowel /a/. Vocal tract anatomy is assessed by magnetic resonance imaging. Results Wilcoxon directional testing demonstrates (1) that the vocal tract volume above the glottal region does not differ statistically in contrast to the subglottal region and (2) significant changes in the configuration of the tongue, the upright position of the epiglottis, the length of the floor of mouth, and the distance between the teeth. Conclusions The narrowing of the subglottis is considered to be secondary to suction forces used in the inhaling singing technique. The changes in the anatomical structures above the vocal folds possibly suggest a valve-like function controlling the air inlet together with the regulator function of the resonator capacities of the vocal tract. [ABSTRACT FROM AUTHOR]

Although the socket is critical in a prosthetic system for a person with limb amputation, the methods of its design are largely artisanal. A roadblock for a repeatable and quantitative socket design process is the lack of predictive and patient specific biomechanical models of the residuum. This study presents the evaluation of such a model using a combined experimental–numerical approach. The model geometry and tissue boundaries are derived from magnetic resonance imaging (MRI). The soft tissue non-linear elastic and viscoelastic mechanical behavior was evaluated using inverse finite element analysis (FEA) of in-vivo indentation experiments. A custom designed robotic in-vivo indentation system was used to provide a rich experimental data set of force versus time at 18 sites across a limb. During FEA, the tissues were represented by two layers, namely the skin-adipose layer and an underlying muscle-soft tissue complex. The non-linear elastic behavior was modeled using 2nd order Ogden hyperelastic formulations, and viscoelasticity was modeled using the quasi-linear theory of viscoelasticity. To determine the material parameters for each tissue, an inverse FEA based optimization routine was used that minimizes the combined mean of the squared force differences between the numerical and experimental force-time curves for indentations at 4 distinct anatomical regions on the residuum. The optimization provided the following material parameters for the skin-adipose layer: [ c = 5 . 22 kPa m = 4 . 79 γ = 3.57 MPa τ = 0 . 32 s ] and for the muscle-soft tissue complex [ c = 5 . 20 kPa m = 4 . 78 γ = 3.47 MPa τ = 0 . 34 s ]. These parameters were evaluated to predict the force–time curves for the remaining 14 anatomical locations. The mean percentage error (mean absolute error/ maximum experimental force) for these predictions was 7 ± 3%. The mean percentage error at the 4 sites used for the optimization was 4%. [ABSTRACT FROM AUTHOR]

Summary Background Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. Method In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Results Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Discussion/Conclusion Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum. [ABSTRACT FROM AUTHOR]

This paper discusses tension–compression asymmetry properties of Ogden hyperelastic formulations. It is shown that if all negative or all positive Ogden coefficients are used, tension–compression asymmetry occurs the degree of which cannot be separately controlled from the degree of non-linearity. A simple hybrid form is therefore proposed providing separate control over the tension–compression asymmetry. It is demonstrated how this form relates to a newly introduced generalised strain tensor class which encompasses both the tension–compression asymmetric Seth–Hill strain class and the tension–compression symmetric Bažant strain class. If the control parameter is set to q = 0.5 a tension–compression symmetric form involving Bažant strains is obtained with the property Ψ ( λ 1 , λ 2 , λ 3 ) = Ψ ( 1 λ 1 , 1 λ 2 , 1 λ 3 ) . The symmetric form may be desirable for the definition of ground matrix contributions in soft tissue modelling allowing all deviation from the symmetry to stem solely from fibrous reinforcement. Such an application is also presented demonstrating the use of the proposed formulation in the modelling of the non-linear elastic and transversely isotropic behaviour of skeletal muscle tissue in compression (the model implementation and fitting procedure have been made freely available). The presented hyperelastic formulations may aid researchers in independently controlling the degree of tension–compression asymmetry from the degree of non-linearity, and in the case of anisotropic materials may assist in determining the role played by, either the ground matrix, or the fibrous reinforcing structures, in generating asymmetry. [ABSTRACT FROM AUTHOR]

It is envisioned that by the year 2020 the Internet will contain more than 50 billion devices, among which the majority of them will have constraints in terms of memory, processing power or energy. As a consequence, they are often unable to run current standard Internet protocols, requiring special, optimized protocols. A number of these protocols, covering the different layers of the protocol stack, have been developed and standardized lately. At the application level, the Constrained Application Protocol (CoAP) is proposed by the IETF as an HTTP replacement that is suitable for constrained devices. CoAP is a very light-weight base protocol that can be extended with optional specifications to satisfy specific use case needs. Two important optional specifications are observe , allowing monitoring of a CoAP resource over a period of time, and group communication , supporting interactions with multiple CoAP devices at once. Currently, these two optional specifications do not work together, i.e., it is not possible to gain the benefits of both of them at the same time. In this paper we present an alternative and novel approach to CoAP group communication that works well with the CoAP observe extension. In addition, it enables to perform operations on the observed results, bringing intelligence closer to the data sources. [ABSTRACT FROM AUTHOR]

The Internet-of-Things (IoT) represents the third wave of computing innovation and relies on small, cheap and/or energy efficient devices, densely deployed in various spaces. Automatically managing, updating and upgrading the software on these devices, particularly the network stacks, with new, improved functionality is currently a major challenge. In this paper we propose GITAR, a generic extension for Internet-of-Things architectures, that enables dynamic application and network level upgrades in an efficient way. GITAR consists of four design concepts which can be applied to any operating system running on IoT/M2M devices. The proof of concept implementation in this paper uses the Contiki OS and the evaluation, based on analytical and experimental methods, shows that GITAR i) is up to 14% more efficient in terms of memory usage and ii) has less or similar run-time CPU overhead as state of the art solutions while offering upgrade functionality down to the network level and iii) can reuse existing Contiki network protocols for dynamic updates without requiring modifications to the code. [ABSTRACT FROM AUTHOR]

The treatment of soft tissue defects of the ankle, combined with an implant-related infection, remains a challenge. The present case report illustrates the use of a pedicled perforator flap for soft tissue reconstruction to cover a postoperative defect at the lateral malleolus after an ankle fracture. [ABSTRACT FROM AUTHOR]

A large amount of research focuses on experimentally optimizing the performance of wireless solutions. Finding the optimal performance settings typically requires investigating all possible combinations of design parameters, while the number of required experiments increases exponentially for each considered design parameter. The aim of this paper is to analyze the applicability of global optimization techniques to reduce the optimization time of wireless experimentation. In particular, the paper applies the Efficient Global Optimization (EGO) algorithm implemented in the SUrrogate MOdeling (SUMO) toolbox inside a wireless testbed. Moreover, to cope with the unpredictable nature of wireless testbeds, the paper applies an experiment outlier detection which monitors outside interference and verifies the validity of conducted experiments. The proposed techniques are implemented and evaluated in a wireless testbed using a realistic wireless conferencing scenario. The performance gain and experimentation time of a SUMO optimized experiment is compared against an exhaustively searched experiment. In our proof of concept, it is shown that the proposed SUMO optimizer reaches 99.79% of the global optimum performance while requiring 8.67 times less experiments compared to the exhaustive search experiment. [ABSTRACT FROM AUTHOR]

During cardiac surgery with cardiopulmonary bypass, the heart is isolated from the circulation. This inevitably induces myocardial ischemia. In addition to this ischemic insult, an additional hit will occur upon reperfusion, which may worsen the extent of tissue damage and organ dysfunction. Over the years, several strategies have been developed that aim to attenuate and/or modulate the extent of this ischemia-reperfusion injury related to the episode of cardiopulmonary bypass. This article reviews the pathophysiology of myocardial injury related to cardiopulmonary bypass and summarizes potential therapeutic strategies that may modulate the extent of this myocardial injury. [ABSTRACT FROM AUTHOR]

Incisional hernia is a severe complication post-laparoscopic/laparotomy surgery that is commonly associated with the linea alba. However, the few studies on the mechanical properties of the linea alba in the literature appear contradictory, possible due to challenges with the physical dimensions of samples and variations in protocol. This study focuses on the tensile mechanical characterisation of the porcine linea alba, as determined by uniaxial and equi-load biaxial testing using image-based strain measurement methods. Results show that the linea alba demonstrated a non-linear elastic, anisotropic behaviour which is often observed in biological soft tissues. The transverse direction (parallel to fibres) was found to be approximately eight times stiffer than the longitudinal (cross-fibre) direction under both uniaxial and equi-load biaxial loading. The equi-load biaxial tensile tests revealed that contraction could occur in the transverse direction despite increasing load, probably due to the anisotropy of the tissue. Optical surface marker tracking and digital image correlation methods were found to greatly improve the accuracy of stretch measurement, resulting in a 75% change in the apparent stiffness compared to using strain derived from machine cross-head displacement. Additionally, a finite element model of the experiments using a combination of an Ogden and fibre exponential power law model for the linea alba was implemented to quantify the effect of clamping and tissue dimensions (which are suboptimal for tensile testing) on the results. The preliminary model results were used to apply a correction factor to the uniaxial experimental data prior to inverse optimisation to derive best fit material parameters for the fibre reinforced Ogden model. Application of the model to the equi-load biaxial case showed some differences compared to the experimental data, suggesting a more complex anisotropic model may be necessary to capture biaxial behaviour. These results provide an improved assessment of the mechanical properties of the porcine linea alba for wound closure and other studies. [ABSTRACT FROM AUTHOR]

Domestic water supply systems are the final stage of the transport process to deliver potable water to the customers’ tap. Under the influence of temperature, residence time and pipe materials the drinking water quality can change while the water passes the domestic drinking water system. According to the Dutch Drinking Water Act the drinking water temperature may not exceed the 25 °C threshold at point-of-use level. This paper provides a mathematical approach to model the heating of drinking water within the domestic water supply system. It appears that residence time influences the drinking water temperature more than the ambient temperature itself. [ABSTRACT FROM AUTHOR]

Multi-scale modelling offers physical insights in the relationship between microstructure and properties of a material. The macroscopic anisotropic plastic flow may be accounted for by consideration of (a) the polycrystalline nature and (b) the anisotropic grain substructure. The latter contribution to anisotropy manifests itself most clearly in the event of a change in the strain path, as occurs frequently in multi-step forming processes. Under monotonic loading, both the crystallographic texture and the loading-dependent strength contribution from substructure influence the macroscopically observed strength. The presented multi-scale plasticity model for BCC polycrystals combines a crystal plasticity model featuring grain interaction with a substructure model for anisotropic hardening of the individual slip systems. Special attention is given to how plastic deformation is accommodated: either by slip of edge dislocation segments, or alternatively by dislocation loop expansion. Results of this multi-scale modelling approach are shown for a batch-annealed IF steel. Whereas both model variants are seen to capture the transient hardening after different types of strain path changes, the dislocation loop model offers more realistic predictions under a variety of monotonic loading conditions. [ABSTRACT FROM AUTHOR]

Abstract: The rapid evolution of information and positioning technologies, and their increasing adoption in tourism management practices allows for new and challenging research avenues. This paper presents an empirical case study on the mining of association rules in tourist attraction visits, registered for 15 days by the Bluetooth tracking methodology. This way, this paper aims to be a methodological contribution to the field of spatiotemporal tourism behavior research by demonstrating the potential of ad-hoc sensing networks in the non-participatory measurement of small-scale movements. An extensive filtering procedure is followed by an exploratory analysis, analyzing the discovered associations for different visitor segments and additionally visualizing them in ‘visit pattern maps’. Despite the limited duration of the tracking period, we were able to discover interesting associations and further identified a tendency of visitors to rarely combine visits in the center with visits outside of the city center. We conclude by discussing both the potential of the employed methodology as well as its further issues. [Copyright &y& Elsevier]

Abstract: Completion axillary lymph node dissection (cALND) is the golden standard if breast cancer involves the sentinel lymph node (SLN). However, most non-sentinel lymph nodes (NSLN) are not involved, cALND has a considerable complication rate and does not improve outcome. We here present and validate our predictive model for positive NSLNs in the cALND if the SLN is positive. Consecutive early breast cancer patients from one center undergoing cALND for a positive SLN were included. We assessed demographic and clinicopathological variables for NSLN involvement. Uni- and multivariate analysis was performed. A predictive model was built and validated in two external centers. 21.9% of 470 patients had at least one involved NSLN. In univariate analysis, seven variables were significantly correlated with NSLN involvement: tumor size, grade, lymphovascular invasion (LVI), number of positive and negative SLNs, size of SLN metastasis and intraoperative positive SLN. In multivariate analysis, LVI, number of negative SLNs, size of SLN metastasis and intraoperative positive pathological evaluation were independent predictors for NSLN involvement. The calculated risk resulted in an AUC of 0.76. Applied to the external data, the model was accurate and discriminating for one (AUC = 0.75) and less for the other center (AUC = 0.58). A discriminative predictive model was constructed to calculate the risk of NSLN involvement in case of a positive SLN. External validation of our model reveals differences in performance when applied to data from other institutions concluding that such a predictive model requires validation prior to use. [Copyright &y& Elsevier]

Abstract: Background: Invasive lobular breast cancer (ILC) is generally believed to have an increased risk for late relapse compared to invasive ductal breast cancer (IDC). However, the study most often referred to is a chemotherapy trial that mainly included node positive patients. We hypothesize that nodal status may influence the hazard of relapse since time of diagnosis differently in invasive ductal carcinoma (IDC) and ILC. Methods: Primary operable breast cancer patients from our institution diagnosed between 2000 and 2009 were studied. Multivariable analysis and subgroup analyses were performed to assess whether ILC carries a different prognosis compared to IDC. SEER data were used for external validation. Results: In lymph node negative patients, ILC carries a better prognosis regarding distant metastasis free interval (DMFI) (HR 3.242 (1.380–7.614), p = 0.0069) with a trend towards improved breast cancer specific survival (BCSS), over the entire study frame (UZ Leuven data). In lymph node positive patients, both DMFI (HR 0.466 (0.309–0.703), p = 0.0003) and BCSS (HR 0.441 (0.247–0.788), p = 0.0057) are significantly worse for ILC, especially after longer follow-up (>4–5 years) (UZ Leuven data). Similar results were found in the SEER cohort. Results remained identical when excluding screen detected cases (data not shown). Conclusion: The prognostic impact of lobular histology not only depends on time since diagnosis but also on nodal status. The general believe that ILC have compromised late-term outcome compared to IDC seems untrue for the majority ( = node negative) of ILCs. [Copyright &y& Elsevier]

Abstract: Due to a drastic increase in the number of wireless communication devices, these devices are forced to interfere or interact with each other. This raises the issue of possible effects this coexistence might have on the performance of these networks. Negative effects are a consequence of contention for network resources (such as free wireless communication frequencies) between different devices, which can be avoided if co-located networks cooperate with each other and share the available resources. This paper presents a self-learning, cognitive cooperation approach for heterogeneous co-located networks. Cooperation is performed by activating or deactivating services such as interference avoidance, packet sharing, various MAC protocols, etc. Activation of a cooperative service might have both positive and negative effects on a network’s performance, regarding its high level goals. Such a cooperation approach has to incorporate a reasoning mechanism, centralized or distributed, capable of determining the influence of each symbiotic service on the performance of all the participating sub-networks, taking into consideration their requirements. In this paper, a cooperation method incorporating a machine learning technique, known as the Least Squares Policy Iteration (LSPI), is proposed and discussed as a novel network cooperation paradigm. [Copyright &y& Elsevier]

Abstract: Timing is a key issue in many wireless, lower-layer (e.g., physical and data link layer) communication protocols. Maintaining time-critical behavior while increasing MAC protocol complexity is the challenge for many MAC implementations. To comply with stringent time constraints, current MAC implementations typically require such a tight integration to the radio driver that they become one monolithic block of code with MAC-specific logic hard coded at the lowest firmware level. Execution of time-critical functions in the firmware is a good strategy, but results in limited flexibility for MAC designers because the radio driver is dedicated for specific MAC protocol logic. We propose “snapMac”: a generic MAC/PHY architecture with a clean separation between the MAC protocol logic at the user level and the execution at the radio firmware level (Patent Pending). Our generic programming interface enables more flexibility, an easy way to compose new MAC designs, and getting feedback from the radio capabilities We demonstrate the feasibility and performance of this architecture by implementing it on a resource-constrained wireless sensor node. The experimental evaluation shows, for example, that we can simultaneously keep the flexibility of a software ACK and meet the ACK timing constraints as specified in the 802.15.4 standard. We also achieve 97% (i.e., 218kbit/s) of the theoretical 802.15.4 throughput. This new implementation approach for MAC/PHY interactions has potential to be applied in other domains (e.g., WiFi, software defined radio, cognitive radio, etc.). Demonstrating the portability of snapMac is future work. “snapMac” enables the design and execution of new MAC protocols in a snap. [Copyright &y& Elsevier]

Abstract: Appropriate mechanical representation of passive muscle tissue is crucial for human body impact modelling. In this paper the experimental and modelling results of compressive loading of freshly slaughtered porcine muscle samples using a drop-tower testing rig are reported. Fibre and cross-fibre compression tests at strain rates varying from 11,600%/s to 37,800%/s were performed. Experimental results show a nonlinear stress–stretch relationship as well as a clear rate dependency of the stress. The mean (standard deviation) engineering stress in the fibre direction at a stretch of 0.7 was 22.47 kPa (5.34 kPa) at a strain rate of 22,000%/s and 38.11k Pa (5.41 kPa) at a strain rate of 37,800%/s. For the cross-fibre direction, the engineering stresses were 5.95 kPa (1.12 kPa) at a strain rate of 11,600%/s, 25.52 kPa (5.12 kPa) at a strain rate of 22,000%/s and 43.66 kPa (6.62 kPa) at a strain rate of 37,800%/s. Significant local strain variations were observed, as well as an average mass loss of 8% due to fluid exudation, highlighting the difficulties in these kinds of tests. The inverse analysis shows for the first time that the mechanical response in terms of both applied load and tissue deformation for each of the strain rates can be captured using a 1st order Ogden hyperelastic material law extended with a three-term quasilinear viscoelastic (QVL) expansion to model viscoelastic effects. An optimisation procedure was used to derive optimal material parameters for which the error in the predicted boundary condition force at maximum compression was less than 3% for all three rates of testing (11,600%/s, 22,000%/s and 37,800%/s). This model may be appropriate for whole body impact modelling at these rates. [Copyright &y& Elsevier]

Abstract: Purpose: To investigate the clinical behavior of triple negative breast cancer (TNC), including age distribution, occurrence of LN (lymph node) invasion and prognosis in different histological subtypes. Methods: For this cohort study we used data on 476 patients with newly diagnosed TNC at the University Hospitals Leuven (Belgium) between 1999 and 2009. Of these, 395 received upfront surgery, 68 neoadjuvant chemotherapy and 21 had metastases at diagnosis. Results: Apocrine and invasive lobular TNC occur more often in older patients compared to IDC-NOS. Of the primarily operated patients with TNC, 35.1% has pathological LN involvement. There were no significant differences in nodal invasion between different histological subtypes, but most subtypes contained few patients. In contrast to previous reports, 6/14 of apocrine TNC had LN involvement. Disease free survival (DFS) was different in different histological subtypes, but group sizes were insufficient to be able to draw firm conclusions. Within the histologically ‘homogeneous’ IDC-NOS group with primary surgery and outcome data (n = 300), DFS with 3.5 year median follow-up decreased with increasing age, but chemotherapy and radiotherapy were much less frequently given with increasing age. In multivariable analysis, lower age, presence of LN involvement, lack of administration of chemotherapy and radiotherapy were significant predictors of relapse. Conclusion: TNC is not a uniform disease. Different histological subtypes have different age distribution and behavior. The prognosis of the most common histological subgroup, IDC-NOS, is better in older patients, but this is counterbalanced by significantly decreased use of chemotherapy and radiotherapy. [Copyright &y& Elsevier]

Abstract: Measuring CA15.3 serum levels in the early breast cancer setting is not recommended by current ASCO guidelines. In this large single center study, we assess the prognostic value of preoperative (n = 3746), postoperative (n = 4049) and change in (n = 3252) CA15.3, also across different breast cancer phenotypes. Preoperative, postoperative and change in CA15.3 were all significant (p = 0.0348, p < 0.0001, p < 0.0001 respectively in multivariate analysis) predictors of distant metastasis free survival. For breast cancer specific survival, only postoperative and change in CA15.3 were significant predictors (p < 0.0001 both). Multivariate prognostic models did not improve by incorporating information on preoperative CA15.3, but did improve when introducing information on postoperative CA15.3 for distant metastasis (p = 0.0365) and on change in CA15.3 for breast cancer specific survival (p = 0.0291). Change in CA15.3 impacts on prognosis (distant metastasis) differently in different breast cancer phenotypes. A decrease in CA15.3 may be informative of improved prognosis in basal like and HER2 like breast cancer. [Copyright &y& Elsevier]

Abstract: Purpose: Lymph node involvement is the most important prognostic factor in breast cancer. It is a multifactorial event determined by patient and tumour characteristics. The purpose of this study was to determine clinical and pathological factors predictive for axillary lymph node metastasis (ALNM) in patients with early breast cancer and to build a model to portend lymph node involvement. Methods: We evaluated 1300 consecutive patients surgically treated in our institution (2007–2009) for cT1-T2 invasive breast cancer. The patient and tumour characteristics evaluated included: age at diagnosis, number of foci, histologic grade, location, tumour size, histologic subtype, lymphovascular invasion (LVI), estrogen-receptor (ER), progesterone-receptor (PR) and Her-2 status. Univariate and multivariate analyses were performed. Factors significantly associated with ALNM by univariate analysis plus histologic subtype were included in the multivariate analysis. Results: By univariate analysis, the incidence of ALNM was significantly associated with the presence of LVI (P < 0.0001), larger tumour size (P < 0.0001), higher histologic grade (P < 0.0001), retroareolar or lateral location in the breast (P < 0.0001), multiple foci (P = 0.0002) and in patients who underwent an axillary lymph node dissection. We found no effect of age, ER⁄PR nor HER-2 status. By multivariate analysis, ALNM was significantly associated with the presence of LVI (P < 0.0001), larger tumour size (P < 0.0001), axillary lymph node dissection (P = 0.0003), retroareolar and lateral tumour location in the breast (P = 0.0019) and the presence of multiple foci (P = 0.0155). Conclusions: LVI and tumour size emerged as the most powerful independent predictors of ALNM, followed by the location of the tumour in the breast and the presence of multiple foci. [Copyright &y& Elsevier]

The author reviews 10 of his favorite studies which are said to be about the ''placebo effect,'' but which, instead, show the significance of meaning in a medical context. ''Placebos,'' he argues, are inert substances which can't do anything. Yet it's clear that after the administration of such drugs, things do happen. The one (and maybe only) clear thing here is that whatever happens is not due to the placebo (that is what ''inert'' means). But placebos can be of various colors and forms which can convey compelling meaning to patients. They often represent medical treatment in compelling ways; they can be metonymic representations of the entire medical experience (a metonym is a representation where a part of something comes to represent it all, as in ''counting noses,'' where the nose represents the whole person, or a ''White House statement'' where the White House represents the Executive Branch of the US Government; here, the pill represents the whole medical experience). More precisely, they can be metonymic simulacra (a simulacrum is a sort of artificial object, like a statue rather than a man, or a placebo rather than an aspirin). Such objects are well known for their powerful abilities to contain and convey meaning; for example, a European cathedral ordinarily is constructed of thousands of metonymic simulacra, from the rose window to the altar. In this context, a placebo can repeatedly remind the patient of the medical encounter, its shadings and comforts. Placebos can convey the physicians innermost feelings about medication and treatment; and the clinician can by her simple presence enhance the effectiveness of a medical procedure (and a clinician is hardly a placebo, hardly inert). Inert placebos can help us see the human dimensions of medical treatment; but calling these things ''placebo effects'' dramatically distorts our understanding of such treatments, by focusing on the inert, and avoiding the meaningful. Think ''meaning response,'' not ''placebo effect.'' [ABSTRACT FROM AUTHOR]

Abstract: Passive skeletal muscle derives its structural response from the combination of the titin filaments in the muscle fibres, the collagen fibres in the connective tissue and incompressibility due to the high fluid content. Experiments have shown that skeletal muscle tissue presents a highly asymmetrical three-dimensional behaviour when passively loaded in tension or compression, but structural models predicting this are not available. The objective of this paper is to develop a mathematical model to study the internal mechanisms which resist externally applied deformation in skeletal muscle bulk. One cylindrical muscle fibre surrounded by connective tissue was considered. The collagenous fibres of the endomysium and perimysium were grouped and modelled as tension-only oriented wavy helices wrapped around the muscle fibre. The titin filaments are represented as non-linear tension-only springs. The model calculates the force developed by the titin molecules and the collagen network when the muscle fibre undergoes an isochoric along-fibre stretch. The model was evaluated using a range of literature based input parameters and compared to the experimental fibre-direction stress–stretch data available. Results show the fibre direction non-linearity and tension/compression asymmetry are partially captured by this structural model. The titin filament load dominates at low tensile stretches, but for higher stretches the collagen network was responsible for most of the stiffness. The oblique and initially wavy collagen fibres account for the non-linear tensile response since, as the collagen fibres are being recruited, they straighten and re-orient. The main contribution of the model is that it shows that the overall compression/tension response is strongly influenced by a pressure term induced by the radial component of collagen fibre stretch acting on the incompressible muscle fibre. Thus for along-fibre tension or compression the model predicts that the collagen network contributes to overall muscle stiffness through two different mechanisms: (1) a longitudinal force directly opposing tension and (2) a pressure force on the muscle fibres resulting in an indirect longitudinal load. Although the model presented considers only a single muscle fibre and evaluation is limited to along-fibre loading, this is the first model to propose these two internal mechanisms for resisting externally applied deformation of skeletal muscle tissue. [Copyright &y& Elsevier]

Abstract: The passive mechanical properties of muscle tissue are important for many biomechanics applications. However, significant gaps remain in our understanding of the three-dimensional tensile response of passive skeletal muscle tissue to applied loading. In particular, the nature of the anisotropy remains unclear and the response to loading at intermediate fibre directions and the Poisson''s ratios in tension have not been reported. Accordingly, tensile tests were performed along and perpendicular to the muscle fibre direction as well as at 30°, 45° and 60° to the muscle fibre direction in samples of Longissimus dorsi muscle taken from freshly slaughtered pigs. Strain was measured using an optical non-contact method. The results show the transverse or cross fibre (TT′) direction is broadly linear and is the stiffest (77kPa stress at a stretch of 1.1), but that failure occurs at low stretches (approximately λ=1.15). In contrast the longitudinal or fibre direction (L) is nonlinear and much less stiff (10kPa stress at a stretch of 1.1) but failure occurs at higher stretches (approximatelyλ=1.65). An almost sinusoidal variation in stress response was observed at intermediate angles. The following Poisson''s ratios were measured: V LT=V LT′=0.47, V TT′=0.28 and V TL=0.74. These observations have not been previously reported and they contribute significantly to our understanding of the three dimensional deformation response of skeletal muscle tissue. [Copyright &y& Elsevier]

Abstract: Objective: We describe a case of chorangiocarcinoma, a complex lesion consisting of a trophoblastic proliferation within a chorangioma, presenting in a term placenta. Materials and methods: The lesion was diagnosed by ultrasound at a second trimester check-up after amniocentesis, performed because of increased combined risk at first trimester screening for trisomy 21. After uncomplicated vaginal delivery, a healthy child was born and the placenta was expelled spontaneously. Results: Gross examination of the placenta showed a well-demarcated mass, bulging paracentrally from the fetal surface. Histology revealed a trophoblastic proliferation inside a chorangioma, consisting of multiple nodules with characters of focal multinucleation and pleomorphic cell nuclei, extensive central necrosis and high mitotic activity. Immunohistochemical staining showed strong intensity for hCG; Ki-67 (MIB-1) demonstrated a high proliferation index. Histopathological and immunohistochemical profile was compatible with a malignant trophoblastic proliferation. Conclusions: This is only the fifth reported case of so-called “chorangiocarcinoma” of the placenta (). However, histopathologically only one reported case was identical to ours. A proliferation of atypical trophoblast was observed inside a chorangioma, which formed as it were a shield around the trophoblast. No extravascular stromal invasion was present. Follow-up revealed no metastases, either in the mother or the child, up to 3 months after birth. [Copyright &y& Elsevier]

Abstract: In a future internet of things, an increasing number of every-day objects becomes interconnected with each other. Current network solutions are not designed to connect a large number of co-located devices with different characteristics and network requirements. To cope with increasingly large and heterogeneous networks, this paper presents an ‘incentive driven’ networking approach that optimizes the network performance by taking into account the network goals (‘incentives’) of all individual devices. Incentive driven networking consists of the following steps. First, devices dynamically search for co-located devices with similar network preferences and hardware and/or software capabilities. Next, if such devices are found, communities consisting of interconnected objects with similar network expectations are formed on an ad hoc basis. Due to the similarities between the involved devices, it is easier to optimize the network performance of each individual community. Finally, different communities can cooperate with each other by activating and sharing (software or hardware) network resources. The paper describes which (future) research is needed to realize this vision and illustrates the concepts with a number of simple algorithms. Through an experimental proof-of-concept implementation with two networks of resource-constrained embedded devices, it is shown that even these simple algorithms already result in improved network performance. Finally, the paper describes a large number of example use cases that can potentially benefit from our innovative networking methodology. [Copyright &y& Elsevier]

Abstract: Since energy is scarce in sensor nodes, wireless sensor networks aim to transmit as few packets as possible. To achieve this goal, sensor protocols often aggregate measured data from multiple sensor nodes into a single packet. In this paper, a survey of aggregation techniques and methods is given. Based on this survey, it is concluded that there are currently several dependencies between the aggregation method and the behavior of the other network layers. As a result, existing aggregation methods can often not be combined with different routing protocols. To remedy this shortcoming, the paper introduces a new ‘non-intrusive’ aggregation approach which is independent of the routing protocol. The proposed aggregation method is evaluated and compared to traditional aggregation approaches using a large-scale sensor testbed of 200 TMoteSky sensor nodes. Our experimental results indicate that existing aggregation approaches are only suited for a limited set of network scenarios. In addition, it is shown both mathematically and experimentally that our approach outperforms existing non-intrusive techniques in a wide range of scenarios. [ABSTRACT FROM AUTHOR]

Summary: Background: Despite success in controlling measles through a national immunization program, Israel recently experienced its largest measles outbreak since 1994. Methods: Using data reported by health district offices to the Ministry of Health, an epidemiological analysis of the 2007–08 measles outbreak was performed. Results: 1467 measles cases were reported in Israel, primarily among ultra-orthodox Jewish communities in the Jerusalem Health District and to a lesser extent in other areas. The highest age-specific incidence rate (122.5 per 100,000) occurred among infants. 38.6% of all measles patients were under the age of five, and 53.4% were under the age of ten. 186 patients (12.7%) were hospitalized; there were no fatalities. Only 4.6% of measles patients had been fully vaccinated for their age. Conclusion: To minimize the risk of future outbreaks in Israel, successful marketing of the MMR vaccine to under-vaccinated sub-groups is essential. [Copyright &y& Elsevier]

Abstract: Study Objective: Port site metastases (PSM) after laparoscopic surgery for advanced-stage ovarian carcinoma are a cause of concern, but the pathophysiology is unknown. Because CO2 pneumoperitoneum was recently demonstrated to be a cofactor in adhesion formation and tumor implantation in a laparoscopic mouse model, and because both could be prevented by the addition of 4% oxygen to the CO2 pneumoperitoneum, we wanted to test the hypothesis that PSM could be related to tumor cell hypoxia during CO2 pneumoperitoneum. Design: A randomized controlled pilot trial to compare the incidence of PSM in women undergoing laparoscopy with a pure CO2 pneumoperitoneum in comparison with women with CO2 pneumoperitoneum with the addition of 4% oxygen (Canadian Task Force classification C). Setting: University Hospital Gasthuisberg, Leuven, Belgium. Patients: Since January 1, 2007, 22 consecutive women undergoing laparoscopy for suspected ovarian cancer with subsequent debulking laparotomy were included. Interventions: Diagnostic laparoscopy with 100% CO2 versus laparoscopy with addition of 4% oxygen. Measurements and Main Results: In the control group, 9 (47%) PSM found in 19 port sites were excised. In the CO2+oxygen group, a similar incidence was found, that is, 8 (50%) PSM in 16 port sites. The incidence of PSM was higher in small women (p <.018) and in high-grade malignancies. The pathophysiology of PSM is unknown, but besides direct wound contamination, aerosolization of tumor cells and gas leaks have been suggested together with a causal relationship with the CO2 pneumoperitoneum. Tumor cell hypoxia probably is not an important mechanism because PSM were not prevented by adding small amounts of oxygen to the CO2 pneumoperitoneum. Conclusion: The hypothesis of tumor cell hypoxia by the CO2 pneumoperitoneum as a mechanism for PSM could not be confirmed. [Copyright &y& Elsevier]

Background: Demand for colonoscopy and EGD procedures is increasing. Impediments to performing these examinations persist. Patients perceive these procedures as unpleasant and painful. The use of suboptimal sedatives results in inefficiency in endoscopy practices. Improving sedation methods utilizing precise control of preferred sedatives may increase patient satisfaction and practice efficiency. Objective: Our purpose was to demonstrate the feasibility of computer-assisted personalized sedation (CAPS) for facilitating the precise administration of propofol by endoscopist/nurse teams, achieving minimal to moderate sedation in subjects undergoing routine endoscopies. Design: Open label, single-center studies. Setting: Endoscopy clinics in Charlottesville, Virginia, and Gent, Belgium. Subjects: Twenty-four adults per center; 12 colonoscopies, 12 EGDs. Interventions: Propofol sedation with CAPS by endoscopist/registered nurse care teams. Main Outcome Measurements: Sedation level measured by modified observer''s assessment of alertness/sedation (MOAA/S), recovery time measured from endoscope removal until Aldrete ≥ 12, dosage of propofol, oxygen saturation, and safety assessments. Results: Subjects responded to mild tactile and verbal stimuli MOAA/S = 5, 4, 3, or 2) 99% of the time. Mean propofol doses in the United States and Belgium were 65.4 and 72.1 mg, respectively. Mean recovery times were 29 and 10 seconds, respectively. Oxygen desaturation occurred in only 6% of subjects. No device-related adverse events occurred. Limitation: Open-label design. Conclusions: Using CAPS, the endoscopist/nurse teams precisely controlled the administration of propofol achieving minimal to moderate sedation in subjects undergoing colonoscopy and EGD procedures. Mean propofol dosage was low and post-procedure recovery times were rapid. The device performed well when operated by the endoscopist/nurse team, with no device-related adverse events. [Copyright &y& Elsevier]

Hereditary heart diseases are most often characterized by autosomal dominant inheritance and delayed cardiac expression. Predictive genetic testing (PGT) is offered to asymptomatic relatives to allow targeted medical care with early therapeutics in order to reduce the risk of complications. The aim of this study was to evaluate the psychological and socio-professional impact of predictive genetic testing in hereditary heart diseases through a prospective and retrospective study. This multicentric French study involved 20 expert centers in hereditary heart diseases. We included 517 adult relatives (42.3 ± 16.7 years, 60.6% females) who performed PGT (prospective study: n = 264, retrospective study: n = 253). The opinion and experience were collected via auto-questionnaires, at various moments in the prospective study, with different items and validated scales (STAI and IES). In the prospective study, family history was characterized by cardiomyopathy (88.4%) and channelopathies (11.6%). The main motivations for performing the test were: "to remove doubt" (65.3%), "for children" (64.0%), "to benefit from medical supervision" (34.9%). A mutation was present in 39.4% of relatives. No regret was expressed after testing (only 2.3% regrets). The result did not lead to a socio-professional change or family relationship change in 60.7%. Among those who had a change, it was perceived as unfavorable for only 3%. The level of anxiety (STAI) increases before the test result and decreased to return to baseline. Subjects with depression history were more likely to develop anxiety at long-term after multivariate analyses (P = 0.004). Our results show that contrary to a widespread opinion, the medical benefit was not the main motivation for predictive genetic testing. In most cases, no or marginal adverse psychological and socio-professional impact of genetic testing was observed when performed by a team expert in predictive testing. [ABSTRACT FROM AUTHOR]