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Chronological age is a crucial risk factor for diseases and disabilities among older adults. However, individuals of the same chronological age often exhibit divergent biological aging states, resulting in distinct individual risk profiles. Chronological age estimators based on omics data and machine learning techniques, known as aging clocks, provide a valuable framework for interpreting molecular-level biological aging. Metabolomics is an intriguing and rapidly growing field of study, involving the comprehensive profiling of small molecules within the body and providing the ultimate genome-environment interaction readout. Consequently, leveraging metabolomics to characterize biological aging holds immense potential. The aim of this review was to provide an overview of metabolomics approaches, highlighting the establishment and interpretation of metabolomic aging clocks while emphasizing their strengths, limitations, and applications, and to discuss their underlying biological significance, which has the potential to drive innovation in longevity research and development. Huang et al. conducted a comprehensive review of the literature on metabolomic aging clocks. They particularly emphasized how metabolomic aging clocks, as a novel tool for quantifying aging, are developed, applied, and interpreted. [Display omitted] [ABSTRACT FROM AUTHOR]

Emergency Department (ED) Observation Units (OU) can provide safe, effective care for low risk patients with intracranial hemorrhages. We compared current ED OU use for patients with subdural hematomas (SDH) to the validated Brain Injury Guidelines (BIG) to evaluate the potential impact of implementing this risk stratification tool. Retrospective cohort of patients ≥18 years old with SDH of any cause from 2014 to 2020 to evaluate for potential missed OU cases. Missed OU cases were defined as patients with an initial Glasgow Coma Score (GCS) of 15 with hospital length of stays (LOS) <2 days, who did not meet the composite outcome and were not cared for in the OU or discharged from the ED. Composite outcome included in-hospital death or transition to hospice care, neurosurgical intervention, GCS decline, and worsening SDH size. Secondary outcomes were whether application of BIG would increase ED OU use or reduce CT use. 264 patients met inclusion criteria over 5.3 year study timeframe. Mean age was 61 years (range 19–93) and 61.4% were male. SDH were traumatic in 76.9% and 60.2% of the cohort had additional injuries. The admission rate was 81.4% (n = 215). Fourteen (6.5%) missed OU cases were identified (2.6/year). Retrospective application of BIG resulted in 82.6% (n = 217) at BIG 3, 10.2% (n = 27) at BIG 2 and 7.6% (n = 20) at BIG 1. Application of BIG would not have decreased admission rates (82.6% BIG 3) and BIG 1 and 2 admissions were often for medical co-morbidities. The composite outcome was met in 50% of BIG 3, 22% of BIG 2, and no BIG 1 patients. In a level 1 trauma center with an established observation unit, current clinical care processes missed very few patients who could be discharged or placed in ED OU for SDH. Hospital admissions in BIG 1/2 were driven by co-morbidities and/or injuries, limiting applicability of BIG to this population. • The Brain Injury Guidelines (BIG) are validated recommendations for admission risk stratification for intracranial bleeds. • BIG does not consider medical comorbidities. In this BIG low risk cohort, comorbidities often necessitated admissions. • Current care resulted in higher levels of patients being discharged or placed in ED Observation than BIG recommendations. • BIG may not apply as well to a population with high acuity and a high comorbidity burden. [ABSTRACT FROM AUTHOR]

To examine the cardiorespiratory effects of a forced-rate aerobic exercise (FE) intervention among individuals with chronic stroke compared with an upper extremity repetitive task practice (UE RTP) control group. Secondary analysis of data from a randomized controlled trial. Research laboratory. Individuals with chronic stroke (N=60). Participants completed 24 sessions of FE followed by RTP (FE+RTP, N=30) or time matched RTP alone (N=30). The FE+RTP group was prescribed exercise at 60%-80% of heart rate reserve on a motorized stationary cycle ergometer for 45 minutes followed by 45 minutes of RTP. The control group completed 90 minutes of RTP. Metabolic exercise stress tests on a cycle ergometer were conducted at baseline and post-intervention. Outcomes included peak oxygen consumption (peak V̇ o 2) and anaerobic threshold (AT). Fifty participants completed the study intervention and pre/post stress tests. The FE+RTP group demonstrated significantly greater improvements in peak V̇ o 2 from 16.4±5.7 to 18.3±6.4 mL/min/kg compared with the RTP group (17.0±5.6 to 17.2±5.6 mL/min/kg, P =.020) and significantly greater improvements in AT from 10.3±2.8 to 11.5±3.6 mL/min/kg compared with the RTP group (10.8±3.9 to 10.4±3.2 mL/min/kg, P =.020). In analyzing predictors of post-intervention peak V̇ o 2 , the multivariable linear regression model did not reveal a significant effect of age, sex, body mass index, or beta blocker usage. Similarly, bivariate linear regression models for the FE group only did not find any exercise variables (aerobic intensity, power, or cycling cadence) to be significant predictors of peak V̇ o 2. While the aerobic exercise intervention was integrated into rehabilitation to improve UE motor recovery, it was also effective in eliciting significant and meaningful improvements in cardiorespiratory fitness. This novel rehabilitation model may be an effective approach to improve motor and cardiorespiratory function in persons recovering from stroke. [ABSTRACT FROM AUTHOR]

Advanced cryopreservation technologies have the potential to transform organ transplants, biomedical research, food storage, aquaculture, biodiversity repositories, ecological restoration, and numerous other applications. These surpass the capability of existing cryopreservation technologies to extend the life and viability of biological materials at various scales from cells to tissues, organs, and entire organisms. In this article, we demonstrate why innovations in advanced cryopreservation, which we analyze as emergent, convergent platform technologies, raise novel concerns for research ethics and coordination, governance, and equitable access to benefits. As emerging technologies, they may disrupt markets or destabilize social institutions, including the systems that govern the distribution of organs for transplant. As convergent technologies, their impact will be heightened through interaction with other technologies. The technologies that may intensify the social and ethical effects of advanced cryopreservation include information technologies that permit the administration of complex logistics of storage and transport, biotechnologies for the management of floral and faunal species and populations, and 3D printing technologies that may enable the development and distribution of customizable peripheral components of this platform technology. The speed of development among diverse applications of the core platform is likely to vary between sectors in ways that are responsive to public support as well as to ethical constraints, and advancements in any sector will affect the achievement of reliability for the core technology across sectors. We recommend that societal benefits and risks be assessed both in the specific contexts for which peripheral components are developed and for the core technology. • Advanced cryopreservation technologies may transform biomedicine, food storage, aquaculture, and conservation. • Advanced cryopreservation technologies are emerging, converging, and platform technologies. • The development pathway of advanced cryopreservation technologies depends on applications scaling up. • Advanced cryopreservation technologies should improve food security, biodiversity, and equitable access to healthcare. [ABSTRACT FROM AUTHOR]

Rural governance increasingly involves a broad range of political agents – but whom do rural dwellers consider responsible for creating and maintaining local opportunity structures? Focusing on the issue of places to socialise, our paper investigates resident-municipality relations in peripheralised rural regions of Czechia and eastern Germany. We draw from problem-centred resident interviews using an actor-centred, multimodal concept of responsibility. Analysing residents' ideals of active citizenship, mutuality, and municipal care, we find that despite the considerable differences in the ways rural dwellers conceptualise the relationship between the municipality and its residents, the provision of local opportunities to socialise represents a realm in which they perceive the local state as both powerful and responsible for taking action. We conclude that a multimodal understanding of responsibility can provide insights into the normative conditions on which local attributions of responsibility are based. We further argue that research on rural facilities should take into account the symbolic and political meaning that third places have for rural residents. • Rural studies can benefit from multimodal conceptualisations of responsibility. • Experiences of political agency crystallise around mundane places to socialise. • The municipal level is key for rural residents' experience of rural governance. • A perceived lack of places to socialise can foster distrust in the local state. • Resident engagement does not equal identification with active rural citizenship. [ABSTRACT FROM AUTHOR]

Cone-beam computed tomography (CBCT) is an essential diagnostic tool in oral radiology. Radiolucent periapical lesions (PALs) represent the most frequent jaw lesions. However, the description, interpretation, and documentation of radiological findings, especially incidental findings, are time-consuming and resource-intensive, requiring a high degree of expertise. To improve quality, dentists may use artificial intelligence in the form of deep learning tools. This study was conducted to develop and validate a deep convolutional neuronal network for the automated detection of osteolytic PALs in CBCT data sets. CBCT data sets from routine clinical operations (maxilla, mandible, or both) performed from January to October 2020 were retrospectively screened and selected. A 2-step approach was used for automatic PAL detection. First, tooth localization and identification were performed using the SpatialConfiguration-Net based on heatmap regression. Second, binary segmentation of lesions was performed using a modified U-Net architecture. A total of 144 CBCT images were used to train and test the networks. The method was evaluated using the 4-fold cross-validation technique. The success detection rate of the tooth localization network ranged between 72.6% and 97.3%, whereas the sensitivity and specificity values of lesion detection were 97.1% and 88.0%, respectively. Although PALs showed variations in appearance, size, and shape in the CBCT data set and a high imbalance existed between teeth with and without PALs, the proposed fully automated method provided excellent results compared with related literature. [ABSTRACT FROM AUTHOR]

Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017. Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics. We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist. [ABSTRACT FROM AUTHOR]

This is a Delphi study based on a scoping literature review. Targeted muscle reinnervation (TMR) enables patients with high upper limb amputations to intuitively control a prosthetic arm with up to six independent control signals. Although there is a broad agreement regarding the importance of structured motor learning and prosthetic training after such nerve transfers, to date, no evidence-based protocol for rehabilitation after TMR exists. We aimed at developing a structured rehabilitation protocol after TMR surgery after major upper limb amputation. The purpose of the protocol is to guide clinicians through the full rehabilitation process, from presurgical patient education to functional prosthetic training. European clinicians and researchers working in upper limb prosthetic rehabilitation were invited to contribute to a web-based Delphi study. Within the first round, clinical experts were presented a summary of recent literature and were asked to describe the rehabilitation steps based on their own experience and scientific evidence. The second round was used to refine these steps, while the importance of each step was rated within the third round. Experts agreed on a rehabilitation protocol that consists of 16 steps and starts before surgery. It is based on two overarching principles, namely the necessity of multiprofessional teamwork and a careful selection and education of patients within the rehabilitation team. Among the different steps in therapy, experts rated the training with electromyographic biofeedback as the most important one. Within this study, a first rehabilitation protocol for TMR patients based on a broad experts' consensus and relevant literature could be developed. The detailed steps for rehabilitation start well before surgery and prosthetic fitting, and include relatively novel interventions as motor imagery and biofeedback. Future studies need to further investigate the clinical outcomes and thereby improve therapists' practice. Graded rehabilitation offered by a multiprofessional team is needed to enable individuals with upper limb amputations and TMR to fully benefit from prosthetic reconstruction. Low. • TMR rehabilitation should already start before surgical interventions. • TMR rehabilitation is best provided in multiprofessional teams. • Surface EMG biofeedback can assist in motor learning after nerve transfers. • The patient's goals direct decision-making. [ABSTRACT FROM AUTHOR]

Background: Febrile neutropenia (FN) is an important oncological emergency seen in the emergency department (ED), and the American Society of Clinical Oncology recommends risk stratification of patients with febrile neutropenia using the Multinational Association for Supportive Care in Cancer (MASCC) Index, with ED discharge on oral antibiotics recommended for low-risk patients.Objectives: To determine the prevalence of FN neutropenia and medical system wide ED treatment guideline adherence.Methods: We performed a retrospective chart review of all patients with an ICD-10 confirmed diagnosis of FN from January 2016-2019at 13 affiliated EDs within one medical system. Only cancer/chemotherapy related FN were included. Following the MASCC guidelines, we used post-hoc calculations to classify patients as low/high-risk, and compared key clinical variables (mortality, blood culture positivity, interventions).Results: 203 patients were found to have FN. 97.9% (184/203) received broad spectrum antibiotics, including 92% of the low-risk group (60/65). All patients were admitted, and no observed in-hospital mortality was noted in the low-risk group, meanwhile 5.1% (7/138) of the high-risk group died. 14/203 patients had positive blood cultures, none in the low-risk group.Conclusion: The prevalence of FN is low among 13 EDs that had almost 1.7 million ED visits over a 3-year period. Guideline compliance for low-risk FN was poor. All patients were admitted, and nearly all patients received IV fluids and IV antibiotics. Improving FN management to align with national guidelines represents an opportunity to improved ED care of patients with cancer by reducing unnecessary hospitalizations. [ABSTRACT FROM AUTHOR]

The number of approved immune checkpoint inhibitors (ICIs) and their indications have significantly increased over the past decade. Immune-related adverse effects (irAEs) of ICIs vary widely in presentation and symptoms and can present diagnostic challenges to emergency department (ED) physicians. Moreover, when ICIs are combined with radiotherapy, cytotoxic chemotherapy, or targeted therapy, the attribution of signs and symptoms to an immune-related cause is even more difficult. Here, we report a series of 5 ED cases of adrenal insufficiency in ICI-treated cancer patients. All 5 patients presented with severe fatigue and nausea. Four patients definitely had and one patient possibly had central adrenal insufficiency, and 4 patients had undetectable serum cortisol levels. The majority of the patients had nonspecific symptoms that were not recognized at their first ED presentation. These cases illustrate the need for a heightened level of suspicion for adrenal insufficiency in ICI-treated cancer patients with hypotension, nausea and/or vomiting, abdominal pain, fatigue, or hypoglycemia. As ICI use increases, irAE-associated oncologic emergencies will become more prevalent. Thus, ED physicians must update their knowledge regarding the diagnosis and management of irAEs and routinely inquire about the specific antineoplastic therapies that their ED patients with cancer are receiving. A random cortisol level (results readily available in most EDs) with interpretation taking the circadian rhythm and the current level of physiological stress into consideration can inform the differential diagnosis and whether further investigation of this potential irAE is warranted. [ABSTRACT FROM AUTHOR]

Maternal asthma is known to impact intrauterine growth outcomes, which may be mediated, in part, by altered androgen signalling. Our aim was to explore whether the sheep placenta expresses androgen receptor (AR) isoforms and determine if the differential expression of AR protein isoforms is altered by maternal asthma. Four known AR isoforms were detected (AR-FL, AR-v1, AR-v7, and AR-45), and their expression and subcellular distribution was altered in the presence of maternal allergic asthma. These findings underscore the importance for in vivo models of maternal asthma to delineate molecular patterns that may contribute to feto-placental growth and development. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, a protocol was designed for mail-out devices and educational materials created to teach patients how to install a device for 2 weeks of continuous ambulatory ECG monitoring. We compared data collection from two sequential patient populations; one who received standard device application in the same clinic in the months before the pandemic response, and another, who received their device by mail for self-installation. Patients received a single phone call when the device was mailed and were able to contact the manufacturer as needed for support. A total of 47 devices were assessed from each group. Each group was similar in age (70 vs 65 years), and clinical indication for monitoring. Noise signal magnitude (22.34 vs 26.28%), symptom based manual activation (10 vs 8 events) and APB/recorded hour burden measurements (37.05 vs 23.36%) were similar in both groups (all comparisons were statistically non-significant). Both groups had a similar mean of hours recorded (240.37 vs. 245.05 h). Zero patient kits were lost, and all reports were delivered. Overall, it was found that a mail-delivered home-based recording platform can be reliably used to acquire clinical data with similar data quality and patient compliance as a conventional in-clinic model for long term ambulatory ECG monitoring. [ABSTRACT FROM AUTHOR]

The non-residential building stock in Germany, as in many other countries, is not fully represented in any official statistics, in contrast to residential buildings. This is surprising given the economic significance of this asset and its importance as a source of greenhouse gases. The knowledge gap was closed in a representative sample survey providing statistically valid data on structural parameters and energy-related characteristics of the non-residential building stock in Germany. This became possible because by December 2014 authoritative building polygons from all German cadastres were available in a national database for the first time. These geospatial data, adjusted for topological inconsistencies and supplemented with owner information in an on-site screening, were used as a sampling frame in the previously unknown population of the non-residential buildings, a new approach in building stock statistics worldwide. While the geometry of all buildings can be derived from the geospatial data, energy-related characteristics and renovation activities have to be obtained by interviews with the owners of the relevant non-residential buildings in the sample. With this methodology, regular monitoring of building stocks at reasonable costs becomes possible. It also can be transferred to other states with similar geospatial data infrastructure, in particular to other EU Member States. • A representative sample survey was carried out in the NRBS in Germany. • Authoritative cadastral geodata was used as a sampling frame. • Structural parameters of the NRBS were quantified. • Modernization rates of building components were determined. • The methodology is a model for other EU Member States. [ABSTRACT FROM AUTHOR]

The present study investigated the potential links between Internet Use Disorder tendencies, well-being and the impact of COVID-19 on Internet usage patterns. A sample of 2498 participants filled out the Compulsive Internet Use Scale (CIUS), the Satisfaction with Life Scale (SWLS; the cognitive facet of well-being) and the Sofalizing Scale which comprises the Online Displacement and Social Compensation dimensions. Participants were also asked to report the extent to which changes in Internet use occurred due to COVID-19 pandemic (i.e., reductions, no changes, increases). The present study comprised a survey study with cross-sectional character. The statistical analyses demonstrated that the aforementioned variables were robustly associated with each other. In a first mediation model, the association between higher levels of Internet Use Disorder and reduced well-being was partially mediated by the two dimensions of the Sofalizing scale called Online Displacement and Social Compensation. The results of the second mediation model showed that the relationship between changes in Internet use due to COVID-19 pandemic and well-being was fully mediated by CIUS scores, suggesting that increased Internet use due to the COVID-19 pandemic increased levels of Internet Use Disorder tendencies, which in turn decreased levels of well-being. The findings are discussed in the context of human social needs in a time of crisis, where meeting people in-person was restricted. • The link between change in Internet use due to the pandemic and well-being was investigated. • Higher Internet use in the pandemic was associated with lower well-being. • Internet Use Disorder tendencies represented a mediator in this relationship. • The present study further sheds light on the role of the construct of Sofalizing in the context of Internet Use Disorders. [ABSTRACT FROM AUTHOR]

Apical surgery is frequently indicated in maxillary first molars. Occasionally, a vascular anastomosis in the lateral maxillary sinus wall can be observed during surgery. The aim of this study was to examine the distance between the vascular bone channel (VBC) and the root apices of maxillary first molars using cone-beam computed tomographic imaging. Cone-beam computed tomographic images of 104 maxillary first molars were oriented in the coronal plane to evaluate the distance between the roots and the VBC. The measurements were only recorded in relation to the buccal roots. In addition, demographic parameters and further measurements such as the diameter of the VBC and the proximity to the periapical pathology were evaluated. A total of 210 VBCs were assessed. The mean distance from the VBC to the apices of the buccal roots of the maxillary first molars was 6.18 mm ± 3.84 mm. The VBC was mostly located intrasinusally (74.3%) and only rarely superficially (0.5%). The diameter of the VBC was on average 0.88 ± 0.32 mm. In this study, the VBC was usually found closer to the mesiobuccal than to the distobuccal root apex. During preparation of the access window, the existence of the VBC should be kept in mind because the mesiobuccal roots of maxillary first molars undergo apical surgery to the buccally positioned roots only. [ABSTRACT FROM AUTHOR]

Maternal asthma increases the risk of adverse pregnancy outcomes and may affect fetal growth and placental function by differential effects on the expression of glucocorticoid receptor (GR) isoforms, leading to altered glucocorticoid signalling. Our aim was to examine the effect of maternal asthma on placental GR profiles using a pregnant sheep model of asthma. Nine known GR isoforms were detected. There was a significant increase in the expression of placental GR isoforms that are known to have low trans-activational activity in other species including GR A, GR P and GRγ which may result in a pro-inflammatory environment in the presence of allergic asthma. [ABSTRACT FROM AUTHOR]

Abstract Benthic plants such as seagrasses rely on light availability, which is controlled by light attenuation in the water column. Elevated suspended sediment within estuaries strongly influences light attenuation and is governed by the recent history of natural events and human activities. To determine the constituents controlling light penetration (quantified by the irradiance attenuation coefficient, K d (PAR)), we measured irradiance profiles, suspended particulate matter, chlorophyll- a and coloured dissolved organic matter (CDOM) in a barrier-enclosed estuary in New Zealand, subjected to dredging activity. These discrete measurements were then used to relate a continuous records of turbidity to potential light availability at multiple sites within the estuary. To do this, we use a regression model to enable turbidity measurements to be used as a proxy to estimate K d (PAR). Measured K d (PAR) ranged from 0.16 m-1 to 0.98 m-1 with overall average of 0.40 m-1, while K d (PAR) inferred from continuous turbidity (which included many more events) reached higher values with average of 0.63 m-1. Continuous measurements of turbidity taken around the harbour dredging sites during dredging were slightly higher at some sites and slightly lower at others (∼2 mg l−1) compared to background measurements, indicating dredging had no consistent effect on conditions. Variations in K d (PAR) were explained mostly by suspended particulate matter (accounting for 38%–50% of variance), chlorophyll-a (explaining 25%–33%) and to a lesser extent by coloured dissolved organic matter (CDOM explaining 10%–28%). Inferred benthic light availability in the intertidal zone when immersed ranged from 28% to 76% of surface irradiance, suggesting that light availability in the intertidal zone is not limiting seagrass photosynthesis but that growth in subtidal areas such as channels may be impacted. Results, inferred from continuous turbidity measurements, demonstrate the critical importance of including storm events in monitoring to develop robust limits on light attenuation for management. Highlights • We propose using turbidity data as a proxy for K d (PAR). • Inclusion of storm events increases the light attenuation coefficient. • Post-dredging K d (PAR) was comparable to background coefficients. • Longer-term measurements of light conditions in estuaries and harbours is crucial. • Monitoring background is important to distinguish between anthropogenic versus natural. [ABSTRACT FROM AUTHOR]

• Both EBRT and MRT are continuously evolving towards personalization. • Differently from EBRT, a clear path to include dose calculations is missing in MRT. • Same as for EBRT, dosimetry will likely be one of the main drivers of MRT evolution. Radionuclide therapy, also called molecular radiotherapy (MRT), has come of age, with several novel radiopharmaceuticals being approved for clinical use or under development in the last decade. External beam radiotherapy (EBRT) is a well-established treatment modality, with about half of all oncologic patients expected to receive at least one external radiation treatment over their disease course. The efficacy and the toxicity of both types of treatment rely on the interaction of radiation with biological tissues. Dosimetry played a fundamental role in the scientific and technological evolution of EBRT, and absorbed doses to the target and to the organs at risk are calculated on a routine basis. In contrast, in MRT the usefulness of internal dosimetry has long been questioned, and a structured path to include absorbed dose calculation is missing. However, following a similar route of development as EBRT, MRT treatments could probably be optimized in a significant proportion of patients, likely based on dosimetry and radiobiology. In the present paper we describe the differences and the similarities between internal and external-beam dosimetry in the context of radiation treatments, and we retrace the main stages of their development over the last decades. [ABSTRACT FROM AUTHOR]

Objective: In the presence of inferior myocardial infarction (MI), ST depression (STD) in lead I has been claimed to be accurate for diagnosis of right ventricular (RV) MI. We sought to evaluate this claim and also whether ST Elevation (STE) in lead V1 would be helpful, with or without STD in V2.Methods: Retrospective study of consecutive inferior STEMI, comparing ECGs of patients with, to those without, RVMI, as determined by angiographic coronary occlusion proximal to the RV marginal branch. STE and STD were measured at the J-point, relative to the PQ junction. The primary outcomes were sensitivity/specificity of 1) STD in lead I ≥ 0.5 mm and 2) STE in lead V1 ≥ 0.5 mm, stratified by presence or absence of posterior (inferobasal) MI, as determined by ≥0.5 mm STD in lead V2, for differentiating RVMI from non-RVMI.Results: Of 149 patients with inferior STEMI, 43 (29%) had RVMI and 106 (71%) did not. There was no difference in the presence or absence of at least 0.5 mm STD in Lead I between patients with (37/43, 86%) vs. without RVMI (85/106, 80%, p = 0.56). In those with, vs. without, RVMI, (15/43, 35%) had STE in V1, versus (17/106, 16%) (p = 0.015). Specificity of STE in V1 for RVMI was 84%; sensitivity was 35%. Sensitivity was higher without (69%), than with (35%), STD in V2.Conclusion: Among inferior STEMI, the presence of any ST depression in lead I does not help to diagnose RVMI. ST elevation ≥0.5 mm in lead V1 is specific for RVMI, and moderately sensitive only if concomitant STD ≥ 0.5 mm in V2 is not present. Although STE in V1 is quite specific, overall the diagnostic characteristics of the standard 12‑lead ECG are inadequate to definitively diagnose, or exclude, RVMI, as defined angiographically. [ABSTRACT FROM AUTHOR]

The International Atomic Energy Agency (IAEA) developed a comprehensive program-Quality Management Audits in Nuclear Medicine (QUANUM). This program covers all aspects of nuclear medicine practices including, but not limited to, clinical practice, management, operations, and services. The QUANUM program, which includes quality standards detailed in relevant checklists, aims at introducing a culture of comprehensive quality audit processes that are patient oriented, systematic, and outcome based. This paper will focus on the impact of the implementation of QUANUM on daily routine practices in audited centers. Thirty-seven centers, which had been externally audited by experts under IAEA auspices at least 1 year earlier, were invited to run an internal audit using the QUANUM checklists. The external audits also served as training in quality management and the use of QUANUM for the local teams, which were responsible of conducting the internal audits. Twenty-five out of the 37 centers provided their internal audit report, which was compared with the previous external audit. The program requires that auditors score each requirement within the QUANUM checklists on a scale of 0-4, where 0-2 means nonconformance and 3-4 means conformance to international regulations and standards on which QUANUM is based. Our analysis covering both general and clinical areas assessed changes on the conformance status on a binary manner and the level of conformance scores. Statistical analysis was performed using nonparametric statistical tests. The evaluation of the general checklists showed a global improvement on both the status and the levels of conformances (P < 0.01). The evaluation of the requirements by checklist also showed a significant improvement in all, with the exception of Hormones and Tumor marker determinations, where changes were not significant. Of the 25 evaluated institutions, 88% (22 of 25) and 92% (23 of 25) improved their status and levels of conformance, respectively. Fifty-five requirements, on average, increased from nonconformance to conformance status. In 8 key areas, the number of improved requirements was well above the average: Administration & Management (checklist 2); Radiation Protection & Safety (checklist 4); General Quality Assurance system (checklist 6); Imaging Equipment Quality Assurance or Quality Control (checklist 7); General Diagnostic (checklist 9); General Therapeutic (checklist 12); Radiopharmacy Level 1 (checklist 14); and Radiopharmacy Level 2 (checklist 15). Analysis of results related to clinical activities showed an overall positive impact on both the status and the level of conformance to international standards. Similar results were obtained for the most frequently performed clinical imaging and therapeutic procedures. Our study shows that the implementation of a comprehensive quality management system through the IAEA QUANUM program has a positive impact on nuclear medicine practices. [ABSTRACT FROM AUTHOR]

Several institutions collect statistical data about cities, regions, and countries for various purposes. Yet, while access to high quality and recent such data is both crucial for decision makers and a means for achieving transparency to the public, all too often such collections of data remain isolated and not re-useable, let alone comparable or properly integrated. In this paper we present the Open City Data Pipeline, a focused attempt to collect, integrate, and enrich statistical data collected at city level worldwide, and re-publish the resulting dataset in a re-useable manner as Linked Data. The main features of the Open City Data Pipeline are: (i) we integrate and cleanse data from several sources in a modular and extensible, always up-to-date fashion; (ii) we use both Machine Learning techniques and reasoning over equational background knowledge to enrich the data by imputing missing values, (iii) we assess the estimated accuracy of such imputations per indicator. Additionally, (iv) we make the integrated and enriched data, including links to external data sources, such as DBpedia, available both in a web browser interface and as machine-readable Linked Data, using standard vocabularies such as QB and PROV. Apart from providing a contribution to the growing collection of data available as Linked Data, our enrichment process for missing values also contributes a novel methodology for combining rule-based inference about equational knowledge with inferences obtained from statistical Machine Learning approaches. While most existing works about inference in Linked Data have focused on ontological reasoning in RDFS and OWL, we believe that these complementary methods and particularly their combination could be fruitfully applied also in many other domains for integrating Statistical Linked Data, independent from our concrete use case of integrating city data. [ABSTRACT FROM AUTHOR]

The International Atomic Energy Agency has developed a program, named Quality Management Audits in Nuclear Medicine (QUANUM), to help its Member States to check the status of their nuclear medicine practices and their adherence to international reference standards, covering all aspects of nuclear medicine, including quality assurance/quality control of instrumentation, radiopharmacy (further subdivided into levels 1, 2, and 3, according to complexity of work), radiation safety, clinical applications, as well as managerial aspects. The QUANUM program is based on both internal and external audits and, with specifically developed Excel spreadsheets, it helps assess the level of conformance (LoC) to those previously defined quality standards. According to their level of implementation, the level of conformance to requested standards; 0 (absent) up to 4 (full conformance). Items scored 0, 1, and 2 are considered non-conformance; items scored 3 and 4 are considered conformance. To assess results of the audit missions performed worldwide over the last 8 years, a retrospective analysis has been run on reports from a total of 42 audit missions in 39 centers, three of which had been re-audited. The analysis of all audit reports has shown an overall LoC of 73.9 ± 8.3% (mean ± standard deviation), ranging between 56.6% and 87.9%. The highest LoC has been found in the area of clinical services (83.7% for imaging and 87.9% for therapy), whereas the lowest levels have been found for Radiopharmacy Level 2 (56.6%); Computer Systems and Data Handling (66.6%); and Evaluation of the Quality Management System (67.6%). Prioritization of non-conformances produced a total of 1687 recommendations in the final audit report. Depending on the impact on safety and daily clinical activities, they were further classified as critical (requiring immediate action; n = 276; 16% of the total); major (requiring action in relatively short time, typically from 3 to 6 months; n = 604; 36%); whereas the remaining 807 (48%) were classified as minor, that is, to be addressed whenever possible. The greatest proportion of recommendations has been found in the category "Managerial, Organization and Documentation" (26%); "Staff Radiation Protection and Safety" (17.3%); "Radiopharmaceuticals Preparation, Dispensing and Handling" (15.8%); and "Quality Assurance/Quality Control" and "Management of Equipment and Software" (11.4%). The lowest level of recommendations belongs to the item "Human Resources" (4%). The QUANUM program proved applicable to a wide variety of institutions, from small practices to larger centers with PET/CT and cyclotrons. Clinical services rendered to patients showed a good compliance with international standards, whereas issues related to radiation protection of both staff and patients will require a higher degree of attention. This is a relevant feedback for the International Atomic Energy Agency with regard to the effective translation of safety recommendations into routine practice. Training on drafting and application of standard operating procedures should also be considered a priority. [ABSTRACT FROM AUTHOR]

An effective management system that integrates quality management is essential for a modern nuclear medicine practice. The Nuclear Medicine and Diagnostic Imaging Section of the International Atomic Energy Agency (IAEA) has the mission of supporting nuclear medicine practice in low- and middle-income countries and of helping them introduce it in their health-care system, when not yet present. The experience gathered over several years has shown diversified levels of development and varying degrees of quality of practice, among others because of limited professional networking and limited or no opportunities for exchange of experiences. Those findings triggered the development of a program named Quality Management Audits in Nuclear Medicine (QUANUM), aimed at improving the standards of NM practice in low- and middle-income countries to internationally accepted standards through the introduction of a culture of quality management and systematic auditing programs. QUANUM takes into account the diversity of nuclear medicine services around the world and multidisciplinary contributions to the practice. Those contributions include clinical, technical, radiopharmaceutical, and medical physics procedures. Aspects of radiation safety and patient protection are also integral to the process. Such an approach ensures consistency in providing safe services of superior quality to patients. The level of conformance is assessed using standards based on publications of the IAEA and the International Commission on Radiological Protection, and guidelines from scientific societies such as Society of Nuclear Medicine and Molecular Imaging (SNMMI) and European Association of Nuclear Medicine (EANM). Following QUANUM guidelines and by means of a specific assessment tool developed by the IAEA, auditors, both internal and external, will be able to evaluate the level of conformance. Nonconformances will then be prioritized and recommendations will be provided during an exit briefing. The same tool could then be applied to assess any improvement after corrective actions are taken. This is the first comprehensive audit program in nuclear medicine that helps evaluate managerial aspects, safety of patients and workers, clinical practice, and radiopharmacy, and, above all, keeps them under control all together, with the intention of continuous improvement. [ABSTRACT FROM AUTHOR]

In this paper, we demonstrate how to extend perfect spatial hashing (PSH) in order to hash multidimensional scientific data. As a use case we employ the problem domain of indexing nodes in a graph that represents Super Carbon Nanotubes (SCNTs). The goal of PSH is to hash multidimensional data without collisions. Since PSH results from the research on computer graphics, its principles and methods have only been tested on 2- and 3-dimensional problems. In our case, we need to hash up to 28 dimensions. In contrast to the original applications of PSH, we do not focus on GPUs as target hardware but on an efficient CPU implementation. Thus, this paper highlights the extensions to the original algorithm to make it suitable for higher dimensions. Comparing the compression and performance results of the new PSH based graphs and a structure-tailored custom data structure in our parallelized SCNT simulation software, we find that PSH in some cases achieves better compression by a factor of 1.7 while only increasing the total runtime by several percent. In particular, after our extension, PSH can also be employed to index sparse multidimensional scientific data from other domains where PSH can avoid additional index-structures like KD- or R-trees. [ABSTRACT FROM AUTHOR]

The microstructuring of component surfaces via micro-cutting processes (e.g. micro milling) are adequate techniques for tribological or medical applications. Compared to conventional cutting processes, size effects influencing the chip formation and as a consequence the surface integrity arise. Those are for instance the ploughing effect or the growing influence of the cutting edge with decreasing depth of cut. In this research, the chip formation of cp-Titanium when micro-cutting in an orthogonal micro-cutting process is investigated. Ultra-fine grain cemented carbide cutting tools were used in quick-stop tests. The results show the coherences between the chip formation and the surface integrity [ABSTRACT FROM AUTHOR]

Nanoparticles are widely used as contrast and therapeutic agents. As such, imaging modalities that can accurately estimate their distribution in-vivo are actively sought. We present here our method Magneto Acoustic Tomography (MAT), which uses magnetomotive force due to a short pulsed magnetic field to induce ultrasound in the magnetic nanoparticle labeled tissue and estimates an image of the distribution of the nanoparticles in-vivo with ultrasound imaging resolution. In this study, we image the distribution of superparamagnetic iron oxide nanoparticles (IONP) using MAT method. In-vivo imaging was performed on live, nude mice with IONP injected into LNCaP tumors grown subcutaneously within the hind limb of the mice. Our experimental results indicate that the MAT method is capable of imaging the distribution of IONPs in-vivo. Therefore, MAT could become an imaging modality for high resolution reconstruction of MNP distribution in the body. From the Clinical Editor Many magnetic nanoparticles (MNPs) have been used as contrast agents in magnetic resonance imaging. In this study, the authors investigated the use of ultrasound to detect the presence of MNPs by magneto acoustic tomography. In-vivo experiments confirmed the imaging quality of this new approach, which hopefully would provide an alternative method for accurate tumor detection. [ABSTRACT FROM AUTHOR]

Objective Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and is associated with an enhanced risk for liver and cardiovascular diseases and mortality. NAFLD can progress from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH). However, the mechanisms predisposing to this progression remain undefined. Notably, hepatic mitochondrial dysfunction is a common finding in patients with NASH. Due to a lack of appropriate experimental animal models, it has not been evaluated whether this mitochondrial dysfunction plays a causative role for the development of NASH. Methods To determine the effect of a well-defined mitochondrial dysfunction on liver physiology at baseline and during dietary challenge, C57BL/6J-mt FVB/N mice were employed. This conplastic inbred strain has been previously reported to exhibit decreased mitochondrial respiration likely linked to a non-synonymous gene variation (nt7778 G/T) of the mitochondrial ATP synthase protein 8 (mt-ATP8). Results At baseline conditions, C57BL/6J-mt FVB/N mice displayed hepatic mitochondrial dysfunction characterized by decreased ATP production and increased formation of reactive oxygen species (ROS). Moreover, genes affecting lipid metabolism were differentially expressed, hepatic triglyceride and cholesterol levels were changed in these animals, and various acyl-carnitines were altered, pointing towards an impaired mitochondrial carnitine shuttle. However, over a period of twelve months, no spontaneous hepatic steatosis or inflammation was observed. On the other hand, upon dietary challenge with either a methionine and choline deficient diet or a western-style diet, C57BL/6J-mt FVB/N mice developed aggravated steatohepatitis as characterized by lipid accumulation, ballooning of hepatocytes and infiltration of immune cells. Conclusions We observed distinct metabolic alterations in mice with a mitochondrial polymorphism associated hepatic mitochondrial dysfunction. However, a second hit, such as dietary stress, was required to cause hepatic steatosis and inflammation. This study suggests a causative role of hepatic mitochondrial dysfunction in the development of experimental NASH. [ABSTRACT FROM AUTHOR]

Objective: Abnormal ECG findings suggestive of cardiac disease are frequent in patients with funnel chest, although structural heart disease is rare. Electrocardiographic characteristics and changes following new surgical treatments in young adults are not described so far. The aim of the study was to analyze electrocardiographic characteristics of patients with funnel chest before and after minimally invasive funnel chest correction by the Nuss procedure.Methods: Twenty-six patients with surgical correction of funnel chest using pectus bar were included. Twelve-lead ECGs before and later than one year after surgery were analyzed.Results: In postoperative ECGs, amplitude of P wave in lead II and negative terminal amplitude of P wave in lead V1 decreased from 0.13 to 0.10mV (p=0.03), and from 0.10 to 0.04mV (p<0.001), respectively. Mean QRS duration decreased from 108ms to 98ms (p=0.003) after correction. A pathological left and right Sokolow-Lyon index was observed in 35% and 23% of patients before, versus 8% (p=0.04) and 0% (p=0.01) after correction, respectively. In contrast, the rate of patients with J wave pattern in precordial leads V4-V6 increased from 8% before to 42% after surgery (p=0.004).Conclusions: ECG abnormalities in patients with funnel chest are frequent, and can normalize after surgical correction by the Nuss procedure. De novo J wave pattern in precordial leads V4-V6 is a frequent finding after surgical funnel chest correction using pectus bar. [ABSTRACT FROM AUTHOR]

In C++, new features and semantics can be added to an existing software package without sweeping code changes by introducing a user-defined type using operator overloading. This approach is used, for example, to add capabilities such as algorithmic differentiation. However, the introduction of operator overloading can cause a multitude of compilation errors. In a previous paper, we identified code constructs that cause a violation of the C++ language standard after a type change, and a tool called OO-Lint based on the Clang compiler that identifies these code constructs with lint-like messages. In this paper, we present an extension of this work that automatically transforms such problematic code constructs in order to make an existing code base compatible with a semantic augmentation through operator overloading. We applied our tool to the CFD software OpenFOAM and detected and transformed 23 instances of problematic code constructs in 160,000 lines of code. A significant amount of these root causes are included up to 425 times in other files causing a tremendous compiler error amplification. In addition, we show the significance of our work with a case study of the evolution of the ice flow modeling software ISSM, comparing a recent version which was manually type changed with a legacy version. The recent version shows no signs of problematic code constructs. In contrast, our tool detected and transformed a remarkable amount of issues in the legacy version that previously had to be manually located and fixed. [ABSTRACT FROM AUTHOR]

While already established in other disciplines, integrated degree programs have become more popular in computer science and mathematical education in Germany as well over the last few years. These programs combine a theoretical education and a vocational training. The bachelor degree course “Scientific Programming”, offered at FH Aachen University of Applied Sciences, is such an integrated degree program. It consists of 50% mathematics and 50% computer science. It incorporates the MATSE (MAthematical and Technical Software dEveloper) vocational training in cooperation with research facilities and IT companies located in and nearby Aachen, Jülich and Cologne. This paper presents the general concept behind integrated degree programs in Germany and the Scientific Programming educational program in particular. A key distinguishing feature of this concept is the continuous combination of theoretical education at university level with practical work experience at a company. In this fashion, students end up being very well positioned for the labor market, and companies educate knowledgeable staff familiar with their products and processes. Additionally students are able to earn two degrees in three years, which is a rare approach for computer science programs in Germany. Therefore, Scientific Programming offers an important contribution towards reducing the shortage in advanced software development and engineering on the German labor market. [ABSTRACT FROM AUTHOR]

Background: ST-segment elevation (STE) due to inferior STE myocardial infarction (STEMI) may be misdiagnosed as pericarditis. Conversely, this less life-threatening etiology of ST elevation may be confused for inferior STEMI. We sought to determine if the presence of any ST-segment depression in lead aVL would differentiate inferior STEMI from pericarditis.Methods: Retrospective study of 3 populations. Cohort 1 included patients coded as inferior STEMI, cohort 2 included patients with a discharge diagnosis of pericarditis who presented with chest pain and at least 0.5 mm of ST elevation in at least 1 inferior lead. We analyzed the presenting electrocardiogram in both populations, with careful assessment of leads II, III, aVF, and aVL. In addition, we retrospectively studied a third cohort of patients with subtle inferior STEMI (<1-mm STE with occluded artery on catheterization) and assessed the sensitivity of ST depression in lead aVL for this group.Results: Of 154 inferior STEMI patients, 154 had some amount of ST depression in lead aVL (100%; confidence interval, 98%-100%). Of the 49 electrocardiograms in the pericarditis group, all 49 had some inferior STE but none had any ST-segment depression in lead aVL (specificity, 100%; confidence interval, 91%-100%). In the third cohort, there were 272 inferior MIs with coronary occlusion, of which 54 were "subtle." Of these, 49 had some ST depression in lead aVL.Conclusion: When there is inferior ST-segment elevation, the presence of any ST depression in lead aVL is highly sensitive for coronary occlusion in inferior myocardial infarction and very specific for differentiating inferior myocardial infarction from pericarditis. [ABSTRACT FROM AUTHOR]

Objective of this paper is to examine whether the available epidemiological evidence provides information on the link between outdoor air ventilation rates and health, and whether it can be used for regulatory purposes when setting ventilation requirements for non-industrial built environments. Effects on health were seen for a wide range of outdoor ventilation rates from 6 to 7 L/s per person, which were the lowest ventilation rates at which no effects on any health outcomes were observed in field studies, up to 25–40 L/s per person, which were in some studies the lowest outdoor ventilation rates at which no effects on health outcomes were seen. These data show that, in general, higher ventilation rates in many cases will reduce health outcomes, and that there are the minimum rates, at which some health outcomes can be avoided. But these data have many limitations, such as crude estimation of outdoor ventilation rates, diversity and variability of ventilation rates at which effects were seen, a diversity of outcomes (in case of health otcomes being mainly acute not chronic). Among other limitations there are incomplete data on the strength of pollution sources and exposures as well as a wide range of sensibility of the exposed populations. The available data do not provide a sound basis for determining specific outdoor air ventilation rates that can be universally applicable in different public and residential buildings to protect against health risks. They cannot be used for regulative purposes, unless the required ventilation rates are related to actual exposures and are prescribed only when full advantage of other methods for controlling exposures has been taken. [ABSTRACT FROM AUTHOR]

Background Data are limited for mortality and comorbidities in patients with multiple sclerosis (MS). Objectives Compare mortality rates and event rates for comorbidities in MS ( n =15,684) and non-MS ( n =78,420) cohorts from the US Department of Defense (DoD) database. Methods Comorbidities and all-cause mortality were assessed using the database. Causes of death (CoDs) were assessed through linkage with the National Death Index. Cohorts were compared using mortality (MRR) and event (ERR) rate ratios. Results All-cause mortality was 2.9-fold higher in the MS versus non-MS cohort (MRR, 95% confidence interval [CI]: 2.9, 2.7–3.2). Frequent CoDs in the MS versus non-MS cohort were infectious diseases (6.2, 4.2–9.4), diseases of the nervous (5.8, 3.7–9.0), respiratory (5.0, 3.9–6.4) and circulatory (2.1, 1.7–2.7) systems and suicide (2.6, 1.3–5.2). Comorbidities including sepsis (ERR, 95% CI: 5.7, 5.1–6.3), ischemic stroke (3.8, 3.5–4.2), attempted suicide (2.4, 1.3–4.5) and ulcerative colitis (2.0, 1.7–2.3), were higher in the MS versus non-MS cohort. The rate of cancers was also higher in the MS versus the non-MS cohort, including lymphoproliferative disorders (2.2, 1.9–2.6) and melanoma (1.7, 1.4–2.0). Conclusions Rates of mortality and several comorbidities are higher in the MS versus non-MS cohort. Early recognition and management of comorbidities may reduce premature mortality and improve quality of life in patients with MS. [ABSTRACT FROM AUTHOR]

Carbon nanotubes possess many interesting properties, which make them a promising material for a variety of applications. In this paper, we present a unified framework for the simulation of the mechanical behavior of carbon nanotubes. It allows the creation, simulation and visualization of these structures, extending previous work by the research group “MISMO” at TU Darmstadt. In particular, we develop and integrate a new matrix-free iterative solving procedure, employing the conjugate gradient method, that drastically reduces the memory consumption in comparison to the existing approaches. The increase in operations for the memory saving approach is partially offset by a well scaling shared-memory parallelization. In addition the hotspots in the code have been vectorized. Altogether, the resulting simulation framework enables the simulation of complex carbon nanotubes on commodity multicore desktop computers. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to determine if Sonoclot with its sensitive glass bead–activated, viscoelastic test can predict postoperative bleeding in patients undergoing cardiac surgery at predefined time points. Design A prospective, observational clinical study. Setting A teaching hospital, single center. Participants Consecutive patients undergoing cardiac surgery (N = 300). Interventions Besides routine laboratory coagulation studies and heparin management with standard (kaolin) activated clotting time, additional native blood samples were analyzed on a Sonoclot using glass bead–activated tests. Glass bead–activated clotting time, clot rate, and platelet function were recorded immediately before anesthesia induction and at the end of surgery after heparin reversal but before chest closure. Measurements and Main Results Primary outcome was postoperative blood loss (chest tube drainage at 4, 8, and 12 hours postoperatively). Secondary outcome parameters were transfusion requirements, need for surgical re-exploration, time of mechanical ventilation, length of intensive care unit and hospital stay, and hospital morbidity and mortality. Patients were categorized into “bleeders” and “nonbleeders.” Patient characteristics, operations, preoperative standard laboratory parameters, and procedural times were comparable between bleeders and nonbleeders except for sex and age. Bleeders had higher rates of transfusions, surgical re-explorations, and complications. Only glass bead measurements by Sonoclot after heparin reversal before chest closure but not preoperatively were predictive for increased postoperative bleeding. Conclusions Sonoclot with its glass bead–activated tests may predict the risk for postoperative bleeding in patients undergoing cardiac surgery at the end of surgery after heparin reversal but before chest closure. [ABSTRACT FROM AUTHOR]

Abstract: Evolutionary theory, augmented by a vast literature on gaze cuing and gaze following, suggests that the unique high-contrast morphology of the human eye evolved for rapid and silent communication between conspecifics. While this theory rests on the fundamental idea that humans use their eyes to signal information, empirical studies have focused exclusively on the effects of gaze cues on human receivers. In a series of three experiments we examined the other side of the communication dynamic by investigating if, and when, humans signal gaze information to other humans in a natural, but controlled, situation involving food consumption. First, we established that there is a normative behavior to look away when someone begins to bite. Second, we found that participants were significantly more likely to look down at their food before taking a bite when they were eating with another person versus alone. Lastly, we found that in pairs where a social connection has been established, when one person looks down signaling that a bite is forthcoming, the other person tends to look away. These results demonstrate that natural gaze signaling occurs in the context of eating, and it can, dependent on the relationship between the pair, trigger a gaze response that is different from gaze following. Our study shows that natural social attention between individuals is a two-way street, where each person can signal and read gaze information, consistent with the idea that human eye morphology evolved to facilitate communication between conspecifics. [Copyright &y& Elsevier]

Abstract: Pharmaceutical compounds enter the body via several major natural gateways; i.e. the lung, the skin and the gastrointestinal tract. Drug application during surgical operations can lead to severe impairment of gastrointestinal motility, which can contribute to a paralytic ileus. Here we investigated an ex vivo perfused small intestine model that allows us to ascertain the influence of pharmaceuticals upon the gut. Corresponding segments from the proximal jejunum of adult rats were used. Their mesenteric arteries and veins were cannulated and the jejunal segment excised. The individual segments were placed in a custom designed perfusion chamber and perfusion performed through the intestinal lumen as well as the mesenteric superior artery. Three test drugs, which are commonly used in anesthesiology; i.e. pentobarbital, propofol and ketamine were administered via the blood vessels. Their effects upon gastrointestinal motility patterns were evaluated by optical measurements. Longitudinal and pendular movements were distinguishable and separately analyzed. Pharmacological effects of the individual substances could be investigated. Propofol (50–200μg/ml) was found to decrease intestinal motility, especially longitudinal movements in a dose dependent manner. Pentobarbital decreased intestinal motility only at high concentrations, above 2.5mg/ml. A dose of 2.5mg/ml lead to an increase in longitudinal- and pendular movements in comparison to control, while ketamine (2.5–10mg/ml) did not alter intestinal motility at all. Histological examination of the perfused segments revealed only minor changes in tissue morphology after perfusion. The perfusion approach shown here allows for the identification of compounds which interfere with gut motility in a highly sophisticated way. It is suitable for characterization of drug and dose specific changes in motility patterns and can be used in drug development and preclinical studies. [Copyright &y& Elsevier]

The photosynthetic behaviour and composition of photosynthetic pigments of four Cosmarium strains collected from different geographic areas were examined under moderate and photoinhibitory white light by means of PAM fluorometry and high-performance liquid chromatography. Generally, all of the Cosmarium strains displayed the photosynthetic performance and the composition of xanthophyll cycle pigments corresponding to that of high-light adapted plants and algae, when grown under the standard laboratory conditions. However, photoinhibitory treatments provoked several strain- and species-specific characteristics despite the long-term cultivation in laboratory conditions. The typical arctic taxon, C. crenatum var. boldtianum, displayed an incomplete violaxanthin cycle yielding an accumulation of antheraxanthin during high light stress, which is considered as an adaptation to occasional high irradiances in the polar zone due to the albedo. So far, the violaxanthin/antheraxanthin turnover was known only in some prasinophycean algae. Antheraxanthin actively participated in the heat dissipation from PSII centres in C. crenatum, as concluded from a significant positive correlation between non-photochemical quenching (NPQ) and the quantity of antheraxanthin. In contrast, all the other Cosmarium strains displayed a complete violaxanthin de-epoxidase action during the high light treatments, as judged from the relatively high production of zeaxanthin which participated in thermal dissipation of excess energy. [ABSTRACT FROM AUTHOR]

Abstract: Ultrasound is widely used in clinical practice, mostly in diagnostic studies, but increasingly in therapeutic applications as well. This may be the case in acceleration of wound healing or treatment of cancer. Still, little is known about the direct effect of frequency or energy density of the ultrasound upon the cells themselves. We therefore investigated the impact of three different protocols using high, medium and low energy densities at three different frequencies on normal endothelial and epithelial as well as carcinoma cell lines (neuroblastoma and adenocarcinoma cell lines). Proliferation of endothelial and epithelial cell lines was significantly increased depending on the frequency and energy density applied. No influence on actin cytoskeleton formation was seen in these cells after treatment, while a significant decrease in the density of microvilli and the length of filopodia in the epithelial cell line could be noted. The proliferation rate of the carcinoma cell lines was reduced and cells destroyed. Apoptosis was induced in the adenocarcinoma cells after ultrasound exposure. Additionally, the expression of neurofilament was increased in neuroblastoma cells as evidence of beginning differentiation. So, different settings of frequency and energy density in an ultrasonic treatment protocol lead to different impacts on proliferation, morphology and differentiation and might be used to stimulate or inhibit the growth of individual cell types. [Copyright &y& Elsevier]

Abstract: The Wadden Sea region along the Dutch coast is currently an area undergoing a turning point in the context of both environmental change and economic growth and development, which will inevitably result in pivotal alterations of its natural systems. In this work, we apply scenarios as a tool to explore possible futures of both environmental conditions and use-regimes in this region. Implications of divergent world-views about the Wadden Sea environment and its development potential are evaluated with this methodology to find common ground among stake-holders regarding management trajectories and the possible environmental conditions that may result from prospective policy options. Particular considerations of how to generate and evaluate scenarios are identified and applied to reveal how current environmental tensions regarding development, resource exploitation, and conservation in the Wadden Sea region can be useful to frame feasible policy prescriptions and mitigate conflict among user-groups. Two scenarios, “Nature First” and “Food and Energy” were constructed based on present-day attitudes and perceptions of how this region should be managed, given its particular status as a unique and sensitive ecosystem that also harbors abundant resources and industrial growth capacity. We show that by looking ahead into potential outcomes of current trends in development efforts, these scenarios can effectively inform the decision-making processes by revealing the potential consequences, both beneficial and adverse, that could result from the variety of development goals currently being considered for the Wadden Sea region. We show that this heavily-utilized coastal zone requires a strategic long-term integrated vision that includes the flexibility to accommodate unexpected circumstances that result from short-term management decisions. [Copyright &y& Elsevier]

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Abstract: Behavioural, physiological and psychological adaptive processes are presumed reasons for the discrepancies between predicted mean vote (PMV) and observed comfort votes during field studies. However, few is known about the individual portions of these processes to this effect. This paper describes the development of an experimental design which aims at identifying those portions and is meant for climate chambers with at least one façade connected to the exterior. The experimental design consists of distinctive settings with respect to variations in outside conditions and the number of control opportunities so that one or more of the three adaptive processes are blocked. The results of a first implementation of this experimental design presented show the ability to analyse the three processes individually with the data gathered by such procedures. As a result, the permission to interact with the built environment by means of using a fan or opening a window alone leads to an increased satisfaction with the thermal conditions. At the same time, the restriction of such behavioural reactions seems to be counterbalanced by an increased amount of physiological reactions such as an increased level of skin moisture and skin temperature. In conclusion, the developed experimental design looks promising in order to reveal the single effects leading to the phenomenon called adaptive comfort, while small adjustments are discussed for further improvements. [Copyright &y& Elsevier]

Abstract: Background: Because women have been excluded from many study populations in investigations of diabetes care, there is insufficient information on sex-specific differences in glycemic control. Objective: The aim of the present study was to assess whether treatment goals for glycemic and cardiovascular risk factor control are achieved equally in older, Central European, female and male patients with type 2 diabetes mellitus (T2DM). Methods: In a retrospective cross-sectional study, data were analyzed from consecutive older (aged ≥60 years) female and male patients with insulin-treated T2DM who attended a diabetes outpatient clinic between January 2007 and April 2008 at the Medical University of Vienna, Austria. Sex-specific differences in glycosylated hemoglobin (HbA1c) levels were assessed as the primary outcome. LDL-C and HDL-C, as well as systolic and diastolic blood pressure (SBP and DBP, respectively), were assessed as secondary outcomes and were adjusted for age, duration of diabetes, duration of insulin treatment, body mass index, insulin units per kilogram per day, and secondary causes of diabetes. P values were adjusted using the Bonferroni correction. Results: Data were analyzed from 183 female and 209 male patients with insulin-treated T2DM. In multivariate linear regression models, women had significantly higher levels of LDL-C (P = 0.008), HDL-C (P < 0.001), SBP (P < 0.001), and DBP (P = 0.034), but not HbA1c (P = NS). Multivariate logistic regression models revealed that women were significantly less likely to meet treatment goals for blood pressure (SBP, P = 0.044; DBP, P = 0.024), but not for cholesterol or HbA1c levels (P = NS for LDL-C, HDL-C, and HbA1c). Conclusion: In this study of older patients with insulin-treated T2DM, whereas glycemic control was comparable between women and men, a more adverse cardiovascular risk factor profile was observed in female patients. [Copyright &y& Elsevier]

Abstract: Environmental problems are becoming increasingly unwieldy, particularly those which are highly debated because of their political and financial consequences and have been termed as in “crisis”. In coral reef environments, these considerations spill into decisions on mitigation of reef decline and attendant questions of territorial and resource-access rights. Historical foundations of reef science show that early applications of reef inquiries centered on environmental connection and inevitably led to establishing not only the baseline of reef ecosystems, but also contributed to the evolution of conservation crisis in this environment. This work applies Q-methodology towards determining attitudes, prioritizing statements and finding consensus regarding management issues that are tied to the science of coral reef environments and their conservation “crisis”. This work delineates the social construction of attitudes, perceptions, and foundations of coral conservation science by examining the scientifically-grounded statements that constitute conservation debates. Study participants were comprised of the coral reef science and conservation professional network. The Q-sample (n = 43) was structured around some central debates over the dilemmas and strategies of reef management and decline-mitigation, both recent and long-running. Four attitudes or viewpoints were isolated in terms of their preferred management models, geographic perspectives and the role scientific findings play within these core beliefs. These can be generally described as Community and Locally-centered Humanists, Scientific Idealists, Skeptical and Utilitarian Pragmatists, and Politically-oriented Positivists. Evaluating agreement about central issues showed a high degree of consensus regarding the relative importance of community input in the role of successful reef management while the highest degree of contention was seen in scalar issues such as human-environment feedback systems that are inherent in solving environmental crises. [Copyright &y& Elsevier]

Abstract: Aims: quantitative description of adherence to motivational interviewing (MI) in smoking cessation sessions; and examination of the relationships between client characteristics and adherence to MI, and between adherence to MI and future smoking status. Methods: 84 sessions were conducted during a randomised controlled trial to test the effectiveness of a population-based smoking intervention in women during the postpartum period. Demographic and behaviour-related variables were included in a logistic regression to predict adherence to MI. Measurements: adherence was measured using the MI Treatment Integrity Scale. Findings: 38.1% of sessions showed good adherence to MI. Receiving a good MI session was not related to any demographic or behavioural variables. The relationship between adherence and intervention outcome after six months was not statistically significant (χ 2=0.355, p=0.551). Conclusions: the smoking cessation sessions examined in this study failed to adhere to MI. There was no relationship between adherence to MI and behavioural outcome six months after the intervention, indicating that women who smoke post partum may be a high-risk group for whom specific smoking cessation interventions need to be developed. [Copyright &y& Elsevier]

Classic studies in sheep have contributed greatly to our understanding of lung physiology in health and disease. Similarities in size and structure between sheep and human lungs allow testing of new treatments using the same equipment and procedures used in human medicine, thereby facilitating translation of findings into the clinic. Sheep models of respiratory diseases, in particular sheep models of asthma, continue to be refined and provide unique opportunities for both basic and applied studies of respiratory diseases and their treatments. [Copyright &y& Elsevier]

Purpose: To develop a model for study of exothermic chemical reactions potentially useful for tissue ablation. Materials and Methods: Seven gelatins ranging from 0.5% to 30% wt/vol with and without 15% or 30% caps and several commercial gels were evaluated. Baseline temperature measurements were taken. Acetic acid and ammonium hydroxide were sequentially injected over periods of 10–15 seconds in 1-mL aliquots, forming a discrete aqueous reaction chamber. Congo red pH indicator was included to assess the reaction. A thermocouple allowed data collection at completion of injection and every 15 seconds for 5 minutes. Injections were performed in triplicate, and average temperatures for each time point were reported. Results: Gelatins fractured or refluxed even at the lowest concentrations tested. Most commercial gels proved too viscous and likewise led to reflux along the needle tract. A mineral oil–based gel was selected because of its ability to form a chamber without reflux or fracture and its clear colorless character, hydrophobic nature, chemical stability, viscosity, specific gravity, and cost. Temperatures during the first 60 seconds of the neutralization reaction showed an immediate increase that correlated well with concentration. Conclusions: The oil gel phantom is a safe, useful, readily available, inexpensive model to study mixing behaviors and maximum heating potentials for reactions that may prove useful in thermochemical tissue ablation for oncologic interventions. Measurable temperature changes occurred even at the lowest concentrations, and higher concentrations produced a greater release of heat energy. [Copyright &y& Elsevier]

Purpose: This case report discusses 2 patients who required implant placement in the atrophic posterior maxilla to support a fixed prosthesis with the least invasive and shortest procedure. Materials and Methods: The reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach with delayed implant placement. However, in these cases, the posterior maxillas were treated with an osteotome sinus floor elevation procedure without grafting material and simultaneous placement of short, 8- and 10-mm-long, tapered implants. Results: All implants achieved primary stability and were successfully loaded after 3.6 months of healing. At the 1- and 2-year follow-up visits, they were clinically stable and the final prostheses were functioning. The mean endosinus bone gain was 5.1 ± 1.3 mm. In 1 of the patients, the implants were completely embedded in the newly formed bone and the sinus floor had been relocated apical to its previous demarcation. Conclusions: The findings from these 2 cases suggest that the osteotome sinus floor elevation procedure without grafting material, and immediate placement of tapered implants, might be applied in situations for which previously only the lateral approach was considered (at the condition that implants achieve firm primary stability). More patients and longer follow-up are warranted to investigate how reliable this technique can be when applied to the atrophic maxilla. [Copyright &y& Elsevier]

Background: Health care expenditures continue to escalate, and pressures for increased spending will continue. Health care decision makers from publicly financed systems, private insurance companies, or even from individual health care institutions, will continue to be faced with making difficult purchasing, access, and reimbursement decisions. As a result, decision makers are increasingly turning to evidence-based platforms to help control costs and make the most efficient use of existing resources. Most tools used to assist with evidence-based decision making focus on clinical outcomes. Health Technology Assessment: Health technology assessment (HTA) is increasing in popularity because it also considers other factors important for decision making, such as cost, social and ethical values, legal issues, and factors such as the feasibility of implementation. In some jurisdictions, HTAs have also been supplemented with primary data collection to help address uncertainty that may still exist after conducting a traditional HTA. Role of Primary Data Collection: The HTA process adopted in Ontario, Canada, is unique in that assessments are also made to determine what primary data research should be conducted and what should be collected in these studies. In this article, concerns with the traditional HTA process are discussed, followed by a description of the HTA process that has been established in Ontario, with a particular focus on the data collection program followed by the Programs for Assessment of Technology in Health Research Institute. An illustrative example is used to show how the Ontario HTA process works and the role value of information analyses plays in addressing decision uncertainty, determining research feasibility, and determining study data collection needs. [Copyright &y& Elsevier]