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In computer-mediated communication, small graphical icons (emojis) can be used to compensate for the lack of nonverbal cues such as facial expressions or hand gestures. Accordingly, literature suggests that the use of emojis may also be subject to social norms—similar to nonverbal behavior in face-to-face interactions. However, actual empirical investigations into this assumption remain lacking. To remedy this research gap, I explored whether traditional norms of appropriate emotional intensity and reciprocity also apply to emoji usage. A first online experiment (N = 188) revealed that excessive emoji use in a first-contact scenario leads to diminished interpersonal outcomes, corresponding to the drawbacks of overly intense nonverbal displays in natural interactions. Proceeding to a different communicative stage, Experiment 2 (N = 242) explored nonverbal reciprocity with acquainted interaction partners. Inviting participants to reply to fictitious text messages (at varying levels of interpersonal intimacy), it was observed that stimulus messages containing more emojis also evoke stronger emoji use in return—indicating that principles of nonverbal attunement are in full effect during text-based online interactions.

When interacting with sophisticated digital technologies, people often fall back on the same interaction scripts they apply to the communication with other humans—especially if the technology in question provides strong anthropomorphic cues (e.g., a human-like embodiment). Accordingly, research indicates that observers tend to interpret the body language of social robots in the same way as they would with another human being. Backed by initial evidence, we assumed that a humanoid robot will be considered as more dominant and competent, but also as more eerie and threatening once it strikes a so-called power pose. Moreover, we pursued the research question whether these effects might be accentuated by the robot’s body size. To this end, the current study presented 204 participants with pictures of the robot NAO in different poses (expansive vs. constrictive), while also manipulating its height (child-sized vs. adult-sized). Our results show that NAO’s posture indeed exerted strong effects on perceptions of dominance and competence. Conversely, participants’ threat and eeriness ratings remained statistically independent of the robot’s depicted body language. Further, we found that the machine’s size did not affect any of the measured interpersonal perceptions in a notable way. The study findings are discussed considering limitations and future research directions.

Meal-concurrent media use has been linked to several problematic outcomes, including higher caloric intake and an increased risk for obesity. Nevertheless, the sociocultural and dispositional predictors of using media while eating are not yet well-understood, including potential cross-cultural differences. Inspired by the recent emergence of a new food-related media phenomenon called “mukbang”—digital eating broadcasts that have become immensely popular throughout East and Southeast Asia—we inquire 296 participants from two cultures (Germany and South Korea) about their meal-concurrent media use. Our results suggest that South Koreans tend to use media more frequently during meals than Germans, especially for social purposes. Meanwhile, younger age only predicts meal-concurrent media use in the German sample. Apart from that, however, many other examined predictors (e.g., gender, living situation, body-esteem, the Big Five) remain statistically insignificant, indicating notable universality for the behavior in question. In the second part of our study, we then put special focus on the emerging mukbang trend and conduct a theory-driven exploration of its gratifications. Doing so, we find that participants' parasocial and social experiences during eating broadcasts significantly predict their enjoyment of the genre.

Faced with the ongoing diversification and commercial success of highly immersive media technologies (e.g., VR headsets), both content producers and scientific scholars have become highly invested in understanding the psychological consequences of experiencing media in these new and lifelike ways. While many studies underscore positive effects of high media immersivity—such as increased enjoyment or persuasive success—others warn about the intense cognitive load that technologies such as VR might put on their users. In a laboratory experiment with N = 121 participants, we compare the cognitive load experienced while watching a 360° video on a laptop screen or via an immersive VR head-mounted display. Furthermore, we scrutinize two prominent explanations for the additional cognitive load in immersive media settings, i.e., the role of spatial presence and cybersickness. As expected, the VR condition results in higher cognitive load, spatial presence, and cybersickness than the 2D condition. However, by means of a parallel mediation model, we observe that only cybersickness emerges as a meaningful mediator of participants’ strained cognitive capacity; spatial presence, on the other hand, remains statistically irrelevant in this regard. We discuss our findings considering implications for media producers and future research.

BACKGROUND: Approximately every third surgical patient is anemic. The most common form, iron deficiency anemia, results from persisting iron-deficient erythropoiesis (IDE). Zinc protoporphyrin (ZnPP) is a promising parameter for diagnosing IDE, hitherto requiring blood drawing and laboratory workup. STUDY DESIGN AND METHODS: Noninvasive ZnPP (ZnPP-NI) measurements are compared to ZnPP reference determination of the ZnPP/heme ratio by high-performance liquid chromatography (ZnPP-HPLC) and the analytical performance in detecting IDE is evaluated against traditional iron status parameters (ferritin, transferrin saturation [TSAT], soluble transferrin receptor-ferritin index [sTfR-F], soluble transferrin receptor [sTfR]), likewise measured in blood. The study was conducted at the University Hospitals of Frankfurt and Zurich. RESULTS: Limits of agreement between ZnPP-NI and ZnPP-HPLC measurements for 584 cardiac and noncardiac surgical patients equaled 19.7 μmol/mol heme (95% confidence interval, 18.0-21.3; acceptance criteria, 23.2 μmol/mol heme; absolute bias, 0 μmol/mol heme). Analytical performance for detecting IDE (inferred from area under the curve receiver operating characteristics) of parameters measured in blood was: ZnPP-HPLC (0.95), sTfR (0.92), sTfR-F (0.89), TSAT (0.87), and ferritin (0.67). Noninvasively measured ZnPP-NI yielded results of 0.90. CONCLUSION: ZnPP-NI appears well suited for an initial IDE screening, informing on the state of erythropoiesis at the point of care without blood drawing and laboratory analysis. Comparison with a multiparameter IDE test revealed that ZnPP-NI values of 40 μmol/mol heme or less allows exclusion of IDE, whereas for 65 μmol/mol heme or greater, IDE is very likely if other causes of increased values are excluded. In these cases (77% of our patients) ZnPP-NI may suffice for a diagnosis, while values in between require analyses of additional iron status parameters.

Humanoid robots (i.e., robots with a human-like body) are projected to be mass marketed in the future in several fields of application. Today, however, user evaluations of humanoid robots are often based on mediated depictions rather than actual observations or interactions with a robot, which holds true not least for scientific user studies. People can be confronted with robots in various modes of presentation, among them (1) 2D videos, (2) 3D, i.e., stereoscopic videos, (3) immersive Virtual Reality (VR), or (4) live on site. A systematic investigation into how such differential modes of presentation influence user perceptions of a robot is still lacking. Thus, the current study systematically compares the effects of different presentation modes with varying immersive potential on user evaluations of a humanoid service robot. Participants (N = 120) observed an interaction between a humanoid service robot and an actor either on 2D or 3D video, via a virtual reality headset (VR) or live. We found support for the expected effect of the presentation mode on perceived immediacy. Effects regarding the degree of human likeness that was attributed to the robot were mixed. The presentation mode had no influence on evaluations in terms of eeriness, likability, and purchase intentions. Implications for empirical research on humanoid robots and practice are discussed.

Social networking sites such as Instagram provide users with numerous social comparison cues, potentially leading to envy and lower self-esteem. We conducted two experiments, examining whether such negative consequences could be mitigated by brief cognitive interventions. In Experiment 1 (N = 391), we reminded users of the unrealistic nature of most Instagram posts in a 2 (intervention: disclaimer vs. control) × 2 (Instagram profile: upward vs. downward comparison standard) between-subjects design. Positive and negative affect, envy, self-esteem, and well-being served as dependent variables. Experiment 2 (N = 184) explored whether slightly longer cognitive interventions (“cognitive bias” vs. “growth mindset” vs. control) could improve participants’ experience of upward comparisons, shielding them against envy or the loss of self-esteem. Both experiments included social comparison orientation (SCO) as a potential moderator. Results show that eliciting upward comparisons indeed evoked more envy, with SCO moderating the effect. We further observed indirect effects of the shown Instagram profiles on positive affect, envy, self-esteem, and well-being via participants’ social comparison experience. Concerning the cognitive interventions, however, we report that neither an authoritative disclaimer, nor educating users about cognitive biases or mindsets significantly reduced the negative consequences of social comparisons.

Postpartum hemorrhage is the major cause of maternal mortality worldwide. Retained placenta accounts for nearly 20% of severe cases. We investigated the influence of the time factor and retained placenta etiology on postpartum hemorrhage dynamics.Our retrospective study analyzed a single-center cohort of 296 women with retained placenta. Blood loss was measured using a validated and accurate technique based on calibrated blood collection bags, backed by the post- vs pre-partum decrease in hemoglobin. We evaluated the relationship between these two blood loss parameters and the duration of the third stage of labor using Spearman rank correlation, followed by subgroup analysis stratified by third stage duration and retained placenta etiology.Correlation analysis revealed no association between third stage duration and measured blood loss or decrease in hemoglobin. A shorter third stage ( 60 min) was associated with significantly increased uterine atony (p = 0.001) and need for blood transfusion (p = 0.006). Uterine atony was significantly associated with greater decrease in hemoglobin (p 0.001), higher measured blood loss (p 0.001), postpartum hemorrhage (p = 0.048), and need for blood transfusion (p 0.001).Postpartum blood loss does not correlate with third stage duration in women with retained placenta. Our results suggest that there is neither a safe time window preceding postpartum hemorrhage, nor justification for an early cut-off for manual removal of the placenta. The prompt detection of uterine atony and immediate prerequisites for manual removal of the placenta are key factors in the management of postpartum hemorrhage.

Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.

Zusammenfassung. Das Patient Blood Management ist ein multidisziplinäres Behandlungskonzept, das vorrangig die Behandlung von Anämie und Eisenmangel, die Minimierung von Blutverlusten und die Erhöhung der Anämietoleranz beinhaltet. Die Anwendung des Patient Blood Management Konzeptes ist nicht nur für die perioperative Phase, sondern für alle Bereiche der Medizin indiziert, die sich mit der Behandlung mit Blut und Blutprodukten auseinandersetzen. Eine Vielzahl von Studien mit bis zu 605’000 Patienten haben die Sicherheit und Effektivität dieses Konzepts geprüft. Dabei konnten Fremdbluttransfusionen reduziert, finanzielle Ressourcen geschont und klinische, patientenbezogene Outcomeparameter, inklusive Morbidität und Mortalität, verbessert werden. Patient Blood Management ist daher zu einem Standard der Patientenversorgung geworden.

Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid. The incidence of massive transfusion (≥ 10 units of red blood cells from emergency department arrival until intensive care unit admission) was compared with the predicted incidence according to the trauma associated severe haemorrhage score. All adult (≥ 16 years) trauma patients primarily admitted to the University Hospital Zürich with an injury severity score ≥ 16 were included. In 2005-2007, the observed and trauma associated severe haemorrhage score that predicted the incidence of massive transfusion were identical, whereas in 2012-2014 the observed incidence was less than half that predicted (3.7% vs. 7.5%). Compared to 2005-2007, the proportion of patients transfused with red blood cells and fresh frozen plasma was significantly lower in 2012-2014 in both the emergency department (43% vs. 17%; 31% vs. 6%, respectively), and after 24 h (53% vs. 27%; 37% vs. 16%, respectively). The use of tranexamic acid and coagulation factor XIII also increased significantly in the 2012-2014 time period. Implementation of a revised trauma management strategy, which included goal-directed coagulation management, was associated with a reduced incidence of massive transfusion and a reduction in the transfusion of red blood cells and fresh frozen plasma.

Background A factor-based coagulation management following major trauma is recommended as standard of care by the European Trauma Treatment Guidelines. However, concerns about the thromboembolic risk of this approach are still prevalent. Our study therefore aims to assess if such a haemostatic management is associated with an increased risk for thromboembolic events. Methods In this retrospective observational study carried out at the University Hospital Zurich we compared two three-year periods before (period 1: 2005–2007) and after (period 2: 2012–2014) implementation of a factor-based coagulation algorithm. We included all adult patients following major trauma primarily admitted to the University Hospital Zurich. Thromboembolic events were defined as a new in-hospital appearance of any peripheral thrombosis, arterial embolism, pulmonary embolism, stroke or myocardial infarction. A logistic regression was performed to investigate the association of thromboembolic events with possible confounders such as age, sex, specific Abbreviated Injury Scale (AIS) subgroups, allogeneic blood products, and the coagulation management. Results Out of 1138 patients, 772 met the inclusion criteria: 344 patients in period 1 and 428 patients in period 2. Thromboembolic events were present in 25 patients (7.3%) of period 1 and in 42 patients (9.8%) of period 2 (raw OR 1.39, 95% CI 0.83 to 2.33, p = 0.21). Only AIS extremities (adjusted OR 1.26, 95% CI 1.05 to 1.52, p = 0.015) and exposure to allogeneic blood products (adjusted OR 2.39, 95% CI 1.33 to 4.30, p = 0.004) were independently associated with thromboembolic events in the logistic regression, but the factor-based coagulation management was not (adjusted OR 1.60, 95% CI 0.90–2.86, p = 0.11). Conclusion There is no evidence that a goal-directed, factor-based coagulation management is associated with an increased risk for thromboembolic events following major trauma.

Digital technologies are advancing rapidly, growing to be more human-like and intelligent by the day. However, research shows that a machine's resemblance to humans can reach a critical level, which makes it seem uncanny to observers. While scholars have discussed this effect in terms of both human-like appearances and mental abilities, a potential interaction between the two aspects has hardly been addressed in literature. We designed a two-factorial experiment to overcome the identified research gap, introducing participants to digital agents with varying embodiment (text interface/human rendering) and mental capacity (simple algorithms/complex artificial intelligence). Our results show that the interaction of both factors indeed affects participants’ experience in a crucial way: Whereas an agent based on simple algorithms only evokes discomfort when embedded in a human-like body, the artificial intelligence is always perceived as eerie, regardless of its embodiment. Yet, additional findings raise doubts on the unidimensionality of participants’ affective response.

The application of surface texturing on sheet metal is a widely used approach to improve lubrication and control friction in deep drawing applications. However, it has been shown that current texturing processes are not robust to produce uniform textures on the sheet due to rapid and severe wear on texture-rolls. Furthermore, in multi-stage forming processes, deterioration of the sheet texture even at the first stage of forming makes texturing of the sheet metal surface ineffective. Tool surface texturing is a new method to control friction and tool wear in metal forming industry. In the current study, a multi-scale friction model is adopted to investigate the effect of tool texturing on the evolution of friction during sheet metal forming operations. The multi-scale friction model accounts for surface topography changes due to deformation of asperities and ploughing of tool asperities on the sheet metal surface, mixed lubrication regime and furthermore the tool micro-texture effects on lubricant distribution at tool-sheet metal interface. The model is validated with respect to strip-draw experiments using different tool textures. The model is later applied to the simulation of a U-bend forming process. The results show that using textured tools, it is possible to reduce friction and punch force in sheet metal forming processes. The model can be used to tailor and optimize textures on stamping tools for complex parts.

In human-to-human contexts, display rules provide an empirically sound construct to explain intercultural differences in emotional expressivity. A very prominent finding in this regard is that cultures rooted in collectivism—such as China, South Korea, or Japan—uphold norms of emotional suppression, contrasting with ideals of unfiltered self-expression found in several Western societies. However, other studies have shown that collectivistic cultures do not actually disregard the whole spectrum of emotional expression, but simply prefer displays of socially engaging emotions (e.g., trust, shame) over the more disengaging expressions favored by the West (e.g., pride, anger). Inspired by the constant advancement of affective technology, this study investigates if such cultural factors also influence how people experience being read by emotion-sensitive computers. In a laboratory experiment, we introduce 47 Chinese and 42 German participants to emotion recognition software, claiming that it would analyze their facial micro-expressions during a brief cognitive task. As we actually present standardized results (reporting either socially engaging or disengaging emotions), we manipulate participants' impression of having matched or violated culturally established display rules in a between-subject design. First, we observe a main effect of culture on the cardiovascular response to the digital recognition procedure: Whereas Chinese participants quickly return to their initial heart rate, German participants remain longer in an agitated state. A potential explanation for this—East Asians might be less stressed by sophisticated technology than people with a Western socialization—concurs with recent literature, highlighting different human uniqueness concepts across cultural borders. Indeed, while we find no cultural difference in subjective evaluations of the emotion-sensitive computer, a mediation analysis reveals a significant indirect effect from culture over perceived human likeness of the technology to its attractiveness. At the same time, violations of cultural display rules remain mostly irrelevant for participants' reaction; thus, we argue that inter-human norms for appropriate facial expressions might be loosened if faces are read by computers, at least in settings that are not associated with any social consequence.

Vorstellung der Kasuistik eines 60-jahrigen Patienten mit Verletzung durch einen schweren Gegenstand am zervikothorakalen Ubergang. Bei progredienter Dyspnoe infolge einer entstandenen Paraplegie erfolgte die Intubation mittels Larynxtubus bei schwierigem Atemweg. Bergungstechnisch wurde die Indikation zur Windenbergung des Patienten mittels Rettungshelikopter im unwegsamen Baustellengelande gestellt. Diskussion der folgenden Punkte: praklinischer schwieriger Atemweg und Windenbergung eines beatmeten Patienten.

The tetradymite compound BiSbTeSe$_2$, is one of the most bulk-insulating three-dimensional topological insulators, which makes it important in the topological insulator research. It is a member of the solid-solution system Bi$_{2-x}$Sb$_x$Te$_{3-y}$Se$_y$, for which the local crystal structure, such as the occupation probabilities of each atomic site, is not well understood. We have investigated the temperature and polarization dependent spontaneous Raman scattering in BiSbTeSe$_2$, revealing a much higher number of lattice vibrational modes than predicted by group theoretical considerations for the space group R$\bar{3}$m corresponding to an ideally random solid-solution situation. The density functional calculations of phonon frequencies show a very good agreement with experimental data for parent material Bi$_2$Te$_3$, where no disorder effects were found. In comparison to Bi$_2$Te$_3$ the stacking disorder in BiSbTeSe$_2$, causes a discrepancy between theory and experiment. Combined analysis of experimental Raman spectra and DFT calculated phonon spectra for different types of atomic orders showed coexistence of different sequences of layers in the material and that those with Se in the center and a local order of Se-Bi-Se-Sb-Te, are the most favored., Comment: 6 pages, 4 figures, 2 tables

In the last years it has become evident that the use of blood products should be reduced whenever possible. There is increasing evidence regarding serious adverse events, including higher mortality and morbidity, related to transfusions. The use of point of care (POC) devices integrated in algorithms is one of the important mechanisms to limit blood product exposure. Any type of algorithm, especially the POC-based ones, allows goal-directed transfusions of blood products and even better targeted factor concentrate substitutions. Different types of algorithms in different surgical settings (cardiac surgery, trauma, liver surgery etc.) have been established with growing interest in their use as they offer objective therapy for management and reduction of blood product use. The use of POC devices with evidence-based algorithms is important in the bleeding patient independent of its origin (traumatic vs. surgical). The use of factor concentrates compared to the classical blood products can be cost-saving, beneficial for the patient, and in agreement with the WHO-requested standard of care. The empiric and uncontrolled use of blood products such as fresh frozen plasma, red blood cells, and platelets without POC monitoring should no longer be followed with regard to actual evidence in literature. Furthermore, the use of factor concentrates may provide better outcomes and potential for cost saving.

There is limited data on prehospital administration of tranexamic acid (TXA) in civilian trauma. The aim of this study was to evaluate changes in coagulation after severe trauma from on-scene to the hospital after TXA application in comparison to a previous study without TXA.The study protocol was registered at ClinicalTrials.gov (NCT02354885). A prospective, multicenter, observational study investigating coagulation status in 70 trauma patients receiving TXA (1 g intravenously) on-scene versus a control group of 38 patients previously published without TXA. To account for potential differences in patient and trauma epidemiology, crystalloid and colloidal resuscitation fluid, 2 propensity score matched groups (n = 24 per group) were created. Measurements included ROTEM, standard coagulation tests and blood gas analyses on-scene and emergency department admission. Presented values are mean and [standard deviation], and difference in means and 95% confidence intervals.Patient epidemiology was not different between groups. Coagulation assays on-scene were comparable between the TXA and C. Prehospital hyperfibrinolysis was blunted in all 4 patients in the TXA group. Viscoelastic FIBTEM maximum clot firmness (MCF), representing functional fibrinogen levels, did not change from on-scene to the emergency department in the TXA group, whereas MCF decreased -3.7 [1.8] mm in the control group. Decrease of MCF was significantly reduced in the TXA group in EXTEM by 9.2 (7.2-11.2) mm (P.001) and INTEM by 6.8 (4.7-9.0) mm (P.001) in favor of the TXA group. Production of fibrinogen fragments (represented by D-dimers) was significantly lower in the TXA group compared to group C.Early prehospital administration of TXA leads to clot stabilization and a reduction of fibrinolytic activity, causing a decrease in fibrin degradation products buildup (D-dimer).

Tranexamic acid is used both pre-hospital and in-hospital as an antifibrinolytic drug to treat or prevent hyperfibrinolysis in trauma patients; dosing, however, remains empirical. We aimed to measure plasma levels of tranexamic acid in patients receiving pre-hospital anti-hyperfibrinolytic therapy and to build a population pharmacokinetic model to propose an optimised dosing regimen. Seventy-three trauma patients were enrolled and each received tranexamic acid 1 g intravenously pre-hospital. A blood sample was drawn after arrival in the emergency department, and we measured the plasma tranexamic acid concentration using liquid chromatography-mass spectrometry, and modelled the data using non-linear mixed effect modelling. Tranexamic acid was administered at a median (IQR [range]) time of 43 (30-55 [5-135]) min after trauma. Plasma tranexamic acid levels were determined on arrival at hospital, 57 (43-70 [20-148]) min after pre-hospital administration of the drug. The measured concentration was 28.7 (21.5-38.5 [8.7-89.0]) μg.ml-1 . Our subjects had sustained severe trauma; injury severity score 20 (16-29 [5-75]), including penetrating injury in 2.8% and isolated traumatic brain injury in 19.7%. The pharmacokinetics were ascribed a two-compartment open model with body-weight as the main covariate. As tranexamic acid concentrations may fall below therapeutic levels during initial hospital treatment, we propose additional dosing schemes to maintain a specific target blood concentration for as long as required. This is the first study to investigate plasma level and pharmacokinetics of tranexamic acid after pre-hospital administration in trauma patients. Our proposed dosing regimen could be used in subsequent clinical trials to better study efficacy and tolerance profiles with controlled blood concentrations.

PURPOSE OF REVIEW To point out the tolerance of anemia, the possible use of alternatives to allogeneic blood products as well as the pathophysiological effects of transfusions in the context of multiple trauma patients. RECENT FINDINGS Restrictive transfusion triggers are beneficial for patient outcome in trauma.The actual European Trauma Treatment Guidelines suggest the use of point-of-care devices, the use of transfusion algorithms and factor concentrates to control coagulopathy. The use of high ratios of plasma to red blood cells to improve survival has been shown to suffer from a time-dependent survival bias. In massive bleeding, factor-based treatment of coagulopathy is feasible and preferable to plasma transfusion, if available. In nonmassive bleeding, allogeneic transfusion of blood products increases the appearance of serious adverse events and mortality and should be avoided unless clearly indicated. SUMMARY Transfusion in trauma has to be an individual decision for a specific patient, not for a specific laboratory value. Transfusion management must aim at reducing or even avoiding the use of allogeneic blood products. This may lead to a new gold standard with cost reduction and amelioration of outcome of major trauma patients.

PURPOSE OF REVIEW: The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. RECENT FINDINGS: Early administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SUMMARY: Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.

Fibrinogen has a central role in coagulation. Following trauma and perioperatively, low fibrinogen levels have been found to be risk factors for exaggerated bleeding, transfusion needs, and adverse outcome. Conversely, treatment with exogenous fibrinogen in critically bleeding patients with low fibrinogen levels has been shown to decrease transfusion needs. Because following trauma and in many perioperative situations fibrinogen is the first coagulation "element" to become critically low, it appears reasonable to target fibrinogen in clinical coagulation algorithms aiming at early specific and goal-directed treatment. A low fibrinogen can be a low plasma concentration or a low functional fibrinogen as assessed by point-of-care techniques such as thromboelastography (TEG) or thromboelastometry (ROTEM). This review summarizes the evidence base for perioperative algorithm-based fibrinogen administration, including the exact thresholds for fibrinogen administration used in the different algorithms. Algorithm-based individualized goal-directed use of fibrinogen resulted in highly significant reduction in transfusion needs, adverse outcomes, in certain studies even mortality, and where investigated reduced costs, with high safety levels at the same time. Best evidence exists in cardiac surgery, followed by trauma, postpartum hemorrhage, and liver transplantation. The introduction of these concepts is highly demanding and requires a tremendous educational effort to familiarize all health care workers with the necessary knowledge and the skills of how to run TEG/ROTEM tests. Future research is needed to compare the efficacy, safety, and costs of different algorithms. This, however, should not prevent us from introducing these expedient point-of-care-based algorithms clinically today.

To a certain extent, adhesive bonding of measurement equipment is very common in science and technology, e.g. adhesive bonding of small-scale strain gauges. Adhesive bonding of the entire equipment for a fully autonomous pile driving monitoring of an impact-driven large-scale foundation structure for an offshore wind farm is a completely new application method. Several offshore wind farms are currently under construction in the North and Baltic Seas. Impact pile driving of the large-scale foundations usually causes much louder noise than permitted by regulations, so methods for noise reduction are necessary. Geotechnical engineers of the TU Braunschweig are investigating combined methods for reducing that noise, and in 2014 they had the opportunity to install measurement equipment for the investigation of dynamic pile deflections during pile driving into three of in total eighty monopiles (length: 60 m, diameter: 6 m) of an offshore wind farm in the German North Sea. Due to certification issues conventional methods of fastening such as screwing or welding were not permitted. Instead, adhesive bonding of all parts (sensors, cables, shielding, recorder/computer) was successfully applied and withstood impact driving with several thousand blows of up to 1200 g (earth gravity). The authors would like to present the concept and preceding tests of the adhesive bonding applied within the research project ‘triad’.

Background Pre-hospital paediatric airway management is complex. A variety of pitfalls need prompt response to establish and maintain adequate ventilation and oxygenation. Anatomical disparity render laryngoscopy different compared to the adult. The correct choice of endotracheal tube size and depth of insertion is not trivial and often challenged due to the initially unknown age of child. Methods Data from 425 paediatric patients (