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Purpose Atypical variants of the hepatic artery are common and pose a technical challenge for normothermic machine perfusion (NMP). The transplant surgeon has three options when confronted with hepatic arterial variation in a liver graft to be subjected to NMP: to perform arterial reconstruction (i) prior, (ii) during, or (iii) following NMP. Methods Herein, we report our experience and technical considerations with pre-NMP reconstruction. Out of 52 livers, 9 had an atypical hepatic artery (HA): 3 replaced right HA, 3 replaced left HA, 1 accessory left HA, 1 accessory left and right HA, and 1 replaced left and right HA. Results Reconstruction was conducted during back-table preparation. A single vascular conduit was created in all grafts to allow single arterial cannulation for NMP, necessitating only one arterial anastomosis within the recipient. All grafts were subjected to NMP and subsequently successfully transplanted. Conclusion Our approach is being advocated for as it preserves the ability to alter the reconstruction in case of problems resulting from the reconstruction itself, thereby allowing functional evaluation of the reconstruction prior transplantation, permitting simultaneous reperfusion in the recipient, and providing the shortest possible duration for vascular reconstruction once the graft is rewarming non-perfused within the recipient. In addition, in light of the frequency of technically demanding reconstructions with very small vessels, we consider our technique beneficial as the procedure can be performed under ideal conditions at the back-table.

In this paper, the effects of bond deterioration due to fatigue loading on the structural response of reinforced concrete tension members are studied. A comprehensive experimental campaign on reinforced concrete ties and pull-out specimens was carried out under monotonic and repeated loading. The use of distributed fibre optical sensing to assess the local strains allowed the bond deterioration mechanism under repeated loading to be observed. Previously applied load cycles caused a reduction in tension stiffening for load levels below the maximum cyclic load but did not significantly influence the deformation behaviour of the member near the ultimate load. The bond stresses at the maximum cyclic load decreased fairly linearly with the logarithm of load cycles, with the most pronounced reduction in bond stresses near the cracks. At the minimum cyclic load, the bond stress distribution along the tie changed and bond stresses reversal occurred close to the cracks. This caused negative tension stiffening in some cases, i.e., the mean strains exceeded those occurring in a bare reinforcing bar at the same load. The mean steel stresses and the steel stress amplitudes between the cracks increased with the number of load cycles due to the gradual reduction of the concrete contribution and bond degradation. Bond degradation occurred linearly on a semi-logarithmic scale, as expected for the generated bond stresses, which were below the fatigue bond strength. The test results highlight that accounting for shrinkage-induced strains is essential for a realistic evaluation of tension stiffening and residual deformations in particular. Based on the experimental observations and previously developed models for monotonic and cyclic loading, two approaches were used to predict the response of reinforced concrete tension members under repeated loading: the Local Fatigue Damage Model (LFDM), based on the local bond stress-slip relationship, and the adapted Tension Chord Model (TCM) which assumes constant bond stresses and mean strains. The results of both approaches agree well with the test results at the maximum load but yielded less satisfactory predictions at the minimum loading level where only the LFDM was able to be applied successfully. Further research is required to validate the negative bond stresses occurring upon slip reversal in the LFDM and the reduction factor proposed in the adapted TCM., Engineering Structures, 289, ISSN:0141-0296

Thomas Vogel, Fehderecht und Fehdepraxis im Spätmittelalter am Beispiel der Reichsstadt Nürnberg (1404-1438) (Freiburger Beiträge zur mittelalterlichen Geschichte, Bd. 11), Frankfurt (Peter Lang Verlag) 1998. 324 S.

Kidney allografts are subjected to ischemia reperfusion injury during the process of transplantation. Hypothermic machine perfusion (HMP) of deceased donor kidneys from organ procurement until transplantation is associated with a superior outcome when compared to static cold storage (SCS). Nevertheless, cold ischemia time (CIT) remains an independent risk factor for delayed graft function (DGF) in HMP-preserved kidney allografts as well. We performed a retrospective single-center study including all adult recipients who underwent deceased donor kidney-only transplantation at our center between January 2019 and December 2020. Beside the clinicopathological donor and recipient data, flow and resistance data during HMP were assessed. Short- and long-term kidney allograft outcome after end-ischemic HMP and SCS were analyzed and compared. Organ preservation consisted of either SCS (n = 88) or HMP (n = 45). There were no differences in recipient demographics and donor details between groups. CIT was significantly longer in the HMP group (16.5 [8.5–28.5] vs. 11.3 [5.4–24.1], p < 0.0001). The incidence of DGF as well as serum creatinine at discharge and at 1 year post transplant were comparable between groups. Duration of SCS prior to HMP was comparable among grafts with and without DGF. Flow rate and organ resistance at the start of HMP were significantly worse in DGF-kidney grafts (arterial flow 22.50 [18.00–48.00] vs. 51.83 [25.50–92.67] ml/min, p = 0.0256; organ resistance 123.33 [57.67–165.50] vs. 51.33 [28.17–111.50] mmHg/mL/min, p = 0.0050). Recipients with DGF had significantly worse creatinine levels at discharge (2.54 [1.08–7.64] vs. 1.67 [0.90–6.56], p < 0.0001) and at 1 year post transplant (1.80 [1.09–7.95] vs. 1.59 [0.87–7.40], p = 0.0105). In conclusion, baseline HMP parameters could be applied as a predictive tool for initial graft function, which in turn determines long-term outcome.

Kidney allografts are subjected to ischemia reperfusion injury during the process of transplantation. Hypothermic machine perfusion (HMP) of deceased donor kidneys from organ procurement until transplantation is associated with a superior outcome when compared to static cold storage (SCS). Nevertheless, cold ischemia time (CIT) remains an independent risk factor for delayed graft function (DGF) in HMP-preserved kidney allografts as well. We performed a retrospective single-center study including all adult recipients who underwent deceased donor kidney-only transplantation at our center between January 2019 and December 2020. Beside the clinicopathological donor and recipient data, flow and resistance data during HMP were assessed. Short- and long-term kidney allograft outcome after end-ischemic HMP and SCS were analyzed and compared. Organ preservation consisted of either SCS (

In liver transplantation, older donor age is a well-known risk factor for dismal outcomes, especially due to the high susceptibility of older grafts to ischemia-reperfusion injury. However, whether the factors correlating with impaired graft and patient survival following the transplantation of older grafts follow a linear trend among elderly donors remains elusive. In this study, liver transplantations between January 2006 and May 2018 were analyzed retrospectively. Ninety-two recipients of grafts from donors ≥65 years were identified and divided into two groups: (1) ≥65–69 and (2) ≥ 70 years. One-year patient survival was comparable between recipients of grafts from donors ≥65–69 and ≥70 years (78.9% and 70.0%). One-year graft survival was 73.1% (donor ≥65–69) and 62.5% (donor ≥ 70), while multivariate analysis revealed superior one-year graft survival to be associated with a donor age of ≥65–69. No statistically significant differences were found for rates of primary non-function. The influence of donor age on graft and patient survival appears not to have a distinct impact on dismal outcomes in the range of 65–70 years. The impact of old donor age needs to be balanced with other risk factors, as these donors provide grafts that offer a lifesaving graft function.

In liver transplantation (LT), steatosis is commonly judged to be a risk factor for graft dysfunction, and quantitative assessment of hepatic steatosis remains crucial. Liver biopsy as the gold standard for evaluation of hepatic steatosis has certain drawbacks, that is, invasiveness, and intra- and inter-observer variability. A non-invasive, quantitative modality could replace liver biopsy and eliminate these disadvantages, but has not yet been evaluated in human LT.We performed a pilot study to evaluate the feasibility and accuracy of hyperspectral imaging (HSI) in the assessment of hepatic steatosis of human liver allografts for transplantation. Thirteen deceased donor liver allografts were included in the study. The degree of steatosis was assessed by means of conventional liver biopsy as well as HSI, performed at the end of back-table preparation, during normothermic machine perfusion (NMP), and after reperfusion in the recipient.Organ donors were 51 [30-83] years old, and 61.5% were male. Donor body mass index was 24.2 [16.5-38.0] kg/mHSI may safely be applied for accurate assessment of hepatic steatosis in human liver grafts. Certainly, TLI needs further assessment and validation in larger sample sizes.

PMCID: PMC8250917; No abstract available

In liver transplantation, older donor age is a well-known risk factor for dismal outcomes, especially due to the high susceptibility of older grafts to ischemia-reperfusion injury. However, whether the factors correlating with impaired graft and patient survival following the transplantation of older grafts follow a linear trend among elderly donors remains elusive. In this study, liver transplantations between January 2006 and May 2018 were analyzed retrospectively. Ninety-two recipients of grafts from donors ≥65 years were identified and divided into two groups: (1) ≥65-69 and (2) ≥ 70 years. One-year patient survival was comparable between recipients of grafts from donors ≥65-69 and ≥70 years (78.9% and 70.0%). One-year graft survival was 73.1% (donor ≥65-69) and 62.5% (donor ≥ 70), while multivariate analysis revealed superior one-year graft survival to be associated with a donor age of ≥65-69. No statistically significant differences were found for rates of primary non-function. The influence of donor age on graft and patient survival appears not to have a distinct impact on dismal outcomes in the range of 65-70 years. The impact of old donor age needs to be balanced with other risk factors, as these donors provide grafts that offer a lifesaving graft function.

The aim of our study was to evaluate hyperspectral imaging (HSI) as a rapid, non-ionizing technique for the assessment of organ quality and the prediction of delayed graft function (DGF) in kidney transplantation after static cold storage (SCS, n = 20), as well as hypothermic machine perfusion (HMP, n = 18). HSI assessment of the kidney parenchyma was performed during organ preservation and at 10 and 30 min after reperfusion using the TIVITA® Tissue System (Diaspective Vision GmbH, Am Salzhaff, Germany), calculating oxygen saturation (StO2), near-infrared perfusion index (NIR), tissue haemoglobin index (THI), and tissue water index (TWI). Recipient and donor characteristics were comparable between organ preservation groups. Cold ischemic time was significantly longer in the HMP group (14.1 h [3.6–23.1] vs. 8.7h [2.2–17.0], p = 0.002). The overall presence of DGF was comparable between groups (HMP group n = 10 (55.6%), SCS group n = 10 (50.0%)). Prediction of DGF was possible in SCS and HMP kidneys; StO2 at 10 (50.00 [17.75–76.25] vs. 63.17 [27.00–77.75]%, p = 0.0467) and 30 min (57.63 [18.25–78.25] vs. 65.38 [21.25–83.33]%, p = 0.0323) after reperfusion, as well as NIR at 10 (41.75 [1.0–58.00] vs. 48.63 [12.25–69.50], p = 0.0137) and 30 min (49.63 [8.50–66.75] vs. 55.80 [14.75–73.25], p = 0.0261) after reperfusion were significantly lower in DGF kidneys, independent of the organ preservation method. In conclusion, HSI is a reliable method for intraoperative assessment of renal microperfusion, applicable after organ preservation through SCS and HMP, and predicts the development of DGF.

Background: The prevention of falls is a major public health issue. A fall can have serious consequences in frail patients, as are most patients hospitalized in acute geriatrics department. Gait disorders are predisposing factors for falls. They are accessible to rehabilitation and can be analyzed using tools that collect spatio-temporal parameters of walking, such as the GAITRite® mat. Objective: To find differences between the spatio-temporal gait parameters in patients who fall compared to patients who do not fall in a population of older patients hospitalized in acute geriatrics department. Material and methods: In this retrospective, observational, single-center study, patients over 75 years hospitalized in acute geriatrics department were included. For each patient, spatio-temporal gait parameters were collected using the GAITrite® mat. The patients were divided into two groups according to whether or not they had a history of fall. The spatio-temporal parameters were compared between the two groups and in relation to the general population. Results: 67 patients, with an average age of 85.9 ± 6 years, were included. Seventy percent of patients had cognitive impairment and 66% required technical walking assistance. The mean Charlson score was 7.00 +/- 1.87 and a large majority of patients was polymedicated with a mean of 7.04 +/- 3.25 medications at admission. The mean walking speed was 51.4 ± 19.9 cm/s in non-fallers group, and 47.3 ± 17.7 cm/s in fallers group (p = 0.539), indicating pathological walking in comparison with the general population of the same age (average 100 cm/s). No association was found between the spatio-temporal gait parameters and fall. Conclusion: In our population of hospitalized older adults, the spatio-temporal gait parameters didn’t seem to discriminate anymore a faller from a non-faller, probably linked to many confounding factors such as the pathological gait of the entire study population and their comorbidities.Clinical Trial registration: NCT05152069.

We identify configurational phases and structural transitions in a polymer nanotube composite by means of machine learning. We employ various unsupervised dimensionality reduction methods, conventional neural networks, as well as the confusion method, an unsupervised neural-network-based approach. We find neural networks are able to reliably recognize all configurational phases that have been found previously in experiment and simulation. Furthermore, we locate the boundaries between configurational phases in a way that removes human intuition or bias. This could be done before only by relying on preconceived, ad-hoc order parameters.

Veterans with diabetic foot ulcers (DFUs) represent the highest percentage of lower extremity amputations (LEAs) within the Veterans Affairs (VA) population. Many veterans have additional risk factors for amputation. Few studies focus on advanced therapies for this population. This study explores the impact of early application of dehydrated human amniotic membrane allograft (DAMA) with comprehensive care on preventing amputation. This prospective, single-center cohort study (ClinicalTrials.gov Identifier NCT02632929) was conducted through Boise VA Medical Center. Patients with DFUs were objectively stratified for LEA risk. Those with moderate to high amputation risk could participate. Participants received comprehensive care and weekly application of DAMA. Primary endpoint was avoidance of major LEA. Secondary endpoint was wound epithelialization. Monitoring continued 4 months. Between July 2015 and March 2017, 20 patients (mean age 67.2 years) with 24 DFU classified as moderate (12 wounds) to high risk (12 wounds) for amputation were enrolled. Wound volumes ranged from 0.072 cm3 to 56.4 cm3. Risk factors included neuropathy (20 patients), osteomyelitis (16 wounds), exposed tendon/ligament/bone (19 wounds), Charcot (5 patients), and peripheral arterial disease (13 wounds). All subjects avoided amputation within the study period, all 24 wounds achieved re-epithelialization within 4 to 33 weeks; mean healing time 13.2 weeks. Cost for the DAMA tissue ranged from $750 to $38 150. Estimated cost for LEA ranges from $30 000 to $50 000. No treatment-related adverse events during the study period were reported. The results suggest that early and frequent application of DAMA with comprehensive care may help prevent amputation. Additional research will help inform third-party payors and clinicians.

Context: Safety is of paramount importance for cyber-physical systems in domains such as automotive, robotics, and avionics. Formal methods such as model checking are one way to ensure the safety of cyber-physical systems. However, adoption of formal methods in industry is hindered by usability issues, particularly the difficulty of understanding model checking results. Objective: We want to provide an overview of the state of the art for counterexample explanation by investigating the contexts, techniques, and evaluation of research approaches in this field. This overview shall provide an understanding of current and guide future research. Method: To provide this overview, we conducted a systematic literature review. The survey comprises 116 publications that address counterexample explanations for model checking. Results: Most primary studies provide counterexample explanations graphically or as traces, minimize counterexamples to reduce complexity, localize errors in the models expressed in the input formats of model checkers, support linear temporal logic or computation tree logic specifications, and use model checkers of the Symbolic Model Verifier family. Several studies evaluate their approaches in safety-critical domains with industrial applications. Conclusion: We notably see a lack of research on counterexample explanation that targets probabilistic and real-time systems, leverages the explanations to domain-specific models, and evaluates approaches in user studies. We conclude by discussing the adequacy of different types of explanations for users with varying domain and formal methods expertise, showing the need to support laypersons in understanding model checking results to increase adoption of formal methods in industry., Accepted Manuscript. Information and Software Technology

Background Endoscopic treatment of Zenker’s diverticulum is an attractive minimally invasive alternative compared to the classic open approach. However, increased recurrence rate were reported. In case of relapse, endoscopic therapy might be repeated, or alternatively open surgery is performed. This study aimed to identify potential differences in the outcomes between primary or secondary surgical treatment in Zenker’s diverticulum. Methods From January 2003 to April 2019, 227 subsequent patients underwent surgical diverticulectomy and cervical myotomy at the surgical department of TUM. 41 of 227 patients had received previous therapy, either open or endoscopic. Perioperative parameters in priorly untreated patients were retrospectively compared to those after previous therapy (mostly endoscopic) with special regard to perioperative data and postoperative complications. Univariate and multivariate regression analyses were performed to identify predictors for postoperative complications. Results We could show that the number of complications (p = 0.047) in pretreated patients is significant higher as well as the severity after Clavien–Dindo (p = 0.025). Stapler line leakage, wound infections, and operative revision rate was higher also pretreated group. Pretreatment and surgery time showed a significant association with postoperative complications in univariate analysis. In multivariate analysis, pretreatment remained a significant independent predictor of complications. Conclusion The present data indicate that endoscopic therapy might represent a risk factor for postoperative complications in case of relapse surgery. Therefore primary open surgery should be debated in patients with an increased high risk of relapse. Graphical abstract

Context: The goal of specification pattern catalogs for real-time requirements is to mask the complexity of specifying such requirements in a timed temporal logic for verification. For this purpose, they provide frontends to express and translate pattern-based natural language requirements to formulae in a suitable logic. However, the widely used real-time model checking tool UPPAAL only supports a restricted subset of those formulae that focus only on basic and non-nested reachability, safety, and liveness properties. This restriction renders many specification patterns inapplicable. As a workaround, timed observer automata need to be constructed manually to express sophisticated requirements envisioned by these patterns. Objective: In this work, we fill these gaps by providing a comprehensive specification pattern catalog for UPPAAL. The catalog supports qualitative and real-time requirements and covers all corresponding patterns of existing catalogs. Method: The catalog we propose is integrated with UPPAAL. It supports the specification of qualitative and real-time requirements using patterns and provides an automated generator that translates these requirements to observer automata and TCTL formulae. The resulting artifacts are used for verifying systems in UPPAAL. Thus, our catalog enables an automated end-to-end verification process for UPPAAL based on property specification patterns and observer automata. Results: We evaluate our catalog on three UPPAAL system models reported in the literature and mostly applied in an industrial setting. As a result, not only the reproducibility of the related UPPAAL models was possible, but also the validation of an automated, seamless, and accurate pattern- and observer-based verification process. Conclusion: The proposed property specification pattern catalog for UPPAAL enables practitioners to specify qualitative and real-time requirements..., Comment: Accepted Manuscript

INTRODUCTIONThe objectives of this study were to assess the dynamics of the SARS-CoV-2 anti-RBD IgG response over time among older people after COVID-19 infection or vaccination and its comparison with speculative levels of protection assumed by current data.METHODSFrom November 2020 to October 2021, we included geriatric patients with serological test results for COVID-19.We considered antibody titre thresholds thought to be high enough to protect against SARS-CoV-2 infection: 141 BAU/ml for protection/vaccine efficacy > 89.3%.Three cohorts are presented. A vaccine group (n=34) that received two BNT162b2/Comirnaty injections 21 days apart, a group of natural COVID-19 infection (n=32) and a third group who contracted COVID-19 less than 15 days after the first BNT162b2/Comirnaty injection (n=17).RESULTS83 patients were included, the median age was 87 (81-91) years.In the vaccine group at 1 month since the first vaccination, the median BAU/ml with IQR was 620 (217-1874) with 87% of patients above the threshold of 141 BAU/ml. Seven months after the first vaccination the BAU/ml was 30 (19-58) with 9.5% of patients above the threshold of 141 BAU/ml.In the natural COVID-19 infection group, at 1 month since the date of first symptom onset, the median BAU/ml was 798 (325-1320) with 86.7% of patients above the threshold of 141 BAU/ml and fell to 88 (37-385) with 42.9% of patients above the threshold of 141 BAU/ml at 2 months. The natural infection group was vaccinated three months after the infection. Five months after the end of the vaccination cycle the BAU/ml was 2048 (471-4386) with 83.3% of patients above the threshold of 141 BAU/ml.DISCUSSIONOn the humoral level, this supports the clinical results describing the decrease in vaccine protection over time.

Background Anastomotic leakage (AL) is a major complication after esophagectomy, potentiating morbidity and mortality. There are several patient risk factors associated with AL, but high-fidelity postoperative predictors are still under debate. The aim was to identify novel reliable predictors for AL after esophagectomy. Methods A high-volume single-center database study, including 138 patients receiving Ivor-Lewis-esophagectomy between 2017 and 2019, was performed. Serum levels of albumin, aPTT, and lactate before and after surgery were extracted to assess their impact on AL and in-hospital mortality. Results High serum lactate on postoperative day 1 (POD1) could be shown to predict AL after esophagectomy [AL vs. no AL: 1.2 (0.38) vs. 1.0 (0.37); p p p = 0.018]. Further, low serum albumin on POD0 [2.6 (0.53) vs. 3.1 (0.56); p = 0.001] and high serum lactate on POD 0–1 [1.1 (0.29) vs. 0.9 (0.30); p = 0.043] were associated with in-hospital death. Strikingly, logistic-regression (HR: 0.111; p = 0.008) and cox-regression analysis (HR: 0.118; p = 0.003) showed low serum albumin as an independently predictor for in-hospital death after esophagectomy. Conclusions This study identified high serum lactate as an independent predictor of AL and low serum albumin as a high-fidelity predictor of in-hospital death after esophagectomy. These parameters can facilitate improved postoperative treatment leading to better short-term as well as long-term outcomes.

Purpose The SARS-CoV-2 pandemic has almost stopped all elective surgical treatment throughout the world. As operating room (OR) capacities are reduced everywhere to ensure availability of intensive care capacities, especially low-complex surgical procedures are often postponed. These include totally implantable central-venous access ports which are important for the oncologic treatment of cancer patients. Methods In our study, we investigated the potential of an outpatient surgical centre (OSC) in terms of workflow effectiveness compared to the central operating room complex (COR) of a university hospital using low-complex surgical procedures as an example. Data of 524 consecutive patients who received a Port-a-cath procedure (422 implantations (80.5%) and 102 explantations (19.5%)) in our department between February 2019 and February 2020 were evaluated. Results A total of 277 patients were operated in outpatient surgical centre (OSC), and 247 patients received the procedure in the central OR (COR) complex. Grade II and III complications according to the Clavien–Dindo classification occurred in 5.2% (OSC) and 7.3% (COR) of patients. Incision-to-suture time was significantly quicker in the OSC group (36 vs. 42 min., p p Conclusion In order to ensure effective OR utilization especially in times of the corona pandemic, the use of smaller decentralized OR units, e.g., outpatient surgical centres, for performing low-complex surgical cases is beneficial. Our study revealed shorter total OR and preparation-to-incision times.

Several studies have already explored individual and environmental risk factors for COVID-19 morality, however most study populations consisted of the overall population and mainly from China or the US. Our study focused on COVID-19 mortality in the elderly in seven European cities. Long-term exposure to air pollution was estimated through annual pollutant concentrations at the residential address averaged over the last two years of the study period between February and May 2020. We focused on the main outdoor air pollutants PM10, PM2.5, NO2 and O3. Short-term variations in air pollutants and weather parameters (e.g. temperature, UV, relative humidity) were also examined through a 20-day period before the confirmed PCR diagnostic of COVID-19. Individual risk factors such as smoking status, sex, body mass index (BMI), ischemic heart disease, diabetes, hypertension, chronic renal failure, history of cancer, COPD, and lung fibrosis, were taken into account. We found positive associations for diabetes and COVID-19 mortality (OR 2.2 CI 95% :1.1, 4.4). Using a multivariate logistic regression model adjusted for all patient characteristics and city, we fail to reject the null hypothesis of no association between COVID-19 mortality and long-term and short-term increase in PM2.5, PM10, NO2 and O3. Our study suffers from the fact that patient profiles strongly differ between high-polluted and less-polluted cities. Strong differences in COVID-19 mortalities were observed between cities, which could be due to differences in COVID-19 management and treatment, such as accessibility to reanimation and intensive units between cities. Overall, our study highlights the need to improve estimation of individual exposure to air pollution. Indeed, even with the high-efficiency modelisation systems used in our study, we were unable to estimate the effect of air pollution within each city, because variations in air pollution exposure were too small. Individual markers of air pollution exposure such as recently demonstrated with urinary black carbon or passive individual samplers, would be most suitable for future explorations. Concerning weather parameters, although previous studies concluded that increase in temperature and UV index could decrease COVID-19 morality, our data did not allow us to reject the null hypotheses.

Context: The complexity of modern safety-critical systems in industries keep on increasing due to the rising number of features and functionalities. This calls for formal methods in order to entrust confidence in such systems. Nevertheless, using formal methods in industry is demanding because of usability issues, e.g., the difficulty of understanding model checking results. Thus the hypothesis is, presenting the result of model checker results in a user-friendly manner could promote formal methods usage in industries. Objective: We aim to evaluate the acceptance of formal methods by engineers if the complexity of understanding verification results is made easy. Method: We perform two different exploratory studies. First, we conduct an online survey to explore challenges in identifying inconsistent specifications and using formal methods from engineers. Second, we perform a one group pretest and posttest experiment to collect impressions from engineers using formal methods if understanding verification results is eased. Limitations: The main limitation of this study is the generalization because the survey focuses on a particular target group and it uses a pre-experimental design., 7 pages, 1 figure, 3 tables. This papers is accepted as Registered Reports Track in ICSME 2021

Here, we present the case of an 81‐year‐old male patient, who was hospitalized for a severe form of COVID‐19. Transthoracic echocardiogram (TTE) performed 1 month after symptom onset was normal. Respiratory evolution was favourable, and the patient was discharged at Day 78. At 6 months, despite a good functional recovery, he presented pulmonary sequelae, and the TTE revealed a clear reduction of left ventricular ejection fraction (LVEF) and mild LV dilatation without cardiac symptoms. The cardiac magnetic resonance (CMR) using Lake Louise Criteria (LLC), T1 and T2 mapping showed focal infero‐basal LV wall oedema, elevated T1 and T2 myocardial relaxation times especially in basal inferior and infero‐lateral LV walls, and sub‐epicardial late gadolinium enhancement in those LV walls. The diagnosis of active myocarditis was raised especially based on TTE abnormalities and CMR LLC, T1 and T2 mapping. Currently, we are not aware of published reports of a 6 month post‐COVID‐19 active myocarditis.

With the increase of research in self-adaptive systems, there is a need to better understand the way research contributions are evaluated. Such insights will support researchers to better compare new findings when developing new knowledge for the community. However, so far there is no clear overview of how evaluations are performed in self-adaptive systems. To address this gap, we conduct a mapping study. The study focuses on experimental evaluations published in the last decade at the prime venue of research in software engineering for self-adaptive systems - the International Symposium on Software Engineering for Adaptive and Self-Managing Systems (SEAMS). Results point out that specifics of self-adaptive systems require special attention in the experimental process, including the distinction of the managing system (i.e., the target of evaluation) and the managed system, the presence of uncertainties that affect the system behavior and hence need to be taken into account in data analysis, and the potential of managed systems to be reused across experiments, beyond replications. To conclude, we offer a set of suggestions derived from our study that can be used as input to enhance future experiments in self-adaptive systems.

Background: Interval aerobic training programs with active recovery bouts (IATP-R) are reported as being more adapted to seniors while improving cardiorespiratory and endurance parameters. Report of benefits on vascular function is still limited. Purpose: To measure the impact of IATP-R on vascular function among seniors. Methods: Sedentary volunteers (≥70 years of age) were randomly assigned to either IATP-R (n = 30) or control group (n = 30). The IATP-R consisted of 2 weekly sessions of 30-min (6 × 4-min at first ventilatory threshold (VT1) intensity + 1-min at 40% of VT1) cycling exercise over 9.5-week. Controls remained their sedentary life over the same period. In all participants, the endothelial function was measured by flow-mediated dilation (FMD) in brachial artery and arterial stiffness through the carotid/radial and carotid/femoral pulse wave velocity (PWV). Systolic (SBP) and diastolic blood pressure (DBP) were measured at baseline and 9.5 weeks later. Results: Resulting from a planned interim analysis, IATP-R improved SBP (IATP-R: from 133.7 ± 9.8 to 122.6 ± 9.4 mmHg vs. Controls: from 128.9 ± 12.5 to 132.6 ± 14.7 mmHg), DBP (IATP-R: from 80.2 ± 7.0 to 74.1 ± 6.7 mmHg vs. Controls: from 77.1 ± 6.8 to 80.3 ± 7.5 mmHg), and FMD (IATP-R: from 6.7 ± 2.0 to 7.5 ± 2.7% vs. Controls: from 7.9 ± 2.7 to 7.5 ± 2.5%). No significant impact on PWV was measured. Conclusion: Although these findings resulted from an interim analysis, IATP-R might be effective in regulating BP and improving endothelial function among sedentary seniors.

Summary The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by ‘PubMed’ and ‘Scholar Google’ search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the ‘Cochrane Library’ and the ‘ISI Web of Knowledge’. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from ‘CARE B12’ research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.

Thomas Vogel und Heike Frank-Ostarhild (Hrsg.): Neckargeschichten. Klöpfer & Meyer Tübingen 2010. Gebunden, 352 Seiten, € 22,–. ISBN 978-3-940086-46-4

The effectiveness of iron-based shape memory alloy (Fe-SMA, ‘memory-steel’) reinforcements has been proven in several studies and site applications. Due to the novelty of ribbed memory-steel reinforcement bars, limited research has been performed on their application in structural engineering, however. In this study, the bond behaviour of memory-steel bars in a near-surface-mounted configuration designed for prestressed strengthening of concrete structures was investigated. Memory-steel bars were installed on concrete blocks and activated by resistive heating before being subjected to pull-out load. The effects of heating and hence prestressing, bar ductility, bond length and rigidity of the fixation were studied based on obtained prestress, crack development, slip and bar strain. During activation of the bars, a longitudinal splitting crack with insignificant crack width occured. Two failure modes were observed during subsequent external loading, including tensile rupture of the bar when less ductile material was used, or bond failure when material with higher ductility was under investigation. Initial prestressing did not result in a reduced bond capacity. Based on the differential equation of bond behaviour, an analytical calculation procedure was developed that enables prediction of bond shear stress, slip, bar strain, pull-out load, as well as the use of a non-linear material behaviour., Materials & Design, 196, ISSN:0264-1275, ISSN:1873-4197

IntroductionEarly conversion to a CNI-free immunosuppression with SRL was associated with an improved 1- and 3- yr renal function as compared with a CsA-based regimen in the SMART-Trial. Mixed results were reported on the occurrence of donor specific antibodies under mTOR-Is. Here, we present long-term results of the SMART-Trial.Methods and materialsN = 71 from 6 centers (n = 38 SRL and n = 33 CsA) of the original SMART-Trial (ITT n = 140) were enrolled in this observational, non-interventional extension study to collect retrospectively and prospectively follow-up data for the interval since baseline. Primary objective was the development of dnDSA. Blood samples were collected on average 8.7 years after transplantation.ResultsDevelopment of dnDSA was not different (SRL 5/38, 13.2% vs. CsA 9/33, 27.3%; P = 0.097). GFR remained improved under SRL with 64.37 ml/min/1.73m2 vs. 53.19 ml/min/1.73m2 (p = 0.044). Patient survival did not differ between groups at 10 years. There was a trend towards a reduced graft failure rate (11.6% SRL vs. 23.9% CsA, p = 0.064) and less tumors under SRL (2.6% SRL vs. 15.2% CsA, p = 0.09).ConclusionsAn early conversion to SRL did not result in an increased incidence of dnDSA nor increased long-term risk for the recipient. Transplant function remains improved with benefits for the graft survival.