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Highly sensitive terahertz (THz) sensors for a myriad of applications are rapidly evolving. A widespread sensor concept is based on the detection of minute resonance frequency shifts due to a targeted specimen in the sensors environment. Therefore, cutting-edge high resolution continuous wave (CW) THz spectrometers provide very powerful tools to investigate the sensors' performances. However, unpredictable yet non negligible frequency drifts common to state-of-the-art CW THz spectrometers limit the sensors' accuracy for ultra-high precision sensing and metrology. Here, we overcome this deficiency by introducing an ultra-high quality (Q) THz microresonator frequency reference. Measuring the sensor's frequency shift relative to a well-defined frequency reference eliminates the unwanted frequency drift, and fully exploits the capabilities of modern CW THz spectrometers as well as THz sensors. In a proof-of-concept experiment, we demonstrate the accurate and repeated detection of minute resonance frequency shifts of less than 5MHz at 0.6THz of a THz microresonator sensor.

Background An artificial intelligence model that assesses primary bone tumors on radiographs may assist in the diagnostic workflow. Purpose To develop a multitask deep learning (DL) model for simultaneous bounding box placement, segmentation, and classification of primary bone tumors on radiographs. Materials and Methods This retrospective study analyzed bone tumors on radiographs acquired prior to treatment and obtained from patient data from January 2000 to June 2020. Benign or malignant bone tumors were diagnosed in all patients by using the histopathologic findings as the reference standard. By using split-sample validation, 70% of the patients were assigned to the training set, 15% were assigned to the validation set, and 15% were assigned to the test set. The final performance was evaluated on an external test set by using geographic validation, with accuracy, sensitivity, specificity, and 95% CIs being used for classification, the intersection over union (IoU) being used for bounding box placements, and the Dice score being used for segmentations. Results Radiographs from 934 patients (mean age, 33 years ± 19 [standard deviation]; 419 women) were evaluated in the internal data set, which included 667 benign bone tumors and 267 malignant bone tumors. Six hundred fifty-four patients were in the training set, 140 were in the validation set, and 140 were in the test set. One hundred eleven patients were in the external test set. The multitask DL model achieved 80.2% (89 of 111; 95% CI: 72.8, 87.6) accuracy, 62.9% (22 of 35; 95% CI: 47, 79) sensitivity, and 88.2% (67 of 76; CI: 81, 96) specificity in the classification of bone tumors as malignant or benign. The model achieved an IoU of 0.52 ± 0.34 for bounding box placements and a mean Dice score of 0.60 ± 0.37 for segmentations. The model accuracy was higher than that of two radiologic residents (71.2% and 64.9%

The non-physician employees in telemedicine centers (TMC) play a decisive role in the care and treatment of patients with heart failure. For this reason, a holistic profile consisting of professional and methodological as well as social and personal competences is necessary, which should be built up or promoted in corresponding training concepts. This position paper underlines the urgency of appropriate and standardized further training of non-physician employees for quality assurance in TMCs and summarizes the requirements for the additional qualification of a telemedical assistant across the board.

The bone marrow proton density fat fraction (PDFF) assessed with MRI enables the differentiation between osteoporotic/osteopenic patients with and without vertebral fractures. Therefore, PDFF may be a potentially useful biomarker for bone fragility assessment. To evaluate whether magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) of vertebral bone marrow can differentiate between osteoporotic/osteopenic patients with and without vertebral fractures. Of the 52 study patients, 32 presented with vertebral fractures of the lumbar spine (66.4 ± 14.4 years, 62.5% women; acute low-energy osteoporotic/osteopenic vertebral fractures, N = 25; acute high-energy traumatic vertebral fractures, N = 7). These patients were frequency matched for age and sex to patients without vertebral fractures (N = 20, 69.3 ± 10.1 years, 70.0% women). Trabecular bone mineral density (BMD) values were derived from quantitative computed tomography. Chemical shift encoding-based water-fat MRI of the lumbar spine was performed, and PDFF maps were calculated. Associations between fracture status and PDFF were assessed using multivariable linear regression models. Over all patients, mean PDFF and trabecular BMD correlated significantly (r = − 0.51, P

Objetivo: analisar as publicações sobre uso de heparina comparada a solução salina para manter permeabilidade e prevenir oclusão do Cateteres Venosos Centrais (CVC) de curta permanência em pacientes adultos. Métodos: revisão integrativa realizada através das bases MEDLINE/PubMed, CINAHL, Web of Science, Scopus e BVS, de artigos publicados entre 2011 e 2020, com os descritores controlados e operadores booleanos: heparin AND sodium chloride OR saline solution AND central venous catheters AND permeability OR catheter obstruction. Resultados: foram encontrados 1731 artigos na busca, sendo que 6 compuseram a amostra final, todos estrangeiros. Houve maior prevalência de estudo com nível de evidência I (4 publicações). Todos os estudos recomendaram o uso da solução salina devido a pouca ou baixa qualidade da evidência acerca do uso da heparina. Conclusão: parece não haver diferença entre o uso de heparina ou solução salina no que diz respeito a manutenção da permeabilidade do CVC de curta permanência em pacientes adultos. Implicações para a prática: sugere-se o uso da solução salina para manutenção da permeabilidade do CVC de curta permanência, a fim de reduzir a exposição à heparina e suas potenciais complicações, além do que é uma solução mais viável economicamente.

BACKGROUND: Chemical shift encoding-based water-fat separation techniques have been used for fat quantification [proton density fat fraction (PDFF)], but they also enable the assessment of bone marrow T2*, which has previously been reported to be a potential biomarker for osteoporosis and may give insight into the cause of vertebral fractures (i.e., osteoporotic vs. traumatic) and the microstructure of the bone when applied to vertebral bone marrow. METHODS: The 32 patients (78.1% with low-energy osteopenic/osteoporotic fractures, mean age 72.3±9.8 years, 76% women; 21.9% with high-energy traumatic fractures, 47.3±12.8 years, no women) were frequency-matched for age and sex to subjects without vertebral fractures (n=20). All study patients underwent 3T-MRI of the lumbar spine including sagittally acquired spoiled gradient echo sequences for chemical shift encoding-based water-fat separation, from which T2* values were obtained. Volumetric trabecular bone mineral density (BMD) and trabecular bone parameters describing the three-dimensional structural integrity of trabecular bone were derived from quantitative CT. Associations between T2* measurements, fracture status and trabecular bone parameters were assessed using multivariable linear regression models. RESULTS: Mean T2* values of non fractured vertebrae in all patients showed a significant correlation with BMD (r=−0.65, P

The aims of this study were to evaluate histopathologic changes during the transition period, describe the histopathological features of the metabotypes identified in Part I ( Scharen et al., 2021b ), and investigate effects of a metaphylactic treatment with butaphosphan and cyanocobalamin (BCC) on the liver parenchyma. Eighty German Holstein cows (mean 305-d production: 10,957 kg, range: 6,480–15,193 kg; mean lactation number: 3.9, range: 2–9) from a commercial dairy farm in Saxony, Germany, were enrolled in a randomized, prospective, triple-blinded study. Two groups received a treatment with BCC (5 or 10 mL/100 kg of body weight 10% butaphosphan and 0.005% cyanocobalamin, Catosal, Bayer Animal Health, n = 20 each) and one group a placebo treatment (NaCl 0.9%, n = 40). Liver biopsy specimens were collected 14 d antepartum (AP) and 7, 28, and 42 d postpartum (PP), routinely processed for histologic examination, and stained with hematoxylin and eosin, Sudan III, periodic acid-Schiff, and picrosirius red stains. The sections were assessed for fat and glycogen content and degenerative, inflammatory, fibrotic, and proliferative changes. The statistical analysis included the effects of the sampling day, the lactation number, the treatment, and the metabotype (A = medium, B = minor, C = large alterations in the liver metabolome profile between AP and PP status). There was mild to moderate fat infiltration in the liver of 37% of cows in the last 2 wk AP, and moderate to severe fat infiltration in 66% of cows in the first days PP. The degree of fat infiltration increased from 2 wk AP until the end of the first week PP, and then decreased until the end of the study period, at which time about 25% of cows had moderate to severe fatty infiltration. Lipidosis was positively correlated with the severity of liver cell degeneration, and negatively correlated with the degree of glycogen deposits. Complete glycogen depletion of hepatocytes was not observed in cows, even in the presence of severe hepatic lipidosis. Moderate to severe lymphocytic hepatitis was seen in 39% of cows throughout the study period, and cows with lactation numbers 5 or greater had perisinusoidal fibrosis more often than younger cows. Severe fibrosis and cirrhosis of the liver did not occur. Metabotype B animals exhibited a higher chance of fatty infiltration, lower glycogen storage, and perisinusoidal fibrosis and for this metabotype positive correlations were calculated between increased fat deposition in the liver and marked glycogen depletion, and increased degenerative, inflammatory, fibrotic, and proliferative changes of hepatic tissue. For the treatment with BCC, no significant effect was observed. In summary, during the transition period, the liver of dairy cows is characterized by fat accumulation and glycogen depletion and histologic signs of hepatitis and hepatocyte degeneration. These histomorphologic changes were accentuated in animals exhibiting little alterations in their liver metabolome profile across the transition period (metabotype B) and support the assumption of a decreased grass silage quality as a causative factor.

In the wake of Big Data, traditional Machine Learning techniques are now often integrated in the clinical workflow. Despite more capable, Deep Learning methods are not equally accepted given their unsatiated need for great amounts of training data and transversal use of the same architectures in fundamentally different areas with weakly-substantiated adaptations. To address the former, a cardiorespiratory signal synthesizer was designed by conditional sampling from a multimodally trained stochastic system of Gaussian copulas integrated in a Markov chain. With respect to the latter, a multi-branch convolutional neural network architecture was conceived to learn the best cardiac sensor-fusion strategy at every abstraction layer. The network was tailored to the tasks of cycle detection and classification for different cardiac modality combinations by a synthesizer-based data augmentation training framework and Bayesian hyperparameter optimization. The synthesizer yielded highly realistic signals in the time, frequency and phase domains for both healthy and pathological heart cycles as well as artifacts of different modalities. Benchmarking suggested that the network is able to surpass previous architectures and data augmentation provided a performance boost in realistic data availability scenarios. These included insufficient training data volume, as low as 150 cycles long, artifact contamination and absence of a classification data type in training.

Introduction Forearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series. Description of the technique A 3.0 mm Steinmann pin is inserted retrograde in the ulna proximal fragment through the fracture site using the open wound as the approach. With direct visualization of the reduction, the pin is advanced into the distal fragment. The reduction of the longitudinal axis and shortening is thus achieved. Patients and methods This method was used for all open fractures of forearm both-bone fractures in polytrauma patients undergoing DCO from 2014 to 2019. The alignment and length of the ulna were evaluated radiographically after pin fixation and before and after definitive fixation. Differences in the need for secondary procedures and infection rate between DCO and definitive fixation were also evaluated. Results There were 30 males (85.7%) with an average age of 32.9 ± 12.0 years and a mean ISS (Injury Severity Score) of 29.4 (range, 18.0-41.0). The most common associated injuries were thoracic trauma (62.8%) and head trauma (45.7%). In the radius and ulna, 51.4% and 60.0% of fractures, respectively, were multifragmentary (types B and C). Gustilo type IIIA represented 77.1% of the injuries. Pin fixation achieved good alignment and length in all cases. The mean time between DCO and definitive fixation was 12.0 days, and no secondary procedure was needed, nor any case developed either superficial or deep infection. The conversion from DCO to definitive fixation was considered easy in all cases. Conclusion Intramedullary Steinmann pin fixation of the ulna is a viable option for DCO for forearm both-bone fractures in open fractures in polytrauma patients.

Sexual well-being is an important contributor to romantic relationship quality, health, and quality of life, yet couples face significant disruptions to their sexuality during the transition to parenthood. While there is evidence of variability in the sexual well-being of new parents, distinct classes of dyadic trajectories have not been established. Sexual frequency, desire, satisfaction, and distress are each unique components of sexual well-being and may follow different patterns of change within couples. We sought to establish classes of trajectories of four aspects of sexual well-being for couples in the transition to parenthood as well as the associations among identified classes. Couples (N = 203) expecting their first child completed online standardized measures of sexual well-being at 20 and 32 weeks in pregnancy and at 3, 6, 9, and 12 months postpartum. Dyadic latent class growth analyses were conducted to identify classes of trajectories for each facet of sexual well-being, and dual trajectory analyses examined the probability of group membership across classes. Couples' sexual well-being over time was heterogeneous. Sexual frequency had two classes: high (33%) and low (67%); sexual desire had three classes: moderate (36%), high (25%), and discrepant (39%); sexual satisfaction had two classes: high (64%) and low (36%); and sexual distress had two classes: low (76%) and discrepant (24%). Overlap in classes of sexual well-being was variable such that high and low or discrepant (between partners) classes did not always co-occur. Findings provide more nuanced information about new parents' postpartum sexual health, which may facilitate early assessment and intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Our previous study showed the effect of pre-tension onto oscillation at the top of a ladder in raising and lowering processes on turntable ladders when steel wire ropes are added to ladder handrails. However, the oscillation was not switched off quickly. To quickly extinguish oscillation, we use steel ropes and a hydraulic system that is available on the truck to control the vibration. Based on the available multibody dynamic system and motion equation of the ladder, the group minimizes the number of variables in the motion equation and linearizes it. Thereafter, the vibration of the system is controlled and simulated by Matlab-Simulink software. This study presents a new method to control the ladder vibration on the turntable ladder.

The development of modulator therapy has, for the first time, allowed direct targeting of the underlying cause of cystic fibrosis (CF), the cystic fibrosis transmembrane conductance regulator (CFTR). Patients treated with CFTR modulators have improvement in lung function and decreased rates of pulmonary exacerbations. In 2019, elexacaftor/tezacaftor/ivacaftor was approved for use in the United States, opening these therapies to 90% of patients with CF. Intolerable adverse drug reactions to CFTR modulators results in discontinuation of therapy, which can be devastating to our patients. We describe our approach to two cases, not previously reported, of rash to elexacaftor/tezacaftor/ivacaftor in patients with a previous history of cutaneous adverse reactions to dual modulator therapy that had been addressed by desensitization. Case 1 was able to tolerate elexacaftor/tezacaftor/ivacaftor after desensitization to the triple combination therapy, while in Case 2 tolerance was obtained by treating through the reaction. The loss of tolerance in these patients was unexpected, and may be a common finding in patients with history of cutaneous adverse reactions to these drugs. We hope reporting our experience, including our desensitization protocol, may benefit CF patients for whom these drug reactions may be limiting access to powerful disease altering therapies.

To investigate the impact of a preoperative CT on surgical decision making in primary vulvar squamous cell carcinoma (VSCC) and the accuracy of detecting inguinal lymph node metastases (LNM). Secondly to assess prevalence and consequences of incidental findings and comorbidity using a CT.This population-based study comprised of surgically treated patients with primary VSCC, at a regional tertiary center, using the Swedish Quality Registry for Gynecological Cancer for identification, and medical records were reviewed. Results from the preoperative CT was compared with the histological analysis from the lymphadenectomy in the total cohort and between tumor size4 cm versus ≥4 cm.In total 134 women had undergone CT before sentinel node (SN) biopsy (n = 83) or inguinofemoral lymphadenectomy (IFL) (n = 51). Fiftyone patients (38%) had groin LNM. Accuracy of CT in detecting groin LNM was 76%; sensitivity 43% and specificity 96%. Positive (PPV) and negative predictive values (NPV) were 88% and 73% respectively. In tumors4 cm (n = 87), sensitivity, specificity, PPV and NPV were 17%, 95%, 57% and 75% and in tumors ≥4 cm (n = 47) 67%, 100%, 100% and 69% respectively. CT altered surgical method from SN biopsy to IFL in only two cases. Incidental findings led to extra follow-up resulting in a benign diagnosis in 22 patients and major important findings in five patients.In primary VSCC, a preoperative abdominal-inguinal CT is of limited value for surgical decision making. In tumors4 cm, it may be omitted due to low diagnostic accuracy and disturbing incidental findings.

Buerger disease (thromboangiitis obliterans [TAO]) typically occurs in men younger than 40–45 years who have a history of heavy tobacco use.

Mannlicher Haarausfall kann zu einer fehlenden Kontur des Gesichts fuhren. Die Haartransplantation kann diese Kontur wiederherstellen. Asthetische Gesichtspunkte sollten hierbei Berucksichtigung finden, insbesondere finden die Drittelregel sowie der „Goldene Schnitt“ Anwendung. Die Rekonstruktion der seitlichen Gesichtskontur (Schlafenbehaarung, „temporal points“) tragt bei ausgewahlten Patienten wesentlich zum Gesamtbild bei. Erfahrungen in der technischen Durchfuhrung sind fur ein naturliches Ergebnis essenziell.

While aggregate recycling rates in developed countries have plateaued in recent years, the contamination rate of recycling streams due to consumers incorrectly recycling items that cannot be recycled has grown rapidly. We propose that this problem may be partially due to persuasive messages, such as pro-environmental labeling on bins, that encourage recycling, but may lack guidance on how to do so accurately. For example, a number of public garbage receptacles across the U.S. are labeled “Landfill” instead of “Trash,” encouraging recycling by making the negative impact of garbage more salient. However, this labeling may also lead consumers to incorrectly “recycle” items that cannot be recycled (i.e., overinclusive recycling). Two field studies suggest that pro-environmental receptacle labeling can lead to overinclusive recycling, and a controlled experiment provides preliminary process evidence involving anticipated emotion from trashing versus recycling. Research opportunities and public policy implications for point-of-disposal labeling are discussed.

Background The transition to parenthood is associated with changes to new parents’ mood and sexual health. Sexual dysfunction—problems with sexual function accompanied by sexual distress (i.e., worries and concerns about one’s sex life)—is linked to poorer overall health, yet few studies have examined how sexual dysfunction unfolds for couples during this transition. Postpartum depression is a risk factor for sexual dysfunction; however, the association between depressive symptoms and how postpartum sexual dysfunction evolves has not been examined. Purpose To establish trajectories of sexual function and sexual distress for mothers and partners and to examine if postpartum depressive symptoms were associated with these trajectories. Methods Data were collected from 203 first-time parent couples from midpregnancy until 12-months postpartum. Sexual function and sexual distress were assessed at six time points (two prenatal) and depressive symptoms were assessed at 3-months postpartum. Results Dyadic latent piece-wise growth curve models revealed significant declines in mothers’ and partners’ sexual function between pregnancy and 3-months postpartum and significant improvements from 3- to 12-months postpartum. Mothers’ sexual distress increased between pregnancy and 3-months postpartum and decreased thereafter, whereas partner’s sexual distress remained stable. Depressive symptoms were associated with poorer sexual function and higher sexual distress at 3-months postpartum for both partners but did not predict change over time. Conclusions Mothers and their partners experience changes to their sexual function during the transition to parenthood; however, mothers are at greater risk of sexual dysfunction. Depressive symptoms are a risk factor for poorer sexual health at 3-months postpartum for both parents.

Background: Alcohol is a leading cause of morbidity and mortality in the European region, and tackling the harmful use of alcohol is a public health priority. Most countries in the region have national strategies for treating alcohol use disorders (AUD), but there is significant between-country variation. Objectives: This study aimed to compare clinical guidelines for the management of AUD from countries of the European region and to determine whether countries’ relative wealth or quality of their health systems had affected the guidelines. Methods: A survey was conducted of 24 countries. The survey encompassed how AUD clinical guidelines were researched, the range and expertise of contributors, which topics of AUD treatment were included, the definition of a “standard drink” used, and the publishing, funding, endorsement, and dissemination of the guideline. Results: Twenty-one of the 24 countries surveyed had a clinical guideline for AUD. All guidelines were underpinned by a literature review, and psychiatrists were the professional group most commonly involved in producing them. Most of the guidelines covered typical cornerstones of AUD care such as treatment of alcohol dependence, pharmacotherapy for relapse prevention, and detoxification. Definitions of a “standard drink” ranged from 8 to 20 grams of ethanol. Governments or governmental bodies were the main publishers and funders of guidelines, and the vast majority of guidelines were freely available online. There were no statistically significant effects of GDP, GDP per capita, or World Health Organization’s World Health Report rankings on whether countries were more likely to have an AUD clinical guideline, to have performed a systematic literature review, or to have involved service users in producing their guideline. Conclusions: The results of this survey reflect widespread good practice in producing AUD clinical guidelines across European countries. Regional research collaborations could offer significant time and cost savings in producing the evidence base from which guidelines are then written.

Objective: To compare postoperative radiographic outcomes of Schatzker type V and VI tibial plateau fractures treated with double-plate or single lateral locked plate. Methods: Sixty-three patients operated from December 2011 to February 2016 were selected, 47 from the double-plate group and 16 from the single lateral locked plate group. Minimum follow-up for all patients was 6 months. Fracture reduction evaluation was based on radiographic parameters: joint reduction, sagittal alignment, coronal alignment, and condylar width. Results: Radiographic evaluation showed no statistical difference in the immediate or late postoperative periods. Conclusion: Despite the reduced sample, this study is aligned with current results published in the medical literature. The severity of Schatzker type V and VI tibial plateau fractures can be minimized by the correct indication for the implant regarding fracture morphology. Level of Evidence III, Retrospective comparative study. RESUMO Objetivo: Comparar desfechos radiográficos pós-operatórios de fraturas do planalto tibial Schatzker V e VI tratados com dupla placa ou placa bloqueada única lateral. Métodos: Foram selecionados 63 pacientes operados no período de dezembro de 2011 a fevereiro de 2016, sendo 47 do grupo dupla placa e 16 do grupo placa bloqueada lateral única. Todos os pacientes tiveram seguimento mínimo de seis meses. A avaliação da redução das fraturas foi baseada nos parâmetros radiográficos: redução articular, alinhamento sagital, alinhamento coronal e largura condilar. Resultados: A avaliação radiográfica não demonstrou diferença estatística no pós-operatório imediato nem no tardio. Conclusão: Apesar da amostra reduzida, o estudo vai ao encontro dos resultados mais atuais publicados na literatura médica. A gravidade das fraturas do planalto tibial Shatzker V e VI pode ser minimizada com a correta indicação do implante segundo a morfologia da fratura. Nível de Evidência III, Estudo retrospectivo comparativo.

Knowing what predicts consumers’ reliance on web-based information when making purchase decisions is crucial for managing a firm’s digital marketing strategy. The present research takes a cross-cultural perspective and finds that the cultural dimension of collectivism predicts the extent to which consumers rely on user-generated, but not brand-generated, product information when making purchase decisions. Extending research on cultural mindset to self-other perceptions on social media, we identify a conditional process by which collectivism influences seeking user-generated product information. Collectivistic consumers discount differences (e.g., differences in lifestyle, personality, or political orientation) between themselves and other social media users, which fosters a sense of similarity with others (i.e., perceived homophily). Perceived homophily increases trust and, in turn, consumers’ reliance on user-generated product information. We discuss implications for managers and public policy communications.

Background In acute respiratory failure elevated intraabdominal pressure aggravates lung collapse, tidal recruitment, and ventilation inhomogeneity. Low positive end-expiratory pressure (PEEP) may promote lung collapse and intrapulmonary shunting, whereas high PEEP may increase dead space by inspiratory overdistension. The authors hypothesized that an electrical impedance tomography–guided PEEP approach minimizing tidal recruitment improves regional ventilation and perfusion matching when compared to a table-based low PEEP/no recruitment and an oxygenation-guided high PEEP/full recruitment strategy in a hybrid model of lung injury and elevated intraabdominal pressure. Methods In 15 pigs with oleic acid–induced lung injury intraabdominal pressure was increased by intraabdominal saline infusion. PEEP was set in randomized order: (1) guided by a PEEP/inspired oxygen fraction table, without recruitment maneuver; (2) minimizing tidal recruitment guided by electrical impedance tomography after a recruitment maneuver; and (3) maximizing oxygenation after a recruitment maneuver. Single photon emission computed tomography was used to analyze regional ventilation, perfusion, and aeration. Primary outcome measures were differences in PEEP levels and regional ventilation/perfusion matching. Results Resulting PEEP levels were different (mean ± SD) with (1) table PEEP: 11 ± 3 cm H2O; (2) minimal tidal recruitment PEEP: 22 ± 3 cm H2O; and (3) maximal oxygenation PEEP: 25 ± 4 cm H2O; P < 0.001. Table PEEP without recruitment maneuver caused highest lung collapse (28 ± 11% vs. 5 ± 5% vs. 4 ± 4%; P < 0.001), shunt perfusion (3.2 ± 0.8 l/min vs. 1.0 ± 0.8 l/min vs. 0.7 ± 0.6 l/min; P < 0.001) and dead space ventilation (2.9 ± 1.0 l/min vs. 1.5 ± 0.7 l/min vs. 1.7 ± 0.8 l/min; P < 0.001). Although resulting in different PEEP levels, minimal tidal recruitment and maximal oxygenation PEEP, both following a recruitment maneuver, had similar effects on regional ventilation/perfusion matching. Conclusions When compared to table PEEP without a recruitment maneuver, both minimal tidal recruitment PEEP and maximal oxygenation PEEP following a recruitment maneuver decreased shunting and dead space ventilation, and the effects of minimal tidal recruitment PEEP and maximal oxygenation PEEP were comparable. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

The management of pancreatic cancer has dramatically changed since the first major randomized trial published in 2001 by the European Study Group for Pancreatic Cancer (ESPAC) stimulated the development of multimodality oncosurgical therapies. ESPAC-1 demonstrated a survival improvement from upfront surgery of only 8%, increasing to 21% 5-year survival for 5-fluorouracil/folinic acid but only 10.8% for chemoradiotherapy. ESPAC-4 has shown a 5-year survival rate of 30% for all patients without restriction of 30% using a combination of gemcitabine and capecitabine, rising to 40% in those with an R0 resection margin, or nearly 50% in those with N0 lymph node status. In selected patients with favorable prognostic features mFOLFIRINOX can produce a 50% 5-year survival rate but with added toxicity. While a positive resection margin is associated with an increased likelihood of local recurrence, this of itself is not the contributor to reduced survival, but rather reflects the increased probability of systemic disease. Thus, strategies aimed at local control, may reduce subsequent local progression, but will not improve overall survival. Neoadjuvant chemotherapy is increasingly utilized in cases of borderline resectable or locally advanced pancreatic cancer, but there is still a lack of proof of concept studies. High-quality evidence from randomized controlled trials to identify the indications and benefits of neoadjuvant therapy in pancreatic cancer are required. The use of patient-derived tumor organoids may predict response to chemotherapy which could open a new opportunity in pancreatic cancer treatment, stratifying patients into treatment groups based on their response to these therapies in the laboratory.

Background: Acinetobacter baumannii complex is an increasingly important cause of osteomyelitis. It is considered a difficult to treat agent, due to increasing antimicrobial resistance and few available therapeutic options.Objective: To compare effectiveness and tolerability of tigecycline and colistin in patients with osteomyelitis caused by carbapenem-resistant A. baumannii complex (CRABC).Methods: This retrospective review included all patients admitted to a 150-bed tertiary hospital from 2007 to 2015 with microbiologically confirmed CRABC osteomyelitis for which they received tigecycline or colistin. Data on demographic and clinical characteristics, adverse events, and outcomes 12 months after the end of antimicrobial treatment were analysed and stratified according to the antimicrobial used.Results: 65 patients were included, 34 treated with colistin and 31 with tigecycline. There were significantly more men (P = 0.028) in the colistin group, and more smokers (P = 0.021) and greater occurrence of chronic osteomyelitis (P = 0.036) in the tigecycline treatment group. Median duration of therapy was 42.5 days for colistin and 42 days for tigecycline, with no significant difference. Overall incidence of adverse events was higher in the colistin group (P = 0.047). In particular, incidence of renal impairment was also higher in this group (P = 0.003). Nausea and vomiting were more frequent with tigecycline (P = 0.046). There were no significant differences between groups in relapse, amputation, or death.Conclusions: Tigecycline had a better safety profile than colistin in the treatment of osteomyelitis due to CRABC, with no significant difference in outcomes after 12 months of follow-up.

Background: Deep brain stimulation (DBS) is an established method of treatment for Parkinson’s disease (PD). A stimulation sweet spot at the interface between the motor and associative clusters of the subthalamic nucleus (STN) has recently been postulated. The aim of this study was to analyze the available clustering methods for the STN and their correlation to outcome. Methods: This is a retrospective analysis of a group of 20 patients implanted with a DBS device for PD. Atlas-based and diffusion tractography-based parcellation of the STN was performed. The distances of the electrode to the obtained clusters were compared to each other and to outcome parameters, which included levodopa equivalent dose (LED) reduction, Unified Parkinson’s Disease Rating Scale (UPDRS)-III scores, and reduction in scores for items 32 and 36 of the UPDRS-IV. Results: The implanted electrodes were located nearest to the motor clusters of the STN. The following significant associations with postoperative LED reduction were found: (1) distance of the electrode to the motor cluster in the Accolla and DISTAL atlases (p < 0.01) and (2) distance of the electrode to the supplementary motor area cluster (p = 0.02). There was no association with either the UPDRS-III or the UPDRS-IV score. Conclusions: The results of this study suggest the possibility that atlas-based clustering, as well as diffusion tractography-based parcellation, can be useful in estimating the stimulation target (“sweet spot”) for STN-DBS in PD patients. Atlas-based as well as diffusion-based clustering might become a useful tool in DBS trajectory planning.

IEEE access 8, 66338-66352 (2020). doi:10.1109/ACCESS.2020.2985910, Published by IEEE, New York, NY

Pediatric research (2021). doi:10.1038/s41390-021-01594-4, Published by Nature Publishing Group, London [u.a.]

The papers in this special section focus on camera-based monitoring for pervasive healthcare informatics. Measuring physiological signals from the human face and body using video cameras is an emerging research topic that has grown rapidly in the last decade. Remote cameras (in both visible and infrared wavelengths) can be used to measure vital signs from a human body based on skin optics or body movements thereby avoiding mechanical contact with the skin. Camera-based health monitoring will bring a rich set of compelling healthcare applications that directly improve upon contact-based monitoring solutions and impact people’s care experience and quality of life in various scenarios, such as in hospital care units, sleep/senior centers, assisted-living homes, telemedicine and e-health, baby/elderly care at home, fitness and sports, driver monitoring in automotive applications, cardiac/ respiratory gating for MRI/CT, AR/VR based therapy and clinical training, e

Die Wundheilung hat einen entscheidenden Einfluss auf das Ergebnis jeder operativen Masnahme, insbesondere in der kosmetischen Chirurgie und speziell bei Haartransplantationen. Trotz atraumatischer Operationstechnik kann es durch eine „Stressreaktion“ und damit verbundene Wundheilungsstorungen zum Absterben von Transplantaten in der Haarchirurgie kommen. Die Narbenheilung kann verzogert sein. Es ist sinnvoll, sich mit diesem Thema auseinanderzusetzen, da im Vorfeld Komplikationen vermieden werden konnen.

Global thinning is a technique that enables backside failure analysis and radiation testing. In some devices, it can also lead to increased thresholds for single-event latchup and upset. In this study, we examine the impacts of global thinning on 28 nm node FPGAs. Test devices are thinned to 50, 10, and 3 μm via CNC milling. Lattice damage, in the form of dislocations, extends about 1 μm below the surface, but is removed by polishing with colloidal SiO2. As shown by finite-element modeling, thinning increases compressive global stress in the Si while solder bumps (in flip-chip packages) increase stress locally. The results are confirmed by stress measurements obtained through Raman spectroscopy, although more complex models are needed to account for nonlinear effects in devices thinned to 3 μm and heated to 125°C. Thermal imaging shows that increased local heating occurs with increased thinning, but the maximum temperature difference across the 3-μm die is less than 2°C. Ring oscillators throughout the FPGA fabric slow about 0.5% after thinning and another 0.5% when heated to 125°C, which is attributed to stress changes in the Si.

Parkinson’s disease is a neurological disorder characterized by the deficiency of dopamine levels in the brain. More than 75 percent of these patients suffer from tremors. Parkinsonian tremor (PT) is more characterized to be a rest tremor, but some patients suffer from action tremor as well. Usually, patients suffering from this disease are diagnosed by their physicians who perform some battery MDS-UPDRS tasks to determine the disorder. Some sensors were used to diagnose the tremor objectively, but in this study, we are using a new Body Sensor Network (BSN) designed at our institute to be used in detecting the acceleration, gyroscope, and magnetometer of the tremor patients in the clinic. Signal processing of the recorded data is performed to determine and classify the number of times throughout the day the patient suffered from tremors. This is ensured through automatic signal segmentation, extraction of several signal features, and classification with the most accurate machine learning classifier. In this study, we have proved that our BSN sensor is capable of helping clinicians in classifying tremor occurrence in Parkinson diseased patients specifically, and tremor patients generally throughout monitoring their everyday life activities.

OBJECTIVE Ventricular assist devices (VADs) are implanted in patients suffering from end-stage heart failure to sustain the blood circulation. Real-time volume measurement could be a valuable tool to monitor patients and enable physiological control strategies to provide individualized therapy. However, volume measurement using one sensor modality requires re-calibration in the critical time post VAD implantation. METHODS To overcome this limitation, we have integrated ultrasound and impedance volume measurement techniques into a cannula of an apical VAD. We tested both modalities across a volume range from 140-420 mL using two differently sized and shaped biventricular silicon heart phantoms, which were subjected to physiological pressures in an in-vitro test bench. We compared results from standard calibrated measurements with calculations found by a quadratic optimization for the single modality and their combination (dual-modality) and validated the results using twofold cross-validation. RESULTS The dual-modality approach resulted in most favorable limits of agreement (LOA) of -0.83 ± 1.54% compared to -13.88 ± 5.90% for ultrasound and -43.45 ± 10.28% for electric impedance, separately. CONCLUSION The results of the dual-modality approach were as accurate as the standard calibrated measurement and valid over a large range of volumes (140-420 mL). In this in-vitro study, we show how a dual-modality ventricular volume measurement of ultrasound and electric impedance increases the robustness and renders calibration obsolete. SIGNIFICANCE Ventricular volumes could be measured accurately in the critical period post VAD implantation despite ventricular remodeling.

Cardiac implantable electronic device (CIED)-related infections are a major complication of CIED therapy and associated with high morbidity and mortality. The aim of the present study was to evaluate the incidence of lead erosion as one cause of the CIED-related infections and to provide detailed information about the therapy of two cases of lead erosion. We retrospectively screened the database of a large clinic specialized on patients with CIED (HIZ BERLIN Herzschrittmacher- und ICD-Zentrum, Berlin, Germany) for cases of lead erosion between 2015 and 2020. A total of 5971 outpatients were treated at the HIZ BERLIN – including 4782 patients with a one- or two-chamber pacemaker, 837 patients with an implantable cardioverter defibrillator (ICD) and 352 patients with a biventricular device for cardiac resynchronization therapy (CRT). The incidence of lead erosion was 0.033%. As one of the two patients, who suffered from lead erosions, had no signs of systemic infection, the patient received local therapy with an antimicrobial mesh and intravenous antibiotics. After twelve months, he showed a good clinical outcome without ongoing or recurring infection. In conclusion, the incidence of lead erosion is low. In case of lead erosions without signs of systemic infection, an antimicrobial mesh might be implanted as an off-label use in patients that decline complete device removal.

BACKGROUND: Members of the public will soon be taking commercial suborbital spaceflights with significant Gx (chest-to-back) acceleration potentially reaching up to 6 Gx. Pulmonary physiology is gravity-dependent and is likely to be affected, which may have clinical implications for medically susceptible individuals.METHODS: During 2-min centrifuge exposures ranging up to 6 Gx, 11 healthy subjects were studied using advanced respiratory techniques. These sustained exposures were intended to allow characterization of the underlying pulmonary response and did not replicate actual suborbital G profiles. Regional distribution of ventilation in the lungs was determined using electrical impedance tomography. Neural respiratory drive (from diaphragm electromyography) and work of breathing (from transdiaphragmatic pressures) were obtained via nasoesophageal catheters. Arterial blood gases were measured in a subset of subjects. Measurements were conducted while breathing air and breathing 15 oxygen to simulate anticipated cabin pressurization conditions.RESULTS: Acceleration caused hypoxemia that worsened with increasing magnitude and duration of Gx. Minimum arterial oxygen saturation at 6 Gx was 86 1 breathing air and 79 1 breathing 15 oxygen. With increasing Gx the alveolar-arterial (A-a) oxygen gradient widened progressively and the relative distribution of ventilation reversed from posterior to anterior lung regions with substantial gas-trapping anteriorly. Severe breathlessness accompanied large progressive increases in work of breathing and neural respiratory drive.DISCUSSION: Sustained high-G acceleration at magnitudes relevant to suborbital flight profoundly affects respiratory physiology. These effects may become clinically important in the most medically susceptible passengers, in whom the potential role of centrifuge-based preflight evaluation requires further investigation.Pollock RD, Jolley CJ, Abid N, Couper JH, Estrada-Petrocelli L, Hodkinson PD, Leonhardt S, Mago-Elliott S, Menden T, Rafferty G, Richmond G, Robbins PA, Ritchie GAD, Segal MJ, Stevenson AT, Tank HD, Smith TG. Pulmonary effects of sustained periods of high-G acceleration relevant to suborbital spaceflight. Aerosp Med Hum Perform. 2021; 92(7):633641.

We demonstrate a terahertz (THz) frequency reference for precision metrology, by utilising the inherently well- defined resonance frequencies of ultra-high quality (Q) THz microresonators. In a proof-of-concept experiment, we demonstrate the accurate and repeated detection of minute resonance frequency shifts of less than 5 MHz at 0.6 THz of a THz microresonator sensor.

Pancreatic ductal adenocarcinoma (PDAC) is characterized by high drug resistance and poor prognosis. Novel therapeutic and stratification strategies are urgently needed. Here, we present an integration of in-depth genomic and transcriptomic characterization with drug screening and clinical outcome based on a catalogue of 51 patient-derived tumor organoids (PDOs) from resected PDAC. Known PDAC molecular subtypes and their prognostic value are conserved in organoids. Integration of transcriptomic and drug response profiles suggest a metabolism-mediated modulations of drug resistance. Copy number alterations on chromosome 13q and wild-type status of TP53 emerged as potential novel genomic biomarkers for sensitivity to 5-FU and oxaliplatin treatment, respectively. Functional testing of targeted drugs in PDOs revealed its additional value for genome-driven personalized oncology. Co-deletion of TP53/POLR2A increased vulnerability to RNA polymerase II inhibition, pointing to a promising target for personalized treatment in PDAC.SignificancePatient-derived PDAC organoids hold great promise as surrogate tumor models for personalized oncology. By integrating highly granular molecular, drug sensitivity and clinical data, we demonstrate that PDOs are valid models for molecular characterization and response prediction that also enable identification of novel drug sensitivity biomarkers and resistance mechanisms in PDAC.

Background: Ischemic stroke (IS) is a common cause of hospitalization which carries a significant economic burden and leads to high rates of death and disability. Readmission in the first 30 days after hospitalization is associated with increased healthcare costs and higher risk of death and disability. Efforts to decrease the number of patients returning to the hospital after IS may improve quality and cost of care. Methods: Improving care transitions to reduce readmissions is amenable to quality improvement (QI) initiatives. A multi-component QI intervention directed at IS patients being discharged to home from a stroke unit at an academic comprehensive stroke center using IS diagnosis-driven home care referrals, improved post-discharge telephone calls, and timely completion of discharge summaries was developed. The improvement project was implemented on July 1, 2019, and evaluated for the 6 months following initiation in comparison to the same 6-month period pre-intervention in 2018. Results: Following implementation, a statistically significant decrease in 30-day all-cause same-hospital readmission rates from 7.4% to 2.8% ( p = .031, d = 1.61) in the project population and from 6.6% to 3% ( p = .010, d = 1.43) in the overall IS population was observed. Improvement was seen in all process measures as well as in patient satisfaction scores. Conclusions: An evidence-based bundled process improvement intervention for IS patients discharged to home was associated with decreased hospital readmission rates following IS.

Lymph Node Dissection (SLND) is standard of care for diagnosing sentinel lymph node (SLN) status in patients with early breast cancer. Study aim was to determine whether the combination of Superparamagnetic iron oxide nanoparticles (SPIO) MRI-lymphography (MRI-LG) and a Magnetic-guided Axillary UltraSound (MagUS) with biopsy can allow for minimally invasive, axillary evaluation to de-escalate surgery. Patients were injected with 2 mL of SPIO and underwent MRI-LG for SN mapping. Thereafter MagUS and core needle biopsy (CNB) were performed. Patients planned for neoadjuvant treatment, the SLN was clipped and SLND was performed after neoadjuvant with the addition of isotope. During surgery, SLNs were controlled for signs of previous biopsy or clip. The primary endpoint was MagUS SLN detection rate, defined as successful SLN detection of at least one SLN of those retrieved in SLND. In 79 patients, 48 underwent upfront surgery, 12 received neoadjuvant and 19 had recurrent cancer. MagUS traced the SLN in all upfront and neoadjuvant cases, detecting all patients with macrometastases (n = 10). MagUS missed only one micrometastasis, outperforming baseline axillary ultrasound AUS (AUC: 0.950 vs. 0.508, p &lt, 0.001) and showing no discordance to SLND (p = 1.000). MagUS provides the niche for minimally invasive axillary mapping that can reduce diagnostic surgery.

Graphene based 2D electrical contacts have been proposed to mitigate the contact resistance bottleneck in 2D material based transistors. In this work, we present a detailed analysis of Ru-graphene and Ni-graphene contacts to 2.1nm thick CVD MoS 2 , which show a contact resistance of 9.34 kΩ – μm and 17.1 kΩ – μm, respectively. We report a novel physical characterization strategy to characterize the MoS 2 -contact interface by inverting the MoS 2 devices, exposing the contact interface. Using Raman spectroscopy and X-ray photoelectron spectroscopy, we characterize the contact interface to correlate the observed electrical trend with physical characterization of the contact interface.

Deployment of bare metal duodenal stents for individuals with gastric outlet obstructions (GOOs) is a well-characterized measure to improve the quality of life. However, these interventions are palliative in nature and are associated with known complications. We present an unfortunate case of a previously not well described, albeit not surprising, a complication of stent placement. The individual underwent duodenal stent placement due to obstructive metastatic disease and subsequently presented for gastrointestinal (GI) bleed. It was determined that an aortoduodenal fistula acutely developed and, despite heroic efforts, the patient ultimately expired.

This contribution presents a case study on the extension of traditional approaches to blended learning in theoretical computer science at university level by incooperating modern multitouch tabletop displays for collaborative learning. The evaluated serious game about regular expressions provides a collaborative learning experience for groups of students and allows precise control of difficulty. It includes gamification elements and allows extensive analytics of learner activities. The didactical approach is evaluated in a case study with randomized test and control groups consisting of students in the same semester who had no curricular contact with the topic prior to the experiment. The test group consisting of 34 students tackled regular expressions by playing the learning game with minimal intervention by an educator. The control group consisting of 59 students had a lecture about the same contents as the learning game. To measure the success of the game regarding learning outcome, three tests were taken, a pre-test prior to and a post-test after the instructional phase. To compare the sustainability of both methods, a third test was taken two weeks later. The results are discussed regarding the learning outcomes on different levels of Anderson and Krathwohl’s revised version of Bloom’s taxonomy of educational objectives.

Increasing farmers’ acceptance and adoption of environmentally beneficial farming practices is essential for mitigating negative impacts of agriculture. To support adoption through policy, it is necessary to understand which types of farms or farmers do or do not (yet) apply such practices. However, farmers are not a homogeneous group and their behavior is subject to a complex array of structural, socioeconomic, and socio-psychological influences. Reducing this complexity, farmer typologies or archetypes are useful tools for understanding differing motivations for the uptake of sustainable farming practices. Previous investigations of the role of farmer archetypes in the adoption of such practices rely on either purely qualitative or purely quantitative methods in data collection, typology creation, and hypothesis testing. Our study combines both approaches by classifying survey respondents into farmer types based on a previous Q methodological study. We then use these types in a two-part regression model that aims to explain participation in agri-environmental schemes (AES) and the level of scheme participation. To control for farm structural factors, we additionally link our questionnaire data to secondary data from the farm accountancy data network. Results indicate that in Austria, AES are attractive to all types of farmers, but the level of participation (AES income per hectare) in these schemes differs between archetypes: Profitability-oriented farmers participate less, and nature-oriented farmers participate more than other types. This suggests that monetary compensations for sustainable farming practices are not perceived as sufficient by certain groups of farmers, and policy makers need to consider additional kinds of incentives.

Evans syndrome (ES) is a rare hematologic disorder characterized by the development of autoimmune hemolytic anemia (AIHA), idiopathic thrombocytopenia, and occasionally immune-mediated neutropenia. Jehovah’s Witnesses (JW) often decline blood product transfusion on the grounds of a scriptural stand based on biblical texts. The acute management of ES often consists of blood product transfusion in addition to high-dose steroids and intravenous immunoglobulin. We describe the case of a JW female presenting with new-onset, acutely worsening AIHA and thrombocytopenia with concern for hemodynamic compromise who was successfully treated with erythropoietin-stimulating agents, parenteral iron, folic acid, and high-dose steroids.

Group testing, the testing paradigm which combines multiple samples within a single test, was introduced in 1943 by Robert Dorfman. Since its original proposal for syphilis screening, group testing has been applied in domains such as fault identification in electrical and computer networks, machine learning, data mining, and cryptography. The SARS-CoV-2 pandemic has led to proposals for using group testing in its original context of identifying infected individuals in a population with few tests. Studies suggest that non-adaptive group testing - in which all the tests are determined in advance - for SARS-CoV-2 could help save 20% to 90% of tests depending on the prevalence. However, no systematic approach for comparing different non-adaptive group testing strategies currently exists.In this paper we develop a software platform for evaluating non-adaptive group testing strategies in both a noiseless setting and in the presence of realistic noise sources, modelled on published experimental observations, which makes them applicable to polymerase chain reaction (PCR) tests, the dominant type of tests for SARS-CoV-2. This modular platform can be used with a variety of group testing designs and decoding algorithms. We use it to evaluate the performance of near-doubly-regular designs and a decoding algorithm based on an integer linear programming formulation, both of which are known to be optimal in some regimes. We find savings between 40% and 91% of tests for prevalences up to 10% when a small error (below 5%) is allowed. We also find that the performance degrades gracefully with noise. We expect our modular, user-friendly, publicly available platform to facilitate empirical research into non-adaptive group testing for SARS-CoV-2.

Aims To investigate the mechanism of action of 55P0251, a novel multiflorine‐derived substituted quinazolidine that augments insulin release and lowers blood glucose in rodents, but does not act via mechanisms addressed by any antidiabetic agent in clinical use. Materials and Methods Using male mice, we determined the effects of 55P0251 on glucose tolerance, insulin secretion from isolated islets and blood oxygen saturation, including head‐to‐head comparison of 55P0251 to its inverted enantiomer 55P0250, as well as to other anti‐hyperglycaemic multiflorine derivatives discovered in our programme. Results 55P0251 was clearly superior to its inverted enantiomer in the glucose tolerance test (area under the curve: 11.3 mg/kg 55P0251, 1.19 ± 0.04 min*mol/L vs 55P0250, 1.80 ± 0.04 min*mol/L; P