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For the commercial viability of a hydrogen-based transportation, hydrogen infrastructure is key. One of the major issues of hydrogen infrastructure is related to the deployment and costs of the Hydrogen Refuelling Stations (HRSs), where up to 40% of the cost is related to hydrogen compression. The introduction of Metal Hydride Hydrogen Compressors (MHHCs) in the HRSs as compression elements is a potential technology to reduce operational costs, ensure noiseless operation and increase efficiency, if renewable-based thermal energy (and/or industrial waste heat) is supplied to the system. In this work, four different two-stage MHHCs are introduced and examined in terms of compression ratio, hydrogen flow rate (compression duration), thermal energy requirements and efficiency. In addition, for comparison purposes, a three-stage MHHC is also studied. The properties of five different materials are used for the individual compression stages of the MHHCs, where all the necessary thermodynamic properties are extracted experimentally and incorporated in a commercial Multiphysics software. The unsteady heat and mass transfer equations are employed for the development of the numerical model. The hydrogenation/dehydrogenation kinetics and the temperature profile were validated against solid experimental results. In addition, to improve and accelerate the storage/release kinetics, an internal thermal management scenario has been introduced. The results show that for compression at the temperature range of 10–90 °C, the most favourable two-stage compression case (Case 3) showed a compression ratio of 11.18 ÷ 1, an isentropic efficiency of 4.54% with a thermal energy demand of 322 kJ/molH2 and a cycle time of almost 34 min.

OBJECTIVEAneurysm wall enhancement (AWE) on 3D vessel wall MRI (VWMRI) has been suggested as an imaging biomarker for intracranial aneurysms (IAs) at higher risk of rupture. While computational fluid dynamics (CFD) studies have been used to investigate the association between hemodynamic forces and rupture status of IAs, the role of hemodynamic forces in unruptured IAs with AWE is poorly understood. The authors investigated the role and implications of abnormal hemodynamics related to aneurysm pathophysiology in patients with AWE in unruptured IAs.METHODSTwenty-five patients who had undergone digital subtraction angiography (DSA) and VWMRI studies from September 2016 to September 2017 were included, resulting in 22 patients with 25 IAs, 9 with and 16 without AWE. High-resolution CFD models of hemodynamics were created from DSA images. Univariate and multivariate analyses were performed to investigate the association between AWE and conventional morphological and hemodynamic parameters. Normalized MRI signal intensity was quantified and quantitatively associated with wall shear stresses (WSSs) for the entire aneurysm sac, and in regions of low, intermediate, and high WSS.RESULTSThe AWE group had lower WSS (p < 0.01) and sac-averaged velocity (p < 0.01) and larger aneurysm size (p < 0.001) and size ratio (p = 0.0251) than the non-AWE group. From multivariate analysis of both hemodynamic and morphological factors, only low WSS was found to be independently associated with AWE. Sac-averaged normalized MRI signal intensity correlated with WSS and was significantly different in regions of low WSS compared to regions of intermediate (p = 0.018) and high (p < 0.001) WSS.CONCLUSIONSThe presence of AWE was associated with morphological and hemodynamic factors related to rupture risk. Low WSS was found to be an independent predictor of AWE. Our findings support the hypothesis that low WSS in IAs with AWE may indicate a growth and remodeling process that may predispose such aneurysms to rupture; however, a causality between the two cannot be established.

Objective Lately, morphological parameters of the surrounding vasculature aside from aneurysm size, specific for the aneurysm location, e.g., posterior cerebral artery angle for basilar artery tip aneurysms, could be identified to correlate with the risk of rupture. We examined further image-based morphological parameters of the aneurysm surrounding vasculature that could correlate with the growth or the risk of rupture of basilar artery tip aneurysms. Methods Data from 83 patients with basilar tip aneurysms (27 not ruptured; 56 ruptured) and 100 control patients were assessed (50 without aneurysms and 50 with aneurysms of the anterior circle of Willis). Anatomical parameters of the aneurysms were assessed and analyzed, as well as of the surrounding vasculature, namely the asymmetry of P1 and the vertebral arteries. Results Patients with basilar tip aneurysm showed no significant increase in P1 or vertebral artery asymmetry compared with the control patients or patients with aneurysms of the anterior circulation, neither was there a significant difference in asymmetry between cases with ruptured and unruptured aneurysms. Furthermore, we observed no significant correlations between P1 asymmetry and the aneurysm size or number of lobuli in the aneurysms. Conclusion We observed no significant difference in aneurysm size, rupture, or lobulation associated with P1 or vertebral artery (surrounding vasculature) asymmetry. Therefore, the asymmetry of the surrounding vessels does not seem to be a promising morphological parameter for the evaluation of probability of rupture and growth in basilar tip aneurysms in future studies.

In the present work, a numerical analysis on the performance of a seven-stage metal hydride hydrogen compression (MHHC) system is introduced, presented and discussed. The operation efficiency and cost along with the reliability of hydrogen compression is of great importance for the future commercial availability of Hydrogen Refuelling Stations (HRS); thus, significant improvements in hydrogen compression must be achieved and novel methods and approaches are being investigated in that respect. MHHC's offer distinct advantages over conventional mechanical compressors and the present paper aims at contributing to the efficient design and upscaling of such device via advanced numerical simulations of a seven-stage MHHC. The numerical model was supported by and validated with solid experimental data. Furthermore, several different operational temperature ranges for the compressor were examined and the importance of the proper operation conditions is discussed in terms of temperature evolution, pressure profile, cycle duration, compression ratio, thermal energy demand and efficiency.

The Automatic Identification System (AIS) offers automatic traffic control and collision avoidance services to the maritime transportation sector worldwide. Because AIS lacks security mechanisms, it is vulnerable to misuse and exploitation by unlawful adversaries (e.g. sea-pirates, terrorists, smugglers). To address the security issues of the AIS, in an earlier paper [1], we proposed the deployment of a Maritime Certificate-less Identity-Based (mIBC) public-key cryptography infrastructure that enhances AIS with on-demand anonymity, authentication, and encryption capabilities. In this paper we address implementation aspects of that infrastructure. In particular, we propose to use the Sakai-Kasahara Identity-Based Encryption (IBE) approach to implement the mIBC infrastructure, following the IEEE 1363.3-2013 standard for Identity-Based Cryptography.

Objective Symptomatic spine metastases are found in about 10% of patients with cancer. As the long-term survival of patients with carcinoma rises, the number of patients with symptomatic spine metastases is also increasing. In our tertiary referral center, patients usually present rapidly progressive neurologic disorders, which require an urgent treatment decision. Treatment options include extensive 360° stabilizations. These complex interventions are not always readily available. We examined the extent to which the patient population benefited from decompressive surgery without stabilization. We hypothesize that patients benefit from merely dorsal decompression, which preserves stability when they experience symptomatic spine metastases. Methods We performed a retrospective analysis of electronic patient data from 19 patients, who were treated for symptomatic spine metastases by hemilaminectomy between 2009 and 2017. We evaluated the preoperative and postoperative neurologic functions using the American Spinal Injury Association (ASIA) Impairment Scale. A comparative literature analysis was carried out to assess the Spinal Neoplastic Instability Score, Tokuhashi score, and Tomita score. Results Nine participants had prostate cancer, 4 had mammary carcinoma, 3 had bronchial carcinoma, and 3 had other cancers. The median preoperative ASIA score was C, postoperatively, the score significantly improved to D (sign test P = 0.002). None of the patients needed stabilization within the follow-up period of up to 56 months. Conclusions In our patient population, minimal intervention could significantly improve neurologic disorders. This outcome was seen over the whole study period. Even though different scoring systems suggest stabilization, our results show that spinal decompression alone might be indicated as well.

Background Treatment of ruptured dissecting and blister aneurysms is technically challenging with potentially high morbidity and mortality. The Derivo Embolisation Device (Derivo) is a flow diverter stent designed for the treatment of intracranial aneurysms. Purpose To assess the safety and feasibility of the Derivo in the treatment of ruptured dissecting and blister aneurysms. Material and Methods We retrospectively analyzed all patients with ruptured dissecting and blister aneurysms treated with the Derivo between February 2016 and July 2018. Procedural details, complications, morbidity within 30 days, and angiographic aneurysm occlusion rates, initially and after six months, were assessed. Results In 10 patients 11 ruptured dissecting and blister aneurysms were treated with 12 Derivos as monotherapy. No aneurysm rebleeding was observed at follow-up. One treatment-related complication occurred including a coil perforation of an additionally treated aneurysm. One patient died due to brain edema. Initial digital subtraction angiography revealed complete (O’Kelly–Marotta [OKM] classification D) and favorable (OKM D+C) occlusion rate in three aneurysms. Six-month follow-up for digital subtraction angiography and clinical evaluation was available in 6/9 patients with complete (OKM D) occlusion in all aneurysms (6/6). Favorable (modified Rankin Scale [mRS] ≤ 2) and moderate (mRS 3) clinical outcome after a mean follow-up of 10 months was observed in six and two patients, respectively. Conclusion Endovascular treatment with the Derivo in ruptured dissecting and blister aneurysms revealed a sufficient initial division of aneurysms from the circulation without rebleeding. The Derivo is associated with high procedural and clinical short-term safety.

Further developments in disease diagnosis and treatment are of immense relevance for advancements in medical care of the population. A detailed cost-benefit analysis of direct and indirect costs is usually unavailable. In the current article, these aspects are investigated using prospectively collected randomized data over two years. Specifically, the surgical treatment of a herniated lumbar disc is addressed, and whether a newly introduced technique (e.g., annular closure device) can lead to a better quality of care and increased patient satisfaction when performed during the standard operation, while also being economically viable.

Few retrospective studies have addressed Modic changes (MC) following lumbar spine surgery, though it is usually assumed that MC increase in grade and incidence. To test this conventional wisdom, we investigated the natural course of MC following primary lumbar limited discectomy with two-year follow-up. In addition, a possible clinical relevance to those changes was assessed. The data of the control group (278 subjects) of a prospective randomized, controlled trial (RCT) were evaluated retrospectively. We did not observe a simple increase in MC with regard to grade. There is variable activity observed in Type 2 (at 12 months) and in Type 1 (at 24 months). Conversion from one grade to another may occur and may be upward or downward. The incidence of MC increased slightly over time, as after surgery a decreasing percentage of the study group remained without MC over two years (1 year: 34% (85/250); 2 years: 30% (72/237)). Radiological parameters (rotation, translation, and spondylolisthesis) had no significant correlation to MC or MC subtypes. Lastly, we found that neither the different MC types nor their changes were correlated with clinical parameters (VAS back, VAS leg, ODI score) preoperatively or during follow-up. The pattern of Modic changes following lumbar limited discectomy is complex, not simply increasing. There is variable activity in MC Types 1 and 2 at the different time points of follow-up, and conversion from a higher grader to a lower one or vice versa is possible. These slides can be retrieved under Electronic Supplementary Material.

Background Patients with aneurysmal subarachnoid hemorrhage (aSAH) are at risk of the development of chronic shunt-dependent hydrocephalus. However, identification of shunt-dependent patients remains challenging. We sought to develop a prognostic model to identify patients with aSAH at risk of chronic shunt-dependent hydrocephalus. In addition to the well-known prognostic variables, blood clearance in the cerebrospinal fluid (CSF) spaces was considered. Methods We retrospectively analyzed the data from 227 patients treated at our institution from January 2012 to January 2016. The outcome was ventriculoperitoneal shunt placement within 30 days after aSAH. The candidate prognostic variables were patient age, World Federation of Neurological Surgeons grade and Fisher grade, external ventricular drainage, ventricular and intracerebral hemorrhage, and interval to blood clearance in the peripheral/basal CSF spaces. Adjustment for multiple testing was performed. Multivariable logistic regression analysis was used for model development. Bootstrapping was applied for internal validation. The model performance measures included indexes for explained variance (R2), calibration (graphic plot, Hosmer-Lemeshow test), and discrimination (c-statistic). Results Of the 227 patients, 90 (39.6%) required a ventriculoperitoneal shunt. The constructed prognostic model combined external ventricular drainage placement, the presence of ventricular blood, and the duration of blood clearance in the basal cisterns. The model performance was promising, with an R2 of 33% (20% after bootstrapping), the calibration plot was adequate, the Hosmer-Lemeshow test result was not significant, and the c-statistic was 0.85 (0.84 as assessed after bootstrapping) indicating a good discriminating prognostic model. Conclusions Our prognostic model could help identify patients requiring permanent CSF diversion after aSAH, although additional modification and external validation are needed. Interventions aimed at accelerating the clearance of blood in the basal cisterns might have the potential to prevent the development of chronic hydrocephalus after aSAH.

Background De novo aneurysm formation after completely occluded aneurysms via clipping or coiling has not been well studied. Although known to occur several years after initial aneurysm management, the natural history of de novo aneurysms is obscure. We investigated the formation of new aneurysms in patients who had previously undergone treatment of intracranial aneurysms. Methods In a retrospective, single-institutional series, eligible patients who had undergone treatment of ruptured cerebral aneurysms from 2000 to 2011 were included. The primary outcome measure was the development of de novo aneurysms during long-term follow-up. Results Overall, 130 patients (63% women) who had undergone microsurgical clipping (n = 63; 48.5%) or endovascular coiling (n = 67%; 51.5%) for ruptured aneurysms were included. The average follow-up time for our cohort was 10 ± 2.7 years. De novo aneurysms occurred in 10 of 130 patients (7.7%), with a mean time of 7.9 years for aneurysm detection. No association between the formation of de novo aneurysms and the location of the treated aneurysms, smoking status, hypertension, age, or gender was found. Follow-up imaging studies were performed every 2 years. De novo aneurysms had formed in 2 patients within 2–5 years, 7 patients after 5–10 years, and 1 patient after 10 years of follow-up. In 2 of 10 patients, the de novo aneurysm had ruptured and led to subarachnoid haemorrhage. Conclusion The rate of de novo aneurysm occurrence was 7.6%, with a mean time to development of 7.9 years. This underscores the significance of long-term monitoring of patients with intracranial aneurysms. In our series, most new aneurysms had occurred after 5 years of follow-up.

Background Randomized trials on spontaneous lobar intracerebral hemorrhage (ICH) provided no convincing evidence of the superiority of surgical treatment. Since recruitment in the trials was under the premise of equipoise, a selection bias toward patients who did not need surgery or were in hopeless condition must be suspected. The aim of the actual analysis was to compare outcome and patient profile of an unselected hospital series with recent randomized trials and to develop a prognostic model. Methods Of 821 patients with spontaneous ICH managed at the neurosurgical department of the University Hospital Düsseldorf between 2013 and 2018, 159 had lobar bleedings. Patient characteristics, hematoma volume, treatment modality, and 6-month survival were compared with STICH II and the subset of lobar hemorrhage in the MISTIE III trial. In addition, a prognostic model for 6-month survival in our patients was developed using a random forest classifier. Results One hundred and seven patients were managed by surgical evacuation of the hematoma and 52 without surgical evacuation. Median hemorrhage volume in our surgical cohort was 66 and 42 mL in the conservative cohort, compared with 38 and 36 mL in the STICH II trial, and 46 and 47 mL in the surgical and conservative MISTIE III lobar hemorrhage subset. Median initial Glasgow Coma Scale (GCS) score was 12 in our surgical group and 11 in the conservative group, compared with 13 in the STICH II cohorts and 12 in the MISTIE III lobar hemorrhage subset. Median age in our surgical and conservative cohorts was 73 and 74 years, respectively, compared with 65 years in both STICH II cohorts and 68 years in the MISTIE II subsets. Twenty-nine percent of our surgical cohort and 55% of our conservatively managed patients deceased within the first 6 months, compared with 18 and 24%, respectively, in STICH II and 17 and 24% in the MISTIE III subset. Our prognostic model identified large hemorrhage volumes and low admission GCS score as main unfavorable prognostic factors for 6-month survival. The random forest classifier achieved a predictive accuracy of 78% and an area under curve (AUC)- value of 88% regarding survival at 6 months, on a test set independent of the training set. Conclusions In comparison with our surgical group, the STICH II and MISTIE III cohorts, recruited under the premise of physician equipoise, underrepresented patients with large ICHs. The cohorts in the randomized trials were therefore biased toward patients with a favorable perspective under conservative management. Initial hematoma volume and admission GCS were the main prognostic factors in our patients.

The reporting of incidents of misconduct, violence, sexual assault, harassment, and other types of crime that constitute a major concern in modern society is of significant value when investigating such incidents. Unfortunately, people involved in such incidents, either as witnesses or victims, are often reluctant to report them when such reporting demands revealing the reporter’s true identity. In this paper, we propose an online reporting system that leverages Identity-Based Cryptography (IBC) and offers data authentication, data integrity, and data confidentiality services to both eponymous and anonymous users. The system, called ARIBC, is founded on a certificate-less, public-key, IBC infrastructure, implemented by employing the Sakai–Kasahara approach and by following the IEEE 1363.3-2013 standard. We develop a proof-of-concept implementation of the proposed scheme, and demonstrate its applicability in environments with constrained human, organizational and/or computational resources. The computational overheads imposed by the scheme are found to be well within the capabilities of modern fixed or mobile devices.

In light of the rapidly growing passenger and flight volumes, airports seek for sustainable solutions to improve passengers’ experience and comfort, while maximizing their profits. A major technological solution towards improving service quality and management processes in airports comprises Internet of Things (IoT) systems that realize the concept of smart airports and offer interconnection potential with other public infrastructures and utilities of smart cities. In order to deliver smart airport services, real-time flight delay data and forecasts are a critical source of information. This paper introduces an essential methodology using machine learning techniques on Apache Spark, a cloud computing framework, with Apache MLlib, a machine learning library to develop and implement prediction models for air flight delays that could be integrated with information systems in order to provide up-to-date analytics. The experimental results have been implemented with various algorithms in terms of classification as well as regression, thus manifesting the potential of the proposed framework.

This special report was developed to communicate policy and procedures for free-standing acute inpatient rehabilitation hospitals (AIRHs) to protect patients and healthcare personnel and to prevent further spread of severe acute respiratory syndrome coronavirus 2. The recommended policies were developed in conjunction with the New Mexico Department of Health and hospital leadership. As we attain additional knowledge and experience during this pandemic, suggestions of best practice will continue to evolve for AIRHs. The authors encourage readers to work with local regulatory officials to ensure regulatory compliance as well as respect of the availability of local resources., Lay abstract This special report communicates potential policy and procedure modifications for free-standing acute inpatient rehabilitation hospitals in response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease (COVID-19) pandemic. The goal of the communication is to help protect patients and healthcare personnel and to prevent further spread of SARS-CoV-2. The recommendations were developed in conjunction with the New Mexico Department of Health and hospital leadership. A comprehensive response policy to SARS-CoV-2/COVID-19 should include facility changes, enhanced personal protective equipment policy, enhanced admission policy and enhanced surveillance testing policy. In the setting of rapidly changing state and federal guidelines, hospital staff should work with state officials to ensure that potential policy and procedure modifications are in line with state and federal recommendations.

Privacy Preserving and Anonymity have gained significant concern from the big data perspective. We have the view that the forthcoming frameworks and theories will establish several solutions for privacy protection. The k-anonymity is considered a key solution that has been widely employed to prevent data re-identifcation and concerns us in the context of this work. Data modeling has also gained significant attention from the big data perspective. It is believed that the advancing distributed environments will provide users with several solutions for efficient spatio-temporal data management. GeoSpark will be utilized in the current work as it is a key solution that has been widely employed for spatial data. Specifically, it works on the top of Apache Spark, the main framework leveraged from the research community and organizations for big data transformation, processing and visualization. To this end, we focused on trajectory data representation so as to be applicable to the GeoSpark environment, and a GeoSpark-based approach is designed for the efficient management of real spatio-temporal data. Th next step is to gain deeper understanding of the data through the application of k nearest neighbor (k-NN) queries either using indexing methods or otherwise. The k-anonymity set computation, which is the main component for privacy preservation evaluation and the main issue of our previous works, is evaluated in the GeoSpark environment. More to the point, the focus here is on the time cost of k-anonymity set computation along with vulnerability measurement. The extracted results are presented into tables and figures for visual inspection.

Background The aim of this study is to evaluate safety and efficacy of the new-generation Derivo embolization device in complex ruptured (RIA) and unruptured (UIA) intracranial aneurysms. Methods Retrospective analysis of 32 patients with complex RIAs and UIAs treated with Derivo at our hospital from November 2015 to December 2018. Clinical safety was defined as absence of death, transient attack, absence of minor and major stroke, and Derivo associated hemorrhage. Treatment efficacy was assessed angiographically (DSA) immediately after treatment and at 6-month follow-up according to the O'Kelly-Marotta (OKM) Grading Scale (from A=total filling to D=no filling; prolongation of stasis 1=arterial to 3=venous phase). Results Thirty-two patients with 39 aneurysms were treated with 42 Derivos. In five aneurysms, additional coiling was performed. Deployment was technically successful in all cases. Two patients developed a procedure related minor stroke (one transient). In one patient bleeding due to an inflammatory aneurysmatic wall process occurred 20 days after retreatment and in one patient a stroke due to in-stent thrombosis occurred when dual platelet inhibition (PI) was switched to permanent single PI 12 month after FD treatment. No treatment related deaths were observed. Initial DSA revealed three OKM D, six OKM C, five OKM B, and 25 OKM A. Six-month follow-up for DSA and clinical evaluation was available in 20/32 patients (62.5%), 26 of 39 aneurysms (66.7%) and revealed 73.1% complete and 3.8% subtotal occlusion (OKM D: 19 of 26, OKM C3: one of 26). Conclusions Treatment of complex RIAs and UIAs with the new-generation Derivo appeared to be safe and effective in this single-center case series for ruptured and unruptured intracranial aneurysms. Immediate DSA revealed a significant flow modulation; and 6-month follow-up showed a high occlusion rate.

Electronic navigational charts (ENCs) are geospatial databases, compiled for the operational use of Electronic Chart Display and Information systems (ECDIS) according to strict technical specifications of the International Hydrographic Organization (IHO). ECDIS is a GIS system designed for marine navigation according to the relevant standards of the International Maritime Organization (IMO). The international standards for ENCs and ECDIS, issued by the IHO and IMO, cover many aspects of the portrayal of ENCs in ECDIS but do not specify or recommend map projections. Consequently, in some cases, the unjustified employment of map projections by the manufacturers has caused certain functional drawbacks and inadequacies. This article reviews, evaluates and supplements the results of earlier studies on the selection of map projections for the depiction of ENCs in ECDIS and proposes a reasonable set of suitable projections with pertinent selection/implementation rules. These proposals took into consideration that ECDIS users (navigators) are not GIS experts or professional cartographers and consequently, the proposed election/implementation rules have to be simple and straightforward.

This study is a systematic literature review of geographical origin authentication by elemental analytical techniques. Authentication and certification of geographic origin of agri-food products is a useful tool toward the protection of the quality for products. The aim of this work was to map the current state of research in the area of agricultural products and food, identifying emerging fields to the geographical origin of products. The article is divided in three parts. The first part of the article deals with the analytical techniques applied in the food authentication. Special mention is made to elemental analysis and multiple isotope ratio. The second section focuses on statistically published data concerning published research for geographical origin authentication for the period 2015–2019. Specific results are presented inter alia: number of articles according to the type of product, articles according to the type of the analytical techniques, and others. The third part contains characteristic results from articles that were published in the period 2015–2019, on certification of geographical origin on specific agricultural products.

Familial cerebral cavernous malformations due to the common Hispanic mutation (FCCM1-CHM) is an endemic condition among the Hispanic population of the Southwestern United States associated with significant morbidity and mortality. Cutaneous vascular malformations (CVMs) can be found in individuals with FCCM1-CHM, but their morphology, prevalence, and association with cerebral cavernous malformations (CCMs) has not been well characterized. A cross-sectional study of 140 individuals with confirmed FCCM1-CHM was performed with statistical analyses of CVM, CCM, and patient characteristics. We then compared these findings to other cohorts with Familial cerebral cavernous malformations (FCCM) due to other mutations. We observed a higher overall prevalence and a different predominant morphological subtype of CVM compared to previous FCCM cohorts. While the number of CVMs was not a reliable indicator of the number of CCMs present, each person with one or more CVMs had evidence of central nervous system (CNS) disease. Awareness of the morphology of these cutaneous lesions can aid in the diagnosis of individuals with FCCM-CHM in Hispanic patients or those with family history of CCM.

Bow hunter's syndrome is a rare clinical condition. It is caused by dynamic compression of the vertebral artery (VA) either at the level of the transverse foramina (V2 segment) or at the atlantoaxial level (V3 segment). We report a 54-year-old man with typical bow hunter's syndrome caused by compression at the level of C6/C7. He was successfully treated by anterolateral VA decompression without a need for stabilization. We present preoperative imaging (magnetic resonance imaging, computed tomographic angiography, and dynamic angiography) and a high-quality intraoperative video detailing each step of the surgical technique (high-definition video with annotations and audio track of the Doppler ultrasound used as intraoperative control). Furthermore, postoperative imaging and a video of the clinical outcome are presented. Adequate management of bow hunter's syndrome requires good pathophysiologic understanding of the disease and careful clinical examination. Dynamic angiography confirms the exact site of VA compression. Surgical decompression is the treatment of the cause. Surgical techniques include VA decompression by an anterolateral approach (V2 or V3) or a posterior approach (V3). Some authors advocate stand-alone stabilization, which is, however, only an indirect treatment and results in significant loss of head motion. Other nonsurgical treatments such as orthesis, medical therapy, or endovascular stenting have been only anecdotally reported. Bow hunter's syndrome is best treated by VA decompression. This may safely be achieved by good anatomic knowledge and a straightforward surgical technique. Here, the anterolateral approach is presented in detail in a high-definition surgical instruction video.

Objective To evaluate a new surgical tool combining suction and monopolar neurostimulation (stimulation sucker) for cerebellopontine angle (CPA) tumors. The usefulness for continuous (time) and dynamic (space) facial nerve mapping was studied. Methods Patients operated on with the stimulation sucker for a CPA tumor between April 2016 and May 2017 in a tertiary care center were identified. Clinical charts were retrospectively evaluated. The minimum follow-up time of patients was 12 months. Results The study population included 17 patients with tumor (6 women and 11 men). The age range was from 2 to 77 years (mean age, 45.7 years; standard error of the mean, 22.7 years). Most CPA tumors were large (Koos grade 4) vestibular schwannomas (n = 10); other pathologies included petrous meningioma (n = 1), metastasis (n = 1), medulloblastoma (n = 2), ependymoma (n = 2), and pilocytic astrocytoma (n = 1). One patient with trigeminal neuralgia served as the normal control subject. No complications because of the stimulation sucker were encountered. Clinical and radiologic outcomes compared favorably with institutional experience and literature. The stimulation sucker allowed for continuous (time) mapping of the facial nerve at the site of resection (space). This real-time feedback allowed early identification of the facial nerve. Handling and ergonomy were excellent and workflow improved. The shortcomings compared with a bayonet-shaped bipolar probe were decreased visibility of neurovascular structures and lower spatial discrimination. The new device did not simplify delicate at the brainstem and on the nerve. We think it should be considered as a complementary tool in the surgeon's armamentarium. Conclusions Until now, nerve damage as assessed by neuromonitoring (e.g., facial nerve electromyography, motor evoked potential) served as surrogate for nerve function. This concept should be challenged. The studied stimulation sucker detected the facial nerve earlier than conventional techniques, preventing harm by surgical trauma. A larger, prospective study is warranted to better define its role in CPA surgery.

Compression is one of the most critical issues related to almost all hydrogen storage methods and its subsequent usage. Hydrogen compression is only part of the so-called “Hydrogen Value Chain”, but it is crucial for overcoming the entry barriers for a “Hydrogen Economy”. It is widely accepted that there is a strong need for significant improvements in efficiency, durability and reliability of hydrogen compressors as well as for cost reductions, The basic scope of this work is to present the current developments on Metal Hydride Hydrogen Compressors (MH2C) and try to evaluate from both technical and economical point of view the potential integration of MH2C in real power systems comprising Renewable Energy Sources and Hydrogen technologies. In this work, certain target markets for the MH2 compressor are identified, while all technical and financial issues of its integration in complete power systems have been assessed. Through a preliminary analysis of potential markets for the MH2 Compressor, it is shown that there are three major niche markets: (i) Chemical industry, by utilisation of waste industrial and/or available renewable heat; (ii) Hydrogen filling stations for vehicles and (iii) RES & H2 autonomous power systems for remote communities (e.g. off-grid islands). A specific case study (the Greek island of Milos) is analysed in detail (using the HOMER software tool) with the aim of increasing RES penetration. A RES & hydrogen storage power supply system is proposed and examined from an economic, environmental and social perspective drawing the relevant conclusions.

In patients with aneurysmal subarachnoid hemorrhage (aSAH) and multiple aneurysms, there is a need to objectively identify the ruptured aneurysm. Additionally, studying the intra-individual rupture risk of multiple aneurysms eliminates extrinsic risk factors and allows a focus on anatomical factors, which could be extrapolated to patients with single aneurysms too. Retrospective bi-center study (Department of Neurosurgery of the University Hospital Duesseldorf and Bern) on patients with multiple aneurysms and subarachnoid hemorrhage caused by the rupture of one of them. Parameters investigated were height, width, neck, shape, inflow angle, diameter of the proximal and distal arteries, width/neck ratio, height/width ratio, height/neck ratio, and localization. Statistical analysis and logistic regressions were performed by the R program, version 3.4.3. N = 186 patients with aSAH and multiple aneurysms were treated in either department from 2008 to 2016 (Bern: 2008-2016, 725 patients and 100 multiple aneurysms, Duesseldorf: 2012-2016, 355 patients, 86 multiple aneurysms). The mean age was 57 years. N = 119 patients had 2 aneurysms, N = 52 patients had 3 aneurysms, N = 14 had 4 aneurysms and N = 1 had 5 aneurysms. Eighty-four percent of ruptured aneurysms were significantly larger than the largest unruptured. Multilobularity of ruptured aneurysms was significantly higher than in unruptured. Metric variables describing the geometry (height, width, etc.) and shape are the most predictive for rupture. One or two of them alone are already reliable predictors. Ratios are completely redundant in saccular aneurysms.

Background There are controversies concerning the natural history of arteriovenous malformations (AVMs) in literature and it is not clear which AVMs should be treated and which should be just observed. Objective criteria beyond growth in serial MRIs or angiographies are needed. The use of black blood MRI is currently under investigation for evaluating the rupture risk of cerebral aneurysms, however its use for assessment of AVMs has yet to be evaluated. We therefore conducted a feasibility study on the application of black blood MRI (bbMRI) in AVMs to assess rupture risk. Methods Retrospective study of 10 patients with intracranial AVMs and 4 patients with arteriovenous fistulas who received a black blood MRI before treatment. Results AVM niduses (9/10) show contrast enhancement irrespective of rupture or size. All arteriovenous fistulas (4 / 4) were contrast enhancing irrespective of rupture. Conclusion High flow malformations are in a permanent stage of inflammation which does not seem to allow conclusions on their rupture risk at the current stage. BbMRI is a feasible method of identifying inflammation in AVMs and arteriovenous fistulas. However, future prospective studies are needed to evaluate whether bbMRI contrast enhancement correlates with rupture risk.

It is vastly acknowledged that analyzing social networks is a very challenging research area. Take as a striking example the organization of vertices in clusters, with many edges joining vertices of the same cluster and comparatively few edges joining vertices of different clusters. This comprises a fundamental aspect, which concerns the detection of user communities. In certain fields such as sociology and computer science where interactions and associations are often represented in the form of graphs, detecting communities is of vital importance. This paper addresses the need for an efficient and innovative methodology for community detection that will also leverage users’ behavior on emotional level. Ekman emotional scale is the key point with which the methodology analyzes user’s tweets in order to determine their emotional behavior. Consequently, the derived communities are estimated with the use of three different metrics, while the weighted version of a modularity community detection algorithm is utilized. There is substantial evidence indicating that our proposed methodology creates influential enough communities.

Chordomas are very rare tumors of the skull base and the sacrum. They show infiltrating and destructive growth and are known to be chemo- and radio-resistant. After surgical resection, the recurrence rate is high and overall survival limited. As current adjuvant treatments are ineffective, new treatment concepts are urgently needed. 5-aminolevulinic acid-based photodynamic therapy (5-ALA based PDT) showed promising results for malignant gliomas. However, it is unknown so far, whether chordomas accumulate protoporphyrin IX (PPIX) after application of 5-ALA and whether they are sensitive to subsequent 5-ALA based PDT.The immortalized human chordoma cells U-CH2 were used as in vitro model. After incubation for 4h or 6h with different 5-ALA concentrations, PPIX accumulation was determined by flow cytometry. To assess sensitivity to PDT, chordoma cells were incubated at 30.000cells/well (high cell density) or 15.000cells/well (low cell density) with graded doses of 5-ALA (0-50μg/ml) in 96-well plates and subsequently exposed to laser light of 635nm wavelength (18.75J/cmU-CH2 cells dose-dependently accumulated PPIX (ANOVA; p0.0001). PPIX fluorescence was significantly higher, when cells were incubated with 5-ALA for 6h compared to 4h at higher 5-ALA concentrations (ANOVA/Bonferroni; p≤0.05 for≥30μg/ml 5-ALA). For both cell densities, a 5-ALA dose-dependent decline in viability was observed (ANOVA; p0.0001). Viability was significantly lower at higher 5-ALA concentrations, when 30.000 cells/wells were treated compared to 15.000cells/well (ANOVA/Bonferroni; p≤0.001 for≥30μg/ml 5-ALA). LD50 was 30.25μg/ml 5-ALA.The human UCH-2 cell line was a very useful in vitro model to study different effects of 5-ALA based PDT. For the first time, it could be shown that human chordoma cells may be destroyed by 5-ALA/PDT.

Germanium (Ge) is one of the critical elements of modern technologies, with supply risk, inefficient production, and increased demand. It is used in high technology applications such as infrared systems, fiber optics, polymer catalysis, electronics, and solar cells. Its demand is expected to increase due to lack of suitable substitutes, increasing demand for solar cells and 5G networks, and the continuous increasing trend of Ge demand for the past 20 years. Globally, 130 tonnes (t) of Ge are being produced (2020) primarily in China. Germanium is recovered as a byproduct from Zn-refineries and coal fly ash. Yet very low amount (

OBJECTIVEThe aim of this study was to define predictive factors for rupture of middle cerebral artery (MCA) mirror bifurcation aneurysms.METHODSThe authors retrospectively analyzed the data in patients with ruptured MCA bifurcation aneurysms with simultaneous presence of an unruptured MCA bifurcation mirror aneurysm treated in two neurosurgical centers. The following parameters were measured and analyzed with the statistical software R: neck, dome, and width of both MCA aneurysms—including neck/dome and width/neck ratios, shape of the aneurysms (regular vs irregular), inflow angle of both MCA aneurysms, and the diameters of the bilateral A1 and M1 segments and the frontal and temporal M2 trunks, as well as the bilateral diameter of the internal carotid artery (ICA).RESULTSThe authors analyzed the data of 44 patients (15 male and 29 female, mean age 50.1 years). Starting from the usual significance level of 0.05, the Sidak-corrected significance level is 0.0039. The diameter of the measured vessels was statistically not significant, nor was the inflow angle. The size of the dome was highly significant (p = 0.0000069). The size of the neck (p = 0.0047940) and the width of the aneurysms (p = 0.0056902) were slightly nonsignificant at the stated significance level of 0.0039. The shape of the aneurysms was bilaterally identical in 22 cases (50%). In cases of asymmetrical presentation of the aneurysm shape, 19 (86.4%) ruptured aneurysms were irregular and 3 (13.6%) had a regular shape (p = 0.001).CONCLUSIONSIn this study the authors show that the extraaneurysmal flow dynamics in mirror aneurysms are nonsignificant, and the aneurysmal geometry also does not seem to play a role as a predictor for rupture. The only predictors for rupture were size and shape of the aneurysms. It seems as though under the same conditions, one of the two aneurysms suffers changes in its wall and starts growing in a more or less stochastic manner. Newer imaging methods should enable practitioners to see which aneurysm has an unstable wall, to predict the rupture risk. At the moment one can only conclude that in cases of MCA mirror aneurysms the larger one, with or without shape irregularities, is the unstable aneurysm and that this is the one that needs to be treated.

Background and purpose The pathogenesis of poor functional outcome after aneurysmal subarachnoid hemorrhage (aSAH) is not fully understood. Microcirculatory dysfunction, which can be indirectly measured by CT perfusion (CTP), is assumed to play a central role. We evaluated the predictive value of early changes in microcirculation for secondary critical perfusion changes. Materials and methods Out of 351 consecutive aSAH patients, 166 patients with ≥ 1 CTP within 72 h of ictus (early CTP) and ≥ 3 CTPs in total were included in the retrospective analysis (53.2 ± 12.4 years of age). Receiver-operating-characteristic (ROC) analysis was performed to identify the mean transit time (MTT) threshold in early CTP with the highest sensitivity and specificity for predicting secondary critical perfusion changes > 72 h after ictus. The odds ratio was calculated and the threshold for the highest odds ratio was determined. Results Secondary critical perfusion changes were observed in 67/166 patients (40.4%). An early MTT 1.3 times the mean normal MTT could predict those changes with an odds ratio of 2.67 (sensitivity 67.2%, specificity 56.6%). Shifting the threshold to 1.26 times the mean normal MTT resulted in an odds ratio of 3.56 (sensitivity 79.1%, specificity 48.5%). Conclusions Early MTT is predictive of secondary critical perfusion changes, which could have applications for neuromonitoring and treatment.

Background The aim of our study was a pictorial documentation of the anatomical structures of the orbit. Methods We performed a transmaxillary endoscopic approach in nine formalin-fixed human heads. We identified and documented the anatomy of the inferior part of the orbit. Results The first intraorbital anatomical landmark was the inferior rectus muscle, from which important structures medially and laterally could be identified. Anatomical structures and their relation to each other were documented and presented as illustrative figures. Conclusion Knowledge of the topographic anatomy of the inferior part of the orbit could be sufficiently imparted by our illustrations. The presented transmaxillary approach allowed a wide overview of the anatomical structures located in the inferior part of the orbit. Our pictorial documentation may provide neurosurgeons more safety and the opportunity to become familiar with the endoscopic anatomy.

Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological syndrome associated with various clinical conditions, such as headache, encephalopathy, and seizures. It is reversible if a prompt diagnosis is made and treatment undertaken. We report a 52-year-old male with hypertensive crisis. Progressing somnolence and an unresponsive left pupil occurred. MRI revealed an intra-axial hyperintensity of the cerebellum and brainstem and occlusive hydrocephalus suggestive of encephalitis or a tumor. Because of the life-threatening clinical picture, posterior fossa decompression was performed. Histopathology failed to identify any pathology. After decompression, the edema improved immediately. Under life-threatening conditions, a decompressive craniectomy in PRES seems to achieve the same results as supportive treatment.

Objectives The pathophysiology of traumatic brain injury (TBI) largely involves the brains vascular structural integrity. We analyzed the value of an intraoperative cortical indocyanine green (ICG) angiography in patients with severe TBI and acute subdural hematoma who underwent decompressive craniectomy. Methods ICG-derived fluorescence curves of cortex and cerebral vessels were recorded by the use of software integrated into a surgical microscope in 10 patients. The maximum intensity, rise time (RT), time to peak, and residual fluorescence intensity (FI) were estimated from cortical arteries, the parenchyma, and veins. Results ICG-derived fluorescence parameters were correlated with the short-term outcome 3 months after discharge. Five patients had a favorable and 5 an unfavorable outcome. Patients with a favorable outcome showed a significant longer RT in the arteries and a trend towards a significant longer RT in the veins. Overall mean residual FI was 47.5 ± 6.8% for the arteries, 45.0 ± 7% for the parenchyma and 57.6 ± 6% for the veins. The residual FI of the parenchyma and the veins was significantly greater in patients with an unfavorable clinical outcome. Conclusions Patients with an unfavorable clinical outcome showed an altered shape of the ICG-derived fluorescence curve, a shorter increase of the ICG-derived fluorescence intensity in the cortical arteries, and significantly greater residual fluorescence intensity. These observations are likely a correlate of an increased intracranial pressure, a capillary leak, and venous congestion. Intraoperative quantification of the ICG-derived fluorescence might help to appreciate the clinical outcome in patients with severe TBI.

The determination of the fundamental period of vibration of a structure is essential to earthquake design. Current codes provide formulas for the approximate estimation of the fundamental period of earthquake-resistant building systems. These formulas are dependent only on the height of the structure or number of storeys without taking into account the presence of infill walls into the structure, despite the fact that infill walls increase the stiffness and mass of the structure leading to significant changes in the fundamental period. Furthermore, such a formulation is overly conservative and unable to account for structures with geometric irregularities. In this study, which comprises the companion paper of previous published research by the authors, the effect of the vertical geometric irregularities on the fundamental periods of masonry infilled structures has been investigated, through a large set of infilled frame structure cases. Based on these results, an attempt to quantify the reduction of the fundamental period due to the vertical geometric irregularities has been made through a proposal of properly reduction factor.

In this paper, an online regret based dial-a-ride (OR-DARP) algorithm is introduced and its performance evaluated on an actual demand responsive transit (DRT) system. The innovative part of the algorithm is the design of the optimization engine. A signal communication scheme between the trip dispatcher and the algorithm is used to improve utilization of the available idle time that can then be devoted to the optimization engine. The basic concept is as follows: a. Every trip request is treated as an emergency request demanding an immediate answer, b. The optimization engine runs continuously, thereby consuming every idle time fragment unless interrupted by a new trip request. The trip data are real, and they are sourced from a DRT system operating at a municipality in northern Greece where a static dial-a-ride algorithm was used as the optimization engine. Given the fact that these trips data provide all trip details plus the show-up time (the most important feature for our study), these data are the ideal basis for an “a posteriori” evaluation of the proposed online approach. Another contribution of this paper is the identification of the critical parameters in the trade-off between benefits gained from continuing to optimize an online system versus the losses of non-served demands. This important issue when applying online algorithms has not been studied extensively in the literature so far (to the best of our knowledge).

Background: Arthroscopic Bankart repair is the most common procedure for anterior shoulder instability management. However, the long-term efficacy of the procedure is questionable, and the results are different among different populations. Few studies have focused on specific populations, such as recreational athletes and laborers. Hypothesis: Good to excellent long-term results, with a low recurrence rate, can be achieved using arthroscopic Bankart repair in recreational athletes and laborers suffering from anterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: A specific group of laborers and recreational athletes were included in this study. A total of 52 patients (52 shoulders) with anterior-inferior traumatic shoulder instability underwent arthroscopic Bankart repair and met our strict criteria for study inclusion. The recurrence rate was recorded. Patients were evaluated at a minimum follow-up of 5 years using the American Shoulder and Elbow Surgeons (ASES) score, the Rowe score, the Constant score, and a visual analog scale (VAS) for pain. A radiological evaluation for arthritis was also performed according to the Samilson-Prieto classification. Results: The mean follow-up was 105.4 months (range, 65-164 months). Our overall recurrence rate was 11.5% (6/52 patients). All patients were able to return to their previous job status with minimum limitations, and 76.7% of our study population reported returning to their preinjury sporting activities. Postoperatively, all scores were improved, with statistically significant increases from preoperative values ( P < .001). At the last radiographic follow-up, 9 patients (18.8%) had mild arthritis, while 2 patients (4.2%) had moderate arthritis. Conclusion: Arthroscopic soft tissue Bankart repair may provide good to excellent long-term clinical results with an acceptable recurrence rate in medium-demand patients (recreational athletes and laborers).

Assessment of the oxygen and carbon dioxide content of expired air during exercise is critical for determining cardiorespiratory status. The purpose of this study was to compare the new portable metabolic analyzer PNOE with COSMED – Quark CPET, a previously validated stationary metabolic cart. Methods: A total of 22 subjects (17 male and 5 female) aged 32.3 ± 11.1 years took part in the study. Breath by breath gas exchange was measured by both devices during a four-stage incremental protocol on a cycle ergometer. On a separate day, 10 participants repeated the trial to assess the reliability of the PNOE metabolic cart. Results: Strong correlations were obtained in VO2 (r = 0.98, p < 0.001), VCO2 (r = 0.98, p < 0.001), VE (r = 0.98, p < 0.001), and RQ (r = 0.91, p < 0.001), between the two devices. Bland-Altman plots revealed a mean difference of 34.0 ± 118 ml/min and 36.4 ± 110 ml/min in VO2 and VCO2 analysis, respectively. There were no significant differences in VO2, VCO2, VE, or RQ between the two devices. Intraclass correlation coefficient was high between the two trials for VO2 (r = 0.98, p < 0.001), VCO2 (r = 0.98, p < 0.001), VE (r = 0.99, p < 0.001), and RQ (r = 0.93, p < 0.001). Conclusions: Our data indicate that the portable metabolic cart PNOE can accurately determine respiratory gases over a wide range of exercise intensities, in healthy individuals, in a controlled laboratory setting.

Introduction: There is still controversial discussion of the value of transcranial Doppler (TCD) in predicting vasospasms in patients with aneurysmal SAH (aSAH). A newer method of predicting a delayed ischemic deficit (DCI) is CT perfusion (CTP), although it is not quite understood which kind of perfusion deficit is detected by this method since it seems to also identifying microcirculatory disturbances. We compared the TCD and CTP values with angiography and evaluated TCD and CTP changes before and after patients received intra-arterial spasmolytic therapy.

Reported data regarding the relation between the incidence of spontaneous subarachnoid hemorrhage (SAH) and weather conditions are conflicting and do so far not allow prognostic models. Admissions for spontaneous SAH (ICD I60.*) 2009–2018 were retrieved form our hospital data base. Historical meteorological data for the nearest meteorological station, Dusseldorf Airport, was retrieved from the archive of the Deutsche Wetterdienst (DWD). Airport is in the center of our catchment area with a diameter of approximately 100 km. Pearson correlation matrix between mean daily meteorological variables and the daily admissions of one or more patients with subarachnoid hemorrhage was calculated and further analysis was done using deep learning algorithms. For the 10-year period from January 1, 2009 until December 31, 2018, a total of 1569 patients with SAH were admitted. No SAH was admitted on 2400 days (65.7%), 1 SAH on 979 days (26.7%), 2 cases on 233 days (6.4%), 3 SAH on 37 days (1.0%), 4 in 2 days (0.05%), and 5 cases on 1 day (0.03%). Pearson correlation matrix suggested a weak positive correlation of admissions for SAH with precipitation on the previous day and weak inverse relations with the actual mean daily temperature and the temperature change from the previous days, and weak inverse correlations with barometric pressure on the index day and the day before. Clustering with admission of multiple SAH on a given day followed a Poisson distribution and was therefore coincidental. The deep learning algorithms achieved an area under curve (AUC) score of approximately 52%. The small difference from 50% appears to reflect the size of the meteorological impact. Although in our data set a weak correlation of the probability to admit one or more cases of SAH with meteorological conditions was present during the analyzed time period, no helpful prognostic model could be deduced with current state machine learning methods. The meteorological influence on the admission of SAH appeared to be in the range of only a few percent compared with random or unknown factors.

IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

This paper describes a novel methodology of data documentation in materials characterization, which has as starting point the creation and usage of any Data Management Plan (DMP) for scientific data in the field of materials science and engineering, followed by the development and exploitation of ontologies for the harnessing of data created through experimental techniques. The case study that is discussed here is nanoindentation, a widely used method for the experimental assessment of mechanical properties on a small scale. The new documentation structure for characterization data (CHADA) is based on the definition of (i) sample, (ii) method, (iii) raw data and (iv) data analysis as the main component of the metadata associated to any characterization experiment. In this way, the relevant information can be stored inside the metadata associated to the experiment. The same methodology can be applicable to a large number of techniques that produce big amount of raw data, while at the same time it can be invaluable tool for big data analysis and for the creation of an open innovation environment, where data can be accessed freely and efficiently. Other fundamental aspects are reviewed in the paper, including the taxonomy and curation of data, the creation of ontology and classification of characterization techniques, the harnessing of data in open innovation environments via database construction along with the retrieval of information via algorithms. The issues of harmonization and standardization of such novel approaches are also critically discussed. Finally, the possible implications for nanomaterial design and the potential industrial impact of the new approach are described and a critical outlook is given.

Twitter Sentiment Classification is undergoing great appeal from the research community; also, user posts and opinions are producing very interesting conclusions and information. In the context of this paper, a pre-processing tool was developed in Python language. This tool processes text and natural language data intending to remove wrong values and noise. The main reason for developing such a tool is to achieve sentiment analysis in an optimum and efficient way. The most remarkable characteristic is considered the use of emojis and emoticons in the sentiment analysis field. Moreover, supervised machine learning techniques were utilized for the analysis of users’ posts. Through our experiments, the performance of the involved classifiers, namely Naive Bayes and SVM, under specific parameters such as the size of the training data, the employed methods for feature selection (unigrams, bigrams and trigrams) are evaluated. Finally, the performance was assessed based on independent datasets through the application of k-fold cross validation.

In April 2018, the International Maritime Organisation adopted an ambitious plan to contribute to the global efforts to reduce the Greenhouse Gas emissions, as set by the Paris Agreement, by targeting a 50% reduction in shipping’s Green House Gas emissions by 2050, benchmarked to 2008 levels. To meet these challenging goals, the maritime industry must introduce environmentally friendly fuels with negligible, or low SOX, NOX and CO2 emissions. Ammonia use in maritime applications is considered promising, due to its high energy density, low flammability, easy storage and low production cost. Moreover, ammonia can be used as fuel in a variety of propulsors such as fuel cells and can be produced from renewable sources. As a result, ammonia can be used as a versatile marine fuel, exploiting the existing infrastructure, and having zero SOX and CO2 emissions. However, there are several challenges to overcome for ammonia to become a compelling fuel towards the decarbonisation of shipping. Such factors include the selection of the appropriate ammonia-fuelled power generator, the selection of the appropriate system safety assessment tool, and mitigating measures to address the hazards of ammonia. This paper discusses the state-of-the-art of ammonia fuelled fuel cells for marine applications and presents their potential, and challenges.

Introduction With a prevalence of 1–5 %, intracranial aneurysms are common. However, only 20–50 % of these aneurysms will rupture during a person’s lifetime. This often happens spontaneously without exogenous factors. In the present study we reviewed the literature concerning the relation between trauma and rupture of a pre-existing aneurysm. Methods All studies that reported a causal relation between trauma and rupture of a pre-existing aneurysm were included, irrespective of study design. They were limited though to those written in English or German. Excluded were studies with traumatic aneurysms, studies where the rupture of an aneurysm lead to trauma and studies with doubts about the order of events. Results Thirteen studies with twenty-two cases of ruptured aneurysm in context with trauma and two unpublished cases were included. Fourteen patients were involved in a fight, seven patients in a bike/motorbike/bus accident and three got hit on the head in a setting outside of interpersonal violence. The aneurysm was located in internal carotid artery in most cases (7/24). The clear majority of patients (19/24) did not survive. Conclusion Arteries and aneurysms can rupture in context with head trauma although this is rarely the case. Patients after head trauma with typical blood pattern for aneurysmal SAH in the native CT scan should receive conventional angiography to exclude a vascular or aneurysmal rupture, even when CT-angiography is inconspicuous.

Intracranial aneurysms are known to rupture spontaneously in the absence of exogenous stimuli. Physical exercise or stress situations, with their accompanying rise in blood pressure, are often associated with aneurysm rupture. Very few cases reported in the literature show a suspected correlation of aneurysm rupture, aneurysm formation, or both with traumatic head injury. In most cases reported in the literature, a diagnosis of ruptured aneurysm is made only at postmortem examination, which explains why these cases are published in forensic medicine journals. We present a case of a 36-year-old male patient with ruptured aneurysm of the left posterior inferior cerebellar artery (PICA) in the context with head trauma, allegedly under the influence of alcohol. The initial native computed tomography (CT) scan of the patient showed blood pattern, which was atypical for traumatic subarachnoid hemorrhage (SAH) and typical for aneurysmal SAH. The CT-Angiography was inconclusive. Conventional angiography was performed and the PICA aneurysm was diagnosed. Trapping of the aneurysm with PICA-PICA side to side anastomosis was performed. The patient was discharged 21 days after admission without neurological deficits. In conclusion, even in cases of obvious head trauma, patients should undergo further diagnostic testing, when CT imaging reveals a blood pattern, which is typical for aneurysmal SAH.

Background Based upon our excellent previous experience with 151 adult patients and 39 children whom had the peritoneal catheter in ventriculoperitoneal shunting placed laparoscopically, we continued following this technique as a first-line-procedure in ventriculoperitoneal shunting. Now we analyzed our experience with additional 405 cases for a better comprehension of the complications, advantages and disadvantages of this procedure on this high number of patients. A strict interdisciplinary setting with the maximum of medical intraoperative competence was our goal and therefore better results. Material and methods N = 405 patients with intraperitoneal shunt insertion from the years 2006–2013 (Follow-up period ranges from 2 to 9 years with a 5,9-year mean follow-up period) were retrospectively analyzed with a special focus on the possible peritoneal catheter complications after laparoscopical shunt insertion. In our department all the peritoneal catheters in ventriculoperitoneal shunting are inserted laparoscopically, when there is no contraindication for this technique. Results We had 0% peritoneal catheter misplacement rate with help of the laparoscopic technique. In two cases (0.49%) injury of the small bowel could be repaired immediately with no further action required. In two cases umbilical hernias have been accidently discovered and the repair of the hernias took place in the same surgical session. As this technique helps us to control the shunt position intraperitoneally by direct laparoscopic vision, the patients spared an extra radiation exposure, to control the position of the peritoneal catheter. A diagnostic laparoscopy is also possible if needed. The time of the operation is shortened in comparison with the needed time, which is mentioned in literature, for the open laparotomy and of course the needed anesthesia and its possible risks and complications decreased. Conclusion No revision surgeries were required because of any misplacement of the peritoneal catheter, no additional technique related risks compared to the open surgical technique, no abdominal x-rays were needed, the operation time is shortened and the dose of anesthesia needed is decreased and of course its possible side effects' rate is also decreased. Another great benefit of this technique is the possibility of accidental diagnosis of intra-abdominal pathologies. Also, if a surgical treatment of this accidentally discovered intra-abdominal pathologies is needed, it can take place in the same surgical session. No prolonged surgery time as the laparoscopic technique is much easier, controllable and fast.

This paper addresses the inspection and evaluation of design reuse in the conceptual schema of CMS-based Web applications in order to improve their design quality. We have utilized WebML as the design platform of our approach and we capture design reuse by detecting all the recurrent design structures within the hypertext schema of an application. We propose a methodology for automatically extracting the hypertext schema of an application which is then submitted to a pattern-based analysis in order to detect all the incorporated recurrent patterns implying design reuse. A pattern is a design structure consisting of a core specification, i.e., an invariant composition of WebML elements that characterizes the pattern and by a number of pattern variants which extend the core specification with all the valid modalities in which the pattern composition can start (starting variants) or terminate (termination variants). Finally, we apply a number of metrics on the identified patterns to evaluate the appropriateness of reuse which results in categorizing them as effective or poor design solutions. By applying the methodology on a web application, developers can inspect all the design structures that occur in its design probably due to design reuse and identify: (i) either effective reusable design solutions for implementing a certain behavior that can also be used as building blocks in future designs and can even form the basis for the discovery of design patterns in CMS domain, or (ii) ineffective recurrent design fragments causing design inconsistencies which imply the need for refactoring in order to improve the application's quality.