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Background Cognitive Behavioral Social Rhythm Group Therapy (CBSRT) is a chronobiologically-informed group therapy designed to stabilize social rhythms in veterans with comorbid combat-related PTSD and major depressive disorder (MDD). This randomized controlled pilot trial is the first to examine feasibility and preliminary efficacy of group CBSRT as compared to group Present Centered Therapy (PCT), a well-characterized active attention, psychotherapy condition. Methods A total of 43 male veterans with combat-related PTSD, MDD, and disruptions in sleep or daily routine were randomly assigned to CBSRT or PCT. Therapy was provided weekly in a group modality for 12 weeks. Follow-up feasibility and gold-standard PTSD, MDD, and subjective/objective sleep assessments were conducted at post-treatment, 3 months, and 6 months post-treatment. Results Feasibility results demonstrated that veterans assigned to CBSRT had higher rates of attendance than veterans assigned to PCT. Both CBSRT and PCT were associated with improvements in PTSD and MDD symptoms, sleep efficiency, and number of awakenings; there were no differences between group therapies on these indices. Veterans in the CBSRT group had a greater reduction in the number of nightmares than veterans in the PCT group. Limitations Preliminary results must be qualified by the small sample size. Conclusions Group CBSRT may be more feasible for veterans than PCT. Both CBSRT and PCT were associated with improvements in psychiatric symptoms with few differences between conditions. CBSRT is a promising new group therapy that may help address the high-rate of PTSD therapy attrition in combat veterans. Clinical trial registration NCT00984698.

Abdominal cerclage is an effective treatment for cervical incompetence in patients with a previously failed vaginal cerclage or with anatomic restrictions to a vaginal cerclage. Management of second trimester complications that warrant a delivery impose a complex clinical situation in patients with an abdominal cerclage. We report 3 cases of successful removal of an abdominal cerclage by posterior and anterior colpotomy in the second trimester of pregnancy. This new and minimally invasive surgical technique avoids the need for extensive dilation, laparoscopy, or laparotomy to remove the cerclage and allow a vaginal delivery.

BACKGROUND: Literature suggests that patient-informing process prior to obtaining surgical informed consent (SIC) does not function well. This study aimed to provide insight into the current practice of SIC in the Netherlands.METHODS: This is a prospective, observational, and multicenter study, conducted in one academic and two non-academic teaching hospitals in the Netherlands. Audio recordings were made during outpatient consultations with patients presenting with Dupuytren Disease. The recorded informing process was scored according to a checklist. Written documentation of the SIC process in the patient's chart was compared to these scored checklists. Time spent on SIC during the consultations was also recorded.RESULTS: A total of 41 outpatient consultations were included in the study. Consultations were conducted by 25 plastic surgeons and their residents. Average time spent on SIC was 55.6% of the total consultation time. Considerable variation was observed concerning the amount and type of information given and discussed. In 59% of the consultations, discrepancies were observed between written documentation of consultations and audio recordings. Information on treatment risks, the postoperative period, and the operating surgeon was addressed the least.CONCLUSION: Despite a relatively large part of the consultation time being spent on SIC, patients received scarce information concerning treatment risks, postoperative period, and who their operating surgeon would be. Discrepancies were observed between the written documentation of SIC and information recorded on the audio recordings. This occurred predominantly in one hospital that used a pre-made list of 'discussed information' in its digital patient chart.

IntroductionDozens of medications have been re-evaluated as possible treatments for coronavirus 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Tocilizumab is a humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor that has been proposed as a therapy for patients with severe COVID-19 pneumonia. It is possible that the immunomodulatory effects of tocilizumab may also have the unintended consequence of predisposing to secondary infections. We sought to assess the risk of invasive fungal disease and therapeutic impact of tocilizumab on hospital and intensive care unit (ICU) outcomes in critically ill patients with severe COVID-19. MethodsRecords of critically-ill patients with COVID-19 over a 6 month period at our institution were reviewed, and medical histories, treatments, and clinical outcomes were extracted. The incidence of fungal infections in those that received tocilizumab in addition to standard COVID-19 treatments was assessed. ICU length of stay (LOS), duration of mechanical ventilation, and hospital LOS were compared between treatment groups. ResultsOne-hundred and thirty patients were identified, of which 56 met inclusion criteria. 16 patients received tocilizumab, and 40 did not. Invasive fungal infections occurred in 10.7% of all patients. Infection rates were significantly higher in the tocilizumab group than in the control group (31.2% v 2.5%, RR 12.5, p

Background:In preaxial polydactyly of the foot, the choice for excision of the lateral or medial hallux is not straightforward, in particular with proximal phalangeal (type IV) and metatarsal (type VI) duplication, because of anatomical characteristics. We evaluated whether medial or lateral hallux excision gives better outcomes in these duplication types, to help clinical decision making.Methods:Children with type IV or type VI duplication (n=14, age: 4.4-17.2 years), who were operatively treated by excision of the lateral or medial hallux, were assessed for foot function using plantar pressure measurements and clinical examination. Foot aesthetics were scored by the child, an expert, and 10 laypersons, and additional patient-reported outcome questionnaires were obtained. Outcomes were compared between lateral and medial excision, per duplication type.Results:In type IV duplication (n=11), lateral excision showed a better distribution of peak pressure between the hallux and first metatarsal with significantly lower median first metatarsal peak pressure ( P = .008). Lateral excision showed more medial hallux deviation ( P = .017). Foot aesthetics were not different between excision sides. In type VI duplication (n=12), lateral excision showed a 59% higher hallux peak pressure, larger medial hallux deviation ( P = .004), and more reoperations. Foot aesthetics were scored significantly better after lateral excision by experts and laypersons.Conclusions:Foot function by virtue of plantar pressure was better after lateral hallux excision in type IV and after medial hallux excision in type VI duplication. Surgeons and laypersons perceived the foot as more normal after lateral excision in type VI, whereas children reported no differences. These outcomes can be used in clinical decision making.Level of Evidence:Level III, therapeutic, comparative study.

Contains fulltext : 191468.pdf (Publisher’s version ) (Open Access) Background and purpose - Preaxial polydactyly of the foot is a rare malformation and clinicians are often unfamiliar with the associated malformations and syndromes. In order to give guidelines for diagnostics and referral to a clinical geneticist, we provide an overview of the presentation using a literature review and our own patient population. Patients and methods - The literature review was based on the Human Phenotype Ontology (HPO) project. From the HPO dataset, all phenotypes describing preaxial polydactyly were obtained and related diseases were identified and selected. An overview was generated in a heatmap, in which the phenotypic contribution of 12 anatomical groups to each disease is displayed. Clinical cases were obtained from our hospital database and were reviewed in terms of phenotype, genotype, heredity, and diagnosed syndromes. Results - From the HPO dataset, 21 diseases were related to preaxial polydactyly of the foot. The anatomical groups with the highest phenotypic contribution were lower limb, upper limb, and craniofacial. From our clinical database, we included 76 patients with 9 different diseases, of which 27 had a GLI3 mutation. Lower limb malformations (n = 55), upper limb malformations (n = 59), and craniofacial malformations (n = 32) were most frequently observed. Malformations in other anatomical groups were observed in 27 patients. Interpretation - Preaxial polydactyly of the foot often presents with other upper and lower limb malformations. In patients with isolated preaxial polydactyly of the foot, referral to a clinical geneticist is not mandatory. In patients with additional malformations, consultation with a clinical geneticist is recommended. When additional limb malformations are present, analysis of GLI3 is most feasible.

Background:Treatment of preaxial foot polydactyly, a duplication of the first ray, consists of excision of an extra ray, aiming to improve shoe fitting and aesthetic appearance, while maintaining foot function. Currently, the effect of excision on foot function and foot-related patient experiences is unclear.Methods:A cross-sectional comparison between 37 children treated for preaxial foot polydactyly and 37 age- and sex-matched healthy controls was performed. Dynamic foot function was assessed using plantar pressure measurements and static foot characteristics by physical examination. Patient-reported outcomes for foot function and footwear were evaluated, using the Oxford Ankle Foot Questionnaire for Children (score, 0-100).Results:Compared with controls, patients had significantly lower median peak pressures at the hallux (148 kPa [IQR, 98-245] vs 272 kPa [IQR, 205-381], P < .001) and significantly higher peak pressures at the second metatarsal (217 kPa [IQR, 147-338] vs 166 kPa [IQR, 141-235], P = .002) and third to fifth metatarsals (214 kPa [IQR, 147-290] vs 161 kPa [IQR, 135-235], P < .001). Additionally, patients had a more medially deviated hallux, both while seated (15 degrees (IQR, 11-20) vs 12 degrees [IQR, 10-15], P = .001) and standing (20 degrees [IQR, 15-26] vs 18 degrees [IQR, 15-20], P = .001). No significant correlation between peak pressure distribution and hallux deviation was found. Patients reported minimal problems with foot function (87.5 [IQR, 64.6-100]), but distinct problems with footwear use (50.0 [IQR, 25.0-100]).Conclusion:Patients with surgically treated preaxial foot polydactyly had a substantially altered plantar pressure distribution with more lateral foot progression than healthy controls. Although an increased hallux deviation was not related to altered foot function, it seemed to be the reason for the patient-perceived problems with footwear. Level of Evidence: Level III, comparative series.

Background The purpose of this study is to develop a Dutch version of the Oxford Ankle and Foot Questionnaire for Children (OxAFQ-c) to allow evaluation of pediatric foot care. Methods The OxAFQ-c was translated into Dutch, according to the ISPOR-guidelines. Children with different foot and ankle complaints completed the OxAFQ-c at baseline, after two weeks, and after 4–6 months. Measurement properties were assessed in terms of reliability, responsiveness, and construct validity. Results Test–retest reliability showed moderate intraclass correlation coefficients. Bland–Altman plots showed wide limits of agreement. After 4–6 months, the group that experienced improvement also showed improved questionnaire outcomes, indicating responsiveness. Moderate correlation between the OxAFQ-c and the Kidscreen and foot-specific VAS-scores were observed, indicating moderate construct validity. Conclusions The Dutch OxAFQ-c showed moderate to good measurement properties. However, because we observed limited sensitivity to changes and wide limits of agreement in individual patients, we think the questionnaire should only be used in groups.

Objective: To perform a morphological evaluation of the ductus venosus, heart and jugular lymphatic sac (JLS) in first-trimester human fetuses with normal and abnormal ductus venosus flow velocity waveforms (DV-FVWs) and normal and increased nuchal translucency (NT). Method: Postmortem examination was performed on fetuses with increased NT or structural malformations with previous NT and DV-FVW measurements. Ductus venosus morphology was examined using markers for endothelium, smooth muscle actin (SMA), nerves and elastic fibers. Fetal hearts were studied by microscopy. The nuchal region was analyzed using markers for lymphatic vessels, endothelium, SMA and nerves. Results: Two trisomy 21 and two trisomy 18 fetuses with increased NT and abnormal DV-FVWs were analyzed. As a control, one euploid anencephalic fetus with normal NT, cardiac anatomy and DV-FVWs was examined. Similar endothelial and SMA expression was observed in the ductus venosus in all fetuses. Nerve and elastic fiber expression were not detected. Three trisomic fetuses showed cardiac defects, one trisomic fetus demonstrated normal cardiac anatomy. The JLS was abnormally enlarged or contained red blood cells in all trisomic fetuses. The control fetus showed a normal JLS. Conclusion: Abnormal DV-FVWs are not justified by alterations in ductus venosus morphology. DV-FVWs most probably reflect intracardiac pressure. What's Already Known About This Topic? Ultrasound examination of ductus venosus flow velocity waveforms is used to indirectly assess fetal cardiac function and the fetal hemodynamic condition. Abnormal first-trimester ductus venosus flow velocity waveforms are related to chromosomal abnormalities, cardiac defects and increased nuchal translucency. Abnormal formation of the jugular lymphatic sacs is involved in the development of increased nuchal translucency. What Does This Study Add? Abnormal ductus venosus flow velocity waveforms are not caused by local alterations in ductus venosus morphology but reflect a changed hemodynamic status. The morphology of the ductus venosus is not related to abnormal ductus venosus flow velocity waveforms, chromosomal abnormalities, cardiac anatomy and increased nuchal translucency. Increased nuchal translucency in first-trimester human fetuses coincides with abnormal jugular lymphatic sac development.

Research purpose: The aim of this article was to evaluate the relevance of Global Management Accounting Principles (GMAPs) in the sustainability of a mechanised piggery in a South African context.Motivation for the study: Considering the pressure which commercial agriculture in South Africa is experiencing, as well as the growing nature of pork production in this sector, mechanised piggeries would have to consider ways in which to manage their operations in order to remain sustainable.Research approach, design and method: The research design took the form of an exploratory case study and contextual applied research with an inductivist approach to qualitative research.Main findings: The findings include that, without pre-knowledge of GMAPs, Piggery A employed a large number of the concepts and principles described by GMAPs as best practice.Practical and managerial implications: All commercial farming operations should consider GMAPs as a tool to establish best practice in the support of decision-making that promotes sustainability of farming operations.Contribution or value-add: The article’s contribution is to highlight that GMAPs can also be utilised as an effective decision-making tool in a mechanised piggery albeit it was designed for use in large corporations.

Objective To assess whether cardiac failure, because of cardiac defects, and abnormal jugular lymphatic development are involved in nuchal edema (NE) – the morphological equivalent of increased nuchal translucency – in various euploid mutant mouse models. Method Mouse embryos with lymphatic abnormalities and NE (Ccbe1−/−), with cardiac defects and NE (Fkbp12−/−, Tbx1−/−, Chd7fl/fl;Mesp1Cre, Jarid2−/−NE+) and with cardiac malformations without NE (Tbx2−/−, Pitx2−/−, Fgf10−/−, Jarid2−/−NE−) were examined. Embryos were analyzed from embryonic day 11.5 to 15.5. Markers for lymphatic vessels, endothelium, smooth muscle cells and nerves were used to study the nuchal region. Hematoxylin–Azophloxine staining was performed to examine cardiac morphology. Results Mouse embryos with lymphatic abnormalities and NE (Ccbe1−/−) showed no formation of the jugular lymphatic sac but normal cardiac morphology. In mouse embryos with cardiac defects and NE (Fkbp12−/−, Tbx1−/−, Chd7fl/fl;Mesp1Cre, Jarid2−/−NE+) enlarged jugular lymphatic sacs or large nuchal cavities within the NE were found. In mouse embryos with a cardiac malformation without NE (Tbx2−/−, Pitx2−/−, Fgf10−/−, Jarid2−/−NE−) normal jugular lymphatic sacs were observed. Conclusion NE consistently coincides with abnormal jugular lymphatic development in euploid mouse embryos, independent of cardiac anatomy. NE is unlikely to be caused by temporary cardiac failure solely because of a cardiac defect. © 2015 John Wiley & Sons, Ltd.

Machine learning continues to make strident advances in the prediction of desired properties concerning drug development. Problematically, the efficacy of machine learning in these arenas is reliant upon highly accurate and abundant data. These two limitations, high accuracy and abundance, are often taken together, however, insight into the dataset accuracy limitation of contemporary machine learning algorithms may yield insight into whether non-bench experimental sources of data may be used to generate useful machine learning models where there is a paucity of experimental data. We took highly accurate data across six kinase types, one GPCR, one polymerase, a human protease, and HIV protease, and intentionally introduced error at varying population proportions in the datasets for each target. With the generated error in the data, we explored how the retrospective accuracy of a Na&iuml, ve Bayes Network, a Random Forest Model, and a Probabilistic Neural Network model decayed as a function of error. Additionally, we explored the ability of a training dataset with an error profile resembling that produced by the Free Energy Perturbation method (FEP+) to generate machine learning models with useful retrospective capabilities. The categorical error tolerance was quite high for a Na&iuml, ve Bayes Network algorithm averaging 39% error in the training set required to lose predictivity on the test set. Additionally, a Random Forest tolerated a significant degree of categorical error introduced into the training set with an average error of 29% required to lose predictivity. However, we found the Probabilistic Neural Network algorithm did not tolerate as much categorical error requiring an average of 20% error to lose predictivity. Finally, we found that a Na&iuml, ve Bayes Network and a Random Forest could both use datasets with an error profile resembling that of FEP+. This work demonstrates that computational methods of known error distribution like FEP+ may be useful in generating machine learning models not based on extensive and expensive in vitro-generated datasets.

Objectives. Doctors’ empathy towards their patients is considered important for treatment outcome. However, during medical school there might be a decline in empathy called “hardening of the heart.” This study evaluated the cognitive and emotional empathy in medical students and investigated the influence of a preference for a specialty and students attachment styles. Methods. 126 first-year medical students were included and completed the Reading the Mind in the Eyes Test revised version (RME-R), the Balanced Emotional Empathy Scale (BEES), and the Experiences in Close Relationships-Revised Adult Attachment Questionnaire (ECR-R). Results. Students identified of 36 photographs in the RME-R test correctly (norm: 26). The female students’ mean BEES total score was and the male students’ ; . The female students’ mean BEES score was significantly () below the female norm of 60. Students who preferred a specialty with continuity of patient care scored significantly higher in the BEES (). A more avoidant attachment style was associated with a lower BEES score (). Conclusion. The students showed low emotional and cognitive empathy scores and an avoidant attachment style. This supports the inclusion of specific training in cognitive and emotional empathy in medical education.

This paper presents a real-time capable graphics processing unit (GPU)-based ultrasound simulator suitable for medical education. The main focus of the simulator is to synthesize realistic looking ultrasound images in real-time including artifacts, which are essential for the interpretation of this data. The simulation is based on a convolution-enhanced ray-tracing approach and uses a deformable mesh model. Deformations of the mesh model are calculated using the PhysX engine. Our method advances the state of the art for real-time capable ultrasound simulators by following the path of the ultrasound pulse, which enables better simulation of ultrasound-specific artifacts. An evaluation of our proposed method in comparison with recent generative slicing-based strategies as well as real ultrasound images is performed. Hereby, a gelatin ultrasound phantom containing syringes filled with different media is scanned with a real transducer. The obtained images are then compared to images which are simulated using a slicing-based technique and our proposed method. The particular benefit of our method is the accurate simulation of ultrasound-specific artifacts, like range distortion, refraction and acoustic shadowing. Several test scenarios are evaluated regarding simulation time, to show the performance and the bottleneck of our method. While being computationally more intensive than slicing techniques, our simulator is able to produce high-quality images in real-time, tracing over 5000 rays through mesh models with more than 2 000 000 triangles of which up to 200 000 may be deformed each frame.

Background: Polydactyly at the medial side of the foot (“medial polydactyly” of the foot) is a rare and diverse congenital anomaly. In order to plan and evaluate surgical treatment, the classification of medial polydactyly is useful. The aim of our study was to develop a reliable and valid classification system for medial polydactyly of the foot that is more useful than previous systems for preoperative evaluation and surgical planning. Methods: A review of the literature and the clinical experience of a single experienced surgeon were used to determine classification categories. We identified all patients with medial polydactyly who had preoperative radiographs and clinical photographs and were treated at our hospital between 1993 and 2014. All affected feet were assessed according to our proposed classification system, the Rotterdam foot classification. The intrarater and interrater reliability among 5 observers who evaluated 30 feet were assessed with use of the Cohen kappa (κ) statistic. Results: We developed a classification system that describes duplication type, syndactyly, the presence of a hypoplastic ray, and deviation of the hallux. Seventy-three feet were classified according to the system. Seven duplication types were distinguished. Complete metatarsal duplication was most frequently seen (in 29%). Twelve feet showed a broad hallux without external expression of duplication. Syndactyly between medial and lateral (duplicate) halluces was present in 30 feet; between the lateral hallux and second toe, in 13 feet; and between both duplicated halluces and the lateral hallux and second toe, in 21 feet. A hypoplastic ray was seen in 75% of the feet. Intrarater agreement for duplication, hypoplastic rays, syndactyly, and deviation were, respectively, κ = 0.79, 0.75, 0.59, and 0.78. Interrater agreement for duplication, hypoplastic rays, syndactyly, and deviation were, respectively, κ = 0.72, 0.54, 0.48, and 0.64. Conclusions: The proposed classification system contains 4 categories of anatomic features of the foot. Classification of all categories shows moderate to good reliability. Use of the Rotterdam classification in evaluating medial polydactyly improves type-specific description, which may, in the future, enhance the evaluation of surgical treatment. Clinical Relevance: The Rotterdam foot classification system is a reliable and easy-to-use system that we believe will improve communication between clinicians and researchers and facilitate the evaluation of treatment results in medial polydactyly of the foot.

The Keck array is a new multi-camera Cosmic Microwave Background (CMB) polarimeter. Each camera contains 256 polarization pairs of antenna-coupled transition edge sensor (TES) bolometers. We recently deployed three of five cameras at the geographic South Pole, and plan to deploy the final two cameras in early 2012. This new telescope is an ideal instrument to search for the primordial B-mode polarization signal imprinted in the CMB by inflationary gravitational waves. We will discuss the design of the detectors and receivers, the status of current observations, and report on progress toward upgrading the instrument with the full compliment of polarized receivers.

Preterm delivery remains a primary cause of neonatal morbidity and mortality. One cause of preterm birth is cervical incompetence. In women with a shortened or absent cervix or in those in whom previous vaginal cerclage failed, abdominal cerclage may be recommended. We performed a systematic literature search of PubMed, EMBASE, and the Cochrane database. Thirty-one eligible studies were selected. Six studies (135 patients) reported on the laparoscopic approach, and 26 (1116 patients) on the abdominal approach. Delivery of a viable infant at 34 weeks of gestation or more varied from 78.5% (laparoscopic) to 84.8% (abdominal). Second-trimester fetal loss occurred in 8.1% (laparoscopic) vs 7.8% (abdominal), with no reported third-trimester losses (laparoscopic) vs 1.2% (abdominal). We conclude that abdominal cerclage is associated with excellent results as treatment of cervical incompetence, with high fetal survival rates and minimal complications during surgery and pregnancy. Further studies are needed to differentiate which method is superior.

The Millimeter Bolometer Array Camera (MBAC) will be installed on the 6-meter Atacama Cosmology Telescope (ACT) in late 2007. For the first season of observations, MBAC will comprise a 145 GHz diffraction-limited, 1024-pixel, focal plane array of Transition Edge Sensor (TES) Bolometers. This will be the largest array of pop-up-detector bolometers ever fielded as well as one of the largest arrays of TES bolometers. We discuss the design specifications for the array and pre-assembly testing procedures for the cryogenic components. We present dark measurements of the TES bolometer properties of numerous 32-pixel columns that have been assembled into the first kilopixel array for ACT, as well as optical measurements made with our 256-pixel prototype array, including first light measurements on ACT.

We have developed multi-channel electronics (MCE) which work in concert with time-domain multiplexors developed at NIST, to control and read signals from large format bolometer arrays of superconducting transition edge sensors (TESs). These electronics were developed as part of the Submillimeter Common-User Bolometer Array-2 (SCUBA2 ) camera, but are now used in several other instruments. The main advantages of these electronics compared to earlier versions is that they are multi-channel, fully programmable, suited for remote operations and provide a clean geometry, with no electrical cabling outside of the Faraday cage formed by the cryostat and the electronics chassis.

Submillimeter common user bolometer array (SCUBA)-2 is a wide field sub-mm bolometer camera designed to replace the existing SCUBA instrument on the JCMT in Hawaii. It will be many hundreds of times faster in large area mapping than SCUBA and will also go deeper in a single frame. It will enable the many discoveries of SCUBA to be followed up with deep systematic surveys and help act as a pathfinder for the ALMA interferometer. The key technologies for making the arrays have been demonstrated and will be put together to fabricate the first prototype later this year (2003). The wide field nature of the SCUBA-2 bolometer camera, combined with the diffraction limit at sub-mm wavelengths, leads to physically large focal planes where the issues of stray light control, magnetic shielding, and electrical, thermal and mechanical connection must be carefully addressed in order to realise a successful instrument. We describe the solutions we have adopted for these problem areas.

A 28-year-old pregnant woman presented to the VU University Medical Center at 8 weeks’ gestation for prenatal counselling. Her partner was diagnosed with infantile hypertrophic neuropathy causing d...

Searching for evidence of inflation by measuring B-modes in the cosmic microwave background (CMB) polarization at degree angular scales remains one of the most compelling experimental challenges in cosmology. BICEP2 and the Keck Array are part of a program of experiments at the South Pole whose main goal is to achieve the sensitivity and systematic control necessary for measurements of the tensor-to-scalar ratio at σ(r) ~0:01. Beam imperfections that are not sufficiently accounted for are a potential source of spurious polarization that could interfere with that goal. The strategy of BICEP2 and the Keck Array is to completely characterize their telescopes' polarized beam response with a combination of in-lab, pre-deployment, and on-site calibrations. We Sereport the status of these experiments, focusing on continued improved understanding of their beams. Far-field measurements of the BICEP2 beam with a chopped thermal source, combined with analysis improvements, show that the level of residual beam-induced systematic errors is acceptable for the goal of σ(r) ~ 0:01 measurements. Beam measurements of the Keck Array side lobes helped identify a way to reduce optical loading with interior cold baffles, which we installed in late 2013. These baffles reduced total optical loading, leading to a ~ 10% increase in mapping speed for the 2014 observing season. The sensitivity of the Keck Array continues to improve: for the 2013 season it was 9:5 μK _/s noise equivalent temperature (NET). In 2014 we converted two of the 150-GHz cameras to 100 GHz for foreground separation capability. We have shown that the BICEP2 and the Keck Array telescope technology is sufficient for the goal of σ(r) ~ 0:01 measurements. Furthermore, the program is continuing with BICEP3, a 100-GHz telescope with 2560 detectors. © (2014) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.

The inflationary paradigm of the early universe predicts a stochastic background of gravitational waves which would generate a B-mode polarization pattern in the cosmic microwave background (CMB) at degree angular scales. Precise measurement of B-modes is one of the most compelling observational goals in modern cosmology. Since 2011, the Keck Array has deployed over 2500 transition edge sensor (TES) bolometer detectors at 100 and 150 GHz to the South Pole in pursuit of degree-scale B-modes, and Bicep3 will follow in 2015 with 2500 more at 100 GHz. Characterizing the spectral response of these detectors is important for controlling systematic effects that could lead to leakage from the temperature to polarization signal, and for understanding potential coupling to atmospheric and astrophysical emission lines. We present complete spectral characterization of the Keck Array detectors, made with a Martin-Puplett Fourier Transform Spectrometer at the South Pole, and preliminary spectra of Bicep3 detectors taken in lab. We show band centers and effective bandwidths for both Keck Array bands, and use models of the atmosphere at the South Pole to cross check our absolute calibration. Our procedure for obtaining interferograms in the field with automated 4-axis coupling to the focal plane represents an important step towards efficient and complete spectral characterization of next-generation instruments more than 10000 detectors.

Diseases of the prostate, prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and carcinoma of the prostate interfere with sexual function. Since the American Urological Association have issued their position statement in 1990 that male sexual dysfunction is a recognized disease entity, studies examined the interrelation between sexuality and the prostate. These studies were identified in our review.A computer- and hand-based search of the literature was conducted with the key words health-related quality of life, sexual function and the various disease states of the prostate, the drawback being that validated quality-of-life instruments have just recently and mostly nationally been validated.Sexual function is a dimension of quality-of-life questionnaires with 1 up to 11 questions addressing sexuality. The effect of aging on male sexuality as determined in Sweden serves as an important background information. Whereas prostadynia and sexual dysfunction aggravate each other, BPH and its treatment influence only certain sexual functions. Carcinoma of the prostate, untreated or under observation, has the greatest impact on sexuality which is tolerated differently from country to country and depends upon the expectation of survival.The impact of treatment of prostatic diseases on sexuality can now be studied easier in utilizing validated questionnaires. This update may serve as a base for these upcoming studies.

Objective To evaluate spontaneous vaginal delivery and complication rates after induction of labor with a transcervical Foley catheter in women with a previous cesarean delivery. Design Retrospective cohort study. Setting Secondary teaching hospital in the second largest city of the Netherlands. Population Women with a history of cesarean delivery (n = 208), undergoing induction of labor with a Foley catheter in a subsequent pregnancy. Material and methods The women who had induction of labor with a transcervical Foley catheter in the Ikazia Hospital, Rotterdam, between January 2003 and January 2012, were identified in a computerized database. Patient's records were checked for accuracy. Main outcome measures Vaginal delivery rate, cesarean section rate, uterine rupture and maternal and neonatal (infectious) morbidity. Results Of the women 60% had a spontaneous vaginal delivery and 11% were delivered by vacuum extraction. Uterine rupture occurred in one woman. Postpartum hemorrhage was the most common maternal complication (12%). Maternal intrapartum and postpartum infections occurred in 5% and 1%. Proven neonatal infection was found in 3% of the cases. Two perinatal deaths occurred (1%), of which one was related to uterine rupture. Conclusion Induction of labor with a transcervical Foley catheter is an effective method to achieve vaginal delivery in women with a previous cesarean delivery. There is a low risk of uterine rupture and maternal and neonatal (infectious) morbidity in this cohort.

Between the BICEP2 and Keck Array experiments, we have deployed over 1500 dual polarized antenna coupled bolometers to map the Cosmic Microwave Background's polarization. We have been able to rapidly deploy these detectors because they are completely planar with an integrated phased-array antenna. Through our experience in these experiments, we have learned of several challenges with this technology- specifically the beam synthesis in the antenna- and in this paper we report on how we have modified our designs to mitigate these challenges. In particular, we discus differential steering errors between the polarization pairs' beam centroids due to microstrip cross talk and gradients of penetration depth in the niobium thin films of our millimeter wave circuits. We also discuss how we have suppressed side lobe response with a Gaussian taper of our antenna illumination pattern. These improvements will be used in Spider, Polar-1, and this season's retrofit of Keck Array., Comment: Presented at SPIE Millimeter, Submillimeter, and Far-Infrared Detectors and Instrumentation for Astronomy VI, July 6, 2012. To be published in Proceedings of SPIE Volume 8452

The Keck Array (SPUD) began observing the cosmic microwave background's polarization in the winter of 2011 at the South Pole. The Keck Array follows the success of the predecessor experiments Bicep and Bicep2, using five on-axis refracting telescopes. These have a combined imaging array of 2500 antenna-coupled TES bolometers read with a SQUID-based time domain multiplexing system. We will discuss the detector noise and the optimization of the readout. The achieved sensitivity of the Keck Array is 11.5 {\mu}K_(CMB)*sqrt{s} in the 2012 configuration., Comment: Presented at SPIE 2012 Astronomical Telescopes and Instrumentation Conference. Will be published in the proceedings

SCUBA-2 is a revolutionary 10,000 pixel wide-field submillimetre camera, recently commissioned and now operational at the James Clerk Maxwell Telescope (JCMT). Twin focal planes each consist of four 32 by 40 sub-arrays of superconducting Transition Edge Sensor (TES) bolometers, the largest combined low temperature bolometer arrays in operation, to provide simultaneous imaging at wavelengths of 450 and 850 microns. SCUBA-2 was designed to map large areas of sky more than 100 times faster than the original ground breaking SCUBA instrument and has achieved this goal. In this paper we describe the performance of the instrument and present results of characterising the eight science grade TES bolometer arrays. We discuss the steps taken to optimise the setup of the TES arrays to maximise mapping speed and show how critical changes to the sub-array module thermal design, the introduction of independent focal plane and 1K temperature control and enhancements to the cryogenics have combined to significantly improve the overall performance of the instrument.

We describe the cryogenic system for SPIDER, a balloon-borne microwave polarimeter that will map 8% of the sky with degree-scale angular resolution. The system consists of a 1284 L liquid helium cryostat and a 16 L capillary-filled superfluid helium tank, which provide base operating temperatures of 4 K and 1.5 K, respectively. Closed-cycle helium-3 adsorption refrigerators supply sub-Kelvin cooling power to multiple focal planes, which are housed in monochromatic telescope inserts. The main helium tank is suspended inside the vacuum vessel with thermally insulating fiberglass flexures, and shielded from thermal radiation by a combination of two vapor cooled shields and multi-layer insulation. This system allows for an extremely low instrumental background and a hold time in excess of 25 days. The total mass of the cryogenic system, including cryogens, is approximately 1000 kg. This enables conventional long duration balloon flights. We will discuss the design, thermal analysis, and qualification of the cryogenic system., 11 pages, 4 figures; as published in the conference proceedings for SPIE Millimeter, Submillimeter, and Far-Infrared Detectors and Instrumentation for Astronomy V (2010)

SCUBA-2 is a 10,000 pixel wide field sub-millimeter camera which started science observing on James Clerk Maxwell Telescope (JCMT) in the spring of 2010. We present the results of characterising individual 1280 bolometer science grade sub-arrays, as well as experience from operating the instrument.

We report on the preliminary detector performance of the B icep 2 mm-wave p olarimeter, deployed in 2009 tothe South Pole. B icep 2 is currently imaging the polarization of the cosmic micro wave bac kground at 150 GHzusing an array of 512 antenna-coupled superconducting bolometers. The antennas, band-de“ning “lters andtransition edge sensor (TES) bolometers are photolithographically fabricated on 4 silicon tiles. Each tile consistsof an 8 × 8 grid of 7 mm spatial pixels, for a total of 256 detector pairs. A spatial pixel contains 2 sets oforthogonal antenna slots summed in-phase, with each set coupled to a TES by a “ltered microstrip. The detectorsare read out using time-domain multiplexed SQUIDs. The detector pair of each spatial pixel is dierenced tomeasure polarization. We report on the performance of the B icep 2 detectors in the “eld, including the focalplane yield, detector and multiplexer optimization, detector noise and stability, and a preliminary estimate ofthe improvement in mapping speed compared to B icep 1.Keywords: Cosmic micr owave bac kground, polarization, TES, noise, in”ation, gravitational waves, cosmology

SCUBA-2 is a state of the art 10,000 pixel submillimeter camera installed and being commissioned at the James Clerk Maxwell Telescope (JCMT) providing wide-field simultaneous imaging at wavelengths of 450 and 850 microns. At each wavelength there are four 32 by 40 sub-arrays of superconducting Transition Edge Sensor (TES) bolometers, each packaged with inline SQUID multiplexed readout and amplifier. In this paper we present the results of characterising individual 1280 bolometer science grade sub-arrays, both in a dedicated 50mk dilution refrigerator test facility and in the instrument installed at the JCMT.

BICEP2/Keck and SPIDER are cosmic microwave background (CMB) polarimeters targeting the B-mode polarization induced by primordial gravitational waves from inflation. They will be using planar arrays of polarization sensitive antenna-coupled TES bolometers, operating at frequencies between 90 GHz and 220 GHz. At 150 GHz each array consists of 64 polarimeters and four of these arrays are assembled together to make a focal plane, for a total of 256 dual-polarization elements (512 TES sensors). The detector arrays are integrated with a time-domain SQUID multiplexer developed at NIST and read out using the multi-channels electronics (MCE) developed at the University of British Columbia. Following our progress in improving detector parameters uniformity across the arrays and fabrication yield, our main effort has focused on improving detector arrays optical and noise performances, in order to produce science grade focal planes achieving target sensitivities. We report on changes in detector design implemented to optimize such performances and following focal plane arrays characterization. BICEP2 has deployed a first 150 GHz science grade focal plane to the South Pole in December 2009., Comment: 10 pages, 7 figures; SPIE proceedings for Millimeter, Submillimeter and Far-Infrared Detectors and Instrumentation for Astronomy V (Conference 7741, June 2010, San Diego, CA, USA)

The upcoming Cosmic Microwave Background (CMB) experiments BICEP2/Keck and SPIDER will be using planar arrays of polarization sensitive antenna‐coupled TES bolometers, operating at frequencies between 96 GHz and 220 GHz. At 145 GHz each array consists of 64 polarimeters (128 TES sensors) and four of these arrays are assembled together to make a focal plane. The detector arrays are integrated with a time‐domain SQUID multiplexer developed at NIST and read out using the Multi‐Channel Electronics (MCE) developed at the University of British Columbia. We present our progress in characterizing focal plane arrays and SQUID multiplexed readout for BICEP2 and SPIDER, describing testing procedures and giving a summary of dark measurements results, as well as preliminary optical measurements.

The total amount of photovoltaic (PV) energy production in the global energy mix has been increasing strongly all over the world in the last decade. This phenomenon has been mainly driven by the promotion of renewable energies, as well as by the well known feed-in tariffs. Although the major part of PV installations consists in roof mounted panels in private, collective or commercial buildings, the amount of large scale PV power plants, from 200 kW to 10 MW or more is increasing drastically. Such large scale PV power plants already represent nearly 20 % of the total installed PV capacity (Fig. 1, left). Indeed, by reducing of the overall system costs, they are becoming serious alternatives to fossil fuel or nuclear power plants for utilities.

The 6-meter Atacama Cosmology Telescope will map the cosmic microwave background at millimeter wavelengths.The commissioning instrument for the telescope, the Millimeter Bolometer Array Camera, is based on arefractive optical system which simultaneously images three separate fields of view at three different frequencies:145, 220, and 280 GHz. Each frequency band contains around twelve individual optical elements at five differenttemperature stages ranging from 300 K to 300 mK and a 32 x 32 array of Transition Edge Sensor bolometers at300 mK. We discuss the design of the close-packed on-axis optical design of the three frequencies. The thermaldesign and performance of the system are presented in the context of the scientific requirements and observingschedule. A major part of the design was the incorporation of multiple layers of magnetic shielding. We discussthe performance of the 145 GHz optical system in 2007 and the implementation of the additional two frequencychannels in 2008.

The detector arrays for the SCUBA-2 instrument consist of TES bolometers with superconducting amplifier and multiplexing circuits based on Superconducting Quantum Interference Devices (SQUIDs). The SCUBA-2 TES arrays and their multiplexed SQUID readouts need to be set-up carefully to achieve correct performance. Algorithms have been developed and implemented based on the first available commissioning grade detector, enabling the array to be set up and optimized automatically.

The Millimeter Bolometer Array Camera (MBAC) was commissioned in the fall of 2007 on the new 6-meterAtacama Cosmology Telescope (ACT). The MBAC on the ACT will map the temperature anisotropies of theCosmic Microwave Background (CMB) with arc-minute resolution. For this first observing season, the MBACcontained a diffraction-limited, 32 by 32 element, focal plane array of Transition Edge Sensor (TES) bolometersfor observations at 145 GHz. This array was coupled to the telescope with a series of cold, refractive, reimagingoptics. To meet the performance specifications, the MBAC employs four stages of cooling using closed-cycle3He/4He sorption fridge systems in combination with pulse tube coolers. In this paper we present the design ofthe instrument and discuss its performance during the first observing season. Finally, we report on the statusof the MBAC for the 2008 observing season, when the instrument will be upgraded to a total of three separate1024-element arrays at 145 GHz, 220 GHz and 280 GHz.

The Atacama Cosmology Telescope observes the Cosmic Microwave Background with arcminute resolution from the Atacama desert in Chile. For the first observing season one array of 32 x 32 Transition Edge Sensor (TES) bolometers was installed in the primary ACT receiver, the Millimeter Bolometer Array Camera (MBAC). In the next season, three independent arrays working at 145, 220 and 280 GHz will be installed in MBAC. The three bolometer arrays are each coupled to a time-domain multiplexer developed at the National Institute of Standard and Technology, Boulder, which comprises three stages of superconducting quantum interference devices (SQUIDs). The arrays and multiplexers are read-out and controlled by the Multi Channel Electronics (MCE) developed at the University of British Columbia, Vancouver. A number of experiments plan to use the MCE as read-out electronics and thus the procedure for tuning the three stage SQUID system is of general interest. Here we describe the automated array tuning procedures and algorithms we have developed. During array tuning, the SQUIDs are biased near their critical currents. SQUID feedback currents and lock points are selected to maximize linearity, dynamic range, and gain of the SQUID response curves. Our automatic array characterization optimizes the tuning of all three stages of SQUIDs by selecting over 1100 parameters per array during the first observing season and over 2100 parameters during the second observing season. We discuss the timing, performance, and reliability of this array tuning procedure as well as planned and recently implemented improvements.

The Atacama Cosmology Telescope (ACT) aims to measure the Cosmic Microwave Background (CMB) temperature anisotropies on arcminute scales. The primary receiver for ACT is the Millimeter Bolometer Array Camera (MBAC). The MBAC is comprised of three 32×32 transition edge sensor (TES) bolometer arrays, each observing the sky with an independent set of band-defining filters. The MBAC arrays will be the largest pop-up detector arrays fielded, and among the largest TES arrays built. Prior to its assembly into an array and installation into the MBAC, a column of 32 bolometers is tested at ~ 0.4 K in a quick-turn-around dip probe. In this paper we describe the properties of the ACT bolometers as revealed by data from those tests, emphasizing a characterization that accounts for both the complex impedance and the noise as a function of frequency.

The Atacama Cosmology Telescope (ACT) is designed to measure temperature anisotropies of the cosmic microwave background (CMB) at arcminute resolution. It is the first CMB experiment to employ a 32×32 close-packed array of free-space-coupled transition-edge superconducting bolometers. We describe the organization of the telescope systems and software for autonomous, scheduled operations. When paired with real-time data streaming and display, we are able to operate the telescope at the remote site in the Chilean Altiplano via the Internet from North America. The telescope had a data rate of 70 GB/day in the 2007 season, and the 2008 upgrade to three arrays will bring this to 210 GB/day.

The Atacama Cosmology Telescope is a six meter, off-axis Gregorian telescope for measuring the cosmic microwave background at arcminute resolutions. The Millimeter Bolometer Array Camera (MBAC) is its current science instrument. Erected in the Atacama Desert of Chile in early 2007, it saw first light with the MBAC on 22 October 2007. In this paper we review its performance after one month of observing, focusing in particular on issues surrounding the alignment of the optical system that impact the sensitivity of the experiment. We discuss the telescope motion, pointing, and susceptibility to thermal distortions. We describe the mirror alignment procedure, which has yielded surface deviations of 31 μm rms on the primary and 10 μm rms on the secondary. Observations of planets show that the optical performance is consistent with the telescope design parameters. Preliminary analysis measures a solid angle of about 215 nanosteradians with a full width at half maximum of 1.44 arcminutes at 145 GHz.

We present the results of characterization measurements on a 1280 pixel superconducting bolometer array designed for operation at wavelengths around 450 μm. The array is a prototype for the sub-arrays which will form the focal plane for the SCUBA-2 sub-mm camera, being built for the James Clerk Maxwell Telescope (JCMT) in Hawaii. With over 10 000 pixels in total, it will provide a huge improvement in both sensitivity and mapping speed over existing instruments. The array consists of molybdenum-copper bi-layer TES (transition edge sensor) pixels, bonded to a multiplexer. The detectors operate at a temperature of approximately 175 mK, and require a heat sink at a temperature of approximately 60 mK. In contrast to previous TES arrays, the multiplexing elements are located beneath each pixel (an "in-focal plane" configuration). We present the results of electrical and optical measurements, and show that the optical NEP (noise equivalent power) is less than 1.4 × 10-16 W Hz-0.5 and thus within the goal of 1.5 × 10-16 W Hz-0.5.

Recently, high-concentration PV using III-V solar cells becomes more attractive and several companies were founded. In the first part of this paper we present examples of III-V based high-concentration systems. The second part of the paper is devoted to experimental results obtained for a CPV system using FLATCON®-type modules. An averaged system efficiency of 19.1 % and a maximum system efficiency of 22.2 % were determined. FLATCON® test modules using triple-junction solar cells achieved outdoor measured efficiencies of 26.8 %.

The sizing of grid-connected PV systems does not usually take into account the site-dependent peculiarities of the solar irradiation distribution characteristics. Because of the perceived notion that PV systems hardly ever have a DC output equal to or above their STC-rated nominal power, inverters are usually sized with a nominal AC output power some 30% (sometimes even more) below the PV array nominal power. This practice might lead to considerable energy losses, especially in the case of PV technologies with low temperature coefficients of power and at sites with warm climates and an energy distribution of sunlight shifted to higher irradiation levels. We discuss the consequences of the time resolution of the irradiation data set used to determine a particular site irradiation distribution on inverter sizing. Most of the available irradiation data measured at individual sites are hourly averages, which lead to filtering of irradiation peaks, which might result in inaccurate performance estimations. When calculating inverter yearly efficiencies using both hourly averages and one-minute averages of the solar irradiation, we can show that the actual losses due to inverter undersizing increase with increased time resolution, revealing that hourly averages hide important irradiation peaks.