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This paper identifies the inherent strengths/weaknesses of rigid timber-framed partitions and quantifies the onset drifts for different damage thresholds under bi-directional seismic actions. It reports construction and quasi-static lateral cyclic testing of a multi-winged timber-framed partition wall specimen with details typical of New Zealand construction practice. Furthermore, the cyclic performance of the tested rigid timber-framed partition wall is also compared with that of similar partition walls incorporating ‘partly-sliding’ connectiondetails, and ‘seismic gaps’, previously tested under the same test setup. Based on the experimentally recorded cyclic performance measures, theoretical equations proposed/derived in the literature to predict the ultimate strength, initial stiffness, and drift capacity of different damage states are scrutinized, and some equations are updated in order to alleviate identified possible shortcomings. These theoretical estimates are then validated with the experimental results. It is found that the equations can reasonably predict the initial stiffness and ultimate shear strength of the partitions, as well as the onset-driftscorresponding to the screw damage and diagonal buckling failure mode of the plasterboard. The predicted bi-linear curve is also found to approximate the backbone curve of the tested partition wall sensibly.

Abstract Zirconium-doped hafnium oxide (HZO) crystallizes at low temperatures and is thus ideal to implement ferroelectric (FE) functionalities into the back end of line (BEoL). Therefore, metal-ferroelectric-metal (MFM) capacitors are of great interest. Placed in the BEoL, they can be connected either to the drain- or the gate-contact of a standard logic device to realize different emerging FE-embedded non-volatile memory (eNVM) concepts. However, the low crystallization temperature increases also the risk for a premature crystallization of the HZO films during the growth of the top electrode (TE), in particular, if high-temperature processes like atomic layer deposition (ALD) or chemical vapor deposition (CVD) are used. Herein, the TE is deposited at room temperature via physical vapor deposition (PVD). The impact of different process gas flows on the FE properties of the HZO films is studied by X-ray diffraction and polarization versus electric field measurements. Graphic abstract

Background and Objective: The Trials within Cohorts design aims to reduce recruitment difficulties and disappointment bias in pragmatic trials. On cohort enrollment, broad informed consent for randomization is asked, after which cohort participants can be randomized to interventions or serve as controls without further notification. We evaluated patients' recollection, understanding, and acceptance of broad consent in a clinical oncology setting. Methods: We surveyed 610 patients with cancer participating in ongoing TwiCs; 482 patients (79%) responded, of which 312 patients shortly after cohort enrollment, 108 patients after randomization to an intervention (12-18 months after cohort enrollment), and a random sample of 62 cohort participants who had not been selected for interventions (1-6 months after cohort enrollment). Results: Shortly after providing cohort consent, 76% of patients (238/312) adequately remembered whether they had given broad consent for randomization. Of patients randomly offered interventions, 76% (82/108) remembered giving broad consent for randomization; 41% (44/108) understood they were randomly selected, 44% (48/108) were not interested in selection procedures, and 10% (11/108) did not understand selection was random. Among patients not selected for interventions, 42% (26/62) understood selection was random; 89% felt neutral regarding the scenario of "not being selected for an intervention while your data were being used in comparison with patients receiving interventions,"10% felt reassured (6/62) and 2% scared/insecure (2/62). Conclusion: Patients adequately remember giving broad consent for randomization shortly after cohort enrollment and after being offered an intervention, but recollection is lower in those never selected for interventions. Patients are acceptant of serving as control without further notifications. (c) 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background & Aims During treatment of chronic HBV infections, loss or seroconversion of the HBV surface antigen (HBsAg) is considered a functional cure. HBsAg consists of the large (LHBs), middle (MHBs), and small surface protein (SHBs) and their relative proportions correlate strongly with disease stage. Our aim was to assess the association between HBsAg composition and functional cure during treatment. Methods A total of 83 patients were retrospectively analyzed. HBsAg loss was achieved by 17/64 patients during nucleos(t)ide analogue (NA) treatment and 3/19 patients following treatment with pegylated interferon-alfa2a (PEG-IFN) for 48 weeks. Sixty-three patients without HBsAg loss were matched as controls. LHBs, MHBs and SHBs were quantified in sera collected before and during treatment. Results Before treatment, median MHBs levels were significantly lower in patients with subsequent HBsAg loss than in those without (p = 0.005). During treatment, MHBs and LHBs proportions showed a fast decline in patients with HBsAg loss, but not in patients with HBV e antigen seroconversion only or patients without serologic response. MHBs became undetectable by month 6 of NA treatment in all patients with HBsAg loss, which occurred on average 12.8 ± 8.7 (0–52) months before loss of total HBsAg. Receiver-operating characteristic analyses revealed that the proportion of MHBs was the best early predictor of HBsAg loss before NA treatment (AUC = 0.726, p = 0.019). In patients achieving HBsAg loss with PEG-IFN, the proportions of MHBs and LHBs showed similar kinetics. Conclusion Quantification of HBsAg proteins shows promise as a novel tool to predict early treatment response. These assessments may help optimize individual antiviral treatment, increasing the rates of functional cure in chronically HBV-infected patients. Lay summary The hepatitis B surface antigen (HBsAg) is a key serum marker for viral replication. Loss of HBsAg is considered stable remission, which can be achieved with antiviral treatments. We have investigated whether the ratios of the different components of HBsAg, namely the large (LHBs) and medium (MHBs) HBsAg during different treatments are associated with the occurrence of HBsAg loss. We found that LHBs and MHBs decrease earlier than total HBsAg before HBsAg loss and we propose LHBs and MHBs as promising novel biomarker candidates for predicting cure of HBV infection.

Purpose Laboratory animal workers (LAW) working with laboratory mice are exposed to mouse allergens (MA). If MA are spread to home environments, this might increase the risk for allergies in LAW and their families. This study aimed to assess 1. whether spreading of MA from workplace to home environment takes place; 2. which factors increase spreading of MA. Methods In a cross-sectional study, dust samples were taken on the mattress and seating in homes of LAW (n = 105) and an unexposed comparison group (n = 13). From 89 LAW, additional dust samples were taken from their workplaces. Samples were analysed using Mus m1 ELISA kits [detection limit (DL) 0.2 ng mus m1/ml]. Sociodemographic data, personal history of allergies and cleaning habits, as well as work-related characteristics (LAW only) were assessed by questionnaire. Latent factors were assessed via factor analysis. Tobit models were fitted to analyse the latent factors’ contribution to MA spreading. Results MA concentration on the seating was significantly higher in home environments of LAW (median = 1.28 ng mus m1/m2) than in the comparison group (median p = 0.019). The highest workplace MA concentration was found on the floor of the scullery (median = 140,000.00 ng mus m1/m2), followed by hair-covering caps (median = 76.02 ng mus m1/m2). Cage and mouse facility cleaning tasks and infrequent changing of bed linen at home were statistically significantly associated with higher MA concentrations at home. Conclusions Spreading of MA from LAW’s workplace to their home environment takes place, especially among LAWs involved in cleaning tasks.

Background Nickel allergy is the most prevalent contact allergy. It belongs to a different hypersensitivity type to asthma and rhinoconjunctivitis. The aim of this analysis was to assess whether self-reported nickel allergy is associated with incident wheezing, asthma and rhinoconjunctivitis in young German adults, taking into account potential effect modification by sex. Methods In total, 2051 (70.6%) participants aged 19–24 years took part in the second phase of SOLAR (Study on Occupational Allergy Risks), a follow-up study of ISAAC II (the second phase of the International Study of Asthma and Allergies in Childhood) in Germany. Self-reported nickel allergy, as well as having pierced ears, and the three outcomes incident wheezing, asthma and rhinoconjunctivitis, were analysed stratified for sex. Logistic regression adjusted for potential confounders was performed. Results An association between self-reported nickel allergy and incident wheezing was observed for men and women, while only in males did pierced ears show a significant association with the outcome (adjusted OR 2.26, 95% CI 1.10–4.62). Also only in males, self-reported nickel allergy was associated with elevated odds for incident asthma (adjusted OR 4.34, 95% CI 1.22–15.41). Neither in men nor in women was a significant association observed for incident rhinoconjunctivitis. Conclusion Our results suggest that self-reported nickel allergy is associated with incident wheezing. Whether this association is due to environmental or genetic predisposition, or due to an overlap of the mechanisms of type I and type IV hypersensitivity, needs to be elucidated., Self-reported nickel allergy is associated with incident wheezing in young German males and females, and with incident asthma in males, whereas no significant association was observed for self-reported nickel allergy and incident rhinoconjunctivitis http://bit.ly/2YHmwBA

BACKGROUND & AIMS: Hepatitis B virus (HBV) contains three viral surface proteins, large, middle and small hepatitis B surface protein (LHBs, MHBs, SHBs). Proportions of LHBs and MHBs are lower in patients with inactive versus active chronic infection. Interferon alfa may convert HBeAg-positive chronic hepatitis B (CHB) to an inactive carrier state, but prediction of sustained response is unsatisfactory. The aim of this study was to test the hypothesis that quantification of MHBs and LHBs may allow for a better prognosis of therapeutic response than total hepatitis B surface antigen (HBsAg) concentration. METHODS: HBs proteins were measured before and during peginterferon alfa-2a therapy in serum from 127 Asian patients with HBeAg-positive CHB. Sustained response was defined as hepatitis B e antigen (HBeAg) seroconversion 24 weeks post-treatment. RESULTS: Mean total HBs levels were significantly lower in responders versus nonresponders at all time points (P0.70). CONCLUSIONS: HBs proteins levels differ by HBV genotype. However, quantification of HBs proteins has no advantage over the already established HBsAg assays to predict response to peginterferon alfa-2a therapy in HBeAg-positive patients.

In two research projects, rheumatological patient education programmes were updated. The first step was to develop an expert consented framework for all rheumatological patient education programmes. From this, curricula and working materials for rheumatoid arthritis (RA) and axial spondyloarthritis (AS) were derived and two exemplary patient education manuals developed. A randomized controlled trail was designed for the five-hour RA basic education program. Finally, existing train-the-trainer training courses were adapted for these patient education programmes.

Background The current desirable endpoint of treatment against chronic hepatitis B virus infection (cHBV) is to achieve a functional cure, which is defined as HBsAg loss (sAg-L) with or without anti-HBs seroconversion. However, the immunological features that are associated with functional cure have not been studied in detail. Methods 172 cHBV patients (67 HBeAg+ and 105 HBeAg-), including 141 HBsAg retained (sAg-R) patients (115 chronic hepatitis and 26 asymptomatic carriers), 31 sAg-L patients, and 24 healthy individuals (vaccinated but not infected with HBV) were examined for their T cell phenotypic profile and HBV-specific T cell responses by flow cytometry. 18 cHBV patients with low serum HBsAg levels were also longitudinally followed for their T cell phenotypic profile and HBV-specific T cell responses up to 60 weeks. Findings sAg-L patients showed distinct CD4+ and CD8+ T cell phenotype fingerprints compared to those of sAg-R patients, as mainly indicated by the upregulation of HLA-DR on both CD4+ and CD8+ T cells, and a potent HBcAg-specific CD8+ T cell response. The changes in the T cell phenotype in cHBV patients were even more profound during rapid HBsAg decrease and was associated with interferon α treatment. The expression of HLA-DR (r = 0·3269, p = 0·0037), CD95 (r = 0·2796, p = 0·0151), CD40L (r = 0·2747, p = 0·0156), CTLA-4 (r = 0·2786, p = 0·0148), TIM-3 (r = 0·3082, p = 0·0068), CD107a (r = 0·3597, p = 0·0013) on CD4+ T cells, and HLA-DR (r = 0·3542, p = 0·0016), CD69 (r = 0·2507, p = 0·0279), CD107a (r = 0·2875, p = 0·0112) on CD8+ T cells were positively correlated with the rate of HBsAg decrease. The expression of HLA-DR (r = 0·2846, p = 0·0009) and CD95 (r = 0·2442, p = 0·0049) on CD8+ T cells were positively correlated with the magnitude of the HBcAg-specific T cell responses in cHBV patients. Importantly, CTLA-4, CD95 and CD107a expression on CD4+ T cells, as well as HLA-DR and TIM-3 expression on CD8+ T cells in combination with HBsAg quantification were identified as potential predictive factors for sAg-L within 48 weeks in cHBV patients. Interpretation The onset of HBsAg decrease and subsequent loss in cHBV patients on treatment is associated with significant alterations of both CD4+ and CD8+ T cell phenotypes. Characterization of the T cell phenotype in cHBV patients may present predicative value for sAg-L. Funding National Natural Science Foundation of China, National Scientific and Technological Major Project of China, Integrated Innovative Team for Major Human Diseases Program of Tongji Medical College, “Double-First Class” Project for the International Cooperation Center on Infection and Immunity, HUST.

The objective was to evaluate the effectiveness of a self-management patient education programme for fibromyalgia syndrome (FMS) as compared with usual care education in inpatient rehabilitation. In a multicentre cluster-randomized controlled trial, 583 inpatients in 3 rehabilitation centres received an advanced self-management patient education programme or usual care education. Patients completed questionnaires at admission, discharge and after 6 and 12 months. Primary outcomes were disease- and treatment-specific knowledge at discharge, and self-management-competencies after 6 months. Secondary outcomes included satisfaction, attitudes, coping competencies, psychological distress and health impairment. We found a medium-sized effect on disease- and treatment-specific knowledge at discharge (P < 0.05, Cohen's d = 0.45, 95% CI = 0.27-0.63), and small effects for subjective knowledge, pain-related control, self-monitoring and insight, communication about disease, action planning for physical activity and treatment satisfaction (all P < 0.05). Only the effect on knowledge persisted for 6 and 12 months. This advanced education programme seemed to be more effective in the short term than usual education. However, intermediate- and long-term effects did not emerge. While superior long-term effects on knowledge as well as short-term effects on self-management skills may suggest implementation, additional long-term effects on other patient-relevant outcomes would be desirable. Trial registration: German Clinical Trials Register, DRKS00008782, Registered 8 July 2015.

This study analyzes the association of work-related stress with incident asthma and rhinitis in young adults with a special focus on gender-specific differences. Incident asthma, wheezing and rhinitis were measured in a cohort of 2051 young German adults (aged 16–18 years at baseline) recruited by the prospective population-based SOLAR study (Study of Occupational Allergy Risks). Work-related stress was measured by the Trier Inventory for the Assessment of Chronic Stress (TICS). Two TICS scales, work overload and work discontent, were analysed. Logistic regression was conducted to calculate odds ratios (OR) and 95% confidence intervals (CI). In females, the odds for incident asthma were found to be 17% higher for each increase of the work discontent score by one point (OR 1.17, 95% CI 1.04–1.31). In males, no association was statistically significant. Incident rhinitis showed no association with any exposure variable. This study shows a link between work-related stress and incident asthma which seems to be confined to women. This study adds evidence about the association of work-related stress and asthma in young adults and can contribute to prevention for that particular age group.

Sodium hypochlorite (NaClO) is a chemical commodity widely employed as a disinfection agent in water treatment applications. Its production commonly follows electrochemical routes in an undivided reactor. Powering the process with photovoltaic (PV) electricity holds the potential to install stand-alone, independent generators and reduce the NaClO production cost. This study reports the comparative assessment of autonomous, solar-powered sodium hypochlorite generators employing different photovoltaic (PV) technologies: silicon hetero-junction (SHJ) and multi-junction (MJ) solar cells. For Si hetero-junctions, the series connection of either four or five SHJ (4SHJ and 5SHJ, respectively) cells was implemented to obtain the reaction potential required. MJ cells were illuminated by a novel planar solar concentrator that guarantees solar tracking with minimal linear displacements. The three solar-hypochlorite generators were tested under real atmospheric conditions, demonstrating solar-to-chemical conversion efficiencies (SCE) of 9.8% for 4SHJ, 14.2% for 5SHJ and 25.1% for MJ solar cells, respectively. Simulations based on weather databases allowed us to assess efficiencies throughout the entire model year and resulted in specific sodium hypochlorite yearly production rates between 7.2-28 g(NaClO) cm(-2) (referred to the PV surface), depending on the considered PV technology, location, and deployment of electronics converters. The economic viability and competitiveness of solar hypochlorite generators have been investigated and compared with an analog disinfection system deploying ultraviolet lamps. Our study demonstrates the feasibility of off-grid, solar-hypochlorite generators, and points towards the implementation of SHJ solar cells as a reliable technology for stand-alone solar-chemical devices.

OBJECTIVES To investigate real-world data on warfarinisation rates and results in the elderly patients with atrial fibrillation (AF). BACKGROUND AF is the most frequent arrhythmia in the elderlies with considerable risk of devastating stroke-related consequences. Guidelines prefer non-vitamin K antagonist oral anticoagulants (NOAC) to warfarin for thromboprophylaxis. Nevertheless, warfarin is still widely used, even if it is challenging, especially in polymorbid elderlies, to achieve the therapeutic international normalised ratio (INR). There are only scarce real-world data on INR in warfarinised elderly AF patients. METHODS The study was based on multicentric observational Slovak audit of atrial fibrillation in seniors (SAFIS) performed on 4,252 hospitalised AF patients aged over 64 years (mean age 80.9 yrs.). INR data from warfarinised patients were analysed (955 at admission and 870 at discharge). RESULTS At hospital admission and discharge, the warfarin medication rates were 22.6 % and 23.5 %, respectively, INR lower than 2 was present in 41.8 % and 30.6 % of patients, respectively, and INR higher than 3 was in 27.0 % and 7.7 %, respectively and altogether, 68.8 % and 38.3 % of warfarinised patients, respectively, were out of therapeutic range. CONCLUSION Warfarin is still frequently used in the elderlies with AF, but the success rates are unsatisfactory in a huge number of patients. It is urgent to improve seniors' access to NOAC (Fig. 2, Ref. 34).

This paper describes fatigue tests performed on 6061-T651 and 5083-H321 aluminum friction stir welded joints with dimensions and loading conditions typical for structural applications. Butt and lap joint details with various defects intentionally introduced were tested under tension-only constant and variable amplitude loading conditions. In this paper, the fatigue test results are presented along with supporting metallurgical and nonlinear fracture mechanics analyses. Based on this work, it is concluded that kissing bond defects on the order of 0.3–1.0 mm can result in a significant fatigue life reduction and a shift in the failure mode to the weld root. The investigated toe-flash defect had less of an effect on fatigue performance. The lap joint did not perform as well as the butt joint detail.

Background and aims: Peripartum transmission of hepatitis B virus (HBV) from an infected mother to the child can be prevented in most but not all cases by immediate vaccination of the newborn. The aim of this study was to compare the efficacy of two licensed hepatitis B vaccines, Engerix-B versus Sci-B-Vac, in preventing peripartum HBV transmission. Methods: A prospective multicenter randomized controlled study in 4 delivery centers was performed from 2009 to 2014. HBsAg positive pregnant women and their newborns were recruited at the delivery rooms. All newborns received Hepatitis B Immune Globulin within 10 h after birth, as well as active HBV vaccination at 0, 1 and 6 months of age. Maternal assessment at delivery included transaminases, blood count, international normalized ratio and viral status. Infants were tested for HBsAg, anti-HBc and anti-HBs at 12 months of age. Results: In the intention to treat (ITT), 171 infant and mother pairs fulfilled the study enrollment criteria and completed follow up, 82 received Engerix-B and 89 Sci-B-Vac. Maternal parameters and viral status were similar in both groups. At 12 months of age, the Sci-B-Vac group had lower HBsAg carriage rates (1/89, 1.1%) than the Engerix-B group (5/82, 6.1%) with borderline significance (risk difference of −0.05, 95% CI −0.11–0.007, t-test = 0.05), and borderline significance lower vaccine failure rates with anti-HBs &lt, 10 mIU/mL in the Sci-B-Vac (2/89, 2.2%) than in the Engerix-B (8/82, 9.8%, p = 0.05). Higher seroprotection rates were found in the Sci-B-Vac group with all anti-HBs titer stratifications of &gt, 10 mIU/mL (p = 0.05), &gt, 100 mIU/mL (p = 0.05) and &gt, 1000 mIU/mL (p = 0.01). Active/passive vaccination was effective in 10/13 cases with maternal HBV DNA levels &gt, 7 log10 IU/mL up to 9.5 log10 IU/mL, but failed in 3 cases for unknown reasons. Conclusion: Sci-B-Vac was superior to Engerix-B in preventing peripartum HBV transmission in neonates from HBsAg+ mothers and induces significantly higher anti-HBs levels. NIH registration number: NCT 01133184.

Additive manufacturing (AM) help in delivering spare parts within short lead times and thus avoid maintaining huge inventories. Companies exploring opportunities to produce spare parts using AM face challenges in identifying suitable spare parts. Moreover, a single method may not be applicable for all companies. An idiosyncratic approach needs to be adopted by considering the characteristics of parts in the portfolio. This study follows a design science approach to address an evident research gap by developing a process to identify spare parts suitable for AM. The case data were analysed using multi-criteria decision-making and cluster analysis techniques. The research contributes by developing and demonstrating a methodology to identify spare parts suitable for AM from a portfolio of a large number of spare parts, where adequate discrimination was not obtained by ranking all parts together. The study develops generic guidelines for spare parts selection for AM and outline the generalizability of the proposed methodology beyond the domain of part selection for AM.

A tracking‐integrated hybrid micro‐concentrator module is presented that can harvest direct, diffuse, and albedo irradiance components. It uses biconvex 180× lens arrays to concentrate direct light on high‐efficiency III–V solar cells (29% module efficiency has been demonstrated outdoors on direct sunlight at Concentrator Standard Test Conditions) and a planar micro‐tracking mechanism to allow installation in static frames. Two architectures have been developed to harvest diffuse irradiance: (1) a hybrid architecture where the backplane is covered with monofacial or bifacial Si cells; (2) a translucent architecture where diffuse light is transmitted through the module for dual‐land‐use applications, such as agrivoltaics. Simulations show that the hybrid architecture provides an excess of yearly energy production compared to 20% efficiency flat‐plate photovoltaic (PV) module in all locations studied, including those with a low direct normal irradiance (DNI) content, and up to 38% advantage in high‐DNI locations. The use of bifacial heterojunction and interdigitated back‐contact Si cells has been explored for the glass–Si–glass backplane laminate to harvest albedo light. Bifacial gains modeled can boost energy yield by about 30% in the best scenario. We discuss the perspectives of the translucent modules for dual‐land‐use applications as well, such as integration in greenhouses for agriculture‐integrated PV (agrivoltaics). This architecture can provide up to 47% excess electricity compared to a spaced reference Si array that transmits the same amount of solar photosynthetically active radiation for crop production. The HIPERION consortium funded by the European H2020 program is making an intensive effort to take this technology to the industrial scale.

Communication interfaces are particularly challenging to test using automatically generated test data. The test data sent through the interface must be ”valid enough” to overcome initial sanity checks of the interface and reach functions deep inside the integrated software. Machine-readable information about what data forms ”valid enough” messages is rarely available to test data generation tools. So instead, we evolve the messages with an evolutionary algorithm. This enables efficient fuzz testing for the communication interface between a satellite and its ground station. In this paper, using an algorithm implementation in our fuzzing tool DCRTT, we investigate the impact of algorithm parameter selection on the performance and the possibility of efficient general default parameter values. The preliminary results promise significant improvements to automated testing with respect to software security testing and quality assurance.

Wireless networks have become a common part of everyone’s life who wants to connect to the Internet network. Despite the rapid development of wireless technologies, common users still do not pay much attention to the security questions. One of the most challenging security problems of Wi-Fi networks is to detect and prevent the fake access point attack. Existing solutions require the installation of proprietary hardware, protocol changes, measuring frame characteristics etc. Moreover, these solutions are strictly focused on an individual cyber attack detection. In this work, we propose our method that detects a fake access point and that allows the detection of multiple cyber attacks in local wireless networks. In our research, we focus on the detection of the fake access point attack, the KARMA attack, the frequency congestion attack and the de-authentication attack.

We used electrical characterization as well as surface analytical methods to understand leakage behavior and breakdown mechanisms of three different interlayer dielectrics (ILD) in detail. Leakage current measurements were conducted on Back End of Line (BEoL) metal comb structures with variations of line spaces. Schottky barriers as well as trap potential heights were estimated. Furthermore the Schottky barrier height was determined on blanked wafers by X-Ray Photoelectron Spectroscopy (XPS) and Reflection Electron Energy Loss Spectroscopy (REELS). A correlation between the two methods was established. In addition REELS studies were performed on samples with etch induced damage that was emulated by argon sputtering of pristine ILDs. Two defect states have been found within the band gap of all ILDs, which could influence the electron transport at the dielectrics interface.

A new conceptual framework has enabled the flexible development of rheumatological patient educational programs for different healthcare settings. On this basis, a 5‑h basic training program for patients with rheumatoid arthritis (RA) was developed to be used in specialized centers. Rheumatologists and psychologists were first trained and then the efficacy of the patient training program was evaluated based on the causal model of patient education.The externally randomized waiting control group study with 249 RA patients included 3 measurement points. The impact of the 5‑h basic training on disease and treatment-related knowledge as well as health competence of RA patients was examined. Secondary questions included attitudinal parameters, communication competence, effects on the disease and satisfaction with the educational program. Data were analyzed on an intention to treat basis by means of covariance analyses for the main target variables, adjusted for baseline values.The analyses showed that the training program was effective. Even 3 months after training, participants reported more knowledge and health competence than the waiting control group, with small to medium-sized effects (d = 0.37 and 0.38, respectively). With the exception of disease communication, no other effects of training were observed in the secondary objectives.The basic training program provides a good foundation to develop further interventions to improve attitudinal and disease parameters. It can serve as a central component for rheumatological healthcare for patients with RA at various levels.HINTERGRUND: Ein neues Rahmenkonzept hat die flexible Ableitung und Nutzung von rheumatologischen Schulungsprogrammen für unterschiedliche Versorgungsbereiche ermöglicht. Auf dieser Grundlage wurde eine 5‑stündige Basisschulung für Patienten mit rheumatoider Arthritis (RA) entwickelt, es wurden rheumatologische Fachärzte und Psychologen trainiert, und dann wurde die Wirksamkeit nach dem Wirkmodell der Patientenschulung evaluiert.Mit dem Studiendesign einer extern randomisierten Wartekontrollgruppenstudie mit 3 Messzeitpunkten wurde geprüft, wie sich die 5‑stündige Basisschulung auf das Erkrankungs- und Behandlungswissen sowie auf die Gesundheitskompetenz von RA-Patienten (n = 249) auswirkt. Weitere Fragen betrafen Einstellungsparameter, Kommunikationskompetenz, Erkrankungsauswirkungen und die Zufriedenheit mit der Schulung. Die Auswertungen erfolgten auf Intention-to-treat-Basis mit Kovarianzanalysen für die Hauptzielgrößen unter Berücksichtigung des Ausgangswertes.Die Analysen zeigen, dass die Basisschulung RA wirksam ist. Noch 3 Monate nach der Schulung verfügten die Schulungsteilnehmer über mehr Wissen und Gesundheitskompetenz als die Wartekontrollgruppe mit kleinem bis mittelgroßem Effekt (d = 0,37 bzw. 0,38). In den Nebenzielgrößen zeigten sich mit Ausnahme der Krankheitskommunikation keine weiteren Schulungseffekte.Die Basisschulung bietet eine gute Grundlage, auf der weitere Interventionen zur Verbesserung von Einstellungs- und Erkrankungsparametern aufbauen können. Sie eignet sich damit als zentraler Baustein für die rheumatologische Versorgung auf verschiedenen Ebenen.

Most of the cryptographic constructions deployed in practical systems today, in particular digital signatures and key-establishment schemes, are vulnerable to attacks using quantum computers. Post-quantum cryptography (PQC) deals with the design and implementation of cryptographic algorithms that are resistant to these attacks. In this paper, we evaluate the NIST’s PQC competition candidates with respect to their suitability for the implementation on special hardware platforms. In particular, we focus on the implementability on constrained platforms (e.g., smart cards, small single-board computers) on one side and on the performance on very fast hardware-accelerated platforms (i.e., field-programmable gate arrays - FPGAs) on the other side. Besides the analysis of the candidates’ design features affecting the performance on these devices and security aspects, we present also the practical results from the existing implementation on contemporary hardware.

The demands for higher fuel efficiency in the automotive sector have motivated the increased use of multi-material combinations for lightweight designs in recent years. This has inevitably led to challenges in joining materials where aluminum alloys, magnesium alloys, and steels (i.e. low, medium and ultra-high strength) are combined. Since each of these materials offer varying performance and property advantages for various components, they have been introduced progressively in different locations of new designs. Consequently, these material combinations will inevitably need to be joined, which presents major challenges due to their incompatibility during conventional fusion welding processes used in vehicle manufacture. This paper summarizes recent progress in friction-based techniques for joining dissimilar material combinations, and discusses factors controlling bonding and joint strength. Since friction stirs welding (FSW) and its sub-family do not involve bulk melting of the components (the peak temperature in FSW is about 0.6–0.95 melting point of materials), it is among most capable welding techniques for joining dissimilar materials. In the automotive industries, the attention and application of FSW has been in three general sets. These include the joining of extruded parts to form “larger extrusions”, the joining of tailor welded blanks, and the joining for various assembly applications. FSW in each of these has diverse advantages and resulting cost reductions. However, cost effective and reliable joints of light weight alloys (i.e. aluminum) and steel will demand significant development and consideration. The purpose of the present review paper is to assess the status of friction-based solid state welding of dissimilar automotive alloys, with specific attention to the automotive industry, future trend, challenges and limitations. The main difference between the FSW of similar and dissimilar alloys is the incoherency in properties across the butting surfaces which has a significant influence on the flow behavior of materials during stirring.

BACKGROUND: Previous studies showed controversial results for the influence of pregnancy-related and perinatal factors on subsequent respiratory and atopic diseases in children. The aim of this study was to assess the association between perinatal variables and the prevalence of asthma, bronchial hyperreactivity (BHR), flexural eczema (FE), allergic rhinitis, and sensitization in childhood and early adulthood. METHODS: The studied population was first examined in Munich and Dresden in 1995/1996 at age 9-11 years. Participants were followed until age 19-24 years using questionnaires and clinical examinations. Associations between perinatal data and subsequent atopic diseases were examined using logistic regression analyses adjusting for potential confounders. RESULTS: Cesarean section was statistically significantly associated with BHR in early adulthood (odds ratio 4.8 [95% confidence interval 1.5-15.2]), while assisted birth was associated with presence of asthma symptoms in childhood (2.2 [1.2-3.9]), FE symptoms (2.2 [1.2-4.3]) and doctor's diagnosis of atopic dermatitis (1.9 [1.0-3.4]) in childhood, and sensitization in early adulthood (2.2 [1.1-4.3]). Lower birth length (1.9 [1.1-3.2]), lower birthweight (0.5 [0.3-0.9]), and higher birthweight (0.6 [0.4-1.0]) were predictive of sensitization in early adulthood compared to average birth length and birthweight, respectively. None of the other perinatal factors showed statistically significant associations with the outcomes. CONCLUSIONS: Our results indicate that children who are born by cesarean section and especially by assisted birth, might be at greater risk for developing asthma, FE, and sensitization and should hence be monitored. Prenatal maternal stress might partly explain these associations, which should be further investigated.

Background: In metastatic renal cell carcinoma (mRCC) there has been a treatment shift towards targeted therapy, which has resulted in improved overall survival. Therefore, there is a need for better local control of the tumor and its metastases. Image-guided stereotactic body radiotherapy (SBRT) in bone metastases provides improved symptom palliation and local control. With the use of SBRT there is a need for accurate target delineation. The hypothesis is that MRI allows for better visualization of the extend of bone metastases in mRCC and will optimize the accuracy of tumor delineation for stereotactic radiotherapy purposes, compared with CT only. Methods: From 2013 to 2016, patients who underwent SBRT for RCC bone metastases were included. A planning CT and MRI were performed in radiotherapy treatment position. Gross tumor volumes (GTV) in both CT and MRI were delineated. Contouring was performed by a radiation oncologist specialized in bone metastases and verified by a radiologist, based on local consensus contouring guidelines. In both CT and MRI, the GTV volumes, conformity index (CI) and distance between the centers of mass (dCOM) were compared. Results: Nine patients with 11 RCC bone metastases were included. The GTV volume as defined on MRI was in all cases larger or at least as large as the GTV volume on CT. The median GTV volume on MRI was 33.4 mL (range 0.2–247.6 mL), compared to 18.1 mL on CT (range 0.1–195.9) (P=0.013). Conclusions: Contouring of RCC bone metastases on MRI resulted in clinically relevant and statistically significant larger lesions (mean increase 41%) compared with CT. MRI seems to represent the extend of the GTV in RCC bone metastases more accurately. Contouring based on CT-only could result in an underestimation of the actual tumor volume, which may cause underdosage of the GTV in SBRT treatment plans.

Automated software verification tools support developers in detecting faults that may lead to runtime errors. A fault in critical software that slips into the field, e.g., into a spacecraft, may have fatal consequences. However, there is an enormous variety of free and commercial tools available. Suppliers and customers of software need to have a clear understanding what tools suit the needs and expectations in their domain. We selected six tools (Polyspace, QA C, Klocwork, and others) and applied them to real-world spacecraft software. We collected reports from all the tools and manually verified whether they were justified. In particular, we clocked the time needed to confirm or disprove each report. The result is a profile of true and false positive and negative reports for each tool. We investigate questions regarding effectiveness and efficiency of different tools and their combinations, what the best tool is, if it makes sense at all to apply automated software verification to well-tested software, and whether tools with many or few reports are preferable.

ObjectiveAmong individuals with chronic hepatitis B, those with hepatitis B e-antigen (HBeAg)-negative chronic hepatitis (CHB) can be difficult to distinguish from those with HBeAg-negative chronic HBV infection, also referred to as inactive HBV carriers (ICs), but both require different medical management. The level of HBV surface antigen (HBsAg) has been proposed as a marker to discriminate between chronic infection and hepatitis stages. HBsAg consists of large, middle and small HBs. The aim of this study was to determine whether the composition of HBsAg improved the identification of ICs among HBsAg-positive subjects with different phases of HBV infections.DesignHBV large surface proteins (LHBs) and HBV middle surface proteins (MHBs) were quantified in serum samples from 183 clinically well-characterised untreated patients with acute (n=14) HBV infection, ICs (n=44), CHBs (n=46), chronic HBeAg-positive phase (n=68) and hepatitis delta coinfection (n=11) using an ELISA, with well-defined monoclonal antibodies against the preS1 domain (LHBs) and the preS2-domain (MHBs). A Western blot analysis was used to verify the quantitation of the components of HBsAg. Total HBsAg was quantified using a modified commercially available assay (HBsAg V.6.0, Enzygnost, Siemens, Erlangen).ResultsThe composition of HBsAg showed specific patterns across different phases of hepatitis B. Individuals in the IC phase had significantly lower proportions of LHBs and MHBs than patients in acute or chronic phases irrespective of their HBV e-antigen status (pConclusionQuantification of MHBs, particularly LHBs represents a novel tool for the identification of the IC stage.

The characteristics of a pulsed gas metal arc welding (GMAW-P) process that simultaneously achieves streaming transfer and low arc length are described. The process uses a nearly square shaped current profile. It was found that when high pulse frequency pulses are used with high peak and low background current, stream metal transfer is achieved at short arc lengths. Stable streaming transfer was accomplished at a wire feeding speeds of 13.97 m/min with heat input as low as 0.58 kJ/mm. Therefore, a high productivity welding process with potential advantages for narrow groove welding of heat sensitive materials is presented.

A 100-µm diameter, nearly flat, instrumented, indenter is used to indent aluminum AA-6463 and X80 pipeline steel. In contrast to sharp and spherical indenters, a rising load-displacement response is followed by a concave-downwards response during indentation. The substrate materials are characterized using tension and compression tests. Yield strengths measured under compression are within +/− 10% of the tensile values thereby providing partial support for assuming symmetric tension-compression response. Based on imaging of the actual indenter using a Scanning Electron Microscope, a model of the indenter that accounts for the curved contact profile was created, assumed to be rigid and used in the finite element simulations. In the simulations, tensile yield strength and flow properties, obtained by tensile testing are used to describe the behavior of the substrate and good agreement with measured indentation force-displacement curves was obtained when the exact shape of the indenter was used. The agreement is poor when the contact profile of the indenter was idealized as flat. In the context of the inverse approach, using the Efficient Global Optimization technique, fits to the stress-strain curves of both of the alloys were obtained, and again the curvature of the indenter contact profile is found to be crucial. This work sets the stage for a large-scale deployment of the inverse approach to map the stress-strain response of heterogeneous microstructures such as welds.

This work investigates the detection and mitigation methods that aim at Slow Denial of Service attacks. The paper focuses mainly on Slowloris and Slow Read DoS attacks which are resistant to classical DoS detection and mitigation techniques. The proposed approach consists of the detection phase and mitigation phase. Detection methods are based on network traffic analysis and anomalous traffic monitoring. Furthermore, if an attack is recognized then classified malicious traffic is blocked and web server resources are released. The proposed methods are implemented and consolidated into an intrusion prevention system software. The implemented system is tested and obtained results prove its functionality.

Rugged GaN HEMT low-noise amplifiers are well established, but the common concept of achieving ruggedness by applying the gate supply voltage through a high ohmic resistance might not be sufficient in addition to control the maximum output power. This paper shifts the focus to the protection of subsequent stages and proposes a circuit concept based on an output attenuator and an adaptive drain supply. It is shown that the concept implementation provides an attenuation of up to 28 dB under input overdrive condition while leaving small-signal noise figure unaffected.

ObjectivesSince 2014, the Federal German Pension Insurance has approved several departments to implement work-related medical rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related medical rehabilitation under real-life conditions.MethodsParticipants received either a common or a work-related medical rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related medical rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the rehabilitation programme.ResultsWe compared 641 patients who were treated in work-related medical rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related medical rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common medical rehabilitation. A per-protocol analysis revealed that work-related medical rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered.ConclusionsThe implementation of work-related medical rehabilitation in German rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care.Trial Registration NumberDRKS00009780

Distributed Denial of Service attacks (DDoS) are used by attackers for their effectiveness. This type of attack is one of the most devastating attacks in the Internet. Every year, the intensity of DDoS attacks increases and attackers use sophisticated multi-target DDoS attacks. In this paper, a modular system that allows to increase the filtering capacity linearly and allows to protect against the combination of DDoS attacks is designed and implemented. The main motivation for development of the modular filtering system was to find a cheap solution for filtering DDoS attacks with possibility to increase filtering capacity. The proposed system is based on open-source detection and filtration tools.

Objectives: We aimed at analysing the association of occupational disinfectants use with asthma and wheezing in early-career professionals. Methods: Three hundred and fifty-six participants from the German Study on Occupational Allergy Risks (SOLAR) II (2007-2009, overall response: 70.6%) aged 20 to 24 years and working in cleaning or health services answered a questionnaire on respiratory health (doctor’s diagnosis of asthma and current symptoms of asthma and wheezing or asthma medication), occupational exposure to disinfectants, and potential confounders such as sociodemographic, lifestyle, and additional occupational factors. Logistic regression models evaluated the association between duration of occupational exposure to disinfectants (no exposure, exposure for up to 12 months, exposure for more than 12 months) with the three outcome variables doctor-diagnosed asthma, current asthma, and current wheezing. Results: After adjustment for potential confounders, individuals occupationally exposed to disinfectants for more than twelve months had almost three times the odds of doctor-diagnosed asthma compared to those not exposed (OR: 2.86, 95% CI: 1.18-6.90). The evidence for an association between occupational exposure to disinfectants for up to twelve months and current asthma was slightly weaker (OR: 2.78, 95% CI: 0.93-8.32), while for current wheezing we observed no evidence for an association. Conclusions: Our results provide some further evidence for an association between occupational exposure to disinfectants and asthma, indicating that this can be seen after a relatively short period of exposure.

Pre-print of article presented for publication in the Proceedings of the 46th IEEE PVSC, Chicago, USA, June 2019 Abstract — The Swiss start-up Insolight aims to be the first company to commercialize a high-efficiency III-V based low profile micro-CPV product that uses planar micro-tracking to eliminate the need for a tilting solar tracker, allowing rooftop mounting using typical flat-plate hardware, as well diffuse light capture using low cost Si solar cells which cover the area of the back plane not taken up by III-V solar cells. The IES-UPM has made an initial performance evaluation of a 0.1m2 prototype. We show that the integrated planar tracking can reach 55° AOI, show CSTC efficiency near to 30% for III-V output, and demonstrate the diffuse capture and planar tracking capability in a multi-week test campaign at our test site in Madrid. This preprint was uploaded before review by IEEE. The post-print is now available and may be viewed in Open Access at the UPM Open Access Repository (oa.upm.es/57352/). No changes to the text were made between the pre- and post- print versions.

Background: Assessment of pain is important in daily clinical practice and as an endpoint in clinical studies. Because pain perception is highly subjective, pain measurement is complex. Selfrating pain scales are currently of great importance but have limitations. They depend on many more factors than pain, which could lead to an incorrect assessment of therapies or clinical studies. Therefore, there is need for valid, reliable, safe, and low-cost methods to determine and quantify patients’ pain more objectively. Objective: To provide an overview of devices and techniques that can be used to administer a pain stimulus with similar intensity as the endogenous pain experienced by the patient, in order to quantify and subsequently follow patients’ pain more objectively. Study Design: In this systematic review, articles from PubMed, EMBASE, Cochrane library and Scopus were reviewed for eligibility. Methods: Studies that described a device or technique that could be used to induce a variable, controlled, and measurable pain stimulus were included. Studies that made correlations with established pain scales or those who compared outcomes in multiple tests were selected to assess validity and reliability. Results: A total of 1,308 manuscripts were initially retrieved. After independent screening by a team of 4 reviewers, 19 studies were eventually included describing 15 different devices or techniques. These devices could be divided into groups based on stimulus administration: electrical, external pressure (probe) and miscellaneous pain stimulators. Electrical stimulators were found to be tested extensively and proven to be both valid and reliable. Limitations: To correlate new techniques with older methods such as the Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) for which an improvement is desired, is debatable. To (partially) address this problem, the reliability is added as an additional primary outcome to assess which device works best. Further limitations include the heterogeneity of studies found in both the types of pain measured as in outcome measures presented. In addition, it is important to note that part of the devices described cannot directly be used for clinical practice due to products that have cease to exist or the description of solely techniques rather than testing ready-to-use devices. Conclusion: Several devices and techniques compared pain intensity experienced by patients with an external pain stimulus that potentially could be used as a new objective pain measurement tool. Given the results of our review, electrical stimulators that have been tested extensively with high validity, reliability, and feasibility would be recommended for use for clinical and research purposes. Moreover, normalization of pain intensity scores for current perception is important. Pain intensity normalization leads to higher correlations with established pain scales and possibly to increased inter-patient reliability. Registration number: Registered in the PROSPERO database (PROSPERO 2016:CRD42016041974) Key words: Systematic review, objective pain measurement, pain scales; devices, techniques, validity, reliability, safety, feasibility

Objective: Radiotherapy is the standard local treatment for patients with painful bone metastases, but effectiveness has primarily been evaluated in trial populations. The aim of this study was to study pain response to palliative radiotherapy in a prospective cohort of unselected patients with bone metastases. Methods: Patients with painful bone metastases referred to the UMC Utrecht for radiotherapy and enrolled in the PRESENT cohort were included in this study. For all patients, pain response to radiotherapy was assessed, and responders were defined as patients with a complete or partial pain response. Patients with stable pain scores, pain increase, or undetermined response were regarded non-responders. Pain scores obtained at baseline and after 2, 4, 6, 8, and 12 weeks following radiotherapy were obtained. Pain response rates of the total treated population, as well as response rates of the assessable patients, were calculated. To measure the percentage of the remaining time spent with pain relief, the net pain relief (NPR) was calculated by dividing the period of pain relief by the period of survival. Results: Of the 432 patients enrolled in this study, 262 patients (61%) experienced a complete or partial response. In the 390 assessable patients, this percentage was 67%. Median time to response was 4 weeks (range 1-15 weeks), and the NPR was 64%. Conclusion: Compared to randomized trial populations, palliative radiotherapy in our unselected patients with bone metastases showed similar pain response rates (61%), with a reasonable duration of this effect.