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Introduction Suicide is a leading cause of mortality in the United States and recent initiatives have sought to increase monitoring of suicide risk within healthcare systems. Working-age adults (22–64 years) admitted to nursing homes may be at risk for suicidal ideation, yet little is known about this population. Methods The national nursing home database, Minimum Dataset 3.0, was used to identify 323,436 working-age adults newly admitted to a nursing home in 2015. This cross-sectional study sought to describe sociodemographic and clinical characteristics, examine behavioral health treatment received, and determine resident characteristics associated with suicidal ideation at nursing home admission using logistic regression and reports adjusted odds ratios (aOR). Results Suicidal ideation was present among 1.27% of newly admitted working-age residents. Almost 25% of those with suicidal ideation had no psychiatric diagnosis. Factors associated with increased odds of suicidal ideation included younger age (aOR 1.90), admission from the community (aOR 1.92) or a psychiatric hospital (aOR 2.38), cognitive impairments (aOR 1.46), pain (aOR 1.40), rejection of care (aOR 1.91), and psychiatric comorbidity (aOR depression: 1.91, anxiety disorder: 1.11, bipolar disorder: 1.62, schizophrenia: 1.32, post-traumatic stress disorder: 1.17). Limitations Due to the cross-sectional nature of this study, no causal inferences about suicidal ideation and the explored covariates can be made. The Minimum Dataset 3.0 has only one measure of suicidal ideation the Patient Health Questionnaire. Conclusion Factors other than psychiatric diagnosis may be important in identifying newly admitted working-age nursing home residents who require on-going suicide screening and specialized psychiatric care.

This study aimed to investigate the use thermography of rewarming hands (a) for individuals without a clinical diagnosis for circulatory issues, evaluating the distal dorsal difference (DDD) and the absolute temperature after cold stress; (b) to evaluate individuals which have been previously diagnosed with primary and secondary Raynaud’s phenomenon (RP); and (c) to indicate parameters (most suitable finger and trial period) to support the RP diagnostic with thermography. We evaluated 174 individuals, 150 without specific diagnosis and 24 participants with RP. A thermal camera was used to record skin temperature following a cold stress protocol. The hands were then immersed up to the carpal level in a container with cold water. Images were recorded immediately after the emersion and every 5 min, until 20 min post-immersion. For the data analysis, normalized histograms were mapped to define the probability density function of absolute temperature and DDD. The best finger and the best analysis time were defined by the ratio between variance and chi-square, to find the best trade-off between model fitting and data separation into two distinct groups. A hit rate (recall value) of 91.7% for the DDD model and 79.2% for the absolute temperature model were found using DDD ≥ − 1.0 °C for the ring finger and T ≥ 25.5 °C for the index finger. Results show that DDD and absolute temperature models could be suitable as a RP condition exclusion criterion. Moreover, the use of multiple fingers is recommended. We recommend using at least 15 min for the rewarming analysis period to maximize the thermal differences and the inspection using the ring finger (if the metric is the DDD) and the index finger (if the used metric is the absolute temperature).

A 46-year-old man was admitted to the hospital by ambulance due to syncope. A standard blood screening showed a normal Hb value. The man had known hemorrhoids and a single fresh rectal bleeding earlier at home. On the following morning, the patient suddenly required resuscitation within a few minutes and subsequently died. Autopsy revealed a fatal hemorrhage with blood loss in the stomach and small and large intestines and a mucosal defect of the duodenum. After autopsy, the question arose whether the cause of death might have been a rare Dieulafoy’s lesion—aim of this case report was to clarify the diagnosis.

Background Little is known about the heterogeneous clinical profile of physical frailty and its association with cognitive impairment in older U.S. nursing home (NH) residents. Methods Minimum Data Set 3.0 at admission was used to identify older adults newly-admitted to nursing homes with life expectancy ≥6 months and length of stay ≥100 days (n = 871,801). Latent class analysis was used to identify physical frailty subgroups, using FRAIL-NH items as indicators. The association between the identified physical frailty subgroups and cognitive impairment (measured by Brief Interview for Mental Status/Cognitive Performance Scale: none/mild; moderate; severe), adjusting for demographic and clinical characteristics, was estimated by multinomial logistic regression and presented in adjusted odds ratios (aOR) and 95% confidence intervals (CIs). Results In older nursing home residents at admission, three physical frailty subgroups were identified: “mild physical frailty” (prevalence: 7.6%), “moderate physical frailty” (44.5%) and “severe physical frailty” (47.9%). Those in “moderate physical frailty” or “severe physical frailty” had high probabilities of needing assistance in transferring between locations and inability to walk in a room. Residents in “severe physical frailty” also had greater probability of bowel incontinence. Compared to those with none/mild cognitive impairment, older residents with moderate or severe impairment had slightly higher odds of belonging to “moderate physical frailty” [aOR (95%CI)moderate cognitive impairment: 1.01 (0.99–1.03); aOR (95%CI)severe cognitive impairment: 1.03 (1.01–1.05)] and much higher odds to the “severe physical frailty” subgroup [aOR (95%CI)moderate cognitive impairment: 2.41 (2.35–2.47); aOR (95%CI)severe cognitive impairment: 5.74 (5.58–5.90)]. Conclusions Findings indicate the heterogeneous presentations of physical frailty in older nursing home residents and additional evidence on the interrelationship between physical frailty and cognitive impairment.

A systematic review did not show any usability evaluation tool specifically developed for blind people. This paper reports an empirical study, investigating the similarity between usability evaluat...

To describe the development process of wrist, hand, and finger orthoses for children with cerebral palsy using low-cost additive manufacturing and also consider the perspective of caregivers and occupational therapists to evaluate the potential of applying this process. Four cases of study were conducted of orthoses developed for children with cerebral palsy, all of whom were indicated for the use of orthoses. The applied development process has 8 stages: data collection, client preferences, acquisition of anatomy, 3D scanning, 3D cad modelling, 3D printing, finishing, and delivery and evaluation. There was the participation of caregivers and occupational therapists in the evaluation of the process and of the product development. An adaptation of QUEST was used in order to assess satisfaction at the time of product delivery. One year after delivery, OTs who monitored the cases completed a questionnaire. As a result, it was identified that it is possible to use the proposed process. Furthermore, the four hand and finger wrist orthoses were produced for children with cerebral palsy using low-cost materials and methods. By evaluating with professionals and stakeholders, the products were considered to be light weight and aesthetically pleasing. The OTs considered the orthoses to be clinically adequate and corresponding to the therapeutic objective. It is concluded that the low-cost additive manufacturing process used to produce customized wrist, hand, and finger orthoses for children with cerebral palsy is feasible. The generated orthoses were considered adequate from the perspective of caregivers and therapists.

Zusammenfassung. Einleitung: Neben der Prävention des Tabakkonsums bleibt die Herstellung und Sicherung eines hohen Niveaus der Behandlungsqualität bei schädlichem Gebrauch und Abhängigkeit von Tabakprodukten eine wichtige gesundheitsbezogene Aufgabe in Deutschland. Eine regelmäßige Aktualisierung der AWMF-S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“ schafft eine nachhaltige und seriöse Quelle für den Wissensstand zur Tabakentwöhnung. Methoden: Unter Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und Suchttherapie e. V. (DG-Sucht) wurde die Tabakleitlinie 2019–2020 von insgesamt 63 am Entstehungsprozess des Textes beteiligten Personen in 11 Arbeitsgruppen überarbeitet. Der Einfluss von Interessenkonflikten (COI) konnte durch ein sorgfältiges COI-Management minimiert werden. Über die 80 Leitlinienempfehlungen diskutierten Delegierte aus 50 Fachgesellschaften und stimmten in einem moderierten Konsensprozess online ab. Ergebnisse: Neben Empfehlungen zum Screening und zur Diagnostik nimmt die Leitlinie positiv Stellung zur Nutzung niederschwelliger Beratungs- und Unterstützungsangebote. Falls aufgrund des Schweregrads der tabakbezogenen Störung Kurzberatung, Telefonberatung oder Internet- bzw. Smartphone-gestützte Verfahren nicht hinreichend wirksam sind, ist eine verhaltenstherapeutisch basierte Einzel- oder Gruppenbehandlung, ggf. in Verbindung mit Medikamenten, indiziert. Wenn eine Nikotinersatztherapie nicht wirksam sein sollte, soll Vareniclin oder Bupropion angeboten werden. Alternative Strategien mit niedrigerem Empfehlungsgrad sind Hypnotherapie, achtsamkeitsbasierte Verfahren, oder auch Cytisin. Bei Jugendlichen und Schwangeren ist das Angebot von Medikamenten auf genau spezifizierte Ausnahmen und Nikotinersatz zu beschränken. Die mittlere Zustimmung für die Empfehlungen der Leitlinie erreichte 98 %. Eine Gesamtübersicht über die Behandlungsempfehlungen der Tabakleitlinie geben drei klinische Algorithmen.

This investigation aims to categorize and identify the general teaching competencies that professors who work in a public innovative Brazilian university should develop. It employs the Delphi Panel method, which allows a consensus of opinions to be reached by a group of experts. This study had eight expert participants from different fields of study. They engaged answering five rounds of instrument, that were sent by email to them. After analyzing the competencies, the experts suggested agglutination between some categories and some eliminations. As a result, the competences were summarized in six categories: Digital, Internalized, Externalized, Teaching Knowledge, Technical and Innovative. This research will serve as theoretical support for the construction and elaboration of a theoretical-practical model for the identification of teaching competencies to work in Brazilian public innovative universities.

Self-reported physical activity differs from activity levels measured by device. We tested the effect of a video that visualizes the intensity levels of physical activity to increase the agreement between self-reported and accelerometer-based moderate-to-vigorous physical activity (MVPA) within a single-blinded, randomized study. Participants (N = 378, 40-75 years) wore an accelerometer for seven days. Prior to the collection of self-reported data by the IPAQ-SF, participants were randomly assigned (1:1) to a control group (CG) or a video group (VG). The outcome was the absolute difference between self-reported and accelerometer-based time spent in MVPA (Δ MVPAIPAQ-Accelerometry ). To examine the agreement, we used Spearman correlation coefficients and Bland-Altman analysis. To test the video effect, we used Wilcoxon signed-rank test, Bayes factor, and simultaneous-quantile regression. In total, 302 participants fulfilled the accelerometer wear time criteria (≥10 hours/day; ≥6 days) and completed self-reports within three days after the wearing period. The median of Δ MVPAIPAQ-Accelerometry was -9.0 min/day (IQR: -32.0 to 66.6) for CG and -11.5 min/day (IQR: -29.9 to 14.3) for VG. Wilcoxon signed-rank test revealed no differences in Δ MVPAIPAQ-Accelerometry between study groups whereas Bayes factor indicated insensitivity of the data. Simultaneous-quantile regression revealed no relationship between video presentation and Δ MVPAIPAQ-Accelerometry in the 25th percentile. In the 50th (b = -12.4 [95% CI = -23.2 to -1.5] and 75th percentile (b = -45.7 [95% CI = -70.5 to -20.9]), Δ MVPAIPAQ-Accelerometry was negatively associated with video presentation. To conclude, video-supported assessment may increase the accuracy of self-reported MVPA among individuals who slightly underestimated and those who overestimated their MVPA.

Background: The purposes of this study were to examine accelerometer measurement reactivity (AMR) in sedentary behavior (SB), physical activity (PA), and accelerometer wear time in 2 measurement periods and to quantify AMR as a human-related source of bias for the reproducibility of SB and PA estimates. Methods: In total, 136 participants (65% women, mean age = 54.6 y) received 7-day accelerometry at the baseline and after 12 months. Latent growth models were used to identify AMR. Intraclass correlations were calculated to examine the reproducibility using 2-level mixed-effects linear regression analyses. Results: Within each 7-day accelerometry assessment, the participants increased their time spent in SB (b = 2.4 min/d; b = 3.8 min/d) and reduced their time spent in light PA (b = −2.0 min/d; b = −3.2 min/d), but did not change moderate to vigorous PA. The participants reduced their wear time (b = −5.2 min/d) only at the baseline. The intraclass correlations ranged from .42 for accelerometer wear time to .74 for SB. The AMR was not identified as a source of bias in any regression model. Conclusions: AMR may influence SB and PA estimates differentially. Although 7-day accelerometry seems to be a reproducible measure, our findings highlight accelerometer wear time as a crucial confounder in analyzing SB and PA data.

Monoclonal gammopathy of undetermined significance (MGUS), precursor of multiple myeloma, is an asymptomatic plasma cell disorder that overproduces serum monoclonal protein. Older age, male sex, black race, and family history of MGUS increase the risk of MGUS, yet other risk factors are known. We systematically reviewed observational epidemiological studies that examined sociodemographic, clinical, and behavioral risk factors for the development of MGUS. The protocol for this study was registered on the PROSPERO registry for systematic reviews. We identified epidemiological studies from PubMed and Scopus. Articles were limited to those written in English and published before February 2019. Five case-control and three cohort studies were eligible for data extraction. Studies evaluating factors associated with MGUS risk are limited, with conflicting conclusions regarding risk associated with obesity. Despite the limited research, a significant elevated risk for being diagnosed with MGUS was associated with several specific prior infections, inflammatory disorders, and smoking. The sparse existing literature suggests an increased risk of MGUS associated with several risk factors related to immune function. Further research is needed to explore the potential mechanisms underlying the development of MGUS and to confirm risk factors, both modifiable and non-modifiable.

Introduction Chronic kidney disease (CKD) patients are vulnerable to hepatitis B, and immunization prior to end stage kidney disease is recommended to optimize seroconversion. Our institution undertook a process improvement approach to increase hepatitis B vaccination in stage 4 and 5 CKD patients. Methods Four strategies were utilized such as: (1) Electronic health record (EHR)-based CKD registry to identify patients, (2) EHR-based physician/nurse reminders, (3) a co-located nurse appointment for vaccine administration, and (4) information sharing and provider awareness effort. The CKD registry was utilized to identify patients with stage 4 or 5 CKD, with at least two clinic visits in the prior 2 years, who had not received the hepatitis B vaccine or did not have serologic evidence of immunity. Target monthly vaccination rate was set at 75%, based on clinic leadership, nephrologist, and nurse consensus. Results A total of 239 patients were included in the study period, from November 2018 to January 2019 (observation period) and from February 2019 to September 2019 (intervention period). Monthly vaccination rate improved from 48% in November 2018 to the target rate of 75% by the end of the intervention (August and September 2019). There was a statistically significant increase from the rate of vaccination at a unique patient level in the first month of the baseline period, compared to the last month of the intervention period (51 vs. 75% p = 0.03). Conclusions Utilizing a nurse-led approach to hepatitis B vaccination, coupled with EHR-based tools, along with continuous monitoring of performance, helped to improve hepatitis B vaccination among CKD stage 4 and 5 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-020-02013-4.

© 2020 Elsevier Ltd. All rights reserved., Background: Hereditary transthyretin-mediated amyloidosis is a rare, inherited, progressive disease caused by mutations in the transthyretin (TTR) gene. We assessed the safety and efficacy of long-term treatment with patisiran, an RNA interference therapeutic that inhibits TTR production, in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Methods: This multicentre, open-label extension (OLE) trial enrolled patients at 43 hospitals or clinical centres in 19 countries as of Sept 24, 2018. Patients were eligible if they had completed the phase 3 APOLLO or phase 2 OLE parent studies and tolerated the study drug. Eligible patients from APOLLO (patisiran and placebo groups) and the phase 2 OLE (patisiran group) studies enrolled in this global OLE trial and received patisiran 0·3 mg/kg by intravenous infusion every 3 weeks with plans to continue to do so for up to 5 years. Efficacy assessments included measures of polyneuropathy (modified Neuropathy Impairment Score +7 [mNIS+7]), quality of life, autonomic symptoms, nutritional status, disability, ambulation status, motor function, and cardiac stress, with analysis by study groups (APOLLO-placebo, APOLLO-patisiran, phase 2 OLE patisiran) based on allocation in the parent trial. The global OLE is ongoing with no new enrolment, and current findings are based on the interim analysis of the patients who had completed 12-month efficacy assessments as of the data cutoff. Safety analyses included all patients who received one or more dose of patisiran up to the data cutoff. This study is registered with ClinicalTrials.gov, NCT02510261. Findings: Between July 13, 2015, and Aug 21, 2017, of 212 eligible patients, 211 were enrolled: 137 patients from the APOLLO-patisiran group, 49 from the APOLLO-placebo group, and 25 from the phase 2 OLE patisiran group. At the data cutoff on Sept 24, 2018, 126 (92%) of 137 patients from the APOLLO-patisiran group, 38 (78%) of 49 from the APOLLO-placebo group, and 25 (100%) of 25 from the phase 2 OLE patisiran group had completed 12-month assessments. At 12 months, improvements in mNIS+7 with patisiran were sustained from parent study baseline with treatment in the global OLE (APOLLO-patisiran mean change -4·0, 95 % CI -7·7 to -0·3; phase 2 OLE patisiran -4·7, -11·9 to 2·4). Mean mNIS+7 score improved from global OLE enrolment in the APOLLO-placebo group (mean change from global OLE enrolment -1·4, 95% CI -6·2 to 3·5). Overall, 204 (97%) of 211 patients reported adverse events, 82 (39%) reported serious adverse events, and there were 23 (11%) deaths. Serious adverse events were more frequent in the APOLLO-placebo group (28 [57%] of 49) than in the APOLLO-patisiran (48 [35%] of 137) or phase 2 OLE patisiran (six [24%] of 25) groups. The most common treatment-related adverse event was mild or moderate infusion-related reactions. The frequency of deaths in the global OLE was higher in the APOLLO-placebo group (13 [27%] of 49), who had a higher disease burden than the APOLLO-patisiran (ten [7%] of 137) and phase 2 OLE patisiran (0 of 25) groups. Interpretation: In this interim 12-month analysis of the ongoing global OLE study, patisiran appeared to maintain efficacy with an acceptable safety profile in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Continued long-term follow-up will be important for the overall assessment of safety and efficacy with patisiran.

Introduction: In older US nursing home (NH) residents, there is limited research on the prevalence of physical frailty, its potential dynamic changes, and its association with cognitive impairment in older adults’ first 6 months of NH stay. Methods: Minimum Data Set (MDS) 3.0 is the national database on residents in US Medicare-/Medicaid-certified NHs. MDS 3.0 was used to identify older adults aged ≥65 years, newly admitted to NHs during January 1, 2014, and June 30, 2016, with life expectancy ≥6 months at admission and NH length of stay ≥6 months ( N = 571,139). MDS 3.0 assessments at admission, 3 months, and 6 months were used. In each assessment, physical frailty was measured by FRAIL-NH (robust, prefrail, and frail) and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale (none/mild, moderate, and severe). Demographic characteristics and diagnosed conditions were measured at admission, while presence of pain and receipt of psychotropic medications were at each assessment. Distribution of physical frailty and its change over time by cognitive impairment were described. A nonproportional odds model was fitted with a generalized estimation equation to longitudinally examine the association between physical frailty and cognitive impairment, adjusting for demographic and clinical characteristics. Results: Around 60% of older residents were physically frail in the first 6 months. Improvement and worsening across physical frailty levels were observed. Particularly, in those who were prefrail at admission, 23% improved to robust by 3 months. At admission, 3 months, and 6 months, over 37% of older residents had severe cognitive impairment and about 70% of those with cognitive impairment were physically frail. At admission, older residents with moderate cognitive impairment were 35% more likely (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.33–1.37) and those with severe impairment were 74% more likely (aOR: 1.74, 95% CI: 1.72–1.77) to be frail than prefrail/robust, compared to those with none/mild impairment. The association between the 2 conditions remained positive and consistently increased over time. Discussion/Conclusion: Physical frailty was prevalent in NHs with potential to improve and was strongly associated with cognitive impairment. Physical frailty could be a modifiable target, and interventions may include efforts to address cognitive impairment.

Microwave Kinetic Inductance Detector (MKID) arrays are currently being developed and deployed for astronomical applications in the visible and near infrared and for sub-millimetre astronomy. One of the main drawbacks of MKIDs is that large arrays would exhibit a pixel yield, the percentage of individually distinguishable pixels to the total number of pixels, of 75 - 80 %. Imperfections arising during the fabrication can induce an uncontrolled shift in the resonance frequency of individual resonators which can end up resonating at the same frequency of a different resonator. This makes a number of resonators indistinguishable and therefore unusable for imaging. This paper proposes an approach to individually re-tune the colliding resonators in order to remove the degeneracy and increase the number of MKIDs with unique resonant frequencies. The frequency re-tuning is achieved through a DC bias of the resonator, the kinetic inductance of a superconducting thin film is current dependent and its dependence is non linear. Even though this approach has been already proposed, an innovative pixel design, described in this paper, may solve two issues previously described in literature such as increased electromagnetic losses to the DC-bias line, and the multiplexibility of multiple resonators on a single feedline., 8 pages, 7 figures, SPIE Proceedings

OBJECTIVES: To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents. METHOD: Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission. RESULTS: Four latent statuses of depressive symptoms were identified: ‘Multiple Symptoms’ (prevalence at admission: 17.3%; 90 days: 13.6%), ‘Depressed mood’ (20.0%; 19.5%), ‘Fatigue’ (27.4%; 25.7%), and ‘Minimal Symptoms’ (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in ‘Multiple Symptoms’ and ‘Fatigue’ statuses; those with severe impairment had lower odds of belonging to ‘Multiple Symptoms’, ‘Depressed Mood’, and ‘Fatigue’ statuses. CONCLUSION: By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.

Background The aim was to investigate the suitability of a municipal registry office for alcohol screening and brief intervention. We analyzed whether trial participation and retention differ by alcohol- and health-related, demographic and socio-economic participant characteristics. Methods Over 3 months, all 18- to 64-year-old visitors of a registry office were systematically screened. Persons with alcohol consumption in the past 12 months (N = 1646) were randomized to brief alcohol intervention (BAI) or assessment only. BAI was delivered by computer-generated individualized feedback letters at baseline, 3 and 6 months. Logistic and ordered logistic regression models were used to investigate whether the odds of trial participation and retention depended on participant characteristics. Models were rerun separately for low-risk and at-risk drinkers with Alcohol Use Disorder Identification Test-Consumption scores ≥4/≥5 for women/men indicating at-risk drinking. Results The trial participation rate was 67% with higher odds of participation in younger adults (P Conclusion Our data suggest that registry offices could be a suitable setting to reach people from the general population for BAI. Especially the understudied group of low-risk drinkers was well reached through BAI and showed high adherence. BAI that addresses alcohol consumers beyond those at risk may be well accepted in proactively recruited people from the general population.

Background Participation in an assessment may change health behavior. This “mere-measurement effect” may be used for prevention purposes. However, little is known about whether individuals’ characteristics moderate the effect. The objective was to explore whether changes of physical activity (PA) and sedentary time (ST) after a cardiovascular assessment depend on sociodemographic variables and cardiometabolic risk factors. Methods A sample of n = 175 adults aged 40 to 65 received baseline assessment including self-administered PA and ST questionnaires and standardized measurement of blood pressure, waist circumference, and blood parameters. After 5 weeks, participants again reported PA and ST without any prior treatment or intervention. Linear regression models were used to analyze the dependence of five-week changes in PA and ST on baseline sociodemographic and cardiometabolic variables. Results Men increased transport-related PA more than women (b = 9.3 MET-hours/week, P = .031). Men with higher triglycerides increased transport-related PA less than men with lower triglycerides (b = − 5.6 MET-hours/week, P = .043). Men with higher systolic blood pressure reduced ST more than those with lower systolic blood pressure (b = − 35.7 min/week, P = .028). However, this linear association ceased to exist at a level of approximately 145 mmHg (b of squared association = 1.0, P = .080). A similar relationship was found for glycated hemoglobin and ST. Conclusions The findings suggest that sex and cardiometabolic risk factors moderate mere-measurement effects on PA and ST. Researchers and practitioners using mere measurement for prevention purposes may address PA and ST according to these individual characteristics. Trial registration ClinicalTrials.govNCT02990039. Registered 7 December 2016. Retrospectively registered.

The pediatric relative fat mass (RFM) has been recently presented and validated as an index for estimating percentage body fat (%BF) in North American children and adolescents. Similar to body mass index (BMI) and tri-ponderal mass index (TMI), RFM uses anthropometric measures (i.e., weight, height and waist circumference) to estimate body composition. The primary purpose of this study was to validate the newly developed RFM equation for %BF prediction in Southern Brazilian adolescents; as secondary objective, we compared %BF estimation from BMI- and TMI-derived equations. A total of 631 individuals (434 boys) aged 11 to 18 were analyzed. Bland–Altman analyses were used to determine concordance between predicted equations and %BF measured by DXA; results are presented using mean difference (i.e., bias) and standard deviation. Sensitivity and specificity were calculated for %BF percentile classifications. RFM underestimated %BF in 65.2% of boys (− 4.3 ± 2.8%) and 84.8% of girls (− 5.3 ± 2.7%). In contrast, TMI overestimated %BF in 62.9% of boys (4.0 ± 2.9%) and 56.3% (3.5 ± 3.0%) of girls. The performance of BMI showed mixed results; %BF was overestimated in 68.4% of boys (5.0 ± 4.0%) and underestimated in 67.5% of girls (− 3.9 ± 2.6%), all p

Objectives To identify subgroups of nursing home (NH) residents in the USA experiencing homogenous depression symptoms and evaluate if subgroups vary by cognitive impairment. Methods We identified 104 465 newly admitted, long-stay residents with depression diagnosis at NH admission in 2014 using the Minimum Data Set 3.0. The Patient Health Questionnaire-9 was used to measure depression symptoms and the Brief Interview of Mental Status for cognitive impairment (intact; moderately impaired; severely impaired). Latent class analysis (LCA) with logistic regression was used to: (a) construct the depression subgroups and (b) estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the associations between the subgroups and cognitive impairment level, adjusting for demographic and clinical characteristics. Results The best-fitted LCA model suggested four subgroups of depression: minimal symptoms (latent class prevalence: 42.4%), fatigue (32.0%), depressed mood (14.5%), and multiple symptoms (11.2%). Odds of subgroup membership varied by cognitive impairment. Compared to residents with intact cognition, those with moderate or severe cognitive impairment were less likely to belong to the fatigue subgroup [aOR(95% CI): moderate: 0.75 (0.71-0.80); severe: 0.26 (0.23-0.29)] and more likely to belong to the depressed mood subgroup [aOR (95% CI): moderate: 4.54 (3.55-5.81); severe: 6.41 (4.86-8.44)]. Residents with moderate cognitive impairment had increased odds [aOR (95% CI): 1.19 (1.12-1.27)] while those with severe impairment had reduced odds of being in the multiple symptoms subgroup [aOR (95% CI): 0.63 (0.58-0.68)]. Conclusions Findings provide a basis for improving depression management with consideration of both subgroups of depression symptoms and levels of cognitive function.

Cervical disc arthroplasty is a treatment option for symptomatic cervical disc disease. There is a paucity of literature on long-term safety outcomes, durability, and device-related failure rates. The M6-C artificial cervical disc is a device with titanium alloy endplates and a complex polymeric centerpiece. To date, trials have exhibited acceptable safety profiles.This case series describes the presentation, management, and pathological findings of a delayed prevertebral periprosthetic mass anterior to the M6-C disc. Four patients at 3 different institutions underwent cervical disc replacement with the M6-C disc. Two to seven years postoperatively, they presented with dysphagia secondary to a compressive mass anterior to the disc. Case notes were reviewed to collect data on symptoms, management, and outcomes. The patients were systemically well and presented with progressive dysphagia. They had imaging findings of a mass anterior to the disc. They underwent a decompressive procedure, with 2 patients undergoing device removal and fusion. In 2 cases, a soft-tissue mass was seen intraoperatively, with frank pus. In 3 cases, Propionibacterium acnes was identified and antibiotic treatment given. Histopathology demonstrated mixed inflammatory infiltrates with foreign body–type granulomas. Postoperatively, the dysphagia resolved.The development of delayed dysphagia in a patient with an M6-C disc should prompt investigation to identify a mass lesion. To the authors’ knowledge, this is the first report of delayed infection, or suspected delayed-type hypersensitivity reaction, following M6-C disc implantation. It is important for this to be added to the device safety concerns. Further prospective studies are needed to establish the incidence and the long-term safety and failure rates of the M6-C disc.

Zusammenfassung Durch den großflächigen Einsatz der Computertomographie (CT) in unterschiedlichen Industriebereichen steigen auch die Anforderungen an die quantitative Bildanalyse. Subjektive Bildwahrnehmung muss durch objektive Algorithmen ersetzt werden. In diesem Artikel stellt die Bundesanstalt für Materialforschung und -prüfung (BAM), die seit den 1980er Jahren an der Entwicklung der industriellen CT beteiligt ist, anhand ausgewählter Beispiele den aktuellen Stand ihrer Analysemethoden an verschiedenen Anwendungsbeispielen der CT vor.

Background: Effective and measurable participant recruitment methods are urgently needed for clinical studies in Alzheimer’s disease. Objectives: To develop methods for measuring recruitment tactics and evaluating effectiveness. Methods: Recruitment tactics for the Alzheimer’s Disease Neuroimaging Initiative (ADNI3) were measured using web and phone analytics, campaign metrics and survey responses. Results: A total of 462 new participants were enrolled into ADNI3 through recruitment efforts. We collected metrics on recruitment activities including 82,003 unique visitors to the recruitment website and 3,335 calls to study phone numbers. The recruitment sources that produced the most screening and enrollment included online advertisements, local radio and newspaper coverage and emails and referrals from registries. Conclusions: Analysis of recruitment activity obtained through tracking methods provided some insight for effective recruitment. ADNI3 can serve as an example of how a data-driven approach to centralized participant recruitment can be utilized to facilitate clinical research.

In this article, we take forward recent initiatives to assess regulation based on contemporary computer technologies such as big data and artificial intelligence. In order to characterize current phenomena of regulation in the digital age, we build on Karen Yeung's concept of "algorithmic regulation," extending it by building bridges to the fields of quantification, classification, and evaluation research, as well as to science and technology studies. This allows us to develop a more fine‐grained conceptual framework that analyzes the three components of algorithmic regulation as representation, direction, and intervention and proposes subdimensions for each. Based on a case study of the algorithmic regulation of Uber drivers, we show the usefulness of the framework for assessing regulation in the digital age and as a starting point for critique and alternative models of algorithmic regulation.

Conflicting information in an agent's knowledge base may lead to a semantical defect, that is, a situation where it is impossible to draw any plausible conclusion. Finding out the reasons for the observed inconsistency (so-called diagnoses) and/or restoring consistency in a certain minimal way (so-called repairs) are frequently occurring issues in knowledge representation and reasoning. In this article we provide a series of first results for these problems in the context of abstract argumentation theory regarding the two most important reasoning modes, namely credulous as well as sceptical acceptance. Our analysis includes the following problems regarding minimal repairs/diagnoses: existence, verification, computation of one and enumeration of all solutions. The latter problem is tackled with a version of the so-called hitting set duality first introduced by Raymond Reiter in 1987. It turns out that grounded semantics plays an outstanding role not only in terms of complexity, but also as a useful tool to reduce the search space for diagnoses regarding other semantics.

The M4F project brings together the fusion and fission materials communities working on the prediction of radiation damage production and evolution and their effects on the mechanical behaviour of irradiated ferritic/martensitic (F/M) steels. It is a multidisciplinary project in which several different experimental and computational materials science tools are integrated to understand and model the complex phenomena associated with the formation and evolution of irradiation induced defects and their effects on the macroscopic behaviour of the target materials. In particular the project focuses on two specific aspects: (1) To develop physical understanding and predictive models of the origin and consequences of localised deformation under irradiation in F/M steels; (2) To develop good practices and possibly advance towards the definition of protocols for the use of ion irradiation as a tool to evaluate radiation effects on materials. Nineteen modelling codes across different scales are being used and developed and an experimental validation programme based on the examination of materials irradiated with neutrons and ions is being carried out. The project enters now its 4th year and is close to delivering high-quality results. This paper overviews the work performed so far within the project, highlighting its impact for fission and fusion materials science. Peer Reviewed L. Malerba a,*, M.J. Caturla b, E. Gaganidze c, C. Kaden d, M.J. Konstantinovi´c e, P. Olsson f, C. Robertson g, D. Rodney h, A.M. Ruiz-Moreno i, M. Serrano a, J. Aktaa c, N. Anento j, S. Austin i, A. Bakaev e, J.P. Balbuena b, F. Bergner d, F. Boioli k, M. Boleininger l, G. Bonny e, N. Castin e, J.B. J. Chapman l, P. Chekhonin d, M. Clozel m, B. Devincre k, L. Dupuy g, G. Diego a, S.L. Dudarev l, C.-C. Fu g, R. Gatti k, L. G´el´ebart g, B. G´omez-Ferrer n, D. Gonçalves g, C. Guerrero a, P.M. Gueye n, P. H¨ahner i, S.P. Hannula o, Q. Hayat p, M. Hern´andez-Mayoral a, J. Jagielski m, N. Jennett p, F. Jim´enez a, G. Kapoor d, A. Kraych h, T. Khvan e,q, L. Kurpaska m, A. Kuronen r, N. Kvashin j, O. Libera s, P.-W. Ma l, T. Manninen o, M.-C. Marinica g, S. Merino a, E. Meslin g, F. Mompiou t, F. Mota a, H. Namburi s, C.J. Ortiz a, C. Pareige n, M. Prester u, R.R. Rajakrishnan t, M. Sauzay g, A. Serra j, I. Simonovski i, F. Soisson g, P. Sp¨atig v, D. Tanguy h, D. Terentyev e, M. Trebala o, M. Trochet g, A. Ulbricht d, M.Vallet g, K. Vogel d, T. Yalcinkaya w, J. Zhao r a Centro de Investigaciones Energ´eticas, Medioambientales y Tecnol´ogicas (CIEMAT), Madrid, Spain b Universidad de Alicante, San Vicente del Raspeig, Spain c Karlsruher Institut für Technologie (KIT), Karlsruhe, Germany d Helmholtz-Zentrum Dresden-Rossendorf Ev (HZDR), Rossendorf, Germany e Studiecentrum voor Kernenergie / Centre d’´Etude de l’´Energie Nucl´eaire (SCK CEN), Mol, Belgium f KTH Royal Institute of Technology, Stockholm, Sweden g Universit´e Paris-Saclay, Commissariat `a l’´Energie Atomique et aux ´Energies Alternatives (CEA), Gif-sur-Yvette, France h Institut Lumi`ere Mati`ere (ILM), Centre National de la Recherche Scientifique, Lyon, France i Joint Research Centre (JRC)- European Commission, Petten, the Netherlands j Universitat Polit`ecnica de Catalunya, Barcelona, Spain k Laboratoire d’Etude des Microstructures (LEM), Centre National de la Recherche Scientifique, Chˆatillon, France l United Kingdom Atomic Energy Authority (UKAEA), Culham, UK m Narodowe Centrum Badan Jadrowych (NCBJ), Swierk, Poland n Normandie Univ, UNIROUEN, INSA Rouen, CNRS, Groupe de Physique des Mat´eriaux, 76000 Rouen, France o Aalto University, Espoo, Finland p Coventry University, UK q Universit´e de Li`ege, Belgium r Helsingin Yliopisto, Helsinki, Finland s Centrum Vyzkumu ˇReˇz S.R.O. (CVR), ˇReˇz, Czech Republic t Centre pour l’´Elaboration Elaboration de Mat´eriaux et pour l’´Etude des Structures (CEMES), Centre National de la Recherche Scientifique, Toulouse, France u Institut za Fiziku, Zagreb, Croatia v Paul Scherrer Institut (PSI), Villingen, Switzerland w Middle East Technical University (METU), Ankara, Turkey

Recently, the European Commission supported by many European countries has announced large investments towards the commercialization of quantum technology (QT) to address and mitigate some of the biggest challenges facing today's digital era - e.g. secure communication and computing power. For more than two decades the QT community has been working on the development of QTs, which promise landmark breakthroughs leading to commercialization in various areas. The ambitious goals of the QT community and expectations of EU authorities cannot be met solely by individual initiatives of single countries, and therefore, require a combined European effort of large and unprecedented dimensions comparable only to the Galileo or Copernicus programs. Strong international competition calls for a coordinated European effort towards the development of QT in and for space, including research and development of technology in the areas of communication and sensing. Here, we aim at summarizing the state of the art in the development of quantum technologies which have an impact in the field of space applications. Our goal is to outline a complete framework for the design, development, implementation, and exploitation of quantum technology in space., 13 pages, 1 figure

Simulation-based fault injection is an approach, which is usually conducted in the design phase to evaluate the reliability of circuits. However, this approach is frequently time-consuming, especially for large designs. This paper explores the possibilities of applying machine learning (ML) as enhancement to the fault injection to reduce the runtime of the fault verification. The proposed approach separates the target gates for fault injection into two subsets. Standard simulation-based fault injection is only performed for first subset to get the result of fault propagation in the circuit, and enables machine learning process. Based on such partial classical fault injection campaign, a dataset is built to train and validate machine learning models that are able to predict the fault injection result of the remaining gates. The machine learning approach is based on a set of relevant features that could be easily extracted based on the netlist. The dataset in this study, used to validate the approach, is obtained from the ADC digital core. We have evaluated this netlist and provided ML-driven assessment whether the fault injection in some gate will propagate to primary outputs. We have evaluated several machine learning models with different loss functions. The best prediction accuracy is 95% and achieved by a 4 layer neural network with weighted Cross Entropy.

Because of the ground-breaking results in many different fields, Deep Neural Networks (DNNs) have also been widely adopted for safety-critical applications i.e. autonomous driving and space exploration. These applications are not only resource-constrained but also require a high level of reliability. DNNs quantization is viewed as a viable method to minimize the implementation cost and maximize the resiliency of the DNNs while preserving the inference accuracy. We perform a comprehensive layer-wise fault analysis of homogeneous and heterogeneous quantized DNNs and study the impact of faults (e.g., soft errors modeled as bit flips) in the DNNs' weights. The findings of this study suggest that quantizing the DNN model to fewer bits helps to increase the resiliency of the model i.e., quantizing the model from a fixed point (FxP) 32-bit to FxP 4-bit can increase the resiliency of the model by 20.7 % at 10 % Bit Error Rate (BER). But more vigorous quantization could sacrifice the resiliency and accuracy.

We live in a time of expansion and popularization of the processes of acquisition, retention, and sharing of knowledge in virtual media. Platforms geared towards digital learning now play a fundamental role in mediating knowledge processes. Many of them already use gamification with the use of game elements to increase engagement and stimulate the participants’ immersion and flow status. But in addition to the development of dynamic platforms that enhance learning, it is essential that they are accessible to disabled people, allowing gamification resources and interactions between participants to be used by any audience, including people with visual and hearing disabilities. From this premise, this research problematizes the need to think from the initial project on the accessibility tools of an LMS following the recommendations prepared by groups such as the World Wide Web Consortium (W3C) and Global Learning Consortium (GLC), including Web Accessibility Initiative - World Wide Web Consortium (WAI-W3C), IMS GLC - Accessibility Guidelines (IMS GLC-ACC) and Web Accessibility Initiative - Accessible Rich Internet Applications (WAI-ARIA). In addition to studies for the development of accessible LMS, this research also presents the use of gamification strategies and design thinking in the development process, also using the method called Design Science Research to define the steps, thus seeking to promote engagement and immersion of the team, stimulating practical experiences with the gamification process. For the result, the proposal for the development of accessible LMS based on gamification and design thinking strategies is presented, with explicit use in the phases of empathy, definition, and ideation.

Transparency - the provision of information about what personal data is collected for which purposes, how long it is stored, or to which parties it is transferred - is one of the core privacy principles underlying regulations such as the GDPR. Technical approaches for implementing transparency in practice are, however, only rarely considered. In this paper, we present a novel approach for doing so in current, RESTful application architectures and in line with prevailing agile and DevOps-driven practices. For this purpose, we introduce 1) a transparency-focused extension of OpenAPI specifications that allows individual service descriptions to be enriched with transparency-related annotations in a bottom-up fashion and 2) a set of higher-order tools for aggregating respective information across multiple, interdependent services and for coherently integrating our approach into automated CI/CD-pipelines. Together, these building blocks pave the way for providing transparency information that is more specific and at the same time better reflects the actual implementation givens within complex service architectures than current, overly broad privacy statements., Accepted for publication at the 2021 International Workshop on Privacy Engineering (IWPE'21). This is a preprint manuscript (authors' own version before final copy-editing)

Surface patterning is a recent promising approach to promote performance of pressure-driven membranes in water treatment and desalination. Nevertheless, knowledge about foulant deposition mechanisms, especially at early stage of filtration, is still lacking. The applicability of particle imaging velocimetry to study fluid characteristics atop surface patterned thin-film composite membranes was investigated at different operating conditions. This work is an important first step toward reliable understanding of the impacts of topographical membrane surface modification on hydrodynamic conditions and foulant deposition mechanisms.

Forensic physical anthropometry allows the determination of animal species and estimates sex, ancestry, age and height. Aim: To analyze the effectiveness of a cranioscopic/ morphological evaluation for sex estimation with a sample of the Brazilian mixed-race population by conducting a qualitative visual assessment without prior knowledge of sex. Methods: This is a blind cross-sectional study that evaluated 30 cranial characteristics of 192 skulls with mandible, 108 male and 84 female individuals, aged 22 to 97 years, from the Osteological and Tomographic Biobank. The qualitative characteristics were classified and compared to the actual sex information of the Biobank database. The statistical analysis was used to calculate de Cohen’s kappa coefficient, total percentage of agreement, sensitivity and specificity of visual sex classification. Results: Of the 30 cranial variables analyzed, 15 presented moderate degree of agreement, achieving value of Kappa test between 0.41–0.60: Glabella (Gl), Angle and lines (At), Mental eminence (Em), Mandible size (Tm), Cranial base (Bc), Mouth depth (Pb), Nasal aperture (Anl), Supraorbital region (Rs), Orbits (Orb), Mastoid processes (Pm), Alveolar arches (Aa), Zygomatic arch (Az), Orbital edge (Bo), Supraorbital protuberances (Pts), and Supramastoid crests and rugosity (Crsm). The Facial physiognomy (Ff) presented substantial reliability (0.61-0.80) with 89.8% sensitivity for male sex and 70.2% specificity. Conclusions: Cranial morphological characteristics present sexual dimorphism; however, in this study only 15 variables showed moderate degree of agreement and can be used in sex estimation. Only one variable (Ff) 81.2% total agreement with substantial reliability. Quantitative methods can be associated for safe sex estimation.

Manihot esculenta Crantz is originally from the Amazon region of Brazil, which has the highest genetic diversity. Due to the wide adaptation of cassava to the most diverse environments, the evolutionary forces acted on the crop, resulting in a more complex genetic structure. This study evaluated the population structure and the genetic diversity through 25 SSR markers of 144 sweet cassava accessions collected in seven places in the south of Brazil. All the loci analyzed were polymorphic and showed several alleles per loci with a mean of 3.36 alleles and 38 rare alleles in the population. The mean value of polymorphism information content (PIC) was 0.488, which indicates that the markers were informative and the mean observed heterozygosity was 0.644, while the mean expected heterozygosity was 0.557. The sweet cassava accessions were divided into 10 groups based on the population structure analysis. There was a moderate genetic differentiation (PhiPT = 0.106) among the sweet cassava subpopulations. The wide genetic variability among the studied accessions of sweet cassava demonstrates the importance of the emergency in the conservation of plants in germplasm banks, because the intense change in agriculture; the expansion of areas occupied by soybeans, corn, and other crops; and also the farmers’ migration from rural areas to urban areas reduced cassava cultivation over time, and as a consequence, genetic variability has been lost.

Study Design:Prospective cohort study.Objective:To evaluate the long-term effectiveness of a posterior dynamic spine stabilization (PDS) System called PercuDyn system as a treatment for low back pain (LBP) in patients with degenerative disc disease who have failed conservative treatment.Methods:Thirty-five patients (21 males, 14 females, mean age 36 years) with chronic LBP due to degenerative disc disease underwent percutaneous facet augmentation with the PercuDyn system. Indications for implanting the PercuDyn device were chronic LBP without sciatica, significant disc degeneration, and who failed conservative treatment. Follow-up after surgery ranged from 4 to 8 years. Patients were clinically evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI) questionnaire, and the EQ-5D3L.Results:The VAS scale and ODI scores improved at 6 months, 1 year, 2 years, and 4 to 8 years in comparison with the baseline values ( P < .001 and P < .01, respectively). Equally, data from the EQ-5D-3L questionnaire suggested improvements in all domains, including pain and discomfort, over the follow-up period. However, during follow-up, 16 patients (46%) have had unsatisfactory outcome including failure of implant to resolve symptoms (n = 8), developed symptomatic disc protrusion (n = 4), and loosening of the screws (n = 4).Conclusion:Our clinical experience highlights the rather high overall failure rate of this system. Although, some patients show significant improvement in their symptoms, we believe that patients with LBP related to degenerative disc disease are a poor indication for this PDS device.However, large scale studies, with optimised selection criteria are needed to demonstrate the exact role of this device in spinal patients.

Background: A pre-post pilot study was conducted to test the feasibility, acceptability, and potential effectiveness of a fully automatized computer-based intervention targeting hazardous drinking and depressiveness in proactively recruited health care patients (HCPs). To address the importance of the sample selection when testing interventions, HCPs were compared to media recruited volunteers (MVs). Method: In a multicenter screening program 2,773 HCPs were screened for hazardous drinking and depressive symptoms. MVs were recruited via media solicitation. Over a period of 6 months, study participants received 6 individualized counseling letters and weekly short messages. Pre-post data were analyzed for 30 participants (15 HCPs, 15 MVs). Intervention acceptability was assessed in post-intervention interviews conducted with 32 study participants. Results: MVs showed higher problem severity and motivation to change than HCPs. Over the course of the intervention both subsamples reduced regular binge drinking (HCPs: p = 0.016; MVs: p = 0.031) and depressiveness (HCPs: p = 0.020; MVs: p < 0.001). MVs further reduced average daily alcohol consumption (p = 0.034). The intervention received positive ratings from both subsamples, the alcohol module was rated more favorably by MVs than by HCPs (p = 0.012). Subsamples further differed in terms of intervention usage (p = 0.013). Conclusion: The intervention was technically and logistically feasible, well accepted, and may have the potential to reduce hazardous drinking and depressive symptoms in different populations. Subsamples differed in terms of problem severity, motivation to change, intervention usage, pre-post changes, and attitudes toward the intervention, showing that intervention development should involve the intended target populations to avoid biased conclusions on intervention effectiveness and acceptability.

The objective of this study was to analyze if the linear measurements performed on 206 CT scans are dimorphic and can be used as an auxiliary method for forensic identification as a secondary method according to INTERPOL 2014. A logistic regression model was developed to determine the sex of the individual analyzed. The measurements were performed on computed tomography of the Osteological Biobank and tomography of FOP_UNICAMP, in 117 male and 89 female CT scans with known age, ancestry and cause of death. OnDemand3D® software was used for the following measures: sella turcica (center) to nasal suture, sella turcica (center) to anterior nasal spine, sella turcica to ENP, sella turcica (center) to start; Nasal suture to ENA; Nasal suture to the ENP, in the median sagittal section. The Kolmogorov-Smirnov test was used to establish the distribution and equality of variances (homoscedasticity) of the variables under study. The unpaired t-test and the Pearson correlation coefficient were conducted, resulting in a logistic regression using the Stepwise-Forward method for sex. This study was approved by CAAE 54171916.0.0000.5418. It was verified that all measures studied are dimorphic, but the ß of the measures PPST-ENA; SNRE-ENA; SNRE-ENP; ENA-ENP were the most statistically significant, being selected to determine the multiple model. The logistic regression model was created: [Logit: -19.909 + 0.177 (SNRE-ENA) + 0.231 (ENA-P)]. The model obtained in this study, presented a 77.2% accuracy, being a good result to be used as a coadjuvant method to other sex estimation methods in mixed populations, such as Brazil.

AIM: Surgery for spinal metastases can improve symptoms, but sometimes complications can negate the benefits. Operations may have different indications, complexities and risks, and the choice for an individual is a tailor-made personalised decision. Previous prognostic scoring systems are becoming out of date and inaccurate. We designed a risk calculator to estimate survival after surgery, to inform clinicians and patients when making management decisions. METHODS: A prospective cohort study was performed, including 1430 patients with spinal metastases who underwent surgery. Of them, 1264 patients from 20 centres were used for model development using a Cox frailty model. Calibration slope, D-statistic and C-index were used for model validation based on 166 patients. Follow-up was to death or minimum of 2 years after surgery. Pre-operative indices (examination findings, pain, Karnofsky physical functioning score, and radiology) were assessed. RESULTS: An algorithm to predict survival was constructed including the tumour type, ambulatory status, analgesic use, American Society of Anesthesiologists score, number of spinal metastases, previous radiotherapy or chemotherapy, presence of visceral metastases, cervical or thoracic spine involvement, as predictors. An Internet-based risk calculator was developed based on this algorithm, with similar or improved accuracy compared to other validated prognostic scoring systems (C-index, 0.68; 95% confidence interval, 0.63--0.73, and calibration slope, 1.00; 95% confidence interval, 0.68--1.32). CONCLUSION: A large, prospective, surgical series of patients with symptomatic spinal metastases was used to create a validated risk calculator that can help clinicians to inform patients about the most appropriate treatment plan. The calculator is available at www.spinemet.com. ispartof: EUROPEAN JOURNAL OF CANCER vol:107 pages:28-36 ispartof: location:England status: published

Study Design. A prospective multicenter cohort study.Objective. To assess the clinical accuracy of six commonly cited prognostic scoring systems for patients with spinal metastases.Summary of Background Data. There are presently several available methods for the estimation of prognosis in metastatic spinal disease, but none are universally accepted by surgeons for clinical use. These scoring systems have not been rigorously tested and validated in large datasets to see if they are reliable enough to inform day-to-day patient management decisions. We tested these scoring systems in a large cohort of patients. A total of 1469 patients were recruited into a secure internet database, and prospectively collected data were analyzed to assess the accuracy of published prognostic scoring systems.Methods. We assessed six prognostic scoring systems, described by the first authors Tomita, Tokuhashi, Bauer, van der Linden, Rades, and Bollen. Kaplan-Meier survival estimates were created for different patient subgroups as described in the original publications. Harrell's C-statistic was calculated for the survival estimates, to assess the concordance between estimated and actual survival.Results. All the prognostic scoring systems tested were able to categorize patients into separate prognostic groups with different overall survivals. However none of the scores were able to achieve "good concordance" as assessed by Harrell's C-statistic. The score of Bollen and colleagues was found to be the most accurate, with a Harrell's C-statistic of 0.66.Conclusion. No prognostic scoring system was found to have a good predictive value. The scores of Bollen and Tomita were the most effective with Harrell's C-statistic of 0.66 and 0.65, respectively. Prognostic scoring systems are calculated using data from previous years, and are subject to inaccuracies as treatments advance in the interim. We suggest that other methods of assessing prognosis should be explored, such as prognostic risk calculation.

Background and aims There are safety issues regarding plant sterol ester-enriched functional food. Oxidized plant sterols, also called oxyphytosterols, are supposed to contribute to plant sterol atherogenicity. This study aimed to analyze associations of plasma oxyphytosterol levels with cardiovascular events. Methods Plasma cholesterol was measured by gas chromatography-flame ionization detection. Plasma campesterol and sitosterol and their 7-oxygenated metabolites were analyzed by gas chromatography-mass selective detection. Results In 376 patients admitted for elective coronary angiography, who were not on lipid-lowering drugs, 82 cardiovascular events occurred during a follow-up period of 4.2 ± 1.8 years. Patients with cardiovascular events had significantly higher 7α-hydroxycampesterol plasma levels (median, 0.46; [interquartile range (IQR) 0.22–0.81] nmol/L vs. median, 0.25 [IQR, 0.17–0.61] nmol/L; p = 0.003) and 7α-hydroxycampesterol-to-cholesterol ratios (median 0.08 [IQR, 0.04–0.14] nmol/mmol vs. median, 0.05 [IQR 0.03–0.11] nmol/mmol; p = 0.005) than controls without such events. Patients above the median were characterized by higher cumulative event rates in Kaplan-Meier-analysis (Logrank-test p = 0.084 and p = 0.025) for absolute and cholesterol corrected 7α-hydroxycampesterol, respectively. After adjustment for influencing factors and related lipids, the hazard ratios per one standard deviation of the log-transformed variables (HR) were 1.19 [95% confidence interval (CI), 0.95–1.48], p = 0.132 for 7α-hydroxycampesterol and HR, 1.18 [95% CI, 0.94–1.48], p = 0.154 for 7α-hydroxycampesterol-to-cholesterol ratio. None of the other investigated oxyphytosterols showed an association with cardiovascular events. Conclusions In patients not on lipid-lowering drugs, absolute plasma levels of 7α-hydroxycampesterol and their ratios to cholesterol are associated with cardiovascular events. Further research is required to elucidate the role of OPS in cardiovascular diseases.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): University Medicine Munich University Medicine Greifswald Introduction The vascular cell adhesion molecule-1 (VCAM-1) is overexpressed in a number of different inflammatory processes on activated endothelium. This could be shown in both a mouse model for autoimmune myocarditis and in human heart tissue from patients with lymphocytic myocarditis. In addition to the tissue-bound one, a soluble isoform of VCAM-1 (s-VCAM-1) can also be detected in the blood. Higher levels have been associated with worse clinical outcome in chronic heart failure patients of different etiology and other patient groups. Purpose Since both inflammation and fibrosis are key processes involved in the pathogenesis of dilated cardiomyopathy (DCM) and hypokinetic non-dilated cardiomyopathy (HNDC), we aimed to investigate the prognostic value of s-VCAM-1 plasma levels for survival in a large cohort of DCM and HNDC patients. Methods The cohort comprised of patients with a primary diagnosis of DCM, defined as reduced left ventricular ejection fraction (LVEF 117%) at time of diagnosis as well as HNDC, defined as a reduced left ventricular ejection fraction (LVEF 50%, peripheral artery occlusive disease, known auto-immune disease and heart failure of other origins. Levels of s-VCAM-1 were measured in human plasma using an enzyme-linked immunosorbent assay (R&D Systems, USA). A Cox proportional hazard model for the association between s-VCAM-1 and all-cause mortality was adjusted for age, sex, time since symptom-onset, LVEF, kidney function (eGFR-CKDEPI), CRP and NT-proBNP. Results A total of 334 DCM patients were included in this single-center cohort (78.4 % males) with a mean age of 54.0 years [interquartile range [IQR] 47.0, 63.2). On average time since symptom onset was 1.5 years (IQR 0.1, 1.1), LVEF 30.7 % (IQR 25, 37), LVEDD 67.1 mm (IQR 62, 72). During a median follow-up of 12.4 years (IQR 10.1, 13.9), a total of 118 (35.3 %) patients died. Multivariable-adjusted cox regression model revealed a significantly increased all-cause mortality risk with increasing levels of s-VCAM-1 (p for trend =0.039), (hazard ratio [HR] 1.00045 (Conf. Interval 1.00002, 1.00087) for VCAM increase of 1 ng/mL, for increase of 100 ng/ml HR 1.046 (Conf- interval 1.002, 1.091), for increase of 1000ng/ml HR 1.57 (Conf_interval 1.02-2.41) (Kaplan Meier survival estimates see Figure 1, median s-VCAM-1 = 664 ng/ml, IQR 515,874). Conclusions s-VCAM-1 predicts long-term survival in DCM patients independent of NT-pro-BNP and other risk determinants. Further research needs to evaluate whether this biomarker proves useful in monitoring and planning management of DCM and HNDC patients (e.g. more intensive management in high-risk patients). Abstract Figure. Kaplan-Meier survival estimates

Introduction: Sex estimates are generally based on the evaluation of qualitative and quantitative aspects of anatomic structures, however, the latter has better reproducibility and reliability. Objective: Aiming to evaluate the viscerocranium as a tool for sexual prediction and verify the possibility of creation of a logistic regression model for sexual prediction. Materials and Methods: 167 craniums - 100 male and 67 female between 22 and 85 years old from a Brazilian university´s Biobank - were evaluated. Results: It was observed that of the measures carried out were presented as sexually dimorphic, except for the measures of the right frontozygomatic point – right zygion; left frontozygomatic point – left zygion. Besides, it was possible to create a logistic regression model Sex = [logits/Sex = -24.5 + (0.20 * Nasion - Naso spine) + (0.18 * Right zygion - Naso spine)]. Conclusion: It was concluded that the measures of the viscerocranium present themselves as a factor of sexual dimorphism and the quantitative method developed was 81.4% accurate.

Laser powder bed fusion is used to create near net shape metal parts with a high degree of freedom in geometry design. When it comes to the production of safety critical components, a strict quality assurance is mandatory. An alternative to cost-intensive non-destructive testing of the produced parts is the utilization of in-situ process monitoring techniques. The formation of defects is linked to deviations of the local thermal history of the part from standard conditions. Therefore, one of the most promising monitoring techniques in additive manufacturing is thermography. In this study, features extracted from thermographic data are utilized to investigate the thermal history of cylindrical metal parts. The influence of process parameters, part geometry and scan strategy on the local heat distribution and on the resulting part porosity are presented. The suitability of the extracted features for in-situ process monitoring is discussed.

Memristor is an emerging electrical device that enables non-volatile storage and in-memory computing. The memristive crossbar with high memory density and low energy consumption has drawn much attention for the implementation of dot-product engines, which can be deployed in power-hungry applications with intensive multiply-accumulate operations. However, simulating the crossbar containing a group of memristors based on the device-level modeling is time consuming. In this paper, we propose a model to simulate the memristive crossbar with high flexibility and automation at the behavioral level to perform the vector-matrix multiplication. This system-level model captures the non-linearity of memristors aiming for fast and accurate simulation. With the significantly reduced simulation time, this model enables simulating the systems containing memristive crossbar with large scale like neural networks in a more practical way. Moreover, this model can be exploited to analyze the effects of variations, which provides a condition and contributes to revealing potential computational errors. A multilayer perceptron detecting breast cancer is simulated based on this model to assess the classification accuracy with the presence of variabilities.

Background Depression, anxiety, and pain are commonly experienced by older adults living in nursing homes. Objectives To describe the prevalence of depression, anxiety disorders, and pain among newly admitted nursing home residents in the United States and to describe the treatment of these disorders. Design Cross-sectional study of newly admitted residents. Setting Residents able to complete a pain assessment (n=783,826) living in Medicare- and Medicaid-certified nursing homes in the United States in 2011-2012. Measures Measures of sociodemographic, mood and behavior, pain, diagnoses, and functioning items from the Minimum Data Set (MDS) version 3.0. Results Approximately 36% of residents had a diagnosis of depression (other than bipolar disorder) and/or an anxiety disorder (n = 272,311). Of these residents, 25.2% had both depression and an anxiety disorder (95% CI = 25.0-25.4%), 54.3% (95% CI = 54.1-54.5%) had depression without an anxiety disorder, and 20.5% had an anxiety disorder without depression (95% CI = 20.3-20.6%). Fifteen percent had the triad of depression, anxiety, and pain at admission (95% CI = 9.3-23.3%). Depressive symptoms were more commonly reported by residents with pain than by those without pain. Receipt of psychological therapy (range: 0.9%-2.0%) or any psychiatric medication was lacking (range: 35.3%-48.5%), regardless of pain status. Participants reporting pain received a combination of scheduled, pro re nata (PRN)/as-needed, and non-medication pain interventions (range: 59.8% depression without anxiety to 62.9% depression and anxiety disorder). Conclusion Residents often suffer from combinations of depression, anxiety and pain at admission to nursing home. While treatment of pain is more common than treatment of psychiatric treatments, both psychiatric treatment and pain management may be suboptimal in nursing homes.

AIMS Implementation of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains incomplete. Non-cardiovascular hospitalization may present opportunities for GDMT optimization. We assessed the efficacy and durability of a virtual, multidisciplinary 'GDMT Team' on medical therapy prescription for HFrEF. METHODS AND RESULTS Consecutive hospitalizations in patients with HFrEF (ejection fraction ≤40%) were prospectively identified from 3 February to 1 March 2020 (usual care group) and 2 March to 28 August 2020 (intervention group). Patients with critical illness, de novo heart failure, and systolic blood pressure

Energy markets worldwide are undergoing a transformative change from fossil energy sources and centralized setups to renewable energy sources and highly decentralized markets with peer-to-peer trading. Blockchain technology has been considered a fundamental enabler for building decentralized energy systems and services. However, existing blockchain-based energy solutions may not be transferable to new contexts, as regulatory, infrastructural, and economic criteria and constrains may not fit or have not been made explicit with existing work. To this end, we present a 3+1 layer model for use case identification and for architecting their realization to ensure coverage early-on of the different critical dimensions. We report on findings from a major project running in Germany by describing five advanced use cases and discussing important architectural considerations.

In this paper, a surgical robot platform with a novel concentric connector joint (CCJ) is presented. The surgical robot is a parallel robot platform comprised of multiple struts, arranged in a geometrically stable array, connected at their end points via the CCJ. The CCJ joints have near-perfect concentricity of rotation around the node point, which enables the tension and compression forces of the struts to be resolved in a structurally-efficient manner. The preliminary feasibility tests, modeling and simulations were introduced.

Objective To elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period. Methods Individuals who experienced a traumatic birth within the last three years (n = 32) completed semi-structured phone interviews about their birth and postpartum experience. The Post-traumatic Stress Disorder Checklist for DSM-V (PCL-5), Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder scale (GAD-7) were administered. Qualitative data was analyzed using a modified grounded theory by three independent coders. Results Among participants, 34.4% screened positive for PTSD, 18.8% for depression, and 34.4% for anxiety. Participants described multi-level barriers that prevented clinicians from recognizing and supporting patients' postpartum mental health needs; those involved lack of communication, education, and resources. Recommendations from participants included that 1) obstetric professionals should acknowledge birth-related trauma experienced by any individual, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support may be needed before the ambulatory postpartum visit. Conclusions There are multi-level barriers towards detecting and responding to individuals' mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively assess mental health throughout the postpartum period.