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Objective: To determine the associations between four validated multidimensional self-report frailty scales and nine indices of oral health in communitydwelling older persons. Materials and Methods: This pilot study was conducted in a sample of 208 older persons aged 70 years and older who visited two dental practices in the Netherlands. Frailty status was measured by four different self-report frailty questionnaires: Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Sunfrail Checklist (SC), and the Sherbrooke Postal Questionnaire (SPQ). Oral health was assessed by two calibrated examiners. Results: The prevalence of frailty according to the four frailty measures TFI, GFI, SC, and SPQ was 32.8%, 31.5%, 24.5%, and 49.7%, respectively. The SC correlated with four oral health variables (DMFT, number of teeth, percentage of occlusal contacts, Plaque Index), the TFI with three (number of teeth, percentage of occlusal contacts, Plaque Index), the GFI only with DPSI, and the SPQ with the number of teeth and the number of occlusal contacts. Conclusion: Of the studiedmultidimensional frailty scales, the SC and TFIwere correlated with most oral health variables (four and three, respectively). However, it should be noticed that these correlations were small. Clinical relevance: The SCand TFImight help to identify older people with risk of poor oral health so that preventive care can be used to ensure deterioration of oral health and maintenance of quality of life. Vice versa early detection of frailty by oral care professionals could contribute to interprofessional management of frailty.

Standard reference terminology of diagnoses and risk factors is crucial for billing, epidemiological studies, and inter/intranational comparisons of diseases. The International Classification of Disease (ICD) is a standardized and widely used method, but the manual classification is an enormously time-consuming endeavor. Natural language processing together with machine learning allows automated structuring of diagnoses using ICD-10 codes, but the limited performance of machine learning models, the necessity of gigantic datasets, and poor reliability of terminal parts of these codes restricted clinical usability. We aimed to create a high performing pipeline for automated classification of reliable ICD-10 codes in the free medical text in cardiology. We focussed on frequently used and well-defined three- and four-digit ICD-10 codes that still have enough granularity to be clinically relevant such as atrial fibrillation (I48), acute myocardial infarction (I21), or dilated cardiomyopathy (I42.0). Our pipeline uses a deep neural network known as a Bidirectional Gated Recurrent Unit Neural Network and was trained and tested with 5548 discharge letters and validated in 5089 discharge and procedural letters. As in clinical practice discharge letters may be labeled with more than one code, we assessed the single- and multilabel performance of main diagnoses and cardiovascular risk factors. We investigated using both the entire body of text and only the summary paragraph, supplemented by age and sex. Given the privacy-sensitive information included in discharge letters, we added a de-identification step. The performance was high, with F1 scores of 0.76–0.99 for three-character and 0.87–0.98 for four-character ICD-10 codes, and was best when using complete discharge letters. Adding variables age/sex did not affect results. For model interpretability, word coefficients were provided and qualitative assessment of classification was manually performed. Because of its high performance, this pipeline can be useful to decrease the administrative burden of classifying discharge diagnoses and may serve as a scaffold for reimbursement and research applications.

Vocal cord palsy after cervical mediastinoscopy is usually reported at less than 1%. However, its incidence might be underestimated and no follow-up studies are available. Our study aimed to evaluate the incidence of voice changes after cervical mediastinoscopy and report on long-term outcomes, including quality of life, after at least one-year follow-up.A retrospective cohort study was performed, considering all patients who underwent cervical mediastinoscopy in our center between January 2011 and April 2016. Patients with pre-existing voice changes, voice changes only after pulmonary resection and patients who underwent neoadjuvant chemo(radio)therapy were excluded. Voice changes with full recovery within 14 days were attributed to intubation-related causes. Follow-up questionnaires, including the standardized Voice Handicap Index, were sent to patients with documented voice changes.Of 270 patients who were included for final analysis, 17 (6.3%) experienced voice changes after cervical mediastinoscopy, which persisted 2 years in 4 patients (1.5%), causing mild to moderate disabilities in daily living. Twelve patients (out of 17, 71%) were referred for otolaryngology consultation, and paresis of the left vocal cord suggesting recurrent laryngeal nerve injury was confirmed in 10 (3.7% of our total study group). Additionally, 83% of the patients who were referred for otolaryngology consultation received voice treatment. Recovery rate after vocal exercises therapy and injection laryngoplasty was respectively 71% and 33%.Voice changes after cervical mediastinoscopy is an underreported complication, with an incidence of at least 6.3% in our retrospective study, with persisting complaints in at least 1.5% of patients, leading to mild to moderate disabilities in daily living. These findings highlight the need for appropriate patient education for this underestimated complication, as well as the exploration of possible preventive measures.

Beyond fifth generation (5G) communication systems aim towards data rates in the tera bits per second range, with improved and flexible coverage options, introducing many new technological challenges in the fields of network architecture, signal processing, and radio frequency front-ends. One option is to move towards cell-free, or distributed massive Multiple-Input Multiple-Output (MIMO) network architectures and highly integrated front-end solutions. This paper presents an outlook on beyond 5G distributed massive MIMO communication systems, the signal processing, characterisation and simulation challenges, and an overview of the state of the art in millimetre wave antennas and electronics.

Methemoglobinemia is a rare cause of neonatal cyanosis in the newborn. It is considered a medical emergency. Failure of recognition or appropriated treatment could result in serious disease and neonatal death. Neonatal methemoglobinemia can be caused by both hereditary and acquired factors.We present two cases of newborns who developed severe cyanosis a few hours after birth due to methemoglobinemia. This was thought to be related to the local maternal perineal infiltration of prilocaine during childbirth. Though rare, prilocaine is the most potent agent to induce methemoglobinemia compared to other local aneasthetics. After intravenous administration of methylene blue, both newborns fully recovered.Neonatal methemoglobinemia is a rare and potentially fatal complication of local anesthetics, particularly prilocaine, administered to the mother during childbirth. Midwives, obstetricians, gynecologists and pediatricians should be aware of this complication. The use of other local anesthetics, including lidocaine, should be considered.

In Heliconius butterflies, wing colour pattern diversity and scale types are controlled by a few genes of large effect that regulate colour pattern switches between morphs and species across a large mimetic radiation. One of these genes, cortex, has been repeatedly associated with colour pattern evolution in butterflies. Here we carried out CRISPR knockouts in multiple Heliconius species and show that cortex is a major determinant of scale cell identity. Chromatin accessibility profiling and introgression scans identified cis-regulatory regions associated with discrete phenotypic switches. CRISPR perturbation of these regions in black hindwing genotypes recreated a yellow bar, revealing their spatially limited activity. In the H. melpomene/timareta lineage, the candidate CRE from yellow-barred phenotype morphs is interrupted by a transposable element, suggesting that cis-regulatory structural variation underlies these mimetic adaptations. Our work shows that cortex functionally controls scale colour fate and that its cis-regulatory regions control a phenotypic switch in a modular and pattern-specific fashion., eLife digest Heliconius butterflies have bright patterns on their wings that tell potential predators that they are toxic. As a result, predators learn to avoid eating them. Over time, unrelated species of butterflies have evolved similar patterns to avoid predation through a process known as Müllerian mimicry. Worldwide, there are over 180,000 species of butterflies and moths, most of which have different wing patterns. How do genes create this pattern diversity? And do butterflies use similar genes to create similar wing patterns? One of the genes involved in creating wing patterns is called cortex. This gene has a large region of DNA around it that does not code for proteins, but instead, controls whether cortex is on or off in different parts of the wing. Changes in this non-coding region can act like switches, turning regions of the wing into different colours and creating complex patterns, but it is unclear how these switches have evolved. Butterfly wings get their colour from tiny structures called scales, which each have their own unique set of pigments. In Heliconius butterflies, there are three types of scales: yellow/white scales, black scales, and red/orange/brown scales. Livraghi et al. used a DNA editing technique called CRISPR to find out whether the cortex gene affects scale type. First, Livraghi et al. confirmed that deleting cortex turned black and red scales yellow. Next, they used the same technique to manipulate the non-coding DNA around the cortex gene to see the effect on the wing pattern. This manipulation turned a black-winged butterfly into a butterfly with a yellow wing band, a pattern that occurs naturally in Heliconius butterflies. The next step was to find the mutation responsible for the appearance of yellow wing bands in nature. It turns out that a bit of extra genetic code, derived from so-called ‘jumping genes’, had inserted itself into the non-coding DNA around the cortex gene, ‘flipping’ the switch and leading to the appearance of the yellow scales. Genetic information contains the instructions to generate shape and form in most organisms. These instructions evolve over millions of years, creating everything from bacteria to blue whales. Butterfly wings are visual evidence of evolution, but the way their genes create new patterns isn't specific to butterflies. Understanding wing patterns can help researchers to learn how genetic switches control diversity across other species too.

Motivated by applications of soft-contact problems such as guidewires used in medical and engineering applications, we consider a compressed rod deforming between two parallel elastic walls. Free elastica buckling modes other than the first are known to be unstable. We find the soft constraining walls to have the effect of sequentially stabilizing higher modes in multiple contacts by a series of bifurcations, in each of which the degree of instability (the index) is decreased by one. Further symmetry-breaking bifurcations in the stabilization process generate solutions with different contact patterns that allow for a classification in terms of binary symbol sequences. In the hard-contact limit, all these bifurcations collapse into highly degenerate ‘contact bifurcations’. For any given wall separation at most a finite number of modes can be stabilized and eventually, under large enough compression, the rod jumps into the inverted straight state. We chart the sequence of events, under increasing compression, leading from the initial straight state in compression to the final straight state in tension, in effect the process of pushing a rod through a cavity. Our results also give new insight into universal features of symmetry-breaking in higher mode elastic deformations. We present this study also as a showcase for a practical approach to stability analysis based on numerical bifurcation theory and without the intimidating mathematical technicalities often accompanying stability analysis in the literature. The method delivers the stability index and can be straightforwardly applied to other elastic stability problems.

In this comparative study, a solid composite, AN/HTPB-based propellant was prepared by conventional processing in a mechanical mixer and by applying an advanced processing technique relying on resonant acoustic mixing (RAM). After curing of the propellants, cross-sections were prepared and characterized by scanning electron microscopy. Also the density of the propellants was measured and finally the ballistic properties were measured using chimney burner tests. The experimental results clearly showed that the oxidizer particles, the homogeneity of the propellants, the density and the burn rate properties are hardly affected by the processing method. For the propellant studied in this research, resonant acoustic mixing is a very promising, advanced processing technique that can be applied as an alternative to the conventional mechanical mixing of this high solid load propellant composition. © 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim

Purpose: To determine the face and construct validity as well as educational value and user-friendliness of the Simendo knee arthroscopy virtual reality simulator. Methods: Sixty participants were recruited and equally divided into novices (0 arthroscopic procedures), intermediates (1-59 arthroscopic procedures), and experts (60 or more arthroscopic procedures). Participants were excluded if they had previously trained with the studied simulator. Construct validity, that is, the ability to discriminate between different levels of expertise, was examined by a navigation task. All participants were asked to perform 5 navigation trials within 10 minutes. Face validity, educational value, and user-friendliness were examined by questionnaires before and after the navigation trials. Face validity is the subjective impression of how closely the simulation replicates the real environment. Results: The novices were significantly slower than the intermediates in the first (P < .001) and the third (P = .031) trial. The novices were significantly slower than the experts in all trials (P = .016), except for the fifth (P = .054). The experts were significantly faster than the intermediates in every trial except for the fourth (P = .069). Median task time for the fifth trial was 63 seconds (44-80 seconds) for novices, 58 seconds (46-80 seconds) for intermediates, and 41 seconds (33-55 seconds) for experts. Ninety-two percent of all participants agreed that the simulator can be used to train for surgical inspection, and 95% indicated sufficient user-friendliness. Conclusions: Based on the results, this knee simulator can be applied to train the basic arthroscopic hand-eye coordination skills at the start of resident education programs. Further testing is necessary to determine whether the skills are retained. Clinical Relevance: The simulator is partly validated, which contributes to training of basic arthroscopic skills without compromising patient safety.

We study torsional buckling of a rod within the dynamics context, recognising that in a real experiment a twisting moment is not instantaneously applied and therefore an angular velocity (a spin) always accompanies a twist. We derive and solve the wave equation that governs prebuckling torsion dynamics and highlight the compatibility problem between initial and boundary conditions (corner singularity) plaguing numerical solution of the equation. We deal with this problem by introducing a smoothing function. Prebuckling torque oscillations are a major concern in various turbine applications. Torsional instability, upon further increase of the applied moment, is found to be delayed by the dynamic loading. We determine the dependence of the critical load on the rate of application of the moment by computing initial postbuckling solutions and extrapolating back to the critical point. For these computations we use the geometrically-exact Cosserat rod equations, which we discretise with the generalised-α method. We argue that in addition to inertia a gyroscopic effect may play a role in the delay. Our results may help explain delayed torsional buckling recently observed in simulation studies of flexible marine risers.

Despite the widespread use of chlorhexidine (CHX) to prevent infection, data regarding the in vitro action of CHX against methicillin-resistant Staphylococcus aureus (MRSA) are limited. Clinical isolates from Hospital das Clinicas, Sao Paulo, Brazil, identified during 2002/2003 and 2012/2013 were studied to describe the susceptibility to CHX and mupirocin, molecular characteristics, and virulence profile of MRSA. Susceptibility test to Mupirocin was performed by the disk diffusion method and to CHX by the agar dilution technique. PCR for virulence genes, mecA gene and Staphylococcal Cassette Chromosome mec (SCCmec) types were investigated as well. Mupirocin- and CHX-resistant isolates were sequenced using the IlluminaTM plataform. Two hundred and sixteen MRSA clinical isolates were evaluated: 154 from infected and 62 from colonized patients. Resistance to mupirocin was observed in four isolates assigned as SCCmec type III and STs (ST05; ST239 and ST105) carrying mupA and blaZ, two of them co-harboring the ileS gene. Only one isolate assigned as SCCmec type III was resistant to CHX (MIC of 8.0 μg.mL-1) and harbored the qacA gene. Resistance to chlorhexidine and mupirocin were found in isolates carrying qacA and mupA in our hospital. Since these genes are plasmid-mediated, this finding draws attention to the potential spread of resistance to mupirocin in our hospital.

Tools for reliable assessment of socially sensitive or transgressive behavior warrant constant development. Among them, the Crosswise Model (CM) has gained considerable attention. We systematically reviewed and meta-analyzed empirical applications of CM and addressed a gap for quality assessment of indirect estimation models. Guided by the PRISMA protocol, we identified 45 empirical studies from electronic database and reference searches. Thirty of these were comparative validation studies (CVS) comparing CM and direct question (DQ) estimates. Six prevalence studies exclusively used CM. One was a qualitative study. Behavior investigated were substance use and misuse (k= 13), academic misconduct (k= 8), and corruption, tax evasion, and theft (k= 7) among others. Majority of studies (k= 39) applied the “more is better” hypothesis. Thirty-five studies relied on birthday distribution and 22 of these usedP= 0.25 for the non-sensitive item. Overall, 11 studies were assessed as high-, 31 as moderate-, and two as low quality (excluding the qualitative study). The effect of non-compliance was assessed in eight studies. From mixed CVS results, the meta-analysis indicates that CM outperforms DQ on the “more is better” validation criterion, and increasingly so with higher behavior sensitivity. However, little difference was observed between DQ and CM estimates for items with DQ prevalence estimate around 50%. Based on empirical evidence available to date, our study provides support for the superiority of CM to DQ in assessing sensitive/transgressive behavior. Despite some limitations, CM is a valuable and promising tool for population level investigation.

Nonphotochemical laser-induced nucleation (NPLIN) is a promising primary nucleation control method, yet its underlying mechanism remains elusive. To contribute to the discussion on whether the polarization of laser irradiation in NPLIN experiments influences the polymorphic outcome, we revisit NPLIN experiments with aqueous glycine solutions with supersaturations ranging between S = 1.5 and S = 1.7 irradiated by nanosecond pulses (∼7 ns) of near-infrared wavelength (1064 nm). Systematically altering laser light excitation properties, including the number of pulses and type of polarization, we quantified the nucleation kinetics and characterized the polymorphic form that crystallized upon laser irradiation. Due to the stochasticity of the nucleation process, a large number of samples (>100 per each experimental point) were studied under carefully controlled experimental conditions such as the ambient temperature, cooling rate, and aging period. We observed significant differences among laser-irradiated, spontaneously nucleated, and crash-cooled samples in terms of nucleation kinetics and polymorphic form. This result indicates that laser irradiation provides a different polymorph-forming pathway in comparison to crash-cooling and spontaneous nucleation. However, no clear dependence between the polymorphic form and the polarization of laser irradiation is observed. We discuss our results in the context of previous reports supported thorough quantification of sample heating in NPLIN experiments.

A droplet-based microfluidic platform is presented to study the nucleation kinetics of calcium oxalate monohydrate (COM), the most common constituent of kidney stones, while carefully monitoring the pseudo-polymorphic transitions. The precipitation kinetics of COM is studied as a function of supersaturation and pH as well as in the presence of inhibitors of stone formation, magnesium ions (Mg(2+)), and osteopontin (OPN). We rationalize the trends observed in the measured nucleation rates leveraging a solution chemistry model validated using isothermal solubility measurements. In equimolar calcium and oxalate ion concentrations with different buffer solutions, dramatically slower kinetics is observed at pH 6.0 compared to pHs 3.6 and 8.6. The addition of both Mg(2+) and OPN to the solution slows down kinetics appreciably. Interestingly, complete nucleation inhibition is observed at significantly lower OPN, namely, 3.2 × 10(−8) M, than Mg(2+) concentrations, 0.875 × 10(−4) M. The observed inhibition effect of OPN emphasizes the often-overlooked role of macromolecules on COM nucleation due to their low concentration presence in urine. Moreover, analysis of growth rates calculated from observed lag times suggests that inhibition in the presence of Mg(2+) cannot be explained solely on altered supersaturation. The presented study highlights the potential of microfluidics in overcoming a major challenge in nephrolithiasis research, the overwhelming physiochemical complexity of urine.

Contains fulltext : 225023.pdf (Publisher’s version ) (Open Access) An in-depth case study approach was followed and data were collected by means of nine semi-structured interviews with experts from six case organizations. Our findings indicate that gamification of work can be a promising path for working organizations and can be beneficial to both employers and employees. The success of gamification at the workplace is dependent on whether its implementation is able to fulfill employees’ psychological needs for competence, autonomy, and relatedness. To make the most out of gamification at the workplace, employers, supervisors, and employees themselves should pay ample attention to its conditions (i.e., personal preferences of the employees, their demographic characteristics, their need for psychological safety, and the purposefulness of the game). In addition, seven psychological mechanisms underlying successful performance were found in our empirical work (i.e., competition, intrinsic incentives, extrinsic incentives, choice, social interaction, feedback, and ownership). The properties of gamification schemes that also have to be dealt with by the parties involved comprise their duration and intensity, the inclusion of a facilitator, the type of equipment, and scale referring to the size of the gamification scheme. Finally, our study has provided more insight into the possible effects of gamification schemes (i.e., increased insight in the workflow and, through this, a better understanding of both the employees’ own contributions and of their employers’ contributions to the work processes, the transfer of game elements into work processes, team building enhancement, learning effects, and negative emotions). 20 december 2020

In this follow-up study the collaboration between two research groups from the USA and the Netherlands was continued to expand the framework of chemical attribution for the homemade explosive erythritol tetranitrate (ETN). Isotope ratio mass spectrometry (IRMS) analysis was performed to predict possible links between ETN samples and its precursors. Carbon, nitrogen, hydrogen and oxygen isotope ratios were determined for a wide variety of precursor sources and for ETN samples that were prepared with selected precursors. The stability of isotope ratios of ETN has been demonstrated for melt-cast samples and two-year old samples, which enables sample comparison of ETN in forensic casework independent of age and appearance. Erythritol and nitric acid (or nitrate salt) are the exclusive donor of carbon and nitrogen atoms in ETN, respectively, and robust linear relationships between precursor and the end-product were observed for these isotopes. This allowed for defining isotopic enrichment ranges for carbon and nitrogen that support the hypothesis that a given erythritol or nitrate precursor was used to synthesize a specific ETN batch. The hydrogen and oxygen atoms in ETN do not originate from one exclusive donor material, making linkage prediction more difficult. However, the large negative enrichments observed for both isotopes do provide powerful information to exclude suspected precursor materials as donor of ETN. Additionally, combing the isotopic data of all elements results in a higher discrimination power for ETN samples and its precursor materials. Combining the findings of our previously reported LC–MS analysis of ETN with this IRMS study is expected to increase the robustness of the forensic comparison even further. The partially nitrated impurities can provide insight on the synthesis conditions while the isotope data contain information on the raw materials used for the production of ETN.

InHeliconiusbutterflies, wing pattern diversity is controlled by a few genes of large effect that regulate colour pattern switches between morphs and species across a large mimetic radiation. One of these genes,cortex, has been repeatedly associated with colour pattern evolution in butterflies. Here we carried out CRISPR knock-outs in multipleHeliconiusspecies and show thatcortexis a major determinant of scale cell identity. Chromatin accessibility profiling and introgression scans identifiedcis-regulatory regions associated with discrete phenotypic switches. CRISPR perturbation of these regions in black hindwing genotypes recreated a yellow bar, revealing their spatially limited activity. In theH. melpomene/timaretalineage, the candidate CRE from yellow-barred phenotype morphs is interrupted by a transposable element, suggesting thatcis-regulatory structural variation underlies these mimetic adaptations. Our work shows thatcortexfunctionally controls scale colour fate and that itscis-regulatory regions control a phenotypic switch in a modular and pattern-specific fashion.

Whiskers are present in many species of mammals. They are specialised vibrotactile sensors that sit within strongly innervated follicles. Whisker size and shape will affect the mechanical signals that reach the follicle, and hence the information that reaches the brain. However, whisker size and shape have not been quantified across mammals before. Using a novel method for describing whisker curvature, this study quantifies whisker size and shape across 19 mammalian species. We find that gross two-dimensional whisker shape is relatively conserved across mammals. Indeed, whiskers are all curved, tapered rods that can be summarised by Euler spiral models of curvature and linear models of taper, which has implications for whisker growth and function. We also observe that aquatic and semi-aquatic mammals have relatively thicker, stiffer, and more highly tapered whiskers than arboreal and terrestrial species. In addition, smaller mammals tend to have relatively long, slender, flexible whiskers compared to larger species. Therefore, we propose that whisker morphology varies between larger aquatic species, and smaller scansorial species. These two whisker morphotypes are likely to induce quite different mechanical signals in the follicle, which has implications for follicle anatomy as well as whisker function. [Abstract copyright: © 2020 The Authors. Journal of Morphology published by Wiley Periodicals LLC.]

Rat whiskers curve naturally as Euler spirals., This paper reports on an analytical study of the intrinsic shapes of 523 whiskers from 15 rats. We show that the variety of whiskers on a rat’s cheek, each of which has different lengths and shapes, can be described by a simple mathematical equation such that each whisker is represented as an interval on the Euler spiral. When all the representative curves of mystacial vibrissae for a single rat are assembled together, they span an interval extending from one coiled domain of the Euler spiral to the other. We additionally find that each whisker makes nearly the same angle of 47∘ with the normal to the spherical virtual surface formed by the tips of whiskers, which constitutes the rat’s tactile sensory shroud or “search space.” The implications of the linear curvature model for gaining insight into relationships between growth, form, and function are discussed.

Item does not contain fulltext BACKGROUND: Acetabular fractures are difficult to classify owing to the complex three-dimensional (3D) anatomy of the pelvis. 3D printing helps to understand and reliably classify acetabular fracture types. 3D-virtual reality (VR) may have comparable benefits. Our hypothesis is that 3D-VR is equivalent to 3D printing in understanding acetabular fracture patterns. METHODS: A total of 27 observers of various experience levels from several hospitals were requested to classify twenty 3D printed and VR models according to the Judet-Letournel classification. Additionally, surgeons were asked to state their preferred surgical approach and patient positioning. Time to classify each fracture type was recorded. The cases were randomized to rule out a learning curve. Inter-observer agreement was analyzed using Fleiss' kappa statistics (κ). RESULTS: Inter-observer agreements varied by observer group and type of model used to classify the fracture: medical students: 3D print (κ = 0.61), VR (κ = 0.41); junior surgical residents: 3D print (0.51) VR (0.54); senior surgical residents: 3D print (0.66) VR (0.52); junior surgeons: 3D print (0.56), VR (0.43); senior surgeons: 3D print (κ = 0.59), VR (κ = 0.42). Using 3D printed models, there was more agreement on the surgical approach (junior surgeons κ = 0.23, senior surgeons κ = 0.31) when compared with VR (junior surgeons κ = 0.17, senior surgeons 0.25). No difference was found in time used to classify these fractures between 3D printing and VR for all groups (P = 1.000). CONCLUSIONS: The Judet-Letournel acetabular classification stays difficult to interpret; only moderate kappa agreements were found. We found 3D-VR inferior to 3D printing in classifying acetabular fractures. Furthermore, the current 3D-VR technology is still not practical for intra-operative use.

Accurate Calcium Oxalate Monohydrate (COM) solubility measurements are essential for elucidating the physiochemical mechanism behind the formation of kidney stones, nephrolithiasis. Yet the reported solubility values of COM in ultrapure water, arguably the simplest solvent relevant for nephrolithiasis, vary significantly depending on implemented method. To address this variation, we present an experimental study of the solubility of COM validated by a model based on the Debye&ndash, H&uuml, ckel theory describing the solution chemistry and the complex formation. We also carefully monitor potential pseudopolymorphic/hydrate transitions during the solubility measurements with in-situ and ex-situ methods. Our results indicate that the solubility of COM in ultrapure water is a weak function of temperature. However, the measured solubility varies significantly in buffer solutions across physiologically relevant pH values at body temperature. The proposed model explains observed trends as a combined effect of ionic strength, protonation reactions, and soluble complex formation. Moreover, it predicts solubility of COM in buffer solutions remarkably well using our measurements in ultrapure water as input, demonstrating the consistency of presented approach. The presented study parleying experiments and modelling provides a solid stepping stone to extend the physiochemical understanding of nephrolithiasis to more realistic solutions laden with biological complexity.

Given the increasing shortage of active nurses in industrialized countries throughout the world, it is of utmost importance to protect their health, satisfaction, and commitment so that they can continue working in their healthcare institution. Building upon the proposed pattern of specific relationships developed by Houkes et al. (2003), we investigated a model of relationships among working conditions (quantitative, emotional, and physical demands), labor relations (quality of interpersonal relations and psychological support), work content (meaning of work, influence at work), and employment conditions (opportunities for development) on the one hand, and health, job satisfaction, and institutional affective commitment on the other hand, for younger versus older nurses. We used data of 3,399 nurses from the Netherlands and 3,636 nurses from Poland from the larger European Nurses' Early Exit Study (NEXT) and performed longitudinal structural equation modeling (SEM) and multi-group analyses. The results showed that the proposed pattern of relationships generally holds, but that the nurses' level of commitment is more determined by meaning of work than by opportunities for development and that psychological support is associated with job satisfaction (and not only with burnout as hypothesized, in both the Netherlands and Poland). Comparing younger (

Contains fulltext : 227089.pdf (Publisher’s version ) (Open Access) The purpose of this paper is to investigate the effect of intra-organizational networking on individual task performance, via employability. Moreover, this study also examines whether this relationship differs for younger (

The international classification of diseases (ICD) is a widely used tool to describe patient diagnoses. At University Medical Center Utrecht (UMCU), for example, trained medical coders translate information from hospital discharge letters into ICD-10 codes for research and national disease epidemiology statistics, at considerable cost. To mitigate these costs, automatic ICD coding from discharge letters would be useful. However, this task has proven challenging in practice: it is a multi-label task with a large number of very sparse categories, presented in a hierarchical structure. Moreover, existing ICD systems have been benchmarked only on relatively easier versions of this task, such as single-label performance and performance on the higher “chapter” level of the ICD hierarchy, which contains fewer categories. In this study, we benchmark the state-of-the-art ICD classification systems and two baseline systems on a large dataset constructed from Dutch cardiology discharge letters a t UMCU hospital. Performance of all systems is evaluated for both the easier chapter-level ICD codes and single-label version of the task found in the literature, as well as for the lower-level ICD hierarchy and multi-label task that is needed in practice. We find that state-of-the-art methods outperform the baseline for the single-label version of the task only. For the multi-label task, the baselines are not defeated by any state-of-the-art system, with the exception of HA-GRU, which does perform best in the most difficult task on accuracy. We conclude that practical performance may have been somewhat overstated in the literature, although deep learning techniques are sufficiently good to complement, though not replace, human ICD coding in our application.

Erythritol tetranitrate (ETN) was prepared independently by two research groups from the USA and the Netherlands. The partially nitrated impurities present in ETN were studied using liquid chromatography-mass spectrometry to address the ultimate challenge in forensic explosives investigations, i.e., providing chemical and tactical information on the production and origin of the explosive material found at a crime scene. Accurate quantification of the tri-nitrated byproduct erythritol trinitrate (ETriN) was achieved by in-lab production of an ETriN standard and using custom-made standards of the two isomers of ETriN (1,2,3-ETriN and 1,2,4-ETriN). Large differences in levels of ETriN were observed between the two sample sets showing that, even when similar synthesis routes are employed, batches from different production locations can contain different impurity profiles. In one of the sample sets the ratios of the lesser partially nitrated impurities, EDiN and EMN, in the ETN samples could be determined. The impurity profiles enable prediction of post-synthesis work-up steps by reduction of the level of partially nitrated products upon recrystallization. However, impurity analysis does not enable predictions with respect to raw material or synthesis route used. Nonetheless, characteristic impurity profiles obtained can be used in forensic casework to differentiate or link ETN samples. However, forensic interpretation can be complicated by acid catalyzed degradation which can cause changes in impurity levels over time. The high food-grade quality of the erythritol precursor materials did not provide other impurity markers using the LC-MS methods in this study. To expand our framework of chemical attribution a follow-up study will be reported that focuses on stable isotope analysis of ETN and its precursor materials that potentially allow predictions for forensic explosives intelligence. © 2019 Elsevier B.V. Chemicals / CAS erythritol, 149-32-6, 7541-59-5; erythrityl tetranitrate, 7297-25-8

Background: An important focus of post-stroke physical therapy is to improve walking and walking capacity. However, many people after stroke experience difficulties with gait-related participation,...

Unburied subsea pipelines operating under high-temperature and high-pressure conditions tend to relieve their axial compressive force by forming lateral buckles. In order to manage lateral buckling, a sleeper is often employed as a buckle-initiation technique to ensure pipeline integrity. In this study, analytical solutions of third-mode lateral buckling for unburied subsea pipelines with sleeper are derived. The analytical solution is compared with experimental data in the literature and shows good agreement. The stability of the buckled pipeline is investigated by means of an energy analysis and it is found that third-mode lateral buckling has lower energy than first-mode buckling, which means that third-mode buckling is more likely to happen in practice. The influence of sleeper height and sleeper friction on lateral post-buckling behaviour is illustrated and analysed, with particular attention paid to the minimum critical temperature difference, lateral displacement amplitude and maximum stress. Our results show that increasing the height of the sleeper or decreasing the friction between pipeline and sleeper can both be used to decrease the minimum critical temperature difference, but their influence on the maximum stress is opposite.

Buried subsea pipelines under high temperature conditions tend to relieve their axial compressive force by forming localised upheaval buckles. This phenomenon is traditionally studied as a kind of imperfect column buckling problem. We study upheaval buckling as a genuinely localised buckling phenomenon without making any ad hoc assumptions on the shape of the buckled pipeline. We combine this buckling analysis with a detailed state-of-the-art nonlinear pipe-soil interaction model that accounts for the effect of uplift peak soil resistance for buried pipelines. This allows us to investigate the effect of cover depth of subsea pipelines on their load-deflection behaviour. Furthermore, the influence of axial and uplift peak soil resistance on the localised upheaval behaviour is investigated and the maximum axial compressive stress during the buckling process is discussed. Parameter studies reveal a limit to the temperature difference for safe operation of the pipeline. Localised upheaval buckling may then occur if the pipe is sufficiently imperfect or sufficiently dynamically perturbed.

Unburied subsea pipelines operating under high temperature and high pressure (HT/HP) conditions tend to relieve their axial compressive force by forming lateral buckles in an uncontrolled manner. In order to control lateral buckling, a distributed buoyancy section is often employed. In this study, analytical solutions are deduced for lateral buckling of unburied subsea pipelines with a distributed buoyancy section. An energy analysis is employed to investigate the stability of the buckled pipeline. The influence of the length and weight of the distributed buoyancy section on pipeline buckled configurations, typical lateral buckling behaviour and the minimum critical temperature difference is illustrated and analysed. The results are shown to be in good agreement with experimental data in the literature. The effect of imperfections is also discussed and an error analysis is conducted for one of the main assumptions of the proposed analytical method. The results show that increasing the length or decreasing the weight of the distributed buoyancy section can both be used to decrease the minimum critical temperature difference. The maximum compressive stress will decrease with decreasing weight of the distributed buoyancy section. However, the influence of the length of the distributed buoyancy section on the maximum compressive stress is complicated.

We formulate the problem of a slender structure (a rod) undergoing large deformation under the action of a moving mass or load motivated by inspection robots crawling along bridge cables or high-voltage power lines. The rod is described by means of geometrically exact Cosserat theory which allows for arbitrary planar flexural, extensional and shear deformations. The equations of motion are discretised using the generalised-α method. The formulation is shown to handle the discontinuities of the problem well. Application of the method to a cable and an arch problem reveals interesting nonlinear phenomena. For the cable problem we find that large deformations have a resonance detuning effect on cable dynamics. The problem also offers a compelling illustration of the Timoshenko paradox. For the arch problem we find a stabilising (delay) effect on the in-plane collapse of the arch, with failure suppressed entirely at sufficiently high speed.

Unburied subsea pipelines operating under high-temperature and high-pressure conditions tend to relieve their axial compressive force by forming lateral buckles. Uncontrolled lateral buckling may lead to pipeline failure. In order to control lateral buckling, a sleeper is often employed as a buckle-initiation technique. In this study, analytical solutions of lateral buckling for unburied subsea pipelines with sleeper are derived. An energy analysis is employed to investigate the stability of the buckled pipeline. The influence of sleeper height and sleeper friction on pipeline buckled configurations and typical lateral buckling behaviour is illustrated and analysed. The results are shown to be in very good agreement with experimental data in the literature. We also discuss the effect of imperfections and conduct an error analysis of one of the main assumptions of the proposed analytical method. Our results show that increasing the height of the sleeper or decreasing the friction between pipeline and sleeper can all be used to decrease the minimum critical temperature difference. However, only the sleeper height is effective in substantially reducing the maximum compressive stress.

Unburied subsea pipelines under high-temperature conditions tend to relieve their axial compressive stress by forming localised lateral buckles. This phenomenon is traditionally studied under the assumption of a specific lateral deflection profile (mode) consisting of a fixed number of lobes. We study lateral thermal buckling as a genuinely localised buckling phenomenon by applying homoclinic (‘flat’) boundary conditions. By not having to assume a particular buckling mode we are in a position to study transitions between these traditional modes in typical loading sequences. For the lateral resistance we take a realistic nonlinear pipe-soil interaction model for partially embedded pipelines. We find that for soils with appreciable breakout resistance, i.e., nonmonotonicity of the lateral resistance characteristic, sudden jumps between modes may occur. We consider both symmetric and antisymmetric solutions. The latter turn out to require much higher temperature differences between pipe and environment for the jumps to be induced. We carry out a parameter study on the effect of various pipe-soil interaction parameters on this mode jumping. Away from the jumps post-buckling solutions are reasonably well described by the traditional modes whose analytical expressions may be used during preliminary design.

Unburied partially embedded subsea pipelines under high temperature conditions tend to relieve their axial compressive force by forming localised lateral buckles. This phenomenon is traditionally studied as a kind of imperfect column buckling problem. We study lateral buckling as a genuinely localised buckling phenomenon governed by a different static instability, with a different critical load. No ad hoc assumptions need to be made. We combine this buckling analysis with a detailed state-of-the-art nonlinear pipe-soil interaction model that accounts for the effect of lateral breakout resistance. This allows us to investigate the effect of initial embedment of subsea pipelines on their load-deflection behaviour. Parameter studies reveal a limit to the temperature difference for safe operation of the pipeline, in the sense that for higher temperature differences a localised buckling mode has lower total energy than the straight unbuckled pipe. Localised lateral buckling may then occur if the pipe is sufficiently imperfect or sufficiently dynamically perturbed.

“This is the great human rights issue of our time, and as prime minister, I am determined that we will make it a national and international mission to rid our world of this barbaric evil,” declared...

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) is an emergent microorganism of infections after liver transplant (LT). The aim of this study was to analyze the risk factors for CRE acquisition and infection after LT. METHODS: This was a prospective cohort study involving patients who underwent LT in the 2010 to 2014 period. Surveillance cultures for CRE were collected immediately before LT and weekly thereafter until hospital discharge. RESULTS: We analyzed 386 patients undergoing a total of 407 LTs. Before LT, 68 (17.6%) patients tested positive for CRE, 11 (16.2%) of those patients having CRE infection, whereas 119 (30.8%) patients acquired CRE after LT. Post-LT CRE infection was identified in 59 (15.7%) patients: Klebsiella pneumoniae was isolated in 83.2%; surgical site infection was the most common type of infection (46.7%). Multivariate analysis showed that post-LT dialysis was the only risk factor for post-LT CRE acquisition. Eighty-two percent of patients who underwent 3 or more post-LT dialysis sessions and acquired CRE before LT evolved with post-LT CRE infection. Other risk factors for CRE infection were acquisition of CRE post-LT, Model for End-Stage Liver Disease score greater than 32, combined transplantation, and reoperation. Patients who acquired CRE before LT had a high risk of developing CRE infection (P < 0.001). CONCLUSIONS: Measures for minimizing that risk, including altering the antibiotic prophylaxis, should be investigated and implemented.

We study the dynamics of one-dimensional slender structures such as cables, arches and flexible springs, that carry a moving load or mass. In the case of a moving mass we assume that inertial effects can be ignored. The geometrically-exact Cosserat rod theory is used to model the structure, which is allowed to undergo arbitrary three-dimensional flexural and twisting deformations. We use the generalised-α method for both the spatial and temporal discretisation of the equations of motion and Newton iterations to solve the resultant system of algebraic equations. This numerical scheme has good properties of second-order accuracy, unconditional stability and allows for tunable numerical dissipation. The theory is applied to a cable problem motivated by motorised transport systems such as inspection devices moving along bridge or powerline cables. Large deformations are found to have a resonance-detuning effect on the cable. We also consider the problem of an arch subject to a load that would lead to in-plane collapse if it was applied statically. Movement of the load is found to have a stabilising effect on the structure with collapse delayed at small velocities and suppressed altogether at sufficiently high velocity.

Introduction: Worldwide, implants mostly used for fixation of displaced midshaft clavicular fractures (DMCF) are the easily to bend reconstruction plate and the stiffer small fragment locking compression plate. Construct failure rates after plate fixation of DMCF are reported around 5 percent. Possible risk factors for construct failure are implant type and fracture type. However, little is known about the influence of fracture fixation method on construct failure. The aim of this study was to assess construct failure in plate fixation of DMCF and to identify possible risk factors. Methods: All consecutive patients treated in a level 1 trauma centre with open reduction and fixation of DMCF using a 3.5-mm reconstruction plate or 3.5-mm small fragment locking compression plate between 2007 and 2015 were evaluated. Potential risk factors for construct failure were analysed using univariate analysis. Results: Two hundred and fifty-nine patients were analysed. Fifty DMCF (19%) were fixated with a reconstruction plate and 209 (81%) with a small fragment locking compression plate. Construct failure was seen in 18 patients (6.9%), including 5 broken plates and 13 with screw loosening. Eight percent of all reconstruction plates broke in contrast to 0.5 percent of all small fragment locking compression plates (p = 0.001). All broken implants were used as a bridging plate. Loosening of screws was seen in older patients and when the plate was fixated with less than three bicortical screws on one side of the fracture (p = 0.002). Conclusions: Overall construct failure after open reduction and plate fixation of DMCF occurred in 6.9 percent. Risk factors for plate breakage were the use of a reconstruction plate and a bridging method for fracture fixation. Risk factors for screw loosening were an increasing patient age and plate fixation with less than three bicortical screws on one side of the fracture. Recommendations: Based on the results of this study our recommendation is to use a small fragment locking compression plate for open reduction and internal fixation of DMCF. The surgeon should always strive to fixate the plate on both sides of the fracture with at least three bicortical screws.

In response to the letter of Whitehead et al., we further discuss and clarify why shortcomings in the study under scrutiny do not give rise to a satisfactory argument that MSE is, as they say, irre...

Using the Job Demands-Resources model literature and the life-span theory as scholarly frameworks, we examined the effects of job demands and job resources as mediators in the relationship between bundles of used HRM practices and employee outcomes. In addition, we tested for age differences in our research model. Findings confirmed the hypothesized original 2-factor structure representing maintenance and development HRM practices. Structural Equation Modeling analyses showed that the maintenance HRM bundle related directly and negatively to employee outcomes, without moderating effects of age. However, job resources appeared to mediate this relationship in a positive way as it also did for the development HRM bundle. Whereas this study showed the ‘driving power’ of the actual use of HRM bundles through job resources, regardless of the employee’s age, this study also suggests a ‘dark side’ of HRM. In particular, we found that development HRM bundles may also increase job demands, which, in turn, may result in lower levels of beneficial employee outcomes. These empirical outcomes demonstrate the strength of the driving power eliciting from job resources preceded by any HRM bundle. Moreover, this effect appears to apply to employees of all ages. Our moderated-mediation model appeared robust for several control variables. Overall, this study provides an extension of the well-known Job Demands-Resources model by including maintenance and development bundles of HRM practices used by employees that have a differential effect on job demands and job resources which in turn have an impact on employee outcomes.

Distributed buoyancy method is one of the buckle initiation techniques used to trigger controlled lateral buckling at planned locations for subsea pipelines operating under high temperature and high pressure (HT/HP) conditions. Deviations from a straight profile for pipelines may be introduced by the pipe-laying vessel’s sway motion during the installation process. In this study, analytical solutions of lateral buckling are deduced for imperfect unburied subsea pipelines with a distributed buoyancy section. The effect of initial imperfections on buckled configurations and typical post-buckling behaviours is illustrated and analysed. The results show that, compared to the case without initial imperfection, lateral displacement amplitude becomes larger when initial imperfection exists. Maximum compressive stress increases when wavelength of initial imperfection is smaller than buckled length of pipeline. However, maximum compressive stress decreases when wavelength of initial imperfection is larger than buckled length of pipeline. So it’s better to introduce longer wavelength of initial imperfection.