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Low-energy investigations on rare ion beams are often limited by the available intensity and purity of the ion species in focus. Here, we present the first application of a technique that combines in-flight production at relativistic energies with subsequent secondary beam storage, accumulation and finally deceleration to the energy of interest. Using the FRS and ESR facilities at GSI, this scheme was pioneered to provide a secondary beam of $^{118}$Te$^{52+}$ for the measurement of nuclear proton-capture at energies of 6 and 7 MeV/u. The technique provided stored beam intensities of about $10^6$ ions at high purity and brilliance, representing a major step towards low-energy nuclear physics studies using rare ion beams.

Background Infections with S. haematobium are endemic in tropical regions and emerging in some European countries. Prolonged chronic infection with S. haematobium can cause Female Genital Schistosomiasis (FGS), which can lead to serious gynecological conditions, including infertility. However, awareness of FGS is limited, as are adequate guidelines and public health strategies to manage the disease. The aim of this study is to determine the levels and quality of FGS awareness among women and healthcare workers (HCW) in the Boeny region of Madagascar, where the disease is endemic. Methods Data collection involved a cross-sectional survey of adult women (n = 694) and HCWs (n = 93) on topics, such as respondents’ sociodemographic background characteristics, FGS awareness, and risk perceptions. Results were analyzed using descriptive statistics including proportions and 95% confidence intervals. Results Of the 694 women included in the study, 11.2% (CI [9.0-13.8%]) had heard of FGS. Among these, 34.6% (CI [24.1-46.2%]) were unaware of the gynecological symptoms signature for FGS, and 41% (CI [30.0-52.7%]) were unaware of the urological symptoms of the disease. Out of the 93 HCW surveyed, 53.2% (CI [42.6-63.6%]) had heard of FGS. Among these, 42.0% (CI [28.1-56.8%]) were unaware of the gynecological symptoms, and 52.0% (CI [37.4-66.3%]) were unaware of the urological symptoms. Conclusions Preliminary results show overall low levels of FGS awareness among the study population. While more women reported to have never heard of FGS than HCW, the proportion of HCWs who did not know the gynecological and urological symptoms of FGS was higher. Given the occurrence of FGS in Europe and the chronic character of the disease it would be crucial to conduct similar investigations in Europe. Such findings can contribute to the design of targeted local and global FGS awareness campaigns to improve the health of women affected by this disease worldwide. Key messages • Awareness of FGS among the study population in Madagascar, an endemic country, is low. • Lack of awareness can delay the identification of the disease and increase individual and community burden.

Background Prognosis in HFpEF is determined by risk factor control and treatment of comorbidities. Industrially processed TFA (IP-TFA) from partially hydrogenated oils have been linked to altered lipoprotein metabolism, endothelial dysfunction, increased biomarkers of inflammation and increased NTproBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown. Purpose To evaluate associations of blood TFA with cardiovascular risk factors, aerobic capacity and cardiac function in patients with HFpEF. Methods This is a secondary analysis from the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n=404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67±8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥50%, E/e' 7.1±1.5; median NT-proBNP 158 ng/L (IQR 82–298). Multiple linear regression analyses, using sex and age as covariates, were used to describe associations of TFA with metabolic phenotype, functional capacity, echocardiographic markers for left ventricular diastolic function (LVDF), and neurohumoral activation at baseline and after 12-months-follow-up (12mFU). To account for randomization group, all analyses were repeated as sensitivity analysis with group as covariate. A significance level of α=5% was used for all tests. As all tests were hypothesis generating without confirmatory interpretation, no correction was applied to counteract the problem of multiple comparisons. Results Higher blood levels of the naturally occurring TFA C16:1n-7t were broadly associated with a more favorable lipid profile, lower body weight/central adiposity, lower white blood cell count and lower biochemical markers of non-alcoholic fatty liver disease at baseline/12mFU. Conversely, blood levels of the IP-TFA C18:1n9t were directly associated with lipid risk markers [triglycerides (β=19.7, p Conclusions In HFpEF patients, higher blood levels of industrially processed TFA, but not of the TFA C16:1n-7t in full fat dairy and meat, were associated with a higher risk phenotype and lower aerobic capacity. Our findings support efforts to remove IP-TFA from the food supply for improving risk factor control in HFpEF patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): German Foundation of Heart Research

Background Schistosomiasis is a high-burden parasitic disease and endemic in tropical climates, such as Madagascar. Recently it is emerging in Europe. Chronic infections lead to disabilities including loss in work productivity. Current control strategies focus on school-aged children, thereby systematically excluding adults. The goal to eliminate the disease as a public health problem is aligned with the Sustainable Development Goals agenda, including Universal Health Coverage (UHC). We aim at assessing the distribution of schistosomiasis among adults in Madagascar, in order to promote more targeted public health initiatives against the disease. Methods In a cross-sectional study, 1477 blood samples were collected at three primary health-care centers in Madagascar from 03.21 to 01.22. A semi quantitative PCR assay was used to assess the presence of Schistosoma. Positivity rates with 95% Confidence Intervals (CI) were reported by gender and age groups. Results Our study population had a balanced gender distribution with 54.2% [CI: 51.7;56.8] of females and a median age of 37 years (IQR: 24-48). Preliminary results show an overall Schistosome positivity rate of 59.5% [CI: 57.0;62.0]. Positivity was higher in males 62.4% [CI: 58.7;66.1], than in females 57.1% [CI: 53.5;60.5]. Highest positivity was seen in the 18-34 year age group with 66.2% [CI: 62.7;69.6]. Lowest positivity of 46.2% [CI: 39.2;53.2] was observed in adults aged over 55 years. Conclusions Our preliminary results provide evidence of high positivity rates of schistosomiasis among adults in a highly endemic country. Differently from many studies, males seem more affected than females. The youngest age group, representing the more active workforce of a population, shows a higher positivity rate. Our data suggests that, in the logic of UHC and health as a human right, public health strategies for schistosomiasis need to be re-addressed towards a universal coverage of affected individuals. Key messages

Background and objectives Malaria remains a major global public health concern and a leading cause of morbidity and mortality especially among children Methods Using data of 3,004 children from the Malaria Indicator Survey of the Demographic and Health Surveys Program conducted in Ghana in 2019, a household wealth index (quintiles) was derived using principal component analysis based on household assets. Causal multiple mediation analyses investigated mediating effects of treatment-seeking, bed net (LLIN) use, educational attainment, and housing conditions on the association between socioeconomic position and children's malaria fever events. Results Higher maternal educational attainment and housing conditions jointly mediate 18% of the association between socioeconomic position and malaria fever events (OR = 0.98; 95%CI = 0.96-0.99). Maternal educational attainment and seeking formal prenatal health care jointly mediate 20% of the total effect (OR = 0.98; 95%CI = 0.95-1.00), in presence of a lower socioeconomic position. No strong mediation was found for educational attainment jointly with the use of LLINs between malaria and socioeconomic position in this study (OR = 0.99; 95%CI = 0.97-1.01). Conclusions As shown by the proportions mediated between malaria and socioeconomic position, findings suggest that current malaria control efforts could be strengthened by investments at the structural levels, such as increased (female) education, targeted improvements in housing, and stronger integration of informal health care. Key messages

This paper examines two CDC data sets in order to provide a comprehensive overview and social implications of COVID-19 related deaths within the United States over the first eight months of 2020. By analyzing the first data set during this eight-month period with the variables of age, race, and individual states in the United States, we found correlations between COVID-19 deaths and these three variables. Overall, our multivariable regression model was found to be statistically significant. When analyzing the second CDC data set, we used the same variables with one exception; gender was used in place of race. From this analysis, it was found that trends in age and individual states were significant. However, since gender was not found to be significant in predicting deaths, we concluded that, gender does not play a significant role in the prognosis of COVID-19 induced deaths. However, the age of an individual and his/her state of residence potentially play a significant role in determining life or death. Socio-economic analysis of the US population confirms Qualitative socio-economic Logic based Cascade Hypotheses (QLCH) of education, occupation, and income affecting race/ethnicity differently. For a given race/ethnicity, education drives occupation then income, where a person lives, and in turn his/her access to healthcare coverage. Considering socio-economic data based QLCH framework, we conclude that different races are poised for differing effects of COVID-19 and that Asians and Whites are in a stronger position to combat COVID-19 than Hispanics and Blacks.

The prediction of microclimate effects within an urban context through simulations has previously been done through elaborate software packages that offer accurate results but require extensive domain knowledge and time for the preparation of a model. In day-to-day policymaking, however, these efforts may turn out to be a major limiting factor: Policymakers and city administrators need a quick tool that can predict the effects of urban interventions in a variety of possible scenarios rather than a full-fledged simulation study for a limited set of specific interventions. In our work, we have been seeking to address this mismatch in expectations by using the best of both worlds: We have approximated results from a full-fledged simulation that uses a Cellular Automaton running within a 3D city visualization. Policymakers can edit the urban context by changing cell types (placement of greenery, etc.), thus leading to scenarios that can be compared to the status quo. As a matter of fact, policymakers can use these comparisons to argue for measures that mitigate the effects of heat islands, without requiring extensive domain knowledge or the effort to prepare a simulation model.

Experimental determination of the cross sections of proton capture on radioactive nuclei is extremely difficult. Therefore, it is of substantial interest for the understanding of the production of the p-nuclei. For the first time, a direct measurement of proton-capture cross sections on stored, radioactive ions became possible in an energy range of interest for nuclear astrophysics. The experiment was performed at the Experimental Storage Ring (ESR) at GSI by making use of a sensitive method to measure (p,γ) and (p,n) reactions in inverse kinematics. These reaction channels are of high relevance for the nucleosyn-thesis processes in supernovae, which are among the most violent explosions in the universe and are not yet well understood. The cross section of the 118Te(p,γ) reaction has been measured at energies of 6 MeV/u and 7 MeV/u. The heavy ions interacted with a hydrogen gas jet target. The radiative recombination process of the fully stripped 118Te ions and electrons from the hydrogen target was used as a luminosity monitor. An overview of the experimental method and preliminary results from the ongoing analysis will be presented.

Background: Professional identity formation (PIF) is considered a key process in the development of healthcare providers. In medical education, PIF literature has historically centered on cognitive processes and medicine’s socialization practices that help to transform trainees to clinicians. Recent work has begun to unravel how larger socio-historical contexts and identity intersectionality influence PIF in ethnically/racially minoritized physicians,1-2 but has not yet been explored in physician assistant (PA) students and PAs considered underrepresented minorities (URM). Methods: In this qualitative study, 44 URM PA students and practicing PAs were recruited and interviewed from three southern universities/colleges. Participants included three Native Americans, 23 Black/African Americans, 12 Hispanic/Latinos, and six of mixed races/ethnicities. Using constructive grounded theory, the authors analyzed interview data for how the participants construct their professional identity and how factors like ethnicity, race, and gender influence PIF. Constant comparative analysis among the researchers was used to identify themes and discuss differences. Results: The results indicated that minoritized PAs identify their diverse background and experiences as assets to their professional identity and leverage these assets in their interactions with underserved patients. Participants described how their personal identities and socio-historical contexts informed their clinical thinking and practice, especially in instances of racial/ethnic concordance. Conclusions: Race, ethnicity, gender, and socio-historical contexts influence the PIF of minoritized PAs in ways that have been largely ignored in medical literature and PAs leverage these qualities to improve patient interactions., Background: The early months of 2020 strained US health systems, prompting abrupt, unprecedented alteration to medical curricula. We found medical students, from first years to near-graduates, described themselves as ill-equipped sentient “fomites,” unpaid “meat shields,” “wastes of masks,” and impediments to the “real” work of responding to COVID-19. They fell back on well-established student identities and activities, retreating into Anki decks and QBanks, as much a symptom of underpreparedness to support the pandemic response as a remedy. Methods: We collected 5,460 COVID-related r/medicalschool Reddit posts made from 3/12/2020-4/16/2020 and selected those commenting on professional role, identity, or preparation. We then applied Critical Incident Analysis—a method for unpacking “underlying trends, motives and structures”1(p23-24) that “trigger insights about some aspect of teaching and learning.”2(p13) In accordance with Columbia University IRB and the medical school subreddit rules for research studies, this study does not involve the recruitment of participants and falls outside the scope of Human Subjects Research under 45 CFR 46 (Columbia University protocol: AAAS6866(M00Y01)). Results: We offer the analysis of these critical incidents to open discussion of how curricula can support students from day one to step up, rather than step back, from opportunities to provide care in the face of novel challenges to public health. We invite conversation about how medical schools can foster the professional identity formation in today’s students necessary for tomorrow’s physicians to feel as well-equipped to handle unforeseen medical crises as to crush upcoming exams., Summary of Innovation: The attitude medical students have toward disabled persons is mixed: some studies reported students had a worse perception of disabled persons, while in others they were more empathetic.1 One reason why medical students may see disabled persons as deficient is rooted in the medical model of disability, where the problem is a result of an individual’s physiology and/or biology.2 This is contrasted with the human rights model of disability, which stresses that all disabled persons should have both legal and human rights, and that society should have an understanding of the role impairment plays in both their and our lives.3 Disabled persons need and deserve quality and empathetic medical care so that they and we can live our best possible lives. Updating medical school curricula to include perspectives from disabled persons in addition to the reality impairments play in our lives from a rights-based perspective may improve the medical care disabled persons receive. Utilizing an autoethnographic perspective,4,5,6 I reflect on and analyze two specific comments repeated by medical professionals some of the comments made to me that characterize the tone of the medical model of disability. Recognizing that an autoethnographic account is not meant to be generalizable, this commentary on medical education stresses the need to include (a) disability framed using the human rights model, and (b) disabled people in revising medical school curricula., Summary of Innovation: Interprofessional collaboration provides unique opportunities for improving patient care in pediatric hospital medicine. This study used Tajfel and Turner’s Social Identity Theory as a conceptual framework to characterize the relationships between the social identities of pediatric hospitalists and their perceptions of interprofessional collaboration and teamwork. This theory was chosen given its ability to study interpersonal dynamics within complex systems, including healthcare. We used qualitative methods including free-listing and semi-structured interviews to explore these phenomena and examine the relationships among identity, collaboration, and teams. Thirteen pediatric hospitalists were recruited for participation over the course of three months. We identified five key themes: (1) Pediatric hospitalists fall along a spectrum ranging from profession-centered to team-centered, (2) Familiarity is conducive to formation of team identity, (3) Co-creation of a shared vision and practice of creating shared mental models strengthens sense of team, (4) Workplace culture, which includes workflows and reporting hierarchies among others, acts as both a facilitator for and barrier to formation of team identity, and (5) Although most participants identified themselves as the leaders of the team, the concept of “flexible leadership“, or identifying the team member with the appropriate expertise and skillset as the leader for a given problem, was prominent in high-functioning teams. We conclude that Social Identity Theory can be a useful theoretical lens for examining interprofessional collaboration and teamwork in healthcare settings, including among pediatric hospitalists. Moving forward, it will be critical to explore the link between social identity and patient-centered outcomes as well as to evaluate the development of profession-based and team-based identities., Background: The literature describes the crucial role of Professional Identity Formation (PIF) in medical students’ transition to physicians. Little is known about how medical students are developing their sense of professional identity during these early months of the COVID-19 pandemic. In this initial study, we explored perceptions and experiences of undergraduate medical students whose training and education have been dramatically affected to better understand how these widespread disruptions have influenced their professional identity formation. Methods: We conducted a conventional content analysis1 of published medical student blogs, commentaries, and perspectives. Inclusion criteria were: (1) the publication highlighted medical students’ experiences; (2) the writer identified as an undergraduate medical student, or the writer stated direct quotations from undergraduate medical students; (3) U.S. and Canada based (4) posted since 17/ Mar/2020. We identified twenty blogs and commentaries that fit inclusion criteria. We, the four authors, independently performed a straightforward content analysis of medical students’ written public statements to identify emerging themes. To ensure validity of the analysis, we then compared and discussed our separate findings to arrive at a consensus position. Findings: We found three major themes: identity dissonance; questioning and asserting the legitimacy of medical students as physicians; and renewed values, commitment, and virtues of a physician. The findings showed that the major disruptions of COVID-19 to medical education and health care can impact PIF in both negative and positive ways. This study will further inform the design and components of future projects on medical students’ PIF amid COVID-19.

Obstipation ist ein haufiges Symptom, das mit zahlreichen Erkrankungen assoziiert oder auf strukturelle oder funktionelle Erkrankungen des Kolons und Rektums zuruckzufuhren sein kann. Je nach Ursache lasst sich die Obstipation oft mit einer Umstellung der Lebens- und Ernahrungsgewohnheiten sowie Quellmitteln und Laxanzien beheben. Sprechen die Patienten darauf nicht an, kann eine Operation indiziert sein.

Approximately 4% of pregnant patients with COVID-19 infection require intensive care unit admission. Given the practical implications of advanced ventilatory and circulatory support techniques, urgent or emergent delivery for non-reassuring fetal status frequently represents a logistical impossibility. This manuscript proposes a protocol for obstetrical management of patients in these situations, emphasizing coordinated preparation between obstetric, anesthesiology, and intensivist teams, with planned preterm delivery at gestational ages when neonatal outcomes are likely to be favorable.

Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use for this procedure. Here, we describe our experience with a simple technique using a mobilized falciform ligament flap in minimally invasive liver surgery (MILS). We retrospectively analyzed the charts from 46 patients who received minor MILS between 2011 and 2019 from the same surgical team in a university hospital setting in Germany. Twenty-four patients underwent laparoscopic liver resection, and 22 patients received robotic-assisted liver resection. Sixteen patients in the laparoscopic group and fourteen in the robotic group received a falciform ligament flap (FLF) to cover the resection surface after liver surgery. Our cohort was thus divided into two groups: laparoscopic and robotic patients with (MILS + FLF) and without an FLF (MILS−FLF). Twenty-eight patients (60.9%) in our cohort were male. The overall mean age was 56.8 years (SD 16.8). The mean operating time was 249 min in the MILS + FLF group vs. 235 min in the MILS−FLF group (p = 0.682). The mean blood loss was 301 ml in the MILS + FLF group vs. 318 ml in the MILS−FLF group (p = 0.859). Overall morbidity was 3.3% in the MILS + FLF group vs. 18.8% in the MILS−FLF group (p = 0.114). One patient in the MILS−FLF group (overall 2.2%), who underwent robotic liver surgery, developed bile leakage, but this did not occur in the MILS + FLF group. Covering the resection surface of the liver after minor minimally invasive liver resection with an FLF is a simple and cost-effective technique that does not prolong surgical time or negatively affect other perioperative parameters. In fact, it is a safe add-on step during MILS that may reduce postoperative morbidity. Further studies with larger cohorts will be needed to substantiate our proof of concept and results.

Hospital refurbishments often take place in parallel to regular operation, resulting in a scheduling problem: Construction activities must located such as they do not clash with daily work activities and vice versa. To be able to see this mutual influence, we have devised a tool in which we are able to visualize the adverse effects of construction on daily operation. The approach uses a cellular automaton to represent the three-dimensional hospital environment and uses a particle simulation for computing the distribution of dust, noise and vibrations. By interactively relocating work activities and construction activities, our tool can be used to solve the mentioned scheduling problem. It also enables us to show the sequence of construction and relocation activities in 3D, which might be easier to interpret than a classical project plan in tabular form.

Fecal incontinence refers to the inability to pass stool in a localized and timely manner resulting in the involuntary loss of intestinal contents such as air, intestinal mucus or stool. The prevalence of fecal incontinence in the general population is approximately 2-21%. Women are more frequently affected than men. Physiotherapeutically guided pelvic floor training, otherwise known as Kegel exercise, is the mainstay of treatment for fecal incontinence. The objective of this study was to evaluate the feasibility and potential benefits of a new biofeedback training, which uses a non-insertable pelvic floor sensor with digital interface, called ACTICORE1.From January 2020 to April 2021, we conducted a prospective non-randomized multicentric clinical pilot study at the Alexianer St. Hedwig Hospital Berlin (Germany), private clinic Strack (Germany) and the University Hospital Magdeburg (Germany). Patients with fecal incontinence, defined as a Wexner score2, were recruited and asked to either perform biofeedback training with ACTICORE1 (6 min daily for 16 weeks) or daily Kegel exercise (Physiotherapeutic guidance weekly for the first 6 weeks; biweekly for the remaining 10 weeks). The primary outcome was severity of fecal incontinence after 16 weeks of training assessed using the Wexner score. Secondary outcomes were severity of fecal incontinence after 12 weeks and patients' quality of life assessed using the EQ-5D-3L questionnaire after 16 weeks of training. The two-one-sided t-tests (TOST) procedure was used to determine if training with ACTICORE1 has equivalent or noninferior efficacies compared to Kegel exercise.A total of 40 individuals were included. Dropout occurred in 4 cases. The final sample included 19 patients who performed the ACTICORE1 training (ACTICORE-group) and 17 patients who performed guideline-based physiotherapy (PHYSIO-group). Univariate analysis of biometric parameters showed no statistically significant differences. Individuals in the ACTICORE-group were younger (M=46,6 (SD=18,9) years vs. M=57,1 (SD=17,3) years, p=0.093). In terms of endpoint evaluation, a non-inferiority of ACTICORE1 compared to the therapy standard (Kegel exercise) was detected. Both groups showed a statistically significant intraindividual improvement in fecal incontinence as measured by Wexner scoring after 16 weeks. The TOST detected a non-inferiority of ACTICORE1 training (98% confidence interval with equivalence bounds 5 for low and high; Results: 1.36, upper 6.75).Pelvic floor training with ACTICORE1 may enable sufficient pelvic floor training as a digital health application. The study at hand revealed a non-inferiority of ACTICORE1 training compared to Kegel exercise.

Eine Hyperthermie endet nicht selten letal und muss daher umgehend erkannt und suffizient behandelt werden. Ein 28-jahriger Mann nahm an einem heisen Sommertag (28 °C) an einem Langstreckenwettlauf (3 km) teil. Dabei kollabierte der Laufer, ubergab sich, setzte aber den Lauf weiter fort und erreichte das Ziel. Neurologisch zeigte sich der Patient mit intermittierenden zerebralen Krampfanfallen. Es wurden sofort externe Kuhlakkumulatoren angelegt und kalte Infusionen angewendet. Der Patient wurde auf die Intensivstation des Universitatsklinikums aufgenommen (Korpertemperatur 40,2 °C). Nach wenigen Stunden entwickelte sich eine manifeste disseminierte intravasale Koagulopathie mit Multiorganversagen. In den ersten 12 h waren zur Stabilisierung eine Volumensubstitution von 12 l sowie die Gabe von 8 Konserven „fresh frozen plasma“ und 2 Erythrozytenkonzentraten notig. Obwohl mit forcierter externer Kuhlung und kalten Infusionen die Korpertemperatur bis zum nachsten Morgen auf 38 °C gesenkt werden konnte, verschlechterte sich die Gesamtsituation des Patienten weiter. Trotz Dialyse und Massivsubstitution von Gerinnungsfaktoren konnte der Patient nicht ausreichend stabilisiert werden und verstarb an einem Hirnodem. Nicht nur altere Menschen oder Kleinkinder, sondern auch junge, athletische Sportler nach normaler sportlicher Betatigung (3-km-Lauf) unterliegen der potenziellen Gefahr eines letalen Hitzeschocks. Mit der Kuhlung muss sofort begonnen und der Patient stationar als vitaler Notfall auf eine Intensivstation aufgenommen werden. Tritt erst ein Versagen der Hamostase durch den hitzebedingten Verlust der hepatogenen Proteinsynthese ein, beginnt ein Circulus vitiosus, der wie im berichteten Fall trotz maximaler Therapie und Substitution nicht reversibel ist.

INTRODUCTION Assessment of axillary lymph node status is important in breast cancer staging. UK guidance recommends sentinel lymph node biopsy (SLNB) or 4-node sampling (4-NS) where ultrasound and ultrasound-guided biopsy are negative. Where biopsy, SLNB or 4-NS are positive, axillary lymph node dissection (ALND) is recommended. The surgical procedure ALND, and to a lesser extent SLNB and 4-NS, are associated with adverse effects such as arm lymphoedema. Magnetic resonance imaging (MRI) provides detailed images of the body in any plane and is a non-invasive technique with few adverse events. An MRI scan may provide information on whether a lymph node is suspicious for metastasis, avoiding the need for surgery and its associated adverse effects. However, it is unclear whether MRI can match the excellent diagnostic accuracies of ALND, SLNB and 4-NS. OBJECTIVE To assess the diagnostic accuracy and effect on patient outcomes of MRI for assessment of axillary lymph nodes in newly diagnosed early breast cancer.

This paper is based on the assumption that a key challenge of good design is spatial organization as a result of functional requirements. The authors present a new NetLogo application that assists designers in understanding proposed functional relationships (of spaces) by visualizing them graphically. In more detail, the tool translates adjacency matrices (as representation of functional relationships) into a graph (in architecture known as bubble diagram). The latter can be considered as a pre-step of the actual design, by which the information about functional interrelations becomes more readable and understandable for the designer.

Perovskite silicon tandem solar cells combine potentially low production costs with the ability to surpass the efficiency limit of silicon single junction solar cells. Optical modeling and optimization are crucial to achieve this ambitious goal in the near future. The optimization should seek to maximize the energy yield based on realistic environmental conditions. This work analyzes the energy yield of perovskite silicon tandem solar cells and modules based on realistic experimental data, with a special focus on the investigation of surface textures at the front and rear side of the solar cell and its implication for reflection as well as parasitic absorption properties. The investigation reveals a 7.3%

Hyperthermia often ends fatally and must therefore be promptly recognized and adequately treated.A 28-year-old man participated in a long-distance race (3 km) on a hot summer day (28 °C). The runner collapsed, had to vomit but continued the run and reached the finish. Neurologically, the patient presented with intermittent cerebral seizures. External cooling batteries were immediately applied and cold infusions were started. The patient was admitted to the intensive care unit of the university hospital (body temperature 40.2 °C). After a few hours, a manifest disseminated intravascular coagulopathy developed with multiple organ failure. It took 12 l of volume replacement, 8 units of fresh frozen plasma and 2 units of erythrocyte concentrates in the first 12 h to stabilize the patient. Although with the help of forced external cooling and application of cold infusions, the body temperature could be lowered to 38 °C by the next morning, the overall situation of the patient continued to deteriorate. Despite dialysis and massive substitution of coagulation factors, the patient could not be sufficiently stabilized and died of brain edema.Not only the old or young children are subject to the potential danger of a fatal heat stroke but also young athletic persons after normal sports activities (3 km run). Cooling must be started immediately and the patient must be hospitalized as a vital emergency. If hemostasis fails due to the heat-related loss of hepatogenic protein synthesis, a viscious circle begins, which, as in the reported case, is irreversible despite maximum therapy and substitution.

Indications of a GeV component in the emission from GRBs are known since the EGRET observations during the 1990's and they have been confirmed by the data of the Fermi satellite. These results have, however, shown that our understanding of GRB physics is still unsatisfactory. The new generation of Cherenkov observatories and in particular the MAGIC telescope, allow for the first time the possibility to extend the measurement of GRBs from several tens up to hundreds of GeV energy range. Both leptonic and hadronic processes have been suggested to explain the possible GeV/TeV counterpart of GRBs. Observations with ground-based telescopes of very high energy photons (E>30 GeV) from these sources are going to play a key role in discriminating among the different proposed emission mechanisms, which are barely distinguishable at lower energies. MAGIC telescope observations of the GRB 090102 (z=1.547) field and Fermi Large Area Telescope (LAT) data in the same time interval are analysed to derive upper limits of the GeV/TeV emission. We compare these results to the expected emissions evaluated for different processes in the framework of a relativistic blast wave model for the afterglow. Simultaneous upper limits with Fermi and a Cherenkov telescope have been derived for this GRB observation. The results we obtained are compatible with the expected emission although the difficulties in predicting the HE and VHE emission for the afterglow of this event makes it difficult to draw firmer conclusions. Nonetheless, MAGIC sensitivity in the energy range of overlap with space-based instruments (above about 40 GeV) is about one order of magnitude better with respect to Fermi. This makes evident the constraining power of ground-based observations and shows that the MAGIC telescope has reached the required performance to make possible GRB multiwavelength studies in the very high energy range., 8 pages, 5 figures, 2 tables. Submitted to MNRAS

Helminths are complex pathogens that ensure their long-term survival by influencing the immune responses of their host. Excretory/secretory products (ESP) can exert immunoregulatory effects which foster parasite survival. Galectins represent a widespread group of β-galactoside-binding proteins which are involved in a multitude of biological processes operative in parasite-host interaction. We had earlier identified seven galectins in Strongyloides ratti, four of them detected in the ESP of distinct developmental stages of the parasite. In the present report, we focused on the characterization of two of them, Sr-galectin-1 (Sr-Gal-1) and Sr-galectin-3 (Sr-Gal-3). While Sr-Gal-3 expression was strongest in parasitic females, Sr-Gal-1 was predominantly expressed in free-living females. Both proteins were cloned and recombinantly expressed in an E. coli expression system. Their glycan-binding activity was verified by haemagglutination and glycan array analysis. Furthermore, primary immunological activities of the Sr-galectins were initially investigated by the application of an in vitro mucosal 3D-culture model, comprising of mucosa-associated epithelial and dendritic cells. The Sr-galectins stimulated preferentially the release of the type 2 cytokines thymic stromal lymphopoietin and IL-22, a first indication for immunoregulatory activity. In addition, the Sr-galectins dose-dependently fostered cell migration. Our results confirm the importance of these carbohydrate-binding proteins in host-parasite-interaction by indicating possible interaction with the host mucosa-associated cells.

Discrete-event simulation of hospitals typically specifies flow by means of a process graph through which patients are routed. While this is generally fine for models in which processes are clearly defined, e.g. smaller units such as emergency departments, it falls short of capturing the fact that a patient can in principle go from one unit to any other unit if medical procedure requires it. This problem becomes even more evident when modeling a whole hospital, at which level specifying each individual treatment through directed edges and nodes becomes unviably complex. In the past three years, we have been developing a combined hospital simulation/space design tool in which processes are defined individually by patient, as sequence of visited units imported from the Hospital Information System (treatment chains). The major advantage of this approach lies in the fact that we can now design a future space layout in which assumed capacities (staffing, equipment, required space) can be tested against the recorded patient volume, using an Agent-Based Simulation to re-enact each treatment chain. In contrast to other hospital simulations, this approach targets early stages of architectural conception, during which the actual building structure is elaborated. Using the method, we can compare and contrast different layouts during that stage, making simulation a driver for design rather than a tool for late optimization within the final floor plan.