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The response of a crystal lattice to strong, resonant excitation of an infrared-active phonon mode can be described by separating the crystal Hamiltonian into its linear and nonlinear terms: H [...], Terahertz-frequency optical pulses can resonantly drive selected vibrational modes in solids and deform their crystal structures (1-3). In complex oxides, this method has been used to melt electronic order (4-6), drive insulator-to-metal transitions (7) and induce superconductivity (8). Strikingly, coherent interlayer transport strongly reminiscent of superconductivity can be transiently induced up to room temperature (300 kelvin) in Y[Ba.sub.2][Cu.sub.3][O.sub.6+x] (refs 9,10). Here we report the crystal structure of this exotic non-equilibrium state, determined by femtosecond X-ray diffraction and ab initio density functional theory calculations. We find that nonlinear lattice excitation in normal-state Y[Ba.sub.2][Cu.sub.3][O.sub.6+x] at above the transition temperature of 52 kelvin causes a simultaneous increase and decrease in the Cu-[O.sub.2] intra-bilayer and, respectively, inter-bilayer distances, accompanied by anisotropic changes in the in-plane O-Cu-O bond buckling. Density functional theory calculations indicate that these motions cause drastic changes in the electronic structure. Among these, the enhancement in the [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] character of the in-plane electronic structure is likely to favour superconductivity.

Using ultrafast resonant soft x-ray diffraction, we demonstrate photoinduced melting of antiferromagnetic order in the correlated electron insulator NdNiO3. Time-dependent analysis of the resonant diffraction spectra allows us to follow the temporal evolution of the charge imbalance between adjacent Ni sites. A direct correlation between the melting of magnetic order and charge rebalancing is found. Furthermore, we demonstrate that the magnetic ordering on the Ni and Nd sites, which are locked together in equilibrium, become decoupled during this nonthermal process. [ABSTRACT FROM AUTHOR]

Oceanic 87Sr/86Sr-isotope ratios are strongly influenced by rates of silicate weathering and therefore linked not only to glaciation but also to sea-level change. The present study combines analysis of sequence stratigraphy and basin architecture with Sr-isotope stratigraphy in Miocene shallow-water sediments in southern Portugal and Crete (Greece). The common method is to use smoothed global sea water Sr-isotope reference curves but here a different approach is chosen. Instead, measured Sr-isotope curves are correlated with unsmoothed reference curves by identification of similar fluctuations in the order of several 100 kyr. Transgressive intervals are characterized by increasing Sr-isotope ratios interpreted as corresponding to intensified silicate weathering as a consequence of deglaciation, while lowstand deposits have low Sr-isotope ratios. Comparison of Sr-isotope curves and sedimentary sequences in the studied basins with independent global δ18O data and data on global sea-level might suggest a general relationship, supporting a connection to global climate change. Because of these relationships, the method presented herein has a high potential for use in high-resolution age dating and is also applicable in shallow-water sediments. [ABSTRACT FROM AUTHOR]

Health education is currently considered the most important factor in the prevention of HIV infection. Many AIDS education programs have started within the past several years, but few have undergone rigorous evaluation. This article presents findings from an outcome evaluation of the state of California AIDS Education and Prevention Program, the largest AIDS public education program in the country. The data suggest that the specific educational intervention programs suffered from many design defects which made it impossible to determine accurately the effectiveness of the programs. The programs did not use standard pre/post design, for example, or use standardized testing procedures. Moreover, only cognitive knowledge about AIDS transmission and prevention was stressed in the educational interventions and measures of effectiveness. The Education and Prevention Program must now move to promoting and measuring attitude and behavior change in addition to cognitive knowledge. The article concludes that AIDS education and prevention programs must place greater emphasis on conducting thorough evaluations, if the goals of attitude and behavior change are to be achieved. [ABSTRACT FROM AUTHOR]

The goal of this analysis is to describe seasonal disaster patterns in Central Europe in order to raise awareness and improve hospital disaster planning and resilience, particularly during peak events. Hospitals are essential pillars of a country's critical infrastructure, vital for sustaining healthcare services and supporting public well-being-a key issue of national security. Disaster planning for hospitals is crucial to ensure their functionality under special circumstances. But the impact of climate change and seasonal variations in the utilization of hospital services are raising challenges. Therefore, the knowledge of perennial disaster patterns could help strengthen the resilience of hospitals. We conducted a cross-sectional analysis of the Emergency Events Database EM-DAT for disasters in Central Europe (Germany, France, Denmark, The Netherlands, Belgium, Luxembourg, Switzerland, Austria, Czech Republic, and Poland) between January 2000 and December 2023. Time distribution of disasters, patterns and longitudinal trends, were analyzed to discuss impact on disaster preparedness in hospitals. Out of 474 events, 83% were associated with a natural hazard and only 80 events (17%) were of technological cause. While technological disasters were spread equally over the whole year, the vast majority of disasters related to natural hazards (n = 394), i.e. storms (n = 178, 45%), floods (n = 101, 26%), and extreme temperatures (n = 93, 24%) peaked during summer and winter months. Fewer disasters were registered during autumn and especially spring seasons. More than 50% of the technological disasters were categorized in the transport accident subgroup. Technological disasters were spread equally over the whole year. Looking at the three most common disaster types, extreme temperatures, floods, and storms are clearly dominating and cause over 90% of the disasters due to natural hazards in central Europe. Overall, the number of events per year fluctuates without a clear trend, only the technological events appear to become less frequent with 70% (n = 56) of the registered disasters occurring in the first half of the study period (2000-2011). An overlap of hospital admissions due to seasonal effects and catastrophic events, mainly triggered by disasters of natural cause in vulnerable periods may lead to a partial collapse of the health care system. To close knowledge gaps, future comprehensive data collection is vital for informed decision-making. Awareness and preparedness are key: an "all-hazards" approach to manage diverse, potentially simultaneous seasonal threats is often the most versatile strategy for hospital emergency planning., Competing Interests: Declarations. Competing interest: Markus Ries: Is a guest Editor of the collection „Disaster and emergency preparedness “ of Scientific Reports. The remaining authors have no conflicts of interest to declare., (© 2024. The Author(s).)

Introduction: Viscoelastic hemostatic assays (VHA) are integral in contemporary hemostatic resuscitation, offering insights into clot formation, firmness, and lysis for rapid diagnosis and targeted therapy. Large animal models, particularly swine, provide anatomical and physiological analogies for coagulation research. Despite the growing use of VHAs, the ClotPro ® device's applicability in porcine models remains unexplored. This study investigates ClotPro ® in a porcine model of abdominal surgery, severe hemorrhage, and resuscitation, comparing it with the established ROTEM ® delta system., Methods: Twenty-seven healthy pigs underwent abdominal surgery, hemorrhage and resuscitation. ClotPro ® and ROTEM ® were used to assess viscoelastic hemostatic properties at baseline, after surgery, 60 min after shock induction, 60 and 120 min after resuscitation., Results: Clotting times in extrinsically and intrinsically stimulated assays exhibited fair to moderate correlation. Clot firmness in extrinsically stimulated tests could be used interchangeably while fibrin polymerization assays revealed significant differences between the devices. Fibrin polymerization assays in ClotPro ® consistently yielded higher values than ROTEM ® . Furthermore, the study evaluated the ClotPro ® TPA-test's applicability in porcine blood, revealing failure of lysis induction in porcine blood samples., Conclusion: This research contributes valuable insights into the use of ClotPro ® in porcine models of hemorrhage and coagulopathy, highlighting both its applicability and limitations in comparison to ROTEM ® delta. The observed differences, especially in fibrin polymerization assays, emphasize the importance of understanding device-specific characteristics when interpreting results. Due to its inapplicability, TPA-test should not be used in porcine blood to evaluate fibrinolytic potential. The study provides a foundation for future investigations into the use of different viscoelastic hemostatic assays in porcine animal models., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gruneberg, Dietrich, Studier-Fischer, Petersen, von der Forst, Özdemir, Schöchl, Nickel, Weigand and Schmitt.)

Introduction: Acute kidney injury (AKI) is a common complication in patients undergoing major vascular surgery. Despite significant research efforts in this area, the incidence of AKI remains high, posing a significant challenge to healthcare systems, especially in situations where resources are limited. Early prediction of AKI severity and individualized postoperative care is therefore essential., Methods: The primary objective of this exploratory study was to assess the diagnostic value of urine cell-cycle arrest biomarkers [(TIMP-2) × (IGFBP7)] and soluble urokinase plasminogen activator receptor (suPAR) for predicting moderate or severe AKI within 24 h after open aortic surgery, and compared to routine kidney biomarkers. Seventy-five patients undergoing elective aortic surgery were included. Clinical parameters, urine and blood samples were collected preoperatively, immediately postoperatively, and 24 h later. AKI was defined using KDIGO criteria. Individual and combined diagnostic performance of biomarkers were evaluated., Results: Of the 75 patients, 61% developed AKI, of which 28% developed moderate or severe AKI within 24 h of surgery. Baseline demographics, comorbidities and kidney parameters did not differ between patients with moderate or severe AKI (AKI II/III) and none or mild AKI (AKI 0/I), except for higher preoperative suPAR levels in later AKI II/III patients. Urine osmolality, Cystatin C and serum creatinine had the highest predictive power for AKI II/III with AUCs of 0.75-0.72. (TIMP-2) × (IGFBP7), and neither (TIMP-2) × (IGFBP7) nor suPAR individually showed superior diagnostic value. Combining CysC or SCr with urine osmolality and 6 h urine output gave the best performance with AUCs of 0.86 (95% CI, 0.74-0.96) and 0.85 (95% CI, 0.75-0.95) respectively., Conclusion: Our study suggests that routine parameters like urine osmolality, CysC, SCr and 6 h urine output perform best in predicting postoperative AKI after aortic surgery compared to the new biomarkers (TIMP-2) × (IGFBP7) and suPAR. Combining biomarkers, particularly CysC or SCr with urine output, urine osmolality, may enhance diagnostic accuracy. Further validation in larger cohorts and clinical settings is warranted to establish their clinical utility., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nusshag, Theobald, Wortmann, Kaimann, Dietrich, Gruneberg, Tourelle, von der Forst, Weigand, Bischoff, Böckler and Schmitt.)

Background: Medical research aims to improve patient safety and efficiency in the perioperative setting. One critical aspect of patient safety is the intrahospital transfer of patients. Also, reliable monitoring of vital signs is crucial to support the medical staff. This study was conducted to assess two monitoring systems in terms of the handover time and staff satisfaction., Methods: To assess several aspects, two monitoring systems were compared: an organizational unit-related monitoring system that needs to be changed and brought back to the initial organizational unit after the patient transfer and a patient-specific monitoring system that accompanies the patient during the whole perioperative process., Results: In total, 243 patients were included, and 375 transfers were examined to analyze economic factors, including differences in handover times and user-friendliness. To this end, 30 employees of the Heidelberg University Hospital were asked about their satisfaction with the two monitoring systems based on a systematic questionnaire. It could be shown that, especially during transfers from the operating theater to the intensive care unit or the recovery room, the time from arrival to fully centralized monitoring and the total handover time were significantly shorter with the patient-specific monitoring system (p < 0.001). Furthermore, the staff was more satisfied with the patient-specific monitor system in terms of flexibility, cleanability and usability., Conclusion: The increased employee satisfaction and significant time benefits during intrahospital transports may increase patient safety and efficiency of patient care, reduce employee workload, and reduce costs in the overall context of patient care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Tourelle et al.)

Background : Viscoelastic hemostatic assays (VHAs) have become an integral diagnostic tool in guiding hemostatic therapy, offering new opportunities in personalized hemostatic resuscitation. This study aims to assess the interchangeability of ClotPro® and ROTEM® delta in the unique context of parturient women. Methods : Blood samples from 217 parturient women were collected at three timepoints. A total of 631 data sets were eligible for our final analysis. The clotting times were analyzed via extrinsic and intrinsic assays, and the clot firmness parameters A5, A10, and MCF were analyzed via extrinsic, intrinsic, and fibrin polymerization assays. In parallel, the standard laboratory coagulation statuses were obtained. Device comparison was assessed using regression and Bland-Altman plots. The best cutoff calculations were used to determine the VHA values corresponding to the established standard laboratory cutoffs. Results : The clotting times in the extrinsic and intrinsic assays showed notable differences between the devices, while the extrinsic and intrinsic clot firmness results demonstrated interchangeability. The fibrinogen assays revealed higher values in ClotPro ® compared to ROTEM ® . An ROC analysis identified VHA parameters with high predictive values for coagulopathy exclusion and yet low specificity. Conclusions : In the obstetric setting, the ROTEM ® and ClotPro ® parameters demonstrate a significant variability. Device- and indication-specific transfusion algorithms are essential for the accurate interpretation of measurements and adequate hemostatic therapy.

Patients with sepsis-associated delirium (SAD) show severe neurological impairment, often require an intensive care unit (ICU) stay and have a high risk of mortality. Hence, useful biomarkers for early detection of SAD are urgently needed. Extracellular vesicles (EVs) and their cargo are known to maintain normal physiology but also have been linked to numerous disease states. Here, we sought to identify differentially expressed proteins in plasma EVs from SAD patients as potential biomarkers for SAD. Plasma EVs from 11 SAD patients and 11 age-matched septic patients without delirium (non-SAD) were isolated by differential centrifugation, characterized by nanoparticle tracking analysis, transmission electron microscopy and Western blot analysis. Differential EV protein expression was determined by mass spectrometry and the resulting proteomes were characterized by Gene Ontology term and between-group statistics. As preliminary results because of the small group size, five distinct proteins showed significantly different expression pattern between SAD and non-SAD patients ( p ≤ 0.05). In SAD patients, upregulated proteins included paraoxonase-1 (PON1), thrombospondin 1 (THBS1), and full fibrinogen gamma chain (FGG), whereas downregulated proteins comprised immunoglobulin (IgHV3) and complement subcomponent (C1QC). Thus, plasma EVs of SAD patients show significant changes in the expression of distinct proteins involved in immune system regulation and blood coagulation as well as in lipid metabolism in this pilot study. They might be a potential indicator for to the pathogenesis of SAD and thus warrant further examination as potential biomarkers, but further research is needed to expand on these findings in longitudinal study designs with larger samples and comprehensive polymodal data collection.