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Background: Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge. Objective: We investigated associations of patients' decisional control preference (DCP) with their medical knowledge, ward round performance measures (e.g., duration, occurrence of sensitive topics), and perceived quality of care measures (e.g., trust in the healthcare team, satisfaction with hospital stay). Design: This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals. Participants: Adult patients that were hospitalized for inpatient care. Main Measures: The primary outcome was patients' subjective average knowledge of their medical care (rated on a visual analog scale from 0 to 100). We classified patients as active, collaborative, and passive according to the Control Preference Scale. Data collection was performed before, during, and after the ward round. Key Results: Among the 761 included patients, those with a passive DCP had a similar subjective average (mean ± SD) knowledge (81.3 ± 19.4 points) compared to patients with a collaborative DCP (78.7 ± 20.3 points) and active DCP (81.3 ± 21.5 points), p = 0.25. Regarding patients' trust in physicians and nurses, we found that patients with an active vs. passive DCP reported significantly less trust in physicians (adjusted difference, − 5.08 [95% CI, − 8.69 to − 1.48 points], p = 0.006) and in nurses (adjusted difference, − 3.41 [95% CI, − 6.51 to − 0.31 points], p = 0.031). Also, patients with an active vs. passive DCP were significantly less satisfied with their hospital stay (adjusted difference, − 7.17 [95% CI, − 11.01 to − 3.34 points], p < 0.001). Conclusion: Patients with active DCP have lower trust in the healthcare team and lower overall satisfaction despite similar perceived medical knowledge. The knowledge of a patient's DCP may help to individualize patient-centered care. A personalized approach may improve the patient-physician relationship and increase patients' satisfaction with medical care. Trial Registration: ClinicalTrials.gov (NCT03210987). [ABSTRACT FROM AUTHOR]

Im Folgenden beschreiben wir das aus dem Myxobakterium Corallococcus coralloides isolierte Antibiotikum Corramycin. Die lineare Peptidstruktur enthält eine bislang unbeschriebene (2R,3S)‐γ‐N‐Methyl‐β‐hydroxyhistidin‐Einheit. Corramycin weist eine anti‐Gram‐negative Aktivität gegen Escherichia coli (E. coli) auf und wird über zwei Tansportersysteme, SbmA und YejABEF, in die Zelle aufgenommen. Darüber hinaus wurde das Corramycin Biosynthese‐Gencluster (BGC) identifiziert und ein Biosyntheseweg bestimmt, welcher auf einer 12‐modularen nicht‐ribosomale Peptidsynthetase/Polyketidsynthase beruht. Die bioinformatische Analyse des BGC in Verbindung mit der Entwicklung einer Totalsynthese ermöglichte die Aufklärung der absoluten Konfiguration des Moleküls. Außerdem führte die intravenöse Verabreichung von 20–30 mg Corramycin pro kg Mausgewicht in einem E. coli‐Infektionsmodell zu einer 100 %igen Überlebensrate der Tiere ohne toxische Nebenwirkungen. Somit ist Corramycin ein vielversprechender Ausgangspunkt für die Entwicklung eines wirksamen antibakteriellen Arzneimittels gegen Krankenhausinfektionen. [ABSTRACT FROM AUTHOR]

Herein, we describe the myxobacterial natural product Corramycin isolated from Corallococcus coralloides. The linear peptide structure contains an unprecedented (2R,3S)‐γ‐N‐methyl‐β‐hydroxy‐histidine moiety. Corramycin exhibits anti‐Gram‐negative activity against Escherichia coli (E. coli) and is taken up via two transporter systems, SbmA and YejABEF. Furthermore, the Corramycin biosynthetic gene cluster (BGC) was identified and a biosynthesis model was proposed involving a 12‐modular non‐ribosomal peptide synthetase/polyketide synthase. Bioinformatic analysis of the BGC combined with the development of a total synthesis route allowed for the elucidation of the molecule's absolute configuration. Importantly, intravenous administration of 20 mg kg−1 of Corramycin in an E. coli mouse infection model resulted in 100 % survival of animals without toxic side effects. Corramycin is thus a promising starting point to develop a potent antibacterial drug against hospital‐acquired infections. [ABSTRACT FROM AUTHOR]

Texture classification generally requires the analysis of patterns in local pixel neighborhoods. Statistically, the underlying processes are comprehensively described by their joint probability density functions (jPDFs). Even for small neighborhoods, however, stable estimation of jPDFs by joint histograms (jHSTs) is often infeasible, since the number of entries in the jHST exceeds by far the number of pixels in a typical texture region. Moreover, evaluation of distance functions between jHSTs is often computationally prohibitive. Practically, the number of entries in a jHST is therefore reduced by considering only two-pixel patterns, leading to 2D-jHSTs known as cooccurrence matrices, or by quantization of the gray levels in local patterns to only two gray levels, yielding local binary patterns (LBPs). Both approaches result in a loss of information. We introduce here a framework for supervised texture classification which reduces or avoids this information loss. Local texture neighborhoods are first filtered by a filter bank. Without further quantization, the jPDF of the filter responses is then described parametrically by Gaussian mixture models (GMMs). We show that the parameters of the GMMs can be reliably estimated from small image regions. Moreover, distances between the thus modelled jPDFs of different texture patterns can be computed efficiently in closed form from their model parameters. We furthermore extend this texture descriptor to achieve full invariance to rotation. We evaluate the framework for different filter banks on the Brodatz texture set. We first show that combining the LBP difference filters with the GMM-based density estimator outperforms the classical LBP approach and its codebook extensions. When replacing these-rather elementary-difference filters by the wavelet frame transform (WFT), the performance of the framework on all 111 Brodatz textures exceeds the one obtained more recently by spin image and RIFT descriptors by Lazebnik et al. [ABSTRACT FROM AUTHOR]

Automated high-throughput liquid handling operations in biolabs necessitate miniaturised and automatised equipment for effective space utilisation and system integration. This paper presents a thermal segment microwell plate control unit designed for enhanced microwell-based experimentation in liquid handling setups. The development of this device stems from the need to move towards geometry standardization and system integration of automated lab equipment. It incorporates features based on Smart Sensor and Sensor 4.0 concepts. An enzymatic activity assay is implemented with the developed device on a liquid handling station, allowing fast characterisation via a high-throughput approach. The device outperforms other comparable devices in certain metrics based on automated liquid handling requirements and addresses the needs of future biolabs in automation, especially in highthroughput screening. [ABSTRACT FROM AUTHOR]

Background: Communicating bad news such as a new cancer diagnosis to patients may have a major impact on their well-being. We investigated differences in patients' psychological distress due to the disclosure of bad news by telephone compared to in person in a systematic review and meta-analysis. Methods: We included all studies that investigated anxiety, depressive or post-traumatic stress disorder (PTSD) symptoms in adult patients in whom bad news by telephone compared to in person were disclosed. We systematically searched PubMed, Embase, PsycINFO and CINAHL from the inception of each database to October 18, 2022. We included randomized and non-randomized trials. Results: We screened 5944 studies and included 11 studies in the qualitative analysis and 9 in the meta-analyses, including four randomized controlled trials. Overall, the quality of studies was moderate to good. There was no difference regarding psychological distress when bad news was disclosed by telephone compared to in person with similar symptom levels of anxiety (3 studies, 285 participants; standardized mean difference [SMD] 0.10 [95% CI -0.15 to 0.35]), depression (3 studies, 284 participants; SMD 0.10 [95% CI -0.30 to 0.49]), and PTSD (2 studies, 171 participants; SMD -0.01 [95% CI -0.48 to 0.36]). Results were similar for satisfaction with care. Discussion: This meta-analysis found no difference regarding psychological distress regardless if bad news were disclosed by telephone or in person, but there were overall only few and heterogeneous studies with a small number of eligible patients. The findings suggest that the modality of disclosure might play a secondary role and the way in which the bad news are communicated might be more important. [ABSTRACT FROM AUTHOR]

The red blood cell distribution width (RDW) is a routinely available blood marker that measures the variation of the size/volume of red blood cells. The aim of our study was to investigate the prognostic value of RDW in cardiac arrest patients and to assess whether RDW improves the prognostic value of three cardiac arrest-specific risk scores. Consecutive adult cardiac arrest patients admitted to the ICU of a Swiss university hospital were included. The primary outcome was poor neurological outcome at hospital discharge assessed by Cerebral Performance Category. Of 702 patients admitted to the ICU after cardiac arrest, 400 patients (57.0%) survived, of which 323 (80.8%) had a good neurological outcome. Higher mean RDW values showed an independent association with poor neurological outcomes at hospital discharge (adjusted OR 1.27, 95% CI 1.14 to 1.41; p < 0.001). Adding the maximum RDW value to the OHCA- CAHP- and PROLOGUE cardiac arrest scores improved prognostic performance. Within this cohort of cardiac arrest patients, RDW was an independent outcome predictor and slightly improved three cardiac arrest-specific risk scores. RDW may therefore support clinical decision-making. [ABSTRACT FROM AUTHOR]

The red blood cell distribution width (RDW) is a routinely available blood marker that measures the variation of the size/volume of red blood cells. The aim of our study was to investigate the prognostic value of RDW in cardiac arrest patients and to assess whether RDW improves the prognostic value of three cardiac arrest-specific risk scores. Consecutive adult cardiac arrest patients admitted to the ICU of a Swiss university hospital were included. The primary outcome was poor neurological outcome at hospital discharge assessed by Cerebral Performance Category. Of 702 patients admitted to the ICU after cardiac arrest, 400 patients (57.0%) survived, of which 323 (80.8%) had a good neurological outcome. Higher mean RDW values showed an independent association with poor neurological outcomes at hospital discharge (adjusted OR 1.27, 95% CI 1.14 to 1.41; p < 0.001). Adding the maximum RDW value to the OHCA- CAHP- and PROLOGUE cardiac arrest scores improved prognostic performance. Within this cohort of cardiac arrest patients, RDW was an independent outcome predictor and slightly improved three cardiac arrest-specific risk scores. RDW may therefore support clinical decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Intensive care unit patients are at risk for post-intensive care syndrome (PICS), which includes psychological, physical and/or cognitive sequelae after their hospital stay. Our aim was to investigate PICS in adult patients with out-of-hospital cardiac arrest (OHCA). Methods: In this prospective observational cohort study, we assessed risks for PICS at 3 and 12-month follow-up within the following domains: a) physical impairment (EuroQol [EQ-5D-3L]), b) cognitive functioning (Cerebral Performance Category [CPC] score >1, modified Rankin Scale [mRS] >2) and c) psychological burden (Hospital Anxiety and Depression Scale [HADS], Impact of Event Scale-Revised [IES-R]). Results: At 3 months, 69/139 patients (50%) met the definition of PICS including 37% in the physical domain, 25% in the cognitive domain and 13% in the psychological domain. Intubation (OR 2.3, 95%CI 1.1 to 5,0 p = 0.03), sedatives (OR 3.4, 95%CI 1 to 11, p = 0.045), mRS at discharge (OR 4.3, 95%CI 1.70 to 11.01, p = 0.002), CPC at discharge (OR 3.3, 95%CI 1.4 to 7.6, p = 0.005) and post-discharge work loss (OR 13.4, 95%CI 1.7 to 107.5, p = 0.014) were significantly associated with PICS. At 12 months, 52/110 (47%) patients had PICS, which was associated with prolonged duration of rehabilitation, higher APACHE scores, and higher mRS and CPC scores at hospital discharge. Conclusions: Nearly half of long-term OHCA survivors show PICS after 3 and 12 months. These high numbers call for more emphasis on appropriate screening and treatment in this patient population. Future studies should evaluate whether early identification of these patients enables preventive strategies and treatment options. [ABSTRACT FROM AUTHOR]

Background: Several scoring systems have been used to predict short-term outcome in patients with out-of-hospital cardiac arrest (OHCA), including the disease-specific OHCA and CAHP (Cardiac Arrest Hospital Prognosis) scores, as well as the general severity-of-illness scores Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II). This study aimed to assess the prognostic performance of these four scores to predict long-term outcomes (≥ 2 years) in adult cardiac arrest patients. Methods: This is a prospective single-centre cohort study including consecutive cardiac arrest patients admitted to intensive care in a Swiss tertiary academic medical centre. The primary endpoint was 2-year mortality. Secondary endpoints were neurological outcome at 2 years post-arrest assessed by Cerebral Performance Category with CPC 1–2 defined as good and CPC 3–5 as poor neurological outcome, and 6-year mortality. Results: In 415 patients admitted to intensive care, the 2-year mortality was 58.1%, with 96.7% of survivors showing good neurological outcome. The 6-year mortality was 82.5%. All four scores showed good discriminatory performance for 2-year mortality, with areas under the receiver operating characteristics curve (AUROC) of 0.82, 0.87, 0.83 and 0.81 for the OHCA, CAHP, APACHE II and SAPS II scores. The results were similar for poor neurological outcome at 2 years and 6-year mortality. Conclusion: This study suggests that two established cardiac arrest-specific scores and two severity-of-illness scores provide good prognostic value to predict long-term outcome after cardiac arrest and thus may help in early goals-of-care discussions. [ABSTRACT FROM AUTHOR]

Aim: For some patients, survival with good neurologic function after cardiopulmonary resuscitation (CPR) is highly unlikely, thus CPR would be considered medically futile. Yet, in clinical practice, there are no well-established criteria, guidelines or measures to determine futility. We aimed to investigate how medical futility for CPR in adult patients is defined, measured, and associated with do-not-resuscitate (DNR) code status as well as to evaluate the predictive value of clinical risk scores through meta-analysis.Methods: We searched Embase, PubMed, CINAHL, and PsycINFO from the inception of each database up to January 22, 2021. Data were pooled using a fixed-effects model. Data collection and reporting followed the PRISMA guidelines.Results: Thirty-one studies were included in the systematic review and 11 in the meta-analysis. Medical futility defined by risk scores was associated with a significantly higher risk of in-hospital mortality (5 studies, 3102 participants with Pre-Arrest Morbidity (PAM) and Prognosis After Resuscitation (PAR) score; overall RR 3.38 [95% CI 1.92-5.97]) and poor neurologic outcome/in-hospital mortality (6 studies, 115,213 participants with Good Outcome Following Attempted Resuscitation (GO-FAR) and Prediction of Outcome for In-Hospital Cardiac Arrest (PIHCA) score; RR 6.93 [95% CI 6.43-7.47]). All showed high specificity (>90%) for identifying patients with poor outcome.Conclusion: There is no international consensus and a lack of specific definitions of CPR futility in adult patients. Clinical risk scores might aid decision-making when CPR is assumed to be futile. Future studies are needed to assess their clinical value and reliability as a measure of futility regarding CPR. [ABSTRACT FROM AUTHOR]

The transition towards renewable electricity provides opportunities for manufacturing companies to save electricity costs through participating in demand response programs. End-to-end implementation of demand response systems focusing on manufacturing power consumers is still challenging due to multiple stakeholders and subsystems that generate a heterogeneous and large amount of data. This work develops an approach utilizing artificial intelligence for a demand response system that optimizes industrial consumers’ and prosumers’ production-related electricity costs according to time-variable electricity tariffs. It also proposes a semantic middleware architecture that utilizes an ontology as the semantic integration model for handling heterogeneous data models between the system’s modules. This paper reports on developing and evaluating multiple machine learning models for power generation forecasting and load prediction, and also mixed-integer linear programming as well as reinforcement learning for production optimization considering dynamic electricity pricing represented as Green Electricity Index (GEI). The experiments show that the hybrid auto-regressive long-short-term-memory model performs best for solar and convolutional neural networks for wind power generation forecasting. Random forest, k-nearest neighbors, ridge, and gradient-boosting regression models perform best in load prediction in the considered use cases. Furthermore, this research found that the reinforcement-learning-based approach can provide generic and scalable solutions for complex and dynamic production environments. Additionally, this paper presents the validation of the developed system in the German industrial environment, involving a utility company and two small to medium-sized manufacturing companies. It shows that the developed system benefits the manufacturing company that implements fine-grained process scheduling most due to its flexible rescheduling capacities. [ABSTRACT FROM AUTHOR]

Communication of "bad news" (such as a new cancer diagnosis) to patients may have a major impact on their well-being. We aimed to investigate differences in psychological distress of breaking bad news in person compared to by telephone in a systematic review and meta-analysis. We included all studies that investigated breaking bad news (such as a new cancer diagnosis or genetic risk for life-limiting diseases) in person compared to by telephone in adult patients regardless of diagnosis regarding the association with symptoms of anxiety, depression or post-traumatic stress disorder. We systematically searched PubMed, Embase, PsycINFO and CINAHL from the inception of each database to June 1, 2021. We included randomized and non-randomized trials. We screened 3625 studies and included eleven studies in the qualitative analysis and nine in the meta-analyses, including four randomized controlled trials. Overall, quality of studies was moderate to good. There was no mean difference regarding psychological distress when bad news was disclosed by telephone compared to in person with similar symptom levels of anxiety (3 studies, 285 participants; standardized mean difference [SMD] 0.10 [95% CI -0.15 to 0.35]), depression (3 studies, 248 participants; SMD 0.10 [95% CI -0.30 to 0.49]), and symptom levels of PTSD (2 studies, 171 participants; SMD -0.01 [95% CI -0.48 to 0.36]). Results: were similar for satisfaction with care. We did not find a difference in psychological distress if breaking bad news was done in person or by telephone but there were too few studies to draw more definite conclusions. Future research is needed to understand in which situation a telephone consultation is appropriate to disclose bad news with a patient. [ABSTRACT FROM AUTHOR]

Background: The gold standard management of aortic dissection, a life-threatening condition, includes multidisciplinary approaches. Although mental distress following aortic dissection is common, evidence-based psychosocial interventions for aortic dissection survivors are lacking. Objective: The aim of this study is to identify the perceived psychosocial needs of aortic dissection survivors by surveying patients, their relatives, and health professionals to inform the development of such interventions. Methods: This study used a cross-sectional survey and collected responses from 41 participants (27 patients with aortic dissection, 8 relatives of patients with aortic dissection, and 6 health professionals) on key topics, types of interventions, best timing, anticipated success, and the intended effects and side effects of psychosocial interventions after aortic dissection. Results: The principal intervention topics were "changes in everyday life" (28/41, 68%, 95% CI 54.5%-82.9%), "anxiety" (25/41, 61%, 95% CI 46.2%-76.2%), "uncertainty" (24/41, 59%, 95% CI 42.9%-73.2%), "tension/distress" (24/41, 59%, 95% CI 43.9%-73.8%), and "trust in the body" (21/41, 51%, 95% CI 35.9%-67.5%). The most commonly indicated intervention types were "family/relative therapy" (21/41, 51%, 95% CI 35%-65.9%) and "anxiety treatment" (21/41, 51%, 95% CI 35%-67.5%). The most recommended intervention timing was "during inpatient rehabilitation" (26/41, 63%, 95% CI 47.6%-77.5%) followed by "shortly after inpatient rehabilitation" (20/41, 49%, 95% CI 32.4%-65%). More than 95% (39/41) of respondents anticipated a benefit from psychosocial interventions following aortic dissection dissection, expecting a probable improvement in 68.6% (95% CI 61.4%-76.2%) of aortic dissection survivors, a worse outcome for 5% (95% CI 2.9%-7.9%), and that 6% (95% CI 1.8%-10.4%) would have negative side effects due to such interventions. Conclusions: Our findings highlight a substantial need for psychosocial interventions in aortic dissection survivors and indicate that such interventions would be a success. They provide a basis for the development and evaluation of interventions as part of state-of-the-art aortic dissection management. [ABSTRACT FROM AUTHOR]