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We provide the first 3D potential energy surface of the PH3–Ar interacting system. This 3D-PES is used later to derive the line broadenings of phosphine perturbed by Ar.

Zusammenfassung Einleitung Die katheterbezogene Lebensqualität (LQ) bei Nephrostomieträgern wurde bisher noch nie systematisch untersucht. Dies sollte nun erstmalig vergleichend mit einer ebenfalls externen Urinableitung, dem suprapubischen Katheter, geschehen. Methodik Das die katheterbezogene LQ untersuchende Assessment nach Mary Wilde wurde bei Patienten mit perkutaner Nephrostomie (PCN) in lebenslanger Intention und minimaler Liegedauer von 3 Monaten vorgelegt. Ergebnisse Es zeigte sich insgesamt bei 66 Patienten (davon 42 mit unilateraler PCN) mit einem Punktwert von median 4,0 auf einer Skala von 0–5 eine nur moderat eingeschränkte katheterbezogene LQ. Diese wurde insgesamt und in allen Domänen schlechter als bei Patienten mit suprapubischem Katheter (SPK) bewertet, bei denen sich ein Score von 4,3 im Median fand. Signifikant waren die Unterschiede in den Einzelitems „Gefühl der Erniedrigung“, „Konflikte mit ärztlichem oder pflegerischem Personal“, „Angst vor schmerzhaften Katheterwechseln“, „Gefühl als kranke Person“, „Behinderungen in Aktivitäten des täglichen Lebens“ und „Besorgnis, nicht alles tun zu können, was ich mag“. Ebenso ergaben sich bei PCN-Trägern signifikant häufiger Angst vor Katheterlecks und Uringeruch. Die Anzahl der einliegenden PCN und die Grunderkrankung spielten für die Beurteilung der LQ keine Rolle. Schlussfolgerung Erstmals wurde die katheterassoziierte LQ, die sich bei PCN-Trägern nur moderat eingeschränkt fand, mit einem validierten Assessment quantitativ eingeordnet. Die Angabe der Betroffenen, sich als „krank“ und in der Ausübung von Aktivitäten des täglichen Lebens „behindert“ zu fühlen und die Angst vor Urinleckagen und schmerzhaften Wechseln sollten Ansporn für eine sorgfältige Indikationsstellung und technisch korrekte Katheterwechsel sein.

Background: Construction projects are among the riskiest businesses due to the number of factors involved that are difficult to control; hence, the popularity of risk management as part of the decision-making process in construction organizations is increasing. Despite the advancements, there are various risks involved that lead to project failure. Aim: Thus, this study aims to assess the risk management strategies in construction organizations in the Gaza Strip, Palestine. Methods: Seventy questionnaires were distributed after subjecting them to pretesting and pilot study that confirmed the validity and reliability of the questions. The target respondents included engineers and consultants from the construction organizations, Ministry of Works and Housing, and international agencies. The questionnaire was retrieved with a 65.71% response rate. Results: Results indicated that the most popular method of risk factor determination in the Gaza Strip is the “checklist” (RII=84%). For tools/methods of risk analysis, relying on experience in the direct assessment is the most prominent, with an RII of 78%. For the methods of avoiding risk before the project implementation, dependence on experience in the work for preparing and planning was ranked highest (having RII of 81.6%). Finally, follow-up on the implementation to avoid rework, with an RII of 77.6%, was ranked highest among other factors of avoiding risk during the construction projects implementation. Conclusion: This study highlights the key risk management strategies that will be beneficial for the construction industry stakeholders to resolve the unwanted risk failures in the construction industry.

Constrictive pericarditis (CP) is a curable cause of diastolic heart failure with prior cardiac surgery being a recognizable etiology. We report a patient who developed CP one year following heart transplantation. Several clinical and imaging related factors may lead to diagnostic delays in similar patients, including the mistaken belief that transplanted hearts are devoid of pericardium and thus do not develop constriction. Post-transplantation pericardial effusion, mediastinitis, and cardiac rejection predispose to future CP. Caretakers should consider this entity in allograft recipients who develop heart failure symptoms of unclear etiology.

BackgroundVestibular side effects such as dizziness and vertigo can be a limitation for some antibiotics commonly used to treat acne, rosacea, and other dermatology indications.ObjectiveUnlike minocycline, which is a second-generation tetracycline, sarecycline, a narrow-spectrum third-generation tetracycline-class agent approved to treat acne vulgaris, has demonstrated low rates of vestibular-related adverse events in clinical trials. In this work, we evaluate the brain-penetrative and lipophilic attributes of sarecycline in 2 non-clinical studies and discuss potential associations with vestibular adverse events.MethodsRats received either intravenous sarecycline or minocycline (1.0 mg/kg). Blood-brain penetrance was measured at 1, 3, and 6 h postdosing. In another analysis, the lipophilicity of sarecycline, minocycline, and doxycycline was measured via octanol/water and chloroform/water distribution coefficients (logD) at pH 3.5, 5.5, and 7.4.ResultsUnlike minocycline, sarecycline was not detected in brain samples postdosing. In the octanol/water solvent system, sarecycline had a numerically lower lipophilicity profile than minocycline and doxycycline at pH 5.5 and 7.4.ConclusionThe reduced blood-brain penetrance and lipophilicity of sarecycline compared with other tetracyclines may explain low rates of vestibular-related adverse events seen in clinical trials.

Background: The construction industry is generally associated with a high level of risk and ambiguity because of the nature of its working contexts. In the Gaza Strip, construction projects are among the riskiest projects, which require the application of the right rules and adherence to the proper management standards. Identification of these risks is the first step in risk management. Aims: This study aims to investigate and understand the main risks faced by the construction projects in the Gaza strip. Methods: A questionnaire survey was conducted to achieve the study aim, whose applicability was tested through a pilot study. Using targeted participants from engineering offices and consulting engineering companies, 70 questionnaires were distributed and collected with a response rate of 85.71%. The Quantitative method was used for data analysis using SPSS. 38 risk factor statements were considered from the seven clusters of risk factors. Results: The results show that the political risk factor was determined to be the highest with a Relative Important Index (RII) of 75.47%, while the design factor was the least factor with an average RII of 61.89%. Conclusion: It is recommended that companies should appoint a specialist in the field of risk management.

Anthracycline chemotherapy is commonly used to treat breast cancer yet may increase the level of matrix metalloproteinases (MMP) -2 and -9, which increase the risk of atherosclerosis. While exercise has been shown to reduce the level of MMP in patients with diabetes, high intensity interval training (HIIT) has not been utilized to improve level of MMP in women with breast cancer receiving anthracycline chemotherapy. Thirty women were randomized to either 8-week HIIT or control (CON) group. The CON group was offered the HIIT intervention after 8 weeks. MMP-1, -2 -7, -9, tissue inhibitor of MMP (TIMP) -1, and-2 were measured at baseline and post-intervention. Repeated measures ANCOVA and paired t-test were performed to assess changes in MMP and TIMP. Post-intervention, no significant between-group differences were observed for MMP and TIMP. However, within-group decrease in MMP-9 was observed in the HIIT group [104.3(51.9) to 65.2(69.1); P = 0.01]. MMP-9 in the CON group was not significantly changed [115.5(47.2) to 90.4(67.9);]. MMP-2 significantly increased in both the HIIT group [76.6(11.2) to 83.2(13.1); P = 0.007) and the CON group [69.0(8.9) to 77.6(11.1) P = 0.003). It is unclear whether an 8-week HIIT intervention influences MMP-9 in breast cancer patients undergoing anthracycline chemotherapy. Additional investigations are required to understand the exercise-induced changes in MMP-2 and -9 in women undergoing anthracycline chemotherapy.

In urology, a subset of patients with lifelong urine drainage are fitted with a catheter valve. Data on catheter-related quality of life (crqol) in this subset of patients are missing.Clarification of the whether there are advantages for valve-aided catheters in comparison with continuous urine drainage in catheter wearers with a lifelong indication.In all, 357 patients with a catheter with lifelong indication of continuous urine drainage from a previous study were compared with 70 valve-aided patients. The crqol was evaluated by a validated assessment with 25 items and five domains.There were statistically more patients with a suprapubic catheter than with a transurethral indwelling catheter (73.4 vs. 54.4%, p = 0.005), significantly more patients with bladder voiding dysfunction (73.5 vs. 52.6%, p = 0.003) and significantly more patients with small catheter sizes (p = 0.001). Crqol was altogether slightly impaired with a median score of 4.2 (no impairment indicated by 5 points) in valve-aided patients, but crqol was more impaired in valve-aided patients compared to patients with continuous drainage (4.4 points, n. s.). Some items demonstrated more problems dealing with urinary urge in valve-aided patients, but catheter-related pain was more often worse in patients with continuous drainage.There is no clear evidence for an advantage of a catheter valve over a continuous urine drainage system. Thus, the decision regarding a catheter-valve system must be made individually according to the indication and the preferences of the patient.HINTERGRUND: In der urologischen Praxis wird ein Teil von Patienten mit einer lebenslangen Katheterableitung mit einem Ventil versorgt. Daten zur katheterbezogenen Lebensqualität (kbLQ) dieser Subgruppe lagen bisher nicht vor.Das Ziel ist die Klärung der Frage, ob eine Ventilversorgung von Katheterträgern im Vergleich mit einer Dauerableitung Vorteile im Hinblick auf die kbLQ hat.Es wurden 357 dauerabgeleitete Patienten aus einer früheren Untersuchung 70 Patienten gegenübergestellt, die eine dauerhafte Ventilversorgung erhalten hatten. Untersucht wurde die kbLQ mit einem validierten Assessment mit fünf Domänen und 25 Einzelfragen.Unter den ventilversorgten Patienten waren statistisch signifikant mehr Patienten mit einem suprapubischen Katheter (SPK) als mit einem transurethralen Dauerkatheter (TDK; 73,4 vs. 54,4 % SPK, p = 0,005), signifikant mehr Patienten mit Blasenentleerungsstörungen (73,5 vs. 52,6 %, p = 0,003) und signifikant mehr Patienten mit geringen Kathetergrößen (p = 0,001). Die kbLQ ventilversorgter Patienten war mit median 4,2 von 5 Punkten insgesamt nur moderat eingeschränkt, sie war jedoch tendenziell schlechter als die dauerabgeleiteter Patienten mit median 4,4 Punkten. Es fand sich für ventilversorgte Katheterträger eine statistisch signifikant schlechter bewertete Lebensqualität bei Items, die auf Harndrangprobleme hinweisen; bei „Katheterschmerzen“ zeigte sich eine signifikant schlechter bewertete Lebensqualität für dauerabgeleitete Patienten.Es konnten keine eindeutigen Vorteile einer Ventilversorgung detektiert werden. Die Indikation für eine Ventilversorgung muss daher individuell je nach Indikation und Vorlieben des Patienten gestellt werden.

There is ongoing debate over the optimal surgical approach for cholesteatoma treatmentMedline, Embase, Cochrane databases and clinicaltrials.gov were searched for studies reporting outcomes of patients undergoing primary CWD-MO for cholesteatoma and directly compared with CWD and CWU mastoidectomies. Data were collated and meta-analysis performed.2379 patients were included from 12 studies that met the inclusion criteria. CWD-MO was found to be associated with significantly less risk of recurrence when compared to CWU (OR = 0.330 (95 % CI 0.191-0.570, p 0.001). When compared to CWD, CWD-MO was associate with significantly lower incidence of persistent otorrhoea (OR 0.405 (95 % CI 0.232-0.706, p 0.001) while the rates of recurrence were comparable (OR: 1.231 [95 % CI: 0.550-2.757] p = 0.613). Otorrhoea rates between CWD-MO and CWU were equivalent as was reoperation. Quality of life and hearing outcomes were variably reported.This systematic review demonstrates that CWD-MO technique achieves lower recurrence rates comparable to CWD approaches and superior to CWU, while offering improved long-term control of otorrhoea. The final procedural choice should be decided based on surgeon experience, skill set and individual patient factors. To address the risk of selection bias, a randomised controlled trial is needed to answer this important research question.

A percutaneous nephrostomy (PCN) affects the integrity of the patient due to the requirement of an external drainage bag and regular changes. The catheter-associated quality of life (QOL) was evaluated using a validated assessment and compared to similar patients with suprapubic bladder drainage.A validated assessment analyzing catheter-related QOL for 5 domains and 25 individual items (first published by Mary Wilde) was completed during a catheter change appointment by patients who had their unilateral or bilateral PCN for a minimum of 3 months in life-long indication.In 66 patients (unilateral PCN: 42 patients), a moderate impairment of their catheter-related QOL was shown. The overall QOL score was median 4.0 on a scale of 0-5. This was rated lower-indicating a stronger impairment of QOL-than in patients with a suprapubic bladder catheter, who had a median score of 4.3. Significant differences were found related to the catheter type in the items "feeling of humiliation due to the PCN", "conflicts with the medical or nursing staff", "fear of painful catheter changes", "feeling ill", "being handicapped in activities of daily living" and "concern of not being able to do what one wants to do" and "fear of catheter leakages". The indication for the PCN due to a malignant or benign underlying disease was not associated with the catheter-related QOL.For the first time, the catheter-related QOL was found to be moderately impaired in patients with a PCN using a validated assessment. Affected individuals report feeling "ill" and "limited/disabled" in activities of daily living; thus, the surgical indication should be strict. Fear of painful catheter changes and of catheter leakages indicates the need of technically correct catheter changes.EINLEITUNG: Die katheterbezogene Lebensqualität (LQ) bei Nephrostomieträgern wurde bisher noch nie systematisch untersucht. Dies sollte nun erstmalig vergleichend mit einer ebenfalls externen Urinableitung, dem suprapubischen Katheter, geschehen.Das die katheterbezogene LQ untersuchende Assessment nach Mary Wilde wurde bei Patienten mit perkutaner Nephrostomie (PCN) in lebenslanger Intention und minimaler Liegedauer von 3 Monaten vorgelegt.Es zeigte sich insgesamt bei 66 Patienten (davon 42 mit unilateraler PCN) mit einem Punktwert von median 4,0 auf einer Skala von 0–5 eine nur moderat eingeschränkte katheterbezogene LQ. Diese wurde insgesamt und in allen Domänen schlechter als bei Patienten mit suprapubischem Katheter (SPK) bewertet, bei denen sich ein Score von 4,3 im Median fand. Signifikant waren die Unterschiede in den Einzelitems „Gefühl der Erniedrigung“, „Konflikte mit ärztlichem oder pflegerischem Personal“, „Angst vor schmerzhaften Katheterwechseln“, „Gefühl als kranke Person“, „Behinderungen in Aktivitäten des täglichen Lebens“ und „Besorgnis, nicht alles tun zu können, was ich mag“. Ebenso ergaben sich bei PCN-Trägern signifikant häufiger Angst vor Katheterlecks und Uringeruch. Die Anzahl der einliegenden PCN und die Grunderkrankung spielten für die Beurteilung der LQ keine Rolle.Erstmals wurde die katheterassoziierte LQ, die sich bei PCN-Trägern nur moderat eingeschränkt fand, mit einem validierten Assessment quantitativ eingeordnet. Die Angabe der Betroffenen, sich als „krank“ und in der Ausübung von Aktivitäten des täglichen Lebens „behindert“ zu fühlen und die Angst vor Urinleckagen und schmerzhaften Wechseln sollten Ansporn für eine sorgfältige Indikationsstellung und technisch korrekte Katheterwechsel sein.

The golf swing has been associated with mechanical injury risk factors at many joints. One swing, the Minimalist Golf Swing, was hypothesised to reduce lumbar spine, lead hip, and lead knee ranges of motion and peak net joint moments, while affecting swing performance, compared to golfers' existing swings. Existing and MGS swings of 15 golfers with handicaps ranging from +2 to -20 were compared. During MGS downswing, golfers had 18.3% less lumbar spine transverse plane ROM, 40.7 and 41.8% less lead hip sagittal and frontal plane ROM, and 39.2% less lead knee sagittal plane ROM. MGS reduced lead hip extensor, abductor, and internal rotator moments by 17.8, 19.7 and 43%, while lead knee extensor, abductor, adductor and external rotator moments were reduced by 24.1, 26.6, 37 and 68.8% respectively. With MGS, club approach was 2° shallower, path 4° more in-to-out and speed 2 m/s slower. MGS reduced certain joint ROM and moments that are linked to injury risk factors, while influencing club impact factors with varying effect. Most golf injuries are from overuse, so reduced loads per cycle with MGS may extend the healthy life of joints, and permit golfers to play injury-free for more years.

Die Arbeits- und Weiterbildungsbedingungen von urologischen Assistenzarzten in Deutschland sind bereits analysiert worden. Aber wie steht es um die urologischen Oberarzte in Deutschland? Unter welchen Bedingungen mussen diese arbeiten? Bislang existieren keine uns bekannten publizierten Daten, die diese Konditionen dieser speziellen urologischen Berufsgruppe beleuchten, daher stellen wir die Ergebnisse der vorliegenden Umfrage vor. Die Analyse der aktuellen Arbeitsbedingungen urologischer Fach- und Oberarzte in Deutschland moglichst umfassend zu erfragen und auszuwerten. Der Arbeitskreis Angestellter Arzte des BvDU fuhrte eine Befragung im Rahmen des Urologischen Oberarztforums 2016 sowie online uber den Email-Verteiler der Deutschen Gesellschaft fur Urologie (DGU) durch. Erfragt wurden die Arbeitsbelastung, Arbeitsbedingungen und -zufriedenheit, geleistete Uberstunden sowie Arbeitszeit- und Opt-out-Regelungen. An der Befragung nahmen 176 Oberarzte teil, davon waren 88 % mannlich und 12 % weiblich. In Deutschland gibt es 1125 Oberarzte. Das Durchschnittsalter der Befragten betrug 44,9 Jahre. Bei >80 % der Befragten lag die durchschnittliche Wochenarbeitszeit bei uber 50 h, 70 % unterschrieben eine Opt-out-Regelung. Es konnte dabei ein Zusammenhang zwischen einer steigenden Jobunzufriedenheit ab einer Wochenarbeitszeit uber 55 h bzw. einer durchschnittlichen Anwesenheit im Rufbereitschaftsdienst uber 4 h hergestellt werden. Die Anzahl der Rufbereitschaftsdienste hatte auf die Zufriedenheit keinen Einfluss. Insgesamt gaben 43 % (70 von 162) der Befragten an, dass regelmasig Uberstunden verfallen, bei 12 % (20 von 162) verfielen alle Uberstunden. Rund 30 % der Oberarzte in der deutschen Urologie sind mit ihren aktuellen Arbeitsbedingungen in der aktuellen Form unzufrieden. Anpassungen und Verbesserungen der Arbeitsbedingungen urologischer Oberarzte sind auf Grundlage der erhobenen Daten erforderlich, um die Attraktivitat des Berufsbildes und Fuhrungspositionen in der deutschen Urologie zu erhalten.

Balance confidence may reflect and affect balance performance, and this effect may be mediated by neural inputs to muscles. Available balance confidence scales are designed for older adults and individuals with pathological conditions. To eliminate ceiling effects for young adults and to enable the study of neural excitability in relation to confidence relevant to balance, we developed a Balance Confidence Scale (BCS), comprised of items depicting single limb stance conditions of varying difficulty. Motor cortical excitability was measured using transcranial magnetic stimulation (TMS). Preliminary construct validity was examined relative to balance performance, perceived steadiness, and previous physical activity in 20 young adults (25.7 ± 4.2 years; 11 females). The scale showed good internal consistency (Cronbach’s α = 0.81) and good test-retest reliability (ICC2,1 = 0.84) in a separate sample of 21 young adults (23.8 ± 4.6 years; 11 females). Balance confidence ranged from 34 to 79.6% in the validity sample. Confidence was correlated with performance indexed using center of pressure velocity (r = −0.62, p = 0.01) and area (r = −0.49, p = 0.04), in a relatively difficult standing condition with one leg positioned on an unstable spring. Perceived steadiness and overall physical activity were not correlated with confidence; however, participants with higher confidence scores reported greater experience with balance-related activities. Finally, confidence was related to indices of motor cortical excitability. The Balance Confidence Scale has sound preliminary validity and reliability and holds promise for the study of neural processes mediating social-cognitive influences on balance performance.

Aufgrund des demographischen Wandels wird der Anteil urologisch zu versorgender Patienten weiter zunehmen. Um dieser Tatsache gerecht zu werden, brauchen wir eine gut ausgebildete und motivierte urologische Arzteschaft. Dabei ist nicht nur die urologische Weiterbildung integraler Bestandteil, sondern diese muss eingebettet sein in zukunftstrachtige, flexible Arbeitszeitmodelle unter Berucksichtigung des Arbeitszeitgesetzes. Um eine bessere Beurteilung der aktuellen Situation der in Weiterbildung befindlichen urologischen Arzte zu erhalten, muss eine Evaluation der zzt. in den urologischen Kliniken angewandten Arbeitszeitmodelle erfolgen. Daraus sollten Ruckschlusse moglich sein, die uns ermoglichen, zukunftsorientierte Losungsansatze zu finden, um der Zukunftsoffensive Urologie 2025 gerecht zu werden. Transparenz, Offenheit, und Kooperation sollten oberstes Gebot sein zwischen den in diesem Bereich tatigen Arbeitsgemeinschaften der Deutsche Gesellschaft fur Urologie (DGU) und den Arbeitskreisen des Berufsverbands der Deutschen Urologen e. V. (BvDU).

The purpose of this study was to determine the effects of an 8-week high-intensity interval training (HIIT) intervention on vascular endothelial function, measured as brachial artery flow-mediated dilation (baFMD), and vascular wall thickness measured by carotid intima media thickness (cIMT) in breast cancer patients undergoing anthracycline-based chemotherapy. Thirty women were randomized to either HIIT or non-exercise control groups (CON). The HIIT group participated in an 8-week HIIT intervention occurring three times per week on a cycle ergometer. The CON group was offered the HIIT intervention after 8 weeks. baFMD was measured from the brachial artery diameter at baseline (D0) and 1 min after cuff deflation (D1); percent change was calculated by measuring brachial artery diameter after cuff deflation relative to the baseline [baFMD = (D1 − D0)/D0 × 100]. The cIMT was obtained from the posterior wall of common carotid artery 10 mm below the carotid bulb. Paired t test and repeated measures ANCOVA were performed to assess changes in baFMD and cIMT. At baseline, the HIIT (n = 15) and CON (n = 15) groups did not differ by age (46.9 ± 9.8 years), BMI (31.0 ± 7.5 kg/m2), and blood pressure (123.4 ± 16.8/72.3.9 ± 5.6 mmHg). Post-exercise, baFMD significantly increased [4.3; 95% confidence interval (CI): (1.5, 7.0), p = 0.005] in HIIT versus CON group. cIMT did not significantly change [0.003, 95% CI − 0.004, 0.009), p = 0.40] in HIIT group, while IMT significantly increased from baseline to post-intervention (0.009, 95% CI 0.004, 0.010, p = 0.003) in CON group. This study may suggest that HIIT improved vascular endothelial function and maintained wall thickness in breast cancer patients undergoing anthracycline-based chemotherapy. Trial registration: ClinicalTrials.gov: NCT02454777.

Natural convection in a square cavity filled with electrically conducting nanofluid that is driven by a periodic temperature profile along on of the vertical wall is studied numerically. The top and bottom horizontal walls are kept adiabatic. The right wall is maintained at low temperature while the temperature of the opposing vertical wall varies sinusoidally with time about a mean temperature. Flow and heat transfer performance through the enclosure is examined over a wide range of oscillation amplitudes and frequencies, Hartmann number, Rayleigh number and solid volume fraction at Prandtl number Pr = 6.2. The results show that oscillation amplitude, A, and frequency, f, of the vertical wall significantly affect the response of heat transfer inside the cavity. For A > 0.5, the forcing frequency is found to remain almost constant at f = 2.5, while it shifts towards a higher frequency f = 5 for A ≤ 0.5. At low Rayleigh number, Nusselt number is found to be independent of Rayleigh and Hartman numbers, while at higher Rayleigh number, convective flow dominates, and Nusselt number becomes independent of Hartmann number. In this regime, the Nusselt scaling with Rayleigh number agrees well with the exponent predicted by theory of natural convection in a cavity without magnetic field or nanoparticles, with a value of 1/4. With the increase of solid volume fraction, the heat transfer rate may increase or decrease depending on the values of Hartmann and Rayleigh numbers.

OBJECTIVE: Two-dimensional (2D) morphometric measures have been previously used to diagnose Chiari I malformation (CMI) and distinguish patients from controls. There is, however, a paucity of literature on whether morphometric differences exist across the range of CMI disease severity. The objective of our study was to evaluate whether 2D morphometrics demonstrate significant changes across standardized grades of CMI severity in adults. METHODS: This was a retrospective observational study of 76 patients having symptomatic CMI with or without syringomyelia. Patients matched for age, sex, and body mass index were selected from each of the three severity grades of the Chiari Severity Index (CSI). A total of 17 2D craniocervical and posterior fossa morphometric variables that were previously found to differentiate CMI subjects from the normal population were used in the study. The measurements were performed on mid-sagittal T1-weighted magnetic resonance imaging sequences using two custom in-house software tools, MorphPro and CerePro, and compared across the CSI grades. RESULTS: Analysis of variance (ANOVA) showed that none of the 17 morphometric variables were significantly different across the 3 CSI grades (p > 0.003). The Bayes Factor (BF(10)) scores ranged from 0.11 to 0.82. Nine variables demonstrated BF(10) scores between 0.10 and 0.30, while eight had scores between 0.30 and 1. None of the BF(10) scores provided support for the alternative hypothesis that the morphometric measures differed across the CSI grades. CONCLUSIONS: Our study indicates that 2D morphometrics are not reflective of CMI disease severity as indicated by the grading system of the CSI. The findings of our study support the need for further investigation into whether non-2D morphometric variables can be used as markers of disease severity.

PurposeThe purpose of the current study was to: 1) evaluate sex differences in peak hip adduction during the late swing and stance phases of running and 2) determine if peak hip adduction during late swing is predictive of peak hip adduction during stance.Methods15 female and 16 male heel strike runners ran over ground at a speed of 4 m/s. Hip joint kinematics during running were quantified using a 3D motion capture system. Sex differences in peak hip adduction during the late swing and stance phases were compared using independent sample t-tests. Linear regression analysis was used to determine the relationship between late swing and stance phase hip adduction.ResultsCompared to males, females exhibited significantly greater peak hip adduction during both the late swing (8.5 ± 2.6 vs 6.1 ± 2.8°, p = 0.019) and stance phases of running (13.3 ± 4.2 vs 9.6 ± 3.4°, p = 0.011). Furthermore, late swing peak hip adduction was predictive of subsequent stance phase peak hip adduction (r = 0.63, p < 0.001).ConclusionSex differences in hip adduction during stance are influenced in part by late swing phase hip adduction. Further studies are needed to identify potential causes of excessive hip adduction during the late swing phase of running.

Introduction and Objectives The impact of the COVID-19 pandemic on the wellbeing and training of junior doctors in the UK remains under-evaluated, with limited published literature The restructuring of rotas, redeployment of specialities and daily risk of COVID-19 exposure are all likely to have had a significant effect on frontline doctors We conducted an anonymous survey with the aim of analysing the impact of COVID-19 on the wellbeing and training of junior doctors at a large tertiary London hospital Methods An anonymous online survey was sent to 600 junior doctors, three weeks after the peak of COVID-19 admissions to obtain feedback on perceptions of the effects of COVID on their wellbeing and training Results Wellbeing: 161 junior doctors responded to the survey, with 34% (n=47) of doctors reporting a high level of concern regarding risk to their personal health and 71% (n=102) reporting a negative effect on their sleep;with 67% (n=64) finding this stayed the same or worsened through the pandemic Clinical capabilities: 26% (n=34) of doctors reported high levels of concern related to their clinical competency in dealing with COVID-19 patients, with surgeons making up the majority of this group Support: 82% (n=112) of doctors felt supported during the pandemic, with friends, family and informal peer support groups being the most used coping systems 22% of trainees (n=31) adapted their living arrangements with 52% (n=13) of those moving accommodation to protect their families Training: 40% (n=52) of doctors felt the pandemic was going to have a long-lasting effect on their careers, with reduced training opportunities and clinical exposure 44% of surgeons (n=7) and 50% of non-acute specialties (n=12) wanted training to be formally extended Conclusion This study highlights the need for hospital trusts and national training bodies to recognise the impact of, and implement robust strategies in response to, the COVID-19 pandemic The perceptions of existing formal hospital wellbeing and psychological support systems, which were not widely accessed by this group, require further analysis, in order to aid the development of initiatives to adequately support junior doctors

Aims Paediatric Ear, Nose and Throat (ENT) conditions are some of the most common presentations to the health service. Despite their prevalence, the treatment choice in children can often be unclear to those outside the ENT field with antibiotic choice often dependent on consultant preference and experience. There are currently few UK-based ENT treatment guidelines available, although local hospitals have formed their own, and there is much debate over the most suitable treatment type for different conditions. The main objective of the work was to form a regional guideline for common inpatient ENT conditions to help simplify current hospital and general practice protocols. Methods We decided to review the past 5 years of ENT admissions who required hospital admission and antibiotics within our trust. This was completed through populating a list of patients using coded hospital data specifically looking at the different types of conditions, choice of medication, treatment length and where possible culture sensitivities. The aim was to them compare them with local and international protocols. A systematic literature search was completed alongside the work. Results In the 5 year period, 3265 patients were seen as an inpatient under ENT and of those 1103 patients received antibiotics. The most common presentations were acute mastoiditis, tonsillitis, neck abscess (superficial and deep) and acute otitis media and externa infections. The most common antibiotic used was Co-amoxiclav of different concentrations with 1245 courses supplied with Co-amoxiclav 1000/200 being the most common. The next most used was Benzyl-penicillin IV with 189 courses given. Conclusion Certain types of antibiotics are used more commonly within paediatric ENT cases that may not be in line with antimicrobial stewardship. Despite some protocols suggesting other antibiotics as first line, medications that are easier for the patient to take and administered less often are used more commonly despite being more broad-spectrum. Clearer guidelines for ENT doctors, general paediatricians and general practitioners are required to ensure the most appropriate antibiotics are prescribed. Further research is needed to identify which antibiotics are most suitable for specific ENT cases before a national guideline can be drawn up.

The da Vinci Single-Port (SP) robot is a novel platform designed to facilitate single-incision robotic surgery (rSILS). The objective of this study was to describe our initial experience using this platform for SP robotic (SPr) right colectomy.Under a Food and Drug Administration-regulated feasibility study and Institutional Review Board approval, a patient with cecal adenocarcinoma underwent an SPr right colectomy. The primary endpoint was the safety and feasibility of the first SPr right colectomy performed in the USA. Secondary endpoints included perioperative metrics, morbidity and mortality.An SPr Standard right colectomy was performed through a 4-cm single incision without the need for conversion or additional port placement. Estimated blood loss was 100 mL and there were no intraoperative complications. The robot was docked once with a docking time of 19 min. Total console time was 116 min and operative time was 219 min. The patient tolerated clear liquids on postoperative day (POD) 0 and a low-residue diet on POD 1. The patient had flatus and a bowel movement on POD 1. She was discharged home on POD 3. Final pathology showed pT3N0 cecal adenocarcinoma with negative margins and 0/24 lymph nodes positive for disease.Our initial experience demonstrates that an SPr right colectomy is feasible and can be safely completed. We completed an oncologic resection of a cecal adenocarcinoma without complications. The SP robot facilitates the utilization of robotic technology in a single-incision platform to perform colorectal procedures and offers promising benefits in the advancement of robotic surgery.

Background Inflammatory bowel disease (IBD) has a lengthy natural history with significant symptomatic impacts. Crohn’s disease (CD) and Ulcerative colitis (UC) both have a major impact on patient Health Related Quality of Life (HRQoL). This study aims to evaluate the postulated negative effect of IBD on HRQoL in the Lebanese population. Methods Cross sectional data was collected from a group of, 55 Lebanese patients with IBD (43 with CD and, 12 with UC). Demographic and disease-related data were recorded. Health Related Quality of Life was assessed by disease-specific and generic questionnaires, Inflammatory Bowel Disease Questionnaire (IBDQ) and Short Form Health Survey (SF-36), respectively. Disease activity was assessed based on Harvey-Bradshaw Index (HBI) and the Colitis Activity Index (CAI) for CD and UC patients, respectively. Results IBD resulted in sub-optimal scores in both IBDQ-32 and SF-36, especially in UC patients (mean IBDQ-32 of, 174.8 [UC]vs, 208.8 [CD]; P60 months” (P Conclusion Health Related Quality of Life in Lebanese patients is negatively impacted by IBD, but relatively to a lesser degree than what has been previously reported from other countries using IBDQ questionnaire as an assessment tool. More specifically, patients with UC, longer disease duration and higher disease activity have an increased negative impact on HRQoL. Treatment modality had significant relation to HRQoL, but larger scale studies are still needed to reach more reliable conclusions.

We propose a novel method to evaluate regional palaeoclimate that can be used to alleviate the problems caused by the discontinuous nature of palaeoenvironmental data found in deserts. The technique involves processing satellite imagery and DEM's to map past rivers, catchments and evaluate the areas and volumes of palaeolakes. This information is used to determine the new Lake Evaluation Index (LEI) that allows a qualitative estimate of the amount of sediment received by lakes and how long-lived those lakes are. Lakes with considerable longevity and large sediment stores are selected for study. Validation is performed using image interpretation of remote sensing data, UltraGPR surveys and fieldwork. These techniques are also used to identify and study spring deposits and fluvial landforms that provide valuable palaeoclimate information. The method is applied to the Fezzan Basin in southern Libya focusing on the Wadi ash Shati and Wadi el-Agial catchments. Results indicate that the palaeohydrology is accurately mapped except within dune fields. We analysed the sedimentology of the key deposits identified by this methodology, developing a chronology using optically stimulated luminescence (OSL) and radiocarbon dating. We find evidence for relatively humid conditions during MIS 5c/d and e, as well as during the early to middle Holocene. Larger lakes and more extensive river systems were present during MIS 5 than are found during the Holocene, suggestive of greater humidity. The Holocene humid period started at ∼11 ka and continued until ∼5 ka being interrupted by abrupt periods of aridity at ∼8.2 ka and ∼6 ka that coincide with North Atlantic cooling. After each of these arid events the climate was less humid than previously, suggesting that they were superimposed upon an overall drying trend. The termination of the Holocene humid period in the Sahara has received much scrutiny in recent years, and sediments of Palaeolake Shati provide a continuous record of this. We do not find evidence to support the hypothesis of either sudden or gradual aridification of the Sahara at ∼5 ka, instead we find that that aridity started to develop at ∼6.5 ka, whereupon the lake levels oscillated until finally drying-up by 5.3 ka. Most of the other lakes in the Fezzan also dried up at ∼ 5ka. We suggest that thousands of years of aridification prior to 5 ka shrunk these lakes so that additional aridity at this time led to their final desiccation. Because lakes are prodigious dust sources this mechanism potentially explains the rapid rise in dust flux to the Atlantic at 5 ka, with this final drying being the culmination of longer term aridity, albeit overprinted with considerable climate variability.

Objectives Recent investigations have revealed lower vertical loading rates and knee energy absorption amongst experienced barefoot runners relative to those who rear-foot strike (RFS). Although this has led to an adoption of barefoot running amongst many recreational shoe runners, recent investigations indicate that the experienced barefoot pattern is not immediately realized. Therefore, the purpose this investigation was to quantify changes in lower-extremity dynamics and clinical outcomes measures for habitually shod runners who perform a transition to barefoot running. Design & Participants We examined lower-extremity dynamics and clinical outcomes for 26 RFS shod runners who performed an 8-10 week transition to barefoot running. Setting Runners were evaluated at the University of Southern California's Musculoskeletal Biomechanics Research Laboratory. Main Outcome Measures Foot-strike patterns, vertical load rates, and joint energetics were evaluated before and after the transition using inverse dynamics. Clinical assessments were conducted throughout the transition by two licensed clinicians. Results Eighteen of the 26 runners successfully completed the transition: 7 maintained a RFS, 8 adopted a mid-foot strike (MFS), and 3 adopted a forefoot strike (FFS) during novice barefoot running. Following the transition, novice MFS/FFS runners often demonstrated reversions in strike-patterns and associated reductions in ankle energetics. We report no change in loading rates and knee energy absorption across transition time points. Importantly, there were no adverse events other than transient pain and soreness. Conclusions These findings indicate that runners do not innately adopt the biomechanical characteristics thought to lower injury risk in-response to an uninstructed barefoot running transition.

The aims of this non-randomized, pre-post, pilot investigation (ClinicalTrials.gov NCT03916887) were to assess: 1) feasibility, safety, and adherence of a 10-week golf program for non-golfer older adults, 2) estimated effects of the program on single- (ST) and dual-task (DT) walking, and cognition, and 3) whether findings support development of a randomized controlled trial (RCT). Eligible participants included healthy male and female non-golfers, 60–80 years, who could walk independently, swing a golf club, and received medical clearance. The program, conducted at a golf course, focused on improving physical and cognitive function, as opposed to golf performance. ST and DT walking speeds were assessed on a ProtoKinetics Walkway, and cognitive changes using the California Verbal Learning Test II, and NIH Cognitive Toolbox. Of fifteen screened and enrolled participants, fourteen (7F and 7M, 69.5 ± 6.05 yrs) completed the study. One participant sustained a work-related injury and did not complete the study. Average attendance was 94.3%; there were no golf-related adverse events. Estimated increase in physical activity was 25.5% with small Hedges g effect size (ES). Estimated increases in CVLT II composite score (11.2%) and immediate recall (12.6%), and ST (7.2%) and DT (9.1%) walking speeds occurred with medium-large ES. Increases in NIH card sorting (9.3%) and composite (7.3%) scores had small ES's. In an exit survey, participants reported improved physical function, mental and social well-being, and all planned to continue playing golf. ES estimates suggest 50 participants per group will be required to adequately power (β = 0.8; p

فزایش تولیدات گلخانه‌ای در استان یزد همراه با افزایش مصرف کود و سم است. در این راستا، ضروری است مصرف مواد شیمیائی در گلخانه‌ها کاهش و تولید محصول ارگانیک افزایش یابد. هدف از انجام این پژوهش، بررسی عوامل موثر بر فرآیند انتقال به کشاورزی ارگانیک در میان تولیدکنندگان خیار گلخانه‌ای استان یزد است. این تحقیق از نوع پژوهش‌های توصیفی- پیمایشی بوده و ابزار جمع‌آوری اطلاعات پرسشنامه با انجام مصاحبه حضوری با گلخانه‌داران تولیدکننده خیار است. تحلیل اطلاعات با استفاده از آزمون آماری t و مدل اقتصادسنجی لاجیت انجام گرفت. از میان 144 نفر از مصاحبه‌شونده‌ها، 59 نفر نسبت به کشاورزی ارگانیک دارای تمایل مثبت و 85 نفر تمایلی نشان ندادند. نتایج پژوهش نشان داد که اطلاعات تولید کنندگان در زمینه کشاورزی ارگانیک کم و نبود حمایت کافی دولت از کشاورزی ارگانیک، خطرپذیری بالای تولید محصول ارگانیک، نبود بازار مشخص و نداشتن علم و مهارت تولید از مهم‌ترین موانع تولید محصولات ارگانیک است. نتایج مدل لوجیت نشان داد که متغیرهای سابقه تولید، سن، میزان تحصیلات، میزان رعایت اصول بهداشتی و نگرش مثبت نسبت به محیط زیست رابطه مثبت و معنی‌دار و متغیرهای مقدار مصرف کود و سموم شیمیائی رابطه منفی و معنی‌دار با تمایل به کشت ارگانیک دارند. با توجه به کمبود اطلاعات فنی، مدیریتی و فروش محصولات ارگانیک، حمایت دولت و نظارت بر تولید در این زمینه ضروری است.

Sprouts of potato tubers were excised from the three potato cultivars Agria, Hermes, and Spunta, sterilized and subjected to shoot formation and propagation on Murashige and Skoog (MS) medium supplemented with 1 mg dm-3 6-benzylaminopurine (BAP) + 0.5 mg dm-3 gibberellic acid. Shoots were rooted on MS medium supplemented with 1 mg dm-3 indole-3-butyric acid. To increase shoot vigour prior tuber formation, shoots were subcultured on MS medium supplemented with 0.56 mg dm-3 BAP, 0.11 mg dm-3 2,4-dichlorophenoxyacetic acid, and 0.96 mg dm-3 naphthaleneacetic acid. Under dark, microtuberization on MS media supplemented with 4 mg dm-3 of both BAP and kinetin was better than 4 mg dm-3 BAP alone, where they induced higher number of microtubers per shoot and/or the percentage of shoots that formed microtubers. The highest frequency of microtuber formation was achieved when sucrose at high concentration (8 %) was used as carbon source in culture media. Glucose ranked at the second position whereas fructose reduced the microtuber formation frequency when it was used alone or in combination with glucose. Under the applied culture conditions, cvs. Agria and Hermes showed better micropropagation and microtuberization in comparison to cv. Spunta. In addition, isozyme and RAPD techniques revealed that Agria and Hermes are closer to each other when compared with the third cultivar.

Habitually shod rear-foot strike (RFS) runners demonstrate changes in spatiotemporal variables when running barefoot; however, it is unknown whether these changes are a function of running barefoot and/or adopting different foot-strike patterns. Therefore, the purpose of this study was to examine changes in spatiotemporal variables when habitually shod RFS runners transition to barefoot running. Inverse dynamic methodology was used to examine 22 habitually shod RFS runners who performed overground running, shod and barefoot. Runners were grouped according to their novice barefoot foot-strike pattern: RFS, mid-foot strike (MFS) and forefoot strike (FFS). Runners were also grouped to examine differences between shod and barefoot running. Of the 22 RFS shod runners, 5 adopted a FFS, 9 adopted a MFS, and 8 maintained a RFS during novice barefoot running. We report a significant main effect of running barefoot for spatiotemporal variables, but not for foot-strike pattern. Relative to when shod, all groups of runners took shorter strides and steps. RFS and MFS runners also exhibited higher step frequency and exhibited shorter step and cycle times, while RFS and FFS runners both exhibited shorter stance times. These findings indicate that barefoot running has a significant influence on spatiotemporal measures, regardless of utilized foot-strike pattern.

The working and continued training conditions of assistant physicians in urology in Germany have already been analyzed. But what about senior urologists in Germany? Under which conditions do they have to work? As far as we know no published data currently exist which illuminate the conditions of this special urological professional group, therefore, the results of this survey are presented.To survey and evaluate the current working conditions of certified and senior urologists in Germany as comprehensively as possible.The working group of employed physicians of the Professional Association of German Urologists (BvDU) carried out a survey within the framework of the urological senior physician forum 2016 and on-line via the e‑mail distributor of the German Society for Urology (DGU). The questions involved the workload, working conditions and satisfaction, overtime performed, working hours and opt out regulations.A total of 176 senior physicians participated in the survey of which 88% were male and 12% female. In Germany there are 1125 senior physicians. The average age of the responders was 44.9 years. In more than 80% of the participants the average weekly working hours were over 50 h and 70% signed an opt out regulation. An association between an increasing job dissatisfaction above a working week over 55 h and an average attendance in on-call service over 4 h could be established. The number of on-call services had no influence on job satisfaction. A total of 43% (70 out of 162) of the participants stated that overtime hours were regularly forfeited and 12% (20 out of 162) that all overtime hours were forfeited. Approximately 30% of senior physicians in German urology were dissatisfied with the current working conditions in the present form.Based on the acquired data, adaptation and improvements in the working conditions of senior urologists are necessary in order to maintain the attractiveness of the occupational image and leading positions in German urology.

Due to demographic changes, the proportion of people requiring urological treatment will continue to rise. In order to better address this development, we need a well-trained and motivated urological medical community. Not only is continued education in urology an integral part of this, but it must also be embedded into future-oriented, flexible work-hour models, taking into account the German Work Time Act. Thus, in order to obtain a better assessment of the current situation of urological physicians undergoing specialist training, work -hour models currently used in urological clinics must be evaluated. This should allow conclusions to be drawn to find future-oriented solutions in order to do justice to the Future Offensive-Urology in 2025. Transparency, openness, and cooperation should be top priority between the DGU (German Association for Urology) working groups active in this field and the working groups of the BvDU (German Professional Association for Urologists).

In standing, coordinated activation of lower extremity muscles can be simplified by common neural inputs to muscles comprising a functional synergy. We examined the effect of task difficulty on common inputs to agonist-agonist (AG-AG) pairs supporting direction specific reciprocal muscle control and agonist-antagonist (AG-ANT) pairs supporting stiffness control. Since excessive stiffness is energetically costly and limits the flexibility of responses to perturbations, compared to AG-ANT, we expected greater AG-AG common inputs and a larger increase with increasing task difficulty. We used coherence analysis to examine common inputs in three frequency ranges which reflect subcortical/spinal (0–5 and 6–15 Hz) and corticospinal inputs (6–15 and 16–40 Hz). Coherence was indeed higher in AG-AG compared to AG-ANT muscles in all three frequency bands, indicating a predilection for functional synergies supporting reciprocal rather than stiffness control. Coherence increased with increasing task difficulty, only in AG-ANT muscles in the low frequency band (0–5 Hz), reflecting subcortical inputs and only in AG-AG group in the high frequency band (16–40 Hz), reflecting corticospinal inputs. Therefore, common neural inputs to both AG-AG and AG-ANT muscles increase with difficulty but are likely driven by different sources of input to spinal alpha motor neurons.

The current version of the urology training program will concentrate on the mediation of competences and skills in various fields of action for outpatient urology instead of persisting on the minimum and reference numbers of surgical and diagnostic procedures. However, the following fields of action must be fulfilled: microbiology, andrology and systemic cancer therapy. There is justifiable concern that various institutions will lose their permission for a complete 5‑year residency program based on the above-mentioned demands since not all institutions have all subspecialties in urology. Those institutions need to define new ways of residency training such as interdisciplinary programs within their own institution between disciplines like pediatric surgery, gynecology and medical oncology. Other options are combined training programs between regional urology departments with different main focuses or training programs between institutions and urologists in private practice. There is an unmet need to improve residency training as well as board examinations by new structures and a reliable curriculum. Based on the changed main focuses of the new version of urology training, we need to discuss the future of residency programs. It might be helpful to discuss two different types of urology training with a common trunk for the first three years followed by a more outpatient-based residency training for the general urologist and a more specialized training for the inpatient urologist to be educated in complex treatment modalities. An open mind to broadening our own horizon, respectful discussion with other departments and the development of common, reliable and interdisciplinary contents represent indispensable prerequisites to realize such an innovative future training program.