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The ECHo experiment aims at determining the effective electron neutrino mass by analyzing the endpoint of the 163Ho electron capture spectrum. High energy resolution detectors with a well-tailored detector response are the essential ingredient for the success of the ECHo experiment. Metallic magnetic calorimeter arrays enclosing 163Ho have been chosen for the ECHo experiment. The first MMC array, ECHo-1k, showed excellent performances with an average energy resolution of 5.5 eV FWHM @ 5.9 keV. Based on the results obtained with the ECHo-1k array, optimization studies have paved the way towards a new detector design for the next experimental phase, ECHo-100k. The ECHo-100k chip features an optimized single pixel design to improve the detector performance as well as an upgraded on-chip thermalization layout. The newly fabricated ECHo-100k detectors have been fully characterized at room temperature, at 4 K and at millikelvin temperature. The obtained results show that the ECHo-100k array achieved the expected performance with an average energy resolution of 3.5 eV FWHM @ 5.9 keV, fulfilling the requirements for the ECHo-100k experimental phase. [ABSTRACT FROM AUTHOR]

Mucous macroaggregates, recently observed in the northern Adriatic in summer of 1997 and late spring of 2000, are primarily the product of phytoplankton (diatom) exudates during favourable environmental conditions in late spring, and can be viewed as macrogels. The FT-IR and 1H-NMR spectra of macroaggregate samples from the northern Adriatic, collected in different formation stages in July 1997, August 1997, September 1997 and June 2000, as well as of cultured diatom Skeletonema costatum, showed that they are similar and composed of aliphatic components and polysaccharides bonded through carboxylic and amide groups, and organosilicon compounds. The stability of macrogels of macroaggregates is, according to FT-IR and X-ray analyses, most probably enhanced by interactions with entrapped particles of calcite, quartz and clay minerals. These organic-mineral associations seem to be important for mucous phenomena. According to 1H-NMR spectra, the temporal differences in macroaggregate composition show a relative increasing percentage of organosilicon compounds and aliphatic components bonded to carbohydrates through ester and amide groups, and an increasing ratio between aliphatic structures and carbohydrates. This indicates that aliphatic chains bonded to Si and carbohydrates may contribute to the persistence and stability of macroaggregates in the summer stratified waters in the northern Adriatic, while the temporal decrease of carbohydrate content is most probably due to microbial and photochemical degradation of algal reserve polysaccharides. [Copyright &y& Elsevier]

Background: Surgical outpatient clinics continuously face challenges in delivering efficient and effective care. An expanding population and chronic staff shortages makes sustainability critical. The primary objective of this study was to identify modifiable factors contributing to longer wait times in an orthopaedic outpatient clinic., Methods: A single-centre prospective observational cohort study was conducted at Western Australia's state trauma centre. Over a four-week period, clinicians completed forms identifying delays in clinic, and clinic numbers were captured through an electronic booking system. Data was analysed using SPSS v27., Results: Face-to-face (FTF) and telehealth (TH) clinic volumes grew by 18.9% and 361.1% respectively between 2018 and 2022. For the study period, 754 forms were completed for attending clinic patients. This captured 42.4% and 96.8% of FTF and TH actual attendance. The average wait time for doctor consultation was 63.9 min. Wait times significantly reduced when x-rays were performed prior to clinic (P < 0.001), and when an unaccredited registrar held the on-call phone (P < 0.001). Trauma clinics ran overtime in 95% of cases compared to elective clinics in which 25% ran overtime. The golden staffing ratio was one doctor for 13 patients. TH experienced few delays related to technological fault., Conclusion: This study demonstrates that clinic volume continues to rise. It highlights the demand for adequate staffing and identifies several modifiable factors that influence clinic efficiency. It demonstrates the growth of TH as an alternative modality for outpatient surgical services and its potential for future expansion., (© 2023 Royal Australasian College of Surgeons.)

Purpose: To assess the impact of a one-time hypertension (HTN)-focused clinical pharmacist intervention on the occurrence of clinical inertia and change in blood pressure (BP)., Methods: This retrospective study included patients 18 to 89 years of age with a current diagnosis of HTN and average systolic BP of ≥150 mm Hg. Centralized outreach coordinators performed telephone outreach to patients to schedule an HTN-focused visit with their primary care provider (PCP) and forwarded outreach notes for half of these patients to clinical pharmacists embedded in an internal medicine clinic. The clinical pharmacists performed a one-time focused medication review and provided evidence-based recommendations to a patient's PCP prior to the scheduled appointment. The primary outcome was therapy intensification (medication adjustment or adherence discussion) as a measure of overcoming clinical inertia. Secondary outcomes were the mean changes in systolic and diastolic BP from preintervention values to 6-month follow-up in the intervention group versus the control group., Results: A total of 91 patients were included, and 34 of 47 intervention patients (72%) had therapy intensification at the HTN-focused PCP appointment, compared to 20 of 44 control patients (46%) (P =0.017). The mean (SD) systolic BP reductions from baseline were 12.26 (29.04) mm Hg and 6.97 (27.05) mm Hg for the intervention and control groups, respectively (P =0.427), with diastolic BP reductions of 3.83 (13.14) mm Hg and 1.35 (10.60) mm Hg, respectively (P =0.380)., Conclusion: A collaborative model involving centralized outreach coordinators and embedded clinical pharmacists led to a significant reduction in clinical inertia. This was a small-scale pilot study, and further research is needed to determine the effect of this intervention on BP reduction., (© American Society of Health-System Pharmacists 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aims: Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) and sigma-1 receptor agonist, has so far shown promise in the prevention of COVID-19 progression as an early treatment option in three trials. The aim of this study was to evaluate the safety and efficacy of fluvoxamine in COVID-19 patients if administered later in the course of the disease., Methods: The study was designed as an open-label, prospective cohort trial with matched controls. In April and May 2021, 51 ICU COVID-19 patients hospitalised in the University Hospital Dubrava and University Hospital Centre Zagreb, Croatia, were treated with fluvoxamine 100 mg three times daily for 15 days in addition to standard therapy and they were prospectively matched for age, gender, vaccination against COVID-19, disease severity and comorbidities with 51 ICU controls., Results: No statistically significant differences between groups were observed regarding the number of days on ventilator support, duration of ICU or total hospital stay. However, overall mortality was lower in the fluvoxamine group, 58.8% (n = 30/51), than in the control group, 76.5% (n = 39/51), HR 0.58, 95% CI (0.36-0.94, P = .027)., Conclusion: Fluvoxamine treatment in addition to the standard therapy in hospitalised ICU COVID-19 patients could have a positive impact on patient survival. Further studies on the effects of fluvoxamine in COVID-19 patients are urgently required., (© 2021 British Pharmacological Society.)

Background: Aortic valve sclerosis (AVS), mitral valve sclerosis (MVS), remodeling of major arteries, and increased pericardial fat are associated with subclinical atherosclerosis. We assessed these markers of atherosclerosis in severely obese patients before and 1 year after bariatric surgery. Methods: Eighty-seven severely obese patients (43 ± 10 years, preoperative body mass index [BMI] 41.8 ± 5 kg/m2) underwent echocardiography before and 1 year after Roux-en-Y bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic aortic wall thickness (AWT), pericardial fat thickness at the right ventricular free wall, and AVS/MVS based on combined aortic leaflet thickness and hyperechoic valve lesions. Results: Postoperatively, patients experienced a reduction of 12.9 ± 3.9 kg/m2 in BMI, 0.5 ± 1.9 mm in AWT, 2.6 ± 2.3 mm in pericardial fat, and 45%/53% in AVS/MVS (p < 0.05). In multivariate regression analyses with adjustment for clinical and hemodynamic variables, less pericardial fat reduction was associated with male sex and higher 1-year blood pressure and BMI, and less AWT-reduction with higher age and 1-year BMI (p < 0.05). Persistent AVS and MVS were related to higher 1-year BMI and more advanced valve sclerosis preoperatively (p < 0.05). Conclusions: Markers of subclinical atherosclerosis decreases significantly 1 year after bariatric surgery, particularly in younger patients that achieve a BMI < 28 kg/m2.

Background and Objective: Liver function assessment in patients with intra-abdominal hypertension (IAH) after major abdominal surgery is complex and often confounding. Elevated intra-abdominal pressure (IAP) often occurs after major abdominal surgery, and is associated with decreased abdominal blood flow and organ dysfunction, and it could cause abdominal compartment syndrome (ACS), which is a life-threatening condition. Plasma disappearance rate (PDR) of indocyanine green (ICG) and ICG retention rate after 15 min (R15) were used to evaluate liver function and as a prognostic parameter after major abdominal surgery., Methods: In this prospective/observational study, 51 patients were followed in the surgical intensive care unit after major abdominal surgery (operation of the small and large intestine, stomach, pancreas, spleen, or resection of the abdominal aorta), 29 had IAH. The PDR-ICG and R15 were analyzed 24 h after surgery concurrently with IAP, APP, bilirubin, AST, ALT, prothrombin time, albumin, cardiac index, arterial lactate, oxygen delivery, MAP (mean arterial pressure), APACHE II (acute physiology and chronic health evaluation), SOFA (sequential organ failure assessment), and SAPS II (simplified acute physiology score). IAH has been defined as a peak intra-abdominal pressure (IAP) value of ≥12 mmHg, at a minimum, as two standardized measurements obtained 1-6 h apart., Results: The PDR-ICG measured 24 h after surgery was not different among groups (20.95% [SD = 10.34] vs 25.40% [SD = 7.42]), p = .094. ICG R15 was significantly higher in patients with IAH, 11.10% [SD = 13.82] vs 8.30 [SD = 11.46], p < .05, respectively. The PDR/ICG value was significantly lower in non-survivors than survivors (16.82 [SD = 10.87] vs 24.35 [SD = 8.48], p < .05)., Conclusions: The results suggest that PDR/ICG and ICG R15 are useful dynamic tests for evaluation of complex liver function and survival prediction after major abdominal surgery in patients with IAH.

Competing Interests: There are no conflicts of interest.

Background: The reduced availability of human cadavers and their associated high costs, coupled with an increasing requirement for meeting continuing professional development targets, has accentuated the need for alternative training models that meet current ethical standards. The aim of this study is to identify suitable substitutes that are accessible and cost effective for use as training models for meniscal repairs and small joint arthroscopy., Method: Ovine, bovine and porcine stifles were analysed for comparable anatomy to the human knee, arthroscopic access, arthroscopic view and ease of meniscal repair., Results: The bovine stifle joint was found to be too large and offered limited access due to a large anterior fat pad and thick surrounding soft tissue. The ovine and bovine stifles were both easily available and had comparable anatomy to the human knee. Advantages of the porcine stifle include better availability and easier accessibility, comparable anatomy to the human knee and its relatively larger size that made it easier to arthroscope., Conclusion: Porcine stifles are cost effective, accessible, allow for meniscal repair and are suitable for arthroscopic access and view. Our view is that they are an ideal training model for arthroscopic meniscal repair, small joint arthroscopy and anterior cruciate ligament reconstruction., (© 2015 Royal Australasian College of Surgeons.)

Human soluble triggering receptor expressed on myeloid cells (sTREM-1) is a glycoprotein of the immunoglobulin superfamily. In normal lung tissue, sTREM-1 is selectively expressed in lung alveolar macrophages specialized for pathogen clearance and is up-regulated in the presence of bacteria and fungi. The aim of this study was to assess sTREM-1 levels in serum and lungs of patients with ventilator associated pneumonia (VAP) and to evaluate its potential diagnostic role. The study cohort included 31 patients meeting the criteria for VAP, including clinical, microbiological, radiological and laboratory findings in patients on mechanical ventilation for more than 48 hours and with Clinical Pulmonary Infection Score (CPIS) > 6. Serum and lung levels of sTREM-1 were obtained and tested for differences. The samples were analyzed using ELISA technique and the values were expressed in pg/mL. The samples for lung sTREM-1 were obtained from direct bronchial lavage fluid and serum samples from peripheral blood. Differences were tested by Mann Whitney U test with P < 0.05 considered significant. In patients with bacterial VAP, a statistically significant difference was found between serum and lung sTREM-1 levels (P < 0.05), with very high levels of sTREM-1 recorded in lung samples (mean value 1565 pg/mL). There was no statistically significant difference in pulmonary sTREM-1 level between the polymicrobial and monomicrobial VAP groups. In conclusion, sTREM-1 is present in a high concentration in the lungs of patients with bacterial VAP. sTREM-1 levels can help in making the diagnosis of bacterial pneumonia as a standalone marker.

The accuracy of cardiac output measurement by two most widely used methods of less invasive hemodynamic monitoring and by the standard technique of thermodilution with pulmonary catheter was assessed. The measurements were carried out in septic surgical patients immediately after and between system calibrations. Study results showed satisfactory compatibility of measurements performed by the two methods and by pulmonary catheter in both phases, thus system calibration being recommendable in hemodynamically unstable septic patients.

Carbohydrate contents in seawater, mucilage, and mucilage interstitial waters were analyzed during episodes of mucilage formation in the summers of 2000 and 2001 in the northern Adriatic Sea off Pesaro and in the Gulf of Trieste using 3-methyl-2-benzothiazolinone hydrazone hydrochloride (MBTH) and 2,4,6-tripyridyl-s-triazine (TPTZ) assays. The significant presence of polysaccharides in seawater in the presence of mucilage has an important impact on the agglomeration processes forming gelatinous material (macrogels). Characterization of oligosaccharides in the water-soluble fraction of mucilage using HPLC/RI revealed maltose and pentaose as the main components.