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Background: One of the government programs that focuses on the first 1000 days of life is exclusive breastfeeding for infants aged 0-6 months, but there is often a failure of exclusive breastfeeding at the age of 0-3 days due to pre-lactal feeding, so education during pregnancy is needed to improve the knowledge and attitudes of pregnant women through KEKASIH (Small Group of Cadres with Pregnant Women) classes. Objectives: This study aims to determine the effectiveness of KEKASIH classes on knowledge and attitudes of pregnant women trimester III in remote areas of Enggano Island, Bengkulu Province in 2023.Methods: Quasi-experimental research design with pre- and post-test and control group. Intervention in the form of KEKASIH class, which is a modified class for pregnant women divided into small groups with cadres as facilitators. Independent variables were KEKASIH class, dependent variables were knowledge and attitude. External variables are age, parity, education, distance of pregnancy, employment. The sample was trimester III pregnant women a total of 50 people consisting of the treatrimesterent group is pregnant women in KEKASIH class, the control group is pregnant women who receive conventional health promotion.Results:The results of the study showed that there was a difference in the mean knowledge score before and after exclusive breastfeeding education through KEKASIH class from 27.36 to 49.04, p=0.00. There is no difference in the mean attitude score before and after exclusive breastfeeding education in the control group from 28.16 to 28.96 p=0.00.Conclusions: KEKASIH Class is more effective in improving mothers' knowledge and attitudes about exclusive breastfeeding with a value of p=00. Educational factors affect mothers' knowledge, but gestational distance and parity affect mothers' attitudes about exclusive breastfeeding.

Machine learning-based solutions rely heavily on the quality and quantity of the training data. In the medical domain, the main challenge is to acquire rich and diverse annotated datasets for training. We propose to decrease the annotation efforts and further diversify the dataset by introducing an annotation-efficient learning workflow. Instead of costly pixel-level annotation, we require only image-level labels as the remainder is covered by simulation. Thus, we obtain a large-scale dataset with realistic images and accurate ground truth annotations. We use this dataset for the instrument localization activity task together with a studentteacher approach. We demonstrate the benefits of our workflow compared to state-of-the-art methods in instrument localization that are trained only on clinical datasets, which are fully annotated by human experts.

This study evaluates a company's resources and capabilities to determine whether they can provide a sustainable competitive advantage on digital transformation. Using VRIO analysis, the study assesses the value, rarity, imitability, and organization of digital transformation in small banks. The results show that digital transformation is valuable for small banks but is familiar and relatively easy to imitate. Organizational support is critical for successful digital transformation in small banks. Small banks must leverage their strengths and adopt emerging technologies to remain competitive in the banking sector. Result of this study suggest that small banks can achieve competitive parity through a strategic focus on digital. Results on VRIO Analysis on PT. Bank XYZ that human resources, organizational structure, technology, product & services are competitively parity. However, capital resources, information systems, skills, and reputation are competitive advantages. Keywords: digital transformation, resource-based view, VRIO analysis, small banks

Towards computer-assisted neurosurgery, scene understanding algorithms for microscope video data are required. Previous work utilizes optical flow to extract spatiotemporal context from neurosurgical video sequences. However, to select an appropriate optical flow method, we need to analyze which algorithm yields the highest accuracy for the neurosurgical domain. Currently, there are no benchmark datasets available for neurosurgery. In our work, we present an approach to generate synthetic data for optical flow evaluation on the neurosurgical domain. We simulate image sequences and thereby take into account domainspecific visual conditions such as surgical instrument motion. Then, we evaluate two optical flow algorithms, Farneback and PWC-Net, on our synthetic data. Qualitative and quantitative assessments confirm that our data can be used to evaluate optical flow for the neurosurgical domain. Future work will concentrate on extending the method by modeling additional effects in neurosurgery such as elastic background motion.

The Sausapor Declaration has served as a stepping stone towards convening and balancing the dynamics of governmental politics, conservation efforts, the protection of customary communities’ rights, and the sustainable management of natural resources in Tambrauw District. The Declaration supported the establishment of Tambrauw as a Conservation District, while also acknowledging the rights of customary communities in shaping political priorities of the local government, which include: a) stewardship of extensive remaining tropical forests (91.9% forest cover); b) management of protected areas, which represent 77-80% of the total area of the District; c) acknowledging the cultural traditions of five major indigenous groups; and, d) securing the active support of formal institutions for these goals. Two stages have shaped the effort to establish the Conservation District. The first stage involved the period prior to the formal declaration, while the second ecompasses development and implementation of related policies. Establishing local regulations and protecting local communities required extensive lobbying with the provincial and national government, as well as advocacy in various seminars, including both national and international conferences that provided strategic opportunities for securing support for the Conservation District. These steps have been instrumental in gaining legitimacy and public support for relevant conservation policies and for protecting the rights of customary communities. As one example, the review of Tambrauw spatial planning documents (RTRW) led to prioritizing eco-tourism as a leading sector for economic development, along with the creation of an overall agropolitan and renewable energy strategy.

Introduction: Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients., Patients and Methods: We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms., Results: 583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14-4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank p  = 0.03)., Discussion and Conclusion: These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. II is now employed by Boehringer Ingelheim but was working full-time as a Clinical Lecturer at the University of Cambridge during the time this work was carried out and Boehringer Ingelheim have had no input into this work.

Background: As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation., Methods: Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data., Results: Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior., Conclusions: The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether., Trial Registration: The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B)., (© 2024. The Author(s).)

Background: For reasons poorly understood, strokes frequently occur in patients with atrial fibrillation (AF) despite oral anticoagulation. Better data are needed to inform randomised trials (RCTs) of new strategies to prevent recurrence in these patients. We investigate the relative contribution of competing stroke mechanisms in patients with AF who have stroke despite anticoagulation (OAC+) compared with those who are anticoagulant naïve (OAC-) at the time of their event., Patients and Methods: We performed a cross-sectional study leveraging data from a prospective stroke registry (2015-2022). Eligible patients had ischemic stroke and AF. Stroke classification was performed by a single stroke-specialist blinded to OAC status using TOAST criteria. The presence of atherosclerotic plaque was determined using duplex ultrasonography, computerised tomography (CT) or magnetic resonance (MR) angiography. Imaging was reviewed by a single reader. Logistic regression was used to identify independent predictors of stroke despite anticoagulation., Results: Of 596 patients included, 198 (33.2%) were in the OAC+ group. A competing cause for stroke was more frequent in patients with OAC+ versus OAC- (69/198 (34.8%)) versus 77/398 (19.3%), p  < 0.001). After adjustment, both small vessel occlusion (odds ratio (OR): 2.46, 95% CI: 1.20-5.06) and arterial atheroma (⩾50% stenosis) (OR: 1.78, 95% CI: 1.07-2.94) were independently associated with stroke despite anticoagulation., Discussion and Conclusion: Patients with AF-associated stroke despite OAC are much more likely than patients who are OAC-naïve to have competing stroke mechanisms. Rigorous investigation for alternative stroke causes in stroke despite OAC has a high diagnostic yield. These data should be used to guide patient selection for future RCTs in this population.

We here report on a 60-year-old woman with familial Mediterranean fever (FMF) who developed cognitive impairment 16 years after initial diagnosis. On MRI, a new extensive white matter lesion in the right frontal lobe with mild local mass effect but without contrast enhancement was detectable and classified as a tumefactive lesion. Additional MR spectroscopy showed markedly increased choline levels accompanied by a significant lactate peak, highly suggestive of a low-florid demyelinating process. Although diffuse central nervous system (CNS) lesions have been described in single FMF cases, tumefactive lesions have not been observed in FMF patients without concomitant multiple sclerosis. In summary, this case highlights rare differential diagnoses of atypical, inflammatory CNS lesions and the clinical utility of MR spectroscopy., (© 2021. The Author(s).)

Background: The impact of nonalcoholic fatty liver disease (NAFLD) on overall survival (OS), treatment response and toxicity in patients with hepatocellular carcinoma (HCC) treated with sorafenib is unknown. We examined the impact of NAFLD on survival and toxicity in an international cohort of patients receiving sorafenib., Methods: Clinical and demographic data were collected from patients consecutively treated at specialist centres in Europe and North America. The impact of NAFLD on OS, sorafenib-specific survival and toxicity compared with other aetiologies of liver disease using multivariable Cox-proportional hazards and logistic regression modelling was assessed., Results: A total of 5201 patients received sorafenib; 183 (3.6%) had NAFLD-associated HCC. NAFLD-associated HCC patients were more likely to be older women (median age 65.8 versus 63.0 years, p  < 0.01 and 10.4% versus 2.3%, < 0.01), with a median body mass index (BMI) of 29.4. After controlling for known prognostic factors, no difference in OS in patients with or without NAFLD was observed [hazard ratio (HR): 0.99, 95% confidence interval (CI): 0.84-1.18, p  = 0.98]. NAFLD-associated patients had more advanced stage HCC when they commenced sorafenib [Barcelona Clinic Liver Class (BCLC) C/D 70.9% versus 58.9%, p  < 0.01] and were more likely to be commenced on a lower starting dose of sorafenib (51.4 versus 36.4%, p  < 0.01). There was no difference in sorafenib-specific survival between NAFLD and other aetiologies (HR: 0.96, 95% CI: 0.79-1.17, p  = 0.96). Adverse events were similar between NAFLD and non-NAFLD HCC groups, including rates of greater than grade 2 hypertension (6.3% versus 5.8%, p  = 1.00)., Conclusion: Survival in HCC does not appear to be influenced by the presence of NAFLD. NAFLD-associated HCC derive similar clinical benefit from sorafenib compared with other aetiologies., Competing Interests: Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RS received lecture fees from Bayer Healthcare; consulting fees from EISAI, Roche, FALK Foundation; and research funding (to institution) from Incyte, Boston Scientific, AAA and Astex pharmaceuticals. MS received lecture fees from SIRTEX Medical, Cook, Boston Scientific, Falk Foundation, Siemens Healthcare; research funding (to institution) from Bayer and SIRTEX medical. DB: advisory for Bayer HealthCare and Boston Scientific, lecture fees from Falk Foundation. VCT – Honoraria/Advisory Boards: BMS, Eisai, Ipsen, Roche; Research Funding (To Institution): Bayer, Eisai, Ipsen. JS received the Australia Fellowship (Gilead Sciences) in 2017 and 2019., (© The Author(s), 2022.)

Background: The purpose of this trial was to evaluate the effectiveness and safety of the IL-6 receptor antibody Tocilizumab (TCZ) in the treatment of Familial Mediterranean Fever (FMF). Methods: This was a randomized, double-blinded, placebo-controlled phase II trial in adult patients with active FMF and an inadequate response or intolerance to colchicine (crFMF). The physician’s global assessment of disease activity (PGA), based on a five-point scale for six symptoms, was used as a clinical score, which had to be >2 at screening, together with elevated c-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) and serum amyloid A (SAA) levels, to be eligible for inclusion. Patients were randomized 1:1 to either receive monthly TCZ or a placebo over a period of 24 weeks. The primary endpoint was the number of patients achieving an adequate response to treatment at week 16, defined as a PGA of ≤2 and normalized ESR or CRP and normalized SAA. Results: We randomized 25 patients with a median age of 31 years. At week 16, an adequate treatment response was achieved by two patients in the TCZ and none of the patients in the placebo arm (p = 0.089). SAA levels normalized with TCZ, but not with the placebo (p = 0.015). Conclusion: In this first randomized, placebo-controlled study in patients with active crFMF, more patients in the TCZ arm experienced a response to treatment in comparison to those receiving the placebo. As the prevention of amyloidosis is a major treatment goal in FMF, the normalization of SAA in TCZ-treated patients is essential. These findings have to be confirmed in a larger trial.

Objectives: Impulsivity is related to a higher risk of relapse in alcohol use disorders. However, besides drinking behavior, other recovery outcomes like physical and mental health-related quality of life are at least as important. The present study aimed to fill a research gap regarding the association of different impulsivity facets with health-related quality of life and well-being in alcohol use disorder., Methods: Individuals with a primary alcohol use disorder diagnosis (n = 167) were interviewed with standardized self-report measures at the progressed stage of their withdrawal treatment and 6 weeks thereafter. Multiple regression models were calculated to examine the association of impulsivity, craving, and drinking patterns with health-related quality of life and well-being 6 weeks after withdrawal treatment, as well as the predictive role of impulsivity assessed during withdrawal for these two outcomes., Results: Craving was associated with health-related quality of life and well-being 6 weeks after withdrawal. Likewise, non-planning and attentional impulsivity were associated with well-being 6 weeks after withdrawal. Motor impulsivity during withdrawal treatment predicted health-related quality of life 6 weeks thereafter., Conclusion: Impulsivity seems to be negatively related to health-related quality of life and well-being in the first weeks after alcohol withdrawal treatment, probably to a higher extent than drinking patterns, but differentiating between its facets seems to be important. These findings emphasize the importance of treatment approaches aiming at reduced impulsivity in the early recovery process., (© 2022 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Background: Alcohol use disorder, a prevalent and disabling mental health problem, is often characterized by a chronic disease course. While effective inpatient and aftercare treatment options exist, the transferal of treatment success into everyday life is challenging and many patients remain without further assistance. App-based interventions with human guidance have great potential to support individuals after inpatient treatment, yet evidence on their efficacy remains scarce., Objectives: To develop an app-based intervention with human guidance and evaluate its usability, efficacy, and cost-effectiveness., Methods: Individuals with alcohol use disorder (DSM-5), aged 18 or higher, without history of schizophrenia, undergoing inpatient alcohol use disorder treatment (N = 356) were recruited in eight medical centres in Bavaria, Germany, between December 2019 and August 2021. Participants were randomized in a 1:1 ratio to either receive access to treatment as usual plus an app-based intervention with human guidance (intervention group) or access to treatment as usual plus app-based intervention after the active study phase (waitlist control/TAU group). Telephone-based assessments are conducted by diagnostic interviewers three and six weeks as well as three and six months after randomization. The primary outcome is the relapse risk during the six months after randomization assessed via the Timeline Follow-Back Interview. Secondary outcomes include intervention usage, uptake of aftercare treatments, AUD-related psychopathology, general psychopathology, and quality of life., Discussion: This study will provide further insights into the use of app-based interventions with human guidance as maintenance treatment in individuals with AUD. If shown to be efficacious, the intervention may improve AUD treatment by assisting individuals in maintaining inpatient treatment success after returning into their home setting. Due to the ubiquitous use of smartphones, the intervention has the potential to become part of routine AUD care in Germany and countries with similar healthcare systems., Competing Interests: Professor Matthias Berking is stakeholder of the mentalis GmbH, which aims to implement scientific findings related to digital health interventions into routine care and developed the current study's app intervention. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier B.V.)

The human cataract, a developing opacification of the human eye lens, currently constitutes the world's most frequent cause for blindness. As a result, cataract surgery has become the most frequently performed ophthalmic surgery in the world. By removing the human lens and replacing it with an artificial intraocular lens (IOL), the optical system of the eye is restored. In order to receive a good refractive result, the IOL specifications, especially the refractive power, have to be determined precisely prior to surgery. In the last years, there has been a body of work to perform this prediction by using biometric information extracted from OCT imaging data, recently also by machine learning (ML) methods. Approaches so far consider only biometric information or physical modelling, but provide no effective combination, while often also neglecting IOL geometry. Additionally, ML on small data sets without sufficient domain coverage can be challenging. To solve these issues, we propose OpticNet, a novel optical refraction network based on an unsupervised, domain-specific loss function that explicitly incorporates physical information into the network. By providing a precise and differentiable light propagation eye model, physical gradients following the eye optics are backpropagated into the network. We further propose a new transfer learning procedure, which allows the unsupervised pre-training on the optical model and fine-tuning of the network on small amounts of surgical patient data. We show that our method outperforms the current state of the art on five OCT-image based data sets, provides better domain coverage within its predictions, and achieves better physical consistency., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

There is evidence that craving mediates the relationship between Impulsive Personality Traits (IPTs) and relapse during the treatment of an Alcohol Use Disorder (AUD). To provide tailored interventions, a deeper understanding of the relation between IPTs and craving, namely mediating processes, is important. Based on previous literature, we proposed that lower emotion regulation competencies mediate the relation between attentional as well as non-planning IPTs and craving. To investigate these interrelations, we used data from the baseline assessment ( n  = 320) of the SmartAssistEntz project (pre-registered in the German Clinical Trials Register [DRKS00017700]). Inpatients with a primary AUD diagnosis were interviewed using standardized self-report measures (IPTs: BIS-15, emotion regulation competencies: ERSQ, craving: OCDS-G short version) during their withdrawal treatment. Indirect effects were calculated using the SPSS macro PROCESS v3.5 . Attentional as well as non-planning, but not motor, IPTs were associated with craving. Emotion regulation competencies mediated the relationship between attentional as well as non-planning IPTs and craving. Given their mediating role in the present study, it is interesting to investigate if addressing emotion regulation competencies can mitigate the negative influences of attentional and non-planning IPTs. The direct effect of attentional IPTs implicates alternate mediating processes, which should also be investigated in future research.

Purpose of the Review: Elevated levels of anti-phospholipid (aPL) antibodies are the most important criterion in the diagnosis of anti-phospholipid syndrome (APS) and are usually responsible for promoting the risk of thrombotic complications. Now, in the course of the global coronavirus disease 2019 (COVID-19) pandemic, measurable aPL antibodies have also been detected in a noticeable number of patients showing a variety ranging from studies with only isolated positive tests to cohorts with very high positivity. Thus, the question arises as to whether these two different clinical pictures may be linked., Recent Findings: The ambivalent results showed a frequent occurrence of the investigated aPL antibodies in COVID-19 patients to an individually varying degree. While some question a substantial correlation according to their results, a number of studies raise questions about the significance of a correlation of aPL antibodies in COVID-19 patients. Within the scope of this review, these have now been described and compared with each other. Ultimately, it is necessary to conduct further studies that specifically test aPL antibodies in a larger context in order to make subsequent important statements about the role of APS in COVID-19 and to further strengthen the significance of the described comparisons., (© 2021. The Author(s).)

Background: There is no consensus on the effect of sorafenib dosing on efficacy and toxicity in elderly patients with hepatocellular carcinoma (HCC). Older patients are often empirically started on low-dose therapy with the aim to avoid toxicities while maximising clinical efficacy. We aimed to verify whether age impacts on overall survival (OS) and whether a reduced starting dose impacts on OS or toxicity experienced by the elderly., Methods: In an international, multicentre cohort study, outcomes for those aged <75 or ≥75 years were determined while accounting for common prognostic factors and demographic characteristics in univariable and multivariable models., Results: Five thousand five hundred and ninety-eight patients were recruited; 792 (14.1%) were aged ≥75 years. The elderly were more likely to have larger tumours (>7 cm) (39 vs 33%, p < 0.01) with preserved liver function (67 vs 57.7%) (p < 0.01). No difference in the median OS of those aged ≥75 years and <75 was noted (7.3 months vs 7.2 months; HR 1.00 (95% CI 0.93-1.08), p = 0.97). There was no relationship between starting dose of sorafenib 800 mg vs 400 mg/200 mg and OS between those <75 and ≥75 years. The elderly experienced a similar overall incidence of grade 2-4 sorafenib-related toxicity compared to <75 years (63.5 vs 56.7%, p = 0.11). However, the elderly were more likely to discontinue sorafenib due to toxicity (27.0 vs 21.6%, p < 0.01). This did not vary between different starting doses of sorafenib., Conclusions: Clinical outcomes in the elderly is equivalent to patients aged <75 years, independent of dose of sorafenib prescribed.

Objectives: To assess and compare sexual dysfunction (SDF) in female patients with systemic sclerosis (SSc) or systemic lupus erythematosus (SLE), to correlate sexual function with disease characteristics and depression, and to evaluate a short questionnaire (Qualisex) as a screening test., Methods: Female patients with systemic sclerosis or systemic lupus erythematosus in two German tertiary university hospitals were evaluated in a prospective study. A self-designed questionnaire, the Female Sexual Function Index (FSFI), the Qualisex, and the Beck's depression inventory were used., Results: 171 female patients were included into the study (83 with SSc, and 88 with SLE). 62.6% (52 of 83) of SSc patients and 67.0% (59 of 88) of SLE patients were sexually active. Only 9.6% of SSc patients and 14.8% of SLE patients had ever discussed sexual problems with their physician. Significantly more SSc patients would wish to discuss sexuality with their physician more intensively (37.3% vs. 28.4% in SLE patients, p=0.011). Among the 51 sexually active and evaluable SSc patients a mean FSFI of 25.53 (±5.06) was found, with a FSFI value defining sexual dysfunction (SDF) (<26.55) in 49% of patients, which did not differ significantly compared to SLE patients (n=59, mean FSFI 26.92 (±5.17), SDF in 45.8%). The Qualisex correlated significantly with the FSFI, and both Qualisex and FSFI correlated with depressiveness., Conclusions: Sexual dysfunction (SDF) is a frequent problem in female patients with SSc and SLE. Addressing sexual issues during medical consultation is an unmet need. The Qualisex constitutes a short questionnaire, which is suitable for addressing concerns on sexuality.

Objective: The aim of the study was to investigate the relationship between premature ovarian failure and autoimmune disease. Methods: This interdisciplinary prospective study included 52 consecutively recruited women with premature ovarian failure, aged 18-40 years. Diagnosis of premature ovarian failure was defined as amenorrhoea lasting more than 4 months and anti-Müllerian hormone levels below the age-appropriate range. Women with an abnormal karyotype or Fragile X syndrome were excluded from the study. All participants were screened by a rheumatologist for the presence of underlying autoimmune disease. Results: The average age at first diagnosis of premature ovarian failure was 29.5 years; 92.3% of participants ( n  = 48) presented with a secondary amenorrhoea, while only 7.7% ( n  = 4) had primary amenorrhoea. Of all 52 participants, 40.4% ( n  = 21) had at least one confirmed autoimmune disease, including Hashimoto's disease, systemic lupus erythematosus, rheumatoid arthritis, psoriasis, Crohn's disease, polyglandular autoimmune syndrome and coeliac disease. Response rates for hormonal stimulation therapy were low and the presence of autoimmune disease was associated with poor infertility treatment outcome. Conclusions: We found a high prevalence of autoimmune disease in women with premature ovarian failure. Screening for autoimmune diseases should be offered to all women with premature ovarian failure.

In-ethnicity bias, as one of the in-group biases, is widespread in different cultures, interfering with cross-ethnicity communication. Recent studies have revealed that an in-ethnicity bias can be reduced by an in-team bias caused by the membership in a mixed-ethnicity team. However, the neural correlates of different in-group biases are still not clear, especially regarding possible cultural differences. A total of 44 participants (20 Chinese and 24 Germans) were recruited and completed a social categorization fMRI-task, categorizing faces according to their ethnicity and a learned team membership. Our behavioral results revealed both in-ethnicity and in-team bias in German participants, but not in Chinese participants. Our imaging results, however, showed both biases across all participants, as reflected in increased dorsal medial frontal cortex (MFC) activation for in-ethnicity, as well as in-team categorizations, while activation in ventral MFC was higher for in-ethnicity faces in Chinese participants than in the German participants. Our results highlight the importance of the dorsal MFC for in-group categorization across cultures and suggest that cultures might modulate in-group biases., (© The Author(s) 2019. Published by Oxford University Press.)

In the cation of the title salt, C6H14NO(+)·C24H20B(-), the C-N bond lengths are 1.297 (2), 1.464 (2) and 1.468 (2) Å, indicating double- and single-bond character, respectively. The C-O bond length of 1.309 (2) Å shows double-bond character, pointing towards charge delocalization within the NCO plane of the iminium ion. In the crystal, C-H⋯π inter-actions between the iminium H atoms and the phenyl C atoms of the anion are present. The phenyl rings form aromatic pockets, in which the iminium ions are embedded.

In the title salt, C6H14NO(+)·C2H5SO4 (-), the C-N bond lengths in the cation are 1.2981 (14), 1.4658 (14) and 1.4707 (15) Å, indicating double- and single-bond character, respectively. The C-O bond length of 1.3157 (13) Å shows double-bond character, indicating charge delocalization within the NCO plane of the iminium ion. In the crystal, C-H⋯O hydrogen bonds between H atoms of the cations and O atoms of neighbouring ethyl sulfate anions are present, generating a three-dimensional network.

In the title solvated salt, C7H16NO(+)·C24H20B(-)·C2H3N, the C-N bond lengths in the cation are 1.2831 (19), 1.467 (2) and 1.465 (2) Å, indicating double- and single-bond character, respectively. The C-O bond length of 1.2950 (18) Å shows a double-bond character, pointing towards charge delocalization within the NCO plane of the iminium ion. The two C atoms of the n-butyl group are disordered over the two sites, with refined occupancy ratios of 0.890 (5):0.110 (5) and 0.888 (4):0.112 (4). In the crystal, C-H⋯π inter-actions occur between the methine H atom, H atoms of the -N(CH3)2 and -CH2 groups of the cation, and two of the phenyl rings of the tetra-phenyl-borate anion. The latter inter-action forms an aromatic pocket in which the cation is embedded. Thus, a two-dimensional pattern is created in the ac plane.

In the cation of the title salt, C4H10NO(+)·C24H20B(-)·C2H3N, the C-N bond lengths are 1.2864 (16), 1.4651 (17) and 1.4686 (16) Å, indicating double- and single-bond character, respectively. The C-O bond length of 1.2978 (15) Å shows double-bond character, pointing towards charge delocalization within the NCO plane of the iminium ion. C-H⋯π inter-actions are present between the methine H atom and two of the phenyl rings of the tetra-phenyl-borate ion. The latter forms an aromatic pocket in which the cation is embedded. The iminium ion is further connected through a C-H⋯N hydrogen bond to the aceto-nitrile mol-ecule. This leads to the formation of a two-dimensional supramolecular pattern along the bc plane.

In the cation of the title salt, C4H8NO(+)·C24H20B(-), the C-N bond lengths are 1.272 (2), 1.4557 (19) and 1.4638 (19) Å, indicating double- and single-bond character, respectively. The C-O bond length of 1.3098 (19) Å shows that double-bond character and charge delocalization occurs within the NCO plane of the cation. In the crystal, a C-H⋯π inter-action is present between the methyl-ene H atom of the cation and one phenyl ring of the tetra-phenyl-borate ion. The latter forms an aromatic pocket in which the cation is embedded.

Film dosimetry using radiochromic EBT film in combination with a flatbed charge coupled device scanner is a useful method both for two-dimensional verification of intensity-modulated radiation treatment plans and for general quality assurance of treatment planning systems and linear accelerators. Unfortunately, the response over the scanner area is nonuniform, and when not corrected for, this results in a systematic error in the measured dose which is both dose and position dependent. In this study a novel method for background correction is presented. The method is based on the subtraction of a correction matrix, a matrix that is based on scans of films that are irradiated to nine dose levels in the range 0.08-2.93 Gy. Because the response of the film is dependent on the film's orientation with respect to the scanner, correction matrices for both landscape oriented and portrait oriented scans were made. In addition to the background correction method, a full dose uncertainty analysis of the film dosimetry procedure was performed. This analysis takes into account the fit uncertainty of the calibration curve, the variation in response for different film sheets, the nonuniformity after background correction, and the noise in the scanned films. The film analysis was performed for film pieces of size 16 x 16 cm, all with the same lot number, and all irradiations were done perpendicular onto the films. The results show that the 2-sigma dose uncertainty at 2 Gy is about 5% and 3.5% for landscape and portrait scans, respectively. The uncertainty gradually increases as the dose decreases, but at 1 Gy the 2-sigma dose uncertainty is still as good as 6% and 4% for landscape and portrait scans, respectively. The study shows that film dosimetry using GafChromic EBT film, an Epson Expression 1680 Professional scanner and a dedicated background correction technique gives precise and accurate results. For the purpose of dosimetric verification, the calculated dose distribution can be compared with the film-measured dose distribution using a dose constraint of 4% (relative to the measured dose) for doses between 1 and 3 Gy. At lower doses, the dose constraint must be relaxed.

78 benign and malign, formalin-fixed bone or bone-associated tumors of different origin were prepared for image-cytophotometric measuring with a new method of preparing. The DNA-content of the tumors and the so resulting malignancy-grade were determined and compared with the corresponding measurements of unprepared fresh tumors respectively paraffin-embedded tissue sections. Regarding the comparison of the fresh material with the formalin-fixed material, no significant difference (p < or = 0.01) of the data could be found. There was also no significant difference (p < or = 0.01) concerning the comparison of the data obtained from the formalin-fixed material and the data from the tissue sections. The criterium aneuploidy showed a sensitivity of 86% and a specificity of 100% in regards to identifying a malignant tumor, irrespective of the preparation method. A strong correlation could be found (p < 0.001) between the DNA-malignancy grade and the survival rate of the patients.