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Cardiovascular diseases are a leading cause of mortality worldwide. Thus, critically ill patients require continuous monitoring of cardiovascular indicators, such as the left ventricular volume (LVV). Although continuous hemodynamic monitoring of patients is desirable, due to technical limitations, current measurement technologies either require manual intervention of the physician or only provide inaccurate results. Intracardiac impedance measurements are a promising approach for continuous assessment of cardiac function. However, developing and evaluating these methods requires a simulation model of the left ventricle with cardiac motion during an entire cardiac cycle. While many models exist for a fixed ventricle size, to date, no freely available models incorporate time and represent the cardiac motion during a complete cardiac cycle. Therefore, we developed four cardiacmechanical left ventricular models with varying ventricle sizes and complexities. Each model focuses on a different aspect of the geometric shape, thus allowing an isolated analysis of the different influences. This paper presents the development of the models and initial results of the impedance analysis. All measured admittances exhibit a high resemblance for all models and a strong, non-linear correlation with the LVV. A comparison between the models shows how the different geometries affect the impedance. The models, thus, provide a useful basis for the development of LVV estimation algorithms.

Computer technology–based treatment approaches like intraoperative navigation and intensity-modulated radiation therapy have become important components of state of the art head and neck cancer treatment. Multidirectional exchange of virtual three-dimensional patient data via an interdisciplinary platform allows all medical specialists involved in the patients treatment to take full advantage of these technologies. This review article gives an overview of current technologies and future directions regarding treatment approaches that are based on a virtual, three-dimensional patient specific dataset: storage and exchange of spatial information acquired via intraoperative navigation allow for a highly precise frozen section procedure. In the postoperative setting, virtual reconstruction of the tumor resection surface provides the basis for improved radiation therapy planning and virtual reconstruction of the tumor with integration of molecular findings creates a valuable tool for postoperative treatment and follow-up. These refinements of established treatment components and novel approaches have the potential to make a major contribution to improving the outcome in head and neck cancer patients.

Berta Raventós,1,2,* Sergio Fernández-Bertolín,1,* María Aragón,1 Erica A Voss,3– 5 Clair Blacketer,3– 5 Leonardo Méndez-Boo,6 Martina Recalde,1 Elena Roel,1,2 Andrea Pistillo,1,7 Carlen Reyes,1 Sebastiaan van Sandijk,8 Lars Halvorsen,9 Peter R Rijnbeek,4,5 Edward Burn,1,10 Talita Duarte-Salles1,4 1Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; 2Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; 3Janssen Pharmaceutical Research and Development, Titusville, NJ, USA; 4Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands; 5OHDSI Collaborators, Observational Health Data Sciences and Informatics (OHDSI), New York, NY, USA; 6Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut, Barcelona, Spain; 7Universitat Pompeu Fabra, Barcelona, Spain; 8Odysseus Data Services s.r.o., Prague, Czech Republic; 9edenceHealth NV, Kontich, Belgium; 10Centre for Statistics in Medicine, University of Oxford, Oxford, UK*These authors contributed equally to this workCorrespondence: Talita Duarte-Salles, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, Barcelona, 08007, Spain, Tel +34935824342, Email tduarte@idiapjgol.orgPurpose: The primary aim of this work was to convert the Information System for Research in Primary Care (SIDIAP) from Catalonia, Spain, to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). Our second aim was to provide a descriptive analysis of COVID-19-related outcomes among the general population.Patients and Methods: We mapped patient-level data from SIDIAP to the OMOP CDM and we performed more than 3,400 data quality checks to assess its readiness for research. We established a general population cohort as of the 1st March 2020 and identified outpatient COVID-19 diagnoses or tested positive for, hospitalised with, admitted to intensive care units (ICU) with, died with, or vaccinated against COVID-19 up to 30th June 2022.Results: After verifying the high quality of the transformed dataset, we included 5,870,274 individuals in the general population cohort. Of those, 604,472 had either an outpatient COVID-19 diagnosis or positive test result, 58,991 had a hospitalisation, 5,642 had an ICU admission, and 11,233 died with COVID-19. A total of 4,584,515 received a COVID-19 vaccine. People who were hospitalised or died were more commonly older, male, and with more comorbidities. Those admitted to ICU with COVID-19 were generally younger and more often male than those hospitalised and those who died.Conclusion: We successfully transformed SIDIAP to the OMOP CDM. From this dataset, a general population cohort of 5.9 million individuals was identified and their COVID-19-related outcomes over time were described. The transformed SIDIAP database is a valuable resource that can enable distributed network research in COVID-19 and beyond.Keywords: electronic health records, medical ontologies, secondary data use, common data model, OMOP

Suebsarn Ruksakulpiwat,1 Chitchanok Benjasirisan,1 Kedong Ding,2 Lalipat Phianhasin,1 Sutthinee Thorngthip,3 Anuoluwapo D Ajibade,4 Jai Thampakkul,5 Amy Y Zhang,6 Joachim G Voss6 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA; 3Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 4College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA; 5Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA; 6Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USACorrespondence: Suebsarn Ruksakulpiwat, Email Suebsarn25@gmail.comIntroduction: Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke.Objective: To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH.Methods: This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative.Results: Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients.Conclusion: Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.Keywords: ischemic stroke, medication adherence, social determinants of health, systematic review

Annemarie Voss,1 Bianca Kollhorst,2 Katharina Platzbecker,1 Ute Amann,1 Ulrike Haug1,3 1Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 2Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 3Faculty of Human and Health Sciences, University of Bremen, Bremen, GermanyCorrespondence: Ulrike Haug, Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany, Tel +49 421 218 56862, Email haug@leibniz-bips.dePurpose: Over the last decade, the use of direct oral anticoagulants (DOACs) has strongly increased. We aimed to describe and compare risk profiles including potential changes over time among persons with non-valvular atrial fibrillation initiating treatment with different DOACs or phenprocoumon (vitamin K antagonist) between 2011 and 2019 in Germany.Patients and Methods: Using the German Pharmacoepidemiological Research Database (GePaRD; claims data of ~20% of the German population), we identified persons with a first dispensing of phenprocoumon or a DOAC and a diagnosis of non-valvular atrial fibrillation between August 2011 and December 2019. We described the morbidity of included patients prior to treatment initiation, stratified by year of treatment initiation.Results: Overall, we included 448,028 new users (phenprocoumon: N = 118,117, rivaroxaban: N = 130,997, apixaban: N = 130,300, edoxaban: N = 38,128, dabigatran: N = 30,486). Comparing new DOAC users in 2019, the proportion with prior ischemic stroke was highest for dabigatran (17%) and lowest for rivaroxaban (8%). The proportion with prior major bleeding was also highest for dabigatran (25%) and lowest for edoxaban (20%). New users of apixaban were oldest and, eg, showed the highest prevalence of congestive heart failure. Changes over time were most pronounced for phenprocoumon. For example, among persons initiating phenprocoumon in 2012 vs 2019, the proportion with prior major bleeding increased from 18% to 35%; the proportion with renal disease increased from 20% to 36% and the proportion with liver disease from 18% to 24%.Conclusion: This study demonstrated differences in risk profiles between new users of different oral anticoagulants and substantial changes over time among new phenprocoumon users. These differences have to be considered in head-to-head comparisons of these drugs based on observational data, especially regarding potential unmeasured confounding.Keywords: atrial fibrillation, oral anticoagulants, direct oral anticoagulants, DOACs, risk profiles

Katharina Platzbecker,1 Annemarie Voss,1 Jonas Reinold,1 Anne Elbrecht,2 Wolfgang Biewener,2 Daniel Prieto-Alhambra,3,4 Annika M Jödicke,3 Tania Schink1 1Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 2Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany; 3Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; 4Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, NetherlandsCorrespondence: Tania Schink, Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen, 28359, Germany, Tel +4942121856865, Email schink@leibniz-bips.dePurpose: Validation of outcomes allows measurement of and correction for potential misclassification and targeted adjustment of algorithms for case definition. The purpose of our study was to validate algorithms for identifying cases of acute myocardial infarction (AMI), stroke, and cardiovascular (CV) death using patient profiles, ie, chronological tabular summaries of relevant available information on a patient, extracted from pseudonymized German claims data.Patients and Methods: Based on the German Pharmacoepidemiological Research Database (GePaRD), 250 cases were randomly selected (50% males) for each outcome between 2016 and 2017 based on the inclusion criteria age ≥ 50 years and continuous insurance ≥ 1 year and applying the following algorithms: hospitalization with a main diagnosis of AMI (ICD-10-GM codes I21.- and I22.-) or stroke (I63, I61, I64) or death with a hospitalization in the 60 days before with a main diagnosis of CV disease. Patient profiles were built including (i) age and sex, (ii) hospitalizations incl. diagnoses, procedures, discharge reasons, (iii) outpatient diagnoses incl. diagnostic certainty, physician specialty, (iv) outpatient encounters, and (v) outpatient dispensings. Using adjudication criteria based on clinical guidelines and risk factors, two trained physicians independently classified cases as “certain”, “probable”, “unlikely” or “not assessable”. Positive predictive values (PPVs) were calculated as percentage of confirmed cases among all assessable cases.Results: For AMI, the overall PPV was 97.6% [95% confidence interval 94.8– 99.1]. The PPV for any stroke was 94.8% [91.3– 97.2] and higher for ischemic (98.3% [95.0– 99.6]) than for hemorrhagic stroke (86.5% [76.5– 93.3]). The PPV for CV death was 79.9% [74.4– 84.4]. It increased to 91.7% [87.2– 95.0] after excluding 32 cases with data insufficient for a decision.Conclusion: Algorithms based on hospital diagnoses can identify AMI, stroke, and CV death from German claims data with high PPV. This was the first study to show that German claims data contain information suitable for outcome validation.Keywords: claims data, algorithm validation, patient profiles, positive predictive value

We investigate diamond nitrogen-vacancy (NV) centers as alternative labels in stimulated emission depletion (STED) microscopy. To this end, artificial diamond is used as a substrate and Raman spectroscopy in photoluminescence (PL) mode is performed for clearly identifying the emission wavelengths of the NV centers. With the aid of a STED microscopy system, we imaged a random feature on substrate surface with the NV-centers in STED and confocal mode. Our first measurements indicate that the combination of NV centers and STED is very promising for resolving the structures and can be further extended to nanoscale structures applied on the diamond substrates.

The ever-increasing amount of data that is produced by modern scientific facilities like EuXFEL or LHC puts high pressure on the data management infrastructure at the laboratories. This includes poorly shareable resources of archival storage, typically, tape libraries. To achieve maximal efficiency of the available tape resources, a deep integration between hardware and software components is required. The CERN Tape Archive (CTA) is an open-source storage management system developed by CERN to manage LHC experiment data on tape. Although today CTA’s primary target is CERN Tier-0, the data management group at DESY considers the CTA as a main alternative to commercial HSM systems. dCache has an extensible tape interface that allows connectivity to almost any tape system. Together with the CERN Tape Archive developers, the storage team at DESY is working on seamless integration of CTA into dCache.

The use of catheters and guide-wires in minimally invasive therapeutic approaches is an important part of clinical practice. In the neurovascular field, the unique nature of cerebral blood vessels necessitates very thin-walled and flexible catheters. The blood vessels in question are highly branched and at the same time can be less than one millimetre in diameter. This results in high demands on micro-catheters and guide-wires for successful endovascular therapy. The interaction of these surgical tools and the vessel wall is of especial interest. Depending on the catheter stiffness, this interaction can be friction, punctual collision or straightening. The work aims to design and implement a test setup for evaluation of these interactions with the vessel wall. For this purpose, a standardized vessel course with representative characteristics is necessary. Furthermore, by implementing suitable measuring equipment, an endovascular intervention can be simulated.