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Summary:. Clinical and pathological features in 23 children who developed acute renal failure from what was subsequently proven to be diethylene glycol poisoning are presented. Symptoms of cases included anuria, fever, diarrhoea and vomiting. Eighteen (78.3%) had hepatomegaly, 11 (47.8%) had evidence of respiratory dis tress and 7 (30.4%) had acidotic breathing. Seven (30.4%) of the children were dehydrated on physical examination. Alteration in the level of consciousness was observed in 13 (56.5%) children. The major biochemical abnormalities were acidosis and elevated blood urea nitrogen. Although serum bilirubin was normal in those in whom it was determined, the liver enzymes were elevated in the 2 patients in whom they were determined. Patients were treated as for acute renal failure of renal origin and four children had peritoneal dialysis. Twenty-two (95.6%) of the patients died and outcome was unknown in the remaining patient who was dis charged against medical advice. Autopsies in 7 patients revealed a characteristic nephrotoxic acute tubular necrosis and centrilo bular hepatic necrosis characterized by vacuolar and ballooning degeneration of the metabolically active renal tubular cells and hepatocytes.

High-order harmonic generation (HHG) in solids opens new frontiers in ultrafast spectroscopy of carrier and field dynamics in condensed matter, picometer resolution structural lattice characterization and designing compact platforms for attosecond pulse sources. Nanoscale structuring of solid surfaces provides a powerful tool for controlling the spatial characteristics and efficiency of the harmonic emission. Here we study HHG in a prototypical phase-change material Ge2Sb2Te5 (GST). In this material the crystal phase can be reversibly changed between a crystalline and amorphous phase by light or electric current mediated methods. We show that optical phase-switching is fully reversible and allows for dynamic control of harmonic emission. This introduces GST as new addition to materials that enable flexible metasurfaces and photonic structures that can be integrated in devices and allow for ultrafast optical control.

Clinical laboratories invest substantial time and resources to mitigate measurement error but potential errors during the preanalytical phase of testing are not subjected to the same level of scrutiny. Herein, we assess the proportions of intravenous (IV) fluid contamination sufficient to exceed common performance metrics and compare it to contaminated results flagged by current protocols.

Konfessionslosigkeit ist die neue gesellschaftliche Signatur, in die hinein die Theologie ihre Botschaft spricht. Daraus ergeben sich verschiedene Herausforderungen für eine Theologie, die zukunftsfähig sein will. Zum einen muss die Theologie ihre erkenntnistheoretischen Annahmen und Prämissen transparent machen. Zum anderen müssen normative Konzepte von Menschsein grundlegend überdacht werden. Weiter lohnt es sich, gegenwärtig die politische Dimension des Glaubens zu akzentuieren. Diese Themen geben neue Impulse für ein universitäres Lehrangebot, das stärker darauf abzielt, die professionelle Kompetenz zukünftiger Lehrkräfte angesichts der Konfessionslosigkeit zu fördern, und sich als professionsorientiert versteht.

The present paper focuses on farmers’ strategies for coping with the shock caused by the outbreak of the pandemic of COVID-19. Using the concept of farm resilience, which underlines the role of capacity and abilities as well as different actions undertaken in difficult situations, this study proposes an analytical framework of farmers’ coping short-term micro-strategies in relation to external crises, on the example of the COVID-19 pandemic. Taking into account academic literature, qualitative data gathered from fruit and vegetable producers in different regions in Poland and the information from sector experts, the paper outlines the varied consequences of the pandemic for farms, and also farmers’ diverse reactions to them. The findings from this study suggests that the analysed farms’ relative resilience to the crisis was achieved thanks to their available economic and social resources and the actions they undertook. The above-mentioned resources and activities were considered in the study primarily using the relational (process-based) approach, focusing on the ways of their creation, maintenance and adaptation. At the same time, the empirical material under analysis has shown that the adaptive measures adopted were short-term and did not respond to the farms’ permanent problems, which the COVID-19 pandemic has exacerbated significantly. It is assumed that presented results and proposed framework of farmers’ micro-strategies, which were taken during the pandemic, might be useful for future studies focusing on various external shocks as well as for research to be conducted in other CEE countries due to many common contextual factors that has shaped food practices and institutional arrangements.

Purpose - Employing a qualified workforce is a crucial topic for organiza-tional success. Research on employer branding in family businesses has not come to a clear conclusion of which family business characteristics might be attractive for which potential employees. Aim(s) - This paper focuses on family businesses in the IT industry to analyze whether they might or might not profit from the communication of family involvement. Design/methodology/approach - To answer the research question, an online survey was conducted. The participants were divided into two groups, whereby one group was manipulated by the communication of the owner-ship. Findings - The results show that family businesses are associated with greater security but fewer development opportunities. In addition, certain personality traits of job applicants influence the perception of organizational attractiveness. However, the communication of ownership had no significant influence on employer attractiveness. Similarly, the varying importance of job security and development opportunities among applicants cannot be clearly explained by personality traits. Limitation of the Study - The final sample size was relatively small. In addi-tion, in reality the applicants would be provided with more and more detailed information about the company. The representativeness and generalizability of the survey must therefore be questioned. Practical implications – As the results show a positive correlation between perceived job security, opportunities for further development and attractive-ness, it might be valuable for family businesses to support and communicate job security and opportunities for further development for raising increased attractiveness. Originality/value - The attempt is made to give companies, especially family businesses, a better understanding of the effect of communicating the own-ership relationship on potential applicants.

In this contribution we present results from Au+Au collisions at √SNN = 2.42 GeV as well as Ag+Ag collisions at √SNN = 2.42 and 2.55 GeV measured by HADES. We focus on three different observables: electromagnetic probes, collective and bulk-matter phenomena and strangeness production which are discussed in the following.

Dorota Śpiewak,1 Anna Heinke,2,3 Katarzyna Michalska-Małecka4,5 1University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland; 2University of California San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, CA, USA; 3Joan and Irwin Jacobs Retina Center, La Jolla, CA, USA; 4Department of Ophthalmology, Medical University of Gdańsk, Gdańsk, Poland; 5University Clinical Center, University Hospital Medical University of Gdańsk, Gdańsk, PolandCorrespondence: Katarzyna Michalska-Małecka, Department of Ophthalmology, University Hospital Medical University of Gdańsk, Mariana Smoluchowskiego 17, Gdańsk, 80-214, Poland, Tel +48 600 064 150, Email k.michalska.malecka@gmail.comPurpose: To assess the effect of the prolonged-release dexamethasone implant (Ozurdex) in patients with retinal venous thrombosis on blood rheological parameters and evaluate the impact on morphological and functional parameters.Methods: Prospective cross-sectional study involved 35 subjects treated with central retinal vein and vein branch occlusion with intravitreal dexamethasone implant and 35 healthy subjects in control group. Hematocrit, blood and plasma viscosity, erythrocyte aggregation amplitude (EAA), index (EAI), aggregation half-life time (EAT1/2), and erythrocyte deformability (ED) were evaluated. The best-corrected visual acuity (BCVA), central retinal thickness (CRT) and visual field (VF) were examined. All the parameters were examined at the baseline, 7 and 30 days after the treatment. The results were analyzed with correlation and regression and compared to the baseline values.Results: In the studied group, three hemorheological parameters improved as early as on the 7th day after the drug administration, and this improvement remained at a similar level on the 30th day. The EAA increased by 21.26% on day 7 and by 19.78% on day 30, the EAI decreased by 10.55% on day 7 and by 9.14% on day 30 and the EAT1/2 time increased by 38.50% on day 7 and by 31.02% on day 30. On day 7, the BCVA was improved by 1 row, CRT was reduced by 170.77 μm (24.49%), and the VF was improved by 9.8 dB (49.92%) compared to baseline parameters. On day 30, the BCVA was improved by three rows, CRT reduced by 244.68 μm (35.09%), and VF improved by 12.09 dB (61.59%).Conclusion: The intravitreal dexamethasone implant used in treating macular oedema in patients with RVO has a statistically significant effect on some rheological parameters of blood, reduction of CRT and clinical improvement in BCVA and VF.Keywords: retinal venous vein thrombosis, dexamethasone, hemorheology

Giora Pillar,1 Murray Berall,2 Richard B Berry,3 Tamar Etzioni,1 Yaakov Henkin,4 Dennis Hwang,5 Ibrahim Marai,6,7 Faheem Shehadeh,6 Prasanth Manthena,8 Anil Rama,9 Rebecca Spiegel,10 Thomas Penzel,11 Riva Tauman12 1Sleep Laboratory, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel; 2Center of Sleep and Chronobiology, University of Toronto, Toronto, ON, Canada; 3UF Health Sleep Center, University of Florida, Gainesville, FL, USA; 4Cardiology Department, Soroka Medical Center, Be’er Sheva, Israel; 5Kaiser Permanente San Bernardino County Medical Center, Fontana, CA, USA; 6Cardiology Department, Rambam Medical Center, Haifa, Israel; 7Baruch Padeh Medical Center and the Azrieli Faculty of Medicine in the Galilee, Poriya, Israel; 8Sleep clinic, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA; 9Sleep Clinic, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA; 10Department of Neurology and Sleep Center, Stony Brook University Hospital, Stony Brook, NY, USA; 11Charite Universitätsmedizin Berlin, Sleep Medicine Center, Berlin, Germany; 12Sleep Disorders Center, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelCorrespondence: Giora Pillar, Sleep Laboratory, Carmel Medical Center and Technion Faculty of Medicine, Haifa, 31096, Israel, Tel +972 4 8250258, Fax +972 48250699, Email gpillar@technion.ac.ilBackground: The WatchPAT (WP) device was shown to be accurate for the diagnosis of sleep apnea and is widely used worldwide as an ambulatory diagnostic tool. While it records peripheral arterial tone (PAT) and not electrocardiogram (ECG), the ability of it to detect arrhythmias is unknown and was not studied previously. Common arrhythmias such as atrial fibrillation (AF) or premature beats may be uniquely presented while recording PAT/pulse wave.Purpose: To examine the potential detection of common arrhythmias by analyzing the PAT amplitude and pulse rate/volume changes.Patients and Methods: Patients with suspected sleep disordered breathing (SDB) were recruited with preference for patients with previously diagnosed AF or congestive heart failure (CHF). They underwent simultaneous WP and PSG studies in 11 sleep centers. A novel algorithm was developed to detect arrhythmias while measuring PAT and was tested on these patients. Manual scoring of ECG channel (recorded as part of the PSG) was blinded to the automatically analyzed WP data.Results: A total of 84 patients aged 57± 16 (54 males) participated in this study. Their BMI was 30± 5.7Kg/m2. Of them, 41 had heart failure (49%) and 17 (20%) had AF. The sensitivity and specificity of the WP to detect AF segments (of at least 60 seconds) were 0.77 and 0.99, respectively. The correlation between the WP derived detection of premature beats (events/min) to that of the PSG one was 0.98 (p< 0.001).Conclusion: The novel automatic algorithm of the WP can reasonably detect AF and premature beats. We suggest that when the algorithm raises a flag for arrhythmia, the patients should shortly undergo ECG and/or Holter ECG study.Keywords: home sleep apnea test, WatchPAT, obstructive sleep apnea, arrhythmia, atrial fibrillation

Anna Marie Balestra, Katharina Chalk, Claudia Spies, Claudia Denke, Henning Krampe, Sascha Tafelski Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, GermanyCorrespondence: Anna Marie Balestra, Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany, Tel +49 30 450 631 014, Fax +49 30 450 531 904, Email anna-marie.balestra@charite.dePurpose: COVID-19 pandemic containment measures have led to changes in various areas of life, including restrictions on health care. Patients with chronic pain may have faced an increased burden during pandemic and the resources of this vulnerable population are unknown. Therefore, a qualitative study was conducted to understand how people with chronic pain have experienced the course of the pandemic.Patients and Methods: Twenty semi-structured telephone interviews were conducted six months after the initial lockdown in Germany. The participants were patients with chronic pain who exhibited varying changes in their pain during the first German lockdown, recruited from a German outpatient pain clinic at a Department of Anesthesiology and Intensive Care. The semi-structured interview guidelines were designed to explore how patients with chronic pain experienced their pain during the pandemic, how they coped, and how they experienced pain management during this time. The interview recordings were transcribed verbatim and coded using the qualitative content analysis method.Results: Four themes emerged from the results: differential impact on pain experience, difficulty coping with pain, supportive pain management, and endurance.Conclusion: During this uncertain time, it was particularly important to maintain pain treatment in order to establish a sense of safety and stability. This underscores the special role of maintaining therapeutic contact during a pandemic and the potentially special role of telemedicine.Keywords: COVID-19 pandemic, telemedicine, mental distress, coping, chronic pain

Xiaoling Liu,1,2,&ast; Junhua Mai,1,&ast; Chaoyang Meng,1 Aldona J Spiegel,3 Wei Wei,2 Haifa Shen1 1Department of Nanomedicine, Houston Methodist Academic Institute, Houston, TX, 77030, USA; 2Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, People’s Republic of China; 3Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA&ast;These authors contributed equally to this workCorrespondence: Haifa ShenDepartment of Nanomedicine, Houston Methodist Academic Institute, Houston, TX, 77030, USATel +1 713-441-7321Email HaifaShen@gmail.comBackground: Abdominal flaps are routinely performed in clinic after primary mastectomy of breast cancer. However, cancer patients can still develop cancer recurrence and metastasis after surgery. In this study, we evaluated the feasibility of concurrent abdominal flap reconstruction and vaccine inoculation in the tissue for prevention and treatment of HER2-positive breast cancer.Methods: A murine model of metastatic HER2-positive breast cancer was generated by inoculating HER2-expressing TUBO tumor cells into both the mammary gland fat pad and left ventricle. Mammary gland fat pad with primary tumor was resected by mastectomy, and superficial inferior epigastric (SIE) vessel-based abdominal flap was performed for abdominal reconstruction. During the surgery, mice also received a single intra-flap treatment of a microparticulate-based cancer vaccine. Popliteal (Pop) and inguinal (Ing) lymph nodes (LN) were collected at different time points after vaccination, and activation of dendritic cells and T lymphocytes was evaluated with flow cytometry. ELISpot was also performed to measure HER2-specific T cells in splenocytes. In addition, infiltration of CD3+ T cells in brain metastatic nodules was analyzed with immunohistochemistry.Results: Flow cytometry detected increased number of activated dendritic cells in lymph nodes in mice treated with cancer vaccine. ELISpot revealed abundant IFN-γ-expressing T cells in the spleen. Mice treated with abdominal flap-embedded cancer vaccine extended median survival by 9 days over the control group (p< 0.05).Conclusion: Abdominal flap-embedded cancer vaccine effectively stimulated systemic immune response and inhibited tumor progression in a murine model of HER2-positive breast cancer.Keywords: silicon microparticle, cancer vaccine, peddled flap-based reconstruction, breast cancer, HER2

Researchers in Earth and environmental science can extract incredible value from high- resolution (sub-meter, sub-hourly or hyper-spectral) remote sensing data, but these data can be difficult to use. Correct, appropriate and competent use of such data requires skills from remote sensing and the data sciences that are rarely taught together. In practice, many researchers teach themselves how to use high-resolution remote sensing data with ad hoc trial and error processes, often resulting in wasted effort and resources. In order to implement a consistent strategy, we outline ten rules with examples from Earth and environmental science to help academic researchers and professionals in industry work more effectively and competently with high-resolution data.

Konzepte der fachlichen Bildung sind Elemente einer Allgemeinen Fachdidaktik. Die Bedeutung fachlicher Bildung im Bildungsprozess ist bisher nicht eindeutig geklärt. Am Freiburg Advanced Center of Education (FACE) werden aktuell in den Domänen Germanistik, Romanistik und Theologie Lehrprojekte konzipiert, die eine professionsorientierte Fachwissenschaft fokussieren. Professionsorientierte Fachwissenschaft zielt auf den Aufbau eines fachwissenschaftlichen Wissens, das strukturell auf die spätere professionelle Tätigkeit ausgerichtet ist. Der Artikel arbeitet heraus, welchen Beitrag professionsorientierte Fachwissenschaft zum Konzept der fachlichen Bildung leistet, wenn ProFawi fachliche Bildung mit personaler Bildung verbindet.

Arschang Valipour,1 Sergey Avdeev,2 Adam Barczyk,3 Valentina Bayer,4 Zvi Fridlender,5 Mariela Georgieva,6 Ondřej Kudela,7 Alexey Medvedchikov,8 Ramona Miron,9 Maria Sanzharovskaya,8 Virginija Šileikienė,10 Jurij Šorli,11 Marc Spielmanns,12 Zsuzsanna Szalai13 1Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna Health Care Group, Klinik Floridsdorf, Vienna, Austria; 2I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; 3Wydział Nauk Medycznych Śląskiego Uniwersytetu Medycznego, Katowice, Poland; 4Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 5Hadassah-Hebrew University Medical Center, Jerusalem, Israel; 6Medical Center “Sv.ivan Rilski” OOD, Vidin, Bulgaria; 7Department of Pneumology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic; 8Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria; 9Clinical Pneumophtysiology Hospital Iasi, Iasi, Romania; 10Faculty of Medicine, Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania; 11Bolnišnica Topolšica, Topolšica, Slovenia; 12Zürcher RehaZentrum Wald, Wald, Switzerland; 13Petz Aladar County Teaching Hospital, Gyor, HungaryCorrespondence: Arschang ValipourDepartment of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna Health Care Group, Klinik Floridsdorf, Brünner Straße 68, 1210 Vienna, AustriaTel +43 1 277 00-72201Fax +43 1 277 00 99 2208Email arschang.valipour@gesundheitsverbund.atBackground: The Clinical COPD Questionnaire (CCQ) is a simple patient-reported tool to measure clinical control of chronic obstructive pulmonary disease (COPD).Objective: This open-label, single-arm, non-interventional study (NCT03663569) investigated changes in CCQ score during treatment with tiotropium/olodaterol in clinical practice.Methods: Data were included from consenting COPD patients, enrolled in Bulgaria, Czech Republic, Hungary, Israel, Lithuania, Poland, Romania, Russia, Slovenia, Switzerland and Ukraine, who were receiving a new prescription for tiotropium/olodaterol according to the treating physician in a real-world environment. The primary endpoint was the occurrence of therapeutic success, defined as a 0.4-point decrease in CCQ score after treatment with tiotropium/olodaterol for approximately 6 weeks.Results: Overall, 4819 patients were treated; baseline and Week 6 CCQ scores were available for 4700 patients, mostly classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B (51.6%) or D (42.7%). After 6 weeks’ treatment, 81.4% (95% confidence interval [95% CI] 80.24– 82.49) of patients achieved therapeutic success; mean improvement in overall CCQ score was 1.02 points (95% CI 1.00– 1.05). Improved CCQ score was seen in 92.2% of patients (95% CI 91.43– 92.98), 2.5% had no change and 5.3% showed a worsening. When stratified by prior treatment, the greatest benefit was seen in treatment-naïve patients, with 85.7% achieving therapeutic success, compared with 79.5% of those pretreated with long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) and 74.2% of those pretreated with LABA or long-acting muscarinic antagonist (LAMA) monotherapy. Overall, rescue medication decreased by 1.25 puffs/day (95% CI 1.19– 1.31) versus baseline. In total, 29 patients (0.6%) reported drug-related adverse events and 7 patients reported serious adverse events (0.15%).Conclusion: In 4700 COPD patients, 6 weeks’ treatment with tiotropium/olodaterol, as initial treatment or follow-up to LAMA or LABA monotherapy or LABA/ICS, improved CCQ and decreased rescue medication use. The adverse event profile was consistent with the known safety profile of tiotropium/olodaterol.Keywords: tiotropium, olodaterol, COPD, CCQ, Clinical COPD Questionnaire, non-interventional study

The subject of the thesis concerns the application of selected statistical methods searching for outliers in the process of determining the value of real estate, based on a functional model adjusted to market data.

Nick Spindler, Philipp Pieroh, Ulrich Spiegl, Sergey Arakelyan, Johannes Karl Maria Fakler, Christoph-Eckhard Heyde, Stefan Langer Department of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, GermanyCorrespondence: Nick SpindlerDepartment of Orthopedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, GermanyTel +49-341-9717140Fax +49-341-9717139Email nick.spindler@medizin.uni-leipzig.dePurpose: Demographic changes are leading to population aging, and free flap reconstructions for various indications are expected to become increasingly common among older patients. Therefore, this study evaluated free flap reconstruction of the extremities in older patients and compared the outcomes to those from younger patients who underwent similar procedures during the same period.Patients and Methods: This single-center retrospective study used a case-control design to compare older and younger patients who underwent free flap reconstruction of soft tissue defects in the extremities. One-to-one matching was performed for older patients (≥ 65 years) and younger patients (≤ 64 years) according to indication, flap recipient site, and flap type. The parameters of interest were clinico-demographic characteristics, flap type, defect location, indication for free flap reconstruction, number of venous anastomoses, and postoperative complications (flap loss, infection, and wound healing disorders).Results: The study included 48 older patients and 133 younger patients, with a mean follow-up of 12 months after discharge. The free flap reconstruction was performed at a mean interval of 19.8± 22.8 days (range: 0– 88 days). The 1:1 matching created 38 pairs of patients, which revealed no significant differences in the rates of flap necrosis and flap failure.Conclusion: This study failed to detect a significant age-related difference in the flap necrosis rate after free flap reconstruction of extremity defects. Therefore, with careful perioperative management and patient selection, microsurgical free flap reconstruction is a feasible option for older patients.Keywords: older patients, microsurgery, free flap, limb reconstruction

Hydroxychloroquine (HCQ) presents many drug properties that increase its therapeutic use. There are, indeed, different research pathways in numerous autoimmune, inflammatory, and infectious diseases, as well as in cancerology. HCQ is only marketed as HCQ sulfate in film-coated or coated tablets for oral use. No pediatric liquid form is currently available on the market. The purpose of the present study is to develop oral liquid formulations for HCQ at 50 mg/mL with two different oral vehicle suspensions, namely ORA-Plus®/ORA-Sweet® (ORA) and Syrspend® SF PH 4 (SYR).

Background and purpose: Relationship marketing literature acknowledges the important role of attachment in customer-organization relationships, but shows limited theoretical and empirical understanding of the factors that contribute to the development and maintenance of attached customers. To address this gap, this paper draws on the relationship marketing view and synthesizes important relationship constructs with the aim of developing a mediated attachment model for private hospitals in South Africa.

Riva Tauman,1 Murray Berall,2 Richard Berry,3 Tamar Etzioni,4 Noam Shrater,5 Dennis Hwang,6 Ibrahim Marai,7 Prasanth Manthena,8 Anil Rama,9 Rebecca Spiegel,10 Thomas Penzel,11 Nira Koren Morag,12 Giora Pillar4 1Sleep Disorders Center, Tel Aviv Souraski Medical Center, Tel Aviv, Israel; 2Center of Sleep and Chronobiology, Toronto, ON, Canada; 3UF Health Sleep Center, University of Florida, Gainesville, FL, USA; 4Technion Faculty of Medicine, Sleep Laboratory, Carmel Medical Center, Haifa, Israel; 5Cardiology Department, Soroka Medical Center, Be’er Sheva, Israel; 6Kaiser Permanente Fontana Medical Center, Fontana, CA, USA; 7Cardiology Department, Rambam Medical Center, Haifa, Israel; 8Sleep Clinic, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA; 9Kaiser Permanente San Jose Medical Center, San Jose, CA, USA; 10Stony Brook University Hospital, Stony Brook, NY, USA; 11Charite Universitätsmedizin Berlin, Sleep Medicine Center, Berlin, Germany; 12Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelCorrespondence: Riva TaumanSleep Disorders Center, Tel Aviv Souraski Medical Center, 6 Weitzman Street, Tel Aviv 6423906, IsraelTel +972 36974614Fax +1 972 36974634Email tauman@tlvmc.gov.ilBackground: Early diagnosis and treatment of sleep apnea in patients with atrial fibrillation (AF) is critical. The WatchPAT (WP) device was shown to be accurate for the diagnosis of sleep apnea; however, studies using the WatchPAT device have thus far excluded patients with arrhythmias due to the potential effect of arrhythmias on the peripheral arterial tonometry (PAT) amplitude and pulse rate changes.Purpose: To examine the accuracy of the WP in detecting sleep apnea in patients with AF.Patients and Methods: Patients with AF underwent simultaneous WP and PSG studies in 11 sleep centers. PSG scoring was blinded to the automatically analyzed WP data.Results: A total of 101 patients with AF (70 males) were recruited. Forty-six had AF episodes during the overnight sleep study. A significant correlation was found between the PSG-derived AHI and the WP- derived AHI (r=0.80, p< 0.0001). There was a good agreement between PSG-derived AHI and WP-derived AHI (mean difference of AHI: -0.02± 13.2). Using a threshold of AHI ≥ 15 per hour of sleep, the sensitivity and specificity of the WP were 0.88 and 0.63, respectively. The overall accuracy in sleep staging between WP and PSG was 62% with Kappa agreement of 0.42.Conclusion: WP can detect sleep apnea events in patients with AF. AF should not be an exclusion criterion for using the device. This finding may be of even greater importance in the era of the COVID19 epidemic, when sleep labs were closed and most studies were home based.Keywords: home sleep apnea test, WatchPAT, obstructive sleep apnea, atrial fibrillation

Das COACTIV-Modell konzeptualisiert das fachdidaktische Wissen mit drei Facetten: 1. dem Erklärungswissen, 2. dem Wissen über fachbezogene Schülerkognitionen und 3. dem Wissen über fachbezogene Aufgabenstellungen. Anhand eines Unterrichtsdesigns zum Thema „Was meine ich, wenn ich von Auferstehung spreche?“ wurde untersucht, wie das Erklärungswissen im Bereich des Religionsunterrichtes im Kontext der Korrelationsdidaktik zu verstehen ist. Es werden Möglichkeiten entwickelt, Fragen und Vorkonzepte der SchülerInnen als Anknüpfungspunkte für das Erklärungswissen zu nutzen. Durchgeführt wurde das Unterrichtsdesign in der Klasse 9 eines allgemeinbildenden Gymnasiums.

Die Korn- und Stroherträge, der Energie-Input (Kraftstoff, Mineraldünger, Pflanzenschutzmittel, Maschinen) und die Kennzahlen zur Energieeffizienz (Energie-Output, Netto-Energie-Output, Energieintensität, Energienutzungseffizienz) in Abhängigkeit der mineralischen Stickstoffdüngermenge (0 kg, 60 kg, 120 kg und 180 kg N ha−1) und der Düngerstrategie (unterschiedliche Mineraldüngerformen und Gabenteilungen) wurden auf zwei Standorten im Marchfeld (Engelhartstetten und Groß-Enzersdorf) auf Basis von zwei zweijährigen Feldversuchen analysiert. Dabei sollte die Frage beantwortet werden, welche mineralische N-Düngung (N-Form, N-Menge und Splittung der N-Menge) die höchste Energieeffizienz aufweist. Mit zunehmender mineralischer N-Menge (60 kg, 120 kg bzw. 180 kg N ha−1) nahm der energetische Anteil des Mineraldüngers am Gesamtenergie-Input um 24 %, 38 % bzw. 48 % zu. Durch das Gesetz des abnehmenden Ertragszuwachses wurde in Engelhartstetten bei einer N-Düngermenge von 180 kg N ha−1 eine signifikant verringerte Energieeffizienz im Vergleich zu 60 kg N ha−1 und 120 kg N ha−1 festgestellt. Eine Aufteilung der N-Düngermenge auf drei Gaben erhöhte den Kraftstoffverbrauch um 4 % gegenüber einer einmaligen Applikation der gesamten Düngermenge. Die Kennzahlen der Energieeffizienz wurden durch die Gabenteilung kaum beeinflusst. Die N-Düngung mit Kalkammonsalpeter war energieeffizienter als die Harnstoffdüngung (rein, stabilisiert, eingearbeitet). Die Energieeffizienzanalyse kann somit einen wertvollen Beitrag leisten, um pflanzenbauliche Maßnahmen hinsichtlich ihren Umweltauswirkungen zu bewerten.

Martin Luther suggested that God disperses the salvation gained by the sacrifice of Christ both before and after the crucifixion itself. This essay describes how quantum time entanglements can facilitate a timeless dispersal of salvific grace and hypothesizes that it is God who creates, maintains and manipulates space-time using such entanglements, in a way analogous to a spider controlling its web.

Alexander Zargaran,1 Mohammed Adil Turki,2 Jared Bhaskar,3 Harry Victor Michael Spiers,4 David Zargaran3 1King’s College London, Department of Medicine, London, UK; 2St George’s, University of London, Department of Medicine, London, UK; 3Imperial College London, Department of Medicine, London, UK; 4Manchester Royal Infirmary, Department of Medicine, London, UKCorrespondence: David ZargaranImperial College London Email david.zargaran@imperial.ac.ukBackground: This study assesses the scope for using technology to supplement the undergraduate anatomy curriculum at medical school.Methods: A narrative literature review explored the current landscape of anatomy learning. Medical student usage and preferences of technological interventions for anatomy learning were then explored through a cross-sectional survey.Results: The literature review revealed the current teaching strategies for anatomy learning, exploring recent multimedia innovations. The survey demonstrated that technology usage was ubiquitous among medical students with 98% of medical students owning smartphones. Medical education apps were used by 64.3% of medical students, with 61.9% of these apps covering anatomy, and 60.4% of students preferring traditional cadaveric teaching to other technological interventions.Conclusion: Novel technological innovations present the opportunity to deliver accessible and standardised teaching of anatomy to medical students. Many students already use smartphone applications as part of their anatomy learning. Uptake of smartphones and other devices provides opportunities to reach larger target audiences. However, traditional cadaveric teaching remains the learning resource of choice for medical students, and technological interventions are best designed as adjuncts or supplements to cadaveric teaching.Keywords: technology, anatomy, medical education, smartphone

Des initiatives d’approches territorialisées de tout ou partie de la séquence Éviter-Réduire-Compenser (ERC) émergent un peu partout en France. À partir de l’analyse de quatorze de ces initiatives, les auteurs de cet article font le point de leur apport pour la prise en compte des impacts cumulés et l’amélioration de l’efficacité de la séquence ERC. Enfin, les enjeux actuels pour la recherche en écologie sont soulignés.

Since the end of the Cold War, the practice of defence diplomacy has received much attention, as has the proactive prevention of conflict. However, the preventive diplomacy of defence forces – something that is implied in the literature – has been less well articulated. This article addresses the theoretical lacuna by means of a pivotal qualification: the conceptual demarcation is narrowed down to non-coercive defence diplomacy (NCDD). NCDD is based on the principles of transparency, reputation and integrity and, per definition, it eschews violence or the threat thereof. It is therefore an exclusive subset of the wide range of international defence cooperation (generically referred to as ‘defence diplomacy’) in which defence forces engage. When NCDD activities are synchronised with the early stages of conflict development, the escalation of conflict is avoided. This is because NCDD requires of defence forces to conduct their cooperative international relations in a manner that promotes confidence and trust: essential elements of security that are integral to sustainable peace. Within the realm of diplomatic statecraft, the potential agency of defence forces in the prevention of conflict therefore warrants more strategic attention. It is especially required in Africa, where stable peace remains elusive and post-colonial military influence in intra- and inter-state politics has been mostly problematic.

More detailed field measurements are required for a better understanding of surging debris flows. In this work, we analyze a debris flow at the field-scale using timelapse point clouds from a high-resolution, high-frequency 3D LiDAR sensor, which has been installed over a check dam on the fan of the Illgraben catchment in Switzerland. In our investigations, we manually measured the front velocity and tracked individual features such as large boulders and woody debris over a 25 m long channel segment. We observed a change in the front velocity as well as a difference in the velocity of large boulders and woody debris (vboulder ≈ 0.6 vwood) during the second surge of the event. We also estimated the discharge for different closely spaced channel sections based on automated measurements of the cross-sectional area and the surface velocity, which enabled us to infer spatial variations in the bed geometry and the velocity profile. From the discharge estimates, we then derived the volume of this event. Over the course of the next year, the amount of field-scale LiDAR data from the Illgraben will increase substantially and allow for an even more detailed analysis of fundamental debris-flow processes.

In-situ measurements of debris-flow properties are crucial for understanding their movement mechanisms and quantifying their impact. Here we present the first results of a field monitoring campaign, at Illgraben, Switzerland, to measure debris-flow parameters using high temporal (10 Hz) and spatial resolution LiDAR sensors at several locations along the channel. The point cloud data is projected onto video images to enhance visualization and aid in the interpretation of the measurements. We process the data using machine vision and deep learning based algorithms, and show that this system can accurately measure front and flow surface velocity, flow depth and bed elevation change, as well as the size, style of motion (e.g. rotating or floating without rotation) and trajectories of individual particles. This system thus provides a promising new method for inferring the internal dynamics of debris flows.

The aim of this study was to analyse the steam gasification process of ‘Janina’ coal with and without Na-, K- and Ca-catalysts. The catalysts were physically mixed with the coal due to the simplicity of this method, short time of execution and certainty that the amount of catalyst is exactly as the adopted one. The isothermal measurements were performed at 800, 900 and 950°C and a pressure of 1 MPa using thermovolumetric method. The obtained results enabled assessment of the effect of analysed catalysts on the process at various temperatures by determination of: i) carbon conversion degree; ii) yield and composition of the resulting gas; and iii) kinetics of formation reactions of main gas components – CO and H2. The addition of catalysts, as well as an increase in operating temperature, had a positive effect on the coal gasification process – reactions rates increased, and the process time was reduced.

BackgroundA potential benefit of electronic health records (EHRs) is that they could potentially save clinician time and improve documentation by auto-generating the history of present illness (HPI) in partnership with patients prior to the clinic visit. We developed an online patient portal called AEGIS (Automated Evaluation of Gastrointestinal [GI] Symptoms) that systematically collects patient GI symptom information and then transforms the data into a narrative HPI that is available for physicians to review in the EHR prior to seeing the patient. ObjectiveThis study aimed to compare whether use of an online GI symptom history taker called AEGIS improves physician-centric outcomes vs usual care. MethodsWe conducted a pragmatic controlled trial among adults aged ≥18 years scheduled for a new patient visit at 4 GI clinics at an academic medical center. Patients who completed AEGIS were matched with controls in the intervention period who did not complete AEGIS as well as controls who underwent usual care in the pre-intervention period. Of note, the pre-intervention control group was formed as it was not subject to contamination bias, unlike for post-intervention controls. We then compared the following outcomes among groups: (1) documentation of alarm symptoms, (2) documentation of family history of GI malignancy, (3) number of follow-up visits in a 6-month period, (4) number of tests ordered in a 6-month period, and (5) charting time (difference between appointment time and time the encounter was closed). Multivariable regression models were used to adjust for potential confounding. ResultsOf the 774 patients who were invited to complete AEGIS, 116 (15.0%) finished it prior to their visit. The 116 AEGIS patients were then matched with 343 and 102 controls in the pre- and post-intervention periods, respectively. There were no statistically significant differences among the groups for documentation of alarm symptoms and GI cancer family history, number of follow-up visits and ordered tests, or charting time (all P>.05). ConclusionsUse of a validated online HPI-generation portal did not improve physician documentation or reduce workload. Given universal adoption of EHRs, further research examining how to optimally leverage patient portals for improving outcomes are needed.

BackgroundThe evidence base for internet-based cognitive behavioral therapy for insomnia (iCBT-I) is firm; however, little is known about iCBT-I’s health-economic effects. ObjectiveThis study aimed to evaluate the cost-effectiveness and cost–utility of iCBT-I in reducing insomnia among schoolteachers. MethodsSchoolteachers (N=128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided iCBT-I or a wait list control group, both with unrestricted access to treatment as usual. Health care use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and a public health care perspective. Costs were related to symptom-free status (score

BackgroundAs one of the most essential technical components of the intensive care unit (ICU), continuous monitoring of patients’ vital parameters has significantly improved patient safety by alerting staff through an alarm when a parameter deviates from the normal range. However, the vast number of alarms regularly overwhelms staff and may induce alarm fatigue, a condition recently exacerbated by COVID-19 and potentially endangering patients. ObjectiveThis study focused on providing a complete and repeatable analysis of the alarm data of an ICU’s patient monitoring system. We aimed to develop do-it-yourself (DIY) instructions for technically versed ICU staff to analyze their monitoring data themselves, which is an essential element for developing efficient and effective alarm optimization strategies. MethodsThis observational study was conducted using alarm log data extracted from the patient monitoring system of a 21-bed surgical ICU in 2019. DIY instructions were iteratively developed in informal interdisciplinary team meetings. The data analysis was grounded in a framework consisting of 5 dimensions, each with specific metrics: alarm load (eg, alarms per bed per day, alarm flood conditions, alarm per device and per criticality), avoidable alarms, (eg, the number of technical alarms), responsiveness and alarm handling (eg alarm duration), sensing (eg, usage of the alarm pause function), and exposure (eg, alarms per room type). Results were visualized using the R package ggplot2 to provide detailed insights into the ICU’s alarm situation. ResultsWe developed 6 DIY instructions that should be followed iteratively step by step. Alarm load metrics should be (re)defined before alarm log data are collected and analyzed. Intuitive visualizations of the alarm metrics should be created next and presented to staff in order to help identify patterns in the alarm data for designing and implementing effective alarm management interventions. We provide the script we used for the data preparation and an R-Markdown file to create comprehensive alarm reports. The alarm load in the respective ICU was quantified by 152.5 (SD 42.2) alarms per bed per day on average and alarm flood conditions with, on average, 69.55 (SD 31.12) per day that both occurred mostly in the morning shifts. Most alarms were issued by the ventilator, invasive blood pressure device, and electrocardiogram (ie, high and low blood pressure, high respiratory rate, low heart rate). The exposure to alarms per bed per day was higher in single rooms (26%, mean 172.9/137.2 alarms per day per bed). ConclusionsAnalyzing ICU alarm log data provides valuable insights into the current alarm situation. Our results call for alarm management interventions that effectively reduce the number of alarms in order to ensure patient safety and ICU staff’s work satisfaction. We hope our DIY instructions encourage others to follow suit in analyzing and publishing their ICU alarm data.

Objective: The positioning and training of communicative and social competencies to improve interprofessional cooperation is and will be a challenge for educational institutions. The aim of this project was to reorient the interprofessional training elements of bachelor programs in terms of both content and structure, to improve the legally required practical relevance and to aim for a sustainable anchoring through the targeted design of the development process. WIPAKO facilitates the acquisition of communicative and social competencies as a prerequisite for cooperation between the health and medical professions.Methodology: Once suitable process structures had been created, an interprofessional committee of experts defined the training elements (competencies, content, learning and teaching methods, learning objective review and evaluation) in an iterative consensus process based on various framework models and on the involvement of the various stakeholders in the individual study programs.Results: A training concept focusing on communicative and social competencies for interprofessional cooperation is available. The consistent interprofessional development of the concept promoted joint responsibility for training in the sense of an organizational development process.Conclusion: The outlined procedure for the conceptualization and implementation of a corresponding framework model and the framework model itself provide the basis for the empirical examination of competence acquisition and the sustainable anchoring of interprofessional training elements. This will provide suggestions for other educational institutions facing similar challenges.

BackgroundThe COVID-19 pandemic triggered countermeasures like #StayAtHome initiatives, which have changed the whole world. Despite the success of such initiatives in limiting the spread of COVID-19 to #FlattenTheCurve, physicians are now confronted with the adverse effects of the current restrictive pandemic management strategies and social distancing measures. ObjectiveWe aim to draw attention to the particular importance and magnitude of what may be the adverse effects of COVID-19–related policies. MethodsWe herein report a case of an otherwise healthy 84-year-old woman with deep vein thrombosis (DVT) due to COVID-19–related directives. #StayAtHome policies and consequential social isolation have diminished our patient’s social life and reduced her healthy movement behaviors. The patient spent long hours in a seated position while focusing on the intensive flow of media information regarding the pandemic. ResultsReduced mobility due to preventive social isolation during the COVID-19 pandemic was the only identified cause of the DVT. ConclusionsWhile evaluating the effect of the COVID-19 pandemic and governmentally implemented containment measures, including social isolation and mobility reduction, adverse events should be considered. Digital approaches might play a crucial role in supporting public health.

Background. Pedicle screw fixation in the cervical spine provides biomechanical advantages compared to other stabilization techniques. However, pedicle screw insertion in this area is challenging due to the anatomical conditions with a high risk of breaching the small pedicles and violating the vertebral artery or neural structures. Today, several techniques to facilitate screw insertion and to make the procedure safer are used. 3-D-printed patient-matched guides based on a CT reconstruction are a helpful technique which allows to reduce operation time and to improve the safety of pedicle screw insertion at the cervical spine. Cases. 3-D-printed patient-matched drill guides based on a CT scan with a 3-D reconstruction of the spine were used in two challenging cervical spine surgical tumor cases to facilitate the implantation of the pedicle screws. The screw position was controlled postoperatively by means of the routinely performed CT scan. Results. Postoperative imaging (conventional radiographs and CT scan) revealed the correct position of the pedicle screws. The time needed for screw insertion was short, and the need for intraoperative fluoroscopy could be reduced. There was no intra- or postoperative complication related to the pedicle screw implantation. Both tumors could be removed completely. Conclusion. These preliminary results show that 3-D-printed patient-specific guides are a promising tool to support and facilitate the implantation of cervical pedicle screws. The time needed for insertion is short, and intraoperative fluoroscopy time can be reduced. This technique allows for both a meticulous preoperative planning and a correct and therefore safe intraoperative positioning of cervical spine pedicle screws.

BackgroundCollectively, an estimated 5% of the population have a genetic disease. Many of them feature characteristics that can be detected by facial phenotyping. Face2Gene CLINIC is an online app for facial phenotyping of patients with genetic syndromes. DeepGestalt, the neural network driving Face2Gene, automatically prioritizes syndrome suggestions based on ordinary patient photographs, potentially improving the diagnostic process. Hitherto, studies on DeepGestalt’s quality highlighted its sensitivity in syndromic patients. However, determining the accuracy of a diagnostic methodology also requires testing of negative controls. ObjectiveThe aim of this study was to evaluate DeepGestalt's accuracy with photos of individuals with and without a genetic syndrome. Moreover, we aimed to propose a machine learning–based framework for the automated differentiation of DeepGestalt’s output on such images. MethodsFrontal facial images of individuals with a diagnosis of a genetic syndrome (established clinically or molecularly) from a convenience sample were reanalyzed. Each photo was matched by age, sex, and ethnicity to a picture featuring an individual without a genetic syndrome. Absence of a facial gestalt suggestive of a genetic syndrome was determined by physicians working in medical genetics. Photos were selected from online reports or were taken by us for the purpose of this study. Facial phenotype was analyzed by DeepGestalt version 19.1.7, accessed via Face2Gene CLINIC. Furthermore, we designed linear support vector machines (SVMs) using Python 3.7 to automatically differentiate between the 2 classes of photographs based on DeepGestalt's result lists. ResultsWe included photos of 323 patients diagnosed with 17 different genetic syndromes and matched those with an equal number of facial images without a genetic syndrome, analyzing a total of 646 pictures. We confirm DeepGestalt’s high sensitivity (top 10 sensitivity: 295/323, 91%). DeepGestalt’s syndrome suggestions in individuals without a craniofacially dysmorphic syndrome followed a nonrandom distribution. A total of 17 syndromes appeared in the top 30 suggestions of more than 50% of nondysmorphic images. DeepGestalt’s top scores differed between the syndromic and control images (area under the receiver operating characteristic [AUROC] curve 0.72, 95% CI 0.68-0.76; P

BackgroundImportant knowledge gaps have been identified related to the causes and symptoms of inflammatory bowel disease (IBD) and medical treatments and their side effects. Patients with IBD turn to social media to learn more about their disease. However, such information found on the web is misleading and often of low quality. ObjectiveThis study aims to gain an in-depth understanding of the unmet educational needs of patients with IBD and to use the resulting insights to develop a collection of freely available, evidence-based educational videos optimized for dissemination through social media. MethodsWe used design thinking, a human-centered approach, to guide our qualitative research methodology. We performed focus groups and interviews with a diverse sample of 29 patients with IBD. Data collection was performed in 3 phases (inspiration, ideation, and implementation) based on IDEO design thinking. Phase 1 offered insights into the needs of patients with IBD, whereas phases 2 and 3 involved ideation, prototyping, and video testing. A thematic analysis was performed to analyze the resulting data. ResultsPatients emphasized the need for educational videos that address their challenges, needs, and expectations. From the data analysis, 5 video topics and their content emerged: IBD treatments’ risks and benefits; how to be a self-advocate; how to stay healthy with IBD; how to cope with IBD; and educating families, friends, and colleagues about experiences of patients with IBD. ConclusionsDesign thinking offers a deep understanding and recognition of the unmet educational needs of patients with IBD; this approach informed the development of 5 evidence-based educational videos. Future research will formally test and disseminate these freely available videos through social media.

BackgroundJuvenile idiopathic arthritis (JIA) is a serious and potentially debilitating pediatric illness. Improved disease self-management may help to improve health outcomes. ObjectiveThis study aimed to evaluate the effectiveness of the Teens Taking Charge Web-based self-management intervention in reducing symptoms and improving health-related quality of life (HRQL) in adolescents with JIA compared with a Web-based education control condition. MethodsAdolescents with JIA aged 12 to 18 years were recruited from 11 Canadian pediatric rheumatology centers. Caregivers were invited to participate along with their child. In addition to standard medical care, participants were randomized to receive either (1) the Teens Taking Charge self-management intervention or (2) a Web-based education control condition for a period of 12 weeks. Adolescents in the intervention group completed website modules addressing cognitive behavioral coping skills, stress management, and other self-management topics, while also receiving monthly telephone calls from a trained health coach. Adolescents in the education control group were instructed to view a series of preselected public JIA educational websites and received monthly calls from a coach who asked about their own best efforts at managing JIA. Caregivers in the intervention group completed website modules related to promoting independence and disease self-management in their child. Caregivers in the education control group were instructed to view a series of preselected public JIA educational websites. Outcome assessment occurred at baseline, 12 weeks (posttreatment), and at 6 and 12 months postrandomization. The primary outcomes were pain intensity, pain interference, and HRQL. Secondary outcomes were emotional symptoms, adherence, coping, knowledge, and self-efficacy. ResultsIn total, 333 adolescents and 306 caregivers were enrolled. Significant overall reductions in pain intensity (P=.02) and pain interference (P=.007) were observed for intervention group participants compared with those in the education control group, after adjusting for baseline levels. There was a significant overall improvement in HRQL related to problems with pain (P=.02) and problems with daily activities (P=.01). There was also a significant difference in the intervention group over time (P=.008) for HRQL related to treatment problems, with the intervention group participants demonstrating improved HRQL by 12 months compared with education control group participants. Both groups showed nonsignificant improvements compared with baseline in other primary outcomes. There were no significant differences between the groups in any secondary outcomes or caregiver-reported outcomes. ConclusionsThe results of this randomized trial suggest that the Teens Taking Charge Web-based intervention is effective at reducing both pain intensity and pain interference, as well as improving HRQL in adolescents with JIA, compared with education control. These effects are sustained for up to 12 months following program completion. The Teens Taking Charge program is now publicly available at no cost. Trial RegistrationClinicalTrials.gov NCT01572896; https://clinicaltrials.gov/ct2/show/NCT01572896

BackgroundText message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited. ObjectiveThe aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement. MethodsWe recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency. ResultsThe participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income

BackgroundDue to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development. ObjectiveThis study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups. MethodsThis survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups. ResultsIn total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring. ConclusionsThis survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. Trial RegistrationClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

Objective: Age-related disorders, such as dementia, significantly contribute to the global burden of disease. Adequate screening in the primary care setting is critical for early detection and proper management. The Addenbrooke’s Cognitive Examination III (ACE-III) is an open-source neuropsychological test with superior diagnostic quality in comparison to the Mini-Mental State Examination (MMSE). Our aim was to perform a guideline-conform English-German translation and cultural adaptation of the ACE-III in order to enable implementation in German-speaking countries.Methods: The translation and cultural adaptation were performed in accordance with the “Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures” from the International Society for Pharmacoeconomics and Outcome Research (ISPOR) (Wild et al. 2005). Four separate English-German translations were compiled into one German consensus translation, which was then translated back into English and compared to the original English version. After comparison, the German consensus translation was revised with emphasis on the identified differences between the English original version and the English translated version. This revised German consensus translation was subsequently evaluated for clinical applicability on a 5-point scale (0 – not applicable; 5 – applicable without any restrictions) by 20 practitioners experienced in the field of neuropsychological testing, using an anonymized, paper-based 22-item survey.Results: Nineteen of the 20 practitioners (95.0%) rated the German ACE-III translation as overall applicable. The median rating was 4.0 [IQ4.0/5.0)]. When evaluating survey items assessing the appliclity of the individual 19 subtests of the ACE-III, all of them (100%) were rated as applicable with a median rating of 4.5 [IQR (4.1/4.9)].Conclusion: The German ACE-III translation in its current form is generally applicable and can be utilized for clinical and scientific purposes.

Organisé le 15 décembre 2020, le colloque « Sites naturels de compensation : quels freins et perspectives ? » a fait le point des opportunités et des écueils rencontrés lors de la mise en œuvre, en France et à l’étranger, de dispositifs de compensation par l’offre. Vous trouverez dans ce numéro de la revue Sciences Eaux Territoires la valorisation des présentations de scientifiques et d’acteurs impliqués dans des projets de sites naturels de compensation.

In March 2019 the HADES experiment recorded 14 billion Ag+Ag collisions at √sNN = 2.55 GeV as a part of the FAIR phase-0 physics program. In this contribution, we present and investigate our capabilities to reconstruct and analyze weakly decaying strange hadrons and hypernuclei emerging from these collisions. The focus is put on measuring the mean lifetimes of these particles.