Characterization data of reference materials used for phase II of the priority program DFG SPP 2005 "Opus Fluidum Futurum - Rheology of reactive, multiscale, multiphase construction materials"

A thorough characterization of base materials is the prerequisite for further research. In this paper, the characterization data of the reference materials (CEM I 42.5 R, limestone powder, calcined clay and a mixture of these three components) used in the second funding phase of the priority program 2005 of the German Research Foundation (DFG SPP 2005) are presented under the aspects of chemical and mineralogical composition as well as physical and chemical properties. The data were collected based on tests performed by up to eleven research groups involved in this cooperative program.

The vision of Dutch paediatric care until the year 2030: prevention and collaboration as key ingredients

There are many societal developments in The Netherlands that have or will have an impact on Dutch paediatric care. These developments both reveal potential risks in paediatric care and require future improvement of paediatric practices to achieve the best possible outcomes for Dutch children. To realise this, the Dutch Paediatric Society decided in their renewed vision to have a closer focus on prevention and on building partnership with public health, by implementing a building block ‘Interprofessional Collaboration between Paediatricians and Other Health Care Providers’. This building block formulates the wish of the Dutch Paediatric Society to work together in networks with other domains of care, such as public health. Preferably, it will be a flexible network in which the disciplines involved align the needs of the specific child. In order to develop and participate in such a network, pediatricians and public health professionals actively have to invest in connecting, establishing, and further developing professional networks (including patient societies). A first precondition for the development and successful functioning of such a network is the implementation and use of a joint electronic medical record in which all diagnostics, treatment plans and positive health aspects of the child are collected, and which is accessible to all professionals involved. A patient record which guarantees a barrier-free exchange of medical and non-medical information between paediatricians and public health professionals within the framework of the current privacy legislation. A second precondition regards an improvement of the paediatric training curriculum in which the paediatrician of the future will gain knowledge of positive health and integrative medicine. The future paediatrician must be trained to function in networks and to make connections. In this presentation we present an update of the implementation of this building block: what is already realised and how.

Exploratory application of machine learning methods on patient reported data in the development of supervised models for predicting outcomes

BACKGROUND

Patient-reported outcome measurements (PROMs) are commonly used in clinical practice to support clinical decision making. However, few studies have investigated machine learning methods for predicting PROMs outcomes and thereby support clinical decision making.

OBJECTIVE

This study investigates to what extent different machine learning methods, applied to two different PROMs datasets, can predict outcomes among patients with non-specific neck and/or low back pain.

METHODS

Using two datasets consisting of PROMs from (1) care-seeking low back pain patients in primary care who participated in a randomized controlled trial, and (2) patients with neck and/or low back pain referred to multidisciplinary biopsychosocial rehabilitation, we present data science methods for data prepossessing and evaluate selected regression and classification methods for predicting patient outcomes.

RESULTS

The results show that there is a potential for machine learning to predict and classify PROMs. The prediction models based on baseline measurements perform well, and the number of predictors can be reduced, which is an advantage for implementation in decision support scenarios. The classification task shows that the dataset does not contain all necessary predictors for the care type classification. Overall, the work presents generalizable machine learning pipelines that can be adapted to other PROMs datasets.

CONCLUSION

This study demonstrates the potential of PROMs in predicting short-term patient outcomes. Our results indicate that machine learning methods can be used to exploit the predictive value of PROMs and thereby support clinical decision making, given that the PROMs hold enough predictive power.

Real-time non-adiabatic dynamics in the one-dimensional Holstein model: Trajectory-based vs exact methods

We benchmark a set of quantum-chemistry methods, including multitrajectory Ehrenfest, fewest-switches surface-hopping, and multiconfigurational-Ehrenfest dynamics, against exact quantum-many-body techniques by studying real-time dynamics in the Holstein model. This is a paradigmatic model in condensed matter theory incorporating a local coupling of electrons to Einstein phonons. For the two-site and three-site Holstein model, we discuss the exact and quantum-chemistry methods in terms of the Born-Huang formalism, covering different initial states, which either start on a single Born-Oppenheimer surface, or with the electron localized to a single site. For extended systems with up to 51 sites, we address both the physics of single Holstein polarons and the dynamics of charge-density waves at finite electron densities. For these extended systems, we compare the quantum-chemistry methods to exact dynamics obtained from time-dependent density matrix renormalization group calculations with local basis optimization (DMRG-LBO). We observe that the multitrajectory Ehrenfest method, in general, only captures the ultrashort time dynamics accurately. In contrast, the surface-hopping method with suitable corrections provides a much better description of the long-time behavior but struggles with the short-time description of coherences between different Born-Oppenheimer states. We show that the multiconfigurational Ehrenfest method yields a significant improvement over the multitrajectory Ehrenfest method and can be converged to the exact results in small systems with moderate computational efforts. We further observe that for extended systems, this convergence is slower with respect to the number of configurations. Our benchmark study demonstrates that DMRG-LBO is a useful tool for assessing the quality of the quantum-chemistry methods.

Factors used by general practitioners for referring patients with chronic musculoskeletal pain: a qualitative study

Around 20% of the Dutch population is living with chronic musculoskeletal pain (CMP), which is a complex and multifactorial problem. This complexity makes it hard to define a classification system, which results in non-satisfactory referring from the general practitioner (GP). CMP is often explained using the biopsychosocial model in which biological, psychological and social factors cause and maintain the pain. The presented study investigated the factors related to the GPs' referral for patients with CMP to further treatment.Using convenience sampling, semi-structured interviews and a focus group were conducted among 14 GPs. The interviews were iteratively analyzed using inductive conventional content analysis.Analysis of the interviews demonstrated that there were 28 referral factors that were mentioned by more than 50% of the interviewed GPs. The results showed that the GPs were mostly focussing on the physical (e.g. pain location) and psychological (e.g. acceptation of pain) factors, indicating that they lack focus on the social factors. Furthermore, unfamiliarity of GPs with treatment options was a noteworthy finding.The referral of patients with CMP by GPs is complex and based on multiple factors. To improve referral, it is recommended to include social factors in the decision-making process and to increase the familiarity of the GPs with available treatments.

Organisational barriers to accessing vaccination services: a literature overview focusing on underserved populations in Europe

Background

Immunization and equitable access to immunization are core components of the right to health (WHO). Although more and more children in the WHO European Region are being vaccinated against measles than ever before, coverage gaps even persist within countries. As a result, specific, underserved populations are left unprotected, resulting in a record number of these populations affected by the virus in 2018. Aim of this presentation is 1) to explore barriers that underserved populations might encounter and 2) share good examples of organisation of vaccination services for underserved populations.

Methods

Literature searches have been conducted in a variety of databases, using different search terms. Published studies in English that explores 1) barriers in the organization of care; 2) successful interventions related to the organization of care, in (expected) low vaccination uptake populations will be included. The databases will extend beyond the medical literature to include social science literature. The literature search included peer reviewed international academic literature and government reports dating from 2010 to 2019.

Results

In this presentation the results of the literature review will be presented: what barriers in the organization of care are experienced by populations that have low vaccination uptake? And what evidence does the literature present concerning the organisation of care that lead to a sufficient to high uptake of vaccination in populations where you would not expect this?

Conclusions

the results of the literature review will provide a useful and valuable overview of barriers and facilitators of accessing vaccination services of (expected) low uptake populations in Europe. Since access, as a key dimension of organisation of care, is still the main factor hindering vaccine uptake it is important to learn lessons not only from poor practices but also from good practices.

Characterization data of reference cement CEM III/A 42.5N used for priority program DFG SPP 2005 "Opus Fluidum Futurum - Rheology of reactive, multiscale, multiphase construction materials"

Two types of cements were selected as the reference cement in the priority program 2005 of the German Research Foundation (DFG SPP 2005). A thorough characterization of CEM I 42.5 R has been made in a recent publication [1]. In this paper, the characterization data of the other reference cement CEM III/A 42.5 N are presented from the aspects of chemical and mineralogical compositions as well as physical and chemical properties. The characterization data of the slag, which is the second main constituent of this specific cement besides the clinker, are presented independently. For all data received, the mean values and the corresponding errors were calculated. The data shall be used for the ongoing research within the priority program. Also, researchers from outside this priority program can benefit from these data if the same materials are used.

Characterization data of reference cement CEM I 42.5 R used for priority program DFG SPP 2005 "Opus Fluidum Futurum - Rheology of reactive, multiscale, multiphase construction materials"

A thorough characterization of starting materials is the precondition for further research, especially for cement, which contains various phases and presents quite a complex material for fundamental scientific investigation. In the paper at hand, the characterization data of the reference cement CEM I 42.5 R used within the priority program 2005 of the German Research Foundation (DFG SPP 2005) are presented from the aspects of chemical and mineralogical compositions as well as physical and chemical properties. The data were collected based on tests conducted by nine research groups involved in this cooperative program. For all data received, the mean values and the corresponding errors were calculated. The results shall be used for the ongoing research within the priority program.

Revisiting breast masses with the plastic surgeon: suggestions for biopsy and resection

Between 250,000 and 500,000 breast mass biopsies are performed each year. This is a common procedure of the breast that should be planned such that maximum treatment is achieved with minimal disfigurement and scarring. Plastic surgery techniques must be used in the choice of biopsy site and planned excision and can result in an improved cosmetic result for the patient. Subareolar masses are resected using a radial elliptical incision. Lateral and medial masses are resected using the Wise pattern reduction mammaplasty whereas the vertical mammaplasty is used for lesions of the central inferior breast and inframammary fold. Awareness of these basic reconstructive principles by the general surgeon can minimize disfigurement and facilitate future reconstruction by the plastic surgeon so that both cure and cosmesis can be achieved.

Cloning and characterization of a novel Kruppel-associated box family transcriptional repressor that interacts with the retinoblastoma gene product, RB

The retinoblastoma gene product, RB, seems to function as a key tumor suppressor by repressing the expression of genes activated by members of the E2F family of transcription factors. In order to accomplish this, RB has been proposed to interact with a transcriptional repressor. However, no genuine transcriptional repressors have been identified by virtue of interaction with RB. By using the yeast two-hybrid system, we have identified a novel member of a known family of transcriptional repressors that contain zinc fingers of the Kruppel type and a portable transcriptional repressor motif known as the Kruppel-associated box (KRAB). The mouse and human forms of the novel RB-associated KRAB protein (RBaK) are widely expressed. The amino acid motif that links the KRAB domain and zinc fingers appears to be required for interaction with RB in vitro. Human RBaK ectopically expressed in fibroblasts is an 80-kDa protein that is localized to the nucleus. The expression of either RB or RBaK in 10T1/2 fibroblasts represses the activation of an E2F-dependent promoter and decreases DNA synthesis to a similar degree. However, a mutant form of RBaK that cannot interact with RB in vitro is unable to prevent DNA synthesis. We present a model in which RB physically interacts with the novel transcriptional repressor RBaK to repress E2F-dependent genes and prevent DNA synthesis.

Marked impairment of protein tyrosine phosphatase 1B activity in adipose tissue of obese subjects with and without type 2 diabetes mellitus

Protein tyrosine phosphatases (PTPs) are required for the dephosphorylation of the insulin receptor (IR) and its initial cellular substrates, and it has recently been reported that PTP-1B may play a role in the pathogenesis of insulin resistance in obesity and type 2 diabetes mellitus (DM). We therefore determined the amount and activity of PTP-1B in abdominal adipose tissue obtained from lean nondiabetic subjects (lean control (LC)), obese nondiabetic subjects (obese control (OC)), and subjects with both type 2 DM (DM2) and obesity (obese diabetic (OD)). PTP-1B protein levels were 3-fold higher in OC than in LC (1444 +/- 195 U vs 500 +/- 146 U (mean +/- SEM), P < .015), while OD exhibited a 5.5-fold increase (2728 +/- 286 U, P < .01). PTP activity was assayed by measuring the dephosphorylating activity toward a phosphorus 32-labeled synthetic dodecapeptide. In contrast to the increased PTP-1B protein levels, PTP-1B activity per unit of PTP-1B protein was markedly reduced, by 71% and 88% in OC and OD, respectively. Non-PTP-1B tyrosine phosphatase activity was comparable in all three groups. Similar results were obtained when PTP-1B activity was measured against intact human IR. A significant correlation was found between body mass index (BMI) and PTP-1B level (r = 0.672, P < .02), whereas BMI and PTP-1B activity per unit of PTP-1B showed a strong inverse correlation (r = -0.801, P < .002). These data suggest that the insulin resistance of obesity and DM2 is characterized by the increased expression of a catalytically impaired PTP-1B in adipose tissue and that impaired PTP-1B activity may be pathogenic for insulin resistance in these conditions.

Type VI collagen is associated with microfibrils and oxytalan fibers in the extracellular matrix of periodontium, mesenterium and periosteum

Type VI collagen was immunolocalized in several soft connective tissues at the light and electron microscopic level. Positive labeling was found in all tissues examined, periodontal ligament, gingiva, mesenterium and periosteum. The labeled structures could be divided into 2 categories: microfibrils intermingling with collagen fibrils, and those that formed bundles (oxytalan fibres and elastin-associated microfibrils). Control sections incubated with antibody preabsorbed to purified type VI collagen, or with non-immune antibody, proved to be negative. Our observations indicate that the structural organization of type VI collagen varies from small microfibrillar structures associated with the collagen and elastin fibre systems to highly ordered parallel arrays of oxytalan bundles.

Air-coupled Lamb wave tomography

An entirely air-coupled inspection system using a pair of micromachined silicon capacitance transducers has been used to image defects in thin plates of different materials (0.7 mm to 2.22 mm thick) using air-coupled Lamb wave tomography. A filtered back projection algorithm was used in a form of difference tomography to reconstruct images of defects up to 10 mm diameter machined in aluminium and perspex (Plexiglas) plates, as well as in samples of carbon fiber reinforced polymer (CFRP). The technique was able to resolve non-central defects as well as multiple flaws within the scan area. This flexible tomographic system was able to produce images of the change in a variety of different acoustic variables from only one set of experimental data, with success dependent on the size, shape, and location of the defect in the scan area.

[The monorail system--bone segment transport over unreamed interlocking nails]

A treatment protocol is demonstrated, consisting of an osteotomy, either proximal or distal, of the bone defect with subsequent segmental transport via an anteromedially (tibia) or laterally (femur) mounted AO external fixation over an unreamed interlocking nail (monorail system). Twenty patients were treated by this method with indications as follows: 13 had a segmental bone defect of the tibia, 3 of the femur. Three patients showed post-traumatic and postinfectious leg-length discrepancies and one was treated for hypertrophic non-union of the femur. Defect distance varied between 5 and 18.5 cm and average time for transport was 19,42 days/ cm for the tibial shaft, 15,93 days/cm for the femur. Two patients developed deep infection, which required change of treatment, removing the monorail system and application of an Ilizarov apparatus. Despite complications using the monorail system, all patients healed and no amputations were required. The monorail system can be used as an alternative to the Ilizarov method under certain criteria of patient selection; these criteria are shown by an algorithm for segmental bone defects without infection, respecting the soft-tissue status with or without neurovascular compromise.

The impact of a clinical nurse's role on CVC infections and bacteremia: a two year comparative, retrospective study

The purpose of this study was to compare the central venous catheter (CVC) tip infection rate among patients in general wards for the 12 months prior to, and during, the appointment of a TPN clinical nurse at the 500 bed Gold Coast Hospital, Southport, Queensland. These data could then be utilized to assess the benefits of a TPN clinical nurse dedicated to the care of CVCs on the central line infection rate. A comparative retrospective study of 542 CVC tips cultured and analysis of positive blood cultures growing the same organisms was carried out over a two year period. The incidence of CVC tip infections over the study period showed a significant reduction from 37% in the year prior to the appointment of the TPN clinical nurse, to 16% during the first year of appointment. The incidence of bacteremia from all positive CVC tips cultured also decreased from 7.1% to 3.3% respectively.

Laser thermal ablation

Continuous wave and pulsed laser ablation of tissue is described as an explosive event. A subsurface temperature maximum and superheated tissue produce high pressures that eject fragments from the tissue. Decreased water content due to dehydration and vaporization decreases thermal conductivity which reduces heat conduction. Also, a decrease in water content dramatically alters the local rate of heat generation of laser radiation above 1.3 microns since water is the primary absorber. In contrast, at UV wavelengths protein and DNA are the primary absorbers so destruction of tissue bonds is due to direct absorption of the laser light rather than heat transfer from water.