The European Grief Conference, Copenhagen 2022: An effort to unite the field of bereavement care in Europe

Bereavement care in Europe varies in quality and availability. Through greater collaboration across Europe, there could potentially be an opportunity to improve care. This article discusses the inaugural European Grief Conference held in Denmark in 2022: "Bereavement and Grief in Europe - Emerging Perspectives & Collaborations". The conference was structured around a 4-tiered public health model of bereavement care needs. It included practice, research, policy, and educational perspectives. A total of 250 people from 27 different countries participated. To determine if the conference had appealed to a broad European audience of grief professionals and to assess how the conference was received by participants, we examined registration/submission data, the results of a one-word real-time feedback exercise, and the answers to an online satisfaction survey. The results indicated wide interest in greater information sharing and collaboration across Europe among bereavement care, research, and education professionals.

Impact of individualized treatment on recovery from fatigue and return to work in survivors of advanced-stage Hodgkin's lymphoma: results from the randomized international GHSG HD18 trial

BACKGROUND

Persisting cancer-related fatigue impairs health-related quality of life (HRQoL) and social reintegration in patients with Hodgkin's lymphoma (HL). The GHSG HD18 trial established treatment de-escalation for advanced-stage HL guided by positron emission tomography after two cycles (PET-2) as new standard. Here, we investigate the impact of treatment de-escalation on long-term HRQoL, time to recovery from fatigue (TTR-F), and time to return to work (TTR-W).

PATIENTS AND METHODS

Patients received European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and life situation questionnaires at baseline, interim, end of treatment, and yearly follow-up. TTR-F was defined as time from the end of chemotherapy until the first fatigue score <30. TTR-W was analyzed in previously working or studying patients and measured from the end of treatment until the first documented work or education. We compared duration of treatment on TTR-F and TTR-W using Cox proportional hazards regression adjusted for confounding variables.

RESULTS

HRQoL questionnaires at baseline were available in 1632 (83.9%) of all randomized patients. Overall, higher baseline fatigue and age were significantly associated with longer TTR-F and TTR-W and male sex with shorter TTR-W. Treatment reduction from eight to four chemotherapy cycles led to a significantly shorter TTR-F [hazard ratio (HR) 1.41, P = 0.008] and descriptively shorter TTR-W (HR 1.24, P = 0.084) in PET-2-negative patients. Reduction from six to four cycles led to non-significant but plausible intermediate accelerations. The addition of rituximab caused significantly slower TTR-F (HR 0.70, P = 0.0163) and TTR-W (HR 0.64, P = 0.0017) in PET-2-positive patients. HRQoL at baseline and age were the main determinants of 2-year HRQoL.

CONCLUSIONS

Individualized first-line treatment in patients with advanced-stage HL considerably shortens TTR-F and TTR-W in PET-2-negative patients. Our results support the use of response-adapted shortened treatment duration for patients with HL.

Design strategies to influence health behaviour and mental wellbeing in the urban setting

The design of objects, spaces and systems can have a profound influence on the behaviours as well as emotional and cognitive states of the people confronted with it. With regards to health behaviour, elaborating on Schwarzer's HAPA model (1992), the Design Model for Health Behaviour Change - DMHBC (Rehn, 2018) proposes the use of the built environment to act as situative barriers or opportunities to change health behaviours and overall health promoting mindsets. Regarding urban space and mental health, most environmental stimuli and related behavioural patterns focus on consumption (e.g. retail stores) or daily routines (e.g. commuting). Using objects such as specifically designed furniture, installations and other elements to act as perceived affordances and stimuli can affect both cognitive-emotional states as well as specific behavioural responses. For instance, based on the research on mindfulness, drawing people's attention towards their own bodily sensations (e.g. breath) by playful interactive installations or information signs can increase feelings of calm, appreciation and contentment. The same applies to design interventions that guide one's view towards otherwise overlooked urban features (e.g. natural scenery). While mindfulness and relaxation are powerful techniques for increasing mental health, many other approaches (such as physical activity, social interactions etc.) can be found to have similar benefits. In fact, the orchestrated combination of various forms of stimuli might prove to be more effective than the sum of the individual interventions as they create a subsequent chain of stimuli that form a coherent experience. This approach poses particular potentials to foster mental health in vulnerable groups that usually suffer most from urban environmental risk factors. Thus, providing public and open access stimuli and affordances in this way, can have a significant effect on overall urban public health and reduce social inequalities at the same time.

Risk factors and potentials for fostering mental health and wellbeing in urban space

People shape their physical environments - and vice versa. As such, cities provide both resources (e.g., job opportunities, cultural diversity) as well as stressors (e.g., crowding, noise pollution) to their residents and visitors. In this context, numerous studies illustrate a considerable influence of the built environment (townscape, architecture) on health and well-being of interacting people. This impact ranges from physical aspects (e.g., traffic safety, particulate matter) to psychological processes (e.g., stress, loneliness) and behavioral aspects (e.g., physical activity, social behavior). At the same time, phenomena such as homelessness, crime, or mental disorders (e.g., substance addictions, schizophrenia) occur more frequently in cities compared to rural areas, illustrating causal as well as selective processes in the relation of urban environment and mental health. Increasing overall incidences in mental disorders (especially anxiety disorders and depression), the short-term shortage of psychotherapeutic care as well as the long-term economic burden on the health care system ask for a twofold strategy in public health: a) an extension of preventive measures with low threshold, i.e., accessible by large shares of the population, b) an extension of mental health literacy, which will empower the population to be attentive to mental health issues in themselves and others and which in turn can help to reduce stigmatization. While urban green and blue spaces have been researched in terms of restorative environments - allowing to regenerate resources consumed during the day - the built environment is still a resource for this strategy that has received insufficient attention to date. Utilizing the urban built environment not only as restorative but also informative and engaging environments thus affords an opportunity to address and potentially foster mental health and mental health literacy in citizens across socioeconomic backgrounds.

Potentials of participatory approaches for urban mental health

Aspects of mental health, society, space and environment share entangled relations being studied in health geography. Recreational spaces as well as places that are commonly perceived as strenuous, unsafe, or highly stressful are unevenly distributed within urban areas, which is also associated with spatial differences in mental disorders. Spaces in general represent social constructions that reflect power inequalities; they are filled with subjective emotional resonances and sometimes visualize stigmatization of specific groups. As such, the interplay of socio-demographic factors, socio-economic factors and built environment is complex. To capture these entanglements represented in heterogeneous user groups, participatory approaches promise valuable insights. Yet, despite their great potential for fostering mental health in urban space, participatory approaches are still less common in health geography. Therefore, critical voices question whether the limitations of marginalized groups have been sufficiently considered in this field of study so far. Similar challenges arise in urban planning processes: Specific (vulnerable) groups such as children, women, foreign residents, and people with disabilities or elderly people are insufficiently included in planning processes, leading to an underrepresentation of their needs in the resulting environments. To tackle this shortcoming, the approach of co-creation offers a process in which participants jointly develop a solution without being the object of research or interview partners, but creators. Using rather practical or creative (e.g., joint mapping of the built environment, photo-elicitation) than discursive techniques allows contributions from population groups otherwise often excluded from planning processes. Despite certain limitations, participatory approaches promise the possibility to develop appropriate and just solutions in urban mental health.

Chronic ozone exposure preferentially modifies root rather than foliar metabolism of date palm (Phoenix dactylifera) saplings

In their natural environment, date palms are exposed to chronic atmospheric ozone (O₃) concentrations from local and remote sources. In order to elucidate the consequences of this exposure, date palm saplings were treated with ambient, 1.5 and 2.0 times ambient O₃ for three months in a free-air controlled exposure facility. Chronic O₃ exposure reduced carbohydrate contents in leaves and roots, but this effect was much stronger in roots. Still, sucrose contents of both organs were maintained at elevated O₃, though at different steady states. Reduced availability of carbohydrate for the Tricarboxylic acid cycle (TCA cycle) may be responsible for the observed reduced foliar contents of several amino acids, whereas malic acid accumulation in the roots indicates a reduced use of TCA cycle intermediates. Carbohydrate deficiency in roots, but not in leaves caused oxidative stress upon chronic O₃ exposure, as indicated by enhanced malonedialdehyde, H₂O₂ and oxidized glutathione contents despite elevated glutathione reductase activity. Reduced levels of phenolics and flavonoids in the roots resulted from decreased production and, therefore, do not indicate oxidative stress compensation by secondary compounds. These results show that roots of date palms are highly susceptible to chronic O₃ exposure as a consequence of carbohydrate deficiency.

[Effect of a multimodal pain management protocol and age on wound healing after thermal disbudding of female German Holstein calves]

INTRODUCTION

Hot-iron disbudding of calves is a stressful and painful procedure and leaves a burn wound. Pain management procedures and the effects of hot-iron disbudding on biochemical markers of pain perception and stress response have been widely investigated in recent years. The aim of this study was to investigate the potential effects of pain management and age of the calf on the healing of burn wounds caused by disbudding. 327 healthy female German Holstein calves were included in this randomised, triple-blinded, prospective study. Calves were either disbudded at the age of four to 10 or 15 to 28 days using a gas-powered hot iron. Each calf was randomly allocated to one of nine possible treatment groups (BG). All calves received either the active ingredients to be tested (xylazine hydrochloride with 0.2 or 0.05 mg / kg body mass (BM) intramuscular for sedation, procaine hydrochloride (2 %) each 8 ml locally on both sides subcutaneously (SC) to the cornual nerves, meloxicam with 0,5 mg / kg BM SC for anti-inflammatory purposes) or an identical amount of saline solution (placebo). Calves in the group `thermE` and `ScheinE` received only placebo. In group `ScheinE` disbudding was simulated and in `thermE` it was carried out. The calves were clinically monitored starting one day before and ending 28 days after the procedure and the burn wounds were assessed. Both the rectal temperature and parameters of wound healing changed significantly during the study period and had characteristic profiles over time. Wound healing was not influenced by the different analgesic protocols, indicating that a multimodal analgesia does not pose a risk for wound healing after thermal disbudding. There were no observed differences between the age groups. The results of this study show, that disbudding of young calves and a multimodal pain management protocol does not affect wound healing in calves.

[Cortisol concentrations in sheep before, during and after sham foot trimming on a tilt table - the suitability of different matrices]

INTRODUCTION

Matrices that can be collected non-invasively for quantification of a stress response in sheep have received little attention in the veterinary literature. This study examines the suitability of blood, tears and saliva for determining a stress response in sheep undergoing sham foot trimming on a tilt table. The cortisol concentration of blood, tears and saliva and the concentration of cortisol metabolites in faeces were measured in 13 healthy Meat Merino ewes once a day for six days. Sham foot trimming on a tilt table was used as the stressor and was done during a one-hour period on day 4; cortisol concentrations of blood and tears were measured at 0, 10, 20, 30, 40 and 60 minutes. Cortisol concentrations of blood (maximum at 30 minutes) and tears (maximum at 40 minutes) increased during the procedure and then decreased. There were significant correlations between cortisol concentrations of blood and tears (p = 0,04) during sham foot trimming (area under the curve, 0 to 60 minutes). Over the entire 6-day study period, significant correlations were seen between the cortisol concentrations of blood and tears (r = 0,55; p.

On the psychological importance of control and valorisation in psychiatric environments

When people suffering from severe mental illnesses are treated in psychiatric facilities, there appear conflicting priorities between security and individual control that are often skewed towards security. As a result, patients admitted to highly institutionalised psychiatric wards do not only suffer from mental illness but also from loss of control as a basic human need (Grawe, 2000). Through this loss of control (e.g., not being able to choose where to go), people become especially dependent on their immediate social and spatial surroundings. From a psychological point of view, the concept of control reflects in concepts such as self-efficacy (Bandura, 1977), internal vs. external locus of control (Rotter, 1966), or environmental mastery (Ryff, 1989), all pointing to a beneficial influence on well-being and health. Yet, depending on their current situation, psychiatric patients may also feel overwhelmed by an excess of choices. Increasing patients' sense of control by offering them small choices during their stay at a psychiatric environment, however, might increase well-being (cf. Langer & Rodin, 1968). This possibility of control has the potential to also activate the feeling of valorisation in patients: As a positive fundamental attitude towards another person, implying appreciation and respect, valorisation poses an important element of psychotherapy (e.g., Rogers, 1951). Especially as people with psychiatric disorders are still stereotyped and stigmatized (e.g., as a homogenous group of “the mentally ill”), actively searching for new ways to foster valorisation in psychiatric environments may further contribute to patients' well-being and individualisation. Transferring the concept of valorisation to physical objects as primes affords an opportunity to extend feeling appreciated beyond immediate social interaction.

[Thermographic monitoring of skin surface temperature associated with hot-iron disbudding in calves]

INTRODUCTION

The goal of this study was to determine the skin surface temperatures of the head using thermography in 28 German Holstein heifer calves at the time of hot iron disbudding. Calves were divided into group 1 (hot-iron disbudding, n = 14) and 2 (sham disbudding, n = 14). Thermographic measurements were made at eight locations of the head (area surrounding both horn buds, both horn buds, muzzle, mucous membranes of the muzzle, both eyes) at nine time points (- 60 min (basal value), time of disbudding, 5, 30, 60, 90, 120, 240 and 480 min after disbudding) using a high-end thermographic camera (ThermoPro TP8, Firma DIAS Infrared GmbH). The rectal temperature was measured 60 min before and 5, 240 and 480 min after disbudding. The statistical software SAS version 9.4 was used for analysis. Skin surface temperatures and rectal temperature correlated at several locations (rp ≥ 0.45; p ≤ 0.05). The maximum temperature (approx. 67 ºC) was measured at the horn buds immediately after the hot-iron procedure. By five and 30 min after hot-iron disbudding, the temperature of the horn buds had decreased by up to 50%, whereas the temperatures at the other locations had increased significantly (p.

Cognitive and emotional empathy in individuals at clinical high risk of psychosis

BACKGROUND

Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive.

METHODS

Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined.

RESULTS

Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms.

CONCLUSION

Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.

Thrombosis as a treatment complication in Hodgkin lymphoma patients: a comprehensive analysis of three prospective randomized German Hodgkin Study Group (GHSG) trials

BACKGROUND

The prognosis of Hodgkin lymphoma (HL) is excellent rendering research into treatment complications highly important. An important complication of cancer and its treatment is thrombosis. Thrombotic events are regularly observed in HL patients but precise information on incidence and risk factors is lacking and the value of prophylactic anticoagulation unclear.

PATIENTS AND METHODS

Thus, we comprehensively studied thrombotic events in 5773 patients from the German Hodgkin Study Group (GHSG) HD13-15 trials in early-favorable, intermediate and advanced HL. We estimated the incidence of and identified risk factors for thrombotic events. Additionally, we provide detailed data on the time course and characteristics of thrombotic events.

RESULTS

A total of 193 thrombotic events occurred for an incidence of 3.3%. Out of these, 175 (90.7%) were venous thromboses, 3 (1.5%) newly emerging post-thrombotic syndromes and 15 (7.8%) arterial thromboses. There were 11 (0.7%) events in early-favorable, 27 (1.3%) in early-unfavorable and 155 (7.3%) in advanced patients, the latter incidence being significantly higher (P < 0.001). The most common locations were deep vein thrombosis of the arm (46.3%) and leg (24.6%). Most venous thrombotic events occurred during chemotherapy (78.9%). We observed 59 (30.6%) catheter-associated events and a descriptively increased risk of venous thrombotic events in patients with oral contraception use during treatment (6.8% versus 3.9%). In advanced HL, the incidence of venous thrombotic events was increased upon treatment with BEACOPP-14 (9.4%, P = 0.0079) compared with 5.1% with 6×BEACOPPesc and 5.7% with 8×BEACOPPesc. Among commonly applied risk factors, including the Khorana score, only age and smoking were prognostic.

CONCLUSIONS

The incidence of thrombotic events in advanced stage HL is comparable to other high-risk cancer patients, especially if treated with dose-dense regimens. Additional risk factors are higher age and smoking. Selected HL patients could benefit from prophylactic anticoagulation, however, further interventional studies are needed before general recommendations can be made.

[Patient safety: current problems and challenges]

Two decades after "To Err Is Human", the groundbreaking report published by the Institute of Medicine in the US, the German Patient Safety Alliance (Aktionsbündnis Patientensicherheit, APS) has published the "White Paper on Patient Safety". Based on the throughput model of health services research, the paper proposes a revised concept and definition of patient safety that focuses not only on the presence of adverse events (AE), but also on the ability of organizations and systems to adequately prioritize patient safety and implement this sustainably with improvement processes. Accordingly, a concept for measuring patient safety will be developed that no longer only quantitatively records AE, but also focuses on patient safety indicators that describe innovation competence. The epidemiological data will be updated; the rates of approximately 2-4% avoidable AE and 0.1% avoidable deaths among hospital patients appear to be highly conservative estimates. Data from non-representative sources, such as on legal procedures, underestimate frequencies by a factor of 30 ("litigation gap"). The most important obstacles to improving the situation are analyzed and give rise to the recommendation that, instead of one-point interventions (e.g., of a technical nature, such as IT-supported procedures), complex multicomponent interventions should increasingly be used in Germany, combining interventions with different approaches. Interventions at team level and with regard to management structures are focused on here.

[Thermographic examination of head surface temperatures of calves under field conditions]

INTRODUCTION

Thermographic examination of 157 German Holstein heifer calves was performed to investigate the feasibility of this technique for on-farm recording of surface temperature of the head and to examine potential factors that affect the recordings. Baseline values were obtained from six defined locations on the head including both eyes, both horn buds, the muzzle and the mucous membrane of the muzzle using a high-end thermographic camera (ThermoPro TP8, Firma DIAS Infrared GmbH). Evaluation of the influence of various factors on thermographic measurements showed that ambient temperature had the largest effect on surface temperature of the head (regression coefficient, 0.10 to 0.32, p ≤ 0.01) whereas humidity had no effect (in t-test p ≥ 0.33 over all locations). There was a no correlation between rectal temperature and surface temperature (rp ≤ 0.05). The surface temperature decreased with increasing age of the calves (regression coefficient, - 0.42 to - 0.14, p ≤ 0.01). The agreement between double readings made shortly after one another was excellent at all locations (r ≥ 0.95). The emission of infrared energy varied among different locations; the most infrared energy was emitted by the eyes and the least by the muzzle. Paired locations (eyes and horn buds) had symmetric emission patterns of infrared energy. Measuring the surface temperature of the head of calves in their normal barn environment using a standardised protocol was feasible and thus could potentially be used for monitoring calves under field conditions.

Recent developments in the Inorganic Crystal Structure Database: theoretical crystal structure data and related features

The article discusses how theoretical crystal data are supplementing experimental data for simulation and prediction of structures of inorganic solids in the Inorganic Crystal Structure Database.

The Inorganic Crystal Structure Database (ICSD) is the world’s largest database of fully evaluated and published crystal structure data, mostly obtained from experimental results. However, the purely experimental approach is no longer the only route to discover new compounds and structures. In the past few decades, numerous computational methods for simulating and predicting structures of inorganic solids have emerged, creating large numbers of theoretical crystal data. In order to take account of these new developments the scope of the ICSD was extended in 2017 to include theoretical structures which are published in peer-reviewed journals. Each theoretical structure has been carefully evaluated, and the resulting CIF has been extended and standardized. Furthermore, a first classification of theoretical data in the ICSD is presented, including additional categories used for comparison of experimental and theoretical information.

On the residual six-fold astigmatism in DCOR/ASCOR

After the introduction of the hexapole C_s-correctors for scanning transmission electron microscopes (STEM), the next big step forward was the strong reduction of the six-fold astigmatism A₅ by means of an advanced hexapole design (DCOR/ASCOR). As a result all axial aberrations up to fifth order are sufficiently small to allow for large semi-aperture angles beyond 40 mrad for electron energies in the range of 30 to 300 kV without deterioration of the STEM resolution. In this paper we derive simple expressions for the optimum hexapole strength for minimum A₅ and the size of the residual A₅. Both quantities are intrinsic properties of the hexapoles and the transfer lens doublet in between. The optimum hexapole strength scales with the inverse of the electron wavelength, while the residual A₅ does not depend on the electron energy directly, but on the spherical aberration C_s of the pole piece. With the given properties of the DCOR/ASCOR and typical values of C_s in the range of 0.5 to 2.7 mm, at all acceleration voltages A₅ remains in the range from 0.03 to 0.4 mm, the latter even for a large-gap pole piece.

Evaluation of arterial digital blood flow in dairy cows with claw horn disruption lesions using Doppler ultrasonography

Vascular changes play an important role in the pathogenesis of claw horn disruption lesions in cattle. The aim of the study was to measure arterial blood flow in the hind limbs of German Holstein cows with claw horn disruption lesions. A 10-MHz linear transducer was used to assess blood flow in the interdigital artery in the dorsal pastern region in the hind limbs of 11 non-lame and 33 lame German Holstein cows in which lameness was scored clinically. Qualitative and quantitative blood flow parameters were compared in affected limbs and unaffected contralateral hind limbs in lame cows and in the hind limbs of lame cows and non-lame cows. A pulsed-wave Doppler signal suitable for analysis was obtained in 78 of 88 limbs (33 affected and contralateral limbs, 22 limbs of control cows). Blood flow curve types 1 and 2 were predominant in the hind limbs of lame cows. Vessel diameter, end-diastolic velocity, and blood flow rate were significantly greater in lame cows than in non-lame cows and were numerically greater in moderately lame cows than in mildly lame cows. The differences in the qualitative and quantitative parameters between lame and non-lame cows were most likely caused by inflammation of the pododerm. The role of weight distribution between the paired hind limbs and the existence of claw horn disruption appeared to have an effect on the differences in local circulation in the affected and unaffected contralateral hind limbs in lame cows.

Evaluation of arterial digital blood flow in dairy cows with claw horn disruption lesions using Doppler ultrasonography

Vascular changes play an important role in the pathogenesis of claw horn disruption lesions in cattle. The aim of the study was to measure arterial blood flow in the hind limbs of German Holstein cows with claw horn disruption lesions. A 10-MHz linear transducer was used to assess blood flow in the interdigital artery in the dorsal pastern region in the hind limbs of 11 non-lame and 33 lame German Holstein cows in which lameness was scored clinically. Qualitative and quantitative blood flow parameters were compared in affected limbs and unaffected contralateral hind limbs in lame cows and in the hind limbs of lame cows and non-lame cows. A pulsed-wave Doppler signal suitable for analysis was obtained in 78 of 88 limbs (33 affected and contralateral limbs, 22 limbs of control cows). Blood flow curve types 1 and 2 were predominant in the hind limbs of lame cows. Vessel diameter, end-diastolic velocity, and blood flow rate were significantly greater in lame cows than in non-lame cows and were numerically greater in moderately lame cows than in mildly lame cows. The differences in the qualitative and quantitative parameters between lame and non-lame cows were most likely caused by inflammation of the pododerm. The role of weight distribution between the paired hind limbs and the existence of claw horn disruption appeared to have an effect on the differences in local circulation in the affected and unaffected contralateral hind limbs in lame cows.

Magnetic Cc/Cs-corrector compensating for the chromatic aberration and the spherical aberration of electron lenses

Aberration correction in transmission electron microscopy has proven feasible and useful over a large range of acceleration voltages. The spherical aberration has been corrected for beam energies from 15 kV [1] up to 1.2 MeV [2] while the correction of the chromatic aberration has been achieved for beam energies ranging from 20 kV[3] up to 300 kV[4]. Above this threshold the conventional correction principle based on mixed electric and magnetic focusing elements becomes infeasible with present technology [5]. For conventional electron sources at high voltages the relative energy width of the beam gets so small that chromatic correction becomes less important. Nevertheless, for new applications with pulsed electron sources with energy spreads in the order of 100 eV chromatic aberration will become a limiting factor even at high energies [6]. To enable chromatic aberration correction for such systems a novel type of a feasible, purely magnetic multipole aberration corrector with curved optic axis is proposed which is capable of compensating for the chromatic and spherical aberration up to several MeV.

Evidence for the Existence of Foetal Fibrinogen

Human fibrinogen was isolated from the blood of adults and from umbilical cord blood. The fibrinogen preparations obtained were clottable with thrombin to between 97 and 98% and homogeneous in acrylamide gel electrophoresis. Comparative analyses of these highly purified foetal and adult fibrinogen showed that they have the same quantitative amino acid composition and the same mobility in acrylamide gel electrophoresis at pH 9.2.

Chromatography on DEAE-cellulose made it likely that foetal and adult fibrinogen have a slightly different electrical charge. The pH-dependency of the thrombin clotting time is strikingly different. The fingerprints of the tryptic peptides showed at least 3 peptides with different mobility in chromatography.

From these data it is assumed that foetal and adult fibrinogen have a different molecular structure. Hitherto it cannot be decided if the two proteins have a different primary structure, which is most probable, or if they are chemical modifications.

Boron-phil and boron-phob structure units in novel borides Ni3Zn2B and Ni2ZnB: experiment and first principles calculations

The crystal structures of two novel borides in the Ni-Zn-B system, τ₅-Ni₃Zn₂B and τ₆-Ni₂ZnB, were determined by single crystal X-ray diffraction (XRSC) in combination with selected area electron diffraction in a transmission electron microscope (SAED-TEM) and electron probe microanalysis (EPMA). Both compounds crystallize in unique structure types (space group C2/m, a = 1.68942(8) nm, b = 0.26332(1) nm, c = 0.61904(3) nm, β = 111.164(2)°, R_F = 0.0219 for Ni₃Zn₂B, and space group C2/m, a = 0.95296(7) nm, b = 0.28371(2) nm, c = 0.59989(1) nm, β = 93.009(4)°, R_F = 0.0163 for Ni₂ZnB). Both compounds have similar building blocks: two triangular prisms centered by boron atoms are arranged along the c-axis separated by Zn layers, which form empty octahedra connecting the boron centered polyhedra. Consistent with the (Ni+Zn)/B ratio, isolated boron atoms are found in τ₅-Ni₃Zn₂B, while B-B pairs exist in τ₆-Ni₂ZnB. The crystal structure of Ni₂ZnB is closely related to that of τ₄-Ni₃ZnB₂, i.e. Ni₂ZnB can be formed by removing the nearly planar nickel layer in Ni₃ZnB₂ and shifting the origin of the unit cell to the center of the B-B pair. The electrical resistivity and specific heat of τ₅-Ni₃Zn₂B reveal the metallic behavior of this compound with an anomaly at low temperature, possibly arising from a Kondo-type interaction. Further analysis on the lattice contribution of the specific heat reveals similarity with τ₄-Ni₃ZnB₂ with some indications of lattice softening in τ₅-Ni₃Zn₂B, which could be related to the increasing metal content and the absence of B-B bonding in τ₅-Ni₃Zn₂B. For the newly found phases, τ₅-Ni₃Zn₂B and τ₆-Ni₂ZnB as well as for τ₃-Ni₂₁Zn₂B₂₀ and τ₄-Ni₃ZnB₂ density functional theory (DFT) calculations were performed by means of the Vienna Ab initio Simulation Package (VASP). Total energies and forces were minimized in order to determine the fully relaxed structural parameters, which agree very well with experiment. Energies of formations in the range of -25.2 to -26.9 kJ mol^-1 were calculated and bulk moduli in the range of 179.7 to 248.9 GPa were derived showing hardening by increasing the B concentration. Charge transfer is discussed in terms of Bader charges resulting in electronic transfer from Zn to the system and electronic charge gain by B. Ni charge contributions vary significantly with crystallographic position depending on B located in the neighbourhood. The electronic structure is presented in terms of densities of states, band structures and contour plots revealing Ni-B and Ni-Zn bonding features.

Sensors, Medical Images and Signal Processing:

Objectives To summarize current excellent research in the field of medical sensor, signal and imaging informatics.

Method: Synopsis of the articles selected for the IMIA (International Medical Informatics Association) Yearbook 2010.

Results: Current research in the field of sensor, signal, and imaging informatics is characterized by theoretically sound techniques and evaluations with focus in imaging informatics.

Conclusions: The best paper selection of articles on sensors, signal, and imaging informatics shows examples of excellent research on methods concerning theoretically sound original development in this field. Research published in 2009 was characterized by the emergence of mature computerized diagnosis aid frameworks with assessment of input and output quality. The purpose of these systems is clearly to bring new image and signal interpretation tools to clinicians.

Clinical Data Mining: a Review

Objective Clinical data mining is the application of data mining techniques using clinical data. We review the literature in order to provide a general overview by identifying the status-of-practice and the challenges ahead.

Methods The nine data mining steps proposed by Fayyad in 1996 [4] were used as the main themes of the review. MEDLINE was used as primary source and 84 papers were retained based on our inclusion criteria.

Results Clinical data mining has three objectives: understanding the clinical data, assist healthcare professionals, and develop a data analysis methodology suitable for medical data. Classification is the most frequently used data mining function with a predominance of the implementation of Bayesian classifiers, neural networks, and SVMs (Support Vector Machines). A myriad of quantitative performance measures were proposed with a predominance of accuracy, sensitivity, specificity, and ROC curves. The latter are usually associated with qualitative evaluation.

Conclusion Clinical data mining respects its commitment to extracting new and previously unknown knowledge from clinical databases. More efforts are still needed to obtain a wider acceptance from the healthcare professionals and for generalization of the knowledge and reproducibility of its extraction process: better description of variables, systematic report of algorithm parameters including the method to obtain them, use of easy-to-understand models and comparisons of the efficiency of clinical data mining with traditional statistical analyses. More and more data will be available for data miners and they have to develop new methodologies and infrastructures to analyze the increasingly complex medical data.

A User-oriented Protocol for Integrating Heterogeneous Communication Systems of Medical Facilities Using Ports

The crucial feature of future communication systems in hospitals will be the heterogeneity between the individual systems. People working in a hospital do not communicate via data objects, but via highly complex functions like preparation of a patient report or diagnosis of patients’ symptoms and signs. Essentially such tasks are accomplished by initiating remote functions in various modes of a communication system. The aim of the MEDAS protocol developed by our group is to propose a definition of such a high-level medical protocol and then to implement it. Our user-oriented protocol permits information exchange between heterogeneous systems. Modules and functions are defined. Message passing to and from a processor is realized using ports. The protocol sequence of every communication request is described. The relation of ports to the ISO model is specified. First experiences in a network for a medical school are reported.

Proton Therapy for Craniopharyngioma - An Early Report from a Single European Centre

AIMS

Proton beam therapy (PBT) is being increasingly used for craniopharyngioma. We describe our early outcome of patients treated with PBT.

MATERIALS AND METHODS

Between August 2013 and July 2016, 18 patients with craniopharyngiomas were treated with 54 Cobalt Gray Equivalent (CGE) in 30 fractions over 6 weeks at our centre. The early outcome of 16 patients included in a registry study was analysed. Radiological response was assessed by RECIST criteria and the disease- and treatment-related toxicities were scored according to the CTCAE 4.0.

RESULTS

All patients are alive at a median follow-up of 32.6 months (range 9.2-70.6 months) from initial diagnosis. The median age at PBT was 10.2 years (range 5.4-46.9 years). One patient progressed 8.7 months after PBT and subsequently had complete resection of the tumour. At a median follow-up of 18.4 months after PBT, five patients remained in complete remission, four in partial remission and seven with stable disease. The most common adverse effects during PBT were grade 1 (cutaneous in seven patients and fatigue in six patients). There were no treatment-related grade 3 toxicities.

CONCLUSIONS

Our early results are encouraging and comparable with the limited literature on PBT for craniopharyngioma.

Registration of Biplane Angiography and Intravascular Ultrasound for 3D Vessel Reconstruction

Abstract: If planned and applied correctly, intra-vascular brachytherapy (IVB) can significantly reduce the risk of restenosis after interventional treatment of stenotic arteries.

Objectives: In order to facilitate computer-based IVB planning, a three-dimensional reconstruction of the stenotic artery based on intravascular ultrasound (IVUS) sequences is desirable.

Methods: To attain a 3D reconstruction, the frames of the IVUS sequence are properly aligned in space and completed with additional intermediate frames generated by interpolation. The alignment procedure uses additional information that is obtained from biplane X-ray angiography performed simultaneously during the capturing of the IVUS sequence. After IVUS images and biplane angiography data are acquired from the patient, the vessel-wall borders and the IVUS catheter are detected by an active contour algorithm. Next, the twist between adjacent IVUS frames is determined by a sequential triangulation method combined with stochastic analysis.

Results: The above procedure results in a 3D volume-model of the vessel, which also contains information from the IVUS modality. This data is sufficient for computer-based intravascular brachytherapy planning.

Conclusion: The proposed methodology can be used to improve the current state-of-the-art IVB treatment planning by enabling computerized dosage computations on a highly accurate 3D model.

Health Information Search to Deal with the Exploding Amount of Health Information Produced

Objectives: This focus theme deals with the various aspects of health information search that are necessary to cope with the challenges of an increasing amount and complexity of medical information currently produced.

Methods: This editorial reviews the main challenges of health information search and summarizes the five papers of this focus theme.

Results and Conclusions: The five papers of the focus theme cover a large part of the current challenges in health information search such as coding standards, information extraction from complex data, user requirements analysis, multimedia data analysis and the access to big data. Several future challenges are identified such as the combination of visual and textual data for information search and the difficulty to scale when analyzing big data.

Multi-GEM Detectors in High Particle Fluxes

Gaseous Electron Multipliers (GEM) are well known for stable operation at high particle fluxes. We present a study of the intrinsic limits of GEMdetectors when exposed to very high particle fluxes of the order of MHz/mm2. We give an interpretation to the variations of the effective gain, which, as a function of the particle flux, first increases and then decreases. We also discuss the reduction of the ion back-flow with increasing flux. We present measurements and simulations of a triple GEM detector, describing its behaviour in terms of accumulation of positive ions that results in changes of the transfer fields and the amplification fields. The behaviour is expected to be common to all multi-stage amplification devices where the efficiency of transferring the electrons from one stage to the next one is not 100%.

Modern morphological methods for tadpole studies. A comparison of micro-CT, and clearing and staining protocols modified for frog larvae

Micro-computed tomography (micro-CT) scanning and three-dimensional reconstruction have revolutionized morphological studies. Whereas species descriptions and comparative studies formerly were based on external appearance and dissection, we now can visualize muscles, skeleton and viscera in intact animals. In most cases, visualization of internal structures depends on appropriate staining methods. Staining with iodine, phosphotungstic acid (PTA) and osmium tetroxide are established methods, but some problems remain. Agents like osmium tetroxide are toxic and the contrast of cartilage generally is unsatisfactory with osmium tetroxide, iodine or PTA. Furthermore, staining results vary for different animals and different developmental stages. We investigated critical point drying as an inexpensive, nontoxic and rapid alternative to staining for frog tadpoles. Critical point drying enables visualization of cartilage and its differentiation from muscle tissue. Shrinkage generally is acceptable. We also present a protocol for clearing and staining frog tadpoles.