[Safety of patient care on an interprofessional training ward in visceral surgery]

BACKGROUND

Interprofessional training wards (ITW) are increasingly being integrated into teaching and training concepts in visceral surgery clinics.

OBJECTIVE

How safe is patient care on an ITW in visceral surgery?

MATERIAL AND METHODS

Data collection took place from November 2021 to December 2022. In this nonrandomized prospective evaluation study the frequency and severity of adverse events (AE) in 3 groups of 100 patients each in a tertiary referral center hospital for visceral surgery were investigated. The groups consisted of patients on the ITW and on the conventional ward before and after implementation of the ITW. The Global Trigger Tool (GTT) was used to search for AE. Simultaneously, a survey of the treatment was conducted according to the Picker method to measure patient reported outcome.

RESULTS

Baseline characteristics and clinical outcome parameters of the patients in the three groups were comparable. The GTT analysis found 74 nonpreventable and 5 preventable AE in 63 (21%) of the patients and 12 AE occurred before the hospital stay. During the hospital stay 50 AE occurred in the operating theater and 17 on the conventional ward. None of the five preventable AE (in 1.7% of the patients) was caused by the treatment on the ITW. Patients rated the safety on the ITW better than in 90% of the hospitals included in the Picker benchmark cohort and as good as on the normal ward.

CONCLUSION

The GTT-based data as well as from the patients' point of view show that patient care on a carefully implemented ITW in visceral surgery is safe.

Multiple independent de novo mutations are associated with the development of schistosoma reflexum, a lethal syndrome in cattle

Schistosoma reflexum (SR) is a lethal congenital syndrome characterized by U-shaped dorsal retroflexion of the spine and exposure of abdominal viscera. SR is usually associated with severe dystocia. The syndrome is thought to be inherited as a Mendelian trait. We collected a series of 23 SR-affected calves from four breeds (20 Holstein, one Red Danish, one Limousin, one Romagnola) and performed whole-genome sequencing (WGS). WGS was performed on 51 cattle, including 14 cases with parents (trio-based; Group 1) and nine single cases (solo-based; Group 2). Sequencing-based genome-wide association studies with 20 Holstein cases and 154 controls showed no association (above Bonferroni threshold; P-value<3 ×10-09). Assuming a monogenic recessive inheritance, no region of shared homozygosity was observed, suggesting heterogeneity. Alternatively, the presence of possible dominant acting de novo mutations were assessed. In Group 1, heterozygous private variants, absent in both parents, were found in seven cases. These involved the ACTL6A, FLNA, GLG1, IQSEC2, MAST3, MBTPS2, and MLLT1 genes. In addition, heterozygous private variants affecting the genes DYNC1LI1, PPP2R2B, SCAF8, SUGP1, and UBP1 were identified in five cases from Group 2. The detected frameshift and missense variants are predicted to cause haploinsufficiency. Each of these 12 affected genes belong to the class of haploinsufficient loss-of-function genes or are involved in embryonic and pre-weaning lethality or are known to be associated with severe malformation syndromes in humans and/or mice. This study presents for the first time a detailed genomic evaluation of bovine SR, suggesting that independent de novo mutations may explain the sporadic occurrence of SR in cattle.

Microbial composition of Saharan dust plumes deposited as red rain in Granada (Southern Spain)

During durst storms, also biological material is transported from arid areas such as the Sahara Desert. In the present work, rain samples containing significant amounts of mineral dust have been collected in Granada during different red rain episodes. Biological features (bacteria, biofilm, pollen grain and fungal spore) as well as size-particle distribution and mineralogical composition were studied by SEM. Nanobacteria were observed for the first time in red rain samples. A preliminary metabarcoding analysis was performed on three red rain samples. Here, Bacillota made up 18 % and Pseudomonadota 23 % of the whole prokaryotic community. The fungal community was characterized by a high abundance of Ascomycota and, dependent on the origin, the presence of Chytridiomycota. By means of 16S rRNA sequencing, 18 cultivable microorganisms were identified. In general, members of the phyla Pseudomonadota and Bacillota made up the majority of taxa. Some species, such as Peribacillus frigoritolerans and Bacillus halotolerans were isolated during three different red rain episodes. Generally, red rain carries a wide variety of microorganisms, being their ecosystem and health effects largely unknown.

Measurement accuracy in silicon photonic ring resonator thermometers: identifying and mitigating intrinsic impairments

Silicon photonic ring resonator thermometers have been shown to provide temperature measurements with a 10 mK accuracy. In this work we identify and quantify the intrinsic on-chip impairments that may limit further improvement in temperature measurement accuracy. The impairments arise from optically induced changes in the waveguide effective index, and from back-reflections and scattering at defects and interfaces inside the ring cavity and along the path between light source and detector. These impairments are characterized for 220 × 500 nm Si waveguide rings by experimental measurement in a calibrated temperature bath and by phenomenological models of ring response. At different optical power levels both positive and negative light induced resonance shifts are observed. For a ring with L = 100 µm cavity length, the self-heating induced resonance red shift can alter the temperature reading by 200 mK at 1 mW incident power, while a small blue shift is observed below 100 µW. The effect of self-heating is shown to be effectively suppressed by choosing longer ring cavities. Scattering and back-reflections often produce split and distorted resonance line shapes. Although these distortions can vary with resonance order, they are almost completely invariant with temperature for a given resonance and do not lead to measurement errors in themselves. The effect of line shape distortions can largely be mitigated by tracking only selected resonance orders with negligible shape distortion, and by measuring the resonance minimum wavelength directly, rather than attempting to fit the entire resonance line shape. The results demonstrate the temperature error due to these impairments can be limited to below the 3 mK level through appropriate design choices and measurement procedures.

Kinematic response of seated male volunteers in various reclined postures on a sled subjected to a braking pulse

Vehicle occupants expect greater postural flexibility with the introduction of highly automated vehicles, such as reclined postures. Experiments have been conducted with post mortem human subjects to study the risk of injury under impact conditions in reclined postures. However, the influence of the pre-crash phase on the kinematics in reclined postures has not yet been thoroughly studied. The aim of the present study is to investigate human responses under low g braking conditions focusing on different backrest angles in a generic sled environment. Three 50th percentile male volunteers were recruited to participate in a sled experiment. Each of them was subjected to a total of fourteen trials under a braking pulse with a maximum acceleration of 0.7 g for 700 ms. Different sitting postures were investigated: from 23° to 45°, 60° and 75° backrest tilt with respect to the vertical axis. In addition, two different seat pan tilt angles were considered: a 16° tilt angle for 23°, 45° and 60° backrest inclination and a 36° tilt angle for 60° and 75° backrest inclination. Measurements of volunteer kinematics, muscle activation and interaction forces between the volunteers and the sled, among others, were acquired. Initial results show a significant reduction in maximum forward head displacement from the upright to the reclined postures (p < 0.02), with the exception of the 45° reclined posture. However, no significant difference in maximum head displacement was found between the different reclined postures (p > 0.1). Seat pan tilt angle did significantly influence forward head excursion when considering the same seatback inclination (p < 0.01). It is of great importance to investigate occupant kinematics during the pre-crash phase to understand its influence on the potential injuries that may occur with a reclined posture in the event of a collision.

Société de Biomécanique Young Investigator Award 2019: Upper body behaviour of seated humans in vivo under controlled lateral accelerations

BACKGROUND

A deep understanding of human reactions and stabilization strategies is required to predict their kinematics under external dynamic loadings, such as those that occur in vehicle passengers. Low-level frontal accelerations have been thoroughly investigated; however, the human response to different lateral accelerations is not well understood. The objective of this study is to gain insight regarding the responses of seated humans to lateral perturbations from volunteer experiments in different configurations.

METHODS

Five volunteers anthropometrically comparable to the 50th-percentile American male, were seated on a sled and submitted to 21 lateral pulses. Seven configurations, each repeated three times, were investigated in this study: a relaxed muscular condition with four pulses, namely, sine and plateau pulses of 0.1 and 0.3 g in a straight spinal posture; a relaxed muscular condition with a plateau pulse of 0.3 g in a sagging spinal posture; and a braced condition with both plateau pulses in a straight spinal posture. Upper body segment kinematics were assessed using inertial measurement units.

FINDINGS

The maximum lateral bending of the head was found to differ significantly among the four acceleration pulses (p < 0.001). Braced muscles significantly reduced lateral bending compared to relaxed muscles (p < 0.001). However, no significant difference was found in lateral bending between straight and sagging spinal postures (p = 0.23).

INTERPRETATION

The study shows that not only pulse amplitude but also pulse shape influences human responses to low accelerations, while spinal posture does not influence lateral head bending. These data can be used to evaluate numerical active human body models.

Nanosilver/DCOIT-containing surface coating effectively and constantly reduces microbial load in emergency room surfaces

BACKGROUND

Colonization of near-patient surfaces in hospitals plays an important role as a source of healthcare-associated infections. Routine disinfection methods only result in short-term elimination of pathogens.

AIM

To investigate the efficiency of a newly developed antimicrobial coating containing nanosilver in long-term reduction of bacterial burden in hospital surfaces to close the gap between routine disinfection cycles.

METHODS

In this prospective, double-blinded trial, frequently touched surfaces of a routinely used treatment room in an emergency unit of a level-I hospital were treated with a surface coating (nanosilver/DCOIT-coated surface, NCS) containing nanosilver particles and another organic biocidal agent (4,5-dichloro-2-octyl-4-isothiazolin-3-one, DCOIT), whereas surfaces of another room were treated with a coating missing both the nanosilver- and DCOIT-containing ingredient and served as control. Bacterial contamination of the surfaces was examined using contact plates and liquid-based swabs daily for a total trial duration of 90 days. After incubation, total microbial counts and species were assessed.

FINDINGS

In a total of 2880 antimicrobial samples, a significant reduction of the overall bacterial load was observed in the NCS room (median: 0.31 cfu/cm²; interquartile range: 0.00-1.13) compared with the control coated surfaces (0.69 cfu/cm²; 0.06-2.00; P < 0.001). The nanosilver- and DCOIT-containing surface coating reduced the relative risk of a critical bacterial load (defined as >5 cfu/cm²) by 60% (odds ratio 0.38, P < 0.001). No significant difference in species distribution was detected between NCS and control group.

CONCLUSION

Nanosilver-/DCOIT-containing surface coating has shown efficiency for sustainable reduction of bacterial load of frequently touched surfaces in a clinical setting.

Prolonged postoperative antibiotic administration reduces complications after medial thigh lift

There is widespread consensus that there is no indication for postoperative antibiotic administration after elective surgery. However, medial thigh lift (MTL) remains a procedure with a notoriously high rate of wound-healing disorders and infections. This study investigates the correlation between prolonged antibiotic administration and complications after MTL in massive weight loss patients. We performed a single-institution retrospective review of 121 patients undergoing MTL between 2009 and 2020. Data on postoperative outcome, demography, surgery and comorbidities were collected. All patients received intravenous antibiotics preoperatively. One group was continued on oral antibiotics for two weeks postoperatively. Complications and surgical site infections were observed and evaluated. There was no difference between the groups regarding age, BMI, or presence of obesity-associated risk factors. We observed complications in 76 patients (71%), with 60 (56%) minor and 16 (15%) major complications. The group without prolonged antibiotic administration had a higher number of total complications (OR 3.5; p = 0.0037), major complications (OR 4; p = 0.01), and wound infections (OR 6.8; p = 0.0004). Logistical regression analysis showed that this effect was independent of type of weight loss, resection volume, and age. Reduction of major infections by prolonged antibiotics was, however, dependent on BMI Δ. No side-effects associated with antibiotics were registered in this series. This study suggests that prolonged antibiotic administration may decrease complications in MTL. We thus continue to use prolonged antibiotic administration after MTL. Further research is needed to determine the optimal duration of antibiotic treatment. Level of Evidence: Level IV: therapeutic study.

Weakly Supervised Learning using Attention gates for colon cancer histopathological image segmentation

Recently, Artificial Intelligence namely Deep Learning methods have revolutionized a wide range of domains and applications. Besides, Digital Pathology has so far played a major role in the diagnosis and the prognosis of tumors. However, the characteristics of the Whole Slide Images namely the gigapixel size, high resolution and the shortage of richly labeled samples have hindered the efficiency of classical Machine Learning methods. That goes without saying that traditional methods are poor in generalization to different tasks and data contents. Regarding the success of Deep learning when dealing with Large Scale applications, we have resorted to the use of such models for histopathological image segmentation tasks. First, we review and compare the classical UNet and Att-UNet models for colon cancer WSI segmentation in a sparsely annotated data scenario. Then, we introduce novel enhanced models of the Att-UNet where different schemes are proposed for the skip connections and spatial attention gates positions in the network. In fact, spatial attention gates assist the training process and enable the model to avoid irrelevant feature learning. Alternating the presence of such modules namely in our Alter-AttUNet model adds robustness and ensures better image segmentation results. In order to cope with the lack of richly annotated data in our AiCOLO colon cancer dataset, we suggest the use of a multi-step training strategy that also deals with the WSI sparse annotations and unbalanced class issues. All proposed methods outperform state-of-the-art approaches but Alter-AttUNet generates the best compromise between accurate results and light network. The model achieves 95.88% accuracy with our sparse AiCOLO colon cancer datasets. Finally, to evaluate and validate our proposed architectures we resort to publicly available WSI data: the NCT-CRC-HE-100K, the CRC-5000 and the Warwick colon cancer histopathological dataset. Respective accuracies of 99.65%, 99.73% and 79.03% were reached. A comparison with state-of-art approaches is established to view and compare the key solutions for histopathological image segmentation.

Reactive Nitrogen Hotspots Related to Microscale Heterogeneity in Biological Soil Crusts

Biocrusts covering drylands account for major fractions of terrestrial biological nitrogen fixation and release large amounts of gaseous reactive nitrogen (N_r) as nitrous acid (HONO) and nitric oxide (NO). Recent investigations suggested that aerobic and anaerobic microbial nitrogen transformations occur simultaneously upon desiccation of biocrusts, but the spatio-temporal distribution of seemingly contradictory processes remained unclear. Here, we explore small-scale gradients in chemical concentrations related to structural characteristics and organism distribution. X-ray microtomography and fluorescence microscopy revealed mixed pore size structures, where photoautotrophs and cyanobacterial polysaccharides clustered irregularly in the uppermost millimeter. Microsensor measurements showed strong gradients of pH, oxygen, and nitrite, nitrate, and ammonium ion concentrations at micrometer scales in both vertical and lateral directions. Initial oxygen saturation was mostly low (∼30%) at full water holding capacity, suggesting widely anoxic conditions, and increased rapidly upon desiccation. Nitrite concentrations (∼6 to 800 μM) and pH values (∼6.5 to 9.5) were highest around 70% WHC. During further desiccation they decreased, while emissions of HONO and NO increased, reaching maximum values around 20% WHC. Our results illustrate simultaneous, spatially separated aerobic and anaerobic nitrogen transformations, which are critical for N_r emissions, but might be impacted by future global change and land management.

Key Role of Equilibrium HONO Concentration over Soil in Quantifying Soil-Atmosphere HONO Fluxes

Nitrous acid (HONO) is an important component of the global nitrogen cycle and can regulate the atmospheric oxidative capacity. Soil is an important source of HONO. [HONO]*, the equilibrium gas-phase concentration over the aqueous solution of nitrous acid in the soil, has been suggested as a key parameter for quantifying soil fluxes of HONO. However, [HONO]* has not yet been well-validated and quantified. Here, we present a method to retrieve [HONO]* by conducting controlled dynamic chamber experiments with soil samples applied with different HONO concentrations at the chamber inlet. We show a bi-directional soil-atmosphere exchange of HONO and confirm the existence of [HONO]* over soil: when [HONO]* is higher than the atmospheric HONO concentration, HONO will be released from soil; otherwise, HONO will be deposited. We demonstrate that [HONO]* is a soil characteristic, which is independent of HONO concentrations in the chamber but varies with different soil water contents. We illustrate the robustness of using [HONO]* for quantifying soil fluxes of HONO, whereas the laboratory-determined chamber HONO fluxes can largely deviate from those in the real world for the same soil sample. This work advances the understanding of the soil-atmosphere exchange of HONO and the evaluation of its impact on the atmospheric oxidizing capacity.

National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project

Background

In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON).

Methods

Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified.

Discussion

For a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00898-w.

Potential effect of pre-activated muscles under a far-side lateral impact

OBJECTIVE

The goal of this study is to evaluate the potential effect of muscle pre-activation under a lateral impact scenario, in this case focusing on a far-side impact, using an Active Human Body Model.

METHODS

In total fourteen simulations were run, out of these, twelve were computed with an Active Human Body Model and two with a passive one. The models were subjected to a far-side impact scenario reaching up to 14 g's. Two different pre-crash scenarios were analyzed with the Active Human Body Model: (1) constant velocity, and (2) braking deceleration. During the pre-crash phase a lambda control based on the muscle length computed the muscle activation. Since there is no available data concerning the neuromuscular strategy of the occupants subjected to high accelerations, six different control strategies were analyzed during the in-crash phase. Besides, rib fracture and brain injury risk were analyzed, since they are the two most relevant body regions in this simplified far-side crash scenario.

RESULTS

The pre-activation of the muscles showed an effect on both the occupant kinematics and estimated injury risks. Depending on the considered muscle strategy, the head lateral excursion varied up to 75 mm, specifically for the scenario with constant velocity. Moreover, the rib fracture probability and the brain injury indicator revealed higher injury risks for the passive Human Body Model. When applying the constant velocity during pre-crash, the fracture probability for two or more ribs ranged from 9.91 to 46.06% for the Active Human Body Model, whereas it reached 84.3% for the passive model. The brain injury indicator was reduced by about 10% when using the active model compared to the passive one.

CONCLUSIONS

The numerical results show that the pre-activation of the muscles affects the kinematic and injury outcomes in car crashes. In this study, six muscular control strategies have been proposed. The two muscular controls that may be most realistic are: constant activation after the in-crash phase starts, by trying to hold the position prior to the crash, or no stimulation, by not responding to the upcoming in-crash event.

[Diagnosis of heptic diseases in ruminants and camelids with a special focus on sonographic examination]

INTRODUCTION

Clinical symptoms are mostly unspecific in hepatic diseases, thus most clinical examinations are of limited benefit in the diagnosis of hepatic diseases and often only general statements can be made about parenchymal damage or loss of function. In contrast, sonography of the liver can provide information about the type of lesion and thus also about the prognosis for the animal. A systematic assessment of organ size, parenchymal, vascular and bile duct system structures can facilitate to make possible findings. Sonography is also used in further diagnostics such as liver biopsy or chole-cystocentesis. This review describes the basic procedure for the sonographic examination in ruminants and camelids on the basis of selected findings relevant to the clinical veterinarian. In addition, potential and limits of additional diagnostics are discussed.

[Telemedicine in stroke-pertinent to stroke care in Germany]

BACKGROUND AND OBJECTIVE

Telemedical stroke networks improve stroke care and provide access to time-dependent acute stroke treatment in predominantly rural regions. The aim is a presentation of data on its utility and regional distribution.

METHODS

The working group on telemedical stroke care of the German Stroke Society performed a survey study among all telestroke networks.

RESULTS

Currently, 22 telemedical stroke networks including 43 centers (per network: median 1.5, interquartile range, IQR, 1-3) as well as 225 cooperating hospitals (per network: median 9, IQR 4-17) operate in Germany and contribute to acute stroke care delivery to 48 million people. In 2018, 38,211 teleconsultations (per network: median 1340, IQR 319-2758) were performed. The thrombolysis rate was 14.1% (95% confidence interval 13.6-14.7%) and transfer for thrombectomy was initiated in 7.9% (95% confidence interval 7.5-8.4%) of ischemic stroke patients. Financial reimbursement differs regionally with compensation for telemedical stroke care in only three federal states.

CONCLUSION

Telemedical stroke care is utilized in about 1 out of 10 stroke patients in Germany. Telemedical stroke networks achieve similar rates of thrombolysis and transfer for thrombectomy compared with neurological stroke units and contribute to stroke care in rural regions. Standardization of network structures, financial assurance and uniform quality measurements may further strengthen the importance of telestroke networks in the future.

The Edmonton Obesity Staging System as a predictor for postoperative complications after medial thigh lift in massive weight loss patients

BACKGROUND

This study investigates the correlation between the Edmonton Obesity Staging System (EOSS) and the occurrence of postoperative complications after medial thigh lift in formerly obese patients.

PATIENTS AND METHODS

A single-institution retrospective review of patients undergoing medial thigh lift between 2009 and 2019 after massive weight loss. Data on demography, comorbidities, surgery, and postoperative outcome were extracted from patients' charts. Patients were grouped into EOSS categories. Complications were classified into minor and major. Logistic regression analysis was performed to determine the association between risk factors and complications.

RESULTS

One hundred and eight patients were included in the study. Complications occurred in 76 (70%) of the patients, most of which were minor (60/108, 56%). Complications increased with increasing EOSS stage, and all EOSS 3 patients had complications. Classification as EOSS 2 or 3 significantly associated with occurrence of postoperative complications (OR 99.3, p<0.001) as well as minor and major complications individually (OR 3.1 and 6.5, p<0.05). This effect was independent of body mass index (BMI), maximum BMI loss, type of weight loss, volume of liposuction, weight of resected tissue, and type of surgery.

CONCLUSION

EOSS is a robust and independent predictor for postoperative complications in medial thigh lift surgery after massive weight loss.

[Sclerotherapy of a simple, solitary kidney cyst using intraluminal ethanol instillation in a Swiss Fleckvieh cow]

INTRODUCTION

Renal cysts are fluid-filled cavities with an epithelial lining that, depending on their size, can cause clinical symptoms and thus require conservative or surgical therapy. Nephrectomy is primarily used in cattle for simple kidney cysts while sclerotherapy is well established in humans and individual case reports have been published in small animal medicine. This case report describes the first successful treatment of a solitary, perirenal cyst using a right-sided laparotomy and intraluminal instillation of 96% ethanol solution in a Swiss Fleckvieh cow. Diagnostics, surgical procedures and aftercare are descripted and risks are compared to other methods. Sclerotherapy is an organ-preserving alternative to nephrectomy that is suitable for buiatric practice, the methodology should be confirmed in subsequent intervention studies.

Effects of a Cereal Bar with a Combination of Phytoestrogens on the Climacteric Symptoms: A Placebo-Controlled, Randomized Trial

OBJECTIVE

This study evaluated whether the consumption of a cereal bar combining different phytoestrogens could contribute to the reduction of climacteric symptoms in women.

METHODS

This is a clinical, prospective, randomized, simple-blind trial. Forty-eight women, aged 40-65 years, with climacteric symptoms, from a city in southwestern Paraná, Brazil. Participants were randomly assigned into two groups; Phytoestrogens group (PHY = 24), which received for 90-day period a cereal bar containing 80.73 milligrams of soybean and flaxseed phytoestrogens, and the placebo group (PLA = 24), which consumed rice flakes biscuit. Clinical, sociodemographic and anthropometric data were collected and climacteric symptoms were assessed using the Kupperman Index (KI).

RESULTS

Forty-three women were analyzed (PHY = 21 and PLA = 22). There were significant reductions in the overall KI score in both groups at the end of the intervention period (p < 0.05). However, the comparison between the groups using linear regression models presented expressively better symptom improvement in the PHY group -6.43 over time (95% CI: -11.6; -1.26; p < 0.05) KI points, with perimenopausal -15.15 (95% CI: -28.95; -1.35) and postmenopausal women -19.34 (95% CI: -33.68; -4.99) showed considerably greater reductions in symptoms at the end of the intervention period compared to premenopausal women. There was also significant reduction in symptoms of hot flushes, paresthesia, sexual complaints, insomnia and melancholy.

CONCLUSION

The consumption of a cereal bar containing phytoestrogens was able to improve the symptoms of climacteric syndrome.

Toothbrushing Performance and Oral Cleanliness after Brushing in 12-Year-Old Children

Objectives:

Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old. While in a recent study, toothbrushing behavior of 12-y-old children was analyzed, the present study’s objective was to examine the children’s ability to achieve oral cleanliness and to analyze how toothbrushing behavior and compliance with the toothbrushing recommendations taught in the group prevention programs predict oral cleanliness.

Methods:

Twelve-year-old randomly selected children (N = 174) were asked to brush their teeth to the best of their abilities, and simultaneously a video was recorded for behavioral analyses. Plaque levels were measured before and immediately after toothbrushing. In addition, dental status and gingival bleeding were assessed.

Results:

After brushing to the best of their abilities, there was plaque on 50% (±24.72%) of all measured sites at the gingival margin (Marginal Plaque Index). Regression analyses revealed approximately 22% of the variance of marginal plaque on the outer surfaces to be explained by the time brushed by circular movements (β = −0.41;P < 0.001) and the number of sextants brushed for at least 7.5 s (β = −0.171; P < 0.05). Circular movements explained most additional variance (ΔR² = 0.113; P < 0.001). With respect to inner surfaces, none of the behavioral aspects explained any variance of oral cleanliness.

Conclusion:

Despite regular group prevention measures, 12-y-old children show limited skills to clean their teeth adequately. Furthermore, none of the recommended behaviors relates to oral cleanliness after toothbrushing at inner surfaces. As a consequence, it is necessary to explore further which behavioral sequences effectively improve oral cleanliness.

Knowledge Transfer Statement:

This study illustrates that children’s compliance to toothbrushing recommendations is not necessarily related to toothbrushing effectiveness. Clinicians should therefore assess the effectivity of recommendations individually and provide individual guidance for improvement.

Posttranslational modifications of HBV core protein

Infection with hepatitis B virus (HBV) often leads to development of chronic liver disease. In fact, 10% of infected adults and almost 90% of infected infants develop chronic hepatitis B associated with severe liver diseases, including acute liver failure, liver cirrhosis or hepatocellular carcinoma. At present there is no effective cure for chronic hepatitis B. The current treatment of chronically infected patients is long-term, expensive and relies on treatment with nucleos(t)ide analogs in combination with immune therapies, that frequently lead to adverse side effects. Recently, the National Institute of Health proposed strategic plan for Trans-NIH research to cure hepatitis B. The key priority is better understanding of HBV life cycle and its interactions with host cell. Due to the fact that HBV is a small double stranded DNA virus encoding only a limited number of proteins, HBV replication widely relies on host cell pathways and proteins. As demonstrated by numerous reports, HBV core protein (HBc) which is the main component of viral nucleocapsid, plays multiple roles in HBV life cycle and is engaged in many protein interaction networks of the host cell. Several recent studies have shown that HBV proteins can be modified by different types of posttranslational modifications (PTMs) that affect their protein-protein interactions, subcellular localization and function. In this review, we discuss diverse PTMs of HBc and their role in regulation of HBc function in the context of HBV replication and pathogenesis. Keywords: hepatitis B virus; posttranslational modifications; HBV core protein; phosphorylation; ubiquitination; arginine methylation.

The influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study

BACKGROUND

Epidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data.

METHODS

We included healthy parturients at a cervical dilation ≥2 cm, with or without a request for epidural analgesia (n=32 per group). Ultrasound studies of the uterine arteries, umbilical artery and fetal middle cerebral artery were performed before insertion of the epidural catheter, and 30, 60 and 90 min after; the same time-points were assessed in the non-epidural control group. Maternal blood pressure was measured by a continuous non-invasive arterial pressure monitor.

RESULTS

Ultrasound studies detected no significant differences in pulsatility indices over time in any blood vessel. In contrast to the control group, maternal blood pressures were significantly lower for all measures after the onset of analgesia compared with baseline values (mean systolic pressure decreased from 132.7 ± 15.9 mmHg to 123.1 ± 14.4 mmHg at 30 min, P=0.003). The mean pH value of the umbilical arterial blood was 7.29 (±0.06) in the epidural group versus 7.31 (±0.08) in the control group (P=0.33). The median Apgar score at 5 min was 10 in both groups.

CONCLUSIONS

Pre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.

Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn's Disease: A Population-based Study

INTRODUCTION

Most studies of elderly-onset Crohn's disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD.

METHOD

All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD.

RESULTS

A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10-4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6-5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up.

CONCLUSION

During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.

The Maximum of Minimal Conductivity in Aqueous Electrolytes

The present paper deals with the minima of conductivity in aqueous solutions, which occur due to the hydrolysis reaction with added bases. The minima show lower conductivities than the intrinsic conductivity of pure water. The minimum is a function of the molar conductivity of the added ions. There exists a limiting condition of <75.825 ⋅ 10−4 S ⋅ m2 ⋅ mol−1 for the occurrence of a minimum in the real (positive) concentration area. Values higher than 75.825 ⋅ 10−4 S ⋅ m2 ⋅ mol−1 lead to minimas in the virtual (negative) concentration area. Connecting all the minima, a curve with a maximum is observed. This point is given by 75.825 ⋅ 10−4 S ⋅ m2 ⋅ mol−1 and the intrinsic conductivity of pure water. The effect is independent of whether the added substances come from a strong or weak base. So far, the phenomenon should not influence measurements of conductivity under usual circumstances, but might be more of academic interest. Interestingly, we found that the effect for Rubidium and Cesium ions is different compared to other alkali metal ions. No minimum conductivity is predicted for these ions.

Identification of Rosellinia species as producers of cyclodepsipeptide PF1022 A and resurrection of the genus Dematophora as inferred from polythetic taxonomy

Rosellinia (Xylariaceae) is a large, cosmopolitan genus comprising over 130 species that have been defined based mainly on the morphology of their sexual morphs. The genus comprises both lignicolous and saprotrophic species that are frequently isolated as endophytes from healthy host plants, and important plant pathogens. In order to evaluate the utility of molecular phylogeny and secondary metabolite profiling to achieve a better basis for their classification, a set of strains was selected for a multi-locus phylogeny inferred from a combination of the sequences of the internal transcribed spacer region (ITS), the large subunit (LSU) of the nuclear rDNA, beta-tubulin (TUB2) and the second largest subunit of the RNA polymerase II (RPB2). Concurrently, various strains were surveyed for production of secondary metabolites. Metabolite profiling relied on methods with high performance liquid chromatography with diode array and mass spectrometric detection (HPLC-DAD/MS) as well as preparative isolation of the major components after re-fermentation followed by structure elucidation using nuclear magnetic resonance (NMR) spectroscopy and high resolution mass spectrometry (HR-MS). Two new and nine known isopimarane diterpenoids were identified during our mycochemical studies of two selected Dematophora strains and the metabolites were tested for biological activity. In addition, the nematicidal cyclodepsipeptide PF1022 A was purified and identified from a culture of Rosellinia corticium, which is the first time that this endophyte-derived drug precursor has been identified unambiguously from an ascospore-derived isolate of a Rosellinia species. While the results of this first HPLC profiling were largely inconclusive regarding the utility of secondary metabolites as genus-specific chemotaxonomic markers, the phylogeny clearly showed that species featuring a dematophora-like asexual morph were included in a well-defined clade, for which the genus Dematophora is resurrected. Dematophora now comprises all previously known important plant pathogens in the genus such as D. arcuata, D. bunodes, D. necatrix and D. pepo, while Rosellinia s. str. comprises those species that are known to have a geniculosporium-like or nodulisporium-like asexual morph, or where the asexual morph remains unknown. The extensive morphological studies of L.E. Petrini served as a basis to transfer several further species from Rosellinia to Dematophora, based on the morphology of their asexual morphs. However, most species of Rosellinia and allies still need to be recollected in fresh state, cultured, and studied for their morphology and their phylogenetic affinities before the infrageneric relationships can be clarified.

Neoadjuvant immunotherapy with combined ipilimumab and nivolumab in patients with melanoma with primary or in transit disease

The introduction of new therapeutic agents has revolutionized the treatment of metastatic melanoma. The approval of adjuvant anti-programmed death-1 monotherapy with nivolumab or pembrolizumab, and dabrafenib plus trametinib has recently set a new landmark in the treatment of stage III melanoma. Now, clinical trials have shown that immune checkpoint blockade can be performed in a neoadjuvant setting, an approach established as a standard therapeutic approach for other tumour entities such as breast cancer. Recent studies suggest that a pathological response achieved by neoadjuvant immunotherapy is associated with long-term tumour control and that short neoadjuvant application of checkpoint inhibitors may be superior to adjuvant therapy. Most recently, neoadjuvant ipilimumab plus nivolumab in stage III melanoma was reported. With two courses of dose-optimized ipilimumab (1 mg kg^-1 ) combined with nivolumab (3 mg kg^-1 ), pathological responses were observed in 77% of patients, while only 20% of patients experienced grade 3 or 4 adverse events. However, the neoadjuvant trials employing combined immune checkpoint blockade conducted so far have excluded patients with in transit metastases, a common finding in stage III melanoma. Here we report four patients with in transit metastases or an advanced primary tumour who have been treated with neoadjuvant ipilimumab plus nivolumab according to the OpACIN-neo trial scheme (arm B). All patients achieved radiological disease control and a pathological response. None of the patients has relapsed so far. Linked Comment: Blankenstein and van Akkooi. Br J Dermatol 2020; 183:421-422.

P1485Left atrial reservoir function is associated with major adverse cardiac events in patients undergoing transarterial valve implantation for isolated severe aortic stenosis

Background

Left atrial (LA) reservoir function as measured by LA global longitudinal strain (LAGS) is an independent predictor of left ventricular (LV) performance and has prognostic value.

Purpose

To evaluate by speckle tracking echocardiography (STE), LAGS and other myocardial deformation indices changes after transarterial valve implantation (TAVI) for severe isolated aortic stenosis (AS) in relation to the outcome measures.

Methods

Of 995 pts who underwent TAVI at our Institution between 2017–18, 120 (age = 82.8±7.7 years, 74% female, AVAi = 0.37±0.09 cm2/m2, LVEF = 61.6±11.3%, no > than 2+ mitral or aortic regurgitation, all in NSR) underwent 2-D echocardiography and STE, pre (21±34 days) and post (16±27 days) TAVI. LAGS was measured at QRS onset, and LV global longitudinal strain (LVGS) and RV free wall strain were recorded. The velocity index = peak vel LVOT/AV. Phillips IE 33 scanners (frame rates 60–80 Hz) were used and one observer analyzed data on QLAB software. The median follow-up was 208 days (range 20–763). The outcome variable was a composite of death, atrial fibrillation and hospitalization for heart failure (MACE). Univariate and multivariable logistic regression were used to determine independent predictors of LA, LV and RV free wall global strain changes (covariates; age, sex, BSA, LVEF, systolic blood pressure, LA volume index) and, separately, for predictors of MACE (covariates; age, sex, AVA index, LVEF and E/e'). Intra- and interclass correlation coefficients (ICC) were calculated.

Results

The intra- and inter-observer ICC was 0.70–0.90 and 0.90–0.95, respectively. In the absence of LA volume change, LAGS improved post TAVI in 54% of pts. Overall, mean change was 2.2±11.6% (95% CI; 0.05, 4.3) and it was significantly associated in multivariable analysis with RV free wall strain (OR=2.7, 95% CI; 1.2, 6), velocity index (OR=0.4, 95% CI; 0.2, 1), LVEF (OR= 0.3, 95% CI; 0.2, 0.8) and LVGS (OR=3.8, 95% CI; 1.4, 10), yielding together an AUC of 0.90. LVGS improved in 64% of pts by −2.8±7.5%, (95% CI: −4.2, −1.5) and the velocity index independently predicted the LVGS change (OR = 0.6; 95% CI: 0.4, 0.9). The other deformation indices did not significantly change. At follow-up, there were 6 hospitalizations for heart failure, 5 atrial fibrillation events and 6 deaths. At multivariable logistic regression analysis, post TAVI LAGS was the only variable independently predicting MACE (OR (in units of 1%) = 0.90, 95% CI; 0.82, 0.98), estimating that a 1% increase in post-LAGS decreases the likelihood of MACE by 10%.

Conclusions

1. There was no relationship between LA systolic volume and LAGS change after TAVI. 2. Within a month after the procedure, LAGS improves in less than half of pts and is directly associated with both ventricles systolic function and AS severity. 3. At a median of 9 months after TAVI, post procedural LAGS is an independent predictor of MACE and could be used in the risk stratification of such pts.

P3376Software-based automated CT analysis for planning TAVI-Procedures: Systematic validation against expert and novice human interpretation

Introduction

Cardiac computed tomography (CT) is an established modality for planning TAVI procedures.

We validated CT parameters measured by automated software analysis and by newly trained readers against expert readers.

Methods

Consecutive patients with symptomatic severe aortic valve stenosis referred for CT assessment of the aortic root prior to TAVI were included in this analysis. Measurements were performed manually by an expert reader, a newly trained reader as well as semi-automatically using a commercially available workstation. Manual measurements were performed as per clinical standard. For semi-automatic analysis, CT data sets were exported to a dedicated workstation with fully automated detection of the aortic annulus plane.

Results

Out of 159 consecutive patients, 146 patients were included in this analysis (83+10 years). The median annulus area for expert reader, newly trained reader and software measurement was 468 mm2, 511 mm2 and 513 mm2, respectively (p=0.28) whereas the mean annulus diameter showed a mean±SD of 25.6±2 mm, 25.5±2 mm and 25.6±2 mm, respectively, p=0.47. Agreement between expert and newly trained reader for annulus area was good with Bland-Altman analysis showing a systematic overestimation of the annulus area for the newly trained reader of 16 mm2 (95% limits of agreement 42 to −74 mm2) and for automatic software of 20 mm2 (95% limits of agreement 60 to −99 mm2). Assuming an annulus area-based recommendation for a balloon-expandable Sapien 3 prosthesis (23, 26 or 29 mm prosthesis), kappa statistics revealed moderate agreement between expert measurement, newly trained reader and software measurement (κ 0.60 for newly trained reader, κ 0.58 for software measurement, p<0.0001 for all). The time needed for annulus adjustment measurement for the newly trained reader compared to software measurement was 2±0.6 minutes vs. 1±0.5 minutes, respectively, p<0.0001). The software correctly identified the annulus plane without reader correction in 49% of cases and in 51% of cases manual correction of the cusp insertion point or annular tracing had to be performed. Agreement between expert predicted angulation and software predicted angulation was excellent in 55%, good in 29% vs. 31%, moderate in 11% vs. 6% and fair in 5% vs. 8% for LAO/RAO orientation, CAU/CRA orientation, respectively (assuming excellent agreement when difference: <5°, good agreement: 5–10°, moderate agreement: 10–15° and fair agreement: >15°).

Conclusion

Novice human interpretation manually and with semi-automatic assessment of the aortic root for planning TAVI procedures is feasible with good agreement with expert measurement for annulus dimensions and prediction of implantation angles, however with a trend for systematic overestimation of the annulus area. For semi-automatic assessment, reader correction of cusp insertion point and annular dimensions have to corrected for in 50% of cases

P715Deletion of fibroblast activation protein decreases experimental atherosclerotic plaque formation and vulnerability

Background

Fibroblast activation protein (FAP) is a serine protease that is upregulated in sites of tissue remodeling, including arthritis, tumors and atherosclerosis. We have reported that FAP degrades type I collagen in human thin-cap fibroatheromata; its expression is enhanced in advanced human plaques and induced by inflammation. However, the role of endogenous FAP in atherosclerosis remains unknown.

Purpose

To investigate the effects of constitutive Fap loss-of-function on atherosclerotic plaque formation and vulnerability.

Methods and results

Male 8-week-old Apoe−/− Fap+/+ and Apoe−/− Fap−/− mice were fed a high-cholesterol diet (1.25% chol) for 12 weeks. En face analyses of thoracoabdominal aortae using Oil Red O (ORO) revealed decreased plaques in Apoe−/− Fap−/− mice (5.7±0.5%; n=21) compared to Apoe−/− Fap+/+ mice (10.7±0.7%; n=24; p<0.0001). In parallel, ORO analyses of serial aortic root cross sections showed diminished plaques in Fap-deficient mice (18.4±3.4% vs 27.6±2.1%). As a surrogate of plaque vulnerability, fibrous cap thickness was increased in Apoe−/− Fap−/− mice (65±6 mm vs 35±3 mm; p<0.01), whereas necrotic core size, plaque macrophages (CD68) and T cells (CD3) accumulation, as well as VCAM1 expression did not differ. These changes were independent of plasma triglycerides, total and LDL-cholesterol levels. Plasma of Fap-deficient mice showed decreased FAP activity compared to Fap wildtype controls. Notably, second harmonics generation in cross sections of aortic root plaques showed that the deposition and density of fibrillar collagens was enhanced in Fap-deficient (25.5±4.4%) compared to control plaques (13.8±2.5%; p<0.05). Consistently, Fap deletion led to an accumulation of uncleaved pre-COL3A1, a proteolytic target of FAP.

Conclusions

Constitutive Fap deletion decreases experimental atherosclerosis and features of plaque vulnerability. Thus, inhibition of FAP expression or activity may be a promising therapeutic target in atherosclerosis.

Acknowledgement/Funding

Swiss National Science Foundation, Swiss Heart Foundation

A Closer Look at the Bonding Capacity of Thick Metal-Plastic Hybrids

Metal-plastic hybrids have a lot of advantages compared to purely metal or purely plastic parts. A good design for metal-plastic hybrids can help to save weight, for example in automotive applications. Therefore, it is important to understand the joining mechanisms between both materials. Aluminum AlSi9Cu3(Fe) and polyamide 6.6 with 35 % glass fibers were used as joining partners. The materials were joined by enclosing the metal part at least partially with plastic right inside the injection molding tool. Afterwards, the tensile strength of the metal-plastic hybrids was tested under a quasi-static load. This article provides a short overview of publications related to this topic, and compares their conclusions with our own results. The focus is on the influence of the surface treatment on the metal part (shot-peening) and also the effects of different joining geometries within the bonding area. Statements made in other publications were able to be confirmed and expanded for shot-peened surfaces and particular joining geometries. In most cases, shot-peening the surface of metal parts is advantageous for the joining strength. If the strength of the bond is not important, but, instead, the achievable displacement is, a shot-peened surface is not always advantageous. In addition, the joining geometries have a large influence on the behavior of the part under static load.

Origin of the Preferential Formation of Helicenes in Mallory Photocyclizations. Temperature as a Tool to Influence Reaction Regiochemistry

The regiochemistry of four bis-Mallory photocyclization substrates has been examined from experimental and computational perspectives. Formation of all three possible regioisomers was only observed in the reaction of one of the substrates. In the other three substrates, only the two C₂-symmetric products, but not the C₁ product, were formed. In the three reactions that only formed two products, the photocyclization temperature could be used to select for exclusive formation of one or the other regioisomer. The use of temperature to select between two regioisomers also worked in the photocyclization of the substrate that formed three products. However, no temperature was located for exclusive formation of the third component, one of the C₂-symmetric products, which always formed alongside either one or both of its regioisomers. B3LYP/6-311+G(2d,p) calculations were used to determine the energies of all of the dihydrophenanthrene (DHP), tetrahydrophenanthrene (THP), and mono-Mallory photocyclization intermediates. The oscillator strengths of the DHP precursors to the helicene products were a factor of 4.8-9.2 smaller than those of competitively formed DHPs. This observation suggests that establishment of a photostationary state is responsible for the preferential formation of helicenes that has been observed as a unique and useful feature of many Mallory photocyclizations.

New micro/mesoporous nanocomposite material from low-cost sources for the efficient removal of aromatic and pathogenic pollutants from water

A new micro/mesoporous hybrid clay nanocomposite prepared from kaolinite clay, Carica papaya seeds, and ZnCl2 via calcination in an inert atmosphere is presented. Regardless of the synthesis temperature, the specific surface area of the nanocomposite material is between ≈150 and 300 m2/g. The material contains both micro- and mesopores in roughly equal amounts. X-ray diffraction, infrared spectroscopy, and solid-state nuclear magnetic resonance spectroscopy suggest the formation of several new bonds in the materials upon reaction of the precursors, thus confirming the formation of a new hybrid material. Thermogravimetric analysis/differential thermal analysis and elemental analysis confirm the presence of carbonaceous matter. The new composite is stable up to 900 °C and is an efficient adsorbent for the removal of a water micropollutant, 4-nitrophenol, and a pathogen, E. coli, from an aqueous medium, suggesting applications in water remediation are feasible.

Prevalence and the role of CCR5Δ32 heterozygosity in disease progression in HIV positive patients in the Czech Republic

BACKGROUND

Entry of human immunodeficiency virus type 1 (HIV-1) in target cells is enabled by CD4 receptor and one of two co-receptors, CXCR4 or CCR5. Deletion of 32 bp in CCR5 gene (CCR5Δ32) in both alleles provides strong but not absolute resistance to HIV-1 infection and deletion in one allele slows disease progression to AIDS. Here, we analyzed the prevalence and the role of CCR5Δ32 heterozygosity on the disease progression in HIV positive patients in the Czech Republic.

PATIENTS AND METHODS

A total of 92 HIV-1 seropositive subjects that included 80 Czech individuals from the AIDS center in the Hospital Na Bulovce in Prague were enrolled in CCR5 genotyping as a part of a study of the role of HIV fitness on disease progression. DNA was extracted from patient’s peripheral blood mononuclear cells and subjected to real-time PCR with specific probes detecting wild-type and 32 bp-deleted CCR5 variants. A subgroup of 74 antiretroviral therapy-naive patients with more than one year of follow-up was used to determine the role of the CCR5Δ32 heterozygous phenotype in disease progression.

RESULTS

CCR5Δ32 was found heterozygous in 23.8% of 80 Czech HIV-1 seropositive individuals which is very similar to 21% and 24% prevalence reported in HIV negative Czech population. Homozygous mutant variant was not detected. In CCR5Δ32 heterozygous group we observed slightly higher mean CD4+ T-cell count and lower mean plasma viremia levels.

CONCLUSIONS

Overall, our study indicates no obvious benefit of CCR5Δ32 heterozygosity on HIV transmission and only small benefit on disease progression in the Czech HIV-1 cohort.

Data for Adherence Decision Support

Technological interventions aimed at addressing medication non-adherence have shown some promise but do not deliver the full potential of an Internet of Things based Adherence Decision Support (ADS) system due, in part, to a lack high-resolution definition and measure of adherence. This paper presents a novel methodology and pilot study aimed at collecting data to support an AI-based measure of adherence. The pilot study results demonstrate the viability of the methodology and that a full-scale study could provide meaningful data to support to an AI-based ADS system.

Expanding the Capability of Microwave Multiplexed Readout for Fast Signals in Microcalorimeters

Microwave SQUID multiplexing has become a key technology for reading out large arrays of X-ray and gamma-ray microcalorimeters with mux factors of 100 or more. The desire for fast X-ray pulses that accommodate photon counting rates of hundreds or thousands of counts per second per sensor drives system design toward high sensor current slew rate. Typically, readout of high current slew rate events is accomplished by increasing the sampling rate, such that rates of order 1MHz may be necessary for some experiments. In our microwave multiplexed readout scheme, the effective sampling rate is set by the frequency of the flux-ramp modulation (f r) used to linearize the SQUID response. The maximum current slew rate between samples is then nominally Φ 0 f r/2M in (where M in is the input coupling) because it is generally not possible to distinguish phase shifts of > π from negative phase shifts of < -π. However, during a pulse, we know which direction the current ought to be slewing, and this makes it possible to reconstruct a pulse where the magnitude of the phase shift between samples is > π. We describe a practical algorithm to identify and reconstruct pulses that exceed this nominal slew rate limit on the rising edge. Using pulses produced by X-ray transition-edge sensors, we find that the pulse reconstruction has a negligible impact on energy resolution compared to arrival time effects induced by under-sampling the rising edge. This technique can increase the effective slew rate limit by more than a factor of two, thereby either reducing the resonator bandwidth required or extending the energy range of measurable photons. The extra margin could also be used to improve crosstalk or to decrease readout noise.

Towards a Clinical Analytics Adoption Maturity Framework for Primary Care

Clinical decision support systems are evolving with growing analytics capabilities towards pervasive use of artificial intelligence. Maturity models can guide the adoption of these new technologies in clinical practice to improve patient outcomes in primary care settings. Our literature survey identified the "Health Analytics Adoption Maturity Model" by Canada Health Infoway as a suitable basis for developing an adoption maturity framework with primary care focus. We follow a design-science research paradigm to develop a scientifically-validated mixed-method approach for assessing and guiding the evolution of clinical analytics capabilities in primary care. This paper summarizes the first phase of our research in progress.