bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of raltegravir, etravirine and darunavir/ritonavir for treatment-experienced HIV patients from a non-urban clinic population in the United States
Authors: Ebers Andrew M. , Alkabab Yusra , Wispelwey Brian , Dillingham Rebecca , Wang Xin-Qun , Schexnayder Julie , Heysell Scott K.
Published: September 2017

Background:

The regimen of raltegravir (RAL), ritonavir-boosted darunavir (DAR/r), and etravirine (ETR) for HIV treatment-experienced patients in a non-clinical trial setting in the rural/semi-urban United States had not been evaluated.

Objective:

A retrospective cohort analysis was performed of adult patients prescribed the regimen from 2008 to 2013 at a HIV clinic serving such a population.

Results:

In all, 51 patients met inclusion criteria including 15 with suppressed viral loads at regimen initiation. Of the 36 patients with detectable viral loads, 22 (61.1%) achieved a plasma HIV-1 RNA level < 50 copies/ml at 28 weeks and 17 maintained viral suppression at 56 weeks (50% of those surviving without death). Of 42 patients with long-term follow-up, mean of 216 ± 83 weeks following regimen initiation, 31 (73.8%) had viral suppression. Suppression was significantly more likely in those patients that maintained adherence.

Conclusions:

In a non-urban clinic population from the United States with considerable treatment experience, the combination of RAL, DAR/r, and ETR was well tolerated and resulted in viral suppression in those that maintained adherence. Future prospective studies may better define the role of such a regimen in the context of revised recommendations for first-line medications in the HIV treatment naïve.
Race and Rehabilitation Destination After Elective Total Hip Arthroplasty: Analysis of a Large Regional Data Set
Authors: Vina Ernest R. , Kallan Michael J. , Collier Aliya , Nelson Charles L. , Ibrahim Said A.
Published: September 2017

Background:

Three-quarters of patients who undergo total hip replacement (THR) receive postsurgical rehabilitation care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or through a home health agency. The objectives of this study are to examine racial differences where THR recipients receive postsurgical rehabilitation care and determine whether discharge destination is associated with hospital readmission.

Methods:

Using the Pennsylvania Health Care Cost Containment Council database, we selected African American (AA) or white adults who underwent THR surgery (n = 68,016). We used multinomial logistic regression models to assess the relationship between race and postsurgical discharge destination. We calculated 90-day hospital readmission as function of discharge destination.

Results:

Among patients <65 years, compared to whites, AAs had a higher risk of discharge to an IRF (adjusted relative risk ratio [aRRR]: 2.56, 95% confidence interval [CI]: 1.77-3.71) and a SNF (aRRR 3.37, 95% CI: 2.07-5.49). Among those ≥65 years, AA patients also had a higher risk of discharge to an IRF (aRRR: 1.96, 95% CI: 1.39-2.76) and a SNF (aRRR: 3.66, 95% CI: 2.29-5.84). Discharge to either IRF or SNF, instead of home with self-care, was significantly associated with higher odds of 90-day hospital readmission (<65 years: adjusted odds ratio [aOR]: 4.06, 95% CI: 3.49-4.74; aOR: 2.05, 95% CI: 1.70-2.46, respectively; ≥65 years: aOR: 4.32, 95% CI: 3.67-5.09, respectively; aOR: 1.74, 95% CI: 1.46-2.07, respectively).

Conclusions:

Compared to whites, AAs who underwent THR were more likely to be discharged to an IRF or SNF. Discharge to either facility was associated with a higher risk of hospital readmission.
A Business Paradigm for Corporate Shubh–Labh: An Inquest Study
Authors: Garg Ruchi , Saluja Deepika
Published: September 2017

This study primarily is an inquiry into the business implication of wisdom enshrined in the ancient Indian scriptures for building ethical businesses. This study draws from ethics-related literature and the relationship between kings and subjects from ancient Indian scriptures, to demonstrate the point of convergence and divergence between ancient era and modern management approach for business. The authors suggested three models, namely, Swastika model, “transition from capitalistic to holistic approach,” and trinity model. The models developed in this article forms that foundational basis for the concept of “principles of management” that can be used as basic principles to be adopted by corporate managers. This article concludes with suggestions that would lead us a step further in the direction of creating the Shubh and Mangalam all around.
Distal Fibula Fractures in National Football League Athletes
Authors: Werner Brian C. , Mack Christina , Franke Kristina , Barnes Ronnie P. , Warren Russell F. , Rodeo Scott A.
Published: September 2017

Background:

Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes’ season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition.

Purpose:

To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture rates in NFL athletes by position, type of play, and contact type; (3) determine the rates of distal fibula fracture surgery in NFL athletes; and (4) report the days missed due to distal fibula fractures in NFL athletes.

Study Design:

Descriptive epidemiology study.

Methods:

A retrospective review of distal fibula fractures reported to the NFL from 2000 to 2014 was performed using the NFL Injury Surveillance System. All distal fibula fractures were included, along with isolated and combined fracture patterns. Stress fractures and proximal fibula fractures were excluded. Epidemiological data and rates of surgery were determined. Return to sport was calculated and stratified by injury pattern and management.

Results:

Overall, 237 distal fibula fractures in NFL athletes from 2000 to 2014 were included; 197 (83%) were isolated distal fibula fractures. A mean of 16 distal fibula fractures occurred each year (median, 16 per year). Fractures occurred most frequently on running (38%) and passing (24%) plays, but the frequency was next highest on kickoffs (16%), despite the relative infrequency of kickoffs during the average game compared with other play types. Surgery was reported for more than half of all distal fibula fractures (n = 128, 54%). Overall, patients who underwent surgery missed significantly more days (mean, 123.8 days) than players who did not undergo surgery (mean, 75.3 days) ( P < .001). Players with isolated distal fibula fractures had significantly fewer days missed (mean, 93.6 days) compared with those with combined patterns (mean, 132.3 days) ( P = .0004).

Conclusion:

Fibula fractures affect a number of NFL athletes and result in significant time missed from competition. Further research is required to determine the optimal management of fibula fractures in NFL athletes. In this study, time to return to play depended on both the fracture pattern and whether surgery was required and ranged from 72 to 145 days.
The Use of Contrast-Enhanced Ultrasonography for the Characterization of Focal Liver Lesions
Authors: Bagley Jennifer E. , Paul Dennis E. , Halferty Sutton , DiGiacinto Dora
Published: September 2017

Focal liver lesions often occur with or without an underlying liver disease. Contrast-enhanced ultrasonography can aid in characterizing liver lesions, potentially avoiding biopsy and computed tomography procedures. Contrast-enhanced ultrasonography has a high sensitivity and specificity for differentiating characteristics of liver lesions compared with noncontrast sonography. The different contrast characteristics aid in differentiating benign and malignant lesions. Malignant lesions tend to have washout of contrast in the venous phases, whereas benign lesions have hyperenhancement during the venous phases. Therefore, contrast-enhanced ultrasonography should be considered an essential component of the diagnostic process for diagnosing and following focal liver lesions.
Estimate of dynamic change of fluid saturation during CO2 injection — Case study of a regional aquifer in Croatia
Authors: Vulin Domagoj , Saftić Bruno , Macenić Marija
Published: September 2017

Total carbon dioxide ([Formula: see text]) storage capacities are estimated in numerous studies, but there is a lack of research of possible injection rates at a particular site. We have performed compositional simulation with permeability variation (based on log-normal distribution parameters of the measured data from similar formations in an oil field above the aquifer) to include changes of aqueous and gaseous phase properties (composition, viscosities, density), and heterogeneity of a regional [Formula: see text] storage site. We have performed sensitivity tests on vertical permeability multiplier, different grid block sizes, diffusivity, and capillary pressures to detect the key parameters for injectivity and storage efficiency. In this way, we modeled heterogeneity of a [Formula: see text] storage site and the possible injection rate in this detail for the first time. Based on pressure analysis in simulation cases, we found that it will be hard to avoid fracturing the near-wellbore zone, but fracturing these zones might also increase the injectivity, and this can still be done without damaging the cap rock. Simulation results indicated that maximum pressure will occur in zones above wellbores at the short period after the injection, and almost no change of average pressure in the regional aquifer will be noticeable, which leads to the conclusion that the total (theoretical) storage capacity is not the key issue for [Formula: see text] storage in aquifers and that injectivity for the storage site (expressed as the rate) should be the key parameter for selecting the pilots for [Formula: see text] storage.
Characterizing Chilean blue whale vocalizations with DTAGs: a test of using tag accelerometers for caller identification
Authors: Saddler Mark R. , Bocconcelli Alessandro , Hickmott Leigh S. , Chiang Gustavo , Landea-Briones Rafaela , Bahamonde Paulina A. , Howes Gloria , Segre Paolo S. , Sayigh Laela S.
Published: September 2017

Vocal behavior of blue whales (Balaenoptera musculus) in the Gulf of Corcovado, Chile, was analyzed using both audio and accelerometer data from digital acoustic recording tags (DTAGs). Over the course of three austral summers (2014, 2015, 2016), seventeen tags were deployed, yielding 124 hours of data. We report the occurrence of Southeast Pacific type 2 (SEP2) calls, which exhibit peak frequencies, durations, and timing consistent with previous recordings made using towed and moored hydrophones. We also describe tonal downswept (D) calls, which have not been previously described for this population. Since being able to accurately assign vocalizations to individual whales is fundamental for studying communication and for estimating population densities from call rates, we further examine the feasibility of using high-resolution DTAG accelerometers to identify low-frequency calls produced by tagged blue whales. We cross-correlated acoustic signals with simultaneous tri-axial accelerometer readings in order to analyze the phase match as well as the amplitude of accelerometer signals associated with low-frequency calls, which provides a quantitative method of determining if a call is associated with a detectable acceleration signal. Our results suggest that vocalizations from nearby individuals are also capable of registering accelerometer signals in the tagged whale's DTAG record. We cross-correlate acceleration vectors between calls to explore the possibility of using signature acceleration patterns associated with sounds produced within the tagged whale as a new method of identifying which accelerometer-detectable calls originate from the tagged animal.
Hydrodynamic function of dorsal fins in spiny dogfish and bamboo sharks during steady swimming
Authors: Maia Anabela , Lauder George V. , Wilga Cheryl D.
Published: September 2017

A key feature of fish functional design is the presence of multiple fins that allow thrust vectoring and redirection of fluid momentum to contribute to both steady swimming and maneuvering. A number of previous studies have analyzed the function of dorsal fins in teleost fishes in this context, but the hydrodynamic function of dorsal fins in freely-swimming sharks has not been analyzed, despite the potential for differential functional roles between the anterior and posterior dorsal fins. Previous anatomical research has suggested a primarily stabilizing role for shark dorsal fins. We evaluated the generality of this hypothesis by using time-resolved particle image velocimetry to record water flow patterns in the wake of both the anterior and posterior dorsal fins in two species of freely-swimming sharks: bamboo sharks (Chiloscyllium plagiosum) and spiny dogfish (Squalus acanthias). Cross correlation analysis of consecutive images was used to calculate stroke-averaged mean, longitudinal and lateral velocity components, and vorticity. In spiny dogfish, we observed a velocity deficit in the wake of the first dorsal fin and flow acceleration behind the second dorsal fin, indicating that the first dorsal experiences net drag while the second dorsal fin can aid in propulsion. In contrast, the wake of both dorsal fins in bamboo sharks displayed increased net flow velocity in the majority of trials, reflecting a thrust contribution to steady swimming. In bamboo sharks, fluid flow in the wake of the second dorsal fin had higher absolute average velocity than the first dorsal fin, and this may result from a positive vortex interaction between the first and second dorsal fins. These data suggest that the first dorsal fin in spiny dogfish has primarily a stabilizing function, while the second dorsal fin has a propulsive function. In bamboo sharks both dorsal fins can contribute thrust and should be considered as propulsive adjuncts to the body during steady swimming. The function of shark dorsal fins can thus differ considerably among fins and species, and is not limited to a stabilizing role.
Micro-epidemiological structuring of Plasmodium falciparum parasite populations in regions with varying transmission intensities in Africa
Authors: Omedo Irene , Mogeni Polycarp , Bousema Teun , Rockett Kirk , Amambua-Ngwa Alfred , Oyier Isabella , Stevenson Jennifer C. , Baidjoe Amrish Y. , de Villiers Etienne P. , Fegan Greg , Ross Amanda , Hubbart Christina , Jeffreys Anne , Williams Thomas N. , Kwiatkowski Dominic , Bejon Philip
Published: September 2017

Background: The first models of malaria transmission assumed a completely mixed and homogeneous population of parasites.  Recent models include spatial heterogeneity and variably mixed populations. However, there are few empiric estimates of parasite mixing with which to parametize such models.

Methods: Here we genotype 276 single nucleotide polymorphisms (SNPs) in 5199 P. falciparum isolates from two Kenyan sites (Kilifi county and Rachuonyo South district) and one Gambian site (Kombo coastal districts) to determine the spatio-temporal extent of parasite mixing, and use Principal Component Analysis (PCA) and linear regression to examine the relationship between genetic relatedness and distance in space and time for parasite pairs.

Results: Using 107, 177 and 82 SNPs that were successfully genotyped in 133, 1602, and 1034 parasite isolates from The Gambia, Kilifi and Rachuonyo South district, respectively, we show that there are no discrete geographically restricted parasite sub-populations, but instead we see a diffuse spatio-temporal structure to parasite genotypes.  Genetic relatedness of sample pairs is predicted by relatedness in space and time.

Conclusions: Our findings suggest that targeted malaria control will benefit the surrounding community, but unfortunately also that emerging drug resistance will spread rapidly through the population.
Non-Elementary Formulations for Single Vehicle Routing Problems with Pickups and Deliveries
Authors: Bruck Bruno P. , Iori Manuel
Published: September 2017

We study the class of one-to-many-to-one single vehicle routing problems with pickups and deliveries, in which a single capacitated vehicle is used to serve a set of customers requiring a delivery, a pickup, or both. These problems have many real-world applications, including beverage distribution, courier service transportation, and reverse logistics. We first concentrate on a well-studied problem in this class, known as the single vehicle routing problem with deliveries and selective pickups (SVRPDSP), in which deliveries are mandatory but pickups are optional and generate a revenue if performed, and customers requiring both a delivery and a pickup (combined demand) can be visited either once or twice.

Most exact algorithms in the literature solve SVRPDSP by looking for elementary tours on an extended network that is obtained by transforming each combined demand customer into two different customers, one requiring only the delivery and the other one only the pickup. Because this can result in a significant loss in performance, in this work we focus instead on the original problem network and present formulations that can yield non-elementary tours. Through the use of Benders decomposition, valid inequalities, and tailored optimization techniques based on branch-and-cut frameworks, we develop exact algorithms that outmatch previous results in the literature and obtain proven optimal solutions for all benchmark instances. We then generalize the algorithms to solve several other vehicle routing problems with pickups and deliveries, including the cases of split deliveries, intermediate drop-offs, mandatory pickups, and multiple vehicles.

The online appendix is available at https://doi.org/10.1287/opre.2017.1639 .
Anatomy and physiology, 2. The cell and tissues
Authors: Peate Ian
Published: September 2017

This is the second article in the series focusing on anatomy and physiology. The first article ( Peate, 2017 ) looked at homeostasis and emphasised the need for the healthcare assistant and assistant practitioner (HCA and AP) to have an understanding of how the human body works and functions in illness and health as HCAs and APs offer people safe and effective care.

This second article of the series provides the HCA and AP with an overview of the cells and tissues of the body—understanding these components can help in ensuring that care is safe and appropriate. The cells are the basic building-blocks of all living things. The tissues are made from a group of cells with a similar structure.

In this article, the various aspects of the cells will be outlined and discussion concerning the tissues will be provided. At the end of the article, there is a glossary that can help in understanding some of the terms that have been used in the article. A short quiz is provided.
Falls in the residential independent care sector—ambiguity in guidelines and policies for healthcare assistants
Authors: Stonehouse David , Scott-Thomas Jeanette , Graham Yitka , Ling Jonathan , Barrigan Marie , Hayes Catherine
Published: September 2017

The need for healthcare assistants (HCAs) to have clear policies and guidelines in relation to when falls occur in domiciliary care settings is paramount. If first-line responses are to be appropriately tailored to patient need and discernment is to be used in determining the necessity for intervention by emergency care workers such as paramedics, then standardised frameworks and policies ought to be clearly apparent across care sectors.

Our work focused on the first-line response to patient falls in the independent care sector in a specific geographical region of north-east England. This article provides an insight into what our original findings revealed and how they might be used as a source of reflection for HCAs working in the residential independent care sector.

Using a basic questionnaire, we surveyed 24 (75%) of the 32 independent care sector homes in South Tyneside to establish how policies and guidelines in these organisations were understood by staff. Our findings highlight a diverse array of responses to falls in care home settings. While 96% of homes claimed to have a specific policy on falls, only 80% of them included an assessment of possible injury or harm to residents and 13% included no direct guidance for care staff in instances where residents fell and were still on the floor.

Even in instances where policies did include direct guidance, there was great variation in available information for staff, especially between domiciliary and care home settings. Most commonly, staff were advised to call an emergency ambulance, even in the absence of injury, if patients were found on the floor.

HCAs are working in contexts where there is apparently a high degree of ambiguity around the assessment of injuries sustained as a consequence of falls, particularly where potentially non-visible injuries occur, which are not immediately recognisable or symptomatic. There was also overlap between accident and falls policies, which added a further level of ambiguity to the most appropriate and immediate actions for HCAs to take.
Small Animal Review
Authors: Tennant Bryn
Published: September 2017

Introduction:

There is a need to minimise the use of prophylactic antimicrobial agents in the perioperative setting. With clean surgery the risk of a bacterial infection is very low, but the risk of microbial resistance developing is high. If prophylactic use is necessary it is essential that antimicrobial agents are used appropriately.
Ouch! Understanding and reducing patients' frustration to improve patient welfare and reduce staff injuries
Authors: Hargrave Claire
Published: September 2017

Frustration remains a poorly understood emotion. However, the manifestations of frustration are frequently encountered in the veterinary practice environment, where animals that are failing to cope strive to retain autonomy over their bodies; their experience of pain, anxiety or fear; and access to resources that they consider necessary for their survival. These animals may resort to frustration-driven aggressive behaviours. Frustration not only drives the veterinary patient's initial struggles to retain a concept of coping and control over what is occurring, but it invigorates and escalates behaviours intended to create distance. Hence, frustration-related patient behaviours in the veterinary practice can interfere with patient welfare; hinder, and potentially result in injury to, staff; and distress owners.
Immunisation in the elderly
Authors: Duncan Deborah Louise
Published: September 2017

There is an increase in infectious diseases, such as influenza and pneumonia, presenting in the elderly population, which can lead to a significant proportion of hospital admissions or morbidity. Vaccination is the most efficient strategy in preventing many diseases that affect this age group, such as Streptococcus pneumoniae and varicella zoster. This article will discuss the NHS national vaccination programme, and outlines three main vaccines that can help protect patients. These vaccinate against influenza, pneumococcal disease and herpes zoster.
Retention and recruitment
Authors: Cox Ella
Published: September 2017

Nursing has recently seen a decline in the numbers of people joining the profession, Ella Cox discusses how to entice students to become nurses and how structured training with pay awards would provide motivation and improve retention
Compreensão de textos: Diferenças em função da modalidade de apresentação da tarefa, tipo de texto e tipo de pergunta
Authors: Cadime Irene , Santos Sandra , Leal Teresa , Viana Fernanda Leopoldina , Rodrigues Bruna , Cosme Maria do Céu , Ribeiro Iolanda
Published: September 2017

Na literatura têm sido discutidos diversos fatores que podem influenciar a dificuldade das tarefas de compreensão de textos e, consequentemente, o desempenho dos sujeitos na avaliação. O objetivo deste estudo é perceber se a dificuldade das tarefas de avaliação da compreensão de textos varia em função da modalidade da tarefa de avaliação (oral versus escrita), do tipo de texto (narrativo versus informativo) e do tipo de compreensão avaliado pelas perguntas apresentadas (literal versus inferencial). Avaliaram-se 300 alunos do quarto ano de escolaridade, administrando quatro testes de compreensão de textos: Teste de compreensão de textos na modalidade oral-narrativo, Teste de compreensão de textos na modalidade oral-informativo, Teste de compreensão de textos na modalidade de leitura-narrativo, Teste de compreensão de textos na modalidade de leitura-informativo. Os resultados mostraram a inexistência de diferenças estatisticamente significativas na média da dificuldade das perguntas de compreensão oral e de compreensão da leitura, entre a dificuldade média das perguntas relativas a texto narrativo e informativo e entre a média da dificuldade das perguntas de compreensão literal e inferencial. Não foram observados efeitos de interação. Discutem-se as implicações destes resultados para a avaliação e intervenção no domínio da compreensão de textos, tendo em conta algumas limitações deste estudo.
Kecepatan Putaran Poros Pada Mesin Pembuat Pakan Pelet Berpenggerak Kayuh Sepeda
Authors: Nugroho Adi , Wibowonoto Arif
Published: September 2017

The background of this study is the human power inconsistensy to run the simple pellets machine spinner. One of the efforts is to use bicycle sprocket to transmit the power until it reaches the expected speed. The exact size of spocket is needed to gain the wanted speed which will be obtained through the speed rotation test on various size of spocket. Data collecting methode that are used on this study are literature study and observation. While data analysis is using parametric analysis technique and the measurement parameter variables are spocket size and axis spin speed (rpm). This research aims to determine the exact size of sprocket in order to reach 626 rpm. As it result is required 54 rpm at N₂ (18 T), 63 rpm at N₂ (21 T), and 72 rpm at N₂ (24 T) to reach 626 rpm. And the size of spockets are N₁ (34 T), N₂ (18 T, 21 T, 24 T), N₃ (42 T), N₄ (11T), N₅ (24 T) and N₆ (15 T).
Economic Contribution of Regional Feeder Ports to The Local Economy In Indonesia
Authors: Syabri Ibnu , Widyanarko Pritta Andrani
Published: September 2017

Indonesia regional feeder ports’ main function is to serve marine transport activities between regency/city in a province in limited quantities. The intention of the government to make marine transportation as the backbone of national logistic transportation system puts these ports to an important position, as suppliers for the main and/or collector ports and as goods distribution centers for the region from the bigger ports. Not only as a provider of accessibility between regions, regional feeder ports should be seen as an investation to boost regional economy. This study aims to explain the influences of regional feeder ports on regency/city economy, based on the port types: (1) cargo ports, and (2) cargo & passengers ports. Results showed that both types of ports have positive influences on the regency/city economy, although it is not related to region’s economic base sector. Cargo ports which are mainly located on west area of Indonesia, supports the region’s economy more than cargo & passenger ports which are mainly located on the east.
Aplikasi Pembelajaran Interaktif “Perang Padri” Menggunakan X-Box Kinect Untuk Meningkatkan Minat Siswa Dalam Mempelajari Sejarah Bangsa Indonesia
Authors: Ramadhona Azka , Dewi Meilany , Henim Silvana Rasio
Published: September 2017

A well recognition and understanding national history plays an important role in shaping the character of nation, especially Padri War history which tells about a dispute between two clans but then allied to defend against invaders. History’s subject in school which is taught by telling story and reading books makes student not interested in studying history. In this case, we need a different approach to makes student in fifth grade more interested to learn it. One of alternative learning media that can be applied to fifth graders is the application of Padri War. In this application, Padri War is described in 3D animation video and there are many of trivial questions in it to test user ability. The result of the application testing conducted to five teacher respondents concludes this interactive application could be the best alternative learning method for fifth grade elementary school student today. The conclusion reflects on the assessment indicators of 80% material aspect, 72.5 % general aspect, 78,9% quality display, presentation of the material to 75%, and 84% of user interaction. On the student respondents, the visual design aspect in the Padri War learning is worth 79.3%. Overall, presentation study material in the form of 3D animation video would certainly increase the interest of elementary students in learning history.
Review - bioactive glass implants for potential application in structural bone repair
Authors: Rahaman Mohamed N. , Xiao Wei , Huang Wenhai
Published: September 2017

Bioactive glass particles andweak scaffolds have been used to heal small contained bone defects but an unmet challenge is the development of bioactive glass implants with the requisite mechanical reliability and in vivo performance to heal structural bone defects. Inadequate mechanical strength and a brittle mechanical response have been key concerns in the use of bioactive glass scaffolds in structural bone repair. Recent research has shown the capacity to create strong porous bioactive glass scaffolds and the ability of these scaffolds to heal segmental bone defects in small and large rodents at a rate comparable to autogenous bone grafts. Loading these strong porous scaffolds with bone morphogenetic protein-2 can significantly enhance their ability to regenerate bone. Recentwork has also shown that coating the external surface of strong porous scaffolds with an adherent biodegradable polymer can dramatically improve their load-bearing capacity in flexural loading and their work of fracture (a measure of toughness). These tough and strong bioactive glass-polymer composites with an internal architecture conducive to bone infiltration could provide optimal synthetic implants for structural bone repair.
Contactless in ovo sex determination of chicken eggs
Authors: Galli Roberta , Koch Edmund , Preusse Grit , Schnabel Christian , Bartels Thomas , Krautwald-Junghanns Maria-Elisabeth , Steiner Gerald
Published: September 2017

We resume the research for contactless in ovo sex determination of the domestic chicken, which has the final aim to provide an alternative to day-old cockerels culling in the layer industry. In ovo Raman and fluorescence spectroscopy of blood of eggs incubated until day 3.5 enables correct sexing rates over 90% barely affecting the hatching rate. Full automatization of the processes to guarantee high sexing speed and fulfill industrial demands is required to allow transferring the technology inside the hatcheries in the next future.
Middle ear reconstruction with a flexible prosthesis
Authors: Stoppe Thomas , Bornitz Matthias , Lasurashvili Nikoloz , Sauer Kirsten , Zahnert Thomas , Beleites Thomas
Published: September 2017

The middle ear plays a crucial role in the quality of hearing. This complex construct performs different tasks like the protection against large air pressure input, the transmission of sound and its adaption to the inner ear impedance. Traumas, erosion by chronic otitis media or cholesteatoma, as well as other degenerative or damaging diseases, are reasons for a necessary reconstruction of specific middle ear structures. The reconstruction of the ossicular chain is very often performed by using rigid ossicular replacement prostheses made out of titanium, ceramics or bone. Tilting and dislocation of these passive implants are some of the known complications after middle ear surgery. They are related to loads at the implant coupling points in response to a tension change in the middle ear. The healing process, scar tension and ventilation problems are possible causes.

To increase the sound transmission quality of total reconstructions and safety in case of pressure dependent movement of the tympanic membrane, a novel flexible total ossicular replacement prosthesis (TORP) with a silicone coated ball joint prototype was developed and investigated. Besides measurements of first middle ear transfer functions of temporal bones, the mechanical properties of the flexible TORP were examined with stress relaxation investigations.

The novel silicone coated ball and socket joint TORP provides a sound transfer equivalent to the intact human middle ear at normal pressure and negative pressure in the middle ear. Together with the low stiffness values at an anatomically typical deflection of about 500 μm the prevention of a stiffening of the stapes annular ligament could be approved. Thus, improved acoustic transmission quality and reconstruction stability in comparison to common rigid titanium TORP could be determined. Nevertheless, further design improvements should be accomplished. The demonstrated flexible TORP can solve some common problems in middle ear reconstruction.
Biosignal-guided personalized therapy
Authors: von Stülpnagel Lukas , Wolf Bernhard , Bauer Axel
Published: September 2017

Sudden cardiac death (SCD) is the leading single cause of death in the industrialized world. Current guidelines recommend a prophylactic implantation of an implantable cardioverter-defibrillator (ICD) in patients with reduced left-ventricular ejection fraction (LVEF ≤ 35%). However, most deaths after myocardial infarction (MI) occur in patients with normal or moderately reduced LVEF (>35%). There is a large body of evidence that cardiac autonomic dysfunction after MI is linked to increased susceptibility to malignant arrhythmias. Deceleration capacity of heart rate (DC) and periodic repolarization dynamics (PRD) are novel ECG-based risk markers, which capture different facets of cardiac autonomic dysfunction. Both parameters are strong and independent predictors of mortality and SCD after MI. Previous studies indicated that combined assessment of DC and PRD allows identification of a new high-risk group among post-infarction patients that is not addressed by current guidelines, thus opening new perspectives for biosignal-guided personalized therapies.
EOG feature relevance determination for microsleep detection
Authors: Golz Martin , Wollner Sebastian , Sommer David , Schnieder Sebastian
Published: September 2017

Automatic relevance determination (ARD) was applied to two-channel EOG recordings for microsleep event (MSE) recognition. 10 s immediately before MSE and also before counterexamples of fatigued, but attentive driving were analysed. Two type of signal features were extracted: the maximum cross correlation (MaxCC) and logarithmic power spectral densities (PSD) averaged in spectral bands of 0.5 Hz width ranging between 0 and 8 Hz. Generalised learn-ing vector quantisation (GRLVQ) was used as ARD method to show the potential of feature reduction. This is compared to support-vector machines (SVM), in which the feature reduction plays a much smaller role. Cross validation yielded mean normalised relevancies of PSD features in the range of 1.6 – 4.9 % and 1.9 – 10.4 % for horizontal and vertical EOG, respectively. MaxCC relevancies were 0.002 – 0.006 % and 0.002 – 0.06 %, respectively. This shows that PSD features of vertical EOG are indispensable, whereas MaxCC can be neglected. Mean classification accuracies were estimated at 86.6±b 1.3 % and 92.3±b 0.2 % for GRLVQ and SVM, respectively. GRLVQ permits objective feature reduction by inclusion of all processing stages, but is not as accurate as SVM.
Usability and accuracy of high-resolution detectors for daily quality assurance for robotic radiosurgery
Authors: Loutfi-Krauss Britta , Damme Marie-Christin , Stelljes Tenzin Sonam , Chan Mark KH , Siebert Frank-Andre , Poppe Björn , Ramm Ulla , Blanck Oliver
Published: September 2017

For daily CyberKnife QA a Winston-Lutz-Test (Automated-Quality-Assurance, AQA) is used to determine sub-millimeter deviations in beam delivery accuracy. This test is performed using gafchromic film, an extensive and user-dependent method requiring the use of disposables. We therefore analyzed the usability and accuracy of high-resolution detector arrays. We analyzed a liquid-filled ionization-chamber array (Octavius 1000SRS, PTW, Germany), which has a central resolution of 2.5mm. To test sufficient sensitivity, beam profiles with robot shifts of 0.1mm along the arrays' axes were measured. The detected deviation between the shifted and central profile were compared to the real robot's position. We then compared the results to the SRS-Profiler (SunNuclear, USA) with 4.0mm resolution and to the Nonius (QUART, Germany), a single-line diode detector with 2.8mm resolution. Finally, AQA variance and usability were analyzed performing a number of AQA tests over time, which required the use of specially designed fixtures for each array, and the results were compared to film. Concerning sensitivity, the 1000SRS detected the beam profile shifts with a maximum difference of 0.11mm (mean deviation = 0.03mm) compared to the actual robot shift. The Nonius and SRS-Profiler showed differences of up to 0.15mm and 0.69mm with mean deviation of 0.05mm and 0.18mm, respectively. Analyzing the variation of AQA results over time, the 1000SRS showed a comparable standard deviation to film (0.26mm vs. 0.18mm). The SRS-Profiler and the Nonius showed a standard deviation of 0.16mm and 0.24mm, respectively. The 1000SRS seems to provide equivalent accuracy and sensitivity to the gold standard film when performing daily AQA tests. Compared to other detectors in our study the sensitivity as well as the accuracy of the 1000SRS appears to be superior and more user-friendly. Furthermore, no significant modification of the standard AQA procedure is required when introducing 1000SRS for CyberKnife AQA.
Model based prediction of plateau pressure in mechanically ventilated patients
Authors: Kretschmer Jörn , Patel Aakash , Docherty Paul D. , Laufer Bernhard , Möller Knut
Published: September 2017

The risk of ventilator induced lung injury in mechanically ventilated (MV) critically ill patients can be mitigated by patient-specific optimisation of ventilator settings. Recent studies have shown that driving pressure, i.e. the difference between plateau pressure (Pplat
) and PEEP, is a strong indicator for survival in MV patients suffering from ARDS. However, to measure Pplat
, an extended end-inspiratory pause (EIP) has to be applied, possibly interrupting ventilation therapy. This study presents a method for predicting Pplat
from normal breaths in MV patients.

A total of 859 MV breaths with a 5 second EIP were recorded in 27 MV patients with ARDS. Two methods for determining Pplat
were tested, one using an exponential fit of the pressure data and the other using a four-parameter viscoelastic model (VEM). Each method was identified using various lengths of data after the peak inspiratory pressure (PIP). Using the identified parameters, both methods were then used to predict the Pplat
recorded at 5 seconds.

The exponential method showed a median coefficient of variation (CV) from the real Pplat
of 42.9% using data from PIP to 0.5 seconds after PIP, 24.9% using 1 second of data and 15.2% using 1.5 seconds of data. The respective VEM prediction median CVs were of 17.2%, 9.7% and 8.4%. Therefore, the VEM showed a better prediction than the non-physiological exponential model, allowing it to be used to reduce the clinical burden of determining Pplat
by reducing the required length of the EIP to 1.5 seconds.
Model predictive control approach for a CPAP-device
Authors: Scheel Mathias , Berndt Andreas , Simanski Olaf
Published: September 2017

The obstructive sleep apnoea syndrome (OSAS) is characterized by a collapse of the upper respiratory tract, resulting in a reduction of the blood oxygen- and an increase of the carbon dioxide (CO2
) - concentration, which causes repeated sleep disruptions. The gold standard to treat the OSAS is the continuous positive airway pressure (CPAP) therapy. The continuous pressure keeps the upper airway open and prevents the collapse of the upper respiratory tract and the pharynx. Most of the available CPAP-devices cannot maintain the pressure reference [1]. In this work a model predictive control approach is provided. This control approach has the possibility to include the patient’s breathing effort into the calculation of the control variable. Therefore a patient-individualized control strategy can be developed.
Numerical investigation of the impact of branching vessel boundary conditions on aortic hemodynamics
Authors: Yevtushenko Pavlo , Hellmeier Florian , Bruening Jan , Kuehne Titus , Goubergrits Leonid
Published: September 2017

CFD has gained significant attention as a tool to model aortic hemodynamics. However, obtaining accurate patient-specific boundary conditions still poses a major challenge and represents a major source of uncertainties, which are difficult to quantify. This study presents an attempt to quantify these uncertainties by comparing 14 patient-specific simulations of the aorta (reference method), each exhibiting stenosis, against simulations using the same geometries without the branching vessels of the aortic arch (simplified method).

Results were evaluated by comparing pressure drop along the aorta, secondary flow degree (SFD) and surface-averaged wall shear stress (WSS) for each patient. The comparison shows little difference in pressure drop between the two methods (simplified-reference) with the mean difference being 1.2 mmHg (standard deviation: 3.0 mmHg). SFD and WSS, however, show striking differences between the methods: SFD downstream of the stenosis is on average 61 % higher in the simplified cases, while WSS is on average 3.0 Pa lower in the simplified cases.

Although unphysiological, the comparison of both methods gives an upper bound for the error introduced by uncertainties in branching vessel boundary conditions. For the pressure drop this error appears to be remarkably low, while being unacceptably high for SFD and WSS.
Design of a body energy harvesting system for the upper extremity
Authors: Brunner Stephan , Gerst Maximilian , Pylatiuk Christian
Published: September 2017

Converting energy from human upper limb motions into electrical energy is a challenge, as low frequency movements have to be converted into repetitive movements to effectively drive electromechanical generators. The prototype of an electromagnetic linear generator with gyrating mass is presented. The mechanical motion model first was simulated and the design was evaluated during different activities. An average power output of about 50 μW was determined with a maximum power output of 2.2 mW that is sufficient to operate sensors for health monitoring.
Evaluation of a new hybrid VMAT simultaneous integrated boost technique for breast radiotherapy
Authors: Vaegler Sven , Scheibner Michael , Hartwig Christoph , Jonas Jeannette , Adler Frank , Ranft Dörthe , Otto Stephan , Wurster Stefan , Breitsprecher Regine
Published: September 2017

In this survey we propose a new hybrid simultaneous integrated boost (SIB) delivery method for breast radiotherapy that was implemented in our department of Radiation Oncology. This technique encompasses non-modulated tangential fields as well as VMAT-arcs and combines the robustness and the dose confinement properties of tangential opposed fields with the benefits of a complex VMAT-technique. The results of the dosimetric evaluation indicate that the proposed technique enables a balanced mix between dose coverage, homogeneity and conformity versus the exposure of the organs-at-risks. More precisely, the proposed technique is on par with other recently published SIB techniques for breast radiotherapy.
Labbag® - a versatile bag-based cultivation system for expansion, differentiation and cryopreservation of human stem cells
Authors: Gepp Michael M. , Duckstein Rowena , Kayatz Fabian , Rodler Norbert , Scheuerer Zuzana , Neubauer Julia C. , Lachmann Kristina , Stramm Cornelia , Liebmann Andrea , Thomas Michael , Zimmermann Heiko
Published: September 2017

Novel approaches in regenerative medicine and tissue engineering are highly promoted by human induced pluripotent stem cells. Typical workflows include the expansion, differentiation and/or cryopreservation of these cells. Often, the differentiation, cytotoxicity tests or disease modelling rely on multicellular aggregates. Here, we present the novel bag-based system “Labbag®” to address workflows required for these applications. As a unique feature, the Labbag® provides a chemical spot pattern to allow the formation of several hundreds of hanging droplets within a few seconds with standard laboratory equipment. In this study, we describe the general concept of the Labbag® and show aggregate formation of stem cells as first stem cell workflow successfully transferred.
Methodological aspects of analyzing high resolved brain connectivity for multiple subjects
Authors: Pester Britta , Schmidt Christoph , Bär Karl-Jürgen , Leistritz Lutz
Published: September 2017

Analyzing directed interactions within brain networks of high spatial resolution is always associated with a limited interpretability due to the high amount of possible connections. Here, module detection algorithms have proven to helpfully subsume the information of the resulting networks for each proband. However, the between-subject comparison of clusters is not straightforward since identified modules are not matched to each other across different subjects. Tensor decomposition has successfully been applied for the detection of group-wide connectivity patterns. Yet, a thorough investigation of the effect of the involved analysis parameters and data properties on decomposition results has still been missing. In this study we filled this gap and found that - given appropriate parameter choices - tensor decomposition of functional connectivity data reveals meaningful, group-specific insights into the brain's information processing.