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Wearable electroencephalography devices emerge as a cost-effective and ergonomic alternative to gold-standard polysomnography, paving the way for better health monitoring and sleep disorder screening. Machine learning allows to automate sleep stage classification, but trust and reliability issues have hampered its adoption in clinical applications. Estimating uncertainty is a crucial factor in enhancing reliability by identifying regions of heightened and diminished confidence. In this study, we used an uncertainty-centred machine learning pipeline, U-PASS, to automate sleep staging in a challenging real-world dataset of single-channel electroencephalography and accelerometry collected with a wearable device from an elderly population. We were able to effectively limit the uncertainty of our machine learning model and to reliably inform clinical experts of which predictions were uncertain to improve the machine learning model's reliability. This increased the five-stage sleep-scoring accuracy of a state-of-the-art machine learning model from 63.9% to 71.2% on our dataset. Remarkably, the machine learning approach outperformed the human expert in interpreting these wearable data. Manual review by sleep specialists, without specific training for sleep staging on wearable electroencephalography, proved ineffective. The clinical utility of this automated remote monitoring system was also demonstrated, establishing a strong correlation between the predicted sleep parameters and the reference polysomnography parameters, and reproducing known correlations with the apnea-hypopnea index. In essence, this work presents a promising avenue to revolutionize remote patient care through the power of machine learning by the use of an automated data-processing pipeline enhanced with uncertainty estimation., (© 2024 European Sleep Research Society.)

Objective: To investigate whether tau accumulation is higher in late life depression (LLD) compared to non-depressed cognitively unimpaired (CU) older adults. To situate these findings in the neurodegeneration model of LLD by assessing group differences in tau and grey matter volume (GMV) between LLD, non-depressed CU and mild cognitive impairment due to Alzheimer's Disease (MCI)., Design: Monocentric, cross-sectional study., Setting: University Psychiatric hospital, memory clinic and outpatient neurology practice., Participants: A total of 102 adults over age 60, of whom 19 currently depressed participants with LLD, 19 with MCI and 36 non-depressed CU participants completed neuropsychological testing and tau PET-MR imaging., Measurements: PET-MRI: 18F-MK-6240 tracer SUVR for tau assessment; 3D T1-weighted structural MRI derived GMV in seven brain regions (temporal, cingulate, prefrontal and parietal regions); amyloid PET to assess amyloid positivity; Neuropsychological test scores: MMSE, RAVLT, GDS, MADRS. ANCOVA and Spearman's rank correlations to investigate group differences in tau and GMV, and correlations with neuropsychological test scores respectively., Results: Compared to non-depressed CU participants, LLD patients showed lower GMV in temporal and anterior cingulate regions but similar tau accumulation and amyloid positivity rate. In contrast, MCI patients had significantly higher tau accumulation in all regions. Tau did not correlate with any neuropsychological test scores in LLD., Conclusion: Our findings suggest AD-type tau is not higher in LLD compared to non-depressed, cognitively unimpaired older adults and appears unlikely to contribute to lower gray matter volume in LLD, further underscoring the need to distinguish major depressive disorder from depressive symptoms occurring in early AD., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Both sleep alterations and epileptiform activity are associated with the accumulation of amyloid-β and tau pathology and are currently investigated for potential therapeutic interventions in Alzheimer's disease (AD). However, a bidirectional intertwining relation between sleep and neuronal hyperexcitability might modulate the effects of AD pathology on the corresponding associations. To investigate this, we performed multiple day simultaneous foramen ovale (FO) plus scalp EEG and polysomnography (PSG) recordings and acquired 18F-MK6240 tau PET-MR in three patients in the prodromal stage of AD and in two patients with mild and moderate dementia due to AD, respectively. As an eligibility criterion for the present study, subjects either had a history of a recent seizure (n = 2) or subclinical epileptiform activity (SEA) on a previous scalp EEG taken in a research context (n = 3). The 18F-MK6240 standard uptake value ratio (SUVR) and asymmetry index (AI) were calculated in a priori defined volumes of interest (VOIs). Linear mixed effects models were used to study associations between interictal epileptiform discharges (IEDs), PSG parameters and 18F-MK6240 SUVR. Epileptiform activity was bilateral but asymmetrically present on FO electrodes in all patients and ≥ 95% of IEDs were not visible on scalp EEG. In one patient two focal seizures were detected on FO electrodes, both without visual scalp EEG correlate. We observed lateralized periodic discharges, brief potentially ictal rhythmic discharges and lateralized rhythmic delta activity on FO electrodes in four patients. Unlike scalp EEG, intracranial electrodes showed a lateralization of epileptiform activity. Although the amount of IEDs on intracranial electrodes was not associated to the 18F-MK6240 SUVR binding in different VOIs, there was a congruent asymmetry of the 18F-MK6240 binding towards the most epileptic hemisphere for the mesial (P = 0.007) and lateral temporal cortex (P = 0.006). IEDs on intracranial electrodes were most abundant during slow wave sleep (SWS) (92/h) and N2 (81/h), followed by N1 (33/h) and least frequent during wakefulness (17/h) and REM sleep (9/h). The extent of IEDs during sleep was not reflected in the relative time in each sleep stage spent (REM% (P = 0.415), N1% (P = 0.668), N2% (P = 0.442), SWS% (P = 0.988)), and not associated with the arousal index (P = 0.317), apnea-hypopnea index (P = 0.846) or oxygen desaturation index (P = 0.746). Together, our observations suggest a multi-directional interaction between sleep, epileptiform activity and tau pathology in AD., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Objectives: To investigate the efficacy of closed-loop acoustic stimulation (CLAS) during slow-wave sleep (SWS) to enhance slow-wave activity (SWA) and SWS in patients with Alzheimer's disease (AD) across multiple nights and to explore associations between stimulation, participant characteristics, and individuals' SWS response., Design: A 2-week, open-label at-home intervention study utilizing the DREEM2 headband to record sleep data and administer CLAS during SWS., Setting and Participants: Fifteen older patients with AD (6 women, mean age: 76.27 [SD = 6.06], mean MOCA-score: 16.07 [SD = 6.94]), living at home with their partner, completed the trial., Intervention: Patients first wore the device for two baseline nights, followed by 14 nights during which the device was programmed to randomly either deliver acoustic stimulations of 50 ms pink noise (± 40 dB) targeted to the slow-wave up-phase during SWS or only mark the wave (sham)., Results: On a group level, stimulation significantly enhanced SWA and SWS with consistent SWS enhancement throughout the intervention. However, substantial variability existed in individual responses to stimulation. Individuals received more stimulations on nights with increased SWS compared to baseline than on nights with no change or a decrease. In individuals, having lower baseline SWS correlated with receiving fewer stimulations on average during the intervention., Conclusion: CLAS during SWS is a promising nonpharmacological method to enhance SWA and SWS in AD. However, patients with lower baseline SWS received fewer stimulations during the intervention, possibly resulting in less SWS enhancement. Individual variability in response to stimulation underscores the need to address personalized stimulation parameters in future research and therapy development., Competing Interests: DISCLOSURE The authors report no conflicts with any product mentioned or concept discussed in this article., (Copyright © 2024. Published by Elsevier Inc.)

Background and Objectives: The number of people with dementia is expected to triple to 152 million in 2050, with 90% having accompanying behavioral and psychological symptoms (BPSD). Agitation is among the most critical BPSD and can lead to decreased quality of life for people with dementia and their caregivers. This study aims to explore objective quantification of agitation in people with dementia by analyzing the relationships between physiological and movement data from wearables and observational measures of agitation., Research Design and Methods: The data presented here is from 30 people with dementia, each included for 1 week, collected following our previously published multimodal data collection protocol. This observational protocol has a cross-sectional repeated measures design, encompassing data from both wearable and fixed sensors. Generalized linear mixed models were used to quantify the relationship between data from different wearable sensor modalities and agitation, as well as motor and verbal agitation specifically., Results: Several features from wearable data are significantly associated with agitation, at least the p  < .05 level (absolute β: 0.224-0.753). Additionally, different features are informative depending on the agitation type or the patient the data were collected from. Adding context with key confounding variables (time of day, movement, and temperature) allows for a clearer interpretation of feature differences when a person with dementia is agitated., Discussion and Implications: The features shown to be significantly different, across the study population, suggest possible autonomic nervous system activation when agitated. Differences when splitting the data by agitation type point toward a need for future detection models to tailor to the primary type of agitation expressed. Finally, patient-specific differences in features indicate a need for patient- or group-level model personalization. The findings reported in this study both reinforce and add to the fundamental understanding of and can be used to drive the objective quantification of agitation., Competing Interests: None., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Objectives: In psychogeriatric units for patients with dementia and behavioral problems, aggression is prevalent. Predictions and timely interventions of aggression are essential to create a safe environment and prevent adverse outcomes. Our study aimed to determine whether aggression severity early during admission to these units could be used as an indicator of adverse outcomes., Design: During one year, all aggressive incidents on a psychogeriatric unit were systematically recorded using the Revised Staff Observation of Aggression Scale (SOAS-R). The study investigated the link between the severity of incidents within the first 48 hours of admission and adverse outcomes., Setting and Participants: All patients included in the study were admitted to a psychogeriatric unit for dementia and behavioral problems between November 2020 and October 2021., Methods: The study population was categorized into groups according to the level of aggression severity during the first 48 hours of admission. The impact of aggression severity on the duration of admission, aggression frequency and severity during admission, medication usage at discharge, discharge destination, and mortality risk were examined., Results: During the initial 2 days of admission, 9 of 88 patients had 1 or more severe aggression incidents. An early manifestation of severe aggression was significantly associated with more incidents during hospitalization, a higher total SOAS-R score, and a sevenfold higher 1-year mortality risk compared with patients who did not or only mildly manifested aggression in the first 48 hours of admission., Conclusions and Implications: An early manifestation of aggression not only poses a direct safety risk to all involved but is also an early indicator of patients at risk for more detrimental outcomes, specifically mortality risk. By identifying patients at higher risk for adverse outcomes early, health care providers can provide preventive or timelier interventions, mitigating the risk of adverse outcomes and optimizing care services., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

We present an ab initio tight-binding method that allows to improve on the effective potential and minimal basis approximations employed in semiempirical calculations. Three-center expansions are used to evaluate the zeroth-order Hamiltonian matrix elements and repulsive energy terms in the spirit of the Horsfield method. Self-consistency is handled by expanding atomic orbital products in an auxiliary basis following the work of Giese and York, combined with a two-center expansion of the exchange-correlation kernels. Together with nonminimal main basis sets (double-ζ plus polarization), we show that the resulting method trades a modest amount of accuracy for a significant gain in speed, compared to that of numerical atomic orbital density functional theory, in calculations on small molecules, bulk compounds, and metal nanoclusters.

Study Objectives: Sleep disturbances are common in people with Alzheimer's disease (AD), and a reduction in slow-wave activity is the most striking underlying change. Acoustic stimulation has emerged as a promising approach to enhance slow-wave activity in healthy adults and people with amnestic mild cognitive impairment. In this phase 1 study we investigated, for the first time, the feasibility of acoustic stimulation in AD and piloted the effect on slow-wave sleep (SWS)., Methods: Eleven adults with mild to moderate AD first wore the DREEM 2 headband for 2 nights to establish a baseline registration. Using machine learning, the DREEM 2 headband automatically scores sleep stages in real time. Subsequently, the participants wore the headband for 14 consecutive "stimulation nights" at home. During these nights, the device applied phase-locked acoustic stimulation of 40-dB pink noise delivered over 2 bone-conductance transducers targeted to the up-phase of the delta wave or SHAM, if it detected SWS in sufficiently high-quality data., Results: Results of the DREEM 2 headband algorithm show a significant average increase in SWS (minutes) [ t (3.17) = 33.57, P = .019] between the beginning and end of the intervention, almost twice as much time was spent in SWS. Consensus scoring of electroencephalography data confirmed this trend of more time spent in SWS [ t (2.4) = 26.07, P = .053]., Conclusions: Our phase 1 study provided the first evidence that targeted acoustic stimuli is feasible and could increase SWS in AD significantly. Future studies should further test and optimize the effect of stimulation on SWS in AD in a large randomized controlled trial., Citation: Van den Bulcke L, Peeters A-M, Heremans E, et al. Acoustic stimulation as a promising technique to enhance slow-wave sleep in Alzheimer's disease: results of a pilot study. J Clin Sleep Med . 2023;19(12):2107-2112., (© 2023 American Academy of Sleep Medicine.)

We argue that a clear view of quantum mechanics is obtained by considering that the unicity of the macroscopic world is a fundamental postulate of physics, rather than an issue that must be mathematically justified or demonstrated. This postulate allows for a framework in which quantum mechanics can be constructed in a complete mathematically consistent way. This is made possible by using general operator algebras to extend the mathematical description of the physical world toward macroscopic systems. Such an approach goes beyond the usual type-I operator algebras used in standard textbook quantum mechanics. This avoids a major pitfall, which is the temptation to make the usual type-I formalism 'universal'. This may also provide a meta-framework for both classical and quantum physics, shedding new light on ancient conceptual antagonisms and clarifying the status of quantum objects. Beyond exploring remote corners of quantum physics, we expect these ideas to be helpful to better understand and develop quantum technologies.

New measurement methods and equipment for correct 5G New Radio (NR) electromagnetic field (EMF) in-situ exposure assessment of instantaneous time-averaged exposure (Eavg) and maximum extrapolated field exposure (Emax) are proposed. The different options are investigated with in-situ measurements around 5G NR base stations (FR1) in different countries. The maximum electric field values satisfy the ICNIRP 2020 limit (maximum 7.7%). The difference between Emax and Eavg is <3 dB for the different measurement equipment at multiple sites in case there is only self-generated traffic. However, in a more realistic scenario, Eavg cannot be used to assess the exposure correctly due to influence of other users as the spatial distribution of user equipment (UE) influences Eavg, while Emax is not affected. However, when multiple UEs are collocated, there is no influence of the number of UEs. A broadband measurement can give a first impression of the RF-EMF exposure up to 700 m, but is not enough to assess the 5G-NR exposure., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: Unlike in neurological patient populations, the effects of Extended Reality within the context of sports medicine have rarely been studied. This systematic review was conducted to investigate the value of Extended Realty-assisted rehabilitation and injury prevention strategies on injury rehabilitation and prevention outcomes., Methods: PubMed and Web of Science databases were consulted. The search strategy consisted of the terms Virtual Reality (Intervention), rehabilitation and injury prevention (Outcome) and healthy athletes or athletes with a musculoskeletal sports injury (Population). After eligibility and Risk of Bias screening, ten articles were included. Risk of Bias analysis resulted in a level of evidence varying between C (three articles), B (six articles) and A2 (one article) scores., Results: Extended Reality was found to provide an added value for both sports injury prevention and rehabilitation outcomes. It particularly provides clinicians with the opportunity to address the underlying biomechanical risk profile for common sports injuries, allowing the athletes to train protective movement patterns more effectively., Conclusion: More large-scale high-quality prospective research is needed in order to determine whether Extended Reality-assisted therapy is superior to conventional therapy in sports rehabilitation and injury prevention circles with strong conclusive evidence., Competing Interests: Declaration of competing interest None declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

In an increasingly wireless world, spatiotemporal monitoring of the exposure to environmental radiofrequency (RF) electromagnetic fields (EMF) is crucial to appease public uncertainty and anxiety about RF-EMF. However, although the advent of smart city infrastructures allows for dense networks of distributed sensors, the costs of accurate RF sensors remain high, and dedicated RF monitoring networks remain rare. This paper describes a comprehensive study comprising the design of a low-cost RF-EMF sensor node capable of monitoring four frequency bands used by wireless telecommunications with an unparalleled temporal resolution, its application in a small-scale distributed sensor network consisting of both fixed (on building façades) and mobile sensor nodes (on postal vans), and the subsequent analysis of over a year of data between January 2019 and May 2020, during which slightly less than 10 million samples were collected. From the fixed nodes' results, the potential errors were determined that are induced when sampling at lower speeds (e.g., one sample per 15 min) and measuring for shorter periods of time (e.g., a few weeks), as well as an adequate resolution (30 min) for diurnal and weekly temporal profiles which sufficiently preserves short-term variations. Furthermore, based on the correlation between the sensors, an adequate density of 100 sensor nodes per km 2 was deduced for future networks. Finally, the mobile sensor nodes were used to identify potential RF-EMF exposure hotspots in a previously unattainable area of more than 60 km 2 . In summary, through the analysis of a small number of RF-EMF sensor nodes (both fixed and mobile) in an urban area, this study offers invaluable insights applicable to future designs and deployments of distributed RF-EMF sensor networks.

Surfaces of aluminum alloys are often coated with ultra-thin alumina films which form by self-limited selective oxidation. Although the presence of such films is of paramount importance in various applications, their structural and stability characteristics remain far from being known. In particular, on the NiAl(100) substrate, the observed structure has been tentatively assigned to a distorted θ-alumina polymorph, but the film stoichiometry, the nature of its surface and interface terminations, as well as the mechanisms that stabilize the θ phase remain unknown. Using a combined tight-binding/DFT genetic algorithm approach, we explicitly demonstrate that ultra-thin θ(100)-type films correspond to the structural ground state of alumina supported on the (2 × 1)-NiAl(100) substrate. Thus, experimentally observed θ-alumina films correspond to thermodynamic equilibrium, rather than being the result of kinetic effects involved in the alloy oxidation and film growth. They are favoured over other Al 2 O 3 phases of dehydrated boehmite, pseudo-CaIrO 3 , γ, or bixbyite structures, which have recently been identified among the most stable free-standing ultra-thin alumina polymorphs. Moreover, our results prove that nonstoichiometry can be easily accommodated by the supported θ(100) film structure via an excess or deficiency of oxygen atoms at the very interface with the metal substrate. Dedicated DFT analysis reveals that the oxide-metal interaction at stoichiometric interfaces depends surprisingly little on the composition of the NiAl surface. Conversely, at oxygen-rich/poor interfaces, the number of additional/missing Al-O bonds is directly responsible for their relative stability. Finally the comparison between the experimental and theoretical electronic characteristics (STM and XPS) of supported θ(100)-type films provides clues on the detailed structure of the experimentally observed films.

Background: Exposure to radiofrequency electromagnetic fields (RF-EMF) is often measured with personal exposimeters, but the accuracy of measurements can be hampered as carrying the devices on-body may result in body shielding. Further, the compact design may compromise the frequency selectivity of the sensor. The aim of this study was to compare measurements obtained using a multi-band body-worn distributed-exposimeter (BWDM) with two commercially available personal exposimeters (ExpoM-RF and EmeSpy 200) under real-life conditions., Methods: The BWDM measured power density in 10 frequency bands (800, 900, 1800, 2100, 2600 MHz, DECT 1900 MHz, WiFi 2.4 GHz; with separate uplink/downlink bands for 900, 1800 and 2100 MHz); using 20 separate antennas integrated in a vest and placed on diametrically opposite locations on the body, to minimize body-shielding. RF-EMF exposure data were collected from several microenvironments (e.g. shopping areas, train stations, outdoor rural/ urban residential environments, etc.) by walking around pre-defined areas/routes in Belgium, Spain, France, the Netherlands and Switzerland. Measurements were taken every 1-4 s with the BWDM in parallel with an ExpoM-RF and an EmeSpy 200 exposimeter. We calculated medians and interquartile ranges (IQRs) and compared difference, ratios and correlations of geometric mean RF-EMF exposure levels per microenvironment as measured with the exposimeters and the BWDM., Results: Across 267 microenvironments, medians and IQR of total BWDM measured RF-EMF exposure was 0.13 (0.05-0.33) mW/m 2 . Difference: IQR of exposimeters minus BWDM exposure levels was -0.011 (-0.049 to 0.0095) mW/m 2 for the ExpoM-RF and -0.056 (-0.14 to -0.017) for the EmeSpy 200; ratios (exposimeter/BWDM) of total exposure had an IQR of 0.79 (0.55-1.1) for the ExpoM-RF and 0.29 (0.22-0.38) for the EmeSpy 200. Spearman correlations were 0.93 for the ExpoM-RF vs the BWDM and 0.96 for the EmeSpy 200 vs the BWDM., Discussion and Conclusions: Results indicate that exposimeters worn on-body provide somewhat lower total RF-EMF exposure as compared to measurements conducted with the BWDM, in line with effects from body shielding. Ranking of exposure levels of microenvironments showed high correspondence between the different device types. Our results are informative for the interpretation of existing epidemiological research results., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Recently, the European Commission supported by many European countries has announced large investments towards the commercialization of quantum technology (QT) to address and mitigate some of the biggest challenges facing today's digital era - e.g. secure communication and computing power. For more than two decades the QT community has been working on the development of QTs, which promise landmark breakthroughs leading to commercialization in various areas. The ambitious goals of the QT community and expectations of EU authorities cannot be met solely by individual initiatives of single countries, and therefore, require a combined European effort of large and unprecedented dimensions comparable only to the Galileo or Copernicus programs. Strong international competition calls for a coordinated European effort towards the development of QT in and for space, including research and development of technology in the areas of communication and sensing. Here, we aim at summarizing the state of the art in the development of quantum technologies which have an impact in the field of space applications. Our goal is to outline a complete framework for the design, development, implementation, and exploitation of quantum technology in space., (© The Author(s) 2021.)

BACKGROUND: Although the understanding of hypobaric hypoxia is increasing, it remains a hazard in aviation medicine. This study examined the feasibility of detecting voice markers sensitive to acute hypobaric hypoxia in an early presymptomatic (PRE-SYMP) stage. METHOD: Eight subjects qualified with hypobaric training completed a series of standardized speech tests in a hypobaric chamber at 20,000 ft and 25,000 ft (6096 and 7620 m) of altitude. Voice response patterns were analyzed in terms of fundamental frequency (F0), F0 range, and voice onset time (VOT). We hypothesized a PRE-SYMP compensatory stage in voice reactivity. RESULTS: There was a different dose-response reactivity course at 20,000 ft vs. 25,000 ft, nonlinear to altitude. At 20,000 ft, our hypothesis was confirmed. In comparison to sea level, a PRE-SYMP compensatory stage could be distinguished, characterized by a decreased F0 range, decreased VOT, and increased F0. During a transitional (TRANS) stage, in comparison with sea level, the F0-range reset, VOT decreased, and F0 increased. During a symptomatic (SYMP) stage, F0 increased, F0 range increased, and VOT decreased. At 25,000 ft, in comparison to sea level, voice reactivity showed increased F0 and F0 range and decreased VOT in a PRE-SYMP stage and increased F0 and F0 range in the SYMP stage. DISCUSSION: The compensatory PRE-SYMP stage is suggested to be the expression of ongoing bottom-up and top-down regulatory mechanisms, whereas the 25,000-ft results are interpreted as a combination of tonic and phasic voice reactivity. This tonic component needs to be foreseen in sea level baseline measures. Van Puyvelde M, Neyt X, Vanderlinden W, Van den Bossche M, Bucovaz T, De Winne T, Pattyn N. Voice reactivity as a response to acute hypobaric hypoxia at high altitude . Aerosp Med Hum Perform. 2020; 91(6):471-478.

This paper describes radiofrequency (RF) electromagnetic field (EMF) measurements in the vicinity of single and banks of advanced metering infrastructure (AMI) smart meters. The measurements were performed in a meter testing and distribution facility as well as in-situ at five urban locations. The measurements consisted of gauging the RF environment at the place of assessment, evaluating the worst-case electric-field levels at various positions around the assessed AMI meter configuration (spatial assessment), which ranged from a single meter to a bank of 81 m, and calculating the duty cycle of the system, i.e. the fraction of time that the AMI meters were actually transmitting (12-h temporal assessment). Both in-situ and in the meter facility, the maximum field levels at 0.3 m from the meter configurations were 10-13 V/m for a single meter and 18-38 V/m for meter banks with 20-81 m. Furthermore, 6-min average duty cycles of 0.01% (1 m) up to 13% (81-m bank) were observed. Next, two general statistical models (one for a single meter and one for a meter bank) were constructed to predict the electric-field strength as a function of distance to any configuration of the assessed AMI meters. For all scenarios, the measured exposure levels (at a minimum distance of 0.3 m) were well below the maximum permissible exposure limits issued by the International Commission on Non-Ionizing Radiation Protection (ICNIRP), the U.S. Federal Communications Commission (FCC), and the Institute of Electrical and Electronics Engineers (IEEE). Indeed, the worst-case time-average exposure level at a distance of 0.3 m from an AMI installation was 5.39% of the FCC/IEEE and 9.43% of the ICNIRP reference levels., (Copyright © 2020 Elsevier Inc. All rights reserved.)

(Sub)nanometre-thin alumina films are frequently encountered due to the self-limited oxidation of Al and its alloys, and seem to display an even larger structural variety than bulk alumina itself. While the nature of the underlying substrate and the oxidation kinetics are known to modulate the structure of supported films, understanding the intrinsic stability of freestanding films constitutes an important first step in itself, especially when the interaction with the substrate is rather weak. Using a combined tight-binding/DFT genetic algorithm approach, we identify particularly stable θ(100)-type films along with a host of novel stable thin film structures. Several of these correspond to cuts from relatively high energy bulk structures, e.g. dehydrated boehmite, pseudo-CaIrO3, defective rocksalt and LuMnO3, which are not commonly associated with alumina. DFT calculations allow to rationalize this stability reversal with respect to α-Al2O3 in terms of low surface energies compared to α(0001) and to identify the underlying mechanisms: breaking a low density of relatively weak Al-O bonds, filling of Al surface vacancies, and polarity-induced relaxation of the whole film. These observations provide interesting insights into existing supported ultrathin films.

Early descriptions about the presentation of COVID-19 focused primarily on respiratory symptoms. However, we now know that COVID-19 can also present with one or more atypical symptom(s). With this case-report we want to draw attention to atypical presentations of COVID-19 that can occur in psychiatric practice, especially in the elderly. We report the case of an elderly woman with an atypical presentation of a COVID-19 pneumonia, namely without the often mentioned respiratory symptoms, gastrointestinal symptoms or fever, but with acute confusion. It is important to swiftly consider the possibility of a COVID-19 infection in (elderly) patients who present with delirium, as missing an infection can have important negative consequences, both for the treatment of the patient and for further spread within the (hospital) environment.

Background: Mini-One Anastomosis Gastric Bypass is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of MGB-OAGB procedures. The aim of this study is to report the causes and management of these revisions., Methods: From 2010 to 2018, 925 MGB-OAGB operations were performed at 7 bariatric units across the United Kingdom and included in this retrospective cohort study. The data was retrospectively collected and analysed. The primary end point was the identification of the causes and management of revisions. Follow up ranged from 6 months to 3 years., Results: Twenty-two patients [2.3%] required revisional surgery after MGB-OAGB. Five patients [0.5%] developed severe diarrhoea managed by shortening the bilio-pancreatic limb to 150 cm. Four patients [0.4%] developed afferent loop syndrome and bile reflux was reported in another 3 [0.3%] cases; all were managed by either conversion to Roux en Y Gastric Bypass or a Braun anastomosis. Postoperative bleeding was controlled laparoscopically in 3 patients [0.3%]. Liver decompensation that was reported in 2 patients [0.2%] was treated by shortening the BPL in one patient and a reversal to normal anatomy in another. The liver failure resolved in both patients. Other indications for revision included two gastro-jejunal stenosis [0.2%], one perforated ulcer [0.1%], one patient [0.1%] with excessive weight loss and one case [0.1%] of protein malnutrition. None of the 22 patients undergoing revisional surgery after MGB-OAGB died. Lost to follow up rate was 0.2%., Conclusion: Complications requiring revisional surgery after MGB-OAGB are uncommon [2.3%] and the majority can be managed by bilio-pancreatic limb shortening, the addition of a Braun side-to-side anastomosis or conversion to RYGB. Bilio-pancreatic limb length of 200 cm or more resulted in serious complications of liver failure, protein malnutrition, excessive weight loss and diarrhoea., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

The advent of the Internet of things comes with a huge increase in wirelessly communicating devices in our environment. For example, smart energy-consumption meters are being widely deployed in residences from which they communicate their state using radiofrequency networks. Accurate characterization of the radiofrequency emissions from emerging residential wireless solutions is important to inform the public about the potential impact on their exposure to radiofrequency electromagnetic fields. A new measurement procedure to determine the exposure from residential radiofrequency devices is proposed by assessing the peak emitted fields at various distances and the proportion of time they transmit (duty cycle). Radiofrequency emissions from 55 residential devices were measured in 10 residences (Belgium and France) and compared to environmental levels, emissions from 41 mobile phones, and international standards. Overall, residential levels of radiofrequency electromagnetic field exposure are low. In addition to the continuous environmental exposure, wireless access points (due to frequent use) and especially mobile phones and other personal communication devices (due to their use close to the body) continue to represent the bulk of the radiofrequency electromagnetic field exposure in the smart home. However, some residential devices can significantly increase the exposure if their duty cycles are high enough (>10%), especially when held or used close to the body. Individual smart meters, on the other hand, will contribute only little in general, despite emissions of up to 20 V m at 50 cm, due to their low duty cycles (maximum 1%) and locations.

Finding globally optimal structures of nanoclusters is critically important to understand their physicochemical properties but remains prohibitively expensive even with comparatively efficient density functionals. Semiempirical methods such as density functional tight-binding (DFTB), on the other hand, offer a better accuracy-efficiency trade-off but require suitable parametrization. In the present work, we present a largely automatic scheme where, starting from initial guesses based on bulk properties, the atomic confinement, and repulsive potentials are further refined so as to accurately represent the potential energy landscapes of 13- and 55-atom nanoclusters of the late transition metals (Ni, Cu, Pd, Ag, Pt, and Au). With the exception of Ni 13 , Ni 55 , Cu 55 , and Ag 55 , low-symmetry (often disordered) structures are found to be preferred over the symmetric icosahedral arrangement. Similar to what has been previously reported for Au 55 , the lowest-energy Pt 55 structures also appear to contain small cavities below the outer shell.

Solving and predicting atomic structures from first-principles methodologies is limited by the computational cost of exploring the search space, even when relatively inexpensive density functionals are used. Here, we present an efficient approach where the search is performed using density functional tight-binding, with an automatic adaptive parametrization scheme for the repulsive pair potentials. We successfully apply the method to the genetic algorithm optimization of bulk carbon, titanium dioxide, palladium oxide, and calcium hydroxide, and we assess the stability of the unknown crystal structure of palladium hydroxide.

The aims of this study were to: i) investigate the repeatability and representativeness of personal radio frequency-electromagnetic fields (RF-EMFs) exposure measurements, across different microenvironments, ii) perform simultaneous evaluations of personal RF-EMF exposures for the whole body and the head, iii) validate the data obtained with a head-worn personal distributed exposimeter (PDE) against those obtained with an on-body worn personal exposimeter (PEM). Data on personal and head RF-EMF exposures were collected by performing measurements across 15 microenvironments in Melbourne, Australia. A body-worn PEM and a head-worn PDE were used for measuring body and head exposures, respectively. The summary statistics obtained for total RF-EMF exposure showed a high representativeness (r 2 > 0.66 for two paths in the same area) and a high repeatability over time (r 2 > 0.87 for repetitions of the same path). The median head exposure in the 900MHz downlink band ranged between 0.06V/m and 0.31V/m. The results obtained during simultaneous measurements using the two devices showed high correlations (0.42 < r 2 < 0.94). The highest mean total RF-EMF exposure was measured in Melbourne's central business district (0.89V/m), whereas the lowest mean total exposure was measured in a suburban residential area (0.05V/m). This study shows that personal RF-EMF microenvironmental measurements in multiple microenvironments have high representativeness and repeatability over time. The personal RF-EMF exposure levels (i.e. body and head exposures) demonstrated moderate to high correlations., (Copyright © 2017 Elsevier Inc. All rights reserved.)

In this paper we remind the reader of a simple, intuitive picture of chemical shifts in X-ray photoelectron spectroscopy (XPS) as the difference in chemical bonding between the probed atom and its neighbor to the right in the periodic table, the so called Z+1 approximation. We use the classical ESCA molecule, ethyl trifluoroacetate, and 4d-transition metals to explicitly demonstrate agreement between core-level shifts computed as differences between final core-hole states and the approach where each core-ionized atom is replaced by a Z+1 atom. In this final state, or total energy picture, the XPS shift arises due to the more or less unfavorable chemical bonding of the effective nitrogen in the carbon geometry for the ESCA molecule. Surface core level shifts in metals are determined by whether the Z+1 atom as an alloy segregates to the surface or is more soluble in the bulk. As further illustration of this more chemical picture, we compare the geometry of C 1s and O 1s core-ionized CO with that of, respectively, NO + and CF + . The scope is not to propose a new method to compute XPS shifts but rather to stress the validity of this simple interpretation., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

A multi-band Body-Worn Distributed exposure Meter (BWDM) calibrated for simultaneous measurement of the incident power density in 11 telecommunication frequency bands, is proposed. The BDWM consists of 22 textile antennas integrated in a garment and is calibrated on six human subjects in an anechoic chamber to assess its measurement uncertainty in terms of 68% confidence interval of the on-body antenna aperture. It is shown that by using multiple antennas in each frequency band, the uncertainty of the BWDM is 22 dB improved with respect to single nodes on the front and back of the torso and variations are decreased to maximum 8.8 dB. Moreover, deploying single antennas for different body morphologies results in a variation up to 9.3 dB, which is reduced to 3.6 dB using multiple antennas for six subjects with various body mass index values. The designed BWDM, has an improved uncertainty of up to 9.6 dB in comparison to commercially available personal exposure meters calibrated on body. As an application, an average incident power density in the range of 26.7-90.8 μW·m - 2 is measured in Ghent, Belgium. The measurements show that commercial personal exposure meters underestimate the actual exposure by a factor of up to 20.6., Competing Interests: The authors declare no conflict of interest.

Background: There is currently little evidence available on the perioperative practices concerning one anastomosis/mini gastric bypass (OAGB/MGB) and no published consensus amongst experts. Even the published papers are not clear on these aspects. The purpose of this study was to understand various perioperative practices concerning OAGB/MGB., Methods: Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey. Only surgeons performing this procedure were included., Results: Two hundred and ten surgeons from 39 countries with a cumulative experience of 68,442 procedures took the survey. Surgeons described a large number of absolute (n = 55) and relative contraindications (n = 59) to this procedure in their practice. Approximately 71.0% (n = 148/208), 70.0% (n = 147/208) and 65.0% (n = 137/209), respectively, routinely perform a preoperative endoscopy, screening for Helicobacter pylori and ultrasound scan of the abdomen. A minority (35.0%, n = 74/208) of the surgeons used a constant bilio-pancreatic limb (BPL) length for all the patients with remaining preferring to tailor the limb length to the patient and approximately half (49.0%, n = 101/206) routinely approximate diaphragmatic crura in patients with hiatus hernia. Some 48.5% (n = 101/208) and 40.0% (n = 53/205) surgeons, respectively, do not recommend routine iron and calcium supplementation., Conclusion: This survey is the first attempt to understand a range of perioperative practices with OAGB/MGB. The findings will help in identifying areas for future research and allow consensus building amongst experts with preparation of guidelines for future practice.

Historically, assessment of human exposure to electric and magnetic fields has focused on the extremely-low-frequency (ELF) and radiofrequency (RF) ranges. However, research on the typically emitted fields in the intermediate-frequency (IF) range (300Hz to 1MHz) as well as potential effects of IF fields on the human body remains limited, although the range of household appliances with electrical components working in the IF range has grown significantly (e.g., induction cookers and compact fluorescent lighting). In this study, an extensive measurement survey was performed on the levels of electric and magnetic fields in the IF range typically present in residences as well as emitted by a wide range of household appliances under real-life circumstances. Using spot measurements, residential IF field levels were found to be generally low, while the use of certain appliances at close distance (20cm) may result in a relatively high exposure. Overall, appliance emissions contained either harmonic signals, with fundamental frequencies between 6kHz and 300kHz, which were sometimes accompanied by regions in the IF spectrum of rather noisy, elevated field strengths, or much more capricious spectra, dominated by 50Hz harmonics emanating far in the IF domain. The maximum peak field strengths recorded at 20cm were 41.5V/m and 2.7A/m, both from induction cookers. Finally, none of the appliance emissions in the IF range exceeded the exposure summation rules recommended by the International Commission on Non-Ionizing Radiation Protection guidelines and the International Electrotechnical Commission (IEC 62233) standard at 20cm and beyond (maximum exposure quotients EQ E 1.0 and E Q H 0.13)., (Copyright © 2017 Elsevier Inc. All rights reserved.)

In situ exposure of electric fields of 11 microwave ovens is assessed in an occupational environment and in an office. Measurements as a function of distance without load and with a load of 275 ml of tap water were performed at distances of <1 m. The maximal measured field was 55.2 V m(-1) at 5 cm from the oven (without load), which is 2.5 and 1.1 times below the International Commission on Non-Ionizing Radiation Protection reference level for occupational exposure and general public exposure, respectively. For exposure at distances of >1 m, a model of the electric field in a realistic environment is proposed. In an office scenario, switching on a microwave oven increases the median field strength from 91 to 145 mV m(-1) (+91 %) in a traditional Wireless Local Area Network (WLAN) deployment and from 44 to 92 mV m(-1) (+109 %) in an exposure-optimised WLAN deployment., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The catalytic oxidation of methane to carbon dioxide and water over PdO(101) is investigated with first-principles based microkinetic modeling. Extensive exploration of the reaction landscape allows for determination of preferred pathways at different reaction conditions. The predicted kinetic behavior is in good agreement with a range of experimental findings including reaction orders in methane, water, and oxygen as well as apparent activation energies. The results consolidate the role of the PdO(101) surface in the activity of PdO catalysts and offer starting points for computational design of materials with improved catalytic activity. Moreover, the study demonstrates the predictive power of first-principles based kinetic modeling for oxide surfaces when hybrid functionals are applied in conjugation with kinetic models that go beyond the mean-field approximation.

In this study, in situ exposure assessment of both electric and magnetic fields of different intermediate frequency (IF) sources is investigated. The authors investigated smart boards and touchscreens, energy-saving bulbs, fluorescent lamps, a portable hearing unit and an electrosurgical unit (ESU). For most of these sources, the electric field is the dominating quantity. International Commission on Non-Ionizing Radiation Protection reference levels are exceeded for touchscreens (44 kHz: up to 155.7 V m(-1) at 5 cm), energy-saving bulbs (38-52 kHz: up to 117.3 V m(-1)), fluorescent lamps (52 kHz: up to 471 V m(-1) at 5 cm) and ESUs (up to 920 kHz: 792 V m(-1) at 0.5 cm). Magnetic field strengths up to 1.8 and 10.5 A m(-1) were measured close to the ESU and portable hearing unit (69 V m(-1)), respectively. Large differences of measured field values exist among the various operating modes of the IF equipment. Compliance distances for general public range from 15.3 cm (touchscreen) to 25 cm (fluorescent lamps)., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Density functional theory calculations are often used to interpret experimental shifts in core level binding energies. Calculations based on gradient-corrected (GC) exchange-correlation functionals are known to reproduce measured core level shifts (CLS) of isolated molecules and metal surfaces with reasonable accuracy. In the present study, we discuss a series of examples where the shifts calculated within a GC-functional significantly deviate from the experimental values, namely the CLS of C 1s in ethyl trifluoroacetate, Pd 3d in PdO and the O 1s shift for CO adsorbed on PdO(101). The deviations are traced to effects of the electronic self-interaction error with GC-functionals and substantially better agreements between calculated and measured CLS are obtained when a fraction of exact exchange is used in the exchange-correlation functional.

Distinguishing single-nucleotide variants (SNVs) from errors in whole-genome sequences remains challenging. Here we describe a set of filters, together with a freely accessible software tool, that selectively reduce error rates and thereby facilitate variant detection in data from two short-read sequencing technologies, Complete Genomics and Illumina. By sequencing the nearly identical genomes from monozygotic twins and considering shared SNVs as 'true variants' and discordant SNVs as 'errors', we optimized thresholds for 12 individual filters and assessed which of the 1,048 filter combinations were effective in terms of sensitivity and specificity. Cumulative application of all effective filters reduced the error rate by 290-fold, facilitating the identification of genetic differences between monozygotic twins. We also applied an adapted, less stringent set of filters to reliably identify somatic mutations in a highly rearranged tumor and to identify variants in the NA19240 HapMap genome relative to a reference set of SNVs.

A 52-year-old woman with no previous history of major health problems presented with an acute abdomen and symptoms of shock. Three days earlier she had been diagnosed as having acute laryngitis which was treated with steroids. On admission she was suffering from hypotension, renal failure, liver failure and coagulopathy. Emergency laparotomy revealed purulent fluid spread diffusely throughout the abdominal cavity. Streptococcus pyogenes was grown in culture from this fluid, enabling a diagnosis of streptococcal toxic shock syndrome (STSS) with primary peritonitis to be made. This combination is rare, and has been described only a few times. Only one other patient is known in whom this combination was preceded by respiratory symptoms. The treatment consists of abdominal lavage, intravenous administration of antibiotics and immunoglobulins, and support for renal function, liver function, respiration and coagulation.

The low-energy properties of the SU(4) spin-orbital model on a two-leg ladder are studied by a variety of analytical and numerical techniques. As in the case of SU(2) models, there is a singlet-multiplet gap in the spectrum, but the ground state is twofold degenerate. An interpretation in terms of SU(4)-singlet plaquettes is proposed. The implications for general two-dimensional lattices are outlined.

Described is a low-grade fibromyxoid sarcoma (LGFMS) of the abdominal wall muscles in a 38-year-old black woman. There was no evidence of metastatic disease. A 5.2-kg LGFMS - the largest case ever reported - was resected. One year after surgery, the patient is alive without any sign of local recurrence or distant metastasis. Follow-up comprises abdominal and thoracic CT scans at 6-month intervals., (Copyright 2000 S. Karger AG, Basel)

Pulmonary hernias are extremely rare. They are usually treated with open surgical procedures. We describe a case in which a large, spontaneously acquired intercostal pulmonary hernia was successfully repaired by video-assisted thoracoscopic surgery (VATS).

Laparoscopic treatment of benign gastric disease is rapidly expanding. Gastric leiomyoma, a benign gastric neoplasm, can now be resected laparoscopically. A wide variety of laparoscopic procedures is presented in case reports during the last few years. The authors report a successful laparoscopic enucleation of a gastric leiomyoma combined with laparoscopic cholecystectomy for cholelithiasis.

A case of choledochal cyst in an adult is presented. Preoperative diagnosis was established by CT-scanning and MRI. The patient was treated with cyst excision and Roux-en-Y hepaticojejunostomy. A review of the literature is presented.

Splenic hydatidosis is a rare condition. We performed a hand-assisted laparoscopic splenectomy for a large hydatid cyst localized in the center of the spleen. We discuss the advantages of the "helping hand."

This study completes data collected for thick targets exposed to carbon and oxygen ions accelerated at 86 MeV/u. The radioactivity induced in carbon and tungsten targets bombarded by argon projectiles at 95 MeV/u has been studied in order to assess the relative contributions of the incoming heavy ion and the mass number of the bombarded nuclei to the consequent radiation hazards related to the production of radioactive ion beams. Induced radioactivity measurements are only rarely made under controlled irradiation conditions, in order to derive from the measured activities the dose rates after beam bombardment and a prediction of radiation protection constraints.

Controversy surrounds the treatment of open femoral shaft fractures, especially in the multiply injured. We report on 54 patients with 57 open femoral shaft fractures. They were treated according to our policy which deals with the severity of the soft-tissue damage. Low-grade open femoral fractures were primarily treated with internal fixation. A temporary external fixator was used for high-grade open fractures and in multiply injured patients where primary intramedullary nailing was contra-indicated. The external fixator was converted into an intramedullary nail as soon as the local soft-tissue disorders and the general condition of the patient permitted. There were no cases of deep infection. There was one case of malunion. Functional outcome was good to excellent in all cases. The aim of this paper is to show that low-grade open femoral fractures can be safely treated with primary intramedullary nailing and that temporary external fixation of severe open fractures followed by conversion into an intramedullary nail can be done without deep infection.

400 urinary stone patients were treated with the electromagnetic lithotriptor Siemens 'Lithostar': 66.3% had renal stones and 33.7% had ureteral stones. Ninety percent of the treatments were performed under intravenous sedation only: 14.5% of the patients had more than one session. After 3 months more than 80% of the patients with a single stone smaller than 1.5 cm and 46% of the patients with stones larger than 2.5 cm were 'stone-free'.