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Purpose: In this work, we present a subsystem of a robotic circulating nurse, that produces recommendations for the next supplied sterile item based on incomplete requests from the sterile OR staff, the current situation, predefined knowledge and experience from previous surgeries. We describe a structure to store and query the underlying information in terms of entities and their relationships of varying strength. Methods: For the implementation, the graph database Neo4j is used as a core component together with its querying language Cypher. We outline a specific structure of nodes and relationships, i.e., a graph. Primarily, it allows to represent entities like surgeons, surgery types and items, as well as their complex interconnectivity. In addition, it enables to match given situations and partial requests in the OR with corresponding subgraphs. The subgraphs provide suitable sterile items and allow to prioritize them according to their utilization frequency. Results: The graph database was populated with existing data from 854 surgeries describing the intraoperative use of sterile items. A test scenario is evaluated in which a request for “Prolene” is made during a cholecystectomy. The software identifies a specific “Prolene” suture material as the most probable requested sterile item, because of its utilization frequency from over 95%. Other “Prolene” suture materials were used in less than 15% of the cholecystectomies. Conclusion: We have proposed a graph database for the selection of sterile items in the operating room. The example shows how the partial information from different sources can be easily integrated in a query, leading to an unique result. Eventually, we propose possible enhancements to further improve the quality of the recommendations. In the next step, the recommendations of the software will be evaluated in real time during surgeries.

Magnetic Barkhausen noise analysis is an already industrially used method for the detection of grinding burn and offers several advantages over the established nital etching test with respect to objectivity, cost savings as well as occupational safety and environmental protection. Studies on the detectability of damages and influencing factors such as the condition of the surface zone prior to grinding have so far only existed in isolated cases and mostly limited to a few widely used case-hardened steels. For this reason, various steel grades used in particular in the aerospace sector were considered in this study. For one quenched and tempered, one nitrided and two case-hardened steels, the detectability of damages by means of Barkhausen noise and the influence of different heat treatment parameters were investigated. It was shown that the use of Barkhausen noise analysis is also possible on these steel grades and enables more reliable damage detection than nital etching.

Due to its unique characteristics selective laser melting offers the possibility to manufacture highly complex and functional parts out of otherwise difficult processable materials. One example is β-type titanium alloys, which have very promising properties for various engineering applications. Two novel β-type alloys Ti–42Nb and Ti–20Nb–6Ta were compared with commercially pure titanium and Ti–6Al–4V ELI alloy in this study. All four lightweight materials were SLM-processed and the microstructure and corrosion resistance were investigated. While pure titanium and Ti–6Al–4V showed only the martensitic α′-phase, Ti–42Nb consists solely of the β-phase and Ti–20Nb–6Ta of the orthorhombic martensitic α″-phase. Potentiodynamic polarization showed a superior corrosion resistance for both β-type alloys, whereas Ti–42Nb performed slightly better than Ti–20Nb–6Ta. Released V and Al could be clearly observed for the Ti–6Al–4V ELI alloy by mass spectrometry due to corrosion processes, in contrast the release of Nb or Ta was hardly detected for the new alloys.

It is shown that chip formation in high-speed milling of a steel remains unaffected by the presence of a volume fraction of about 10 % ferrite to either martensitic or pearlitic microstructures. Ferrite grains remain visible within the chips and can, therefore, be used for an estimation of the local plastic deformation. In case of the martensite structure, a deformation of 3000 % was measured in the white etching secondary shear zone, while a considerable amount of deformation even takes place within chip segments. The presence of ferrite grains within the white layer is an indication of a thermally-induced phase transformation occurring within the secondary shear zone of the chips.

Anatomical variations of the flexor digitorum superficialis(FDS) include variations of the muscle belly and/or tendon. We present a case of a bilateral accessory FDS muscle and tendon. Dissection was performed in a male specimen (56 years), where an unusual variation was found: a bilateral accessory FDS muscle and tendon. The accessory FDS muscle belly originated at the medial epicondyle, between the tendinous portions of the FDS and flexor carpi radialis, with average dimensions of 70mm in length and 23mm in width. The accessory FDS muscle belly was innervated by the median nerve. After developing a strong tendon, with a length of 51mm (right) and 85mm (left) and width of approximately 9.5mm, the accessory FDS inserted into the dorsal muscle belly of the main FDS. To further analyze the variation, the left accessory FDS muscle and tendon were separated from the adjacent tissues at the elbow and kept attached at the wrist. On a custom jig, 10N were applied sequentially to the main and accessory FDS separately and then together to access their function. Loading of the main FDS muscle resulted in flexion of the fingers with accentuation of the ulnar rays. Loading of the accessory FDS caused flexion of all four long fingers. We described a rare case of an accessory flexor digitorum superficialis, which may assist surgeons with clinical decisions. Surgeons should be aware of variability in forearm anatomy.

The neutral, homoleptic pyridylphosphininenickel(0) complex [Ni(2-Py-4,6-Ph2-PC5H2)2] (1) has been obtained by reaction of the formal Ni(0) source [(IPr)Ni(H2C═CHSiMe3)2] with 2 equiv of 2-(2′-pyridyl)-4,6-diphenylphosphinine (L). Compound 1can be oxidized both electrochemically and through the use of ferrocenium salts, to afford the corresponding Ni(I) complexes [1]BF4, [1(THF)]PF6, and [12](BArF4)2. The structures of these salts reveal an interesting dependence on the nature of the anion. While [1]BF4and [1(THF)]PF6show trigonal-bipyramidal coordination of Ni in the solid state, [12](BArF4)2exists as a dinuclear Ni(I) complex and possesses a bridging phosphinine moiety in a rare μ2mode. Reactions of 1with halobenzenes highlight the noninnocent behavior of the aromatic phosphinine ligand, leading to the formation of oxidized Ni complexes but not to classical oxidative addition products. The reaction of 1with bromobenzene affords the λ5phosphinine 2and the bipyramidal Ni(I) complex [1]Br, whereas a more unconventional oxidation product 3is formed from the reaction of 1and iodobenzene.

The European XFEL is a hard X-ray free-electron laser (FEL) based on a high-electron-energy superconducting linear accelerator. The superconducting technology allows for the acceleration of many electron bunches within one radio-frequency pulse of the accelerating voltage and, in turn, for the generation of a large number of hard X-ray pulses. We report on the performance of the European XFEL accelerator with up to 5,000 electron bunches per second and demonstrating a full energy of 17.5 GeV. Feedback mechanisms enable stabilization of the electron beam delivery at the FEL undulator in space and time. The measured FEL gain curve at 9.3 keV is in good agreement with predictions for saturated FEL radiation. Hard X-ray lasing was achieved between 7 keV and 14 keV with pulse energies of up to 2.0 mJ. Using the high repetition rate, an FEL beam with 6 W average power was created.

Transit time distributions (TTDs) are crucial descriptors of flow and transport processes in catchments, which can be determined from stable water isotope data. Recently, the young water fraction (Fyw) has been introduced as an additional metric derivable from seasonal isotope cycles. In this study, we calculated Fywand TTDs using monthly isotope data from 24 contrasting subcatchments in a mesoscale catchment (3,300 km2) in Germany. Fywranged from 0.01 to 0.27 (mean = 0.11) and was smallest in mountainous catchments. Assuming gamma‐shaped TTDs, we determined stationary TTDs with the convolution integral method for each subcatchment. The convolution integral was first calibrated against the isotope data only (i.e., traditional calibration) and, second, using a multiobjective calibration with the Fywestimates as an additional constraint. This yielded largely differing TTD parameters even for neighboring catchments, with Fywvalues below 0.1 generally involving a delayed peak in TTDs (i.e., gamma‐distribution shape parameter > 1). While the traditional calibration resulted in large uncertainties in TTD parameters, these uncertainties were reduced with the multiobjective calibration, thereby improving the assessment of mean transit times (2 years on average, ranging between 9.6 months and 5.6 years). This highlights the need for uncertainty assessment when using simple isotope models and shows that the traditional calibration might not yield an optimum solution in that it may give a TTD nonconsistent with Fyw. Given the robustness of Fywestimates, isotope models should thus aim at accurately describing both Fywand measured isotope data in order to improve the description of flow and transport in catchments. Information on the age of river water is crucial for assessing the vulnerability of rivers to weather extremes and pollution. The age of river water is defined as the time that water has spent underground after rainfall infiltration and before ending up in the river. The probability distribution of river water age can be determined using environmental tracers, which are tracers that naturally occur in the system such as stable water isotopes. In this study, we used isotope models to analyze time series of stable water isotopes in rainfall and streamwater measured in 24 subcatchments of the Bode catchment in central Germany. We found that the mean age of river water ranges between 9.6 months and 5.6 years depending on catchment characteristics such as climate and soil type. Moreover, river water with an age of below 2 to 3 months accounts for between 1% and 27% of the entire age distribution. We demonstrate how to use this information on young river water to constrain other metrics such as the mean water age. We suggest that this method is valuable for future studies using environmental tracers and models to determine water age in catchments. Calculation of young water fractions and transit time distributions in 24 contrasting subcatchments of a mesoscale catchmentClimate is a key control on young water fractions and transit time distributions in the study catchmentsInformation on young water fractions largely reduces uncertainty in calibrated transit time distributions and mean transit times

In many societies, the majority of adults regularly consume alcohol. However, only a small proportion develops alcohol addiction. Individuals at risk often show a high sensation-seeking/low-anxiety behavioural phenotype. Here we asked which role EF hand domain containing 2 (EFhd2; Swiprosin-1) plays in the control of alcohol addiction-associated behaviours. EFhd2 knockout (KO) mice drink more alcohol than controls and spontaneously escalate their consumption. This coincided with a sensation-seeking and low-anxiety phenotype. A reversal of the behavioural phenotype with β-carboline, an anxiogenic inverse benzodiazepine receptor agonist, normalized alcohol preference in EFhd2 KO mice, demonstrating an EFhd2-driven relationship between personality traits and alcohol preference. These findings were confirmed in a human sample where we observed a positive association of the EFhd2 single-nucleotide polymorphism rs112146896 with lifetime drinking and a negative association with anxiety in healthy adolescents. The lack of EFhd2 reduced extracellular dopamine levels in the brain, but enhanced responses to alcohol. In confirmation, gene expression analysis revealed reduced tyrosine hydroxylase expression and the regulation of genes involved in cortex development, Eomes and Pax6, in EFhd2 KO cortices. These findings were corroborated in Xenopus tadpoles by EFhd2 knockdown. Magnetic resonance imaging (MRI) in mice showed that a lack of EFhd2 reduces cortical volume in adults. Moreover, human MRI confirmed the negative association between lifetime alcohol drinking and superior frontal gyrus volume. We propose that EFhd2 is a conserved resilience factor against alcohol consumption and its escalation, working through Pax6/Eomes. Reduced EFhd2 function induces high-risk personality traits of sensation-seeking/low anxiety associated with enhanced alcohol consumption, which may be related to cortex function.

Abstract

Forced expiratory volume in 1 second (FEV1) from spirometry is the most commonly used parameter to detect early allograft dysfunction after lung transplantation (LTx). There are concerns regarding its sensitivity. Nitrogen‐multiple breath washout (N2‐MBW) is sensitive at detecting early global (lung clearance index [LCI]) and acinar (Sacin) airway inhomogeneity. We investigated whether N2‐MBWindices indicate small airways pathology after LTx in children with stable spirometry. Thirty‐seven children without bronchiolitis obliterans syndrome [BOS]at a median of 1.6 (0.6‐3.0) years after LTx underwent N2‐MBWand spirometry, 28 of those on 2 occasions (≤6 months apart) during clinically stable periods. Additional longitudinal data (11 and 8 measurements, respectively) are provided from 2 patients with BOS. In patients without BOS,LCIand Sacinwere significantly elevated compared with healthy controls. LCIwas abnormal at the 2 test occasions in 81% and 71% of patients, respectively, compared with 30% and 39% of patients with abnormal FEV1/forced vital capacity (FVC). Correlations of LCIwith FEV1/FVC(r = 0.1, P = .4) and FEV1(r = −0.1, P = .6) were poor. N2‐MBWrepresents a sensitive and reproducible tool for the early detection of airways pathology in stable transplant recipients. Moreover, indices were highly elevated in both patients with BOS. Spirometry and LCIshowed poor correlation, indicating distinct and complementary physiologic measures. The authors advocate a greater role for nitrogen multiple breath washout as a diagnostic tool in monitoring pediatric patients after lung transplantation.

Forced expiratory volume in 1 second (FEV1) from spirometry is the most commonly used parameter to detect early allograft dysfunction after lung transplantation (LTx). There are concerns regarding its sensitivity. Nitrogen-multiple breath washout (N2-MBW) is sensitive at detecting early global (lung clearance index [LCI]) and acinar (Sacin) airway inhomogeneity. We investigated whether N2-MBW indices indicate small airways pathology after LTx in children with stable spirometry. Thirty-seven children without bronchiolitis obliterans syndrome [BOS] at a median of 1.6 (0.6-3.0) years after LTx underwent N2-MBW and spirometry, 28 of those on 2 occasions (≤6 months apart) during clinically stable periods. Additional longitudinal data (11 and 8 measurements, respectively) are provided from 2 patients with BOS. In patients without BOS, LCI and Sacinwere significantly elevated compared with healthy controls. LCI was abnormal at the 2 test occasions in 81% and 71% of patients, respectively, compared with 30% and 39% of patients with abnormal FEV1/forced vital capacity (FVC). Correlations of LCI with FEV1/FVC (r= 0.1, P= .4) and FEV1(r= –0.1, P= .6) were poor. N2-MBW represents a sensitive and reproducible tool for the early detection of airways pathology in stable transplant recipients. Moreover, indices were highly elevated in both patients with BOS. Spirometry and LCI showed poor correlation, indicating distinct and complementary physiologic measures.

A two-step process is reported for the electrochemical deposition of copper layers on n-type silicon substrates using an acidic copper sulphate solution without addition of additives and no light assistance. Metal layers were generated on electrodes with different crystal orientations. The process consists of a combination of two very common techniques: chronoamperometry and pulse plating. The former technique is applied to obtain an instantaneous nucleation on the working electrode. Therefore, a large amount of metal nuclei is formed on the substrate before the pulse technique starts. The latter is, then, used to grow the particles previously generated and form a homogeneous metal layer with full coverage onto the semiconductor electrodes. The potential magnitudes are carefully chosen in line with energy levels observed at the semiconductor-electrolyte interface and were also calculated in this work.

Biogeochemical cycling of elements largely occurs in dissolved state, but many elements may also be bound to natural nanoparticles (NNP, 1–100 nm) and fine colloids (100–450 nm). We examined the hypothesis that the size and composition of stream water NNP and colloids vary systematically across Europe. To test this hypothesis, 96 stream water samples were simultaneously collected in 26 forested headwater catchments along two transects across Europe. Three size fractions (~1–20 nm, >20–60 nm, and >60 nm) of NNP and fine colloids were identified with Field Flow Fractionation coupled to inductively coupled plasma mass spectrometry and an organic carbon detector. The results showed that NNP and fine colloids constituted between 2 ± 5% (Si) and 53 ± 21% (Fe; mean ± SD) of total element concentrations, indicating a substantial contribution of particles to element transport in these European streams, especially for P and Fe. The particulate contents of Fe, Al, and organic C were correlated to their total element concentrations, but those of particulate Si, Mn, P, and Ca were not. The fine colloidal fractions >60 nm were dominated by clay minerals across all sites. The resulting element patterns of NNP <60 nm changed from North to South Europe from Fe‐ to Ca‐dominated particles, along with associated changes in acidity, forest type, and dominant lithology. Stream phosphorus is largely bound to natural nanoparticles and colloidsThe chemical composition of colloids varies systematically from Northern to Southern European streams

In 8/8 HLA-matched unrelated donor (UD) hematopoietic cell transplants (HCT), HLA-DPB1 mismatches between alleles from different T-cell epitope (TCE) groups (non-permissive mismatches) are associated with significantly higher risks of mortality compared with those between alleles from the same TCE group (permissive mismatches); however, the relevance of mismatch directionality, that is (host vs graft (uni-directional HvG), graft vs host (uni-directional GvH) or both (bi-directional) in the non-permissive setting is unknown. We show here significantly higher in vitrorelative responses (RR) to bi-directional mismatches compared with uni-directional HvG or GvH mismatches in a total of 420 one-way mixed lymphocyte reactions between 10/10 matched pairs (RR 27.5 vs 7.5 vs 15.5, respectively, P<0.001). However, in 3281 8/8 matched UD HCT for leukemia or myelodysplastic syndrome, the hazards of transplant-related mortality (TRM) were similar for uni-directional HvG or GvH mismatches and bi-directional mismatches (hazard ratio (HR) 1.32, P=0.001 vs HR 1.28, P=0.005 and HR 1.34, P=0.046), compared with permissive mismatches. Similar results were observed for overall survival. No statistical differences between the uni- and the bi-directional non-permissive groups were detected in pairwise comparisons for any of the outcomes tested. We conclude that consideration of directionality does not improve risk stratification by non-permissive HLA-DPB1 TCE mismatches in UD searches.

Cinnamon is a traditional herbal drug, but more importantly, it is used as a flavor compound in the production of foodstuff. Due to the content of significant concentrations of coumarin in Cassia cinnamon, effective control of the coumarin content in seasonal bakery products like ginger bread and cinnamon biscuits is urgently needed. Here we present a novel, fast and fully validated protocol for the determination of coumarin in marketed bakery products using the QuEChERS sample preparation technique in combination with GC-MS analysis. Ten grams of homogenized sample was mixed with 20 mL acetonitrile/water (1:1) and 5 g magnesium sulfate/sodium chloride mixture (4:1). The organic phase was cleaned by dSPE with 25 mg magnesium sulfate/PSA (5:1). The LOD was 0.15 μg/mL and the LOQ 0.50 μg/mL. We detected a mean coumarin content of 19.5 μg/kg in 9 out of 14 seasonal food products (ranging from 1.45 to 39.4 mg/kg). No coumarin was detected in five cinnamon containing products. With this investigation we demonstrate that the QuEChERS sample preparation, previously applied mainly to the analysis of pesticides in vegetables, is also suitable for other complex matrices.

The means for judging optimal tension during tendon transfers are approximate and not very quantifiable. The purpose of this study was to demonstrate the feasibility of quantitatively assessing muscular mechanical properties intraoperatively using ultrasound elastography (shear wave elastography [SWE]) during extensor indicis proprius (EIP) transfer. We report two cases of EIP transfer for post-traumatic rupture of the extensor pollicis longus muscle. Ultrasound acquisitions measured the elasticity modulus of the EIP muscle at different stages: rest, active extension, active extension against resistance, EIP section, distal passive traction of the tendon, after tendon transfer at rest and then during active extension. A preliminary analysis was conducted of the distribution of values for this modulus at the various transfer steps. Different shear wave velocity and elasticity modulus values were observed at the various transfer steps. The tension applied during the transfer seemed close to the resting tension if a traditional protocol were followed. The elasticity modulus varied by a factor of 37 between the active extension against resistance step (565.1 kPa) and after the tendon section (15.3 kPa). The elasticity modulus values were distributed in the same way for each patient. The therapeutic benefit of SWE elastography was studied for the first time in tendon transfers. Quantitative data on the elasticity modulus during this test may make it an effective means of improving intraoperative adjustments.

Härte und Korrosionsbeständigkeit sind die wichtigsten Qualitätsmerkmale von Schneidwaren. Diese werden nur durch eine optimal durchgeführte Wärmebehandlung des martensitischen nichtrostenden Stahls 1.4116 (X50CrMoV15) erreicht. In der industriellen Fertigung wird die Korrosionsbeständigkeit von Schneidwaren durch Wechseltauchversuche überprüft, die herstellerübergreifend eine große Schwankung der Korrosionsbeständigkeit belegen. In den letzten Jahren wurden neue elektrochemische Untersuchungsmethoden für die Werkstoffgruppe der martensitischen nichtrostenden Stähle entwickelt, welche die geringe Lochkorrosionsbeständigkeit von Schneidwaren auf das Phänomen der Chromverarmung zurückführen. Derzeit wird in der wissenschaftlichen und in der industriellen Gemeinschaft der Schritt des Anlassens als Hauptursache der Chromverarmung angesehen. Bei Schneidwaren sind die Anlasstemperaturen aber zu gering, um die auftretende Chromverarmung zu erklären. Aus diesem Grund wurden drei verschiedene Wärmebehandlungsparameter (Austenitisierungsdauer, Abkühlgeschwindigkeit und Anlasstemperatur) systematisch untersucht, um deren Beitrag zur Chromverarmung darzustellen. Dazu wurde die Untersuchungsmethode der elektrochemisch potentiodynamischen Reaktivierung (EPR) eingesetzt, die sehr sensibel auf Veränderungen im Gefüge reagiert und den Grad an Chromverarmung ermittelt. Außerdem wurden KorroPad-Prüfungen durchgeführt und kritische Lochkorrosionspotentiale ermittelt, um den Zusammenhang zwischen Chromverarmung und Lochkorrosionsbeständigkeit herzustellen. Die Ergebnisse aller Untersuchungen verdeutlichen, wie eng das Prozessfenster ist, in dem Schneidwaren mit hoher Korrosionsbeständigkeit hergestellt werden können.

Wir berichten über den Fall eines 19-jährigen Mannes mit rezidivierenden, kreisförmigen und groblamellär geschuppten Hautveränderungen. Anamnestisch war der Patient in seiner Freizeit als Ringer tätig. Nach zunächst frustraner antibiotischer Lokaltherapie konnte im Rahmen einer spezifischen dermatologischen Diagnostik eine Tinea corporis gladiatorum gesichert werden. Unter der leitliniengerechten Therapie für Dermatophytosen mittels systemischer Gabe von Fluconazol sowie einer Lokaltherapie mit Ciclopiroxolamin und Ketoconazol konnte eine schnelle Befundbesserung erwirkt werden. We report the case of a 19-year-old patient who presented with recurrent circular and scaly skin changes. The patient reported wrestling as his main leisure activity. After an unsuccessful attempt at local antibiotic treatment, detailed dermatological work-up revealed the skin changes to be tinea corporis gladiatorum. According to dermatological guidelines for dermatophytosis, systemic treatment with fluconazole and local ointments containing ciclopirox olamine and ketoconazole were administered, which rapidly led to significant improvement.