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Osteochondral lesions (OCLs) in the ankle are more common than OCLs of the foot, but both share a similar imaging appearance. Knowledge of the various imaging modalities, as well as available surgical techniques, is important for radiologists. We discuss radiographs, ultrasonography, computed tomography, single-photon emission computed tomography/computed tomography, and magnetic resonance imaging to evaluate OCLs. In addition, various surgical techniques used to treat OCLs—debridement, retrograde drilling, microfracture, micronized cartilage-augmented microfracture, autografts, and allografts—are described with an emphasis on postoperative appearance following these techniques.

Stomach content samples from 33 minke whales (Balaenoptera acutorostrata), caught during Norwegian commercial whaling between May-June 1998, were collected in four sub-areas in the southern Barents Sea. Simultaneously, a comprehensive resource survey was conducted in order to identify and estimate the abundance of potential prey items for the whales in the four sub-areas. Krill (Thysanoessa sp. and Meganyctphanes norvegica) dominated the diet in all but one sub-area although pelagic fish such as capelin and herring also contributed significantly. The minke whales displayed monophagus feeding in all sub-areas investigated, including the medium-scale area resulting from pooling of all sub-areas. The small-scale resource surveys revealed significant variations in absolute and relative prey abundance between sub-areas, while the temporal (1-7 days) variations in relative prey biomass within sub-areas appeared to be less significant for all prey items, except herring (Clupea harengus) and perhaps capelin (Mallotus villosus). Krill was by far the most important prey item available in all areas, followed by either herring, cod (Gadus morhua) or saithe (Pollachius virens), depending on sub-area and survey. Although minke whale prey preference appeared to vary greatly in space, some new features of minke whale foraging behaviour were evident. Minke whales showed a strong preference for capelin, whereas gadoids (cod, haddock (Melanogrammus aeglefinus) and saithe) appeared to be avoided by the whales. Krill appeared to have been either avoided, fed upon randomly or were the preferred prey depending on sub-area and analyses level.

Invasive emergent and floating macrophytes can have detrimental impacts on aquatic ecosystems. Management of these aquatic weeds frequently relies upon foliar application techniques with aquatic herbicides. However, there is inherent variability of overspray (herbicide loss) for foliar applications into waters within- and adjacent-to the targeted treatment area. The spray retention (tracer dye captured) of four invasive broadleaf emergent species: water hyacinth, alligatorweed, creeping water primrose, parrotfeather, and two emergent grass-like weeds: cattail and torpedograss were evaluated. For all species, spray retention was simulated using foliar applications of rhodamine WT dye (RWT) as an herbicide surrogate under controlled mesocosm conditions. Spray retention of the broadleaf species was first evaluated using a CO2-pressurized spray chamber overtop dense vegetation growth or no plants (positive control) at a greenhouse scale (GH). Broadleaf species and grass-like species were then evaluated in larger outdoor mesocosms (OM). These applications were made using a CO2-pressurized backpack sprayer. Evaluation metrics included species-wise canopy cover and height influence on in-water RWT concentration using image analysis and modeling techniques. Results indicated spray retention was greatest for water hyacinth (GH: 64.7 ± 7.4, OM: 76.1 ± 3.8). Spray retention values were similar among the three sprawling marginal species alligatorweed (GH: 37.5 ± 4.5, OM: 42 ± 5.7), creeping water primrose (GH: 54.9 ± 7.2, OM:52.7 ± 5.7), and parrotfeather (GH: 48.2 ± 2.3, OM: 47.2 ± 3.5). Canopy cover and height were strongly correlated with spray retention for broadleaf species and less strongly correlated for grass-like species. Torpedograss and cattail, while similar in percent foliar coverage, differed in percent spray retention (OM: 8.5± 2.3 and 28.9 ±4.1, respectively). The upright leaf architecture of the grass-like species likely influenced the lower spray retention values in comparison to the broadleaf species.

Expanding the current aquatic herbicide portfolio, reducing total spray volumes, or remotely delivering herbicide using novel spray technologies could improve management opportunities targeting invasive aquatic plants, where options are more limited. However, research on giant salvinia [Salvinia molesta (D. S. Mitchell)] response to foliar herbicide applications at carrier volumes ≤ 140 L ha-1 is incomplete. Likewise, no data exists documenting S. molesta control with unoccupied aerial application systems (UAAS). Following the recent >100 ha incursion of S. molesta in Gapway Swamp, North Carolina, a case study was developed to provide guidance for ongoing management efforts. In total, three field trials evaluated registered aquatic and experimental herbicides using a 140 L ha-1 carrier volume. Select foliar applications from UAAS were also evaluated. Results at 8 weeks after treatment (8 WAT) indicated the experimental protoporphyrinogen oxidase inhibitor, PPO-699-01 (424 g a.i. ha-1), in combination with endothall dipotassium salt (2370 g a.e. ha-1) provided 78% visual control, whereas control when PPO-699-01 (212 g a.i. ha-1) was applied alone was lower at 35%. Evaluations also showed diquat (3136 g a.i. ha-1) alone, glyphosate (4539 g a.e. ha-1) alone, and metsulfuron-methyl (42 g a.i. ha-1) alone achieved 86 to 94% visual plant control at 8 WAT. Sequential foliar applications of diquat, flumioxazin (210 g a.i. ha-1), and carfentrazone (67 g a.i. ha-1) 6 wk following exposure to in-water fluridone treatments were no longer efficacious by 6 WAT due to plant regrowth. Carfentrazone applications made from a backpack sprayer displayed greater control than applications made with UAAS at 2 WAT deploying identical carrier volumes; however, neither application method provided effective control at 8 WAT. Additional field validation is needed to further guide management direction of S. molesta control using low carrier volume foliar applications.

The main objective of this study was to test the longer-term and differential efficacy of a mobile phone‒based life-skills training program designed to prevent substance use among adolescents.A 2-arm, parallel-group, cluster RCT with assessments at baseline and follow-up after 6 and 18 months was conducted. The efficacy of the intervention was compared with that of an assessment-only control condition.A total of 1,473 students with a mean age of 15.4 years were recruited in 2019/2020 within 89 Swiss secondary and upper secondary school classes.The automated intervention program included online feedback and individually tailored text messages provided over 22 weeks. The contents were based on social cognitive theory and addressed self-management, social, and substance use resistance skills.Primary outcomes included 30-day prevalence rates for problem drinking and tobacco use.The 18-month follow-up assessments were completed by 1,232 study (83.6%) participants. Those in the intervention group reported lower tobacco-smoking prevalence than the controls (OR=0.67; 95% CI=0.47, 0.96), but no significant difference in problem drinking (OR=0.84; 95% CI=0.61, 1.17) was observed. Among secondary outcomes, the intervention was effective at reducing cannabis-smoking prevalence (OR=0.55; 95% CI=0.39, 0.76) and cannabis use days (Cohen's d= -0.19; 95% CI= -0.29, -0.09), whereas no effects were observed for quantity of alcohol use, quantity of cigarettes smoked, well-being, or social skills. No significant moderators of the primary outcomes were observed.An automated mobile phone‒based life-skills training program produced longer-term effectiveness in preventing tobacco smoking and cannabis use, whereas no effects were observed for problem drinking. These results suggest that digitally delivered life-skills training programs are similarly effective and are an easy-to-implement alternative to training conducted within a school curriculum.This study is registered at ISRCTN41347061 (registration date: 21/07/2018).

We report a new and unusual beetle larva preserved in ca. 100 million-year-old Kachin amber. Larvae of many modern lineages of beetles are associated with wood, breaking it into smaller pieces or directly digesting it. With such a lifestyle, beetle larvae are important for carbon cycling. We can assume that this is not only the case in modern ecosystems, but was similar in the past. Yet, wood-associated beetle larvae seem so far rare in Kachin amber despite its otherwise rich record of many different ecotypes. Only recently, solid-wood-boring larvae and those living in decaying wood have been reported from this amber deposit. Larvae of the group Eucnemidae, false click beetles, which are also wood-associated, have so far been only known from sedimentary rock deposits. Here we report the first larva of a false click beetle preserved in amber. The fossil larva combines features of different modern lineages of Eucnemidae in a unique morphology that is not known in the modern fauna. The fossil adds to the growing number of wood-associated holometabolan larvae in Kachin amber and with this contributes to a more complete view on this now extinct community and ecosystem.

In this paper, we rewrite the dimensionless gravitational coupling constant: αG, in a different form than has been shown before (without changing its value). We demonstrate that the dimensionless gravitational coupling constant is simply related to the Planck length squared, divided by the reduced Compton wavelength squared, of the mass in question. This could be useful for understanding how the ratio of the gravitational force versus the Coulomb force is linked to the quantum scale, which is linked to the Compton wavelength and the Planck length.

PurposeThe digital transition process is an important strategic initiative for manufacturing companies to ensure continued competitiveness. The purpose is to investigate the relationship between firms' additive manufacturing (AM) readiness and product and process innovation and how this process is mediated by firms' make-or-buy decisions regarding performing AM processes internally or buying AM services from external partners.Design/methodology/approachThe paper is based on a questionnaire survey including full answers from 157 small- and medium-sized manufacturing companies.FindingsResults show a positive relationship between AM readiness and both product and process innovation. Results also reveal that firms with higher readiness invest more in in-house AM, which in turn promotes innovation. There was no significant association between AM readiness and the use of external AM services. Nonetheless, buying external AM services is still associated positively with innovation.Research limitations/implicationsData in the questionnaire survey are provided by single respondents from each company and are only based on Danish respondents.Practical implicationsThe results indicate that firms' product and process innovation benefits from higher AM readiness derive from increased investment in in-house AM rather than from increased use of external AM services. This also signifies that firms with lower levels of AM readiness buy external AM services and derive the innovation benefits hereof.Originality/valueThe paper delivers new, empirically found knowledge about how small- and medium-sized manufacturing can improve innovation by both making and buying AM services.

Variation in fatty acid (FA) composition of blubber collected in 1998 from 170 common minke whales (Balaenoptera acutorostrata) was used to study population structure in the North Atlantic. Samples from seven IWC management units were analysed: West Greenland (‘WG’, n = 69); East Greenland (‘CG’, n = 3); Jan Mayen (‘CM’, n = 24); Svalbard (‘ES’, n = 16); the Barents Sea (‘EB’, n = 30); Vestfjorden/Lofoten (‘EC’, n = 7); and the North Sea (‘EN’, n = 21). FA analyses were conducted on both deep and superficial blubber with a one-step extraction and esterification method followed by gas-chromatography. The 43 FAs identified comprised 93-99% of total FAs. CART and MANOVA analyses on FA signatures in both blubber sections suggested a ‘3-geographic Regions model’ where the regions were Greenland (WG, CG), the Northeast Atlantic (CM, ES, EB, EC) and the North Sea (EN). This is in general agreement with a genetic study on the same samples and suggests that differences in FA signatures can be used for studying population structure in minke whales. Potential variation in FA signatures caused by internal and environmental factors needs to be better understood. It is recommended that future studies of blubber FA signatures in minke whales include samples from their entire North Atlantic range (including Canadian and Icelandic waters). Samples should be collected from a pre-specified body site to rule out possible internal variation and during a narrow time-window in the same year to rule out seasonal exchange between areas.

Introduction: Root canal treatment (RCT) is often considered a difficult procedure for both the patient and treatment provider. The American Association of Endodontists case difficulty assessment form categorizes cases as minimal, moderate, and high difficulty level. We recently showed that endodontic mishaps occur frequently during treatment of teeth in high difficulty category. The aims were to investigate the clinical and radiographic outcome at least 4 years after RCT and to evaluate patients’ perceived oral health-related quality of life (OHRQoL). Methods: Two hundred thirty-four patients (257 endodontically treated teeth) who were previously included in a quality assurance study were offered a recall appointment at the Department of Clinical Dentistry, University of Bergen, Norway. Patients were given a thorough clinical, radiographic examination and asked to fill out the Oral Health Impact Profile-14 questionnaire. Results: A total of 149 patients (160 teeth) attended the 4-year (range, 4–6 years) recall appointment. An unchanged or lower Periapical Index (PAI) score at recall visit was registered on 153 teeth (95.6%) (P < .001). Radiographic success rate (PAI score ≤ 2) was 87.5%, and clinical success (absence of clinical signs and symptoms) was 88.8%. Both radiographic and clinical success was observed in 78.8% of teeth. Teeth in high difficulty category, instrumented with engine-driven files, and molars presented with significantly more clinical signs and symptoms but not high PAI score (PAI score ≥ 3) (P < .05). Endodontic mishaps such as overinstrumentation and overfill with gutta-percha resulted in significantly high PAI score (P < .05). Patients with no clinical signs and symptoms after RCT and elderly had a significantly better OHRQoL (P < .05). Conclusions: Presence of clinical signs and symptoms rather than PAI score affected patients’ OHRQoL. publishedVersion

Background Fatigue is a highly prevalent and debilitating symptom among patients in the chronic phase of aneurysmal subarachnoid haemorrhage (aSAH) with no identified effective treatment. Cognitive therapy has been shown to have moderate effects on fatigue. Delineating the coping strategies used by patients with post-aSAH fatigue and relating them to fatigue severity and emotional symptoms could be a step towards developing a behavioural therapy for post-aSAH fatigue. Methods Ninety-six good outcome patients with chronic post-aSAH fatigue answered the questionnaires Brief COPE, (a questionnaire defining 14 coping strategies and three Coping Styles), the Fatigue Severity Scale (FSS), Mental Fatigue Scale (MFS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). The Brief COPE scores were compared with fatigue severity and emotional symptoms of the patients. Results The prevailing coping strategies were “Acceptance”, “Emotional Support”, “Active Coping” and “Planning”. “Acceptance” was the sole coping strategy that was significantly inversely related to levels of fatigue. Patients with the highest scores for mental fatigue and those with clinically significant emotional symptoms applied significantly more maladaptive avoidant strategies. Females and the youngest patients applied more “Problem-Focused” strategies. Conclusion A therapeutic behavioural model aiming at furthering “Acceptance” and reducing passivity and “Avoidant” strategies may contribute to alleviate post-aSAH fatigue in good outcome patients. Given the chronic nature of post-aSAH fatigue, neurosurgeons may encourage patients to accept their new situation so that they can start a process of positive reframing instead of being trapped in a spiral of futile loss of energy and secondary increased emotional burden and frustration.

Claims to civilizational exceptionalism have long been part of how states manoeuvre international affairs. While scholarly attention has started to move beyond the civilizational claims of western powers by engaging with those of states beyond the West, few accounts provide in-depth examinations of specific cases or bring these into dialogue with one another. This article offers a comparative analysis of how and why India and Turkey are positioning themselves as civilizational forces in global forums and international cooperation initiatives. Under the Narendra Modi regime, civilizational framings in India have found expression in the seemingly benign discourse of Hindu internationalism. In Turkey, successive governments under Recep Tayyip Erdoğan have linked their engagement abroad to the legacies of the Ottoman Empire. While there are clear differences in their respective civilizational antecedents, both countries draw on a combination of moral superiority and responsibility—India as vishwaguru (the world's guru) and Turkey as dünyanın vicdanı (the world's conscience)—as the legitimizing base for their assumed (normative) exceptionalism on the international stage. Overall, we argue that Indian and Turkish claims to civilizational exceptionalism serve two distinct but interrelated political projects: attempts to overcome centuries-long international marginalization, and efforts to buttress competitive authoritarianism domestically.

The phrase “music is the nourishment of the soul” reflects a century-old complex of musical, medical, and astrological thinking; integrated notions of celestial and terrestrial harmony, humoral medicine and ethos theory that reach back to Ancient Greece. Adopted into Islamicate philosophy, those theories were combined with a modal system that amplified them. The present paper traces them in various Ottoman texts with the aim of understanding how concepts of music theory, astrology, medicine, and food interacted. A crucial question is whether music theory sources can be brought into a relationship with descriptions of musical (therapy) practices in hospitals.

Keller, Otto: Vicvs Avrelii oder Oehringen zur Zeit der Römer, in: Fest-Programm zu Winckelmann's Geburtstagsfeier, hrsgg. v. Verein von Alterthumsfreunden im Rheinlande, Bonn 1871, 65 S., VII Bl. : Ill., Kt.

Christ, Karl: Zur älteren Geschichte des untern Neckarthals, besonders von Wimpfen, in: Heidelberger Jahrbücher der Literatur, 1872, Nr. 16 - 19, S. [241] - 295

A total of 210 common minke whales (Balaenoptera acutorostrata) were sampled in five different areas in the northeastern Atlantic during May-June 2000-04. Analysis of forestomach contents revealed a relatively mixed diet at the population level, whereas on an individual level, each whale had fed upon mainly one species. There were significant differences in diet composition between areas and some differences between years. The importance of krill in the Barents Sea increased with latitude and krill dominated the Spitsbergen diet. Capelin dominated the diet around Bear Island and contributed considerably to the diet along the coast of northern Norway. In the latter area, herring and haddock were also a great part of the diet. The diet in the Norwegian Sea consisted of mainly mature herring, while the diet in the North Sea was dominated by sand eels and mackerel. The minke whales were found to feed on a wide range of prey sizes, apparently determined by the availability of different size classes.

BackgroundWe have previously reported arterial remodelling in patients with idiopathic pulmonary fibrosis (IPF) and suggested that endothelial-to-mesenchymal transition (EndMT) might be central to these changes. This study aims to provide evidence for active EndMT in IPF patients.MethodsLung resections from 13 patients with IPF and 15 normal controls (NCs) were immunostained for EndMT biomarkers: vascular endothelial cadherin (VE-cadherin), neural cadherin (N-cadherin), S100A4 and vimentin. Pulmonary arteries were analysed for EndMT markers by using computer- and microscope-assisted image analysis software Image ProPlus7.0. All the analysis was done with observer blinded to subject and diagnosis.ResultsIncreased expression of mesenchymal markers N-cadherin (pConclusionThis is the first study to demonstrate active EndMT in size-based classified pulmonary arteries from IPF patients and potential role in driving remodelling changes. The mesenchymal markers had a negative impact on the diffusing capacity of the lungs for carbon monoxide. This work also informs early origins of pulmonary hypertension in patients with IPF.

ZnFe2O4 nanoparticles and Fe-decorated inversion domain boundaries in ZnO both have their absorption band edge at 2.0 eV, determined by DRS and EELS. The similarity is attributed to the presence of layers of Fe3+ octahedrally coordinated by oxygen.

BACKGROUND AND OBJECTIVE: Methotrexate should be withdrawn before pregnancy because of its teratogenic potential. We aimed to describe the use of methotrexate in women of childbearing age in Germany and the occurrence and outcomes of pregnancies exposed to methotrexate. METHODS: Using the German Pharmacoepidemiological Research Database (GePaRD, covering ~ 20% of the German population), we determined the age-specific and age-standardized prevalence of methotrexate use for each year between 2004 and 2019 among women aged 13–49 years (cross-sectional analyses). In a cohort analysis, we assessed the number and outcomes of pregnancies exposed to methotrexate in the critical time window. Exposure was defined as a dispensation overlapping with the onset of pregnancy or a dispensation in the first 8 weeks of pregnancy. For children born from exposed pregnancies, the mother’s and children’s data were linked and the occurrence of malformations was assessed by reviewing all available data of these children. RESULTS: The age-standardized prevalence of methotrexate use per 1000 females increased from 1.5 in 2004 to 2.3 in 2019, i.e., by 52%. Overall, we identified 184 pregnancies exposed to methotrexate. Of these, 53% ended in a live birth (21% preterm) and 11% in an induced abortion. Among 81 live-born children linked to their mothers, five children (6%) had relevant malformations including congenital heart defects and musculoskeletal malformations. CONCLUSIONS: In Germany, the use of methotrexate in women of childbearing age has substantially increased since 2004. Despite the known teratogenic effect, there was a considerable number of exposed pregnancies. Also, malformations likely associated with methotrexate and thus avoidable were observed.

We will demonstrate that the mass (equivalent mass) of the observable universe divided by the universe radius is exactly identical to the Planck mass divided by the Planck length. This only holds true in the Haug universe model that takes into account Lorentz’s relativistic mass, while in the Friedmann model of the universe, the critical mass of the universe divided by the Hubble radius is exactly equal to m p /(2l p ). Furthermore, in a recently suggested quantum gravity model, the mass of the universe divided by the radius of the universe is exactly identical to mp /lp ; that is, the Planck mass divided by the Planck length. This is much more than just a speculative approximation, for the findings are consistent with a new unified quantum gravity theory that links the cosmological scale directly to the Planck scale.

BackgroundCosmetic breast surgery (CBS) can be subdivided into augmentation, mastopexy, reduction, and reconstruction.ObjectivesThe aim of this study was to retrospectively analyze a multi-institutional national database to investigate the outcomes of CBS and identify clinical patterns to optimize care.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database (2008-2020) was reviewed to identify female patients who underwent CBS. Postoperative outcomes (30-day surgical and medical complications, reoperation, readmission, and mortality) and risk factors for complications were assessed.ResultsIn total, 4733 patients were identified (mean age, 40 [13] years; mean BMI, 24 [4.5] kg/m2) with augmentation accounting for 54% of cases. There were complications in 2.0% of cases. Age >65 years (P = .002), obesity (P < .0001), setting (P < .0001), and diabetes (P = .04) were risk factors for any complication. Age >65 years (P = .02), obesity (P = .03), diabetes (P = .01), history of chronic obstructive pulmonary disease (COPD) (P = .002) and congestive heart failure (P < .0001), smoking in the past year (P = .003), setting (P = .007), and increased American Society of Anesthesiology score (P < .0001) were predictors of surgical complications such as dehiscence and infection. Multivariable analysis confirmed that chronic obstructive pulmonary disease, obesity Class 1 and 3, and inpatient status were independent risk factors for occurrence of any complication (P = .0005, .0003, < .0001 and ConclusionsThis study confirms the positive safety profile of CBS. Healthy BMI is a protective factor, while complications were more likely among inpatient procedures. A correlation between multiple procedures and increased surgical complications was identified. Awareness of these risk factors can assist surgeons to further refine their perioperative protocols.

In revision total knee arthroplasty, zonal fixation methods with a combination of augments, press-fit stems, and sleeves are popular. We hypothesized that high distal femoral augmentation with diaphyseal press-fit stems leads to an increased rate of early aseptic loosening and that femoral metaphyseal sleeves improve implant survival. Therefore, we retrospectively investigated implant survival in relation to augment heights and sleeves.A total of 136 patients with mean clinical follow-up of 50 months (range, 28-85) who underwent modular total knee arthroplasty and revision total knee arthroplasty with semiconstrained implants between January 2012 and July 2018 were retrospectively evaluated. Implant survival with 4, 8, and 12 mm distal femoral augments was compared to no distal augmentation. Subsequently, a subgroup analysis was performed for femoral sleeve implantation.We observed an implant survival rate of 97.0%, 87.5%, and 69.2% for 4, 8, and 12 mm distal femoral augmentation, respectively (P = .73; P = .19; P = .008). The implant survival rate with femoral sleeves was 95.8% for the 8 mm augments and 85.7% for the 12 mm augments (P = .42; P = .96). Without femoral sleeves, the implant survival rate was 78.3% with the 8 mm augments and 50.0% with the 12 mm augments (P = .02; P.001).Higher rates of aseptic femoral loosening were identified for distal femoral augmentation of 8 mm or more without metaphyseal sleeve fixation in semiconstrained implants. Thus, in cases with femoral metaphyseal bone damage requiring high distal femoral augmentation, metaphyseal sleeves should be used to avoid early aseptic femoral loosening.

Patients in specialist mental healthcare services who are at risk of suicide may experience their struggles as existential in nature. Yet, research on meaning in life has been relatively scarce in suicidology. This qualitative study aimed to explore how patients at risk of suicide perceived their encounters with specialist healthcare professionals after a suicide attempt (SA), with special reference to meaning in life experiences. The study was conducted in specialised mental healthcare services in Norway. Data were collected via individual interviews with eight patients aged 20–75 years. Using a four-step procedure, the interviews were analysed by systematic text condensation. The participants understood their feelings of shame, self-contempt and challenging life experiences as contributing factors to their SA. They perceived that existential themes in relation to financial difficulties, shame and trauma were resolved, while issues associated with the SA, such as death, loss and beliefs, were given less attention. The participants were either ambivalent about continuing to live or wished to rebuild a meaningful life. Overall, their experiences of meaningfulness were hampered. Assisting patients with meaning in life experiences may help them alter their life interpretations and increase their ability to rebuild their lives as meaningful. The present study should be seen as a contribution to meaning-informed approaches in specialist mental healthcare services. More research is needed to equip healthcare personnel in their overall aims of preventing suicide and supporting patients at risk in their efforts to live a meaningful life Patients at risk of suicide and their meaning in life experiences