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Prematurity, prenatal growth restriction, and retinopathy of prematurity (ROP) are associated with altered ocular geometry, such as a steeper corneal shape in childhood, but it is unclear whether perinatal history affects corneal thickness development, so this study investigated whether corneal thickness in adulthood is affected by perinatal history. The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination in Germany. The corneal thickness was measured by Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany), and the relationship between perinatal parameters respective birth weight percentile and corneal thickness at different locations was assessed using uni- and multivariable linear regression models. Covariates included age, sex, mean corneal radius, white-to-white distance, gestational age, birth weight percentile, ROP occurrence, and treatment. The main outcome measures were corneal thickness at the apex, the pupil center, and the corneal periphery. The corneal thickness was measured in 390 participants (754 eyes, mean age 29.7+/-8.7 years, 224 females). In multivariable analyses, a lower birth weight percentile was associated with a lower corneal thickness at the apex (B = 0.20, p = 0.003) and the pupil (B = 0.19, p = 0.007). These effects diminished towards the corneal periphery and were not observed beyond the 4-mm diameter circle around the thinnest corneal position. Neither gestational age, ROP occurrence, or ROP treatment affected the corneal thickness. A lower birth weight percentile in subjects born preterm as a proxy for restricted fetal growth is associated with corneal thickness thinning in adults aged 18 to 52 years, indicating that corneal thickness development, particularly in the corneal center, may originate in the fetal stage. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the attitudes of radiologists, information technology (IT) specialists, and industry representatives on artificial intelligence (AI) and its future impact on radiological work.Materials and Methods: During a national meeting for AI, eHealth, and IT infrastructure in 2019, we conducted a survey to obtain participants' attitudes. A total of 123 participants completed 28 items exploring AI usage in medicine. The Kruskal-Wallis test was used to identify differences between radiologists, IT specialists, and industry representatives.Results: The strongest agreement between all respondents occurred with the following: plausibility checks are important to understand the decisions of the AI (93% agreement), validation of AI algorithms is mandatory (91%), and medicine becomes more efficient in the age of AI (86%). In contrast, only 25% of the respondents had confidence in the AI results, and only 17% believed that medicine will become more human through the use of AI. The answers were significantly different between the three professions for four items: relevance for protocol selection in cross-sectional imaging (p = 0.034), medical societies should be involved in validation (p = 0.028), patients should be informed about the use of AI (p = 0.047), and AI should be part of medical education (p = 0.026).Conclusion: Currently, a discrepancy exists between high expectations for the future role of AI and low confidence in the results. This attitude was similar across all three groups. The demand for plausibility checks and the need to prove the usefulness in randomized controlled studies indicate what is needed in future research. [ABSTRACT FROM AUTHOR]

• North Atlantic fish oils often have high levels of LCMUFA and modest omega-3 levels. • Here we present a Cetoleic Rich Oil (CRO) as an alternative to conventional oils. • CRO increases the omega-3 index greater than expected. • CRO improves the redness of skin in a clinical study. • CRO may benefit skin inflammation and skin health. Objective: The objective of the study was to provide preliminary data on the effect of a long chain monounsaturated oil rich in cetoleic acid on the omega-3 index, a validated measure of EPA and DHA in blood cells, as well as a potential effect of the oil on skin quality. Design: Two intervention studies were performed, each as double blinded, placebo controlled, randomised nutritional trials. The CetoIndex study (N = 55) measured omega-3 index using a blood spot collection kit (Omegaquant). The Optihud study (N = 28) measured skin quality parameters in healthy women using the VISIA system. The cetoleic-rich-oil (CRO) was an oil derived from North Atlantic fish with a predominance of long chain mono-unsaturated fatty acids including cetoleic acid (C22:1 n-11) and gondoic acid (C20:1 n-9). Results: In a placebo-controlled study, the omega-3 index in healthy volunteers was increased similar to that seen with an oil with higher levels of omega-3 fatty acids. In a separate placebo-controlled study, the CRO reduced erythema in skin, which is a marker of inflammation. Conclusions: The results of this pilot study suggest that the use of a CRO increases the omega-3 index more than expected from the levels of EPA and DHA in the oil. The CRO may potentially have benefits on skin inflammation. Summary: Long chain polyunsaturated fatty acids (LCPUFA), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are commonly taken as dietary supplements for a range of health benefits. Other marine fatty acids may also provide health benefits and it is of interest to understand their activity. Long chain mono-unsaturated fatty acids (LCMUFA) have shown biological activity in studies of metabolic health in animal models. Here, we report two intervention studies using a fish oil with a high LCMUFA content where cetoleic acid is the predominant fatty acid (Cetoleic rich oil: CRO). In CetoIndex, a placebo-controlled study in 55 healthy volunteers, the omega-3 index increased similarly to that seen with an oil containing higher levels of omega-3 fatty acids. In Optihud, a placebo-controlled study in 28 female volunteers, the CRO reduced erythema in skin, which is a marker of inflammation. The results of this pilot study support the use of a CRO for increasing the omega-3 index with potential benefits on skin inflammation. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the impact of mindfulness meditation offered in a community pharmacy on patients with current anxiety or a history of anxiety, depression, or both.Setting: Community pharmacy clinical space located in a grocery store.Practice Description: An 8-week, once-per-week mindfulness meditation program for patients with anxiety or depression.Practice Innovation: A pharmacist provided mindfulness meditation within the clinical space in a community pharmacy.Evaluation: PHQ-9 and GAD-7 were used to assess prestudy and poststudy depression and anxiety severity, respectively. Items pertaining to participant demographics and experience in the program were also included.Results: Twelve participants completed the study requirements. Three-quarters of participants experienced a reduction in the severity of their depression or anxiety, and no participant experienced an increase in the severity of his or her condition.Conclusion: Findings from this study indicated that a mindfulness meditation program delivered in a community pharmacy and provided by a pharmacist for patients with depression or anxiety, or both, can result in a reduction in severity of their conditions for participants. [ABSTRACT FROM AUTHOR]

Highlights • We report a large-n survey experiment on San Francisco Bay Area residents to investigate how providing personalized risk information shapes sea-level rise risk perceptions • Personalized risk messaging sometimes reduced concern about sea-level rise, particularly among individuals who believe in climate change • We find no effect of personalized risk information on an individual's willingness to pay for regional climate adaptation measures. • Local sea-level rise messaging strategies may not have the clear impacts that some advocates and scholars presume. Abstract One potential barrier to climate policy action is that individuals view climate change as a problem for people in other parts of the world or for future generations. As some scholars argue, risk messaging strategies that make climate change personally relevant may help overcome this barrier. In this article, we report a large-n survey experiment on San Francisco Bay Area residents to investigate how providing spatially-resolved risk information to individuals shapes their climate risk perceptions in the context of sea-level rise. Our results suggest that personalized risk messaging can sometimes reduce concern about sea-level rise. These experimental effects are limited to respondents who believe that climate change is happening. Further, we do not find an effect of providing local risk messages on an individual's willingness to pay for regional climate adaptation measures. Our results emphasize that local messaging strategies around sea-level rise risks may not have the clear impacts that some advocates and scholars presume. [ABSTRACT FROM AUTHOR]

The objective of this project was to improve birth outcomes for babies in a regional referral hospital in Uganda by strengthening factors that influence the retention and application of neonatal resuscitation skills. Initial training in neonatal resuscitation is not enough on its own. In order to better understand the gap between training and effective practice, an evaluation of a neonatal resuscitation program was carried out. This included practical skill testing of local midwives using a neonatal resuscitation doll pre- and post-training, as well as follow up testing at 1 month and 12 months, followed by focus groups and interviews. Test scores revealed that participants’ knowledge grew significantly immediately following the workshop, and remained high after 1 month, but fell by 12 months post-training. Interviews with hospital staff revealed a number of facilitators and barriers to practice, namely knowledge retention and skill application. The most important barrier identified is the lack of refresher training post-workshop. Importantly, the findings demonstrated a need not for refresher training alone, but for improved organizational and administrative support for the newly assigned trainers. [ABSTRACT FROM AUTHOR]

Zusammenfassung Gab es eine ärztliche oder heilkundliche Osteopathie in Deutschland vor 1945? Ja, aber in bescheidenem Ausmaß. Die Rezeption Stills begann schon kurz nach der Jahrhundertwende und in den 1920er-Jahren reagierte die Ärzteschaft. Im Nationalsozialismus wurde anstelle der Osteopathie die Chiropraktik gefördert, auch wenn Osteopathen ihre Technik beim Internationalen Sportärztekongress 1936 in Berlin vorstellen durften. Osteopathy, conducted by laymen or doctors, had been a rare subject in Germany before 1945. Still began to receive attention shortly after the turn of the century and in the 1920s, the medical profession responded. In National Socialism, chiropractic was promoted instead of osteopathy, but osteopaths were allowed to present their technique at the International Sports Physicians' Congress in Berlin in 1936. [ABSTRACT FROM AUTHOR]

This paper presents the design, fabrication and characterization of high-density neural probes based on complementary-metal-oxide-semiconductor (CMOS) technology. A new version of the electronic depth control (EDC) addressing scheme is implemented in the slender probe shaft enabling an increased number of simultaneously addressable electrodes compared to our previous EDC devices. Two further channels allow operating selected electrodes for purposes of stimulation or local referencing. Probes with a shaft width of 100 μm and lengths up to 10 mm carrying a maximum number of 334 electrodes with an inter-electrode spacing of 30 μm have been implemented. The integrated CMOS circuitry is realized using the commercial 0.18 μm double-poly, six-metal CMOS process from XFAB, followed by post-CMOS processing of the electrode metallization and probe geometry. The probe functionality is verified by measuring the impedance of single and combined electrodes. Pt and IrO x electrodes are characterized; they reveal impedance values of 2±0.9 MΩ and 162±40 kΩ, respectively, at 1 kHz. [ABSTRACT FROM AUTHOR]

Zusammenfassung Nach 1945 entwickelten deutsche Ärzte ein Interesse für die Chiropraktik und ließen sich von Heilpraktikern unterweisen. Nach einer Phase der Rezeption heilpraktischer Konzepte emanzipierten sich die Ärzte von deren Lehrern, integrierten neue Aspekte in die Praxis und trennten sich schließlich vollkommen von den Heilpraktikern. Die Heilpraktikerschaft ging ab Mitte der 1950er-Jahre eigene Wege. Die von Ärzten konzipierte „Manuelle Medizin” wurde ein eigenständiges Feld. After 1945 German doctors became interested in chiropractics and had to accept, that lay healers gave first lectures to them. After a period of learning, doctors invented new aspects into therapy and separated their „manual medicine” from lay men. „Manual medicine” was presented as a unique field of clinical medicine, but after some years chiropractics, osteopathy and „manual medicine” came close again. [ABSTRACT FROM AUTHOR]

Objective: We question the hypothesis that vascular tone of human umbilical vein is insensitive to oxygen pressure and minimal already at resting conditions.Study Design: Isometric tension and intracellular membrane potential of native (n = 7) and endothelium-denuded (n = 7) human umbilical vein strips were recorded simultaneously at oxygen pressure values of 5 to 104 mm Hg.Results: Increasing oxygen pressure from 5 to 104 mm Hg led to graded membrane depolarization from -58.2 +/- 1.3 mV (SEM) to -54.0 +/- 0.7 mV (P <.009) and increased isometric tension from 0.576 +/- 0.016 g to 0.790 +/- 0.032 g (P <.0001). The steepest increase in tension (Delta = 0.063 g) occurred within the physiologic intrauterine oxygen tension range (27-35 mm Hg). Isometric tension at hypoxia (partial oxygen pressure, 5 mm Hg) corresponded to 88% of resting tension. Tension and membrane potential were related linearly (r(2) = 0.99). Disruption of the endothelium reversed the effects of oxygen pressure.Conclusion: Human umbilical vein vascular tone was regulated by oxygen tension and showed a hypoxic vasodilator reserve. Oxygen-dependent effects were related to the membrane potential and required the endothelium. [ABSTRACT FROM AUTHOR]

Objective: To characterize a new lethal fetal and early postnatal variant of adenylosuccinate lyase (ADSL) deficiency. Study design: This was a retrospective analysis of 6 patients with very early presentation of ADSL deficiency. Results: Most of the 6 patients had impaired intrauterine growth, microcephaly, fetal hypokinesia, and a lack of fetal heart rate variability. Postnatally, they shared severe muscular hypotonia necessitating mechanical ventilation, intractable seizures, and early death. All 6 patients had biochemical evidence of severe (type 1) disease and low residual ADSL activities. All were compound heterozygous for mutations that, based on expression studies, have a pronounced effect on ADSL activity and/or stability. Conclusions: ADSL deficiency may present with prenatal growth restriction, fetal and neonatal hypokinesia, and rapidly fatal neonatal encephalopathy. This clinical presentation is associated with genotypes resulting in very low residual enzyme activity. [Copyright &y& Elsevier]

Higher education institutions are trying to provide more flexibility and individualization, which is mainly realized through the use of new technologies and implemented in online or blended learning designs. This systematic review aims to investigate the impact of replacing classroom time with an online learning environment. The meta-analysis (k = 21 effect sizes) applied strict inclusion criteria concerning research design, measurement of learning outcomes and implementation of blended learning. The estimated effect size (Hedge's g) was positive, although not significantly different from zero and the confidence interval [-0.13, 0.25], suggesting that overall differences between blended and conventional classroom learning are small, and, at best, very small negative or moderate positive effects are plausible. This means that despite a reduction in classroom time between 30 and 79 per cent, equivalent learning outcomes were found. Consequently, blended learning with reduced classroom time is not systematically more or less effective than conventional classroom learning. • We report a meta-analysis of blended learning with reduced classroom time (k = 21). • Study shows equivalent learning outcomes despite reduced classroom time of 30–79%. • Moderators of condition, methods and practice are not significant. • Gaps in the empirical literature are highlighted and policy implications discussed. [ABSTRACT FROM AUTHOR]

Carmi syndrome is a rare and severe disease defined by pyloric atresia and junctional epidermolysis bullosa. There are no clear recommendations when to consider a curative therapy, including surgical repair of pyloric atresia and when to transition to palliative care. We report the case of a female preterm infant suffering from Carmi syndrome. After definitive diagnosis and appropriate ethical counselling, we decided for surgical repair of the pyloric atresia. Nonetheless, there was no clinical improvement and our patient died after 35 days. Reviewing the literature, we found immunofluorescence microscopy to be most decisive examination to determine the prognosis of this severe disease. • Carmi syndrome (JEP-PA) is a rare and severe disease defined by pyloric atresia and junctional epidermolysis bullosa. • The overall mortality is reported to be 75%. • Decisive for prognosis is the quantity of integrin evaluated by immunofluorescence microscopy. • Decision about curative therapy or a palliative approach should be made in an interdisciplinary clinical committee [ABSTRACT FROM AUTHOR]

• Some types of weather affect Americans' belief that they have experienced global warming. • Americans associate hot, dry days and extreme drought with global warming. • People often fail to interpret extreme rainfall or flooding as due to global warming. Public perceptions of climate change in the United States are deeply rooted in cultural values and political identities. Yet, as the public experiences extreme weather and other climate change-related impacts, their perceptions of the issue may shift. Here, we explore whether, when, and where local climate trends have already influenced perceived experiences of global warming in the United States. Using a large national survey dataset (n = 13,607), we compare Americans' experiences of climate with corresponding trends in seven different high-resolution climate indicators for the period 2008 to 2015. We find that increases in hot dry day exposure significantly increases individuals' perceptions that they have personally experienced global warming. We do not find robust evidence that other precipitation and temperature anomalies have had a similar effect. We also use multilevel modeling to explore county-level patterns of perceived experiences with climate change. Whereas the individual-level analysis describes a likely causal relationship between a changing climate and individuals' perceived experience, the multilevel model depicts county-level changes in perceived experience resulting from particular climate trends. Overall, we find that exposure to hot dry days, has a modest influence on perceived experience, independent of the political and socio-demographic factors that dominate U.S. climate opinions today. [ABSTRACT FROM AUTHOR]

Zusammenfassung Für die aktuelle osteopathische Wissenschaftstheorie spielen die Forschungsarbeiten des Göttinger Embryologen Erich Blechschmidt (1904–1992) eine bedeutende Rolle. Allerdings ist zu fragen, ob es wirklich vorteilhaft sein kann, sich auf die Erkenntnisse eines Mannes zu verlassen, der seine Studien an Präparaten zweifelhafter Herkunft durchführte, die schädliche Wirkung von Contergan in Zweifel zog und schließlich einen wissenschaftsfeindlichen Kreatonismus bewarb. Embryological studies by Erich Blechschmidt (1904–1992) play an important role in present Central European osteopathic theory of science. But Blechschmidt's research was conducted in a dubious way before 1945. Later he claimed innoxiousness of Contergan and left scientific communities for advertising creationism. [ABSTRACT FROM AUTHOR]

Zusammenfassung In der Formierungsphase von Chiropraktik und Osteopathie um 1900 wurde von verschiedener Seite behauptet, die Präzeptoren der eigenen Arbeit stammten aus Böhmen. Aufgrund der Sprachbarriere konnte diese Behauptung nicht verifiziert oder widerlegt werden. Das neue Buch von Popović, „Böhmische Heiler”, gewährt aber Einblicke und Erklärungen. During the founding years of osteopathy and chiropractics, scholars claimed, the roots of manipulative therapy would lie in Bohemia. Because of the problem of understanding czech language, historians and doctors were unable to verify this thesis. The new book by Popović, „Böhmische Heiler”, now offers new insights and helps solving this problem. [ABSTRACT FROM AUTHOR]

For a long time, radiation dose documentation has been done manually. In the late Nineties, DICOM has introduced MPPS (Modality Performed Procedure Step), which has been the first general solution for digital communication of dose measurements. In parallel, OCR has been used to analyse the "images" keeping dose information, which are part of most CT studies. Both of these efforts have some advantages and also a lot of disadvantages, e.g. MPPS is a message based communication, which could fail and OCR could produce errors. Therefore, some years ago DICOM has started to develop new objects for documentation of dose information as "DICOM Dose Structured Reports". These objects are full DICOM objects, which can be communicated, stored and displayed like any other DICOM object. Such Dose SRs are available for many different imaging modalities, meanwhile also a Dose SR for nuclear medicine is available (Supplement 159, 2013). Actually, the second generation of Dose SR on Radiotherapy (Suppl. 177) and a "Patient Radiation Dose Reporting" (Suppl. 191) are in discussion in DICOM. The real world application is "prescribed" with the IHE profile on "Radiation Exposure Monitoring". Based on this profile, different roles for creating, archiving and analysing dose information have been defined and described. This model allows building local, regional or even international dose registers from real life examinations. Such information is optimal for benchmarking or creation of DRLs. Using structured dose information, there are new opportunities for research. Also, in principle there patient-oriented dose-profiles could be created in future. [ABSTRACT FROM AUTHOR]

Objectives: The lack of oral mucosa in oral and maxillofacial surgery for intraoral grafting after trauma or tumor resection can be balanced by tissue-engineered oral mucosa. The aim of this study was to generate a tissue-engineered oral mucosa equivalent (OME). Study Design: First, primary oral fibroblasts were cultured for 7 days on different materials: Tissufoil E (TFE), dermal regeneration template (DRT), and Vicryl. Then, cocultures were established by seeding of primary oral keratinocytes and culturing for another 7-14 days. Immunohistochemical staining for CD90, cytokeratin 14 and collagen IV as well as gene expression analysis using reverse-transcription quantitative polymerase chain reaction were used to get information about cell architecture and basal membrane formation. Results: Vicryl showed good mechanical stability but mixed cell growth. TFE provided the best cell growth with good cell architecture and basal membrane formation but showed degradation. The best results for the above-mentioned criteria were seen with DRT. Conclusions: It was possible to create OMEs on all 3 scaffolds. The arrangement of the cells strongly depends on the texture of the material. [ABSTRACT FROM AUTHOR]

Abstract: Pretty Good Privacy (PGP) encoding is based on the Public-Key-Procedure and permits the safe transmission of medical data. Furthermore it allows the use of an electronic signature provided that keys used belong to the key owner and that the key owner''s identity is guaranteed by a trusted third party. Under the auspices of the Radiological Society of Germany (Deutsche Röntgengesellschaft, DRG) its IT-Working Group (Arbeitsgemeinschaft für Informationstechnik, @GIT) built up an appropriate Certification Authority including the required Public-Key-Infrastructure. These @GIT certified PGP keys allow the legal use of telemedicine in Germany. Digital signatures based to those certified keys correspond to the advanced signature according to the German Signature Law. [Copyright &y& Elsevier]

Abstract: Due to the lack of a standard for teleradiology, the IT Working Group (Arbeitsgemeinschaft für Informationstechnik, @GIT) of the German Radiological Society (Deutsche Röntgengesellschaft, DRG) has set up an initiative for standardizing telemedicine. E-mail has been selected as the ideal basis for ad hoc connections in teleradiology since it is both easy to implement and use. The DICOM standard offers the option of appending DICOM data types as MIME attachments to any e-mail, thus enabling the transmission of the original DICOM data. Nevertheless, there are additional requirements (e.g., data privacy) that must be obeyed and implemented. The first recommendation was introduced at the 85th German Radiology Convention (Deutscher Röntgenkongress) in Wiesbaden in 2004 and was honoured with the @-Roentgen Award (@-Roentgenpreis). Several commercial and open source implementations are now available and in daily use in German hospitals and private practices. [Copyright &y& Elsevier]

To develop a robust open-source method for fully automated extraction of total lung capacity (TLC) from computed tomography (CT) images and to demonstrate its integration into the clinical workflow. Using only open-source software, an algorithm was developed based on a region-growing method that does not require manual interaction. Lung volumes calculated from reconstructions with different kernels (TLC CT) were assessed. To validate the algorithm calculations, the results were correlated to TLC measured by pulmonary function testing (TLC PFT) in a subgroup of patients for which this information was available within 3 days of the CT examination. A total of 288 patients were analysed retrospectively. Manual review revealed poor segmentation results in 13 (4.5%) patients. In the validation subgroup, the correlation between TLC CT and TLC PFT was r =0.87 (p <0.001). Measurements showed excellent agreement between the two reconstruction kernels with an intraclass correlation coefficient (ICC) of 0.99. Calculation of the volumes took an average of 5 seconds (standard deviation: 3.72 seconds). Integration of the algorithm into the departments of the PACS environment was successful. A DICOM-encapsulated PDF document with measurements and an overlay of the segmentation results was sent to the PACS to allow the radiologists to detect false measurements. The algorithm developed allows fast and fully automated calculation of lung volume without any additional input from the radiologist. The algorithm delivers excellent segmentation in >95% of cases with significant positive correlations between lung volume on CT and TLC on PFT. • Our open source algorithm allows fast and fully automated calculation of lung volume in multidetector computed tomography. • Lung volume measured by CT correlated significantly with pulmonary function testing. • Integration into the clinical workflow offers calculations at the start of the reporting process without manual interaction. [ABSTRACT FROM AUTHOR]