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Objective Early decompression after acute spinal cord injury (SCI) is recommended. Acute care is crucial, but optimal management is unclear. The aim of this study was to investigate the role of preoperative magnetic resonance imaging (MRI) in addition to computed tomography (CT) in surgical decision making for acute cervical SCI. Methods All patients with cervical SCI between 2008 and 2016 who had preoperative CT and MRI (n = 63) at the Trauma Center Murnau, Germany, were included. We administered a survey to 10 experienced spine surgeons (5 neurosurgeons, 5 trauma surgeons) regarding the surgical management. First, the surgeons were shown clinical information and CT scans. Two months later, the survey was repeated with additional MRI. Corresponding percentages of change and agreement were obtained for each rater and survey item. Finally, results from both parts of the survey were compared with the definitive treatment option (i.e., real-world decision). Results MRI modified surgical timing in a median of 41% of patients (interquartile range 38%–56%). In almost every fifth patient (17%), no surgery would have been indicated with CT alone. The advocated surgical approach was changed in almost half of patients (median 48%, interquartile range 33%–49%). Surgically addressed levels were changed in a median of 57% of patients (interquartile range 56%–60%). MRI led to higher agreement with the real-world decision concerning addressed levels (median 35% vs. 73%), timing (median 51% vs. 57%), and approach (median 44% vs. 65%). Conclusions Preoperative MRI influenced surgical decision making substantially in our cohort and has become a new standard for patients with cervical SCI in our institution if medically possible.

Purpose To systematically evaluate image characteristics of simultaneous-multislice (SMS)-accelerated diffusion-weighted imaging (DWI) of the liver using different breathing schemes in comparison to standard sequences. Materials and Methods DWI of the liver was performed in 10 healthy volunteers and 12 patients at 1.5T using an SMS-accelerated echo planar imaging sequence performed with respiratory-triggering and free breathing (SMS-RT, SMS-FB). Standard DWI sequences served as reference (STD-RT, STD-FB). Reduction of scan time by SMS-acceleration was measured. Image characteristics of SMS-DWI and STD-DWI with both breathing schemes were analyzed quantitatively (apparent diffusion coefficient [ADC], signal-to-noise ratio [SNR]) and qualitatively (5-point Likert scale, 5 = excellent). Qualitative and quantitative parameters were compared using Friedman test and Dunn-Bonferroni post-hoc method with P-values < 0.05 considered statistically significant. Results SMS-DWI provided diagnostic image quality in volunteers and patients both with RT and FB with a reduction of scan time of 70% (0:56 vs. 3:20 min in FB). Overall image quality did not significantly differ between FB and RT acquisition in both STD and SMS sequences (median STD-RT 5.0, STD-FB 4.5, SMS-RT: 4.75; SMS-FB: 4.5; P = 0.294). SNR in the right hepatic lobe was comparable between the four tested sequences. ADC values were significantly lower in SMS-DWI compared to STD-DWI irrespective of the breathing scheme (1.2 ± 0.2 × 10-3 mm2/s vs. 1.0 ± 0.2 × 10-3 mm2/s; P < 0.001). Conclusion SMS-acceleration provides considerable scan time reduction for hepatic DWI with equivalent image quality compared to the STD technique both using RT and FB. Discrepancies in ADC between STD-DWI and SMS-DWI need to be considered when transferring the SMS technique to clinical routine reading. J. MAGN. RESON. IMAGING 2016;44:865–879.

Current systems for enacting scientific experiments, and simulation workflows in particular, do not support multi-scale and multi-field problems if they are not coupled on the level of the mathematical model. To address this deficiency, we present an approach enabling the trial-and-error modeling and execution of multi-scale and/or multi-field simulations in a top-down and bottom-up manner which is based on the notion of choreographies. The approach defines techniques for composing data-intensive, scientific workflows in more complex simulations in a generic, domain-independent way and thus provides means for collaborative and integrated data management using the workflow/process-based paradigm. We contribute a life cycle definition of such simulations and present in detail concepts and techniques that support all life cycle phases. Furthermore, requirements on a respective software system and choreography language supporting multi-scale and/or multi-field simulations are identified, and an architecture and its realization are presented.

The aim of this study was to evaluate whether a computer-based 3-item version (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C]) of the Alcohol Use Disorders Identification Test (AUDIT) identifies alcohol use disorder (AUD) in the same patients as the full 10-item version in 809 women and 747 men in an anesthesiology preoperative assessment clinic. According to cutoffs used (AUDIT: 5–8 points, AUDIT-C: 4–6 points), rate of disagreement (AUDIT-positive and AUDIT-C-negative or vice versa) ranged between 4% and 31% (men) and between 4% and 19% (women). In male patients, 15% were positive for both the AUDIT (≥8 points) and the AUDIT-C (≥6 points), 7% were positive for AUDIT-C only, and 4% were positive for AUDIT only. In female patients, using cutoffs of 5 more points (AUDIT) and 4 or more points (AUDIT-C), 16% were positive for both versions, 9% were positive for AUDIT-C only, and 2% were positive for AUDIT only. The AUDIT and AUDIT-C seem to identify AUD in differing patients.

The purpose of this study was to determine the diagnostic power of a newly available assay for amino-terminal pro-brain natriuretic peptide (NT-proBNP) to identify patients with acute heart failure. In addition, the influence of initial NT-proBNP measurements on economic consequences, diagnostic procedures and staff involvement was evaluated.401 patients presenting with acute dyspnea or peripheral edema in the emergency department were enrolled. NT-proBNP was measured after initial clinical evaluation. Clinical routine care and diagnostic assessment were blinded to NT-proBNP results. Two cardiologists independently validated the period of hospitalization, clinical examinations and medical therapies of each patient considering NT-proBNP results. The median NT-proBNP level among patients with acute congestive heart failure (CHF) (n=122) was 3497 pg/ml as compared to 320 pg/ml in patients without (n=279) (p0.0001). An NT-proBNP cutoff level300 pg/ml was optimal to rule out acute CHF (negative predictive value 96%; sensitivity 96%). NT-proBNPor=300 pg/ml could strongly predict acute CHF when compared to patients' history or physical examination (odds ratio 9.5; p0.0001) and diagnostic technical findings (odds ratio 14.7; p0.05). In patients with NT-proBNP300 pg/ml, 14% of the period of hospitalization could be saved, corresponding to savings of US $481 per patient. In addition, 9% of the number and time of staff involvement of clinical examinations and therapies could be saved, 10% of the costs of clinical examinations. Chest X-rays were saved in 34%, echocardiography in 9%.Measurement of NT-proBNP leads to multiple saving amounts and optimizes diagnostic pathways and resource allocation.

Insufficiently protected mobile devices present a ubiquitous threat. Due to severe hardware constraints, such as limited printed circuit board area, hardware-based security as proposed by the Trusted Computing Group is usually not part of mobile devices, yet. We present the design and implementation of seTPM, a secure element based TPM, utilizing Java Card technology. seTPM establishes trust in mobile devices by enabling Trusted Computing based integrity measurement services, such as IMA for Linux. Our prototype emulates TPM functionality on a GlobalPlatform secure element, which allows seamless integration into the Trusted Software Stack of Linux-based mobile operating systems like Android. With our work, we provide a solution to run Trusted Computing based security protocols while supplying a similar security level as provided by hardware TPM chips. In addition, due to the flexible design of the seTPM, we further increase the security level as we are able to selectively replace the outdated SHA-1 hash algorithm of TPM 1.2 specification by the present Keccak algorithm. Further, our architecture comprises hybrid support for the TPM 1.2 and TPM 2.0 specifications to simplify the transition towards the TPM 2.0 standard.

Background The immunosuppressant cyclosporin A has been used with success in the treatment of chronic plaque-type psoriasis; little is known about its effect on palmoplantar psoriasis. Subjects and methods Thirty-three patients (12 women, 21 men; mean age = 44.2 years, range 22-68 years) with palmoplantar psoriasis were treated with oral cyclosporin A, (CyA), 2.5 mg/kg/day, which could be increased to 5 mg/kg/day, for 12 weeks. Patients were followed up for a further 4 weeks without CyA treatment. A total of 26 patients completed the 12-week treatment course, an additional six patients were followed up during 4 weeks after premature withdrawal. Efficacy was assessed by calculating the Psoriasis Area and Severity Index (PASl). a Local Psoriasis Severity Index (LPS1), and estimation of the area involved. Results Clinical response, being defined as at least 50% reduction of these parameters at the end of the therapeutic phase compared to baseline before treatment, was reached in 84% of the patients; 61% of the patients showed clinical response after only 6 weeks of treatment. No signs of severe hepatic or renal toxicity were noted during the study period; mild hypertension, which developed in one case, resolved after termination of the treatment. Relapses after treatment never reached the pretreatment baseline levels. Conclusions It is concluded that palmoplantar psoriasis can be treated effectively and safely with oral CyA at the low-dose range of 2.5-5 mg/kg/day. The results demonstrate the necessity for evaluation of a maintenance treatment in this special form of psoriasis, the doses and safety of which remain to be determined in future controlled clinical trials.

Virtualization has become one of the most important security enhancing techniques for embedded systems during the last years, both for mobile devices and cyber-physical system CPS. One of the major security threats in this context is posed by side channel attacks. In this work, Bernstein's time-driven cache-based attack against AES is revisited in a virtualization scenario based on an actual CPS using the PikeOS microkernel virtualization framework. The attack is conducted in the context of the implemented virtualization scenario using different scheduler configurations. We provide experimental results which show that using dedicated cores for crypto routines will have a high impact on the vulnerability of such systems. We also compare the results to previous work in that field and our visualization directly shows the differences between cache architectures of the ARM Cortex-A8 and Cortex-A9. Further, a non-invasive countermeasure against timing attacks based on the scheduler of PikeOS is devised, which in fact increases the system's security against cache timing attacks.

Scientists that use the workflow paradigm for the enactment of scientific experiments need support for trial-and-error modeling, as well as flexibility mechanisms that enable the ad hoc repetition of workflow logic for the convergence of results or error handling. Towards this goal, in this paper we introduce the facilities to repeat partially or completely running choreographies on demand. Choreographies are interesting for the scientific workflow community because so-called multi-scale/field multi-* experiments can be modeled and enacted as choreographies of scientific workflows. A prerequisite for choreography repetition is the rewinding of the involved participant instances to a previous state. For this purpose, we define a formal model representing choreography models and their instances as well as a concept to repeat choreography logic. Furthermore, we provide an algorithm for determining the rewinding points in each involved participant instance.

Siemens Corporate Technology has developed a methodology for formal verification. This methodology allows to prove or falsify the correctness of programs for a PLC (programmable logical controller) fully automatically and exactly in a strongly mathematical sense. A program is correct, if eveiy possible execution trace of the program fulfils a set of required properties specified by the user. For instance, a property for a traffic light control at some given intersection could be 'traffic lights never all show green at the same time' or 'when a car stops at a red traffic light that traffic light will eventually switch to green'. For this verification method a tool has been developed that checks properties fully automatically and completely. In case a given property is not satisfied by the PLC-program, the verification tool generates an execution trace of the program (a so-called countersequence) that illustrates its erroneous behaviour. In a pilot application, tool machine manufacturers used and evaluated the verification tool with respect to specification, error detection, cost/benefit-estimation and other criteria for verification. The verification tool was received very well.

Irradiation scenarios were simulated in order to evaluate different technology and design options for silicon strip detectors exposed to a high luminosity environment. Two-dimensional process and device simulations were performed to get an insight into the device behaviour. The boundary condition of the free oxide regions between the strips was evaluated thoroughly to obtain correct field distributions. Using these results the formation of electron accumulation layers on the surface of the p-side and the depletion voltage dependence on the strip geometry can be explained. We investigated the “blocking implant” and the “spray implant” techniques as promising candidates for the n-side isolation of irradiated detectors. The main drawback of the “blocking implanted” devices is the increase of the electric field with increasing oxide charges. This implies the danger of impact ionization in irradiated devices. A “spray implanted” isolation layer leads to the highest electric field in the non-irradiated state which has the advantage of a better testability. Small gaps between strips as used in charge division readout reduce electric fields and leakage currents.

During the design process for a wind turbine load reduction controller many different, sometimes conflicting requirements must be fulfilled simultaneously. If the requirements can be expressed as mathematical criteria, such a design problem can be solved by a criterion-vector and multi-objective design optimization. The software environment MOPS (Multi-Objective Parameter Synthesis) supports the engineer for such a design optimization. In this paper MOPS is applied to design a multi-objective load reduction controller for the well-known DTU 10 MW reference wind turbine. A significant reduction in the fatigue criteria especially the blade damage can be reached by the use of an additional Individual Pitch Controller (IPC) and an additional tower damper. This reduction is reached as a trade-off with an increase of actuator load.

A long-range multiwavelength laser transmissometer for measuring atmospheric extinction of iodine laser radiation (1.315 μm), simultaneously with Nd:YAG (1.06 μm) and CO2 (10.6 μm) laser radiation was designed, built and operated under different atmospheric conditions, over a distance of 8.6 km in hilly terrain near Tubingen, Germany. Beam extinction was obtained by measuring the ratio of the total laser radiation to the total received radiation as collected by a mirror and focused onto a pyroelectrical detector array. Measured values of laser extinction were compared with model predictions (FASCODE 3P) based on simultaneously measured meteorological data as model input parameters. The agreement was found to be very good. It is shown that the atmospheric extinction coefficient of iodine laser radiation can be predicted to a good approximation by a linear equation containing the extinction coefficients of Nd:YAG and CO2 laser radiation. Statistical analyses of atmospheric laser extinction coefficients are presented for these laser wavelengths. Scatter diagrams of extinction coefficients are presented for the summer and winter season together with an analysis of the annual variability. The iodine laser, if compared to the CO2 laser, shows advantage in molecular extinction which is, however, overcompensated by aerosol extinction being often more than two orders of magnitude larger for iodine laser than for CO2 laser radiation.

A series of investigations proposed that patients' preference on minimal invasive and scarless surgery may be influenced by age, sex, and surgical as well as endoscopic history of the individual patient. However, it is unknown which psychological criteria lead to the acceptance of increased personal surgical risk or increased personal expenses in patients demanding scarless operations. We investigated whether individual body image contributes to the patient's readiness to assume higher risk in favor of potentially increased cosmesis.We conducted a nonrandomized survey among 63 consecutive surgical patients after receiving surgery. Individual body image perception was assessed postoperatively applying the FKB-20 questionnaire extended by four additional items. The FKB-20 questionnaire is a validated tool for measuring body image disturbances resulting in a two-dimensional score with negative body image (NBI) and vital body dynamics (VBD) being the two resulting scores. A subgroup analysis was performed according to the conducted operations: conventional open surgery = group 1, traditional laparoscopic surgery = group 2, and no scar surgery = group 3.There was a significant correlation between a negative body image and the preference for scar sparing and scarless surgery indicated by a significantly increased acceptance of surgical risks and the willingness to spend additional money for receiving scarless surgery (r = 0.333; p = 0.0227). Allocated to operation subgroups, 17 of 63 patients belonged to group 1 (OS), 29 to group 2 (minimally invasive surgery), and 17 patients to group 3 (no scar). Although age and sex were unequally distributed, the groups were homogenous regarding body mass index and body image (NBI). Subgroup analysis revealed that postoperative desire for scar sparing approaches was most frequently expressed by patients who received no scar operations.Patients with an NBI tend towards scarless surgery and are willing to accept increased operative risk and to spend additional money for improved postoperative cosmesis.

Polymeric films are used in very different applications to protect commercial products against ambient substances or mechanical stress. In this chapter we describe the functionality of barrier foils and embedding polymers used in photovoltaic (PV) modules as an example where both properties are relevant. Materials consisting of back sheets and encapsulants provide a barrier to keep water, atmospheric gases, and pollutants away from the silicon solar cell. Nevertheless, during a service life of more than 25 years with frequently changing meteorological conditions, any migration of different chemical species through the polymer barriers has to be taken into account. The transport mechanisms in polymeric materials are not well understood,1 and present a very active research field.2 Methodologies for service life estimation based on successfully established SLP methodologies for other solar energy materials3 are presently under development. The determination of the water concentration during the service life of materials under experimental and real environmental conditions is a starting point for understanding Chapter 24

The high depth of focus provided by 1:1 proximity synchrotron radiation lithography enables good pattern replication even over severe wafer topography. The simulation program XMAS has been extended and is now capable of simulating the lithography step in three dimensions over wafer topography.

We present a phase II study with TAXOL ® (Paclitaxel) in 306 patients (pts) with advanced ovarian cancer, who relapsed after at least one platinum based chemotherapy (CT). Objectives are safety and toxicity. Pts received 175 mg/m 2 , when pretreated with 1–2 prior CT regimens (Group A: 212 pts, 69.3%) and 135 mg/m 2 with 3 and more CT regimens (Group B: 94 pts, 26.4%) by 3 h-infusion every 3 weeks after standard premedication with steroid, antihistamine and H 2 -blocker. The median age was 56 at a performance status of ECOG = 0 in 57.5%, ECOG = 1 in 34.0% and ECOG = 2 in 8.5% of the pts; median time from last CT was 107 days (15–3066). The total number of cycles was 1774, the median number per pt was 6 cycles. For toxicity data 1202 cycles were evaluated. The main toxicity was neutropenia with higher incidence at 175 mg/m 2 (WHO 1 + 2: group A: 63.3%, group B: 71.2%, WHO 3 + 4: group A:36.7%, group B: 28.8%;), which is not statistically significant. Thrombocytopenia : WHO 1 + 2: A: 1.8%, B: 1.3% WHO 3 + 4: A: 15.7%, B: 13.8%. Anemia : WHO 1 + 2: A: 17.8%, B: 19.9%. WHO 3 + 4: A: 1.8%, B:1.2%. Non-hematological toxicities were minimal: Arthralgia/myalgia : WHO 1 + 2: A: 19.1%, B: 14.0%. WHO 3 + 4: A: 2.4%, B: 2.6% Peripheral neuropathy : WHO 1 + 2 A: 36.0%, B: 19.2%. WHO 3 + 4: A: 0.4%, B: 0.9%. Alopecia .: WHO 1 + 2: A: 26.7%, B: 24.2%. WHO 3 + 4: A: 69.5%, B: 71.7%. Hypersensitivitity reactions : WHO 1 + 2: A: 17.2%, B: 8.3%. WHO 3 + 4: A: 0.3%. B: 0.0%. 295 pts could be evaluated for response: complete response (CR): 28 pts (9.5%), partial response (PR): 57 pts (19.3%); stable disease (SD): 119 pts (40.3%) and 85 pts (28.8%) with progression. This study confirmed the efficacy and tolerability of TAXOL ® , administered as 3-h-infusion after premedication, in the treatment of platinum-refractory ovarian cancer. Main toxicity was neutropenia without severe clinical manifestations. The encouraging response rate for these heavily pretreated patients will lead to further studies in firstline ovarian cancer.

The sympathoadrenergic reaction is not only dependent on the duration and intensity of work but also on the body position and the involvement of small or large muscle masses. This observation made in field tests comparing different sports disciplines such as swimming, running, or diving encouraged us to investigate this topic under the following laboratory conditions. Twelve healthy sport students participated in ergometric tests on a bicycle ergometer in a horizontal and vertical body position as well as on a treadmill and a swim bench ergometer. The changes of plasma catecholamines (CA) obtained in the different ergometric tests were compared with those cardiocirculatory, metabolic, and hormonal parameters which can be influenced by the sympathoadrenergic stimulation. In the horizontal body position we found a smaller increase of norepinephrine at submaximal and maximal work loads combined with a similar reaction of renin, whereas the diastolic blood pressure and the mean arterial blood pressure increased more. The substrates of lipolysis and aerobic and anaerobic glycolysis did not show obvious differences depending on the body position. In the swim bench test, however, the lactate increase started earlier and was comparatively higher than in the other ergometric tests in which the maximal work load and VO2max were higher. Although a smaller muscle mass was used and a lower maximal oxygen uptake was reached, we did not find statistically different CA values during the swim bench ergometric test compared with the bicycle ergometric test in a horizontal body position. In our ergometric tests, the venous CA levels (especially norepinephrine) were predominantly influenced by the body position.

An intraindividual comparison of pharmacokinetic parameters of d-norgestrel (d-Ng) lynestrenol (Lyn) and cyproterone acetate (CPA) in 6 women is reported. 2.5 mg Lyn-carbon-14 2 mg CPA-carbon-14 and .25 mg d-Ng-tritium each together with 50 mcg ethinyl estradiol were each administered once consecutively in a randomized sequence orally to 6 women. The combinations were administered as a micronisate with lactose in gelatine capsules at intervals of 14 days. The course of the concentration (norethisterone for Lyn) and of the total radioactivity in plasma and the elimination of the labeled substances were recorded up to the 5th and 8th day after ingestion. The progestogens were absorbed completely at a comparable rate. The respective postmaximum course of the substance level in plasma was characterized by 2 disposition phases of which the 1st phase with a half-life of about 3 hours displayed no substance-specific difference. Marked differences in the pharmacokinetics of the 3 progestogens could be demonstrated in the rate of the terminal disposition of the active substance (norethisterone greater than d-Ng greater than CPA) and total radioactivity in plasma (d-Ng CPA greater than Lyn) in the rate of elimination with urine and feces (Lyn d-Ng greater than CPA) and in the portion of the dose eliminated with the urine (d-Ng Lyn greater than CPA) and feces (CPA greater than d-Ng greater than Lyn).

The residual strength of damaged concrete having a structure similar to a pile of fragments is determined by the frictional resistance to slide of the elements. In the statistical-rheological model this fact is taken into consideration by connecting in parallel extended friction elements. Their load capacity can be expressed by a critical stress which is assumed to be at random in the system and can be described by a steady distribution. A criterion of stability is formulated as an unequation making it possible to compute the stress the system becomes unstable and fail s as well as the total strain at any load. Two examples - the stress-strain relation at elevated temperatures and the restriction of thermal expansion under non-steady state conditions - demonstrate efficiency and bounds of the model.

During work on land adaptational reactions of circulation and hormones are influenced by the body position, the activated muscle mass, and the working extremities. The aim of this study was to explore the additional effect of water immersion during swimming on cardiocirculatory, metabolic, and hormonal regulation under different working conditions. Twelve young men not specifically trained in swimming underwent swimming tests on 3 different days. They had to swim breast stroke in total as well as isolated with legs or arms only each for 10 min at submaximal intensity and 150 m or 100 m at maximal intensity. This study was focused on changes of catecholamines (CA), heart rate (HR), blood pressure (BP), glucose, lactate, plasma renin activity (PRA), and plasma aldosterone (PA). Additionally, parameters of the electrolyte-volume homeostasis were investigated. Norepinephrine (NE) and epinephrine (EPI) increased during swimming under submaximal and maximal conditions. The augmentation of CA and HR was the highest after swimming whole stroke and the lowest after swimming arm stroke only. They were related to intensity within one type of swimming and showed a dependence on muscle mass independent from lactate or glucose levels when the different types of swimming were compared, although a positive correlation between CA and lactate levels was found. The BP was higher after leg work than after arm work, contrary to observations done on land regarding the comparable submaximal work loads. We suppose that this is an effect of water immersion and the horizontal body position whereby the central hemodynamic circulation becomes stabilized.(ABSTRACT TRUNCATED AT 250 WORDS)