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Cardiac chamber rupture from blunt trauma is rare but can be fatal. Surprisingly, in some subsets of patients, it can be subtle and rather easily missed. Rapid recognition and management are essential. Percutaneous closure can be successful in iatrogenic chamber perforation (during pericardiocentesis) but possibly not in traumatic chamber rupture. (Level of Difficulty: Intermediate.)

Communication is a basic need for all people to fully participate in life. Persons with disabilities may face particular challenges in developing their communication skills and using them appropriately in different situations. Augmentative and Alternative Communication (AAC) tools and methods can assist individuals in this process. Increasing digitization has changed the way everyone communicates, and this offers opportunities for persons using AAC. This paper briefly outlines what has been achieved in terms of digitalization in AAC. The need for full, adapted access to technology is highlighted and research desiderata are identified.

Abstract This paper presents a feasibility study for the production of recycled glycol modified polyethylene terephthalate (PETG) material for additive manufacturing. Past studies showed a variety of results for the recycling of 3D-printing material, therefore the precise effect on the material properties is not completely clear. For this work, PETG waste of the same grade was recycled once and further processed into 3D printing filament. The study compares three blend ratios between purchased plastic pellets and recycled pellets to determine the degradation effect of one recycling cycle and possible blend ratios to counter these effects. Furthermore, the results include a commercially available filament. The comparison uses the filament diameter, the dimensional accuracy of the printed test specimen and mechanical properties as quality criteria. The study shows that the recycled material has a minor decrease concerning the tensile strength and Young’s modulus.

Inklusion und Digitalisierung stellen zwei grosse Herausforderungen dar, mit denen sich das deutsche Bildungssystem und die einzelnen schulischen Akteure bereits seit Jahren auseinandersetzen müssen. Einzeln betrachtet handelt es sich bei Beiden um intensiv und differenziert beforschte Themenkomplexe. Die Verzahnung beider Konzepte rückt jedoch erst allmählich in den Fokus der Forschung, obwohl sich Berührungspunkte sowie Chancen identifizieren lassen. Der Beitrag gibt einführend eine kurze Übersicht über die aktuellen Rahmenbedingen und Forschungsergebnisse zu den Themenkomplexen Inklusion und Digitalisierung in deutschen Schulen. Im Anschluss daran werden exemplarisch potentielle Voraussetzungen und Bedingungen für die Implementierung der beiden Konzepte zusammengetragen. Besondere Beachtung bei der Darstellung der ausgewählten Bedingungen erhalten die Perspektiven der Lehrkräfte sowie der Schülerinnen und Schüler.

Introduction: Synthetic cannabinoids are a rapidly expanding subset of designer drugs widely available in the United States since 2008. In Illinois during the spring of 2018, over 160 documented cases of bleeding and prolonged coagulopathy occurred secondary to contaminated synthetic cannabinoids. Methods: We conducted a retrospective cohort study consisting of 38 patients to describe the initial emergency department (ED) presentation, diagnosis, and treatment. Results: Through serum testing we found that three long-acting anticoagulant rodenticides (LAAR) were detected in patients who had inhaled these tainted products: brodifacoum, difenacoum, and bromodialone. Discussion: This study encompasses the largest ED presentation of LAAR poisoning via the inhalational route known to date. Conclusion: The emergency physician should be aware of the potential for tainted coingestants as the cause of undifferentiated coagulopathy.

Phosphorus- and boron-doped silicon nanocrystals (Si NCs) embedded in silicon oxide matrix can be fabricated by plasma-enhanced chemical vapour deposition (PECVD). Conventionally, SiH4 and N2O are used as precursor gasses, which inevitably leads to the incorporation of ≈10 atom % nitrogen, rendering the matrix a silicon oxynitride. Alternatively, SiH4 and O2 can be used, which allows for completely N-free silicon oxide. In this work, we investigate the properties of B- and P-incorporating Si NCs embedded in pure silicon oxide compared to silicon oxynitride by atom probe tomography (APT), low-temperature photoluminescence (PL), transient transmission (TT), and current–voltage (I–V) measurements. The results clearly show that no free carriers, neither from P- nor from B-doping, exist in the Si NCs, although in some configurations charge carriers can be generated by electric field ionization. The absence of free carriers in Si NCs ≤5 nm in diameter despite the presence of P- or B-atoms has severe implications for future applications of conventional impurity doping of Si in sub-10 nm technology nodes.

Abstract Background Cranial irradiation is associated with long-term cognitive changes. Cerebral microbleeds (CMBs) have been identified on susceptibility-weighted MRI (SWI) in patients who have received prior cranial radiation, and serve as radiographic markers for microvascular injury thought to contribute to late cognitive decline. The relationship between CMB formation and radiation dose has not previously been quantified. Methods SWI was performed on 13 patients with stable WHO grade III-IV gliomas between 2 and 4 years after chemoradiotherapy to 60 Gy. The median age at the time of treatment was 41 years (range 25 – 74 years). CMBs were identified as discrete foci of susceptibility on SWI that did not correspond to vessels. CMB density for low (45 Gy) dose regions was computed. Results Twelve of 13 patients exhibited CMBs. The number of CMBs was significantly higher for late (>3 years from treatment) compared to early (

Abstract Boron (B) doping of silicon nanocrystals requires the incorporation of a B-atom on a lattice site of the quantum dot and its ionization at room temperature. In case of successful B-doping the majority carriers (holes) should quench the photoluminescence of Si nanocrystals via non-radiative Auger recombination. In addition, the holes should allow for a non-transient electrical current. However, on the bottom end of the nanoscale, both substitutional incorporation and ionization are subject to significant increase in their respective energies due to confinement and size effects. Nevertheless, successful B-doping of Si nanocrystals was reported for certain structural conditions. Here, we investigate B-doping for small, well-dispersed Si nanocrystals with low and moderate B-concentrations. While small amounts of B-atoms are incorporated into these nanocrystals, they hardly affect their optical or electrical properties. If the B-concentration exceeds ~1 at%, the luminescence quantum yield is significantly quenched, whereas electrical measurements do not reveal free carriers. This observation suggests a photoluminescence quenching mechanism based on B-induced defect states. By means of density functional theory calculations, we prove that B creates multiple states in the bandgap of Si and SiO2. We conclude that non-percolated ultra-small Si nanocrystals cannot be efficiently B-doped.

There is evidence from histopathological studies that glioma tumor cells migrate preferentially along large white matter bundles. If the peritumoral white matter structures can be used to predict the likely trajectory of migrating tumor cells outside of the surgical margin, then this information could be used to inform the delineation of radiation therapy (RT) targets. In theory, an anisotropic expansion that takes large white matter bundle anatomy into account may maximize the chances of treating migrating cancer cells and minimize the amount of brain tissue exposed to high doses of ionizing radiation. Diffusion-weighted MRI (DW-MRI) can be used in combination with fiber tracking algorithms to model the trajectory of large white matter pathways using the direction and magnitude of water movement in tissue. The method presented here is a tool for translating a DW-MRI fiber tracking (tractography) dataset into a white matter path length (WMPL) map that assigns each voxel the shortest distance along a streamline back to a specified region of interest (ROI). We present an open-source WMPL tool, implemented in the package Diffusion Imaging in Python (DIPY), and code to convert the resulting WMPL map to anisotropic contours for RT in a commercial treatment planning system. This proof-of-concept lays the groundwork for future studies to evaluate the clinical value of incorporating tractography modeling into treatment planning.

The recovery of technically important elements like lithium from slag of pyrometallurgical recycling of lithium traction batteries will be very important in future due to the expected increasing demand of this element with the upcoming world-wide implementation of electro mobility. Therefore, the investigation of possibilities to recover lithium from pyrometallurgical slag from the recycling of lithium traction batteries is mandatory. In this context, the EnAM (engineered artificial mineral) approach is very promising. Solidified melt of synthetic recycling slag with the compounds Li2O-MgO-Al2O3-SiO2-CaO-MnO contains various Li-bearing phases including spinel solid solution, Li-aluminate and eucryptite-like Li-alumosilicate. Most probably, the Ca-alumosilicate matrix (melilite-like solid solution) incorporates lithium as well. These compounds can be determined and calculated to an acceptable approximation with electron probe microanalysis (EPMA). Nevertheless, an adequate precise measurement of lithium is virtually impossible due to the extremely low fluorescence yield and long wavelength of Li Kα. Secondary mass spectrometry (SIMS) can be used to fill this gap in the analytical assessment of the slag. Therefore, the combination of these two analytical methods can distinctively improve the mineralogical and chemical characterization of lithium-containing solidified (slag) melt.

Reflectance anisotropy spectroscopy (RAS) equipment is applied to monitor dry-etch processes (here specifically reactive ion etching (RIE)) of monocrystalline multilayered III–V semiconductors in situ. The related accuracy of etch depth control is better than 16 nm. Comparison with results of secondary ion mass spectrometry (SIMS) reveals a deviation of only about 4 nm in optimal cases. To illustrate the applicability of the reported method in every day settings for the first time the highly etch depth sensitive lithographic process to form a film lens on the waveguide ridge of a broad area laser (BAL) is presented. This example elucidates the benefits of the method in semiconductor device fabrication and also suggests how to fulfill design requirements for the sample in order to make RAS control possible.

Background: Poisoning accounts for 30% of suicides in India and accidental and environmental exposures to poisons are frequent. The most common poisonings in India involve insecticides, rodenticides, snakebites, alcohols, sedative hypnotics, opioids, and pain medication. In India in 2017, a few poison information centres exist, but there is no regional integrated poison control and information centre that can be readily accessed by people in the community, where poisonings occur. Here, we describe the implementation of a multispecialty model for an integrated regional poison-control centre in the city of Bangalore, Karnataka. Methods: We developed a model for a poison control centre that includes specialists from emergency medicine, critical care, pharmacology, paediatrics, psychiatry, preventive medicine, and laboratory diagnostics. The centre provides referral and management advice for poisonings, drug information, psychosocial care with suicide prevention, forensic medicine, and poison education for the general public. Patients are initially treated and stabilised at peripheral hospitals and then transferred by paramedics to a toxicology centre of excellence, or hospital, for poisoning consultation, intensive care management, enhanced elimination measures, and antidote therapy. Computerised software treatment modules have been developed for the most common poisonings for use by health-care providers in other hospitals in Bangalore. Findings: In 2016, a toxicology centre of excellence was established at the MS Ramaiah Memorial Hospital and Medical College, a major metropolitan hospital in Bangalore, and linked with five peripheral hospitals in Karnataka. The central hospital provides all-hours, low-cost comprehensive poisoning information software and treatment protocols, forensic toxicology testing, reference laboratory analysis, Hazmat decontamination, intensive care management, and an antidote depot for peripheral hospitals. Interpretation: An integrated multispecialty poison control system has been established for the treatment of poisoning in one defined area of a major metropolitan region in India. The project provides poisoning information and a referral system to other surrounding metropolitan hospitals and will soon be rolled out to the entire city of Bangalore (population 10 million people). In response to findings from this pilot phase, we have added more software modules to include treatment of the most commonly encountered poisons. In response to the high rate of intentional poisonings, a suicide prevention and referral centre is being developed and will be located in the same building as the poison control centre. The next phase of the project will include a mobile telecommunications service to the general public in Karnataka (population 65 million). This system of care could be adopted as a model for other states in India to provide affordable, life-saving poison control information, toxicology surveillance, treatment, referral, and poisoning prevention. Funding: MS Ramaiah University.

Lubricated tetrahedral amorphous carbon coatings can show a very complex tribological behavior. In particular, friction regimes with extremely low friction have been observed. In tribological experiments with a ta-C/steel friction pair that was lubricated with ethylene glycol, we observed a sudden and very strong decrease in the effective friction coefficient from 0.45 to 0.01 after running-in. By varying different components of the tribological system after this abrupt decrease we investigated the role of the counter-body, the lubricant and the coating. To investigate the surface chemistry, static time-of-flight secondary ion mass spectrometry (ToF-SIMS), dynamic secondary ion mass spectrometry (SIMS), and X-ray photoelectron spectroscopy (XPS) measurements were performed. Using deuterated lubricants, ToF-SIMS measurements allowed us to distinguish adsorption of hydrogen and hydroxyl-groups from the lubricant from the adsorption from the environment. Deuterated hydroxyl-groups from the lubricant adsorbed to the surface during the experiment. In particular, more adsorbed deuterated hydroxyl-groups were detected prior to the sudden decrease in the friction coefficient. Thus, the sudden decrease in the coefficient of friction was most likely caused by an interplay between the lubricant, the ta-C coating and the counter-body which lead to the formation of transfer and adsorption layers.

BACKGROUND: Subjects with Attention-Deficit Hyperactivity Disorder (ADHD) are overdistractible by stimuli out of the intended focus of attention. This control deficit could be due to primarily reduced attentional capacities or, e. g., to overshooting orienting to unexpected events. Here, we aimed at identifying disease-related abnormalities of novelty processing and, therefore, studied event-related potentials (ERP) to respective stimuli in adult ADHD patients compared to healthy subjects. METHODS: Fifteen unmedicated subjects with ADHD and fifteen matched controls engaged in a visual oddball task (OT) under simultaneous EEG recordings. A target stimulus, upon which a motor response was required, and non-target stimuli, which did not demand a specific reaction, were presented in random order. Target and most non-target stimuli were presented repeatedly, but some non-target stimuli occurred only once ('novels'). These unique stimuli were either 'relative novels' with which a meaning could be associated, or 'complete novels', if no association was available. RESULTS: In frontal recordings, a positive component with a peak latency of some 400 ms became maximal after novels. In healthy subjects, this novelty-P3 (or 'orienting response') was of higher magnitude after complete than after relative novels, in contrast to the patients with an undifferentially high frontal responsivity. Instead, ADHD patients tended to smaller centro-parietal P3 responses after target signals and, on a behavioural level, responded slower than controls. CONCLUSION: The results demonstrate abnormal novelty processing in adult subjects with ADHD. In controls, the ERP pattern indicates that allocation of meaning modulates the processing of new stimuli. However, in ADHD such a modulation was not prevalent. Instead, also familiar, only context-wise new stimuli were treated as complete novels. We propose that disturbed semantic processing of new stimuli resembles a mechanism for excessive orienting to commonly negligible stimuli in ADHD.

Dopamine promotes the execution of positively reinforced actions, but its role for the formation of behaviour when feedback is unavailable remains open. To study this issue, the performance of treated/untreated patients with Parkinson's disease and controls was analysed in an implicit learning task, hypothesising dopamine-dependent adherence to hidden task rules. Sixteen patients on/off levodopa and fourteen healthy subjects engaged in a Go/NoGo paradigm comprising four equiprobable stimuli. One of the stimuli was defined as target which was first consistently preceded by one of the three non-target stimuli (conditioning), whereas this coupling was dissolved thereafter (deconditioning). Two task versions were presented: in a 'Go version', only the target cue required the execution of a button press, whereas non-target stimuli were not instructive of a response; in a 'NoGo version', only the target cue demanded the inhibition of the button press which was demanded upon any non-target stimulus. Levodopa influenced in which task version errors grew from conditioning to deconditioning: in unmedicated patients just as controls errors only rose in the NoGo version with an increase of incorrect responses to target cues. Contrarily, in medicated patients errors went up only in the Go version with an increase of response omissions to target cues. The error increases during deconditioning can be understood as a perpetuation of reaction tendencies acquired during conditioning. The levodopa-mediated modulation of this carry-over effect suggests that dopamine supports habit conditioning under the task demand of response execution, but dampens it when inhibition is required. However, other than in reinforcement learning, supporting dopaminergic actions referred to the most frequent, i. e., non-target behaviour. Since this is passive whenever selective actions are executed against an inactive background, dopaminergic treatment could in according scenarios contribute to passive behaviour in patients with Parkinson's disease.

The mesocorticolimbic dopamine (DA) system linking the dopaminergic midbrain to the prefrontal cortex and subcortical striatum has been shown to be sensitive to reinforcement in animals and humans. Within this system, coexistent segregated striato-frontal circuits have been linked to different functions. In the present study, we tested patients with Parkinson’s disease (PD), a neurodegenerative disorder characterised by dopaminergic cell loss, on two reward-based learning tasks assumed to differentially involve dorsal and ventral striato-frontal circuits. 15 non-depressed and non-demented PD patients on levodopa monotherapy were tested both on and off medication. Levodopa had beneficial effects on the performance on an instrumental learning task with constant stimulus-reward associations, hypothesized to rely on dorsal striato-frontal circuits. In contrast, performance on a reversal learning task with changing reward contingencies, relying on ventral striato-frontal structures, was better in the unmedicated state. These results are in line with the overdose hypothesis which assumes detrimental effects of dopaminergic medication on functions relying upon less affected regions in PD. This study demonstrates, in a within-subject design, a double dissociation of dopaminergic medication and performance on two reward-based learning tasks differing in regard to whether reward contingencies are constant or dynamic. There was no evidence for a dose effect of levodopa on reward-based behaviour with the patients’ actual levodopa dose being uncorrelated to their performance on the reward-based learning tasks.