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Abstract Delays due to missed connections at an intermodal hub such as an airport or train station may cause individual and overall economic costs. Travelers experience individual stress and may incur costs due to missed business appointments or lost vacation or spare time, for example. Transportation companies may encounter higher costs due to a delay, e.g., for additional employees or overtime, including at night, as well as for rebooking, compensation payments on the basis of passenger rights regulations, or, for example, if entire journeys or flights have to be canceled due to delays. Currently, delays are hardly considered and managed in a coordinated way as expert interviews conducted by the authors revealed. Our modelling results indicate that a coordinated intermodal delay management at intermodal hubs that considers the whole travel chain on the way to the airport can lead to advantages over the current, uncoordinated management of delays.

Abstract Human mitochondrial tRNAs (mt-tRNAs), critical for mitochondrial biogenesis, are frequently associated with pathogenic mutations. These mt-tRNAs have unusual sequence motifs and require post-transcriptional modifications to stabilize their fragile structures. However, whether a modification that stabilizes a wild-type (WT) mt-tRNA would also stabilize its pathogenic variants is unknown. Here we show that the N 1-methylation of guanosine at position 9 (m1G9) of mt-Leu(UAA), while stabilizing the WT tRNA, has a destabilizing effect on variants associated with MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes). This differential effect is further demonstrated, as removal of the m1G9 methylation, while damaging to the WT tRNA, is beneficial to the major pathogenic variant, improving the structure and activity of the variant. These results have therapeutic implications, suggesting that the N 1-methylation of mt-tRNAs at position 9 is a determinant of pathogenicity and that controlling the methylation level is an important modulator of mt-tRNA-associated diseases.

Background Left atrial appendage occlusion (LAAO) is increasingly used as an alternative to oral anticoagulation for stroke prevention in select patients with atrial fibrillation. Data on outcomes in racial and ethnic minority individuals are limited. This analysis assessed differences in the use and outcomes of LAAO by race and ethnicity in a large national registry. Methods and Results This analysis acquired data on patients who underwent WATCHMAN FLX implantation from the retrospective NCDR (National Cardiovascular Data Registry) LAAO registry through September 2022. All patients with an attempted WATCHMAN FLX implantation and known race and ethnicity were included. Baseline characteristics and 1‐year event rates were compared. A total of 97 185 patients were analyzed; 87 339 were White individuals (90%), 3750 Black individuals (3.9%), and 2866 Hispanic individuals (Hispanic/Latinx), 2.9%). Black and Hispanic patients were younger, with a higher incidence of prior stroke and significant bleeding compared with White patients. Black and Hispanic patients were treated with LAAO in smaller numbers relative to their proportion of the US population. Rates of procedural success were similar between groups. Though direct oral anticoagulants were prescribed in most patients across the groups, dual and single antiplatelet therapy were prescribed more often in Black patients. Black patients had significantly higher rates of 1‐year death and bleeding compared with White and Hispanic patients. Conclusions Patients from racial and ethnic minority groups comprise a disproportionately small fraction of all patients who undergo LAAO. Black and Hispanic patients were younger but had significantly higher comorbidities compared with White patients. Procedural success was similar among the groups, but Black patients experienced higher rates of death and bleeding at 1 year.

Abstract Background Advanced Trauma Life Support (ATLS) is the gold standard of initial assessment of trauma patients and therefore a widely used training program for medical professionals. Practical application of the knowledge taught can be challenging for medical students and inexperienced clinicians. Simulation-based training, including virtual reality (VR), has proven to be a valuable adjunct to real-world experiences in trauma education. Previous studies have demonstrated the effectiveness of VR simulations for surgical and technical skills training. However, there is limited evidence on VR simulation training specifically for trauma education, particularly within the ATLS curriculum. The purpose of this pilot study is to evaluate the feasibility, effectiveness, and acceptance of using a fully immersive VR trauma simulation to prepare medical students for the ATLS course. Methods This was a prospective randomised controlled pilot study on a convenience sample of advanced medical students (n = 56; intervention group with adjunct training using a commercially available semi-automated trauma VR simulation, n = 28, vs control group, n = 28) taking part in the ATLS course of the Military Physician Officer School. Feasibility was assessed by evaluating factors related to technical factors of the VR training (e.g. rate of interruptions and premature termination). Objective and subjective effectiveness was assessed using confidence ratings at four pre-specified points in the curriculum, validated surveys, clinical scenario scores, multiple choice knowledge tests, and ATLS final clinical scenario and course pass rates. Acceptance was measured using validated instruments to assess variables of media use (Technology acceptance, usability, presence and immersion, workload, and user satisfaction). Results The feasibility assessment demonstrated that only one premature termination occurred and that all remaining participants in the intervention group correctly stabilised the patient. No significant differences between the two groups in terms of objective effectiveness were observed (p = 0.832 and p = 0.237 for the pretest and final knowledge test, respectively; p = 0.485 for the pass rates for the final clinical scenario on the first attempt; all participants passed the ATLS course). In terms of subjective effectiveness, the authors found significantly improved confidence post-VR intervention (p

Abstract Aim of this study was to evaluate the efficacy of switching treatment to faricimab in neovascular age-related macular degeneration (nAMD) from other anti-VEGF agents. Fifty-eight eyes of fifty-one patients with nAMD and a full upload series of four faricimab injections were included. Demographic data, multimodal imaging and treatment parameters were recorded. The primary outcome measures were changes in central subfield thickness (CST) and subfoveal choroidal thickness (SFCT). A subgroup analysis was performed for eyes with prior ranibizumab (R) or aflibercept (A) treatment. Mean injection intervals before and after switching were comparable (33.8 ± 11.2 vs. 29.3 ± 2.6 days; p = 0.08). Mean CST of 361.4 ± 108.1 µm prior to switching decreased significantly to 318.3 ± 97.7 µm (p

Abstract Background Patients with minor stroke or transient ischemic attacks have an increased risk of future strokes. These patients are often discharged home with limited specialized follow-up, although close to half of them experience cognitive deficits. Simple encouragements to avoid smoking, be physically active, and to take preventive medication are often insufficient to ensure adherence and more comprehensive interventions are needed to support the patients in adapting healthy behaviour. The aim of this study was to test the feasibility and potential effect of an early initiated, patient-centred intervention to patients with minor stroke or transient ischemic attacks targeting smoking, physical activity, and medication adherence, in a randomized, controlled pilot trial. Methods Hospitalized patients were randomized to usual care or an intervention consisting of health behavioural counselling based on the 5A’s model, telephone follow-up (4 and 8 weeks), and monitoring of physical activity. Follow-up time was 12 weeks. Feasibility was on the following domains: eligibility, acceptance, demand and practicality, adherence, attrition, and implementation and integration. Results Forty patients of 84 potentially eligible were randomized to the two treatment arms (20 intervention/20 usual care). Thirty-two completed the 12-week follow-up, while 8 were either excluded or lost to follow-up. With few changes, the intervention was feasible and possible to deliver according to the protocol. Conclusion It was possible to identify relevant patients who could potentially benefit from a behavioural intervention, recruit and randomize them early after admission and retain most participants in the study until follow-up and derive statistical estimates to guide the design of large-scale randomized controlled trials. Trial registration ClinicalTrials.gov Identifier: NCT03648957 . Registered 28 August 2018.

Abstract Objectives To present a framework to develop and implement a fast-track artificial intelligence (AI) curriculum into an existing radiology residency program, with the potential to prepare a new generation of AI conscious radiologists. Methods The AI-curriculum framework comprises five sequential steps: (1) forming a team of AI experts, (2) assessing the residents’ knowledge level and needs, (3) defining learning objectives, (4) matching these objectives with effective teaching strategies, and finally (5) implementing and evaluating the pilot. Following these steps, a multidisciplinary team of AI engineers, radiologists, and radiology residents designed a 3-day program, including didactic lectures, hands-on laboratory sessions, and group discussions with experts to enhance AI understanding. Pre- and post-curriculum surveys were conducted to assess participants’ expectations and progress and were analyzed using a Wilcoxon rank-sum test. Results There was 100% response rate to the pre- and post-curriculum survey (17 and 12 respondents, respectively). Participants’ confidence in their knowledge and understanding of AI in radiology significantly increased after completing the program (pre-curriculum means 3.25 ± 1.48 (SD), post-curriculum means 6.5 ± 0.90 (SD), p-value = 0.002). A total of 75% confirmed that the course addressed topics that were applicable to their work in radiology. Lectures on the fundamentals of AI and group discussions with experts were deemed most useful. Conclusion Designing an AI curriculum for radiology residents and implementing it into a radiology residency program is feasible using the framework presented. The 3-day AI curriculum effectively increased participants’ perception of knowledge and skills about AI in radiology and can serve as a starting point for further customization. Critical relevance statement The framework provides guidance for developing and implementing an AI curriculum in radiology residency programs, educating residents on the application of AI in radiology and ultimately contributing to future high-quality, safe, and effective patient care. Key points • AI education is necessary to prepare a new generation of AI-conscious radiologists. • The AI curriculum increased participants’ perception of AI knowledge and skills in radiology. • This five-step framework can assist integrating AI education into radiology residency programs. Graphical Abstract

Abstract Topological photonic crystals, which offer topologically protected and back-scattering-immune transport channels, have recently gained significant attention for both scientific and practical reasons. Although most current studies focus on dielectric materials with weak dispersions, this study focuses on topological phases in dispersive materials and presents a numerical study of Chern insulators in gaseous-phase plasma cylinder cells. We develop a numerical framework to address the complex material dispersion arising from the plasma medium and external magnetic fields and identify Chern insulator phases that are experimentally achievable. Using this numerical tool, we also explain the flat bands commonly observed in periodic plasmonic structures, via local resonances, and how edge states change as the edge termination is periodically modified. This work opens up opportunities for exploring band topology in new materials with non-trivial dispersions and has potential radio frequency (RF) applications, ranging from plasma-based lighting to plasma propulsion engines.

A nanophotonic passively Q‐switched lasing element in the near infrared is proposed and theoretically investigated. It consists of a silicon‐rich nitride disk resonator enhanced with the contemporary MoS2/WSe2 hetero‐bilayer and a graphene monolayer to provide gain and saturable absorption, respectively. The two‐dimensional materials are placed on top of the disk resonator and are separated by a spacer of hexagonal boron nitride. MoS2/WSe2 emits at 1128 nm due to the radiative recombination of interlayer excitons after being optically pumped at 740 nm. Optical pumping is conducted in a guided‐wave manner aiming at achieving a high overall efficiency by critically coupling to a cavity mode near the pump transition. The response of the proposed pulsed laser is assessed by utilizing a coupled‐mode theory framework fed with linear finite‐element method simulations, rigorously derived from the Maxwell–Bloch equations. Following a meticulous design process and exploiting the guided pumping scheme, an ultralow lasing threshold of just 24.2 μW is obtained. Overall, the Q‐switched laser delivers pulsed light inside an integrated bus waveguide with mW peak power, ps duration, and GHz repetition rates requiring sub‐mW continuous wave pumping. These properties are highly promising for communication applications and highlight the potential of two‐dimensional materials for nanophotonic light sources.

Abstract Objectives Clinical examination alone cannot reliably rule out significant traumatic abdominal injury. Computed tomography (CT) has become the primary method for evaluating blunt abdominal trauma and clinicians rely heavily on it to rule out abdominal injury. Ultrasound examination may miss significant abdominal injury particularly in stable patients. The use of a contrast agent improves ultrasound sensitivity to visceral abdominal injuries. The objective of this diagnostic study is to compare bedside contrast enhanced ultrasound (CEUS) performed by emergency physicians to CT in hemodynamically stable adults for the assessment of blunt abdominal trauma and evaluate CEUS accuracy outcomes. Methods Hemodynamically stable patients with blunt trauma were prospectively enrolled in the trauma bay. After initial evaluation, we included patients at risk of abdominal injury and for whom an abdominal CT was planned by the trauma leader. Ultrasonography was performed prospectively and at the bedside by the emergency physician followed by abdominal CT used as a reference standard. Results Thirty‐three patients were enrolled in the study; among them, 52% showed positive traumatic findings in abdominal CT scans, and 42% were diagnosed with solid organ lesions. Compared to CT, a focused abdominal sonography (FOCUS) examination, looking for free fluid or perirenal hematoma, showed limited performance for traumatic findings with a sensitivity of 65% (95% confidence interval [CI]: 38%–86%), a specificity of 75% (95% CI: 48%–93%), a negative likelihood ratio (NLR) of 0.47 (95% CI: 0.23–0.95), and a positive likelihood ratio (PLR) of 2.59 (95% CI: 1.03–6.48). When combining FOCUS with CEUS, the sensitivity of the sonography increased to 94% (95% CI: 71%–100%) with a specificity of 75% (95% CI: 48%–93%). The PLR was 3.76 (95% CI: 1.6–8.87) and the NLR was 0.08 (95% CI: 0.01–0.54). In our population, abdominal sonography with contrast failed to identify a single positive abdominal CT with a grade 1 kidney injury. Conclusions A FOCUS examination shows limited sensitivity and specificity to detect positive abdominal CT in stable adults with abdominal trauma. With the addition of contrast and careful inspection of solid organs, abdominal sonography with contrast performed by the emergency physician improves the ability to rule out traumatic findings on abdominal CT. CEUS performed by emergency physicians may miss injuries, especially in the absence of free fluid, in cases of low‐grade injuries, simultaneous injuries, or poor‐quality examinations.

Abstract Background Lymphadenopathy refers to any disease process involving lymph nodes that are abnormal in size and consistency. There are multiple etiologies in the setting of a diseased lymph node, including conditions of infection, autoimmune diseases, and neoplasia. Lymphadenitis is a term that refers to lymphadenopathies that are due to inflammatory processes and can represent an acute bacterial infection resulting from streptococcal pharyngitis or a prior viral upper respiratory infection. Cervical lymphadenopathy refers to nodal swelling in the neck region. While cervical lymphadenitis is a common clinical finding in the setting of a transient response to a benign local or generalized infection, it may evade detection sometimes and thus account for a percentage of misdiagnosis or delayed diagnosis in the tropics. This case report is aimed at increasing the awareness about the presentation of bacterial cervical lymphadenitis and how it can sometimes mimic the presentation that is typical and regularly found with plasmodiasis. It contributes to improved awareness and high index of suspicion in clinic when dealing with patients in the tropics. Case presentation We present a case of delayed diagnosis of bacterial cervical lymphadenitis that initially presented with typical features of malaria from Plasmodium falciparum. A 26-year-old Nigerian woman presented to the outpatient department following complaints of a recurring fever of a month’s duration and bilateral neck swelling of about 2 weeks prior to presentation. Conclusion In the setting of a busy clinic, details are easily missed and salient features in the presentation of a patient that are needed for accurate diagnosis and management could go unrecognized. Hence, this case report highlights the importance of proper examination particularly of lymph nodes and use of different diagnostic modalities for the exact diagnosis of disease.

Abstract Corynebacterium glutamicum is a bacterium widely employed in the industrial production of amino acids as well as a broad range of other biotechnological products. The present study describes the characterization of C. glutamicum proteoforms, and their post-translational modifications (PTMs) employing top-down proteomics. Despite previous evidence of PTMs having roles in the regulation of C. glutamicum metabolism, this is the first top-down proteome analysis of this organism. We identified 1125 proteoforms from 273 proteins, with 60% of proteins presenting at least one mass shift, suggesting the presence of PTMs, including several acetylated, oxidized and formylated proteoforms. Furthermore, proteins relevant to amino acid production, protein secretion, and oxidative stress were identified with mass shifts suggesting the presence of uncharacterized PTMs and proteoforms that may affect biotechnologically relevant processes in this industrial workhorse. For instance, the membrane proteins mepB and SecG were identified as a cleaved and a formylated proteoform, respectively. While in the central metabolism, OdhI was identified as two proteoforms with potential biological relevance: a cleaved proteoform and a proteoform with PTMs corresponding to a 70 Da mass shift.

The Nep1 protein is essential for the formation of eukaryotic and archaeal small ribosomal subunits, and it catalyzes the site-directed SAM-dependent methylation of pseudouridine (Ψ) during pre-rRNA processing. It possesses a non–trivial topology, namely, a 31 knot in the active site. Here, we address the issue of seemingly unfeasible deprotonation of Ψ in Nep1 active site by a distant aspartate residue (D101 in S. cerevisiae), using a combination of bioinformatics, computational, and experimental methods. We identified a conserved hydroxyl-containing amino acid (S233 in S. cerevisiae, T198 in A. fulgidus) that may act as a proton-transfer mediator. Molecular dynamics simulations, based on the crystal structure of S. cerevisiae, and on a complex generated by molecular docking in A. fulgidus, confirmed that this amino acid can shuttle protons, however, a water molecule in the active site may also serve this role. Quantum-chemical calculations based on density functional theory and the cluster approach showed that the water-mediated pathway is the most favorable for catalysis. Experimental kinetic and mutational studies reinforce the requirement for the aspartate D101, but not S233. These findings provide insight into the catalytic mechanisms underlying proton transfer over extended distances and comprehensively elucidate the mode of action of Nep1.

BackgroundHypersomnia poses major challenges to treatment providers given the limitations of available treatment options. In this context, the application of non-invasive brain stimulation techniques such as transcranial electrical stimulation (tES) may open up new avenues to effective treatment. Preliminary evidence suggests both acute and longer-lasting positive effects of transcranial direct current stimulation (tDCS) on vigilance and sleepiness in hypersomniac patients. Based on these findings, the present study sought to investigate short-term effects of single sessions of tDCS and transcranial random noise stimulation (tRNS) on sleepiness in persons suffering from hypersomnia.MethodsA sample of 29 patients suffering from narcolepsy or idiopathic hypersomnia (IH) was recruited from the Regensburg Sleep Disorder Center and underwent single sessions of tES (anodal tDCS, tRNS, sham) over the left and right dorsolateral prefrontal cortex on three consecutive days in a double-blind, sham-controlled, pseudorandomized crossover trial. The primary study endpoint was the mean reaction time measured by the Psychomotor Vigilance Task (PVT) before and directly after the daily tES sessions. Secondary endpoints were additional PVT outcome metrics as well as subjective outcome parameters (e.g., Karolinska Sleepiness Scale; KSS).ResultsThere were no significant treatment effects neither on objective (i.e., PVT) nor on subjective indicators of sleepiness.ConclusionWe could not demonstrate any clinically relevant effects of single sessions of tDCS or tRNS on objective or subjective measures of sleepiness in patients with hypersomnia. However, we cannot exclude that repeated sessions of tES may affect vigilance or sleepiness in hypersomniac patients.

Abstract The European Bioeconomy Strategy aims to facilitate the transition from a take–make–dispose fossil economy into one fostering circular bio‐based value chains linking sustainable land use with cutting‐edge products. Optimized designs, implementation and monitoring rely on continuous interactions between policymakers and modellers who run multiple scenarios for environmentally, economically and socially desirable futures. This paper leverages a multi‐layered framework that cross‐references 39 policies and 32 models to assess how they address the five principle objectives of the Bioeconomy Strategy in terms of accompanying sectors, value chains and multi‐dimensional indicators. The framework identifies gaps in bioeconomy knowledge both in policy and modelling. Overall, the analysis found little mention of the wide range of bio‐based products, technologies and processes, bio‐refineries, waste and land conservation. Bio‐based product policies can be simulated only in a limited number of models, compared, for example, to the wide range of modelling capacities that can model bioenergy. Additionally, in both policy and modelling realms, integration of market and biophysical drivers within the full scope of the value chain is scarce. Multidisciplinary studies combining multiple models perform best in this respect by integrating a more comprehensive range of relevant policies, bioeconomy drivers and indicators. Findings point to a more significant issue in policy‐modelling information exchange, and this paper discusses the challenges and opportunities for future improvements in this collaboration.

Abstract “Autonomous weapon systems” (AWS) have been subject to intense discussions for years. Numerous political, academic and legal actors are debating their consequences, with many calling for strict regulation or even a global ban. Surprisingly, it often remains unclear which technologies the term AWS refers to and also in what sense these systems can be characterised as autonomous at all. Despite being feared by many, weapons that are completely self-governing and beyond human control are more of a conceptual possibility than an actual military reality. As will be argued, the conflicting interpretations of AWS are largely the result of the diverse meanings that are constructed in political discourses. These interpretations convert specific understandings of AI into strategic assets and consequently hinder the establishment of common ethical standards and legal regulations. In particular, this article looks at the publicly available military AI strategies and position papers by China and the USA. It analyses how AWS technologies, understood as evoking sociotechnical imaginaries, are politicised to serve particular national interests. The article presents the current theoretical debate, which has sought to find a functional definition of AWS that is sufficiently unambiguous for regulatory or military contexts. Approaching AWS as a phenomenon that is embedded in a particular sociotechnical imaginary, however, flags up the ways in which nation states portray themselves as part of a global AI race, competing over economic, military and geopolitical advantages. Nation states do not just enforce their geopolitical ambitions through a fierce realpolitik rhetoric but also play around with ambiguities in definitions. This especially holds true for China and the USA, since they are regarded and regard themselves as hegemonic antagonists, presenting competing self-conceptions that are apparent in their histories, political doctrines and identities. The way they showcase their AI-driven military prowess indicates an ambivalent rhetoric of legal sobriety, tech-regulation and aggressive national dominance. AWS take on the role of signifiers that are employed to foster political legitimacy or to spark deliberate confusion and deterrence.

Abstract Background The prevalence of obesity in total hip arthroplasty (THA) patients has been studied in the past. However, there has not been direct comparison against obesity in the general population. This study compared yearly trends in BMI and obesity rates between patients who had undergone primary THA and those from the general patient population. Methods We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA and those who had an annual routine physical exam between January 2013 and December 2020 at our academic tertiary medical center. Baseline demographics were controlled in our statistical models. Significance of yearly trends was determined through a linear regression analysis. Independent samples t-test and Chi-square test were used to compare means and proportions between the two groups, respectively. Results A total of 11,250 primary THA patients and 1,039,918 annual physical exam patients were included. Average BMI for the THA group was significantly higher (P

Deep learning techniques usually require a large quantity of training data and may be challenging for scarce datasets. The authors propose a framework that involves contrastive and transfer learning and reduces data requirements for training while keeping the prediction accuracy.

Abstract Optogenetics has become a key tool to manipulate biological processes with high spatio-temporal resolution. Recently, a number of commercial and open-source multi-well illumination devices have been developed to provide throughput in optogenetics experiments. However, available commercial devices remain expensive and lack flexibility, while open-source solutions require programming knowledge and/or include complex assembly processes. We present a LED Illumination Tool for Optogenetic Stimulation (LITOS) based on an assembled printed circuit board controlling a commercially available 32 × 64 LED matrix as illumination source. LITOS can be quickly assembled without any soldering, and includes an easy-to-use interface, accessible via a website hosted on the device itself. Complex light stimulation patterns can easily be programmed without coding expertise. LITOS can be used with different formats of multi-well plates, petri dishes, and flasks. We validated LITOS by measuring the activity of the MAPK/ERK signaling pathway in response to different dynamic light stimulation regimes using FGFR1 and Raf optogenetic actuators. LITOS can uniformly stimulate all the cells in a well and allows for flexible temporal stimulation schemes. LITOS’s affordability and ease of use aims at democratizing optogenetics in any laboratory.

Abstract: The medical team in carrying out health services can cause suffering for patients, namely negligence or carelessness, known as medical malpractice. Sidoarjo District Court Decision Number 1165 / Pid.B / 2010 / PN.Sda with the defendant Dr. Wida Parama Astiti gave an order of authority to inject Otsu KCl 12.5 ml to Nurse Setyo Mujiono but the injection was incomplete in how to use it. Nurse Setyo did not do it herself but instead ordered Dewi Ayu Yulmasari as a student of practical work at the Krian Husada General Hospital, which resulted in the death of Dava Chayanata Oktavianto. The purpose of this study was to determine the criminal liability of doctors who delegate authority in medical actions to nurses resulting in the death of patients in Sidoarjo District Court Decision No. 1165 / Pid.B / 2010 / PN.Sda, including doctor's criminal liability in appeal and cassation decisions; and find out the appropriateness of the judge's decision is associated with the principles of criminal liability regarding the delegation of medical authority in conducting medical actions. The results of this study are the accountability of Dr. Wida Parama Astiti as advocate (uitlokker), nurse Setyo Mujiono as the person who ordered to do (doenpleger) has fulfilled the element of responsibility while Student Dewi Ayu Yulmasari as committing the act allegedly proved, but her actions were not criminal under Article 51 of the Criminal Code (2). Keywords : Criminal Liability, Medical Team, Delegation of Authority, Court Decision. Abstrak: Tim medik dalam menjalankan pelayanan kesehatan dapat menimbulkan penderitaan bagi pasien yaitu kealpaan atau kekurang hati-hatian, dikenal dengan istilah malpraktek medik. Putusan Pengadilan Negeri Sidoarjo Nomor 1165/Pid.B/2010/PN.Sda dengan terdakwa dr. Wida Parama Astiti memberikan perintah kewenangan untuk menyuntikan Otsu KCl 12.5 ml kepada perawat Setyo Mujiono namun pemberian injeksi tersebut tidak lengkap cara penggunaannya. Perawat Setyo tidak melakukan sendiri melainkan menyuruh Dewi Ayu Yulmasari sebagai mahasiswi praktek kerja lapangan di RSU Krian Husada yang berakibatnya meninggalnya pasien Dava Chayanata Oktavianto. Tujuan penelitian ini untuk mengetahui pertanggungjawaban pidana dokter yang melimpahkan kewenangan dalam tindakan medik kepada tenaga perawat yang mengakibatkan matinya pasien dalam Putusan Pengadilan Negeri Sidoarjo No. 1165/Pid.B/2010/PN.Sda, termasuk pertanggungjawaban pidana dokter dalam putusan banding dan kasasi; dan mengetahui kesesuaian putusan hakim dikaitkan dengan asas-asas pertanggungjawaban pidana tentang pelimpahan kewenangan dokter dalam melakukan tindakan medik. Metode Pendekatan pada penelitian menggunakan metode kualitatif normatif dengan pendekatan melakukan wawancara dengan orang-orang tertentu atau pelaku dalam suatu tindak sosial mengenai fakta yang hendak dideskripsikan dan bahan hukum sekunder seperti undang-undang dan Putusan Pengadilan Negeri Sidoarjo Nomor 1165/Pid.B/2010/PN.Sda serta bahan hukum primer adalah hasil wawancara dengan perwakilan Hakim yang memutuskan perkara tersebut. Hasil dari penelitian ini adalah terbuktinya pertanggungjawaban dr. Wida Parama Astiti sebagai penganjur (uitlokker), perawat Setyo Mujiono sebagai orang yang menyuruh melakukan (doenpleger) telah memenuhi unsur pertanggungjawaban sedangkan Mahasiswi Dewi Ayu Yulmasari sebagai yang melakukan perbuatan yang didakwakan terbukti, tetapi perbuatannya bukan tindak pidana Pasal 51 KUHP ayat (2). Kata Kunci : Pertanggung Jawaban Pidana, Tim Medis, Pelimpahan Kewenangan, Putusan Pengadilan.

Most of the patients with head and neck squamous cell carcinoma (HNSCC) are diagnosed with locally advanced disease. Standards of care for curative-intent treatment of this patient group are either surgery and adjuvant radio(chemo)therapy (aRCT) or definitive chemoradiation. Despite these treatments, especially pathologically intermediate and high-risk HNSCC often recur. The ADRISK trial investigates in locally advanced HNSCC and intermediate and high risk after up-front surgery if the addition of pembrolizumab to aRCT with cisplatin improves event-free sur-vival compared to aRCT alone. ADRISK is a prospective, randomized controlled investiga-tor-initiated (IIT)-phase II multicenter trial within the German Interdisciplinary Study Group of German Cancer Society (IAG-KHT). Patients with primary resectable stage III and IV HNSCC of the oral cavity, oropharynx, hypopharynx and larynx with pathologic high (R1, extracapsular nodal extension) or intermediate risk (R0

Objectives To describe the development and usage of www.coronabambini.ch as an example of a paediatric electronic public health application and to explore its potential and limitations in providing information on disease epidemiology and public health policy implementation.Design We developed and maintained a non-commercial online decision support tool, www.coronabambini.ch, to translate the Swiss Federal Office of Public Health (FOPH) paediatric (age 0–18 years) COVID-19 guidelines around testing and school/daycare attendance for caregivers, teachers and healthcare personnel. We analysed the online decision tool as well as a voluntary follow-up survey from October 2020 to September 2021 to explore its potential as a surveillance tool for public health policy and epidemiology.Participants 68 269 users accessed and 52 726 filled out the complete online decision tool. 3% (1399/52 726) filled out a voluntary follow-up. 92% (18 797/20 330) of users were parents.Results Certain dynamics of the pandemic and changes in testing strategies were reflected in the data captured by www.coronabambini.ch, for example, in terms of disease epidemiology, gastrointestinal symptoms were reported more frequently in younger age groups (13% (3308/26 180) in children 0–5 years vs 9% (3934/42 089) in children ≥6 years, χ2=184, p≤0.001). As a reflection of public health policy, the proportion of users consulting the tool for a positive contact without symptoms in children 6–12 years increased from 4% (1415/32 215) to 6% (636/9872) after the FOPH loosened testing criteria in this age group, χ2=69, p≤0.001. Adherence to the recommendation was generally high (84% (1131/1352)) but differed by the type of recommendation: 89% (344/385) for ‘stay at home and observe’, 75% (232/310) for ‘school attendance’.Conclusions Usage of www.coronabambini.ch was generally high in areas where it was developed and promoted. Certain patterns in epidemiology and adherence to public health policy could be depicted but selection bias was difficult to measure showing the potential and challenges of digital decision support as public health tools.

Objective The aim of this study was to explore pandemic telehealth use among walk-in emergency department (ED) patients at Bern University Hospital.Design As in sequential explanatory designs, quantitative data were collected first. To explain the quantitative results, telehealth use was explored qualitatively using an interview guide informed by the quantitative results.Setting The University Hospital of Bern ED designed a follow-up cross-sectional study (baseline done in 2019) to assess telehealth use among ED walk-in patients during the pandemic (2021).Participants We included participants of all age groups that had consented to a follow-up qualitative study and also ensured a gender and age balance. We aimed for data saturation that was achieved by the seventh key informant. A total of 11 key informants took part in the study.Results Three main themes emerged, namely: (1) telehealth use means the use of a telephone for many; (2) telehealth has both remits and limits; and (3) perceived future telehealth opportunities and threats.Conclusion The pandemic seems not to have increased telehealth use among walk-in ED patients. The slight increase observed in telehealth use among women seems related to the use of the COVID-19 app from trusted sites like the Federal Office of Public Health. Telehealth emerged as having remits, limits, opportunities and threats. The human factor preference emerged as very important to all key informants. The fear that telehealth threatens the human factor cannot be over emphasised. The telephone remains the biggest telehealth modality among Swiss ED walk-in patients.

Background The PINNACLE FLX (Protection Against Embolism for Non‐valvular AF [Atrial Fibrillation] Patients: Investigational Device Evaluation of the Watchman FLX LAA [Left Atrial Appendage] Closure Technology) trial evaluated the safety and efficacy of a next‐generation left atrial appendage closure device (WATCHMAN FLX; Boston Scientific, Marlborough, MA). At 1 year, the study met the primary end points of safety and anatomical efficacy/appendage closure. This final report of the PINNACLE FLX trial includes the prespecified secondary end point of ischemic stroke or systemic embolism at 2 years, also making it the first report of 2‐year outcomes with this next‐generation left atrial appendage closure device. Methods and Results Patients with nonvalvular atrial fibrillation with CHA2DS2‐VASc score ≥2 (men) or ≥3 (women), with an appropriate rationale for left atrial appendage closure, were enrolled to receive the left atrial appendage closure device at 29 US centers. Adverse events were assessed by an independent clinical events committee, and imaging was assessed by independent core laboratories. Among 395 implanted patients (36% women; mean age, 74 years; CHA2DS2‐VASc, 4.2±1.5), the secondary efficacy end point of 2‐year ischemic stroke or systemic embolism was met, with an absolute rate of 3.4% (annualized rate, 1.7%) and an upper 1‐sided 95% confidence bound of 5.3%, which was superior to the 8.7% performance goal. Two‐year rates of adverse events were as follows: 9.3% all‐cause mortality, 5.5% cardiovascular death, 3.4% all stroke, and 10.1% major bleeding (Bleeding Academic Research Consortium 3 or 5). There were no additional systemic embolisms, device embolizations, pericardial effusions, or symptomatic device‐related thrombi after 1 year. Conclusions The secondary end point of 2‐year stroke or systemic embolism was met at 3.4%. In these final results of the PINNACLE FLX trial, the next‐generation WATCHMAN FLX device demonstrated favorable safety and efficacy outcomes.

Abstract Background The sandwich principle is an educational concept that regularly alternates between collective and individual learning phases within one learning unit. Applying sandwich principle to lectures has proven to be more effective for learning outcomes than classical lectures. Supposedly, this teaching format also leads to a beneficial knowledge transfer when applied to other teaching formats. Therefore, the aim of this study was to investigate the effect of the sandwich principle on instructional videos and how its use was evaluated by students. Methods Participants (n = 51) were randomly allocated into two groups. Both groups were given a test to assess the baseline level of knowledge. Afterwards, the control group watched the normal instructional video on cleft lips and palates, while the sandwich group watched the same video modified according to the sandwich principle. The participants then had to answer 30 single-choice questions to assess their knowledge gain and evaluate the instructional video. Long-term retention of the knowledge was tested again 6 months later using the same test questions. The unpaired t-test and ANOVA were used to compare the results. Results Comparison of the pre-test and post-test results of both groups showed significantly increased test scores (p 0.05). The evaluation showed that the students highly appreciated the modified video and found the interruptions for repetition of previously learned knowledge useful. Conclusion The hypothesis that the modification of instructional videos according to the sandwich principle would lead to an improved learning outcome could not be proved subjectively or objectively. Nevertheless, the teaching format was highly appreciated by the students and may have increased their motivation to learn with instructional videos.

Introduction Individuals living with and beyond cancer from rural and remote areas lack accessibility to supportive cancer care resources compared with those in urban areas. Exercise is an evidence-based intervention that is a safe and effective supportive cancer care resource, improving physical fitness and function, well-being and quality of life. Thus, it is imperative that exercise oncology programs are accessible for all individuals living with cancer, regardless of geographical location. To improve accessibility to exercise oncology programs, we have designed the EXercise for Cancer to Enhance Living Well (EXCEL) study.Methods and analysis EXCEL is a hybrid effectiveness-implementation study. Exercise-based oncology knowledge from clinical exercise physiologists supports healthcare professionals and community-based qualified exercise professionals, facilitating exercise oncology education, referrals and programming. Recruitment began in September 2020 and will continue for 5 years with the goal to enroll ~1500 individuals from rural and remote areas. All tumour groups are eligible, and participants must be 18 years or older. Participants take part in a 12-week multimodal progressive exercise intervention currently being delivered online. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework is used to determine the impact of EXCEL at participant and institutional levels. Physical activity, functional fitness and patient-reported outcomes are assessed at baseline and 12-week time points of the EXCEL exercise intervention.Ethics and dissemination The study was approved by the Health Research Ethics Board of Alberta. Our team will disseminate EXCEL information through quarterly newsletters to stakeholders, including participants, qualified exercise professionals, healthcare professionals and community networks. Ongoing outreach includes community presentations (eg, support groups, fitness companies) that provide study updates and exercise resources. Our team will publish manuscripts and present at conferences on EXCEL’s ongoing implementation efforts across the 5-year study.Trial registration number NCT04478851.