μ3-Oxido-tris­{dichlorido[1,3-bis­(1,3,5-trimethyl­phen­yl)imidazol-2-yl­idene]gold(III)} bis­(trifluoro­methane­sulfon­yl)imide–[bis­(trifluoro­methane­sulfon­yl)imide]­silver(I) (1/2)

The unusual trinuclear AuIII oxide title complex, [Au3Cl6O(C21H24N2)3](C2F6NO4S2)·2[Ag(C2F6NO4S2)], is the side product of the reaction of [1,3-bis­(1,3,5-trimethyl­phen­yl)imidazol-2-yl­idene]dichloridophenyl­gold(III) with silver bis­(trifluoro­methane­sulfon­yl)imide in the presence of traces of water. In contrast to corresponding AuI complexes, the core structure of the title compound is planar. Two silver(I) bis­(trifluoro­methane­sulfon­yl)imide units are loosely bound to the complex cation. Here the silver atoms, disordered over two positions in a 0.870 (2):0.130 (2) ratio, inter­act either with the lone pairs of three chlorine ligands or two chlorine ligands and one edge of the mesityl π-system. The crystal under investigation was a partial racemic twin

Modulateur à réseau de Bragg intégré sur silicium pour les télécommunications dans les centres de données et leurs applications

Récemment, beaucoup d’efforts ont été investis afin de développer des modulateurs sur silicium pour les télécommunications optiques et leurs domaines d’applications. Ces modulateurs sont utiles pour les centres de données à courte portée et à haut débit. Ainsi, ce travail porte sur la caractérisation de deux types de modulateurs à réseau de Bragg intégré sur silicium comportant une jonction PN entrelacée dont le but est de réaliser une modulation de la longueur d’onde de Bragg par le biais de l’application d’un tension de polarisation inverse réalisant une déplétion des porteurs au sein du guide d’onde. Pour le premier modulateur à réseau de Bragg, la période de la jonction PN est différente de celle du réseau de Bragg tandis que le deuxième modulateur à réseau de Bragg a la période de sa jonction PN en accord avec celle du réseau de Bragg. Ces différences apporteront un comportement différent du modulateur impliquant donc une transmission de données de qualité différente et c’est ce que nous cherchons à caractériser. L’avantage de ce modulateur à réseau de Bragg est qu’il est relativement simple à designer et possède un réseau de Bragg uniforme dont on connaît déjà très bien les caractéristiques. La première étape dans la caractérisation de ces modulateurs fut de réaliser des mesures optiques, uniquement, afin de constater la réponse spectrale en réflexion et en transmission. Par la suite, nous sommes passé par l’approche usuelle, c’est à dire en réalisant des mesures DC sur les modulateurs. Ce mémoire montre également les résultats pratiques sur le comportement des électrodes et de la jonction PN. Mais il rend compte également des résultats de la transmission de données de ces modulateurs par l’utilisation d’une modulation OOK et PAM-4 et permet de mettre en évidence les différences en terme d’efficacité de modulation de ces deux modulateurs. Nous discutons alors de la pertinence de ce choix de design par rapport à ce que l’on peut trouver actuellement dans la littérature.Recently, much effort has been invested to develop silicon modulators for optical telecommunications and their application areas. These modulators are useful for data centers and short-range high capacity links. Thus, this work focuses on the characterization of two types of integrated Bragg grating modulators on silicon waveguide and having an interleaved PN junction whose goal is to achieve a modulation of the Bragg wavelength through the application of an reverse bias voltage creating a carrier depleted region in the waveguide. For the first integrated Bragg grating modulator, the period of the PN junction is not matched to the Bragg grating period while the second integrated Bragg grating modulator has the PN junction matched to the Bragg grating period. This difference brings a different behaviour of the modulator thus resulting in a different quality of data that we seek to characterize. The advantage of this Bragg grating modulator is that it is relatively simple to design and has a uniform Bragg grating which has well known characteristics. The first step in the characterization of these modulators was making optical measurements, only to see the spectral response in reflection and transmission. Afterwards, we went through the usual approach, i.e by making DC measurements on the modulators. This thesis shows the practical results on the behaviour of the electrodes and the PN junction. And it also reports the results of the data transmission of these modulators by using an OOK modulation and PAM-4 modulation highlighting the differences in terms of modulation efficiency of these two modulators. We then discuss the relevance of this design choice compared to what we can currently find in the literature

Acute neurological care in north-east Germany with telemedicine support (ANNOTeM): protocol of a multi-center, controlled, open-label, two-arm intervention study

Background: Both diagnosis and treatment of neurological emergencies require neurological expertise and are time-sensitive. The lack of fast neurological expertise in regions with underserved infrastructure poses a major barrier for state-of-the-art care of patients with acute neurological diseases and leads to disparity in provision of health care. The main purpose of ANNOTeM (acute neurological care in North East Germany with telemedicine support) is to establish effective and sustainable support structures for evidence based treatments for stroke and other neurological emergencies and to improve outcome for acute neurological diseases in these rural regions. Methods: A “hub-and-spoke” network structure was implemented connecting three academic neurological centres (“hubs”) and rural hospitals (“spokes”) caring for neurological emergencies. The network structure includes (1) the establishment of a 24/7 telemedicine consultation service, (2) the implementation of standardized operating procedures (SOPs) in the network hospitals, (3) a multiprofessional training scheme, and (4) a quality management program. Data from three major health insurance companies as well as data from the quality management program are being collected and evaluated. Primary outcome is the composite of first time of receiving paid outpatient nursing care, first time of receiving care in a nursing home, or death within 90 days after hospital admission. Discussion: Beyond stroke only few studies have assessed the effects of telemedically supported networks on diagnosis and outcome of neurological emergencies. ANNOTeM will provide information whether this approach leads to improved outcome. In addition, a health economic analysis will be performed. Study registration: German Clinical Trials Register DRKS00013067, date of registration: November 16 th, 2017, URL: http://www.drks.de/DRKS0001306

Stroke admissions, stroke severity, and treatment rates in urban and rural areas during the COVID-19 pandemic

Background: Many regions worldwide reported a decline of stroke admissions during the early phase of the coronavirus disease 2019 (COVID-19) pandemic. It remains unclear whether urban and rural regions experienced similar declines and whether deviations from historical admission numbers were more pronounced among specific age, stroke severity or treatment groups.Methods: We used registry datasets from (a) nine acute stroke hospitals in Berlin, and (b) nine hospitals from a rural TeleNeurology network in Northeastern Germany for primary analysis of 3-week-rolling average of stroke/TIA admissions before and during the COVID-19 pandemic. We compared course of stroke admission numbers with regional cumulative severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) infections. In secondary analyses, we used emergency department logs of the Berlin Charite University hospital to investigate changes in age, stroke severity, and thrombolysis/thrombectomy frequencies during the early regional Sars-CoV-2 spread (March and April 2020) and compared them with preceding years.Results: Compared to past years, stroke admissions decreased by 20% in urban and 20-25% in rural hospitals. Deviations from historical averages were observable starting in early March and peaked when numbers of regional Sars-CoV-2 infections were still low. At the same time, average admission stroke severity and proportions of moderate/severe strokes (NIHSS >5) were 20 and 20-40% higher, respectively. There were no relevant deviations observed in proportions of younger patients (<65 years), proportions of patients with thrombolysis, or number of thrombectomy procedures. Stroke admissions at Charite subsequently rebounded and reached near-normal levels after 4 weeks when the number of new Sars-CoV-2 infections started to decrease.Conclusions: During the early pandemic, deviations of stroke-related admissions from historical averages were observed in both urban and rural regions of Northeastern Germany and appear to have been mainly driven by avoidance of admissions of mildly affected stroke patients.Clinical epidemiolog

Time-to-care metrics in patients with interhospital transfer for mechanical thrombectomy in north-east Germany: primary telestroke centers in rural areas vs. primary stroke centers in a metropolitan area.

BACKGROUND: Mechanical thrombectomy (MT) is highly effective in large vessel occlusion (LVO) stroke. In north-east Germany, many rural hospitals do not have continuous neurological expertise onsite and secondary transport to MT capable comprehensive stroke centers (CSC) is necessary. In metropolitan areas, small hospitals often have neurology departments, but cannot perform MT. Thus, interhospital transport to CSCs is also required. Here, we compare time-to-care metrics and outcomes in patients receiving MT after interhospital transfer from primary stroke centers (PCSs) to CSCs in rural vs. metropolitan areas. METHODS: Patients from ten rural telestroke centers (RTCs) and nine CSCs participated in this study under the quality assurance registry for thrombectomies of the Acute Neurological care in North-east Germany with TeleMedicine (ANNOTeM) telestroke network. For the metropolitan area, we included patients admitted to 13 hospitals without thrombectomy capabilities (metropolitan primary stroke centers, MPSCs) and transferred to two CSCs. We compared groups regarding baseline variables, time-to-care metrics, clinical, and technical outcomes. RESULTS: Between October 2018 and June 2022, 50 patients were transferred from RTCs within the ANNOTeM network and 42 from MPSCs within the Berlin metropolitan area. RTC patients were older (77 vs. 72 yrs, p = 0.05) and had more severe strokes (NIHSS 17 vs. 10 pts., p < 0.01). In patients with intravenous thrombolysis (IVT; 34.0 and 40.5%, respectively), time from arrival at the primary stroke center to start of IVT was longer in RTCs (65 vs. 37 min, p < 0.01). However, RTC patients significantly quicker underwent groin puncture at CSCs (door-to-groin time: 42 vs. 60 min, p < 0.01). Despite longer transport distances from RTCs to CSCs (55 vs. 22 km, p < 0.001), there was no significant difference of times between arrival at the PSC and groin puncture (210 vs. 208 min, p = 0.96). In adjusted analyses, there was no significant difference in clinical and technical outcomes. CONCLUSION: Despite considerable differences in the setting of stroke treatment in rural and metropolitan areas, overall time-to-care metrics were similar. Targets of process improvement should be door-to-needle times in RTCs, transfer organization, and door-to-groin times in CSCs wherever such process times are above best-practice models

Self-productivity and complementarities in human development : evidence from MARS

This paper investigates the role of self-productivity and home resources in capability formation from infancy to adolescence. In addition, we study the complementarities between basic cognitive, motor and noncognitive abilities and social as well as academic achievement. Our data are taken from the Mannheim Study of Children at Risk (MARS), an epidemiological cohort study following the long-term outcome of early risk factors. Results indicate that initial risk conditions cumulate and that differences in basic abilities increase during development. Self-productivity rises in the developmental process and complementarities are evident. Noncognitive abilities promote cognitive abilities and social achievement. There is remarkable stability in the distribution of the economic and socio-emotional home resources during the early life cycle. This is presumably a major reason for the evolution of inequality in human development