Improved success rates using videolaryngoscopy in unexperienced users: a randomized crossover study in airway manikins

Background: Videolaryngoscopy has been proven to be a safe procedure managing difficult airways in the hands of airway specialists. Information about the success rates in unexperienced users of videolaryngoscopy compared to conventional laryngoscopy is sparse. Therefore, we aimed to evaluate if there might be more success in securing an airway if the unexperienced provider is using a videolaryngoscope in simulated airways in a randomized manikin study. Differences between commonly used videolaryngoscopes were elucidated. Methods: A standardized hands-on workshop prior to the study was performed. For direct laryngoscopy (DL) we used a Macintosh laryngoscope, whereas for videolaryngoscopy (VL) we used the cMac, the dBlade, and a King Vision videolaryngoscope. Endotracheal intubations in three simulated normal and difficult airways were performed. Main outcome parameters were time to view and time to intubation. Cormack and Lehane (C + L) classification and the percentage of glottic opening (POGO) score were evaluated. After every intubation, the participants were asked to review the airway and the device used. Results: 22 participants (14.8 +/- 4.0 intubations per year, mostly trauma surgeons) with limited experience in videolaryngoscopy (mean total number of videolaryngoscopy.4 +/- .2) were enrolled. We found improved C + L grades with VL in contrast to DL. We saw similar data with respect to the POGO score, where the participants achieved better visibility of the glottis with VL. The hyperangulated blade geometries of videolaryngoscopes provided a better visibility in difficult airways than the standard geometry of the Macintosh-type blade. The subjective performance of the VL devices was better in more difficult airway scenarios. Conclusions: After a short introduction and hands-on training, a videolaryngoscope seems to be safe and usable by unexperienced providers. We assume a standard geometry laryngoscope is optimal for a patient with normal anatomy, whereas VL device with a hyperangulated blade is ideal for difficult airway situations with limited mouth opening or restricted neck movement

Transdisziplinäres Innovationsmanagement

Wie man nachhaltige Innovationsideen in Projekte umsetzt, welche Instrumente dabei helfen und wie die erarbeitete Lösung erfolgreich implementiert werden kann, stellen die Beiträge des Praxisbuchs vor. Die Autoren und Autorinnen zeigen, wie Elemente des betrieblichen Innovationsmanagements für die Planung und Steuerung von Nachhaltigkeitsprojekte genutzt werden können. Die Autorinnen und Autoren erläutern an einem Fallbeispiel, welche Aufgaben anfallen und wie sie gelöst werden können. Zu jedem Abschnitt gibt es Aufgabenblätter, mit denen Strategien und Maßnahmen erarbeitet werden können, um das eigene Nachhaltigkeitsprojekt voranzubringen. Das Praxisbuch richtet sich an Menschen mit unterschiedlichen Expertisen und Hintergründen. Gute Allgemeinverständlichkeit, bildhafte Sprache und Illustrationen helfen ihnen, die Grundlagen des Innovationsmanagements schnell zu verstehen und zu nutzen

Oncological impact of perioperative blood transfusion in bladder cancer patients undergoing radical cystectomy: Do we need to consider storage time of blood units, donor age, or gender matching?

Background The oncological impact of perioperative blood transfusions (PBTs) of patients undergoing radical cystectomy (RC) because of bladder cancer (BCa) has been a controversial topic discussed in recent years. The main cause for the contradictory findings of existing studies might be the missing consideration of the storage time of red blood cell units (BUs), donor age, and gender matching. Study Design and Methods We retrospectively analyzed BCa patients who underwent RC in our department between 2004 and 2021. We excluded patients receiving BUs before RC, >10 BUs, or RC in a palliative setting. We assessed the effect of blood donor characteristics and storage time on overall survival (OS) and cancer-specific survival (CSS) through univariate and multivariable Cox regression analysis. We also performed a propensity score matching with patients who received BUs and patients who did not on a 1:1 ratio. Results We screened 1692 patients and included 676 patients for the propensity score matching. In the multivariable analysis, PBT was independently associated with worse OS and CSS (p < .001). Postoperative transfusions were associated with better OS (p = .004) and CSS (p = .008) compared to intraoperative or mixed transfusions. However, there was no influence of blood donor age, storage time, or gender matching on prognosis. Discussion In our study of BCa patients undergoing RC, we demonstrate that PBT, especially if administered intraoperatively, is an independent risk factor for a worse prognosis. However, storage time, donor age, or gender matching did not negatively affect oncological outcomes. Therefore, the specific selection of blood products does not promise any benefits

Resource management for cloud functions with memory tracing, profiling and autotuning

Application software provisioning evolved from monolithic designs towards differently designed abstractions including serverless applications. The promise of that abstraction is that developers are free from infrastructural concerns such as instance activation and autoscaling. Today's serverless architectures based on FaaS are however still exposing developers to explicit low-level decisions about the amount of memory to allocate for the respective cloud functions. In many cases, guesswork and ad-hoc decisions determine the values a developer will put into the configuration. We contribute tools to measure the memory consumption of a function in various Docker, OpenFaaS and GCF/GCR configurations over time and to create trace profiles that advanced FaaS engines can use to autotune memory dynamically. Moreover, we explain how pricing forecasts can be performed by connecting these traces with a FaaS characteristics knowledge base

Expression of Nectin-4 in Variant Histologies of Bladder Cancer and Its Prognostic Value-Need for Biomarker Testing in High-Risk Patients?

Simple Summary Variant histologies of bladder cancer present at advanced stage and are often treated with radical cystectomy. As Nectin-4 appears to be a promising target for novel therapies in conventional bladder cancer, we aimed to analyze the expression of Nectin-4 and its prognostic value in variant histologies of bladder cancer. We found a high expression of Nectin-4 in squamous cell carcinoma and adenocarcinoma and a low expression in sarcomatoid urothelial carcinoma. No impact of Nectin-4 expression on survival has been detected in our study. Our study reveals the need to perform further biomarker testing for Nectin-4 in prospective trials including patients with variant histologies. Variant histologies of bladder cancer (BC) often present with advanced tumor stage and the status of perioperative therapy is unclear. Thereby, squamous cell carcinoma (SCC), adenocarcinoma (ADENO), and sarcomatoid urothelial carcinoma (SARCO) are the most frequent variants. Nectin-4 has emerged as a highly interesting target in BC and might guide therapeutic application of antibody-drug conjugates (ADC). We therefore aimed to investigate expression patterns and prognostic value of Nectin-4 in variant histologies of BC. A single-center retrospective analysis was conducted of patients who underwent radical cystectomy (RC) for BC and revealed variant histologies of BC in the final specimens. Immunohistochemical staining for Nectin-4 was performed on tissue microarrays with 59 SCC, 22 ADENO, and 24 SARCO, and Nectin-4 expression was scored using the histochemical scoring system (H-score). Overall survival (OS) and progression-free survival (PFS) was calculated by Kaplan-Meier method. Median expression of Nectin-4 was 150 (range 0-250) in SCC, 140.5 (range 30-275) in ADENO, and 10 (0-185) in SARCO, with significantly lower levels for SARCO compared to SCC or ADENO (p 0.05). Multivariate analysis revealed nodal stage as an independent prognostic factor for OS and PFS and metastases for PFS but not Nectin-4 expression. In conclusion, Nectin-4 was not prognostic in histological subtypes of BC in our study cohort. However, the high expression of Nectin-4 in SCC and ADENO might guide future treatment with novel Nectin-4-directed ADCs and provide this high-risk patient collective with a new promising therapeutic option. Testing Nectin-4 expression as a biomarker should be considered in trials with SARCO, where low Nectin-4 expression has been observed

Identification of the Tumor Infiltrating Lymphocytes (TILs) Landscape in Pure Squamous Cell Carcinoma of the Bladder

Simple Summary Treatment options in squamous cell carcinoma (SCC) of the bladder are limited and prognosis is poor. In this report we investigated the impact of tumor-infiltrating lymphocytes (TILs) in SCC of the bladder in patients undergoing radical cystectomy. We found that subsets of TILs hold predictive value for OS and PFS. We conclude that TILs might stratify patients with bladder SCC for immunotherapy. Background: Tumor infiltrating lymphocytes (TILs) are known as important prognostic biomarkers and build the fundament for immunotherapy. However, the presence of TILs and its impact on outcome in pure squamous cell carcinoma (SCC) of the bladder remains uncertain. Methods: Out of 1600 patients undergoing radical cystectomy, 61 patients revealed pure bladder SCC in the final histopathological specimen. Retrospectively, immunohistochemical staining was performed on a subset of TILs (CD3+, CD4+, CD8+, CD20+). Endpoints were overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS). The Kaplan-Meier method was used to evaluate survival outcomes. Results: Strong infiltration of CD3+ was found in 27 (44%);of CD4+ in 28 (46%);of CD8+ in 26 (43%);and of CD20+ in 27 tumors (44%). Improved OS was observed for strong CD3+ (p < 0.001);CD4+ (p = 0.045);CD8+ (p = 0.001);and CD20+ infiltration (p < 0.001). Increased rates of PFS were observed for CD3+ (p = 0.025) and CD20+ TILs (p = 0.002). In multivariate analyses, strong CD3+ (HR: 0.163, CI: 0.044-0.614) and strong CD8+ TILs (HR: 0.265, CI: 0.081-0.864) were revealed as predictors for OS and the strong infiltration of CD20+ cells (HR: 0.095, CI: 0.019-0.464) for PFS. Conclusions: These first results of TILs in bladder SCC revealed predictive values of CD3+, CD8+ and CD20+

Development and use of Digital Twins for campuses in Dortmund and Bến Cát for climate adaptation measures

Climate Change is the leading cause for the warming of the atmosphere, land, and oceans. As a result, urban areas are particularly affected by the urban heat island phenomenon, which has a significant negative impact on human health, energy consumption and everyday life. To mitigate the effects on the environment and residents, researching new technologies such as Digital Twins in Smart Cities can be crucial. This research aims to evaluate the effectiveness of the usage of Digital Twins for developing climate adaptation measures to mitigate urban heat island effects. A key element of this evaluation is analyzing the potentials and limitations of the Digital Twin technology, emphasizing the creation process of a Digital Twin as well as the application and its usage. A Digital Twin is created for a building on the campus of the TU Dortmund University and the Vietnamese- German University. The methods of laser scanning and 3D modeling serve as a foundation for the creation process of the Digital Twins. To analyze the effect of climate adaptation measures on built environment, microclimatic simulations are conducted. The results of the research including the 3D model and the microclimatic simulations are visualized in a geoinformation map. The evaluation process revealed multiple challenges in the development process and the usage of the Digital Twin technology. The main areas for improvement were identified in terms of data availability, data interoperability, and mesh creation. However, it is important to note that Digital Twin appears to have a significant potential for future urban development

Arqus Openness Position Paper

The Openness Position Paper published by the Arqus European University Alliance emphasises that Arqus institutions, in line with the policies, roadmaps and strategies of the EU and a wide range of stakeholders, are striving jointly to make further progress towards realising Open Science. The Position Paper identifies and acknowledges aims and values of Open Science and relates them to values, principles, and standards shared by the Arqus Alliance, followed by a vision for a future with Open Science. In the interest of a nuanced picture, the Position Paper discusses not only desired effects, but also possible areas of tension related to Open Science. It presents a wide range of specific aims and recommendations for each of the eleven elements of Open Science defined by the Arqus Openness Task Force: Governance Publications (including Open Access) Data (including research data management, FAIR and Open Data) Infrastructures (including support staff, Open Science software and tools, repositories, Open Labs) Methods (including source code, preregistration, materials, workflows, protocols, lab notes) Awareness and training (including education of early-stage researchers) Evaluation (including Open Metrics, research assessment, Open Peer Review, rewards and incentives) Communication (including multilingualism) Citizen Science Open Education Open Innovation The Position Paper concludes with an annex that highlights the progress already made in the implementation and support of Open Science practices at Arqus institutions.Cofunded by the Erasmus+Programme of the European Unio

Randomized controlled phase 2 trial of hydroxychloroquine in childhood interstitial lung disease

Background No results of controlled trials are available for any of the few treatments offered to children with interstitial lung diseases (chILD). We evaluated hydroxychloroquine (HCQ) in a phase 2, prospective, multicentre, 1:1-randomized, double-blind, placebo-controlled, parallel-group/crossover trial. HCQ (START arm) or placebo were given for 4 weeks. Then all subjects received HCQ for another 4 weeks. In the STOP arm subjects already taking HCQ were randomized to 12 weeks of HCQ or placebo (= withdrawal of HCQ). Then all subjects stopped treatment and were observed for another 12 weeks. Results 26 subjects were included in the START arm, 9 in the STOP arm, of these four subjects participated in both arms. The primary endpoint, presence or absence of a response to treatment, assessed as oxygenation (calculated from a change in transcutaneous O 2 -saturation of ≥ 5%, respiratory rate ≥ 20% or level of respiratory support), did not differ between placebo and HCQ groups. Secondary endpoints including change of O 2 -saturation ≥ 3%, health related quality of life, pulmonary function and 6-min-walk-test distance, were not different between groups. Finally combining all placebo and all HCQ treatment periods did not identify significant treatment effects. Overall effect sizes were small. HCQ was well tolerated, adverse events were not different between placebo and HCQ. Conclusions Acknowledging important shortcomings of the study, including a small study population, the treatment duration, lack of outcomes like lung function testing below age of 6 years, the small effect size of HCQ treatment observed requires careful reassessments of prescriptions in everyday practice (EudraCT-Nr.: 2013-003714-40, www.clinicaltrialsregister.eu , registered 02.07.2013)

Soziale Vergleichsprozesse in Organisationen zwischen Arbeitsklima und -zufriedenheit

Die vorliegende Arbeit vertritt die These, dass kein direkter Zusammenhang zwischen dem Arbeitsklima und der allgemeinen Arbeitszufriedenheit besteht, sondern dass er durch soziale Vergleichsprozesse vermittelt ist. Das Arbeitsklima ist Gegenstand und Moderator sozialer Vergleiche, aus denen Arbeitszufriedenheit resultiert. Das Arbeitsklima beeinflusst damit zwar den Entstehungsprozess von Arbeitszufriedenheit, aber nicht dessen Ausmaß. Von affektiven und regulativen Klimadimensionen gehen unterschiedliche Wirkungsmechanismen aus. Überschreiten soziale Vergleiche die Organisationsgrenze, ändert sich die Logik der Entstehung von Arbeitszufriedenheit