Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction

In dieser Studie wurden Patienten untersucht, die einen malignen Hirninfarkt erlitten hatten und mit Hilfe der dekompressiven Hemikraniektomie behandelt wurden. Es wurden die funktionelle Beeinträchtigung, die Körperbehinderung und die Lebensqualität untersucht. Die Patienten wurden sechs Monate nach dem Ereignis kontaktiert, um eine Nachuntersuchung durchzuführen. Dabei wurden die Patienten bezüglich ihrer Beeinträchtigung, Körperbehinderung und Lebensqualität beurteilt. Die Studie beinhaltete 36 Patienten. Daraus resultiert eine Überlebensrate von 64%. Bei 10 Patienten wurde die Beeinträchtigung mit dem Barthel Index mit 50 Punkten beurteilt. In drei Fällen betrug der BI 90 Punkte. Die Mehrheit der Patienten (12) zeigte ernste Beeinträchtigungen (BI<50). Die Behinderung korrelierte negativ mit dem Patientenalter. 16 Patienten waren nicht in der Lage zu gehen und benötigten bei der täglichen Arbeit Hilfe, was einen mRS von 4 oder 5 Punkten entspricht. Keiner der Patienten erreichte einen unabhängigen Status. Patienten, die eine höhere BI-Punktezahl hatten, waren signifikant jünger, hatten weniger schwere Beeinträchtigungen bei der Krankenhausaufnahme, wurden kürzer mechanisch ventiliert und verließen die Intensivstation früher. Die Schwere der Angst oder der Depression korrelierte dabei signifikant mit der Schwere der Behinderung. Die dekompressive Hemikraniektomie verbessert die Überlebensrate dramatisch, reduziert aber nicht die Größe des Infarktvolumens. Die Mehrzahl der Patienten wurde durch den Infarkt deutlich in ihrem Leben beeinträchtigt. Insgesamt ist die Lebensqualität reduziert.The target of the study was to determine functional impairment, disability and health related quality of life after decompressive hemicraniectomy and to determine the factors associated with functional outcome as well. The study included 36 patients who had undergone decompressive hemicraniectomy for the treatment of malignant MCA infarction. Six months after hospital admission the patients were contacted for a follow-up study. This study consisted of a follow-up visit for a neurological examination and the completion of various questionnaires to assess impairment, disability, handicap and quality of life. By the time of follow-up investigation the overall survival rate was 64%. The functional impairment assessed by the European Stroke Scale had significantly improved compared with the score at admission. In three cases the European Stroke Scale score was worse at the time of the follow-up study. Disability measured by the Barthel Index revealed a score of at least 50 in 10 patients. In three of them the Barthel Index was at least 90, but the majority (12 patients) showed severe disabilities (BI < 50). Disability determined by the Barthel Index correlated negatively with patient age. Disability determined by the modified Rankin Scale showed that none of the patients had reached an independent outcome status. According to the Hospity Anxiety Depression Scale we found moderate to severe anxiety and/or depression in eight patients. The majority of patients suffered from considerable impairment, disability and overall reduction in quality of life. Decompressive hemicraniectomy improves the survival rate dramatically, but the majority of our patients was severly affected by the consequences of the stroke. None of our patients had reached the level of independence

Self-Organisation of Neural Topologies by Evolutionary Reinforcement Learning

In this article we present EANT, "Evolutionary Acquisition of Neural Topologies", a method that creates neural networks (NNs) by evolutionary reinforcement learning. The structure of NNs is developed using mutation operators, starting from a minimal structure. Their parameters are optimised using CMA-ES. EANT can create NNs that are very specialised; they achieve a very good performance while being relatively small. This can be seen in experiments where our method competes with a different one, called NEAT, "NeuroEvolution of Augmenting Topologies", to create networks that control a robot in a visual serving scenario

Comparing simulated 26^{26}Al maps to gamma-ray measurements

© ESO 2019.Context. The diffuse gamma-ray emission of $^{26}{\rm Al}$ at 1.8 MeV reflects ongoing nucleosynthesis in the Milky Way, and traces massive-star feedback in the interstellar medium due to its 1 Myr radioactive lifetime. Interstellar-medium morphology and dynamics are investigated in astrophysics through 3D hydrodynamic simulations in fine detail, as only few suitable astronomical probes are available. Aims. We compare a galactic-scale hydrodynamic simulation of the Galaxy's interstellar medium, including feedback and nucleosynthesis, with gamma-ray data on $^{26}{\rm Al}$ emission in the Milky Way extracting constraints that are only weakly dependent on the particular realisation of the simulation or Galaxy structure. Methods. Due to constraints and biases in both the simulations and the gamma-ray observations, such comparisons are not straightforward. For a direct comparison, we perform maximum likelihood fits of simulated sky maps as well as observation-based maximum entropy maps to measurements with INTEGRAL/SPI. To study general morphological properties, we compare the scale heights of $^{26}{\rm Al}$ emission produced by the simulation to INTEGRAL/SPI measurements.} Results. The direct comparison shows that the simulation describes the observed inner Galaxy well, but differs significantly from the observed full-sky emission morphology. Comparing the scale height distribution, we see similarities for small scale height features and a mismatch at larger scale heights. We attribute this to the prominent foreground emission sites that are not captured by the simulation.Peer reviewedFinal Accepted Versio

Self-Organisation of Neural Topologies by Evolutionary Reinforcement Learning

In this article we present EANT, "Evolutionary Acquisition of Neural Topologies", a method that creates neural networks (NNs) by evolutionary reinforcement learning. The structure of NNs is developed using mutation operators, starting from a minimal structure. Their parameters are optimised using CMA-ES. EANT can create NNs that are very specialised; they achieve a very good performance while being relatively small. This can be seen in experiments where our method competes with a different one, called NEAT, "NeuroEvolution of Augmenting Topologies", to create networks that control a robot in a visual serving scenario

HEart and BRain interfaces in Acute ischemic Stroke (HEBRAS) – rationale and design of a prospective oberservational cohort study

Background An effective diagnostic work-up in hospitalized patients with acute ischemic stroke is vital to optimize secondary stroke prevention. The HEart and BRain interfaces in Acute ischemic Stroke (HEBRAS) study aims to assess whether an enhanced MRI set-up and a prolonged Holter-ECG monitoring yields a higher rate of pathologic findings as compared to diagnostic procedures recommended by guidelines (including stroke unit monitoring for at least 24 h, echocardiography and ultrasound of brain-supplying arteries). Methods/Design Prospective observational single-center study in 475 patients with acute ischemic stroke and without known atrial fibrillation. Patients will receive routine diagnostic care in hospital as wells as brain MRI, cardiac MRI, MR angiography of the brain-supplying arteries and Holter-monitoring for up to 10 days. Study patients will be followed up for cardiovascular outcomes at 3 and 12 months after enrolment. Discussion By comparing the results of routine diagnostic care to the study-specific MRI/ECG approach, the primary outcome of HEBRAS is the proportion of stroke patients with pathologic diagnostic findings. Predefined secondary outcomes are the association of stroke localization, autonomic dysbalance and cardiac dysfunction as well as the effect of impaired heart-rate-variability on long-term clinical outcome. The investigator-initiated HEBRAS study will assess whether an enhanced MRI approach and a prolonged ECG monitoring yield a higher rate of pathological findings than current standard diagnostic care to determine stroke etiology. These findings might influence current diagnostic recommendations after acute ischemic stroke. Moreover, HEBRAS will determine the extent and clinical impact of stroke-induced cardiac damage

26Al kinematics: superbubbles following the spiral arms? : Constraints from the statistics of star clusters and HI supershells

High energy resolution spectroscopy of the 1.8 MeV radioactive decay line of 26Al with the SPI instrument on board the INTEGRAL satellite has recently revealed that diffuse 26Al has large velocities in comparison to other components of the interstellar medium in the Milky Way. 26Al shows Galactic rotation in the same sense as the stars and other gas tracers, but reaches excess velocities up to 300 km s−1Peer reviewe

Galactic Population Synthesis of Radioactive Nucleosynthesis Ejecta

© The Authors 2023. This is an Open Access article, published by EDP Sciences, under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0).Diffuse gamma-ray line emission traces freshly produced radioisotopes in the interstellar gas, providing a unique perspective on the entire Galactic cycle of matter from nucleosynthesis in massive stars to their ejection and mixing in the interstellar medium. We aim at constructing a model of nucleosynthesis ejecta on galactic scale which is specifically tailored to complement the physically most important and empirically accessible features of gamma-ray measurements in the MeV range, in particular for decay gamma-rays such as $^{26}$Al, $^{60}$Fe or $^{44}$Ti. Based on properties of massive star groups, we developed a Population Synthesis Code which can instantiate galaxy models quickly and based on many different parameter configurations, such as the star formation rate, density profiles, or stellar evolution models. As a result, we obtain model maps of nucleosynthesis ejecta in the Galaxy which incorporate the population synthesis calculations of individual massive star groups. Based on a variety of stellar evolution models, supernova explodabilities, and density distributions, we find that the measured $^{26}$Al distribution from INTEGRAL/SPI can be explained by a Galaxy-wide population synthesis model with a star formation rate of $4$-$8\,\mathrm{M_{\odot}\,yr^{-1}}$ and a spiral-arm dominated density profile with a scale height of at least 700 pc. Our model requires that most massive stars indeed undergo a supernova explosion. This corresponds to a supernova rate in the Milky Way of $1.8$-$2.8$ per century, with quasi-persistent $^{26}$Al and $^{60}$Fe masses of $1.2$-$2.4\,\mathrm{M_{\odot}}$ and $1$-$6\,\mathrm{M_{\odot}}$, respectively. Comparing the simulated morphologies to SPI data suggests that a frequent merging of superbubbles may take place in the Galaxy, and that an unknown but strong foreground emission at 1.8 MeV could be present.Peer reviewe

A global investigation of music listening practices: the influence of country latitude and seasons on music preferences

Background: Most research on correlates of music preference considers micro-level influences, such as personality and social positional levels (Rentfrow & Gosling, 2003; North & Hargreaves, 1996). However, it is important to consider macro-level influences, such as cultural norms and the effects of time and weather, as well. An interesting macro-level influence that is gaining research attention is the consideration of seasonal effects (Helmholz, et al., 2017; Krause & North, 2018; Park, et al., 2019). For example, Krause and North’s (2018, p. 89) research demonstrated that listeners preferred “arousing music for the warmer months, serene music for spring, and melancholy music for the cooler months”. Aims: The present study is a replication-extension study of Krause and North’s (2018) research. The aims of the present study included: 1. Replicating their findings drawing on a larger, global sample (including non-western countries and those with varying weather patterns and at different latitudes). 2. Exploring the extent that proxies for country and seasons (latitude) modulate response patterns. Method: A total of 2,140 participants from 47 countries across 4 continents completed an online questionnaire, which consisted of answering background questions and responding to a series of questions concerning the creation of music playlists. Importantly, as in Krause and North (2018), participants rated how well 24 adjectives (from three factors: Arousing, Serene, and Melancholy) describe preferred music for playlists (for each season); also, they indicated their favourite season, the season they were currently experiencing, and their country of residence. Results: Addressing the first aim, an exploratory factor analyses was conducted on the participants' adjective ratings to replicate that reported in Krause and North (2018). The results indicated that the proposed three factor solution on each of the four seasons from Autumn to Summer does not fit the data well using either the Comparitive Fit Index (0.79, 0.79, 0.81, 0.83) or Tucker Lewis Index (0.83, 0.83, 0.84, 0.86). We posit this model fit incongrunacy is due to initial model specification choices. Nevertheless, we continued our planned analyses and considered the impact of the participants’ country of residence. We tested the hypothesis that preferred arousal levels in music fluctuate according to the ecological environment: could countries with warmer summers prefer higher arousal music for warmer (summer) seasons, and countries with colder winters prefer lower arousal (melancholic) music for cooler (winter) seasons? Using mixed effects models with random effects for country, we found that countries with more extreme latitudes (warmer summers) preferred higher arousal music (b = -0.05, p = .036) for summer. However, no significant effect was observed for latitude and low arousal (melancholic) music (b = -0.03, p = .11). Conclusions: By examining the replicability of Krause and North's (2018) findings on a larger set of participants and countries, the present research contributes to the developing body of psychological research on music preference at the macro-level, focusing on contributing to our understanding of how broader factors play a role in music preference and everyday listening behaviours. Moreover, the findings will be considered relative to research concerning seasonal variations in other behaviours and experiences, which may have additional influences on areas such as financial behaviours, aggression, mental health, and mood

Possibilities for emission prevention and reduction

Die Tierproduktion belastet die Umwelt mit Geruch, Ammoniak, Staub, Keimen und Aerosolen. Emissionsmindernde Maßnahmen sind daher unbestreitbar erforderlich, obschon die Datenerhebung einer Aufarbeitung bedarf. Gleichwohl wird in der Geflügelproduktion durch die Genehmigungsbehörden vorrangig auf Abluftreinigung gesetzt. Die Zeitreihenmessungen in den Ställen lassen kaum kausalanalytische Zusammenhänge beim Emissionsgebaren erkennen. Mit dem Programm DEMAP lassen sich wenigstens die Größenordnungen der Einflussgrößen feststellen, was mit der bloßen Abschätzung der Emissionsfaktoren nach VDI 3894 nicht möglich ist. Hier ist die Landwirtschaft aufgerufen, mit modernen Analyseverfahren Zielfunktionen zur Emissionsminderung und den Einsatz von Filtertechniken auch in Hinblick auf die Verbesserung der Tiergesundheit zu erarbeiten.The animal production stresses the environment with odor, ammonia, particulate matter, germs and aerosols. Therefore the demand of emission reduction is incontestable, although the available data needs further recondition. Nevertheless approving authorities preferentially focus on exhaust air treatment in poultry production. Time course measurements in stables hardly reveal causally determined correlations in view of emission behavior. At least the dimensions of influences can be assessed with the software "DEMAP". This is not possible with a bare estimation of emission factors on basis of the VDI 3894. With modern analytical methods agriculture is called in this regard to develop target functions for emission reduction and the use of filter techniques, also in terms of an improvement of animal welfare