Forstliche Bodenkartierungen im Keupergebiet des Strombergs in Wuerttemberg

A detailed soil survey was made for forestry purposes in the Keuper hill area of Stromberg in north-west Wnrttemberg. The soil profiles consisted chiefly of heavily weathered diluvial deposits, usually clayey, sometimes sandy, not rich in lime, and numerous deposits of loess. The Keuper deposits (the most recent deposits of Trias) underlying the soils hardly had any part in their structure. Most soils had moved by soil slip during the glacial period, giving rise to special mixed soils and a multilayered structure. Native weathered soils seldom occurred. From the structure of the shifted material, the land morphology and the slope governing solifluction, 3 terraces could be distinguished. These resulted from the main layers of hard sandstone between the Red and the Grey Keuper Clays.In most of the forests there were slightly podzolized brown forest soils. The growth of all types of timber was determined by the soil units. Growth of the native oak, beech and hornbeam, and the introduced conifers pine, European larch, and spruce distinguished different types of deciduous forest soils of the former middle forest. The economics were discussed first of oak and then of beech. The chief conifer was pine, mixed either with oak or beech according to situation. Its growth on heavy clay in basins was outstanding. European larch was particularly suited to solifluctive soils, consisting of a clayey subsoil with a loamy topsoil. The failure so far of spruce through drought and bark beetles was ascribed entirely to its situation in dry valleys.<p/

The electron density and temperature in the Philips QL-lamp

There is an increasing interest in electrodeless lamps since reactions between the electrodes and the plasma are avoided which leads to a considerably longer life time and less restrictions to the choice of filling than conventional discharge lamps. One special class of electrodeless lamps is that formed by the inductive fluorescent lamps. For some years commercial lamps of this type have been available: the QL-lamp of Philips since 1992 and the Genura of General Electric since 1994. Recently the third major lighting company Osram Sylvania announced the Endura. Within the Eindhoven University of Technology a 2D model is being developed which accurately describes the QL-lamp. The electron density and temperature are key-parameters in the description of the plasma. Moreover it appears that due to the relatively high gas temperature (550 to 800 K, depending on the filling pressure) and electron density the mercury ground state atoms are seriously depleted in the most active zone of the discharge

Effectiveness of Efavirenz-Based Regimens in Young HIV-Infected Children Treated for Tuberculosis: A Treatment Option for Resource-Limited Settings

Background: Antiretroviral treatment (ART) options for young children co-infected with HIV and tuberculosis are limited in resource-poor settings due to limited data on the use of efavirenz (EFV). Using available pharmacokinetic data, an EFV dosing schedule was developed for young co-infected children and implemented as the standard of care at Macha Hospital in Southern Province, Zambia. Treatment outcomes inchildren younger than 3 years of age or weighing less than 10 kg receiving either EFV-based ART plus anti-tuberculous treatment or nevirapine-based (NVP) ART were compared. Methods: Treatment outcomes were measured in a cohort of HIV-infected children seeking care at Macha Hospital in rural Zambia from 2007 to 2010. Informationon the diagnosis and treatment of tuberculosis was abstracted from medical records. Results: Forty-five children treated for tuberculosis initiated an EFV-based regimen and 69 children initiated a NVP-based regimen, 7 of whom also were treated for tuberculosis. Children receiving both regimens were comparable in age, but children receiving EFV started ART with a lower CD4+ T-cell percentage and weight-for-age z-score. Children receiving EFV experienced increases in both CD4+ T-cell percentage and weight-for-age z-score during follow-up, such that levels were comparable to children receiving NVP after two years of ART. Cumulative survival after 12 months of ART did not differ between groups (NVP:87%;EFV:80%;p = 0.25). Eleven children experienced virologic failure during follow-up.The adjusted hazard ratio of virologic failure comparing EFV to NVP was 0.25 (95% CI:0.05,1.24) and 0.13 (95% CI:0.03,0.62) using thresholds of 5000 and 400 copies/mL, respectively.Five children receiving EFV were reported to have had convulsions after ART initiation compared to only one child receiving NVP (p = 0.04). Conclusions: Despite poorer health at ART initiation, children treated for tuberculosis and receiving EFV-based regimens showed significant improvements comparable to children receiving NVP-based regimens. EFV-based regimens should be considered for young HIV-infected children co-infected with tuberculosis in resource-limited settings

Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: randomized controlled trial

BACKGROUNDThe interest in shared decision making has increased considerably over the last couple of decades. Decision aids (DAs) can help in shared decision making. Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIMTo investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis (OA).METHODSIn this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers. One-hundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016. After the first consultation, patients were randomly assigned by a computer to the control group which was treated according to standard care, or to the intervention group which was treated with standard care and provided with a DA. After the first consultation, patients were asked to complete questionnaires about decisional conflict (DCS), satisfaction, anxiety (PASS-20), gained knowledge, stage of decision making and preferred treatment. Follow-up was carried out after 26 wk and evaluated decisional conflict, satisfaction, anxiety, health outcomes (HOOS/KOOS), quality of life (EQ5D) and chosen treatment.RESULTSAfter the first consultation, patients in the intervention group (mean DCS: 25 out of 100, SD: 13) had significantly (P value: 0.00) less decisional conflict compared to patients in the control group (mean DCS: 39 out of 100, SD 11). The mean satisfaction score for the given information (7.6 out of 10, SD: 1.8 vs 8.6 out of 10, SD: 1.1) (P value: 0.00), mean satisfaction score with the physician (8.3 out of 10, SD: 1.7 vs 8.9 out of 10, SD: 0.9) (P value: 0.01) and the mean knowledge score (3.3 out of 4, SD: 0.9 vs 3.7 out of, SD: 0.6) (P value: 0.01) were all significantly higher in the intervention group. At 26-wk follow-up, only 75 of 131 patients (57%) were available for analysis. This sample is too small for meaningful analysis.CONCLUSIONProviding patients with an additional DA may have a positive effect on decisional conflict after the first consultation. Due to loss to follow-up we are unsure if this effect remains over time.Orthopaedics, Trauma Surgery and Rehabilitatio

Friction force on a vortex due to the scattering of superfluid excitations in helium II

The longitudinal friction acting on a vortex line in superfluid $^4$He is investigated within a simple model based on the analogy between such vortex dynamics and that of the quantal Brownian motion of a charged point particle in a uniform magnetic field. The scattering of superfluid quasiparticle excitations by the vortex stems from a translationally invariant interaction potential which, expanded to first order in the vortex velocity operator, gives rise to vortex transitions between nearest Landau levels. The corresponding friction coefficient is shown to be, in the limit of elastic scattering (vanishing cyclotron frequency), equivalent to that arising from the Iordanskii formula. Proposing a simple functional form for the scattering amplitude, with only one adjustable parameter whose value is set in order to get agreement to the Iordanskii result for phonons, an excellent agreement is also found with the values derived from experimental data up to temperatures about 1.5 K. Finite values of the cyclotron frequency arising from recent theories are shown to yield similar results. The incidence of vortex-induced quasiparticle transitions on the friction process is estimated to be, in the roton dominated regime, about 50 % of the value of the friction coefficient, $\sim$8 % of which corresponds to roton-phonon transitions and $\sim$42 % to roton $R^+\leftrightarrow R^-$ ones.Comment: 15 pages, 4 figures; typos corrected, to be published in PR

Non-adherence to antimicrobial guidelines in patients with bloodstream infection visiting the emergency department

_Objective:_ Non-adherence to antimicrobial guidelines in patients with bloodstream infection can result in undertreatment, overtreatment, or equivalent treatment, and could lead to suboptimal care. Our aim was to examine the association between non-adherence and appropriate coverage as well as to assess the impact of non-adherence on 30-day mortality. _Methods:_ We conducted a retrospective cohort study between 2012 and 2017 at a tertiary university hospital. Adult patients attending the emergency department with a bloodstream infection were included. Adherence was defined as guideline-recommended antibiotic therapy. Non-adherence was either undertreatment (too narrow-spectrum), overtreatment (too broad-spectrum), or equivalent treatment. Outcomes were appropriate coverage (i.e. antibiotic therapy that matches in vitro susceptibility of the isolated bacteria) and 30-day mortality. _Results:_ We included 909 patients of whom 395 (43.5%) were treated adherently, 355 (39.1%) were undertreated, 87 (9.6%) were overtreated, and 72 (7.9%) received an equivalent treatment. Overtreated patients were more severely ill, whilst undertreated patients had more favorable patient characteristics. Overtreatment did not result in higher appropriate coverage, whereas undertreatment was associated with lower coverage (OR[95%CI]: 0.18 [0.12; 0.26]). Overtreatment and undertreatment were not associated with 30-day mortality. _Conclusions:_ Guideline adherence likely depends on disease severity, because overtreatment was more often observed in patients with high disease severity and undertreatment in less severely ill patients. Undertreatment was associated lower appropriate coverage but not with higher mortality. However, this can be the result of residual confounding. Overtreatment did not result in higher appropriate antibiotic coverage nor a survival benefit. Therefore, overtreatment seems not justifiable

Untangling a Web of Lies: Exploring Automated Detection of Deception in Computer-Mediated Communication

Safeguarding organizations against opportunism and severe deception in computer-mediated communication (CMC) presents a major challenge to CIOs and IT managers. New insights into linguistic cues of deception derive from the speech acts innate to CMC. Applying automated text analysis to archival email exchanges in a CMC system as part of a reward program, we assess the ability of word use (micro-level), message development (macro-level), and intertextual exchange cues (meta-level) to detect severe deception by business partners. We empirically assess the predictive ability of our framework using an ordinal multilevel regression model. Results indicate that deceivers minimize the use of referencing and self-deprecation but include more superfluous descriptions and flattery. Deceitful channel partners also over structure their arguments and rapidly mimic the linguistic style of the account manager across dyadic e-mail exchanges. Thanks to its diagnostic value, the proposed framework can support firms’ decision-making and guide compliance monitoring system development

Appropriate empirical antibiotic therapy and mortality: Conflicting data explained by residual confounding

Objective Clinical practice universally assumes that appropriate empirical antibiotic therapy improves survival in patients with bloodstream infection. However, this is not generally supported by previous studies. We examined the association between appropriate therapy and 30-day mortality, while minimizing bias due to confounding by indication. Methods We conducted a retrospective cohort study between 2012 and 2017 at a tertiary university hospital in the Netherlands. Adult patients with bloodstream infection attending the emergency department were included. Based on in vitro susceptibility, antibiotic therapy was scored as appropriate or inappropriate. Primary outcome was 30-day mortality. To control for confounding, we performed conventional multivariable logistic regression and propensity score methods. Additionally, we performed an analysis in a more homogeneous subgroup (i.e. antibiotic monotherapy). Results We included 1.039 patients, 729 (70.2%) received appropriate therapy. Overall 30-day mortality was 10.4%. Appropriately treated patients had more unfavorable characteristics, indicating more severe illness. Despite adjustments, we found no association between appropriate therapy and mortality. For the antibiotic monotherapy subgroup (n = 449), patient characteristics were more homogeneous. Within this subgroup, appropriate therapy was associated with lower mortality (Odds Ratios [95% Confidence Intervals] ranging from: 0.31 [0.14; 0.67] to 0.40 [0.19; 0.85]). Conclusions Comparing heterogeneous treatment groups distorts associations despite use of common methods to prevent bias. Consequently, conclusions of such observational studies should be interpreted with care. If possible, future investigators should use our method of attempting to identify and analyze the most homogeneous treatment groups nested within their study objective, because this minimizes residual confounding

Early treatment versus expectative management of patent ductus arteriosus in preterm infants

_Background:_ Much controversy exists about the optimal management of a patent ductus arteriosus (PDA) in preterm infants, especially in those born at a gestational age (GA) less than 28weeks. No causal relationship has been proven between a (haemodynamically significant) PDA and neonatal complications related to pulmonary hyperperfusion and/or systemic hypoperfusion. Although studies show conflicting results, a common understanding is that medical or surgical treatment of a PDA does not seem to reduce the risk of major neonatal morbidities and mortality. As the PDA might have closed spontaneously, treated children are potentially exposed to iatrogenic adverse effects. A conservative approach is gaining interest worldwide, although convincing evidence to support its use is lacking. _Methods:_ This multicentre, randomised, non-inferiority trial is conducted in neonatal intensive care units. The study population consists of preterm infants (GA1.5mm. Early treatment (between 24 and 72h postnatal age) with the cyclooxygenase inhibitor(COXi) ibuprofen (IBU) is compared with an expectative management (no intervention intended to close a PDA). The primary outcome is the composite of mortality, and/or necrotising enterocolitis (NEC) Bell stage ≥ IIa, and/or bronchopulmonary dysplasia (BPD) defined as the need for supplemental oxygen, all at a postmenstrual age (PMA) of 36weeks. Secondary outcome parameters are short term sequelae of cardiovascular failure, comorbidity and adverse events assessed during hospitalization and long-term neurodevelopmental outcome assessed at a corrected age of 2 years. Consequences regarding health economics are evaluated by cost effectiveness analysis and budget impact analysis. _Discussion:_ As a conservative approach is gaining interest, we investigate whether in preterm infants, born at a GA less than 28weeks, with a PDA an expectative management is non-inferior to early treatment with IBU regarding to the composite outcome of mortality and/or NEC and/or BPD at a PMA of 36weeks

Surrogate-free machine learning-based organ dose reconstruction for pediatric abdominal radiotherapy

To study radiotherapy-related adverse effects, detailed dose information (3D distribution) is needed for accurate dose-effect modeling. For childhood cancer survivors who underwent radiotherapy in the pre-CT era, only 2D radiographs were acquired, thus 3D dose distributions must be reconstructed. State-of-the-art methods achieve this by using 3D surrogate anatomies. These can however lack personalization and lead to coarse reconstructions. We present and validate a surrogate-free dose reconstruction method based on Machine Learning (ML). Abdominal planning CTs (n=142) of recently-treated childhood cancer patients were gathered, their organs at risk were segmented, and 300 artificial Wilms' tumor plans were sampled automatically. Each artificial plan was automatically emulated on the 142 CTs, resulting in 42,600 3D dose distributions from which dose-volume metrics were derived. Anatomical features were extracted from digitally reconstructed radiographs simulated from the CTs to resemble historical radiographs. Further, patient and radiotherapy plan features typically available from historical treatment records were collected. An evolutionary ML algorithm was then used to link features to dose-volume metrics. Besides 5-fold cross validation, a further evaluation was done on an independent dataset of five CTs each associated with two clinical plans. Cross-validation resulted in mean absolute errors ≤0.6 Gy for organs completely inside or outside the field. For organs positioned at the edge of the field, mean absolute errors ≤1.7 Gy for Dmean, ≤2.9 Gy for D2cc, and ≤13% for V5Gy and V10Gy, were obtained, without systematic bias. Similar results were found for the independent dataset. To conclude, our novel organ dose reconstruction method is not only accurate, but also efficient, as the setup of a surrogate is no longer needed