NLIE for hole excited states in the sine-Gordon model with two boundaries

We derive a nonlinear integral equation (NLIE) for some bulk excited states of the sine-Gordon model on a finite interval with general integrable boundary interactions, including boundary terms proportional to the first time derivative of the field. We use this NLIE to compute numerically the dimensions of these states as a function of scale, and check the UV and IR limits analytically. We also find further support for the ground-state NLIE by comparison with boundary conformal perturbation theory (BCPT), boundary truncated conformal space approach (BTCSA) and the boundary analogue of the Luscher formula.Comment: 31 pages, LaTeX; graphicx, epstopdf, 4 figure

Knowledge and innovation as value drivers in professional services firms: an empirical research in Central and Eastern Europe

The purpose of this study was to investigate empirically the role of knowledge and innovation within Central and Eastern Europe’s changing economy. We applied qualitative research methods, and focused only on professional services firms within the region. The connection between knowledge and innovation as well as knowledge and competitiveness was analyzed by top managers and senior industry experts. Our findings revealed that knowledge might be a real value driver for professional services firms. These companies can significantly contribute to the development of modern economies through the dissemination of their internal best practices in knowledge management. We found three factors that might influence the effectiveness of knowledge management. These three factors are the involvement of international knowledge networks, the investments in human capital, and focus on critical resources. These issues proved to be essential to maximize the potential of knowledge and to leverage this into increased business performance. Keywords: Knowledge management, professional services, innovation, competitiveness, Central and Eastern Europ

Hygiene beim vaginalen Ultraschall - Risiko einer nosokomialen Infektion durch Verwendung von Schutzhüllen

Hintergrund: Beim vaginalen Ultraschall können Keime von einer Patientin auf die andere übertragen werden. Deswegen sind verschiedene Schutzmaßnahmen etabliert, um die Übertragung zu minimieren. Schutzhüllen, mit denen die Schallkopfe überzogen und damit geschützt werden, stellen dabei eine wichtige Barriere dar. Bisher wurde die Benutzung dieser Hüllen immer nur als zusätzliche Schutzmaßnahme, nicht aber als hygienisches Risiko gesehen. Fragestellung: Ziel der Arbeit war zu untersuchen, ob die Verwendung von Schutzhüllen bei Vaginalultraschall eine Rolle bei der nosokomialen Übertragung von Pathogenen spielen könnte. Methoden: 1. Um deren Rolle als potenzielle Kontaminationsquelle zu zeigen, wurden unterschiedliche Oberflächen des Ultraschallgerätes mittels Abklatsche untersucht. 2. Danach wurden drei Schritte beim Überziehen der Vaginalsonde experimentell untersucht. a. Das Risiko einer bakteriellen Kontamination von Überzügen im Spender wurde während Entfernen von Schutzhüllen (insgesamt 200 Schutzhüllen) aus zuvor ungeöffneten Spendern analysiert. Die Kontamination der Spender und von den im Spender verbliebenden Schutzhüllen wurden mit Abstrichentnahmen untersucht. b. Um Verunreinigungen der Schutzhüllen im Spender zu überwinden, können einzeln verpackte Überzüge verwendet werden. Deren Verpackung kann jedoch ebenfalls kontaminiert sein. Beim Öffnen der Verpackung und beim Aufrollen der Schutzhülle auf die Sonde könnte diese Kontamination auf die patientennahe Oberfläche der Schutzhülle gelingen. Um diese Hypothese zu untersuchen, wurden einzeln verpackte Sondenüberzüge mit Escherichia coli (ATCC 25922) kontaminiert. Nach dem Öffnen der kontaminierten Verpackung wurden die Schutzhüllen auf einen Metallstab aufgerollt, der die Vaginalsonde simulierte. Die Kontamination mit Körperflüssigkeiten wurde mit Magermilch im Vergleich mit Ringer-Lösung simuliert. c. Um den Einfluss der Händehygiene auf die bakterielle Kontamination der Abdeckungen aufzuzeigen, wurde das Überziehen der Schutzhülle auf die vaginale Ultraschallsonde mit und ohne Händedesinfektion und mit der Verwendung von pathogenfreien und sterilen Handschuhen simuliert. Ergebnisse: 1. Die Umfelduntersuchungen zeigten eine bakterielle Besiedlung mit Haut- und Umweltkeime am Ultraschallgerät. 2.a Beim Öffnen der Spender konnte keine bakterielle Kontamination festgestellt werden. Nach wenigen Tagen bzw. Entnahmen war bereits ein Wachstum von Hautkeimen in den Spendern und auf den restlichen Sondenhüllen nachweisbar. 2.b Eine Kontamination der patientennahen Oberfläche der Schutzhüllen wurde zu 100% in den Fällen mit und ohne Milchvorbehandlung beobachtet, wenn die Verpackung der Schutzhüllen mit einer hohen Bakterienkonzentration (5×108 koloniebildende Einheiten (KBE)/ml) inokuliert wurde. Der Anteil der kontaminierten Schutzhüllen und der Zahl der koloniebildenden Einheiten nahm mit der Verdünnung des Inokulums ab. Bei 5×106 KBE/ml betrug die Kontaminationsrate der Schutzhüllen 60% und 30% (mit und ohne Milchvorbehandlung). Aber auch bei geringeren Verdünnungen von bis zu nur 5 KBE/ml konnten in einigen Fällen Escherichia coli an den Schutzhüllen nachgewiesen werden. 2.c Nach dem Aufsetzen der Schutzhülle auf die Vaginalsonde ohne vorherige Händedesinfektion haben wir in allen Fällen (10/10, 100%) eine Kontamination mit Hautbakterien (Staphylococcus epidermidis, Staphylococcus capitis, Micrococcus luteus) festgestellt. Nach der hygienischen Händedesinfektion (ohne Handschuhe) konnte keine bakterielle Kontamination nachgewiesen werden. Die Sonden waren in 6 von 10 Fällen (60%) nach der Verwendung pathogenfreier Einweghandschuhe mit Bacillus spp. kontaminiert. Selbst bei der Verwendung steriler Handschuhe wurde in 1 von 10 Fällen eine mit Staphylococcus warneri festgestellt. Schlussfolgerungen: Wir konnten zeigen, dass die Lagerung der Schutzhüllen und die Händehygiene beim Aufrollen der Schutzhülle auf die vaginale Ultraschallsonde potenzielle Risikofaktoren für nosokomiale Übertragungen sein können. Bisher war die Händehygiene beim Überziehen von Schutzhüllen nicht thematisiert worden, da die von der Weltgesundheitsorganisation etablierten „5-Momente der Händehygiene“ eine solche Prozedur als Indikation nicht vorsehen. Aus diesen Daten ergibt sich folgendes Vorgehen: Schutzhüllen für vaginale Ultraschallsonden sollten einzeln verpackt sein. Sie sollten in Spender angeboten werden, die eine Kontamination der Hüllen bei der Entnahme unmöglich machen. Vor dem Aufziehen ist eine hygienische Händedesinfektion. Durch diese Maßnahmen ließe sich das Risiko der Übertragung weiter minimieren.   SUMMARY Title: Hygiene in vaginal ultrasound - risk of nosocomial infections by using protective covers Background: In vaginal ultrasound, germs can be transmitted from one patient to another. Therefore, various protective measures are established to minimize transmission. Protective probe covers create an important barrier. So far, the use of probe covers has been seen only as additional protective measures, but not as a hygienic risk. Objective: The aim of the study was to investigate whether the use of protective sheaths in vaginal ultrasound could play a role in the nosocomial transmission of pathogens. Methods: 1. In order to show their role as a potential source of contamination, different surfaces of the ultrasound equipment were examined by bacterial culture. 2. Thereafter, three steps of placing the cover onto the vaginal probe were experimentally examined. a. The risk of bacterial contamination of the covers in the dispenser was analyzed while removing the covers (n=200) from previously unopened dispensers. The contamination of the dispensers and the remaining covers were examined with bacterial smears. b. To overcome contamination of covers in a dispenser, individually packaged covers can be used. However, their foil packaging may be contaminated. When opening the packaging and placing the protective cover onto the probe, this contamination could be transferred on the patient-near surface of the cover. To test this hypothesis, individually sealed probe covers were contaminated with Escherichia coli (ATCC 25922). After opening the contaminated foil packaging, the protective covers were removed and placed on a metal rod that simulated the vaginal ultrasound probe. Contamination with body fluids was simulated with skimmed milk and was compared to with Ringer's solution. c. To demonstrate the influence of hand hygiene on the bacterial contamination of the covers, the coating of the protective cover on the vaginal ultrasound probe was simulated with and without hand disinfection and with the use of pathogen-free and sterile gloves. Results: 1. A bacterial colonization (skin and environmental bacteria) on the ultrasound equipment could be found. 2.a When opening the dispenser, no bacterial contamination could be detected. After removing the covers a growth of skin germs in the dispenser and on the remaining probe covers was detectable. 2.b Contamination of the patient-near surface of the covers was observed in 100% in the cases with and without milk pretreatment when inoculating the foil packaging’s of the covers with high bacterial load (5x108 colony forming units (CFU) / ml). The proportion of contaminated covers and contamination (CFU/cover) decreased with the dilution of the inoculum. At 5x106 CFU/ml, the cover contamination rate was 60% and 30% (with and without milk pretreatment). However, even at lower dilutions of up to only 5 CFU/ml, Escherichia coli could be detected on the protective covers in some cases. 2.c After placing the protective cover on the vaginal probe without previous hand disinfection, we have found in all cases (10/10, 100%) a contamination with skin bacteria (Staphylococcus epidermidis, Staphylococcus capitis, Micrococcus luteus). After hygienic hand disinfection (without gloves) no bacterial contamination was detected. The probes were contaminated in 6 out of 10 cases (60%) with Bacillus spp. by using pathogen-free disposable gloves. Even with the use of sterile gloves, contamination with Staphylococcus warneri was noted in 1 in 10 cases. Conclusions: We were able to show that storage of protective covers and hand hygiene while covering the vaginal ultrasound probe can be potential risk factors for contamination of the patient-side of the protective cover and thus for nosocomial transmission. So far, hand hygiene has not been addressed when covering vaginal ultrasound probes, as the "5-moments of hand hygiene", well established by the World Health Organization, do not provide for such a procedure as an indication. The following procedure results from these data: Protective covers for vaginal ultrasound probes should be individually packed. They should be offered in dispensers that make it impossible to contaminate the covers when they are removed. Before placing the cover onto the probe, a hygienic hand disinfection is necessary. These measures could further minimize the risk of transmission

Hydrops fetalis with isolated massive ascites in a preterm neonate with rhesus disease

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Exciton Delocalization Counteracts the Energy Gap: A New Pathway toward NIR-Emissive Dyes

Exciton coupling between the transition dipole moments of ordered dyes in supramolecular assemblies, so-called J/H-aggregates, leads to shifted electronic transitions. This can lower the excited state energy, allowing for emission well into the near-infrared regime. However, as we show here, it is not only the excited state energy modifications that J-aggregates can provide. A bay-alkylated quaterrylene was synthesized, which was found to form J-aggregates in 1,1,2,2-tetrachloroethane. A combination of superradiance and a decreased nonradiative relaxation rate made the J-aggregate four times more emissive than the monomeric counterpart. A reduced nonradiative relaxation rate is a nonintuitive consequence following the 180 nm (3300 cm-1) red-shift of the J-aggregate in comparison to the monomeric absorption. However, the energy gap law, which is commonly invoked to rationalize increased nonradiative relaxation rates with increasing emission wavelength, also contains a reorganization energy term. The reorganization energy is highly suppressed in J-aggregates due to exciton delocalization, and the framework of the energy gap law could therefore reproduce our experimental observations. J-Aggregates can thus circumvent the common belief that lowering the excited state energies results in large nonradiative relaxation rates and are thus a pathway toward highly emissive organic dyes in the NIR regime

Postpartum Assessment of the Correlation between Serum Hormone Levels of Estradiol, Progesterone, Prolactin and ß-HCG and Blood Pressure Measurements in Pre-Eclampsia Patients

Background: Preeclampsia is a pregnancy-related hypertensive disease. Aberrant hormone levels have been implicated in blood pressure disorders. This study investigated the association of postpartum maternal serum hormone levels of estradiol, progesterone, prolactin, and ß-HCG with poorer PE-related complications including arterial hypertension. Methods: Thirty patient women with preeclampsia, and twenty women with uncomplicated pregnancy were included in this study. Serum levels of estradiol, progesterone, prolactin, and ß-HCG were determined immediately after delivery, and on the first and third postpartum days by means of ECLIA. Results: Compared with normal pregnancy cases, preeclampsia cases had higher serum levels of ß-HCG levels on Day 0 (319%), of progesterone on Day-0 (207%) and Day-1 (178%), and of estradiol on Day-1 (187%) and Day-3 (185%). Increased prolactin levels were positively associated with disease severity and estradiol and progesterone levels were decreased in poorer preeclampsia features including disease onset and IUGR diagnosis. No significant correlation between different hormone levels and blood pressure measurements was reported. Conclusions: This study is the first that detected postpartum maternal serum hormone levels and their correlation with blood pressure measurements in preeclampsia. We believe that the persistent arterial hypertension in the puerperium in preeclampsia as well as poorer disease specifications are most likely not of hormonal origin. Larger, well-defined prospective studies are recommended

Urogynecology in obstetrics: impact of pregnancy and delivery on pelvic floor disorders, a prospective longitudinal observational pilot study

Purpose To assess changes in the pelvic floor anatomy that cause pelvic floor disorders (PFDs) in primigravidae during and after pregnancy and to evaluate their impact on women’s quality of life (QoL). Methods POP-Q and translabial ultrasound examination was performed in the third trimester and 3 months after delivery in a cohort of primigravidae with singleton pregnancy delivering in a tertiary center. Results were analyzed regarding mode of delivery and other pre- and peripartal factors. Two individualized detailed questionnaires were distributed at 3 months and at 12 months after childbirth to determinate QoL. Results We recruited 45 women, of whom 17 delivered vaginally (VD), 11 received a vacuum extraction delivery (VE) and 17 a Cesarean section in labor (CS). When comparing third-trimester sonography to 3 months after delivery, bladder neck mobility increased significantly in each delivery group and hiatal area increased significantly in the VD group. A LAM avulsion was found in two women after VE. Connective tissue weakness (p = 0.0483) and fetal weight at birth (p = 0.0384) were identified as significant risk factors for the occurrence of PFDs in a multivariant regression analysis. Urinary incontinence was most common with 15% and 11% of cases at 3, respectively, 12 months after delivery. 42% of women reported discomfort during sexual intercourse, 3 months after delivery and 24% 12 months postpartum. Although 93% of women engage a midwife after delivery, only 56% participated in pelvic floor muscle training. Conclusion Connective tissue weakness and high fetal weight at birth are important risk factors for the occurrence of PFDs. Nevertheless, more parturients should participate in postpartal care services to prevent future PFDs

Students' attitudes toward digital learning during the COVID-19 pandemic: a survey conducted following an online course in gynecology and obstetrics

Purpose The purpose of this survey was to assess medical students’ opinions about online learning programs and their preferences for specific teaching formats during COVID 19 pandemic. Methods Between May and July 2020, medical students who took an online gynecology and obstetrics course were asked to fill in a questionnaire anonymously. The questionnaire solicited their opinions about the course, the teaching formats used (online lectures, video tutorials featuring real patient scenarios, and online practical skills training), and digital learning in general. Results Of 103 students, 98 (95%) submitted questionnaires that were included in the analysis. 84 (86%) students had no problem with the online course and 70 (72%) desired more online teaching in the future. 37 (38%) respondents preferred online to traditional lectures. 72 (74%) students missed learning with real patients. All digital teaching formats received good and excellent ratings from > 80% of the students. Conclusion The survey results show medical students’ broad acceptance of the online course during COVID 19 pandemic and indicates that digital learning options can partially replace conventional face-to-face teaching. For content taught by lecture, online teaching might be an alternative or complement to traditional education. However, bedside-teaching remains a key pillar of medical education

Accurate measurement of long range proton-carbon scalar coupling constants

The accuracy and ease-of-use of various experimental NMR methods for measuringnJCHvalues is assessed.</p

Cytology-based Cancer Surgery of the Head and Neck (CyCaS-HN): a prospective, randomized, controlled clinical trial

Purpose Liquid-based cytology (LBC) is routinely used in gynecology but is rarely applied in head and neck oncology though many suspicious lesions are easily accessible. While several studies have evaluated the potential use of LBC for early detection and molecular characterization of head and neck squamous cell carcinomas (HNSCCs), no study investigated its potential role in surgical management and therapy planning so far. Methods Twenty-fve patients with cT1-2 squamous cell carcinomas of the oral cavity and oropharynx were prospectively enrolled in this study and were randomized to two treatment arms: in the control arm, a diagnostic panendoscopy with incisional biopsy was followed by a second operation with transoral tumor resection±neck dissection and tracheostomy. In the intervention arm, patients underwent LBC diagnostics and in case of a positive result received one single operation with panendoscopy and incisional biopsy for confrmation of LBC result by rapid section histology followed by transoral tumor resection±neck dissection and tracheostomy in the same session. Results Time between clinical diagnosis and defnitive surgical treatment was signifcantly shorter in the intervention group compared with the control group (p<0.0001). Additionally, time of hospitalization (p<0.0001) and cumulative operation time (p=0.062) were shorter in the intervention group. No signifcant diferences in overall, progression-free, and diseasespecifc survival were observed. Conclusion Cytology-based cancer surgery is a promising therapeutic strategy that can potentially be considered for a well-defned group of early-stage HNSCC patients and help to avoid repetitive general anesthesia, shorten the diagnosis-totreatment interval and spare operation as well as hospitalization time