Evaluation of automated tool for two-dimensional fetal biometry.

OBJECTIVE: To evaluate whether an automated tool can recognize a structure of interest and measure fetal head circumference (HC), abdominal circumference (AC) and femur length (FL) on frozen two-dimensional ultrasound images. METHODS: Ultrasound examinations were performed in 100 singleton pregnancies between 20 and 40 weeks of gestation, ensuring an even distribution throughout gestational age. In each pregnancy, three standard biometric variables (HC, AC, FL) were measured each in three different images obtained for this purpose (i.e. nine independent image acquisitions). An algorithm (Philips Research) was used to detect the structure of interest and automatically place calipers for measurement. Caliper placement was assessed in two ways. First, subjective clinical assessment was performed to determine whether the caliper placement was correct, and caliper position was classified as 'acceptable for clinical use', 'minor adjustment required' or 'major adjustment required'. Second, the resulting automatic measurements were compared with manual measurements, taken in real time. Mean difference errors were calculated and expressed as percentages to correct for fetal growth with advancing gestation. RESULTS: After exclusion of one pregnancy due to missing images, a total of 891 images (297 for each biometric variable) from 99 pregnancies were analyzed. The algorithm failed to place calipers for the AC in nine images, whereas there were no failures in caliper placement for measurement of HC and FL. On subjective quality assessment of automatic caliper placement, in 475 (53.3%) images position of the calipers was judged to be clinically acceptable and did not require any adjustment, while in 317 (35.6%) and 90 images (10.1%) minor and major adjustments were required, respectively. The mean error between manual and automatic measurement of HC was -0.21 cm corresponding to a percentage error of -0.81% with 95% limits of agreement (LOA) between -3.73% and 2.12%. For AC and FL measurements, the mean error was, respectively, 0.72 cm (percentage error, 2.40%) with LOA between -9.48% and 14.27%, and 0.21 cm (percentage error, 3.76%) with LOA between -8.38% and 15.91%. CONCLUSIONS: The automated tool identified correctly the biometric variable of interest in 99% of frozen images. The resulting measurements had a high degree of accuracy and compared well with previously published manual-to-manual agreement. The measurements exhibited bias, with the automated tool underestimating biometry; this could be overcome by further improvements in the algorithm. Nevertheless, adjustable calipers for manual correction remains a requirement. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Rydberg Molecules for Ion-Atom Scattering in the Ultracold Regime.

We propose a novel experimental method to extend the investigation of ion-atom collisions from the so far studied cold, essentially classical regime to the ultracold, quantum regime. The key aspect of this method is the use of Rydberg molecules to initialize the ultracold ion-atom scattering event. We exemplify the proposed method with the lithium ion-atom system, for which we present simulations of how the initial Rydberg molecule wave function, freed by photoionization, evolves in the presence of the ion-atom scattering potential. We predict bounds for the ion-atom scattering length from ab initio calculations of the interaction potential. We demonstrate that, in the predicted bounds, the scattering length can be experimentally determined from the velocity of the scattered wave packet in the case of ^{6}Li^{+}-^{6}Li and from the molecular ion fraction in the case of ^{7}Li^{+}-^{7}Li. The proposed method to utilize Rydberg molecules for ultracold ion-atom scattering, here particularized for the lithium ion-atom system, is readily applicable to other ion-atom systems as well.

Observation of Rydberg Blockade Induced by a Single Ion.

We study the long-range interaction of a single ion with a highly excited ultracold Rydberg atom and report on the direct observation of an ion-induced Rydberg excitation blockade mediated over tens of micrometer distances. Our hybrid ion-atom system is directly produced from an ultracold atomic ensemble via near-threshold photoionization of a single Rydberg excitation, employing a two-photon scheme that is specifically suited for generating a very low-energy ion. The ion's motion is precisely controlled by small electric fields, which allows us to analyze the blockade mechanism for a range of principal quantum numbers. Finally, we explore the capability of the ion as a high-sensitivity, single-atom-based electric field sensor. The observed ion-Rydberg-atom interaction is of current interest for entanglement generation or studies of ultracold chemistry in hybrid ion-atom systems.

[Patient-centredness and Quality of Care in Germany in International Comparison - Results of a Telephone Survey of Patients in 11 Countries]. / Patientenzentrierung und Qualität der Versorgung in Deutschland im internationalen Vergleich - Ergebnisse eines Telefon-Surveys von Patienten in 11 Ländern.

OBJECTIVES: The study was conducted to compare the results of the perceived quality of care in 11 industrialised countries from a patient perspective. This paper reports the German results and puts them in an international perspective. METHODS: In a nationwide poll a random sample of high utilising patients was surveyed between March and June 2011. 59,984 random phone numbers were generated for this purpose. Topics were access and coordination of care, patient safety and patient-centredness. RESULTS were weighted according to age, sex, education, place of birth of parents, income and size of dwelling place and further sociodemographic variables. RESULTS: 1,200 patients of 2,048 contacted patients fulfilled the enrollment criteria. Approximately one third felt that overall the health-care system works well while 22% said that the system needs to be completely rebuild. Regarding access to care 22% reported financial barriers while 59% reported to be able to get an appointment the same or next day to see a doctor. With respect to patient safety patients reported increased numbers of nosocomial infections compared to 2005. Patient satisfaction with general practitioners (GPs) is exceptionally high in -Germany. CONCLUSION: Compared to 10 other industrialised nations the picture is heterogeneous. In some areas Germany ranks among the top (satisfaction with GPs) while approximately every fifth surveyed patient feels the system needs to be rebuilt completely. It remains a matter of debate whether this rating regarding the reform needs of the system applies to the financing and structures of the system or the quality of care.

[Inpatient Preventative and Rehabilitative Treatment for Informal Caregivers - An Explorative Investigation of Specific Offers in Germany]. / Stationäre Rehabilitation und Vorsorge für pflegende Angehörige - eine Sondierung der Angebote in Deutschland.

INTRODUCTION: In line with a new law in 2012 (Pflege-Neuausrichtungs-Gesetz) a special regard to informal care givers in inpatient rehabilitation and prevention facilities was established. Thus possibilities were created to facilitate care for people requiring nursing within the rehabilitation hospital while the informal caregiver is treated. On behalf of the German Ministry of Health the BQS Institute of Quality and Patient Safety analysed what specific offers for this target group are available in the rehabilitation setting and to what extent the requirements of the new law are already implemented. METHODS: To identify those specific offers for informal caregivers, a nationwide e-mail survey was conducted in 1,167 rehabilitation hospitals in Germany which was complemented with an internet research. Additionally semi-standardised interviews with 28 experts in different specialty fields as well as a literature research were conducted. RESULTS: 31 rehabilitation hospitals were identified, which provide specific measures for informal caregivers and 53 hospitals which provide care for the dependent person, too (overlaps are possible). By providing those offers, the providers are in unchartered waters in regard to concepts. Usually providers are relating to already existing measures in their indication areas and extend those through specific measures. To date, a targeted allocation of informal caregivers to appropriate facilities is not established.

The use of social network analysis to describe the effect of immune activation on group dynamics in pigs.

The immune system can influence social motivation with potentially dire consequences for group-housed production animals, such as pigs. The aim of this study was to test the effect of a controlled immune activation in group-housed pigs, through an injection with lipopolysaccharide (LPS) and an intervention with ketoprofen on centrality parameters at the individual level. In addition, we wanted to test the effect of time relative to the injection on general network parameters in order to get a better understanding of changes in social network structures at the group level. 52 female pigs (11-12 weeks) were allocated to four treatments, comprising two injections: ketoprofen-LPS (KL), ketoprofen-saline (KS), saline-LPS (SL) and saline-saline (SS). Social behaviour with a focus on damaging behaviour was observed continuously in 10 × 15 min bouts between 0800 am and 1700 pm 1 day before (baseline) and two subsequent days after injection. Activity was scan-sampled every 5 min for 6 h after the last injection in the pen. Saliva samples were taken for cortisol analysis at baseline and at 4, 24, 48, 72 h after the injections. A controlled immune activation affected centrality parameters for ear manipulation networks at the individual level. Lipopolysaccharide-injected pigs had a lower in-degree centrality, thus, received less interactions, 2 days after the challenge. Treatment effects on tail manipulation and fighting networks were not observed at the individual level. For networks of manipulation of other body parts, in-degree centrality was positively correlated with cortisol response at 4 h and lying behaviour in the first 6 h after the challenge in LPS-injected pigs. Thus, the stronger the pigs reacted to the LPS, the more interactions they received in the subsequent days. The time in relation to injection affected general network parameters for ear manipulation and fighting networks at the group level. For ear manipulation networks, in-degree centralisation was higher on the days following injection, thus, certain individuals in the pen received more interactions than the rest of the group compared to baseline. For fighting networks, betweenness decreased on the first day after injection compared to baseline, indicating that network connectivity increased after the challenge. Networks of tail manipulation and manipulation of other body parts did not change on the days after injection at the group level. Social network analysis is a method that can potentially provide important insights into the effects of sickness on social behaviour in group-housed pigs.

'Tailception': using neural networks for assessing tail lesions on pictures of pig carcasses.

Tail lesions caused by tail biting are a widespread welfare issue in pig husbandry. Determining their prevalence currently involves labour intensive, subjective scoring methods. Increased societal interest in tail lesions requires fast, reliable and cheap systems for assessing tail status. In the present study, we aimed to test the reliability of neural networks for assessing tail pictures from carcasses against trained human observers. Three trained observers scored tail lesions from automatically recorded pictures of 13 124 pigs. Nearly all pigs had been tail docked. Tail lesions were classified using a 4-point score (0=no lesion, to 3=severe lesion). In addition, total tail loss was recorded. Agreement between observers was tested prior and during the assessment in a total of seven inter-observer tests with 80 pictures each. We calculated agreement between observer pairs as exact agreement (%) and prevalence-adjusted bias-adjusted κ (PABAK; value 1=optimal agreement). Out of the 13 124 scored pictures, we used 80% for training and 20% for validating our neural networks. As the position of the tail in the pictures varied (high, low, left, right), we first trained a part detection network to find the tail in the picture and select a rectangular part of the picture which includes the tail. We then trained a classification network to categorise tail lesion severity using pictures scored by human observers whereby the classification network only analysed the selected picture parts. Median exact agreement between the three observers was 80% for tail lesions and 94% for tail loss. Median PABAK for tail lesions and loss were 0.75 and 0.87, respectively. The agreement between classification by the neural network and human observers was 74% for tail lesions and 95% for tail loss. In other words, the agreement between the networks and human observers were very similar to the agreement between human observers. The main reason for disagreement between observers and thereby higher variation in network training material were picture quality issues. Therefore, we expect even better results for neural network application to tail lesions if training is based on high quality pictures. Very reliable and repeatable tail lesion assessment from pictures would allow automated tail classification of all pigs slaughtered, which is something that some animal welfare labels would like to do.

Distribution of chicken-II gonadotropin-releasing hormone in mammalian brain.

Brains of nonmammalian vertebrates typically contain multiple forms of gonadotropin-releasing hormone (GnRH). Until recently, only the mammalian form of GnRH (mGnRH) had been isolated in placental mammals. Biochemical and histological data show that both mGnRH and chicken-II GnRH (cGnRH-II) are present in a primitive placental mammal, the musk shrew (Suncus murinus). Similar to the case in nonmammalian species, in the musk shrew, neurons that express cGnRH-II are located in a discrete cluster in the midbrain. We have used a combination of radioimmunoassay and immunocytochemistry, analyzed at the light level and with electron microscopy, to describe the distribution of cGnRH-II cell bodies and fibers in the musk shrew brain. All cGnRH-II-immunoreactive (ir) neurons reside in the midbrain, and this area contains the greatest concentration of cGnRH-II peptide in the brain. At the light and electron micrographic levels, we have identified synaptic terminals containing dense core vesicles that are immunoreactive for cGnRH-II in the medial habenula. Radioimmunoassay reveals that this region contains the second greatest concentration of cGnRH-II in the brain. Widely scattered cGnRH-II-ir fibers are present throughout the forebrain, particularly in the medial septum, hypothalamus, and midbrain central gray. Scant cGnRH-II fibers are present in the median eminence, arcuate nucleus, and infundibular stem, and only low concentrations of the peptide are detected in these areas. Finally, intravenous administration of mGnRH is ten times more effective than cGnRH-II in promoting ovulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Comment on internal feedback as a theory of judgment: a reply to Levin.

Levin's suggestion that internal feedback strategies be employed in judgmental and learning tasks is discussed. The predictions of an internal feedback notion are seen as inconsistent with Veit's ratio and difference task data. Scale-free frameworks and scale-convergence criteria used in previous research are described as useful techniques for separating integration from judgmental processes in information-integration as well as learning-task situations.

Sonographic evolution of cornual pregnancies treated without surgery.

Transvaginal sonography allows early and accurate diagnosis of cornual pregnancy, as well as providing a means for puncture injection treatment of certain ectopic pregnancies. We describe four cases of cornual pregnancy managed nonsurgically and followed with transvaginal sonography for 47-64 weeks. Sonographic evidence of cornual pregnancy persisted throughout the period of follow-up, despite resumption of normal menstrual cyclicity. We conclude that some early live cornual pregnancies can be managed by puncture injection, and cornual pregnancies in which the embryo has died can be followed conservatively.

Motivating mammography adherence in elderly Latinas: a test of three mathematical models of decision making.

Many elderly Latinas do not have mammography every one to two years as recommended by cancer organizations. To elucidate the causal factors underlying this behavior, 52 Latinas, aged 65 and over, were asked to judge the likelihood of having yearly mammography in 79 different scenarios constructed from factor levels of cost, perceived risk, and the source of a recommendation (none, a recognized cancer organization, a doctor), assuming a convenient mammography facility. A configural-weight-averaging model, with different parameter values for the 30 adherers (women who reported having had mammography at least twice in the preceding four years) and the 22 non-adherers, gave a good fit to the data and did well in predicting reported mammography adherence (r = 0.85). According to this model, offering free mammography would not induce non-adherers to adhere; they would require a recommendation, and value a doctor's as highly as that of a recognized cancer organization, but reported never having received one from either source. All 52 women reported never receiving risk information from any source. These results have direct educational and dissemination implications for cancer organizations.

Circadian rhythm in mammary cytoplasmic estrogen receptor content of Balb/C female mice with and without pituitary isografts.

Cytoplasmic estrogen receptors were determined by the dextran-coated charcoal method in inguinal breast tissue of three groups of Balb/C female mice 6-8 weeks following subcutaneous implantation into the intact animals of three pituitary glands and three pieces of skeletal muscle (group I), three pituitary glands and three segments of hypothalamic tissue (group II), or three pieces of skeletal muscle (group III) obtained from animals of the same inbred strain as control. A circadian rhythm in estrogen receptor content was statistically quantified by cosinor analysis in the muscle implanted control and the pituitary and hypothalamic implant groups. In the pituitary and muscle implant group the circadian rhythm is of borderline significance with a P-value between 0.05 and 0.10. The timing (acrophase) and extent of change (amplitude) are similar in all three treatment groups. The average receptor content (MESOR) in the two pituitary-implanted groups, which in previous studies were shown to have an increased breast cancer incidence is about twice that of the control group. The reduction in the pituitary induced breast cancer rate by hypothalamic tissue addition to a cancer incidence between the animals with pituitary and muscle isograft and the mice carrying no pituitary at all has also been shown previously in this strain of mice and is not reflected in receptor content.

Concentration of chicken gonadotropin-releasing hormones I and II in microdissected areas of turkey hen brain during the reproductive cycle.

Chicken gonadotropin-releasing hormones I and II (cGnRH I and II) were measured by radioimmunoassay (RIA) in extracts of microdissected regions of turkey hen brain (preoptic area [POA], region of periventricular nuclei [PHN], septum [SEP], hippocampus [HP], dorsomedial thalamus/habenula [DMT], midbrain central gray [MCG], and caudal lateral hypothalamus [LH]) at five stages of the reproductive cycle: before photostimulation, during egg laying, during incubation, during photorefractoriness, and after return to short daylengths. The highest concentration of cGnRH I occurred in PHN, followed by POA, SEP, DMT, HP, LH, and MCG, in decreasing order, whereas the highest concentration of cGnRH II occurred in SEP, followed by POA, DMT, HP, MCG, PHN, LH. These results agree, with some exceptions, with the distribution of fibers and cells as determined by immunohistochemistry. cGnRH II was from 1.3 to 24 times as abundant as cGnRH I in different brain areas. During incubation, cGnRH I concentrations were significantly elevated in the POA and cGnRH II levels were significantly elevated in HP; few other significant differences were detected. Correlation analysis detected occasional significant positive and negative correlations between cGnRH I and II concentrations in forebrain areas and MCG of laying birds and in PHN and LH of incubating birds. These results demonstrate an approximate correspondence between hormone concentrations measured in tissue extracts by RIA and immunohistochemistry and indicate an abundance of cGnRH II as compared with cGnRH I. cGnRH I and II concentrations did not, however, change in parallel in all brain areas, suggesting that these peptides do not function in an exactly parallel fashion. Thus, an extent to which cGnRH II is involved in gonadotropin release remains unresolved.

Reproductive performance of chimeric mice produced from genetic lines that differ in litter size.

A population of chimeras was made by aggregating 8- and 16-cell embryos from two mouse strains: a randomly bred line (C) and a selected line characterized by large litters (JU), with litter sizes of 7.7 and 13.5, respectively. The two genotypes were developmentally "balanced", as judged by the high frequency (90%) of chimeras with an intermediate or high degree of coat-color chimerism, a chimeric sex ratio of 2.2:1 males:females, and a high percentage of chimeras (31% of males, 71% of females) with germ cells of both strains. Litter size characteristics, including ovulation rate, implantation rate, rates of pre- and postimplantation embryo survival and number born were studied in the female chimeras and compared with the performance of both parent lines and to the genetic cross of the two lines. Values for JU females exceeded those for C females for all parameters studied except postimplantation embryo survival, which was the same for both lines in second litters and was lower for JU's third litters. For most traits, means for genetic crossbreds and chimeras were similar, regardless of whether the means were at or above the midparent average. In contrast, for ovulation rate and body weight, genetic crossbreds and chimeras clearly differed, with chimeric females being similar to the JU line and genetic crossbred females exhibiting additive inheritance. Because of phenotypic differences between experimental chimeras and crossbreds produced from the same two lines, chimeras may provide a useful model for studying the physiologic basis for expression of genetic differences in quantitative traits.

[Aspects of external quality assurance in anesthesiology--experiences in Hamburg]. / Aspekte der externen Qualitätssicherung in der Anästhesiologie--Erfahrungen aus Hamburg.

In 1994, external quality assurance in anaesthesia according to the German Society of Anaesthesiology and Intensive Care (DGAI) was obligatory introduced in Hamburg. Since 1992 in a pilot project and since 1994 compulsory nearly 500,000 anaesthesias were documented by 39 institutions with a standard data set issued by the DGAI and transferred to the project office of the Association for Quality Assurance (EQS) Hamburg. Comparative statistics of these data were produced at the project office. In the controlling committee and in meetings of the project participants the contents, policy and results of the project were critically analyzed and adjustments initiated whenever necessary. With an incidence of 14.1% of all anaesthesias with special occurrences (AVB), the results are in the same range compared to most other studies. To evaluate the concept of documentation the predictory power of single and combined risk assessments for the incidence of particular AVBs in elective anaesthesias were compared to the predictory power of ASA-Classification in order to reduce the parameters that had to be collected. This should lead to a positive influence on the quality of documentation. Besides one exception, no superior prediction power for AVB incidence could be demonstrated for any special risk assessment as compared with the ASA-classification. This is also true for the AVBs which are associated with high lethality. Thus, the documentation of risk factors in the core data set as predictors can be abandoned without major loss of information. The participants consider the project to be a useful support for internal improvement projects. Besides the reduction of the amount of data in quality assurance to get a core of particularly meaningful parameters the classification of the surgical procedure by the ICPM- or OPS 301-Code should be integrated into the core data set of the DGAI. It would lead to an increase in acceptance of the method and thus to an increase in the validity of its results and valuations.

Combining low-energy electron microscopy and scanning probe microscopy techniques for surface science: development of a novel sample-holder.

We introduce an experimental facility dedicated to surface science that combines Low-Energy Electron Microscopy/Photo-Electron Emission Microscopy (LEEM/PEEM) and variable-temperature Scanning Probe Microscopy techniques. A technical challenge has been to design a sample-holder that allows to exploit the complementary specifications of both microscopes and to preserve their optimal functionality. Experimental demonstration is reported by characterizing under ultrahigh vacuum with both techniques: Au(111) surface reconstruction and a two-layer thick graphene on 6H-SiC(0001). A set of macros to analyze LEEM/PEEM data extends the capabilities of the setup.

Unattended fatal haemorrhage due to spontaneous peripheral varicose vein rupture--two case reports.

Venous haemorrhage is a rare complication of varicose veins of the legs. Varicosis is found in 15-50% of the population. Haemorrhage from ruptured varicose veins of the legs can occur spontaneously or after a minor trauma. More frequent complications of varicosis include peripheral oedema of the ankles, skin pigmentation and skin ulcers. In case of venous haemorrhage simple possibilities of first aid can be applied, therefore fatal haemorrhage is a rarity. Two cases of fatal varicose vein rupture are presented. A 58-year-old man and a 76-year-old woman, both living alone, were found dead in the bathrooms of their apartments. Significant traces of blood were found in all rooms. Both corpses showed typical signs of death from exsanguination. No traumatic lesion was found. Cause of the haemorrhage was a small lesion of the skin of the lower legs of the victims with continuation to an underlying superficial varicose vein. Misinterpretation of life-threatening varicose haemorrhage, unconsciousnous, alcohol or drug influence, old age and dementia can promote the death. In case of fatal haemorrhage the death scene can simulate crime due to massive traces of blood and may focus primarily on a non-natural death. However, police investigations and autopsy will disclose the rare cause of spontaneous natural death.