Expert decision support system for aeroacoustic source type identification using clustering.

This paper presents an Expert Decision Support System for the identification of time-invariant, aeroacoustic source types. The system comprises two steps: first, acoustic properties are calculated based on spectral and spatial information. Second, clustering is performed based on these properties. The clustering aims at helping and guiding an expert for quick identification of different source types, providing an understanding of how sources differ. This supports the expert in determining similar or atypical behavior. A variety of features are proposed for capturing the characteristics of the sources. These features represent aeroacoustic properties that can be interpreted by both the machine and by experts. The features are independent of the absolute Mach number, which enables the proposed method to cluster data measured at different flow configurations. The method is evaluated on deconvolved beamforming data from two scaled airframe half-model measurements. For this exemplary data, the proposed support system method results in clusters that mostly correspond to the source types identified by the authors. The clustering also provides the mean feature values and the cluster hierarchy for each cluster, and for each cluster member, a clustering confidence. This additional information makes the results transparent and allows the expert to understand the clustering choices.

Automatic source localization and spectra generation from sparse beamforming maps.

Beamforming is an imaging tool for the investigation of aeroacoustic phenomena and results in high-dimensional data that are broken down to spectra by integrating spatial regions of interest. This paper presents two methods that enable the automated identification of aeroacoustic sources in sparse beamforming maps and the extraction of their corresponding spectra to overcome the manual definition of regions of interest. The methods are evaluated on two scaled airframe half-model wind tunnel measurements and on a generic monopole source. The first relies on the spatial normal distribution of aeroacoustic broadband sources in sparse beamforming maps. The second uses hierarchical clustering methods. Both methods are robust to statistical noise and predict the existence, location, and spatial probability estimation for sources based on which regions of interest are automatically determined.

The impact of age on psoriasis health care in Germany.

INTRODUCTION: Inequality between age groups has been demonstrated in the prescription of biologics, yet systematic real-world data about age-related differences in psoriasis care are missing. OBJECTIVE: To investigate disparities in psoriasis characteristics by age groups and to identify potential impact on psoriasis health care. PATIENTS AND METHODS: Data analysis included 3615 patients from the German psoriasis registry PsoBest, which observes adult patients with moderate-to-severe psoriasis or psoriatic arthritis (PsA) on systemic treatment over a time period of 10 years. RESULTS: With 2376 participants (65.7%), the majority of patients was assigned to the age group 35-64, followed by 776 (21.4%) and 463 (12.8%) for the age groups 18-34 and 65+, respectively. Psoriasis vulgaris was the most frequent form of psoriasis with nearly 90% patients affected. Appearance of psoriasis forms did not differentiate significantly between the age groups except for erythrodermic psoriasis, which was more frequent in the elderly than in patients aged 35-64 (1.9%, P ≤ 0.048). Nail psoriasis appeared significantly more often in patients aged 35-64 (55.5%, P ≤ 0.001) and also showed the highest number of nails involved (6.9 ± 3.3). PsA was less frequent in the age group 18-34 (9.5%, P ≤ 0.001). This group showed the highest rate of scalp psoriasis (85.8%) compared to the elder age groups (P ≤ 0.001). Biologicals were used significantly less in younger patients (16.2%) compared to the age groups 35-64 (23.9%, P ≤ 0.001) and 65+ (21.8%, P ≤ 0.042). CONCLUSION: Middle-aged patients show higher rates of PsA and nail psoriasis, which may explain age-dependent disparities in health care including the use of systemic treatment.

Psoriasis registries worldwide: systematic overview on registry publications.

BACKGROUND: Safety and efficacy of new treatments are analyzed in clinical trials but their capacity to show potential effects of long-term treatment and more than short latency of onset is limited. To meet this challenge, patient registries (of treatments or diseases) collect prospective data of real-world patients in daily practice without tight selection of patients. OBJECTIVE: The aim of this article was to identify existing psoriasis patient registries by published articles and evaluation of monitored treatment classes, patients, research questions addressed, and measurement instruments implemented. MATERIALS & METHODS: A systematic review of Medline (PubMed) and Embase (Ovid) databases for publications on psoriasis patient registries, including cross-validation was conducted October 2015. RESULTS: 14 patient registries for long-term observation of psoriasis patients in real-world care were identified. Registries were established since 2005, the majority is located in Europe. The number of published studies from single registries ranged from 1 to 10. Most registries include patients treated by conventional systemics as well as biologics. The number of patients analyzed ranged from 35 to >12 000 patients. The publications mostly addressed safety issues or treatment outcomes, followed by baseline description, drug survival, predictor analyses, and treatment patterns. CONCLUSION: A variety of local, national, and international patient registries collect longitudinal data on (systemic) psoriasis treatment. The number of publications reflect the main registry objectives of safety and effectiveness, with additional therapy-related investigations being addressed as well. Based on the information from publications, the combination of data from these registries will involve many methodological challenges. To gain comparability and combinability of cohorts and data across registries, further harmonization of data collection is demanded.

Observation of Gravitationally Induced Vertical Striation of Polarized Ultracold Neutrons by Spin-Echo Spectroscopy.

We describe a spin-echo method for ultracold neutrons (UCNs) confined in a precession chamber and exposed to a |B0|=1 µT magnetic field. We have demonstrated that the analysis of UCN spin-echo resonance signals in combination with knowledge of the ambient magnetic field provides an excellent method by which to reconstruct the energy spectrum of a confined ensemble of neutrons. The method takes advantage of the relative dephasing of spins arising from a gravitationally induced striation of stored UCNs of different energies, and also permits an improved determination of the vertical magnetic-field gradient with an exceptional accuracy of 1.1 pT/cm. This novel combination of a well-known nuclear resonance method and gravitationally induced vertical striation is unique in the realm of nuclear and particle physics and should prove to be invaluable for the assessment of systematic effects in precision experiments such as searches for an electric dipole moment of the neutron or the measurement of the neutron lifetime.

Drug safety of systemic treatments for psoriasis: results from The German Psoriasis Registry PsoBest.

The German Psoriasis Registry PsoBest was conducted in 2008 in order to investigate the long-term outcomes and safety of systemic treatments for moderate-to-severe psoriasis. Safety analysis of antipsoriatic drugs with special focus on serious adverse events (SAE) for infections, malignancies and major cardiac events (MACE) was done. Nationwide non-interventional patient treatment registry conducted in 251 active dermatology centers. Until June 2012, n = 2444 patients [40 % female; mean age 47.3 (SD 14.1) years; mean duration of disease 18.2 (SD 14.7) years] were recruited, including n = 1791 patients (3842 patient years) with conventional systemic drugs and n = 908 (3442 patient years) with biological drugs. Mean PASI (Psoriasis Area and Severity Index) at inclusion was 14.7, mean DLQI (Dermatology Life Quality Index) 11.1, mean BMI (Body Mass Index) 28.2. The overall rate of SAE per 100 patient years were 1.3 (SD 0.9) per 100 patient years in conventional systemic and 1.5 (SD 1.2) in biologics (p > 0.5, no significant difference). The rates per 100 patient years for single severe adverse events were as follows (systemic/biologics): serious infections, 0.33/0.65 [CI (confidence interval) 0.13-0.54/0.35-0.98]; MACE, 0.56/0.77 (CI 0.29-0.97/0.41-1.31); malignancies (except non-melanoma skin cancer), 0.46/0.49 (CI 0.22-0.84/0.21-0.97). There were no significant differences between single drugs in any of the safety parameters. The conventional systemic and biologic drugs for psoriasis show satisfying safety under routine psoriasis care in Germany with respect to infections, MACE and malignancies.

Treatment goals in psoriasis routine care.

The treatment goal algorithm for psoriasis, first originated in 2007, has ever since been adopted into treatment guidelines. It remained unclear how many patients have experienced the use of treatment goals in routine care and how these are perceived. The aim of the pilot study was to get first insight in the use and impact of therapeutic goals in a large cohort of patients with psoriasis in routine care. This study is a multicenter, non-interventional, cross-sectional health care study in n = 213 dermatology centers across Germany. A standardized physician and patient questionnaire was used, including demographics, disease and treatment characteristics. To evaluate patient treatment perception and satisfaction, a questionnaire (PsoSat) addressing 8 specific items was designed. Consistency and validity of the questionnaire were controlled by factor analyses and reliability tests. In total n = 1,883 patients were included for analysis (54.2% male). Mean age was 52 years, mean disease duration 19 years. In total 45.5% (n = 856) stated an improvement of psoriatic symptoms in the last 4 weeks. In patients including treatment goals, the course of psoriasis in the last 4 weeks was rated significantly better and predicted significantly higher patient satisfaction. Patients reporting periodic outcomes measurement of psoriasis treatment, also had significantly better course of disease, higher satisfaction and a lower psoriasis severity. A majority of patients experienced the use of treatment goals in practice. The association of using treatment goals with clinical outcomes and treatment satisfaction was markedly positive. These findings indicate that the use of treatment goals and outcome measurements in fact improve psoriasis management.

Prevalence and risk factors of actinic keratoses in Germany--analysis of multisource data.

BACKGROUND: In Europe, only few and inconsistent data on the prevalence and treatment of actinic keratoses (AK) are available. OBJECTIVES: To determine the prevalence of AK in Germany, to identify potential predictors and to estimate the number of AK cases treated in dermatological practices. METHODS: In a multiple-source approach, prevalence was assessed from whole-body examinations in a cohort of 90 800 employees and from nationwide statutory health insurance (SHI) data of 2008. The number of cases documented in dermatological offices was estimated from statistics of a SHI Physicians Association. RESULTS: Standardized prevalence of AK from dermatological examinations was 2.7%; the rate increased with age (11.5% in the group 60-70 years) and was higher for men (3.9%) than for women (1.5%). Significant associations were also identified for skin phototype I, sunburns in childhood and solar lentigines. Vitiligo and a history of melanoma were also, but not significantly, associated with AK. In the SHI data analysis, standardized AK prevalence was 1.8%. Age-specific rates were below 1.5% up to 60 years and rose to 8.2% (13.2% in men) in the group 80-89 years. The prevalence from these large data sets--which is at the lower limit of studies from other countries--suggests about 1.7 million estimated AK cases in Germany. In 2011, AK accounted for 8.3% of the hundred most frequently treated dermatological outpatient diagnoses. The proportion of AK cases has risen almost continuously over the last 10 years, compared to other dermatological conditions. Estimated annual number of AK cases documented by dermatologists in Germany is about 1.7 million. CONCLUSIONS: Actinic keratosis is a frequent condition in higher age groups and more prevalent in men; a relevant need for health care is evident. Predictors and risk factors for AK are easy to identify in the population, which could also help to detect groups with special need for preventive measures.

Effectiveness of advanced versus conventional wound dressings on healing of chronic wounds: systematic review and meta-analysis.

BACKGROUND: Wound dressings are essential in the treatment of chronic wounds and should be selected on valid and recent evidence. OBJECTIVE: Effectiveness of advanced compared to conventional dressings for chronic wound healing. METHODS: Comprehensive literature search, systematic review and meta-analyses of the results of advanced dressing studies on chronic wound treatment. Comprehensiveness and coverage of all relevant studies is the most striking difference in relation to other meta-analyses and systematic reviews. RESULTS: The mean odds ratio of complete healing was 1.52 favouring advanced over conventional dressings in 65 controlled trials. In 287 study conditions including uncontrolled studies, mean odds were 0.97 (advanced dressings/controlled studies), 0.77 (conventional/controlled) and 0.47 (advanced/uncontrolled). The overall healing rate was 33%. When causal treatment was applied, a reduced effect was observed. The consideration of all types of chronic wounds, advanced wound dressings and studies resulted in more study effects, more reliable estimates of mean effects and more statistical power. These differences in the design are likely to explain the differences in the meta-analytic results. CONCLUSION: A general superiority of advanced dressings on complete healing was shown. The generalizability of the results is limited by the methodological and report quality within studies identified, unexplained heterogeneity in study effects and possibly by publication bias.

Experimental demonstration of the stability of Berry's phase for a spin-1/2 particle.

The geometric phase has been proposed as a candidate for noise resilient coherent manipulation of fragile quantum systems. Since it is determined only by the path of the quantum state, the presence of noise fluctuations affects the geometric phase in a different way than the dynamical phase. We have experimentally tested the robustness of Berry's geometric phase for spin-1/2 particles in a cyclically varying magnetic field. Using trapped polarized ultracold neutrons, it is demonstrated that the geometric phase contributions to dephasing due to adiabatic field fluctuations vanish for long evolution times.

[Faulty voiding and drinking habits--a contribution to the genesis of enuretic syndrome?]. / Miktions- und Trinkfehlverhalten--Ein Beitrag zur Genese des enuretischen Syndroms?

In 122 children (85 girls, 37 boys) with nocturnal enuresis, information on drinking and voiding patterns was elicited. Many of them (60% of the girls and 40% of the boys) had previously been continent for 1-5 years. It turned out that the children tried to suppress voiding and had the habit of drinking primarily during the second half of the day. After changing these habits, 119 children became permanently continent.

[Urinary diversion following radical cystectomy: ileal conduit or ileal replacement bladder?]. / Harnableitung nach radikaler Zystektomie: Ileum-Conduit oder Ileum-Ersatzblase?

Among those patients who have undergone radical cystoprostatectomy in the Department of Urology at the Municipal Hospital of Kassel (FRG) since 1985, 57 received a continent ileal bladder anastomosed to the membranous urethra. In a retrospective study intra- and postoperative complications, late complications and prognosis of the tumor disease of these patients were compared with those who had an ileum conduit from 1983 to 1988 (n = 44). The intra- and postoperative complications were nearly identical. During the further postoperative course, patients with a continent ileal bladder may present with strictures at the anastomosis of the ileal bladder and urethra, incomplete voiding with residual urine, secretion of water by the mucosa, and metabolic disturbances because of absorption of substances usually eliminated with the urine. The latter decreases with time as the glandular epithelium of the ileal mucosa changes into mucigenous cells with villous atrophy. The danger of local tumor recurrence and metastasis is the same in patients with an ileal bladder and an ileal conduit.

The continent ileal bladder for urinary tract reconstruction after cystectomy: a survey of 44 patients.

The continent ileal bladder is an ileal pouch that is anastomosed to the urethral stump for urinary diversion after radical cystectomy. The ureters are implanted by an antireflux nipple ureteroileostomy. We report our results in 44 patients who underwent this type of diversion. The perioperative morbidity and mortality were comparable to those of an ileal conduit diversion. Urodynamic evaluation showed the ileal bladder to be a low pressure reservoir with a capacity that increased to more than 300 ml. The ileal bladder was emptied by straining without significant residual urine in all patients. After a training period of a few months all patients were continent in the daytime. However, some patients required pads at night because of occasional loss of urine.

[Ureter replacement operations]. / Ureterersatz-Operationen.

Reviewing the recent literature and own clinical experiences, the possibilities of replacement of the ureter by isolated bowel segments, alloplastic prostheses and xenoplastic or autoplastic transplants are shown and evaluated. Although used only in single cases, the interposition of the appendix vermiformis into larger defects of the ureter seems to render the best results. The interposition of bowel segments in the urinary tract has been applied more often, the results, however, have been variable. Numerous modifications have been proposed. The use of alloplastic prostheses and free autologic transplants have--up to now--led to no satisfying long-term results. Only human deep frozen umbilical veins as xenotransplants seem to be suitable as ureter replacements.