Weaning assessment of veno-arteriovenous (V-AV) extracorporeal membrane oxygenation (ECMO).

Currently, there is a lack of methods for simultaneous assessment of readiness for decannulation of the veno-venous (V-V) and veno-arterial (V-A) components during veno-arteriovenous (V-AV) extracorporal membrane oxygenation (ECMO) support. We describe a novel approach using a simultaneous off-sweep and controlled backflow test to assess readiness for decannulation from V-AV ECMO. This method needs testing in future clinical trials.

Automated detection of cephalometric landmarks using deep neural patchworks.

OBJECTIVES: This study evaluated the accuracy of deep neural patchworks (DNPs), a deep learning-based segmentation framework, for automated identification of 60 cephalometric landmarks (bone-, soft tissue- and tooth-landmarks) on CT scans. The aim was to determine whether DNP could be used for routine three-dimensional cephalometric analysis in diagnostics and treatment planning in orthognathic surgery and orthodontics. METHODS: Full skull CT scans of 30 adult patients (18 female, 12 male, mean age 35.6 years) were randomly divided into a training and test data set (each n = 15). Clinician A annotated 60 landmarks in all 30 CT scans. Clinician B annotated 60 landmarks in the test data set only. The DNP was trained using spherical segmentations of the adjacent tissue for each landmark. Automated landmark predictions in the separate test data set were created by calculating the center of mass of the predictions. The accuracy of the method was evaluated by comparing these annotations to the manual annotations. RESULTS: The DNP was successfully trained to identify all 60 landmarks. The mean error of our method was 1.94 mm (SD 1.45 mm) compared to a mean error of 1.32 mm (SD 1.08 mm) for manual annotations. The minimum error was found for landmarks ANS 1.11 mm, SN 1.2 mm, and CP_R 1.25 mm. CONCLUSION: The DNP-algorithm was able to accurately identify cephalometric landmarks with mean errors <2 mm. This method could improve the workflow of cephalometric analysis in orthodontics and orthognathic surgery. Low training requirements while still accomplishing high precision make this method particularly promising for clinical use.

Mechanisms of limitation of oxygen delivery during veno-venous extracorporal membrane oxygenation.

Delivery of oxygen to the mitochondrium is a process involving multiple steps. We here present the integration of the mechanisms of oxygen delivery (DO2) during veno-venous (V-V) extracorporal membrane oxygenation (ECMO) into a holistic physiological model. The final steps of oxygen transport in this model are the convective transport of oxygen bound to hemoglobin in the arterial blood and the diffusion to the mitochondrium from the microcirculation. Limitation of DO2 may occur on both steps. In cases of severe respiratory failure without lung function, ECMO may provide the entire oxygen supply for the patients. If the cardiac output (CO) is significantly higher than the maximal ECMO flow, the addition of deoxygenated venous blood will lead to a low arterial oxygen saturation (SaO2). In this situation the convective transport of oxygen is mostly limited by the maximal ECMO flow. If a bi-caval dual lumen cannula is used, the recirculation may be very low. Lowering the CO in this situation will increase the arterial SaO2. An increased arterial SaO2 may increase the oxygen transport to the mitochondrium by diffusion. The hypothesis derived from this model is that lowering the CO during V-V ECMO support in the situation described above might increase DO2 to the tissues by improving oxygen diffusion.

Effects of Storage Time and Thawing Method on Selected Nutrients in Whole Fish for Zoo Animal Nutrition.

Piscivores in human care receive whole fish that were frozen, stored and thawed before feeding. Nutrient losses have been documented, but exact changes during storage and with different thawing methods are unknown. Primarily, it was hypothesized that frozen fish lose different vitamins and trace minerals during a storage period of six months. Secondly, that different thawing methods have a significant influence on the degree of vitamin loss. Three fish species, herring (Clupeus harengus), mackerel (Scomber scombrus) and capelin (Mallotus villosus) were analyzed at four time points within a storage period of 6 months at -20 °C. At each time point, three thawing methods were applied: thawing in a refrigerator (R), thawing at room temperature (RT), and thawing under running water (RW). The following nutrients were analyzed: vitamin A, B1, D3 and E, iron (Fe), copper (Cu), zinc (Zn) and selenium (Se). The statistical method used was a linear mixed effect model. Cu was below detection limits in all analyzed samples, vitamin B1 in most analyzed herring (44/48 samples) and capelin (in 25/36 samples), respectively. In addition, the vitamin D3 concentration was also below detection limits in half of the capelin samples (18/36). No concentration changes of Fe (p = 0.616), Zn (p = 0.686) or Se (p = 0.148) were observed during a storage period of six months, in contrast to a significant decrease in vitamin A (p = 0.019), D3 (p = 0.034) and E (p = 0.003) concentrations. Thawing fish with different thawing methods did not result in concentration changes of Fe (p = 0.821), Zn (p = 0.549) or Se (p = 0.633), but in a significant concentration change of vitamin A (p = 0.002). It is essential to supplement vitamins B1 and E in diets containing whole fish to avoid deficiencies in piscivorous species, and care should be taken not to store fish longer than six months, due to the depletion of vitamins A, D3 and E.

Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany.

Hand hygiene is a cornerstone of infection prevention. However, few data are available for school children on their knowledge of infectious diseases and their prevention. The aim of the study was to develop and apply a standardized questionnaire for children when visiting primary schools to survey their knowledge about infectious diseases, pathogen transmission and prevention measures. Enrolling thirteen German primary schools, 493 questionnaires for grade three primary school children were included for further analyses, comprising 257 (52.1%) girls and 236 (47.9%) boys with an age range of 8-11 years. Out of 489 children, 91.2% participants indicated that they knew about human-to-human transmissible diseases. Of these, 445 children responded in detail, most frequently mentioning respiratory and gastrointestinal diseases, followed by childhood diseases. Addressing putative hygiene awareness-influencing factors, it was worrisome that more than 40.0% of the children avoided visiting the sanitary facilities at school. Most of the children (82.9%) noted that they did not like to use the sanitary facilities at school because of their uncleanliness and the poor hygienic behavior of their classmates. In conclusion, basic infection awareness exists already in primary school age children. Ideas about the origin and prevention of infections are retrievable, however, this knowledge is not always accurate and adequately contextualized. Since the condition of sanitary facilities has a strong influence on usage behavior, the child's perspective should be given more consideration in the design and maintenance of sanitary facilities.

Immunocontraception of male and female giraffes using the GnRH vaccine Improvac®.

The aim of this study was to develop protocols for contraception in both sexes of giraffes (Giraffa camelopardalis) by using the GnRH vaccine Improvac®. We evaluated the success of immunization by analyzing fecal reproductive hormone metabolites in female (n = 20) and male (n = 9) giraffes. Endocrine analysis provided the basis for the successful immunization protocol, as well as for assessing long-term effects. Reliable reduction of fecal steroid metabolites to baseline levels in female giraffes was achieved with three, and in males with four or five injections at 4-week intervals. Effective booster injections were administered at 2-month intervals in the first year of treatment and at three to 4-month intervals in the following years. In addition to endocrine analysis, we determined vaccination efficacy in bulls by assessing testicular atrophy. Long-term (>2 years) use in females was often accompanied by prolonged periods of persistent corpus luteum activity, although normal cycles were not observed. Problems might occur with reversibility, because in a few males and females, even after more than 2 years since treatment had been stopped, fecal hormone metabolites have not returned to pretreatment levels. The results are somewhat ambiguous, as reproduction can be suppressed by use of Improvac®, but the question of reversibility remains unsolved.

Analysis of hair steroid hormones in polar bears (Ursus maritimus) via liquid chromatography-tandem mass spectrometry: comparison with two immunoassays and application for longitudinal monitoring in zoos.

Analysis of hair cortisol concentrations (HCCs) is a promising method for monitoring long-term stress in mammals. However, previous measurements of HCCs in polar bears (Ursus maritimus) have yielded highly variable results, which are likely due to different methodological approaches. In this study, hair samples of zoo-housed polar bears were analyzed for cortisol with two independent immunoassays [an enzyme-linked immunoassay (EIA) and a chemiluminescence assay (CLIA)] and liquid chromatography-tandem mass spectrometry (LC-MS/MS). HCC measurements depended significantly on assay type applied, sample processing (cutting vs. powdering hair) and their interaction. Best agreement was observed between LC-MS/MS and CLIA (R2 = 0.81 for powdered hair) and sample processing had a minor, albeit significant, effect on obtained HCC measurements in these assays (R2 > 0.9). EIA measurements were consistently higher than with the other assays. HCC measurement was validated biologically for CLIA and LC-MS/MS in one male polar bear that experienced considerable stress for a prolonged period of time (> 18 weeks). Subsequently, by using the validated LC-MS/MS the measurement of cortisol could be complemented by the analysis of other steroids including cortisone, testosterone and progesterone levels from hair samples collected over a 9-month period (5-13 months) from six zoo-housed polar bears (five males, one female). No seasonal steroid variation was observed except in male progesterone levels. For all steroids except cortisone, a strong body region effect (neck or paw) was observed. Cortisol and cortisone, as well as progesterone and testosterone, concentrations were positively correlated. We show that hair steroid concentrations can be used to longitudinally measure stress and reproductive hormone axes in polar bears. The data established herein provide important basic information regarding methodology and study design for assessing hair steroid hormones.

Faecal glucocorticoid metabolites as a measure of adrenocortical activity in polar bears (Ursus maritimus).

Analysis of faecal glucocorticoid metabolites (FGMs) is frequently applied to assess adrenocortical activity in animal conservation and welfare studies. Faecal sample collection is non-invasive and feasible under field conditions. FGM levels are also less prone to circadian rhythms, episodic fluctuations and short acute stressors than glucocorticoid (GC) levels obtained from other matrices, for example blood or saliva. To investigate the suitability of FGM measurement in polar bears (Ursus maritimus), a species listed as Vulnerable by the IUCN (International Union for Conservation of Nature), a cortisol enzyme immunoassay (EIA) was biologically validated by demonstrating a significant increase in FGMs after five zoo-to-zoo transports. In addition to validating the method, the study also documented an average delay of 7 h until the first occurrence of food colorants in the monitored polar bears, which provides essential information for future studies. After validation, the assay was applied to measure FGM concentrations of five polar bears over a 1-year period. Several pre-defined potentially stressful events were recorded in an event log to measure their effect on FGM concentrations. A mixed model analysis revealed significant increases in FGM concentrations after social tension and environmental changes, whereas season and sex had no significant effect. The study demonstrates that the applied cortisol EIA is suitable for measuring FGM levels in polar bears and that using a carefully validated assay for FGM analysis in combination with a detailed sampling protocol can serve as a valuable tool for evaluating mid- to long-term stress in polar bears. FGM levels can be used to monitor stress in captive polar bears in order to optimize housing conditions but also to elucidate stress responses in wild populations for targeted conservation measures.

A Digital Innovation for the Personalized Management of Adherence: Analysis of Strengths, Weaknesses, Opportunities, and Threats.

Introduction: Personalized medicine and management of adherence are potential solutions for the suboptimal use of medicines. Digital medication management innovations currently under development combine both aspects. This research aims to investigate facilitators for and barriers to the translation of digital innovations for personalized medicine and adherence management into clinical practice from the policymaker and regulator perspective. Methods: A mixed-method study was used combining a scoping review to identify main interests, semi-structured interviews (n = 5) with representatives of European health policymaking and regulatory organizations, and a supplementary literature review to investigate key subthemes. The SWOT analysis was used for the qualitative analysis. Results: The literature reviews and the qualitative interviews suggested that digital solutions can facilitate the personalized management of medications and improve quality and safety, especially as the openness for digital health solutions is increasing. Digital solutions may, on the other hand, add complexity to the treatment, which can be perceived as a potential barrier for their uptake. As more multidisciplinary and participative structures are emerging, digital solutions can promote the implementation of new services. Nevertheless, change progresses slowly in the task-oriented structures of health systems. Integration of digital solutions depends on all stakeholders' willingness and abilities to co-create this change. Patients have different capabilities to self-manage their medical conditions and use digital solutions. Personalization of digital health solutions and integration in existing service structures are crucial to ensure equality among population segments. Developments in the digital infrastructure, although they are partly slow and not well-aligned, enable the implementation of innovations in clinical practice leading to further advances in data generation and usage for future innovations. Discussion: This study suggests that digital solutions have the potential to facilitate high-quality medication management and improve adherence to medications, enable new service structures, and are essential to drive further innovations in health care. Nevertheless, increasing the self-responsibility of patients can have undesirable effects on health outcomes, especially within vulnerable population segments. Digital health solutions can be an opportunity to optimize the use of medicines and thus their efficiency. Well-conceived development and implementation processes are needed to also realize improvements in equality and solidarity within health systems.