A 15-year review of lightning deaths in Germany-with a focus on pathognomonic findings.

Lethal accidents caused by lightning are divided into observed and unobserved events. Pathognomonic or characteristic findings are often overlooked during external postmortem examination. Classical mistakes may be made which may often lead to an incorrect diagnosis. An analysis of 270 fatalities was performed on a historical collection of the Committee for Lightning Conductor Construction for the United Economic Area e. V. (ABBW) on lethal accidents due to lightning that occurred in Germany for the period 1951-1965. Furthermore, a selective literature research was carried out. The aim of the study was to analyze the death scene, the clothing, and the victim. The authors focused on chief findings which were relevant to the correct diagnosis of "death by lightning." Both Lichtenberg figures and singed body hair were considered pathognomonic for a lightning strike. The question arose as to whether Lichtenberg figures, for example, represented the finding that most often led to the correct diagnosis. Of the 270 lightning-struck victims from the case collection, 129 (47.8%) had singed body hair and 25 (9.3%) had Lichtenberg figures. A comparison of the frequency of the two reported findings, singed body hair versus Lichtenberg figures, has only been performed in the literature for case numbers below 40. This study is the first evaluation of a relatively large number of lethal accidents due to lightning. Singed body hair was reported more frequently in lightning-struck victims than Lichtenberg figures. This study showed that singed body hair is probably more diagnostically important than Lichtenberg figures.

Prolepsis and Rendering Futures in Intergovernmental Panel on Climate Change Reports.

Rhetorical figures of speech provide important analytical frames to chart how arguments operate within genres and within genre ecologies. Varieties of the figure prolepsis allow for the rendering of future time or fact in the present, which can be a powerful rhetorical inducement toward social and political action. In this article, we examine how anticipatory arguments drawn from complex data shape a key genre for public and policy-facing work on the climate crisis-the Intergovernmental Panel on Climate Change's Synthesis Report's (SYR) Statement for Policy Makers (SPM). We examine how the rhetorical figure of prolepsis operates within this genre to understand the anticipatory arguments and logics emerging from the synthesis of scientific findings and their reporting. Pairing figural studies and Rhetorical Genre Studies, we further offer an approach to investigate how these patterned operations of language might intersect in their rhetorical workings.

Hemispheric functional asymmetries and sex effects in visual bistable perception.

This study investigates bistable perception as a function of the presentation side of the ambiguous figures and of participants' sex, to evaluate left-right hemispheric (LH-RH) asymmetries related to consciousness. In two experiments using the divided visual field paradigm, two Rubin's vase-faces figures were projected simultaneously and continuously 180 s long to the left (LVF) and right (RVF; Experiment 1) or to the upper (UVF) and lower (DVF; Experiment 2) visual hemifields of 48 healthy subjects monitored with eye-tracker. Experiment 1 enables stimulus segregation from the LVF to the RH and from the RVF to the LH, whereas Experiment 2 does not. Results from Experiment 1 show that males perceived the face profiles for more time in the LVF than in the RVF, with an opposite trend for the vase, whereas females show a similar pattern of perception in the two hemifields. A related result confirmed the previously reported possibility to have simultaneously two different percepts (qualia) in the two hemifields elicited by the two identic ambiguous stimuli, which was here observed to occur more frequently in males. Similar effects were not observed in Experiment 2. These findings suggest that the percepts display the processing abilities of the hemisphere currently processing the stimulus eliciting them (e.g., RH-faces), and that females and males reflect in bistable perception, a genuine manifestation of consciousness, the well-known hemispheric asymmetry differences they show in ordinary perception.

Application of the Model of Spots for Inverse Problems.

This article proposes the application of a new mathematical model of spots for solving inverse problems using a learning method, which is similar to using deep learning. In general, the spots represent vague figures in abstract "information spaces" or crisp figures with a lack of information about their shapes. However, crisp figures are regarded as a special and limiting case of spots. A basic mathematical apparatus, based on L4 numbers, has been developed for the representation and processing of qualitative information of elementary spatial relations between spots. Moreover, we defined L4 vectors, L4 matrices, and mathematical operations on them. The developed apparatus can be used in Artificial Intelligence, in particular, for knowledge representation and for modeling qualitative reasoning and learning. Another application area is the solution of inverse problems by learning. For example, this can be applied to image reconstruction using ultrasound, X-ray, magnetic resonance, or radar scan data. The introduced apparatus was verified by solving problems of reconstruction of images, utilizing only qualitative data of its elementary relations with some scanning figures. This article also demonstrates the application of a spot-based inverse Radon algorithm for binary image reconstruction. In both cases, the spot-based algorithms have demonstrated an effective denoising property.

Lichtenberg figures-morphological findings.

Following a witnessed lethal lightning strike of an adult male who was standing outside in a storm, numerous Lichtenberg figures were identified upon external examination of the body. Sectioning across multiple areas of linear erythema in the figures showed no subcutaneous hemorrhage. This was later confirmed on histology which showed only subtle dermal capillary dilatation with no interstitial hemorrhage or inflammation in these areas. The only areas of interstitial hemorrhage were present in adjacent scattered punctate burns from arcing. The documented resolution of Lichtenberg figures within hours would be more in keeping with temporary functional capillary dilatation, shown in this case, rather than with tissue alteration by interstitial hemorrhage or inflammation.

[Changes in number of emergency medical service deployments in an urban area during the first COVID-19 pandemic-related contact restriction phase]. / Veränderungen der rettungsdienstlichen Einsatzzahlen in einer Metropolregion während der ersten COVID-19-Pandemie-bedingten Kontaktbeschränkungsphase.

Background: To contain the coronavirus disease (COVID-19) pandemic, public life was reduced through contact restriction measures (referred to as "lockdown" in the further course for reading simplicity), among other things to make health system resources available for the treatment of COVID-19 patients. In parallel, a decrease in emergency patients was observed in the public health system. Methods: For two 10-week periods before and during the lockdown, ambulance service deployment rates were analysed in 6 ambulance service areas for 6 tracer diagnoses. Random effects were minimised by comparing the results with the corresponding 2018 and 2019 time periods and a calculated expected value. Results: For emergency ambulance service calls, there was a reduction in call numbers (-16%) during the lockdown. A 20% reduction for the categories cardiac and cerebral ischaemia was found. In the urban area, the reduction in cardiac ischaemia was less pronounced at 14% than in the surrounding area at 23%. The deployment figures for intoxications decreased by 27% and for psychiatric emergencies by 16%. Conclusion: The public ambulance service was not overwhelmed by the COVID-19 pandemic; there was a decrease in depolyments during the lockdown. For the reduction in cerebral or cardiac ischaemias, the explanatory models for the influence of the lockdown are missing. Further studies on the utilisation behaviour of the ambulance service during a lockdown appear necessary in order to detect potentially fatal reductions in utilisation for the patient outcome and to be able to counteract them through education.

Replacing bar graphs of continuous data with more informative graphics: are we making progress?

Recent work has raised awareness about the need to replace bar graphs of continuous data with informative graphs showing the data distribution. The impact of these efforts is not known. The present observational meta-research study examined how often scientists in different fields use various graph types, and assessed whether visualization practices have changed between 2010 and 2020. We developed and validated an automated screening tool, designed to identify bar graphs of counts or proportions, bar graphs of continuous data, bar graphs with dot plots, dot plots, box plots, violin plots, histograms, pie charts, and flow charts. Papers from 23 fields (approximately 1000 papers/field per year) were randomly selected from PubMed Central and screened (n=227998). F1 scores for different graphs ranged between 0.83 and 0.95 in the internal validation set. While the tool also performed well in external validation sets, F1 scores were lower for uncommon graphs. Bar graphs are more often used incorrectly to display continuous data than they are used correctly to display counts or proportions. The proportion of papers that use bar graphs of continuous data varies markedly across fields (range in 2020: 4-58%), with high rates in biochemistry and cell biology, complementary and alternative medicine, physiology, genetics, oncology and carcinogenesis, pharmacology, microbiology and immunology. Visualization practices have improved in some fields in recent years. Fewer than 25% of papers use flow charts, which provide information about attrition and the risk of bias. The present study highlights the need for continued interventions to improve visualization and identifies fields that would benefit most.

Figures of merit of plasmon lattice resonance sensors: shape and material matters.

The figure of merit (FOM) of plasmon lattice resonance (PLR) sensors based on the array of metal/Si/SiO2nanoparticles has been investigated. We demonstrate the shape and material of metal nanoparticles have remarkable effects on the PLR and FOM. FOM is governed by full-widths at half maximum (FWHM) and sensitivity of the PLR. Three different types of PLR can be generated by changing Ag nanoparticles' shapes (pillars, cubes, spheres). One (named PLR1) is mainly originated from the coupling between Mie resonance of individual Si nanopillars and diffraction waves. PLR1of Ag/Si/SiO2nanoparticle arrays is limited in sensing applications due to lower intensity (for Ag pillars and Ag cubes), or smaller FOM (for Ag spheres). The other two are named PLR2. PLR2of Ag/Si/SiO2nanoparticle array with Ag pillars (or Ag cubes) is mainly originated from the coupling between the quadrupole resonance of individual Ag nanopillars (or Ag cubes) and diffraction waves. While PLR2of Ag/Si/SiO2nanoparticle array with Ag spheres is mainly originated from the coupling between dipole resonance of individual Ag nanospheres and diffraction waves. The optimal Ag nanoparticles' shape in FOM is pillar due to the smallest FWHM of PLR2of Ag/Si/SiO2nanoparticle array with Ag pillars. Meanwhile, a comparison of FOM between Au, Ag and Al nanopillars of fixed size is made. The optimal material of metal nanopillars to obtain a high FOM is Ag due to higher sensitivity and narrower FWHM.

Computer-assisted mitotic count using a deep learning-based algorithm improves interobserver reproducibility and accuracy.

The mitotic count (MC) is an important histological parameter for prognostication of malignant neoplasms. However, it has inter- and intraobserver discrepancies due to difficulties in selecting the region of interest (MC-ROI) and in identifying or classifying mitotic figures (MFs). Recent progress in the field of artificial intelligence has allowed the development of high-performance algorithms that may improve standardization of the MC. As algorithmic predictions are not flawless, computer-assisted review by pathologists may ensure reliability. In the present study, we compared partial (MC-ROI preselection) and full (additional visualization of MF candidates and display of algorithmic confidence values) computer-assisted MC analysis to the routine (unaided) MC analysis by 23 pathologists for whole-slide images of 50 canine cutaneous mast cell tumors (ccMCTs). Algorithmic predictions aimed to assist pathologists in detecting mitotic hotspot locations, reducing omission of MFs, and improving classification against imposters. The interobserver consistency for the MC significantly increased with computer assistance (interobserver correlation coefficient, ICC = 0.92) compared to the unaided approach (ICC = 0.70). Classification into prognostic stratifications had a higher accuracy with computer assistance. The algorithmically preselected hotspot MC-ROIs had a consistently higher MCs than the manually selected MC-ROIs. Compared to a ground truth (developed with immunohistochemistry for phosphohistone H3), pathologist performance in detecting individual MF was augmented when using computer assistance (F1-score of 0.68 increased to 0.79) with a reduction in false negatives by 38%. The results of this study demonstrate that computer assistance may lead to more reproducible and accurate MCs in ccMCTs.

Reversible-figure perception: Why is voluntary control limited?

Observers can voluntarily avoid reversals of an ambiguous, reversible figure, extending the duration of an intended percept. This is usually attributed to high-level, top-down attentional processes. However, voluntary control is limited. Reversals occur despite attempts to avoid them. In two experiments, observers demonstrated significant, but limited, voluntary control over Necker cube perception. Cube size and cube completeness, variables associated with stimulus-driven processes involving neural adaptation, influenced the frequency of reversals regardless of observers' intentions. Results are consistent with the hybrid hypothesis that both top-down and bottom-up processes contribute to Necker-cube perception and support the hypothesis that the contribution of bottom-up processes is responsible for the limitation on voluntary control.

Visual Sensitivity in Complex Regional Pain Syndrome and Fibromyalgia: An Online Study.

Perceptual anomalies can provide insights into underlying pathologies even when they are not the main symptom of many clinical conditions. Complex regional pain syndrome (CRPS) and fibromyalgia are chronic pain conditions associated with changes in the central nervous system, possibly leading to enhanced visual sensitivity. It is unclear whether this occurs more than for people with other types of pain. We examined visual sensitivity elicited by different stimuli and in daily life, through an online study of people with CRPS (n = 57), fibromyalgia (n = 74), other pain (n = 50), and no pain (n = 89). Respondents rated changes in pain, discomfort, or distress from viewing patterns with different spatial frequencies (lower-order visual processing), and reversible figures (bistable images; higher-order visual processing). We assessed visual sensitivity in daily life using the Leiden Visual Sensitivity Scale and Visual Discomfort Scale. Respondents with CRPS or fibromyalgia reported more visual discomfort than pain-related and pain-free controls while viewing striped patterns and a circle, with no effect of spatial frequency. They reported more pain while viewing a nonreversible square, but not reversible figures (Necker Cube, Duck/Rabbit). Finally, they reported more daily visual sensitivity than pain-related and pain-free controls. Suppressing visual cortical activity might benefit people with CRPS or fibromyalgia.

Estimating effective infection fatality rates during the course of the COVID-19 pandemic in Germany.

BACKGROUND: The infection fatality rate (IFR) of the Coronavirus Disease 2019 (COVID-19) is one of the most discussed figures in the context of this pandemic. In contrast to the case fatality rate (CFR), the IFR depends on the total number of infected individuals - not just on the number of confirmed cases. In order to estimate the IFR, several seroprevalence studies have been or are currently conducted. METHODS: Using German COVID-19 surveillance data and age-group specific IFR estimates from multiple international studies, this work investigates time-dependent variations in effective IFR over the course of the pandemic. Three different methods for estimating (effective) IFRs are presented: (a) population-averaged IFRs based on the assumption that the infection risk is independent of age and time, (b) effective IFRs based on the assumption that the age distribution of confirmed cases approximately reflects the age distribution of infected individuals, and (c) effective IFRs accounting for age- and time-dependent dark figures of infections. RESULTS: Effective IFRs in Germany are estimated to vary over time, as the age distributions of confirmed cases and estimated infections are changing during the course of the pandemic. In particular during the first and second waves of infections in spring and autumn/winter 2020, there has been a pronounced shift in the age distribution of confirmed cases towards older age groups, resulting in larger effective IFR estimates. The temporary increase in effective IFR during the first wave is estimated to be smaller but still remains when adjusting for age- and time-dependent dark figures. A comparison of effective IFRs with observed CFRs indicates that a substantial fraction of the time-dependent variability in observed mortality can be explained by changes in the age distribution of infections. Furthermore, a vanishing gap between effective IFRs and observed CFRs is apparent after the first infection wave, while an increasing gap can be observed during the second wave. CONCLUSIONS: The development of estimated effective IFR and observed CFR reflects the changing age distribution of infections over the course of the COVID-19 pandemic in Germany. Further research is warranted to obtain timely age-stratified IFR estimates, particularly in light of new variants of the virus.

Cardiovascular disease prevalence in type 2 diabetes - an analysis of a large German statutory health insurance database.

BACKGROUND: The aim of this study was to determine the prevalence of cardiovascular disease in persons with type 2 diabetes mellitus (T2D) in Germany. METHODS: A claims database with an age- and sex-stratified sample of nearly 4 million individuals insured within the German statutory health system was used. All patients aged ≥18 years with T2D documented between 1 January 2015 and 31 December 2015 and complete retrospective documentation of ≥5 years (continuous enrollment in the German statutory health system) before 2015 were selected based on a validated algorithm. Cardiovascular disease (CVD) events were identified based on ICD-10 and OPS codes according to a previous clinical study (EMPA-REG OUTCOME trial). RESULTS: The prevalence of T2D in Germany in 2015 was 9.9% (n = 324,708). Using a narrow definition of CVD, the 6-year observation period prevalence of CVD was estimated as 46.7% [95% CI: 46.52%;46.86%]. Applying a wider CVD definition, the proportion of T2D patients who showed a history of CVD was 57.1% [95% CI: 56.9%;57.24%]. The prevalence of CVD in patients with T2D ranged from 36.3 to 57.1%, depending on the observation period and definition of CVD. CONCLUSIONS: The results underline the need for a population-based registration of cardiovascular complications in T2D.

Divergent Thinking Influences the Perception of Ambiguous Visual Illusions.

This study investigated the relationships between personality and creativity in the perception of two different ambiguous visual illusions. Previous research has suggested that Industriousness and Openness/Intellect (as measured by the Big Five Aspects Scale) are both associated with individual differences in perceptual switching rates for binocular rivalry stimuli. Here, we examined whether these relationships generalise to the Necker Cube and the Spinning Dancer illusions. In the experimental phase of this study, participants viewed these ambiguous figures under both static and dynamic, as well as free-view and fixation, conditions. As predicted, perceptual switching rates were higher: (a) for the static Necker Cube than the Spinning Dancer, and (b) in free-view compared with fixation conditions. In the second phase of the study, personality type and divergent thinking were measured using the Big Five Aspects Scale and the Alternate Uses Task, respectively. Higher creativity/divergent thinking (as measured by the Alternate Uses Task) was found to predict greater switching rates for the static Necker Cube (but not the Spinning Dancer) under both free-view and fixation conditions. These findings suggest that there are differences in the perceptual processing of creative individuals.

Chromatographic Applications in the Multi-Way Calibration Field.

In this review, recent advances and applications using multi-way calibration protocols based on the processing of multi-dimensional chromatographic data are discussed. We first describe the various modes in which multi-way chromatographic data sets can be generated, including some important characteristics that should be taken into account for the selection of an adequate data processing model. We then discuss the different manners in which the collected instrumental data can be arranged, and the most usually applied models and algorithms for the decomposition of the data arrays. The latter activity leads to the estimation of surrogate variables (scores), useful for analyte quantitation in the presence of uncalibrated interferences, achieving the second-order advantage. Recent experimental reports based on multi-way liquid and gas chromatographic data are then reviewed. Finally, analytical figures of merit that should always accompany quantitative calibration reports are described.

Goldwater After Trump.

The "Goldwater rule," a policy adopted by the American Psychiatry Association (APA) in 1973, prohibits organization members from diagnosing or offering professional opinions regarding the mental health of public figures without both first-hand evaluation and authorization. Initially developed in response to a controversial survey of APA members during the 1964 Presidential election campaign, the ethics rule faced few large scale challenges until the election of Donald Trump in 2016. Since that time, a significant number of psychiatrists have either violated or criticized the rule openly. This paper argues that whatever the initial merits of the rule, the prohibition has since been rendered obsolete by the combined lack of professional consensus supporting the policy, absence of a meaningful enforcement mechanism, and the credible statements of non-APA members in the mental health professions regarding public figures.

Father-figure Presence and Externalizing and Internalizing Problems in Mexican and Dominican American Children.

This study examined whether various types of father-figure presence in Mexican (n = 414)- and Dominican- American (n = 336) households measured at baseline predicted child mental health functioning one year later. Results of linear regression analyses showed that the impact of household structure on child functioning was significant and differed by ethnicity. For Mexican-American children, residing with a step-father or other adult male predicted increased externalizing problems compared to children residing their biological father. For Dominican-American children, residing with no father figure predicted increased externalizing problems compared to children residing with a biological father. Implications for practice and future research are discussed.

Matrix-Matched Calibration Curves for Assessing Analytical Figures of Merit in Quantitative Proteomics.

Mass spectrometry is a powerful tool for quantifying protein abundance in complex samples. Advances in sample preparation and the development of data-independent acquisition (DIA) mass spectrometry approaches have increased the number of peptides and proteins measured per sample. Here, we present a series of experiments demonstrating how to assess whether a peptide measurement is quantitative by mass spectrometry. Our results demonstrate that increasing the number of detected peptides in a proteomics experiment does not necessarily result in increased numbers of peptides that can be measured quantitatively.

Objects seen as scenes: Neural circuitry for attending whole or parts.

Depending on our goals, we pay attention to the global shape of an object or to the local shape of its parts, since it's difficult to do both at once. This typically effortless process can be impaired in disease. However, it is not clear which cortical regions carry the information needed to constrain shape processing to a chosen global/local level. Here, novel stimuli were used to dissociate functional MRI responses to global and local shapes. This allowed identification of cortical regions containing information about level (independent from shape). Crucially, these regions overlapped part of the cortical network implicated in scene processing. As expected, shape information (independent of level) was mainly located in category-selective areas specialized for object- and face-processing. Regions with the same informational profile were strongly linked (as measured by functional connectivity), but were weak when the profiles diverged. Specifically, in the ventral-temporal-cortex (VTC) regions favoring level and shape were consistently separated by the mid-fusiform sulcus (MFS). These regions also had limited crosstalk despite their spatial proximity, thus defining two functional pathways within VTC. We hypothesize that object hierarchical level is processed by neural circuitry that also analyses spatial layout in scenes, contributing to the control of the spatial-scale used for shape recognition. Use of level information tolerant to shape changes could guide whole/part attentional selection but facilitate illusory shape/level conjunctions under impoverished vision.

Guidelines for Reporting of Figures and Tables for Clinical Research in Urology.

In an effort to improve the presentation of and information within tables and figures in clinical urology research, we propose a set of appropriate guidelines. We introduce six principles: (1) include graphs only if they improve the reader's ability to understand the study findings; (2) think through how a graph might best convey information, do not just select a graph from preselected options on statistical software; (3) do not use graphs to replace reporting key numbers in the text of a paper; (4) graphs should give an immediate visual impression of the data; (5) make it beautiful; and (6) make the labels and legend clear and complete. We present a list of quick "dos and don'ts" for both tables and figures. Investigators should feel free to break any of the guidelines if it would result in a beautiful figure or a clear table that communicates data effectively. That said, we believe that the quality of tables and figures in the medical literature would improve if these guidelines were to be followed. Patient summary: A set of guidelines were developed for presenting figures and tables in urology research. The guidelines were developed by a broad group of statistical experts with special interest in urology.