Manufacturer-independent medical device interoperability has been strongly demanded by the clinicians and healthcare delivery organizations (HDOs), however has not been achieved in practice for ...decades. The ISO/IEEE 11073 Service-oriented Device Connectivity (SDC) family of standards constitutes a paradigm shift. This work supplements SDC with Device Specializations (DevSpecs) or Modular Specifications (ModSpecs): particular interoperability standards for high frequency (HF) surgical equipment and external control devices, such as foot or finger switches. They provide models to describe these devices in a service-oriented medical device system and modes of interaction with other network participants. Additionally, we contribute to the ISO/IEEE 11073-10101 nomenclature standard to provide semantic descriptions of the exchanged information. This is a key enabler for safe and effective medical device interoperability to support the caregivers and improve patient safety as well as clinical outcome.
Introduction: Anatomical implants enable minimally invasive osteosynthesis (MIO) and represent ideal complements of computer-assisted surgical workflows. This 3D morphometric study analyzes ...anatomical implant forms (AIF) for acetabular fracture osteosynthesis (AFO).
Materials and Methods: Three-dimensional pelvis models were created from clinical CT data of 99 European-Caucasian patients (50 females, 49 males). The mean age of the patients was 60.1 years (range: 20-89; SD 10.8). Definition of a referential region of interest (ROI) corresponding to an AIF for AFO was followed by automated ROI computation for each of the 198 hemipelvises. Three-dimensional statistical modeling and analysis of the resulting 198 homologous ROIs consisted of thin-plate spline transformation, generalized Procrustes fit, and principal component analysis.
Results: The mean ROI length was 18.2 cm (range: 16.1-20.1 cm; SD 0.76). The first principal component (PC1) mainly modeled the ROI length, which correlated well with body height (r = 0.325; p < 0.001). PC1 comprised 47.4% of the overall ROI form variation. PC2 primarily influenced the ROI curvature in the anterior-posterior (inlet) view. Curvatures were more pronounced in female patients compared to males (p < 0.001). There was no gender-specific ROI size variation. PC1-4 contained 80.2% of the total ROI form variation. Left and right ROI forms displayed symmetry.
Conclusion: This 3D morphometric study demonstrates the feasibility of anatomical implants for minimally invasive acetabular fracture osteosynthesis. Implant size/length is by far the most important variable of form variation. The necessity of gender-specific implant forms requires further investigation. The non-fractured, contralateral hemipelvis can be used for preoperative surgical planning. Ultimately, the plate design will depend on prospective implant fit tests based on the required fit as defined by the clinician.
Together with the current shift to cloud-based solutions, various Web applications have been enriched with collaborative features. These collaborative features enable users to work together on ...digital products like documents, diagrams and videos at the same time on a global scale. Implementing them require developers to have knowledge about both complex algorithms for maintaining consistency on one hand and usability issues on the other hand. Besides developing apps from scratch, Web application developers often meet these challenges by employing ready-made libraries for shared editing on the Web. A new generation of these shared editing frameworks has emerged recently; several of these libraries are available as open source solutions. In this paper, we first present general and browser-specific requirements for shared editing like consistency algorithms and means of workspace awareness. Then, state-of-the-art frameworks for shared editing are analyzed in respect of their support of these requirements. As a contribution, we have identified missing features like the availability of general awareness widgets and new architectural designs due to emerging Web standards. To that end, we demonstrate prototypes addressing some of these issues.
•Different types of prefabricated paediatric crowns showed variant wear patterns.•All self-adhesively cemented composite crowns remained intact after testing.•The use of self-adhesive cements lowered ...wear of composite & stainless steel crowns.•No impact of cementation on wear was observed for zirconia crowns.
The purpose of this in vitro study was to assess the two-body wear and fracture behaviour of an experimental additive manufactured composite crown in comparison to zirconia and stainless steel crowns and its cementation protocol for primary molars.
Three different paediatric crowns – experimental composite crowns (CCs, 3M), zirconia crowns (ZCs, NuSmile), and stainless steel crowns (SSCs, 3M)–were cemented with an experimental resin-modified glass ionomer cement (RMGIC, 3M) and two self-adhesive cements (SACs; RelyX Unicem Automix 2, 3M; BioCem, NuSmile). Seven groups, each with eight specimens, were thermally cycled (55 °C/50 °C) and dynamically loaded (50N/ 1.2Hz) in a masticatory simulator with steatite antagonists. The areal and volumetric material loss of all specimens before and after 1,200,000 masticatory cycles was evaluated with a 3D profilometer. Light and scanning electron microscopy were used for qualitative analysis. Pairwise comparisons between all the groups were performed using the Mann–Whitney U test (p < 0.05).
Microscopic imaging revealed different wear patterns for each material. Lowest fracture rates were documented for the CCs. In contrast, all the SSCs showed perforations. The CCs cemented with RMGIC showed the highest significant volumetric wear (6.3 ± 0.72 mm³), followed by the SSCs cemented with RMGIC (3.6 ± 1.79 mm³) and CCs cemented with SAC (3.5 ± 1.92 mm³). No significant differences were found in terms of the wear among all the other groups, ranging between 0.4 ± 0.25 and 0.6 ± 0.32 mm³.
The volume loss of the tested crowns differed for each material and was dependent on the type of cementation. With regard to in vitro wear and fracture patterns, cementation with SAC may increase the clinical performance of CC paediatric crowns.
Stochastic uncertainty can cause coordination problems that may hinder mutually beneficial cooperation. We propose a mechanism of ex-post voluntary transfers designed to circumvent these coordination ...problems and ask whether it can increase efficiency. To test this transfer mechanism, we implement a controlled laboratory experiment based on a repeated Ultimatum Game with a stochastic endowment. Contrary to our hypothesis, we find that allowing voluntary transfers does not lead to an efficiency increase. We suggest and analyze two major reasons for this failure: first, stochastic uncertainty forces proposers intending to cooperate to accept high strategic uncertainty, which many proposers avoid; second, many responders behave only incompletely conditionally cooperatively, which hinders cooperation in future periods.
JEL-Classification: C78, C92, D74
The aim of this study was to evaluate the transmittance of visible light (VL) (λ: 400–700 nm) and blue light (BL) (λ: 360–540 nm) through six CAD/CAM zirconia blanks (ZiB) in comparison to a lithium ...disilicate ceramic (LS2). Disks of the zirconia materials Bruxzir (BX), Cercon (CE), Lava Frame (LF), Lava Plus (LP), Prettau (PT), Zenostar (ZS) and LS2 (EM) were manufactured and the transmittance was measured in a spectrophotometer. ZS, followed by CE, PT, LP, LF, and BX showed the lowest transmittance of VL and BL. The highest transmittance was shown by EM. The transmittance of BL was lower than that of VL in all groups. EM ceramics showed higher transmittance than all zirconia materials and the thickness of zirconia materials influenced the transmittance values. Knowledge about VL and BL transmittance would help clinicians to individually tailor the selection of material to the specific indication and to make the right choice regarding the luting procedure and light curing duration.
•Structural and magnetic properties of (Nd1−xREx)13.6FebalCo6.6Ga0.6B5.6 (RE = Ce, La) melt-spun alloys.•Ce induced grain coarsening whereas La had a grain refinement effect.•Moderate Ce substitution ...mildly deteriorated magnetic properties.•Dilute La addition enhanced remanence and saturation polarization and maintained a high Curie temperature.•Ce substitution improved hot-workability.
Ce and La as very cheap rare-earth elements were used to substitute Nd in nanocrystalline melt-spun ribbons of nominal compositions (Nd1−xREx)13.6FebalCo6.6Ga0.6B5.6 (x = 0, 0.1, 0.2, … 1 for RE = Ce) and (x = 0, 0.1, 0.2, … 0.5 for RE = La). Ce substitution gradually decreased the Nd2Fe14B lattice constants and produced CeFe2 segregation from x = 0.7. La substitution led to lattice expansion along the c-axis and induced segregation of α-Fe and Nd2Fe17 at x = 0.5. Grain coarsening was observed in the Ce-substituted samples while La was found to suppress grain growth. Cerium worsened the magnetic properties of as-spun powders after an initial improvement in (Nd0.9Ce0.1)13.6FebalCo6.6Ga0.6B5.6 alloy which showed a coercivity (µ0Hc) of 1.54 T and a remanence (Br) of 0.81 T. Coercivity dropped with increasing La concentration but remanence increased from 0.73 T in the base composition to 0.88 T at x = 0.3. The Curie temperatures (TC) showed a slight decrease in both cases until x = 0.4. It then dropped abruptly for increasing Ce fractions and increased at x = 0.5 La. For x = 0.2 and 0.3 Ce and x = 0.2 La fractions, the melt-spun samples were further processed by hot-pressing and hot-deformation. The hot-pressed (Nd0.8La0.2)13.6FebalCo6.6Ga0.6B5.6 alloy measured lower coercivity but increased remanence comparing to the Ce-substituted alloys. However, this composition responded poorly to hot-deformation, severe cracking being induced in the process. Due to enhanced hot-workability, best magnetic properties were obtained after deformation for the (Nd0.7Ce0.3)13.6FebalCo6.6Ga0.6B5.6 alloy (µ0Hc = 1.09 T, Br = 0.97 T and energy product (BH)max = 170 kJ/m3).
Therapy-related adverse side effects are a main reason for non-persistence to adjuvant endocrine breast cancer therapy. This study reports frequency of drug-related adverse side effects that were so ...severe that a modification of the therapy was necessary. We evaluated how many patients discontinued adjuvant endocrine therapy because of these side effects (non-persistence). Last, we analyzed how often a drug switch was undertaken for this reason and how often this measure led to the patient successfully continuing their endocrine therapy. Data concerning all postmenopausal breast cancer patients (≤80 years), who initiated endocrine adjuvant therapy between 1998 and 2008 in a Swiss breast center (
n
= 400), were analyzed. Out of these 400 women, 37 (9.3%) were defined as being non-persistent to the therapy; out of these, 24 (64.9%) because of therapy-related side effects. About 78 patients (19.5%) suffered from severe therapy-related side effects that made a modification of therapy necessary. Out of these 78 cases, 14 patients (17.9%) stopped the therapy without attempting a drug switch (non-persistence). In 64 patients (82.1%; 16% of all women who started endocrine therapy), a drug switch was undertaken. Out of these 64 cases, in 52 cases (81.3%) endocrine therapy was completed after therapy modification. Patients who reported one major adverse effect were more likely to continue the endocrine therapy after a drug switch (
P
= 0.048) compared with those who suffered from at least two different side effects. In 10 of the 64 cases (15.6%), modification of the therapy was not successful and the patients stopped the treatment prematurely (non-persistence) because of ongoing side effects. In cases when therapy-related side effects occur, a drug switch is a promising step to further improve persistence and, by doing so, the outcome of breast cancer patients.
This study provides real-world clinical evidence regarding palliative endocrine therapy (ET) in breast cancer (BC). The main questions to be answered were: how often and how long did patients receive ...ET? A particular aspect was the analysis of compliance and persistence with ET.
An analysis of a nonselected/consecutive cohort of women with distant metastatic hormone receptor-positive BC (n = 205) was conducted.
In all, 165 patients (80.5%) received ET during the palliative disease course. The noncompliance rate was 1.5%. Sixty-seven patients (40.6%) had ET as the only antineoplastic therapy. The median number of therapy lines was 2, and the median duration was 18 months. The median metastatic disease survival (MDS) was 34 months. In patients who had an MDS of ≥9 months (n = 145; 87.9%), during 70.6% of the MDS time only ET had been administered. Patients who were naïve to ET more often had a good response to and a longer duration of palliative ET than those who were not. The nonpersistence rate was 4.3%.
Excluding the few patients who had a rapidly progressive course, the disease was controlled for about 70% of the entire palliative disease course with ET alone. Only very few patients were nonpersistent with ET and consciously stopped a still effective, ongoing ET.
This paper considers the problem of optimizing the average tracking error for an elliptic partial differential equation with an uncertain lognormal diffusion coefficient. In particular, the ...application of the multilevel quasi-Monte Carlo (MLQMC) method to the estimation of the gradient is investigated, with a circulant embedding method used to sample the stochastic field. A novel regularity analysis of the adjoint variable is essential for the MLQMC estimation of the gradient in combination with the samples generated using the circulant embedding method. A rigorous cost and error analysis shows that a randomly shifted quasi-Monte Carlo method leads to a faster rate of decay in the root mean square error of the gradient than the ordinary Monte Carlo method, while considering multiple levels substantially reduces the computational effort. Numerical experiments confirm the improved rate of convergence and show that the MLQMC method outperforms the multilevel Monte Carlo method and single level quasi-Monte Carlo method.
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