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We study the thermodynamic properties induced by non-reciprocal interactions between stochastic degrees of freedom in time- and space-continuous systems. We show that, under fairly general conditions, non-reciprocal coupling alone implies a steady energy flow through the system, i.e., non-equilibrium. Projecting out the non-reciprocally coupled degrees of freedom renders non-Markovian, one-variable Langevin descriptions with complex types of memory, for which we find a generalized second law involving information flow. We demonstrate that non-reciprocal linear interactions can be used to engineer non-monotonic memory, which is typical for, e.g., time-delayed feedback control, and is automatically accompanied with a nonzero information flow through the system. Furthermore, already a single non-reciprocally coupled degree of freedom can extract energy from a single heat bath (at isothermal conditions), and can thus be viewed as a minimal version of a time-continuous, autonomous 'Maxwell demon'. We also show that for appropriate parameter settings, the non-reciprocal system has characteristic features of active matter, such as a positive energy input on the level of the fluctuating trajectories without global particle transport.

Many stochastic systems in biology, physics and technology involve discrete time delays in the underlying equations of motion, stemming, e. g., from finite signal transmission times, or a time lag between signal detection and adaption of an apparatus. From a mathematical perspective, delayed systems represent a special class of non-Markovian processes with delta-peaked memory kernels. It is well established that delays can induce intriguing behaviour, such as spontaneous oscillations, or resonance phenomena resulting from the interplay between delay and noise. However, the thermodynamics of delayed stochastic systems is still widely unexplored. This is especially true for continuous systems governed by nonlinear forces, which are omnipresent in realistic situations. We here present an analytical approach for the net steady-state heat rate in classical overdamped systems subject to time-delayed feedback. We show that the feedback inevitably leads to a finite heat flow even for vanishingly small delay times, and detect the nontrivial interplay of noise and delay as the underlying reason. To illustrate this point, and to provide an understanding of the heat flow at small delay times below the velocity-relaxation timescale, we compare with the case of underdamped motion where the phenomenon of “entropy pumping” has already been established. Application to an exemplary (overdamped) bistable system reveals that the feedback induces heating as well as cooling regimes and leads to a maximum of the medium entropy production at coherence resonance conditions. These observations are, in principle, measurable in experiments involving colloidal suspensions.

We study the heat transfer between two nanoparticles held at different temperatures that interact through nonreciprocal forces, by combining molecular dynamics simulations with stochastic thermodynamics. Our simulations reveal that it is possible to construct nano refrigerators that generate a net heat transfer from a cold to a hot reservoir at the expense of power exerted by the nonreciprocal forces. Applying concepts from stochastic thermodynamics to a minimal underdamped Langevin model, we derive exact analytical expressions predictions for the fluctuations of work, heat, and efficiency, which reproduce thermodynamic quantities extracted from the molecular dynamics simulations. The theory only involves a single unknown parameter, namely an effective friction coefficient, which we estimate fitting the results of the molecular dynamics simulation to our theoretical predictions. Using this framework, we also establish design principles which identify the minimal amount of entropy production that is needed to achieve a certain amount of uncertainty in the power fluctuations of our nano refrigerator. Taken together, our results shed light on how the direction and fluctuations of heat flows in natural and artificial nano machines can be accurately quantified and controlled by using nonreciprocal forces.

Understanding nonequilibrium systems and the consequences of irreversibility for the system's behavior as compared to the equilibrium case, is a fundamental question in statistical physics. Here, we investigate two types of nonequilibrium phase transitions, a second-order and an infinite-order phase transition, in a prototypical q-state vector Potts model which is driven out of equilibrium by coupling the spins to heat baths at two different temperatures. We discuss the behavior of the quantities that are typically considered in the vicinity of (equilibrium) phase transitions, like the specific heat, and moreover investigate the behavior of the entropy production (EP), which directly quantifies the irreversibility of the process. For the second-order phase transition, we show that the universality class remains the same as in equilibrium. Further, the derivative of the EP rate with respect to the temperature diverges with a power-law at the critical point, but displays a non-universal critical exponent, which depends on the temperature difference, i.e., the strength of the driving. For the infinite-order transition, the derivative of the EP exhibits a maximum in the disordered phase, similar to the specific heat. However, in contrast to the specific heat, whose maximum is independent of the strength of the driving, the maximum of the derivative of the EP grows with increasing temperature difference. We also consider entropy fluctuations and find that their skewness increases with the driving strength, in both cases, in the vicinity of the second-order transition, as well as around the infinite-order transition.

Following a series of complimentary studies assessing the current application of the principle of transparency of consumer information in Croatia, Germany, Poland, the Netherlands, and the UK, this paper presents research findings on how to improve its effectiveness. Documented differences in national laws and practice indicate the need for a more harmonised approach on the level of the European Union. This demand also arises from the interviews the research team has conducted with various national stakeholders. Whilst the legislative transparency requirements could remain general, e.g., a duty for traders to provide consumer information in “plain and intelligible language,” traders, consumers, and enforcement authorities all require more legal certainty as to what amounts to compliance with these requirements. Based on the stakeholders’ suggestions, an interdisciplinary literature review, findings from doctrinal, comparative legal research, and a conducted quantitative study, the paper recommends empirically motivated, multimodal guidelines to implement textual, contextual, and technical measures.

IntroductionWorldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery.MethodsAn expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group’s first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as “strong” (recommendations) or “weak” (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term “should” refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores.Results and summaryThe risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with “watchful waiting” since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon’s expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10–12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation “Hernia Center”. From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients.ConclusionsThe HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.

Introduction Up to 12% of patients undergoing minimally invasive inguinal hernia repair may develop chronic postoperative inguinal pain (CPIP), possibly explained by the presence of mesh. Recent studies reported that laparoscopic mesh removal is feasible and safe. However, the risk of a hernia recurrence is unknown. This observational study describes the rate of hernia recurrence and evolution in pain score following laparoscopic mesh removal for CPIP after preperitoneal inguinal hernia repair. Methods Prospectively collected questionnaires and operative notes of consecutive patients undergoing a laparoscopic mesh removal for CPIP in our center of expertise between November 2011 and July 2022 were studied. Pain scores were quantified using the Numeric Pain Rating Scale (NRS, 0–10). The presence of a hernia recurrence was based on patient history and clinical findings. Results A total of 89 patients underwent laparoscopic mesh removal, and data of 83 patients (93% response rate) were available for analysis. Median decrease in pain score (NRS) after mesh removal was 4 (range + 2 to − 9). After a median 4.3 years follow up period, a hernia recurrence was present in 18 patients (21.7%). Of these, eight were symptomatic requiring correction using a Lichtenstein repair with a favorable outcome whereas a wait-and-see approach was successfully followed in the remaining 10 patients. Conclusion Laparoscopic mesh removal for CPIP following preperitoneal inguinal hernia repair resulted in an inguinal hernia recurrence in one of five patients requiring remedial surgery in one in ten patients. This knowledge may inform the preoperative counseling process. Graphical abstract

Stochastic processes with temporal delay play an important role in science and engineering whenever finite speeds of signal transmission and processing occur. However, an exact mathematical analysis of their dynamics and thermodynamics is available for linear models only. We introduce a class of stochastic delay processes with nonlinear time-local forces and linear time-delayed forces that obey fluctuation theorems and converge to a Boltzmann equilibrium at long times. From the point of view of control theory, such ‘equilibrium stochastic delay processes’ are stable and energetically passive, by construction. Computationally, they provide diverse exact constraints on general nonlinear stochastic delay problems and can, in various situations, serve as a starting point for their perturbative analysis. Physically, they admit an interpretation in terms of an underdamped Brownian particle that is either subjected to a time-local force in a non-Markovian thermal bath or to a delayed feedback force in a Markovian thermal bath. We illustrate these properties numerically for a setup familiar from feedback cooling and point out experimental implications.

Perivascular spaces are associated with MRI markers of cerebral small vessel disease, including white matter hyperintensities. Although perivascular spaces are considered to be an early MRI marker of cerebral small vessel disease, it is unknown whether they are associated with further progression of MRI markers, especially white matter hyperintensities. We determined the association between perivascular spaces and progression of white matter hyperintensities after 2-year follow-up in lacunar stroke patients. In 118 lacunar stroke patients we obtained brain MRI and 24-hour ambulatory blood pressure measurements at baseline, and a follow-up brain MRI 2 years later. We visually graded perivascular spaces and white matter hyperintensities at baseline. Progression of white matter hyperintensities was assessed using a visual white matter hyperintensity change scale. Associations with white matter hyperintensity progression were tested with binary logistic regression analysis. Extensive basal ganglia perivascular spaces were associated with progression of white matter hyperintensities (OR 4.29; 95% CI: 1.28-14.32; p<0.05), after adjustment for age, gender, 24-hour blood pressure and vascular risk factors. This association lost significance after additional adjustment for baseline white matter hyperintensities. Centrum semiovale perivascular spaces were not associated with progression of white matter hyperintensities. Our study shows that extensive basal ganglia perivascular spaces are associated with progression of white matter hyperintensities in cerebral small vessel disease. However, this association was not independent of baseline white matter hyperintensities. Therefore, presence of white matter hyperintensities at baseline remains an important determinant of further progression of white matter hyperintensities in cerebral small vessel disease.

The application of consumer law to digital content contracts encounters a number of obstacles. Some of these are rather typical for digital content markets, e.g., the legal consequences of the classification of digital content as “goods” or “services” and, more importantly, the absence of general benchmarks to evaluate the conformity of digital content. Other problems, such as the limited usefulness of consumer information and the position of underage consumers, are not as such reserved to digital consumers, but they are amplified in the digital content markets. Moreover, particular attention is paid to the complex relationship between copyright law and consumer law. This paper explores the extent to which consumer (contract) law is fit to address the problems faced by digital consumers wishing to enjoy the benefits of digital content and examines whether the on-going initiatives at national and European level are likely to provide relief. Finally, recommendations for improvement are put forward in cases where the analysis shows that the problems identified are not or are insufficiently solved by these initiatives.