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Objectives To investigate the course of in vivo blood metal ion levels in patients undergoing primary total knee arthroplasty (TKA) and to investigate potential risk factors associated with metal ion release in these patients. Methods Twenty‐five patients with indication for TKA were included in this prospective study. Whole blood metal ion analysis was performed pre‐operatively and at 1 week, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Clinical scores were obtained using the American Knee Society Score (AKSS) and the Oxford Knee Score (OKS) at each follow‐up and patientsʼ activity levels were assessed by measuring the mean annual walking cycles at 12 months follow‐up. Anteroposterior and lateral radiographs of the operated knee were evaluated postoperatively and at 12‐month follow‐up with regard to implant position and radiological signs of implant loosening. Correlation analysis using multivariate linear regression was performed to investigate the influence of different variables (age, gender, functional scores, number of walking cycles, and body mass index [BMI]) on blood cobalt ion concentrations. Results Mean metal ion levels of cobalt, chromium, molybdenum, and titanium were 0.28 μg/L (SD, 0.14), 0.43 μg/L (SD, 0.49), 0.62 μg/L (SD, 0.45), and 1.96 μg/L (SD, 0.98), respectively at 12‐month follow‐up. Mean cobalt ion levels significantly increased 1‐year after surgery compared to preoperative measurements. There was no statistically significant increase of mean metal ion levels of chromium, titanium, and molybdenum at 1‐year follow‐up. Overall, metal ion levels were low and no patient demonstrated cobalt ion levels above 1 μg/L. Postoperative radiographs demonstrated well‐aligned TKAs in all patients and no signs of osteolysis or implant loosening were detected at 1‐year follow‐up. Both the AKSS and OKS significantly improved during the course of the study up to the final follow‐up. Multivariate regression analysis did not show a statistically significant correlation between the tested variables and blood cobalt ion concentrations. Conclusion A statistically significant increase of mean cobalt ion concentration at 1‐year follow‐up was found in this cohort of patients with well‐functioning TKA, although overall blood metal ion levels were relatively low. Despite low systemic metal ion concentrations seen in this cohort, the local effects of increased metal ion concentrations in the periprosthetic environment on the long‐term outcome of TKA should be further investigated.

In recent decades, engineering manufacturers have increasingly adopted servitization strategies, making efficient maintenance service delivery a key corporate activity for revenue growth and profitability. Recently, augmented reality remote maintenance (ARRM) has become available and promises service delivery efficiency gains, which is why engineering manufacturers are starting to adopt it. Therefore, the purpose of this paper is to analyze the promoting and inhibiting factors of ARRM adoption in support of industrial service delivery. To this end, a qualitative explorative approach based on the technology–organization–environment (TOE) framework has been deployed. Data were collected from a systematic literature review and an empirical interview study with 16 companies. In total, 38 interviewees from different hierarchical levels participated in the interview study. Based on a thematic analysis, this paper provides a novel ARRM adoption model and contributes six technological, seven organizational, and four environmental adoption success factors. The promoting factors are ARRM key features, qualitative operational advantages, quantitative operational advantages, value proposition, value creation network, finance, image, adoption management, resource allocation, strategic realignment, skills gap, and governmental regulation; further, augmented reality user experience, data connection, information provision, intellectual property protection, and remote service acceptance were identified as inhibiting factors. This paper qualifies as the first attempt to consolidate engineering-focused ARRM literature with respect to remote service delivery, adding the industrial adoption perspective and elaborating on the impact of the inter-organizational nature of ARRM technology on industrial adoption. Thus, this research contributes to the transition from pure engineering research to industrial ARRM adoption research.

Background: Increasing evidence for the efficacy of analgesic placebo effects in laboratory studies with healthy persons raises the question whether placebos could be used to improve the treatment of pain patients. Expectancies play a central role in shaping analgesic placebo but also nocebo effects. Objectives: We investigated to what extent a sham opioid infusion (saline solution) produces sustained clinically relevant placebo and nocebo effects in chronic back pain patients. Methods: Fifty-nine patients received the sham opioid infusion applied via a large drain dressing and were compared to 14 control patients without intervention (natural history, NH) while experimental pain stimuli were applied. All subjects were told that the infusion would decrease pain although in rare cases pain increase would be possible (induction of expectancy). In addition, conditioning was introduced where the participants either experienced a decrease in experimental pain (n = 17; placebo conditioning), an increase (n = 21; nocebo conditioning), or no change (n = 21, no conditioning). Results: Compared to the NH group, all infusion groups showed positive treatment expectancies and significantly (p < 0.001) reduced clinical back pain (primary outcome) and pain-related disability (secondary outcome, assessed by self-reported functional capacity and perceived impairment of mobility). Even the nocebo conditioned group experiencing increased experimental pain developed positive treatment expectancies followed by reduced pain experience. Positive treatment expectancies and relief in clinical back pain were significantly positively correlated (r = 0.72, p < 0.01). Conclusions: These findings suggest that it may be beneficial to explicitly shape and integrate treatment expectancies into clinical pain management.

To evaluate the cost effectiveness of the Nd-YAG laser and bronchoscopic electrocautery for palliation in patients with symptomatic tumor obstruction. A retrospective study. Bronchoscopy unit of a university hospital. Thirty-one consecutive patients with inoperable non-small cell lung cancer and symptomatic intraluminal tumor underwent bronchoscopic treatment. Dyspnea relief was the primary goal of treatment. Fourteen patients were treated with the Nd-YAG laser and 17 patients with electrocautery. Improvement of symptoms was achieved in 70% of patients treated by either Nd-YAG laser or electrocautery. Mean ± SD survival was 8.0 ± 2.5 months after Nd-YAG laser treatment and 11.5 ± 3.5 months after electrocautery. The number of treatment sessions per patient was comparable: Nd-YAG laser, 1.1; electrocautery, 1.2. Duration of hospital stay was longer in patients treated with the Nd-YAG laser (8.4 vs 6.7 days). Average treatment costs, including admission charges, were $5,321 for the Nd-YAG laser and $4,290 for electrocautery. Higher costs in the group treated with the Nd-YAG laser were caused by a longer hospital stay before bronchoscopic treatment. Costs of equipment (electrocautery $6,701 and Nd-YAG laser $208,333), write-offs, maintenance, and repair were not included in this calculation. Bronchoscopic electrocautery is equally effective but is a less expensive and, in our hospital, a more accessible modality than the Nd-YAG laser for symptomatic palliation of patients with intraluminal airway obstruction.

To evaluate the cost effectiveness of the Nd-YAG laser and bronchoscopic electrocautery for palliation in patients with symptomatic tumor obstruction. A retrospective study. Bronchoscopy unit of a university hospital. Thirty-one consecutive patients with inoperable non-small cell lung cancer and symptomatic intraluminal tumor underwent bronchoscopic treatment. Dyspnea relief was the primary goal of treatment. Fourteen patients were treated with the Nd-YAG laser and 17 patients with electrocautery. Improvement of symptoms was achieved in 70% of patients treated by either Nd-YAG laser or electrocautery. Mean +/- SD survival was 8.0 +/- 2.5 months after Nd-YAG laser treatment and 11.5 +/- 3.5 months after electrocautery. The number of treatment sessions per patient was comparable: Nd-YAG laser, 1.1; electrocautery, 1.2. Duration of hospital stay was longer in patients treated with the Nd-YAG laser (8.4 vs 6.7 days). Average treatment costs, including admission charges, were $5,321 for the Nd-YAG laser and $4,290 for electrocautery. Higher costs in the group treated with the Nd-YAG laser were caused by a longer hospital stay before bronchoscopic treatment. Costs of equipment (electrocautery $6,701 and Nd-YAG laser $208,333), write-offs, maintenance, and repair were not included in this calculation. Bronchoscopic electrocautery is equally effective but is a less expensive and, in our hospital, a more accessible modality than the Nd-YAG laser for symptomatic palliation of patients with intraluminal airway obstruction.

Wir wollen nun abschließend den Ertrag der Arbeit bewerten, indem wir einige zentrale Aspekte der Analyse aufgreifen und die Ergebnisse noch einmal theoretisch und in Anbetracht der Forschungslage reflektieren. Dabei konzentrieren wir uns deshalb auf einige Einzelerkenntnisse, weil eine Darstellung aller Ergebnisse aufgrund der Vielzahl der in der Arbeit integrierten Aspekte wenig erquickend wäre. Hierzu verweisen wir auf die Zusammenfassungen am Ende der Kapitel und das Zwischenresümee in Kapitel 4. Unsere generelle Fragstellung lautete: Wie kommen die Vorstellungen der Menschen von der Wirtschaft zustande und welche Quellen prägen das Bild von der Wirtschaft auf welche Weise und unter welchen Bedingungen? Ausgangspunkt war dabei das Phänomen, dass Menschen über Meinungen und Urteile zu wirtschaftlichen Sachverhalten verfügen und dass sie diese allem Anschein nach mit einer gewissen Leichtigkeit bilden, ohne größeren Aufwand betreiben zu müssen. Konkrete Vorstellungen von der Wirtschaft sind existent, ein bestimmtes Bild von der ökonomischen Realität ist bei den Menschen in der Regel vorhanden. Besonderes Interesse galt bei unseren Analysen nun der Frage, welche Rolle die Wirtschaftsberichterstattung der Medien bei der Konstruktion der ökonomischen Realität spielt, wie sich also die Medienberichterstattung in den Einstellungen der Menschen manifestiert. Dabei haben wir uns theoretisch an den kommunikationswissenschaftlichen Ansätzen zur Nachrichtenrezeption orientiert Basis unserer Analyse bildete die Annahme, dass es neben der eigenen Erfahrung, die jeder im Alltag mit der Wirtschaft macht, vor allem die Medien sind, die den Großteil an wirtschaftlicher Information transportieren. Das Publikum hätte sonst über einige Aspekte der Wirtschaft vermutlich keine eigenen Vorstellungsbilder entwickelt. Besonders deutlich wird dies am Beispiel der erinnerten Wirtschaftsereignisse unserer Befragten (Kapitel 6.2.1.1.1), die sich fast ausschließlich auf Geschehnisse bezogen, bei denen persönliche, direkte Erfahrungen unwahrscheinlich bis unmöglich sind. Bei der Frage nach aktuellen wirtschaftlichen Ereignissen sind es die medienvermittelten Information, die den Menschen sofort präsent sind. Und sie sind offenbar präsenter, als 277 ‚persönliche Wirtschaftsereignisse’. Die Mehrwertsteuererhöhung, der drohende Arbeitsplatzverlust, eine Gehaltserhöhung oder die Einführung von Studiengebühren - diese oder ähnliche Aspekte bilden in der Wahrnehmung der Menschen offenbar keine nennenswerten ‚wirtschaftlichen Ereignisse’ ab.Nun gibt es die Wirtschaft schon seit frühester Menschheitsgeschichte. Sie gab es schon, als es noch keine Medien gab, die eine breite Bevölkerungsschicht mit Wirtschaftsinformationen versorgte. Das heutige Bild der Menschen von der Wirtschaft dürfte sich zu dem vergangener Zeiten, da die Menschen ausschließlich auf ihre eigenen Erfahrungen und Empfindungen angewiesen waren, deutlich unterscheiden. Nicht zuletzt die Ausdifferenzierung des heutigen Wirtschaftssystems führt zu einem erhöhten Informations- und Orientierungsbedürfnis der Menschen zu wirtschaftlichen Aspekten und die Medien helfen, dieses Bedürfnis zu befriedigen - so der Grundgedanke. Für letztere Aussage konnten wir zwei Einschränkungen festmachen. Zum einen ist die tatsächliche Nutzung der Wirtschaftsinformationen der Medien bei der Bevölkerung trotz hohem Informationsbedürfnis nicht besonders ausgeprägt. Im Vergleich zu anderen medial vermittelten Informations- und Unterhaltungsangeboten wird die Wirtschaftsberichterstattung nur wenig genutzt: Gerade mal ein Drittel der Zeitungsleser liest den Wirtschaftsteil, die Wirtschaftssendungen des Fernsehens erreichen nur moderate Quoten. Die zweite Einschränkung bezieht sich auf die Qualität der Wirtschaftsberichterstattung und der damit verbundenen Frage, ob die Medien mit ihrer Berichterstattung dieser Orientierungsfunktion überhaupt gerecht werden.

WaterGAP is a global hydrological model that quantifies human use of groundwater and surface water as well as water flows and water storage and thus water resources on all land areas of the Earth. Since 1996, it has served to assess water resources and water stress both historically and in the future, in particular under climate change. It has improved our understanding of continental water storage variations, with a focus on overexploitation and depletion of water resources. In this paper, we describe the most recent model version WaterGAP 2.2d, including the water use models, the linking model that computes net abstractions from groundwater and surface water and the WaterGAP Global Hydrology Model (WGHM). Standard model output variables that are freely available at a data repository are explained. In addition, the most requested model outputs, total water storage anomalies, streamflow and water use, are evaluated against observation data. Finally, we show examples of assessments of the global freshwater system that can be achieved with WaterGAP 2.2d model output.

In renal transplantation, complement is involved in ischemia reperfusion injury, graft rejection and dysfunction. However, it is still unclear how induction of complement and its activation are initiated. Using allograft biopsies of a well-characterized cohort of 28 renal transplant patients with no rejection (Ctrl), delayed graft function (DGF), acute T-cell-mediated (TCMR) or antibody-mediated rejection (ABMR) we analyzed differences in complement reaction. For that mRNA was isolated from FFPE sections, quantified with a multiplex gene expression panel and correlated with transplant conditions and follow-up of patients. Additionally, inflammatory cells were quantified by multiplex immunohistochemistry. In allograft biopsies with TCMR and ABMR gene expression of C1QB was 2-4 fold elevated compared to Ctrl. In TCMR biopsies, mRNA counts of several complement-related genes including C1S, C3, CFB and complement regulators CFH, CR1 and SERPING1 were significantly increased compared to Ctrl. Interestingly, expression levels of about 75% of the analyzed complement related genes correlated with cold ischemia time (CIT) and markers of inflammation. In conclusion, this study suggest an important role of complement in transplant pathology which seems to be at least in part triggered by CIT. Multiplex mRNA analysis might be a useful method to refine diagnosis and explore new pathways involved in rejection.

Water – Global Assessment and Prognosis (WaterGAP) is a modeling approach for quantifying water resources and water use for all land areas of the Earth that has served science and society since 1996. In this paper, the refinements, new algorithms, and new data of the most recent model version v2.2e are described, together with a thorough evaluation of the simulated water use, streamflow, and terrestrial water storage anomaly against observation data. WaterGAP v2.2e improves the handling of inland sinks and now excludes not only large but also small human-made reservoirs when simulating naturalized conditions. The reservoir and non-irrigation water use data were updated. In addition, the model was calibrated against an updated and extended data set of streamflow observations at 1509 gauging stations. The modifications resulted in a small decrease in the estimated global renewable water resources. The model can now be started using prescribed water storages and other conditions, facilitating data assimilation and near-real-time monitoring and forecast simulations. For specific applications, the model can consider the output of a glacier model, approximate the effect of rising CO2 concentrations on evapotranspiration, or calculate the water temperature in rivers. In the paper, the publicly available standard model output is described, and caveats of the model version are provided alongside the description of the model setup in the ISIMIP3 framework.