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Background Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years’ experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. Methods The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals. Results Overall, 7881 patients were included (mean age 74.6 years ±12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. Conclusion The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.

Background Long-term support of stroke patients living at home is often delivered by family caregivers (FC). We identified characteristics of stroke patients being associated with receiving care by a FC 3-months (3 M) after stroke, assessed positive and negative experiences and individual burden of FC caring for stroke patients and determined factors associated with caregiving experiences and burden of FC 3 M after stroke. Methods Data were collected within TRANSIT-Stroke, a regional telemedical stroke-network comprising 12 hospitals in Germany. Patients with stroke/TIA providing informed consent were followed up 3 M after the index event. The postal patient-questionnaire was accompanied by an anonymous questionnaire for FC comprising information on positive and negative experiences of FC as well as on burden of caregiving operationalized by the Caregiver Reaction Assessment and a self-rated burden-scale , respectively. Multivariable logistic and linear regression analyses were performed. Results Between 01/2016 and 06/2019, 3532 patients provided baseline and 3 M-follow-up- data and 1044 FC responded to questionnaires regarding positive and negative caregiving experiences and caregiving burden. 74.4% of FC were older than 55 years, 70.1% were women and 67.5% were spouses. Older age, diabetes and lower Barthel-Index in patients were significantly associated with a higher probability of receiving care by a FC at 3 M. Positive experiences of FC comprised the importance (81.5%) and the privilege (70.0%) of caring for their relative; negative experiences of FC included financial difficulties associated with caregiving (20.4%). Median overall self-rated burden was 30 (IQR: 0–50; range 0–100). Older age of stroke patients was associated with a lower caregiver burden, whereas younger age of FC led to higher burden. More than half of the stroke patients in whom a FC questionnaire was completed did self-report that they are not being cared by a FC. This stroke patient group tended to be younger, more often male with less severe stroke and less comorbidities who lived more often with a partner. Conclusions The majority of caregivers wanted to care for their relatives but experienced burden at the same time. Elderly patients, patients with a lower Barthel Index at discharge and diabetes are at higher risk of needing care by a family caregiver. Trial registration The study was registered at “German Clinical Trial Register”: DRKS00011696. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011696

Background Large language models (LLMs) such as ChatGPT-4 and Google Gemini show potential for patient health education, but concerns about their accuracy require careful evaluation. This study evaluates the readability and accuracy of ChatGPT-4 and Google Gemini in answering questions about retinal detachment. Methods Comparative study analyzing responses from ChatGPT-4 and Google Gemini to 13 retinal detachment questions, categorized by difficulty levels (D1, D2, D3). Masked responses were reviewed by ten vitreoretinal specialists and rated on correctness, errors, thematic accuracy, coherence, and overall quality grading. Analysis included Flesch Readability Ease Score, word and sentence counts. Results Both Artificial Intelligence tools required college-level understanding for all difficulty levels. Google Gemini was easier to understand ( p  = 0.03), while ChatGPT-4 provided more correct answers for the more difficult questions ( p  = 0.0005) with fewer serious errors. ChatGPT-4 scored highest on most challenging questions, showing superior thematic accuracy ( p  = 0.003). ChatGPT-4 outperformed Google Gemini in 8 of 13 questions, with higher overall quality grades in the easiest ( p  = 0.03) and hardest levels ( p  = 0.0002), showing a lower grade as question difficulty increased. Conclusions ChatGPT-4 and Google Gemini effectively address queries about retinal detachment, offering mostly accurate answers with few critical errors, though patients require higher education for comprehension. The implementation of AI tools may contribute to improving medical care by providing accurate and relevant healthcare information quickly.

The diffusion of atoms in a solid is essential to many of its properties. However, imaging atomic diffusion has been a difficult task. The development of a technique that allows direct time-resolved imaging of atomic diffusion with coherent X-rays may therefore allow a broader study of this process on the atomic scale. Knowledge of atomic diffusion is a fundamental issue in synthesis and stability of materials. Direct studies of the elementary diffusion event, that is, how the individual atoms ‘jump’, are scarce, as the available techniques are limited to selected systems 1 . Here we show how by monitoring the spatial and temporal variations of the scattered coherent X-ray intensity the diffusion of single atoms can be studied. This is demonstrated for the intermetallic alloy Cu 90 Au 10 . By measuring along several directions in reciprocal space, we can elucidate the dynamical behaviour of single atoms as a function of their neighbourhood. This method, usually referred to as X-ray photon correlation spectroscopy 2 , 3 , 4 , 5 (XPCS), does not rely on specific atomic species or isotopes and can thus be applied to almost any system. Thus, given the advent of the next-generation X-ray sources, XPCS has the potential to become the main method for quantitatively understanding diffusion on the atomic scale.

OBJECTIVE: To investigate serum levels of the adipokine chemerin in patients on chronic hemodialysis (CD) as compared with control patients with a glomerular filtration rate (GFR) >50 ml/min. RESEARCH DESIGN AND METHODS: Chemerin was quantified by ELISA in control patients (n = 60) and CD patients (n = 60) and correlated with clinical and biochemical measures of renal function, glucose, and lipid metabolism, as well as inflammation, in both groups. RESULTS: Median serum chemerin levels were more than twofold higher in CD patients (542.2 μg/l) compared with subjects with a GFR >50 ml/min (254.3 μg/l) (P < 0.001). Furthermore, GFR, as assessed by the original Modification of Diet in Renal Disease formula, independently predicted circulating chemerin concentrations in multiple regression analyses in both control patients (P < 0.05) and CD patients (P < 0.01). CONCLUSIONS: We demonstrate that markers of renal function are independently related to circulating chemerin levels.

Background: Chemerin was recently introduced as a novel adipokine playing a crucial role in adipocyte differentiation and insulin signaling. In the current study, we investigated circulating chemerin levels in patients with gestational diabetes mellitus (GDM) as compared to healthy pregnant controls matched for gestational age and fasting insulin. Methods: Chemerin was quantified by ELISA in control (n = 80) and GDM (n = 40) patients and correlated to clinical and biochemical measures of renal function, glucose and lipid metabolism, as well as inflammation, in both groups. Results: Median maternal serum chemerin concentrations were not significantly different in subjects with GDM (230.3 µg/l) as compared to healthy pregnant controls (217.6 µg/l). Chemerin significantly and positively correlated with homeostasis model assessment of insulin resistance (HOMA-IR) and serum creatinine in uni- and multivariate analyses. Furthermore, chemerin serum levels were highest in patients in the third tertile of HOMA-IR. Conclusions: Chemerin is independently associated with markers of insulin resistance and renal dysfunction but is not dysregulated in GDM if patients are matched with controls for fasting insulin.

Optical nonreciprocity is a fundamental requirement for modern optical communications and quantum information processing, where it is essential to protect sensitive sources from destabilizing feedback and preserving quantum coherence. Conventional nonreciprocal devices are based on the Faraday effect; however, their dependence on bulky permanent magnets poses a significant barrier to chip-scale integration and scalability. Moreover, the application of a magnetic field is undesired in many quantum atomic systems. In this work, we demonstrate magnet-free optical nonreciprocity on a fully integrated platform utilizing a Nanophotonic Alkali Silicon Waveguide (NASWAG) interfaced with hot rubidium vapor. By employing velocity-selective optical pumping (VSOP), we break time reversal symmetry by taking advantage of the Doppler effect-generated by the thermally moving atoms, a phenomenon traditionally viewed as a limitation in atomic spectroscopy. We show that the use of suspended tapered waveguides significantly mitigates transit-time broadening, thereby enabling the observation of a robust nonreciprocal response. We further characterize the dependence of the isolation contrast on pump power, finding that the experimental measurements and numerical simulations correspond and provide mutual support for the underlying physical model. With proper optimization, the demonstrated effect may be used in the future for applications such as magnetic free optical isolators.

Magnetic skyrmions and related topological spin textures have emerged as a central topic in condensed-matter physics, combining fundamental significance with potential for transformative applications in spintronics, magnonics, and beyond. Over the past decade, advances in material platforms, imaging techniques, theoretical modeling, and device concepts have established skyrmionics as a rapidly expanding field. At the same time, challenges remain in stabilizing, controlling, and integrating such textures into functional architectures, while novel phenomena such as antiskyrmions, higher-order skyrmions, hopfions, and antiferromagnetic textures arise. The 2026 Skyrmionics Roadmap represents a collective effort of many authors, providing a comprehensive perspective on the current state-of-the-art and the outlook for the coming years. In 33 focused sections, each co-authored by two researchers, we chart progress in theory and modeling, material systems, skyrmion dynamics, and skyrmion technologies. By offering a consolidated vision, this Roadmap aims to guide both fundamental research and application-driven efforts, accelerating the transition of skyrmionics from conceptual breakthroughs toward practical technologies.