Y Stenting in Wide-Necked Bifurcation Aneurysms: A Single-Center Experience

Stent-assisted coiling is an endovascular means of managing wide-necked bifurcation aneurysms. In spite of the wide availability of various newer devices in managing such difficult aneurysms, the Y stenting offers a safe and cost-effective alternative to treat such cases in resource poor settings. This article provides an insight of our initial six cases of Y stent-assisted coiling along with their follow-up over a period of 6 months with no recanalization in any case. It also highlights the various technical aspects involved in such cases. One case had recurrent subdural hematoma probably due to use of antiplatelets and another patient had sudden dip in level of consciousness probably due to hematoma expansion that might also have been due to antiplatelet usage. However, none of the cases had any issues regarding stent migration, malapposition, and dissection. In our experience, Neuroform Atlas stent used for Y stenting offers a safe and technically easy alternative to various newer bifurcation devices.

Feasibility and clinical utility of handheld fundus cameras for retinal imaging

Background/objectives Handheld fundus cameras are portable and cheaper alternatives to table-top counterparts. To date there have been no studies comparing feasibility and clinical utility of handheld fundus cameras to table-top devices. We compare the feasibility and clinical utility of four handheld fundus cameras (Remidio NMFOP, Volk Pictor Plus, Volk iNview, oDocs visoScope) to a table-top camera (Zeiss VisucamNM/FA). Subjects/methods Healthy participants (n = 10, mean age ± SD = 21.0 ± 0.9 years) underwent fundus photography with five fundus cameras to assess success/failure rates of image acquisition. Participants with optic disc abnormalities (n = 8, mean age ± SD = 26.8 ± 15.9) and macular abnormalities (n = 10, mean age ± SD = 71.6 ± 15.4) underwent imaging with the top three scoring fundus cameras. Images were randomised and subsequently validated by ophthalmologists masked to the diagnoses and devices used. Results Image acquisition success rates (100%) were achieved in non-mydriatic and mydriatic settings for Zeiss, Remidio and Pictor, compared with lower success rates for iNview and oDocs. Image quality and gradeability were significantly higher for Zeiss, Remidio and Pictor (p < 0.0001) compared to iNview and oDocs. For cup:disc ratio estimates, similar levels of bias were seen for Zeiss (−0.09 ± SD:0.15), Remidio (−0.07 ± SD:0.14) and Pictor (−0.05 ± SD:0.16). Diagnostic sensitivities were highest for Zeiss (84.9%; 95% CI, 78.2–91.5%) followed by Pictor (78.1%; 95% CI, 66.6–89.5%) and Remidio (77.5%; 95% CI, 65.9–89.0%). Conclusions Remidio and Pictor achieve comparable results to the Zeiss table-top camera. Both devices achieved similar scores in feasibility, image quality, image gradeability and diagnostic sensitivity. This suggests that these devices potentially offer a more cost-effective alternative in certain clinical scenarios.

OptiDiff: structural variation detection from single optical mapping reads

Detecting structural variation (SV) in eukaryotic genomes is of broad interest due to its often dramatic phenotypic effects, but remains a major, costly challenge based on DNA sequencing data. A cost-effective alternative in detecting large-scale SV has become available with advances in optical mapping technology. However, the algorithmic approaches to identifying SVs from optical mapping data are limited. Here, we propose a novel, open-source SV detection tool, OptiDiff, which employs a single molecule based approach to detect and classify homozygous and heterozygous SVs at coverages as low as 20x, showing better performance than the state of the art.

Alternative Extraction and Downstream Purification Processes for Anthocyanins

Anthocyanins are natural pigments displaying different attractive colors ranging from red, violet, to blue. These pigments present health benefits that increased their use in food, nutraceuticals, and the cosmetic industry. However, anthocyanins are mainly extracted through conventional methods that are time-consuming and involve the use of organic solvents. Moreover, the chemical diversity of the obtained complex extracts make the downstream purification step challenging. Therefore, the growing demand of these high-value pigments has stimulated the interest in designing new, safe, cost-effective, and tunable strategies for their extraction and purification. The current review focuses on the potential application of compressed fluid-based (such as subcritical and supercritical fluid extraction and pressurized liquid extraction) and deep eutectic solvents-based extraction methods for the recovery of anthocyanins. In addition, an updated review of the application of counter-current chromatography for anthocyanins purification is provided as a faster and cost-effective alternative to preparative-scale HPLC.

Vorinsolvenzlicher Restrukturierungsrahmen für Deutschland unter dem Einfluss der EU-Restrukturierungsrichtlinie

Under the political pressure of the COVID-19 pandemic, the German legislature implemented the EU Restructuring Directive at record speed with the StaRUG, thus creating for the first time a legal framework for corporate restructuring outside of insolvency proceedings. This study examines the highly topical transposition act in terms of its practical suitability and, on the basis of remaining regulatory gaps, develops an alternative doctrinal and structural approach that initiates further reform debates in the upcoming evaluation process. The author concludes that, de lege ferenda, German restructuring law should be enriched by a minimally invasive contractual framework that offers SMEs in particular a quick and cost-effective alternative.

Web-Based Platform for Planning and Configuration of Robot-Based Automation Solutions: A Retrospective View on the Research Project ROBOTOP

Automation solutions in production represent a sensible and long-term cost-effective alternative to manual work, especially for physically strenuous or dangerous activities. However, especially for small companies, automation solutions are associated with a considerable initial complexity and a high effort in planning and implementation. The ROBOTOP project, a consortium of industrial companies and research institutes has therefore developed a flexible web platform for the simplified, modular planning and configuration of robot-based automation solutions for frequent tasks. In this paper, an overview of the project’s scientific findings and the resulting platform is given. Therefore, challenges due to the scope of knowledge-based engineering configurators like the acquisition of necessary data, its description, and the graphical representation are outlined. Insights are given into the platform’s functions and its technical separation into different Microservices such as Best Practice selection, configuration, simulation, AML-data-exchange and spec-sheet generator with the focus on the configuration. Finally, the user experience and potentials are highlighted.

THE EFFICIENCY OF PROOF IN CIVIL PROCEDURE: THEORETICAL AND METHODOLOGICAL ASPECTS

The effectiveness of judicial protection is largely determined by the efficiency of proof. Modern methods of studying the effectiveness of law and legal activity make it possible to analyze issues of the efficiency of proof. What is the efficiency of proof? Should the proof be effective? Is it necessary to evaluate the effectiveness of evidence and for what? Can the efficiency of proof be assessed? How to evaluate and how to ensure such efficiency? What measures and procedural rules reduce costs and increase the efficiency of proof? The answers to these and many other questions are offered in the article, which also reveals the general theoretical and methodological aspects of the problem of the efficiency of proof. In conclusion of this paper the author puts forward the thesis based on the study that the very study and evaluation of the effectiveness of judicial proof allows to minimize its costs, to select the optimal cost-effective procedural means of achieving the goals of proof, to rationalize its procedural order. The study of the effectiveness of proof, thus, makes it possible to rationally choose the most effective and cost-effective alternative to build a procedural mechanism of proof.

CUSTOM MADE INTERNAL AND EXTERNAL NASAL SPLINTS : A COST EFFECTIVE ALTERNATIVE

Objectives: To evaluate the usability and effectiveness of tailor made internal and external nasal splints after nasal surgery. Study Design: An observational study. Place and Duration of Study: Combined Military Hospital Kohat, from Nov 2015 to Aug 2017. Methodology: the study was carried out on 523 patients who underwent nasal surgery by the same team of surgeons. Custom made free of cost internal and external nasal splints were used as required. Complications pertaining to the use of nasal splints were recorded. Results: The custom made splints were found to be an excellent and cost effective alternative of commercially available expensive splints. The benefits and pitfalls were comparable. Conclusion: Where these free of cost splints does the job they as well save a lot of money and can be used as an effective alternative to commercially available splints.

The Validity and Reliability of Two Commercially Available Load Sensors for Clinical Strength Assessment

Objective: Handheld dynamometers are common tools for assessing/monitoring muscular strength and endurance. Health/fitness Bluetooth load sensors may provide a cost-effective alternative; however, research is needed to evaluate the validity and reliability of such devices. This study assessed the validity and reliability of two commercially available Bluetooth load sensors (Activ5 by Activbody and Progressor by Tindeq). Methods: Four tests were conducted on each device: stepped loading, stress relaxation, simulated exercise, and hysteresis. Each test type was repeated three times using the Instron ElectroPuls mechanical testing device (a gold-standard system). Test–retest reliability was assessed through intraclass correlations. Agreement with the gold standard was assessed with Pearson’s correlation, interclass correlation, and Lin’s concordance correlation. Results: The Activ5 and Progressor had excellent test–retest reliability across all four tests (ICC(3,1) ≥ 0.999, all p ≤ 0.001). Agreement with the gold standard was excellent for both the Activ5 (ρ ≥ 0.998, ICC(3,1) ≥ 0.971, ρc ≥ 0.971, all p’s ≤ 0.001) and Progressor (ρ ≥ 0.999, ICC(3,1) ≥ 0.999, ρc ≥ 0.999, all p’s ≤ 0.001). Measurement error increased for both devices as applied load increased. Conclusion: Excellent test–retest reliability was found, suggesting that both devices can be used in a clinical setting to measure patient progress over time; however, the Activ5 consistently had poorer agreement with the gold standard (particularly at higher loads).