Experimental studies conducted to study the clinical and injury biomechanics of the cervical spine using human cadaver specimens have used the moments in the sagittal, coronal, or axial plane. These planar loading paradigms are used to determine the moment-rotation responses of spinal structures ranging from disc segments, functional units, multilevel segmented columns of the three mobile regions of the spine, and head-neck complexes. Tolerances under uni-axial compression and tension have been used in standards in automotive and other environments to advance safety. In the fore-aft seating environment, the head-neck complex of the human is erect and aligned horizontal with the Frankfort plane. Alternate seating arrangements in automated vehicle designs position the human in an out-of-position alignment. Any variations in the sagittal alignment of the spine induces multiplanar loading to the cervical column. Studies using multiplanar loading are sparse. The objective of this study was to develop injury risk curves under multiplanar loading human cadaver cervical spines and evaluate the performance of a finite element model of the spine using matched pair simulations. Five human cadaver cervical spinal column specimens were fixed at the C7-T1 joint and placed on a custom spinal positioning device. The base of skull was angulated by 30 degrees. The custom device applied the loading using an electrohydraulic piston. Data from the upper neck load cell a were gathered using a data acquisition system. Three tests were conducted on each of the five specimens. The first two non-injury tests were at a low velocity of 0.25 m/s, and the third injury test was at 1.5 m/s. Radiographs and palpation were done in between tests to ensure no injuries, and after the final test, x-rays and computed tomography images were obtained. Occipital condyle axial force and coronal moment were used to develop injury risk curves. A previously validated finite element model was used to simulate all the 15 individual specimen tests, and the experimental force and moment data were compared with model-predicted results. Four out of 15 tests resulted in injury to the atlas. Based on the optimal lognormal distribution, the peak force and moment of 550 N and 26 Nm were associated with the 50% probability of injury. The performance of the model based on the predictions for the forces and moments were well correlated with injury and non-injury experimental outcomes. As the sample size was low, it is recommended to conduct additional experimental and modeling studies to enhance robustness, and as a first step, the computational model can be used to conduct parametric studies that involve multiplanar loading scenarios simulated herein.

OBJECTIVE:The objective of this study was to evaluate the impact of four-rod (4R) constructs and interbody cages (IBCs) on pseudarthrosis and rod breakage (PA/RB) in patients with adult spinal deformity (ASD) who had undergone surgery with pelvic fixation and Schwab grade 2 osteotomies, using a combined finite element model (FEM) and clinical data analysis. METHODS:A validated FEM simulated Schwab grade 2 osteotomies at the L4-5 level in two-rod and 4R configurations, with or without IBCs at L4-5 and L5-S1. Rod strain and range of motion were calculated under a 7.5-Nm moment. Clinical analysis was conducted on ASD patients with pelvic fixation and Schwab grade 2 osteotomies and ≥ 2 years of follow-up. Patients were classified into 2 groups depending on the presence or absence of PA/RB. Demographic, surgical, radiographic, and patient-reported outcome measure (PROM) data were compared. RESULTS:The FEM analysis revealed maximal rod strain of 399 MPa at the osteotomy site in flexion. The 4R constructs and IBCs reduced strain to 114 MPa at L4-5 and 80 MPa at L5-S1. Among the 213 patients included in the study, PA/RB occurred in 61 (28.6%). Multivariate analysis revealed the use of 4R constructs (OR 0.331, 95% CI 0.16-0.71, p = 0.004) and IBCs (OR 0.46, 95% CI 0.23-0.94, p = 0.033) as protective factors. Patients with PA/RB experienced more unplanned reinterventions, worse scores on PROMs, and greater loss of sagittal alignment at 2 years postoperatively. CONCLUSIONS:Constructs with 4Rs and IBCs in ASD surgeries with pelvic fixation and Schwab grade 2 osteotomies significantly reduced rod strain and decreased the risk of PA/RB, leading to better scores on PROMs and decreasing unplanned reinterventions and loss of alignment.

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Model-based brain injury criteria can present higher potential to predict injury than global head kinematic parameters. Numerical head injury prediction tools are time consuming and require Finite Element (FE) skilled users. To address these difficulties, a deep learning technique was applied to an existing previously developed brain FE model for which an injury risk curve has been proposed in terms of maximum Von Mises stress to predict moderate diffuse axonal injury. A total of 4492 experimental head impacts coming from experimental helmet testing were considered as input for the analysis. Each input was expressed in terms of three linear accelerations and three angular velocities versus time, when the target metric was the time history Von Mises Stress (vms) curve computed within the brain via the FE analysis. The architecture used for the Deep Learning (DL) model is the U-Net and four models based on it were evaluated. The dataset was split into three datasets dedicated for learning and testing. The quality of the DL models were assessed via the Maximum Absolute Error between FE and DL models computed brain maximum vms. Further, a regression analysis of brain response with both methods was conducted. The results demonstrated that deep learning methods can be applied in the context of brain response estimation when helmet assessment is considered without any FE computation, only by considering the 6 D head kinematic vs time demonstrating that the deep learning approach should be further developed for research and industrial applications.

More than 25 years after Dayton Peace Accords (DPA), the shadows of the Yugoslav and of the subsequent construction of independent states based on ethnic division still looms over Bosnia & Hercegovina (BiH), its population, and the everyday life of people. The construction of its two major political entities - the Federation of Bosnia & Hercegovina (FBiH) and the Republika Srpska (RS) - is reflected in the health care system where it unfolds highly detrimental effects. Here, we can witness the severe impact on BiH's ability to establish an effective system for organ donation and transplantation. Based on a series of 26 interviews with patients, patients' organisations, clinicians and politicians BiH and its neighbours, the article identifies obstacles in clinical practices, post-Dayton bureaucracy as well as mistrust and corruption as major themes articulated by our respondents, ultimately imprisoning them in a Post-Dayton paralysis. Desperation amid the deadlocked structural conditions and contemplating alternatives ways of getting access to transplantation seem logical outcomes of a system widely regarded as deficient. This exemplifies the prosaic legacies of wars and the fragile state of BiH's politico-administrative system.

European Criminal Law has developed into a complex, jagged subject matter, which at the same time has become increasingly important for everyday criminal law practice. On the one hand, this work aims to do comprehensive justice to the complexity of the matter without sacrificing readability. In order to achieve this, the book’s structure enables legal scholars and experienced practitioners to access the information relevant to them in a targeted manner and, at the same time, enables less-oriented readers to gain access to European Criminal Law. Thus, the volume both answers basic questions and offers discussion in more specialised areas. Written by experts in the field, the book offers discussions that are both of the highest academic standards and accessibly readable.

Criminal law ranks among the most potent enforcement instruments of the EU. Despite its prominence, EU bodies and academia tend to be oblivious of its foundations and implications. This chapter analyses the concept, functioning and manifestations of criminal law as an enforcement instrument of EU law. It anchors criminal law in the enforcement architecture of the EU and explains how criminal law may strengthen compliance with EU law. While the chapter confirms numerous added values of criminal law enforcement it also sheds light on future questions and points of attention for researchers and practitioners. Most importantly, assessments suffer from a lack of statistical data and serious analytic shortcomings that researchers and policy-makers need to confront in the future to increase the effectiveness and legitimacy of criminal law enforcement.

The growing influence of qualitative visualisations that support qualitative and mixed methods approaches in population geography specifically open new perspectives for theoretical and methodological developments. Whereas qualitative research using visualisation remains rare when compared to quantitative approaches, several cases of innovation can be identified in population geography. Furthermore, we identified three favourable conditions to potentially inspire new methods of visualisation: the growing relevance of art-based research, an increasing number of transdisciplinary experiences, and the contemporary critical debate on communicating using maps. Based on this diagnosis, we call for systematic experiments and exchange that can inform an intense transdisciplinary academic debate on key epistemological questions, on different approaches to visualisation, and on new tools and techniques to visualise in population geography and beyond.

Background In settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients. Methods Our set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach. The six stages of the approach drew upon a review of the literature; the expertise of physicians, health services researchers, and representatives of physician associations and statutory health insurers; and the results of a pilot study with six informal network meetings of office-based physicians who share the same patients. Results The process resulted in a set of 248 general and disease specific indicators for 14 disease groups. The set provides information on the quality of care provided and on patient pathways, covering patient characteristics, physician visits, ambulatory care processes, pharmaceutical prescriptions and outcome indicators. The disease groups with the most indicators were ischemic heart diseases, diabetes and heart failure. Conclusion Our set of indicators provides useful information on patients’ health care use, health care processes and health outcomes for 14 commonly treated groups of ambulatory-care-sensitive conditions. This information can inform discussions in interdisciplinary quality circles in the ambulatory sector and foster patient-centered care.

Spätestens seit der Coronakrise ist Resilienz in aller Munde. Ob Mitarbeitende, Unternehmen oder ganze Volkswirtschaften, die Coronakrise stellt alle Teile der Wirtschaft vor große Herausforderungen. Ausgangspunkt dieses Buches ist die Frage, wie Unternehmen Krisen nicht nur überleben, vielmehr gestärkt aus einer Krise hervorgehen können, um schließlich innovativer und zukunftsfähiger zu sein. Der Autor untersucht in zwei Studien, welche Erfolgsfaktoren für Startups relevant sind und was HR-Manager:innen, Organisationsentwickler:innen, Berater:innen und Unternehmer:innen lernen können, um besser gewappnet zu sein für die Herausforderungen der Zukunft.

To compare instrumentation configurations consisting of bilateral single or double rods and additional interbody cages (IBCs) at different levels in terms of Range of Motion (ROM) and distribution of von Mises stress in rods. A previously validated L1-pelvis finite element model was used and instrumented with configurations consisting of single or double bilateral rods and IBCs at multiple levels. Pure moments of 7.5 N.m were applied to L1 in main directions in addition to a follower load of 280 N. Global, segmental ROM and distribution of von Mises stress in rods were studied. All configurations reduced segmental and global ROM from 50 to 100% compared to the intact spine. Addition of IBCs slightly increased ROM at levels adjacent to the IBC placement. The simple rod configuration presented the highest von Mises stress (457 MPa) in principal rods at L5-S1 in flexion. Doubling rods and IBC placement reduced this value and shifted the location of maximum von Mises stress to other regions. Among studied configurations, double rods with IBCs at all levels (L2-S1) showed the lowest ROM. Maximal von Mises stresses in secondary rods were lower in comparison to main rods. Double rods and IBCs reduced global and segmental ROM as well as von Mises stress in rods. The results suggest a possible benefit in using both strategies to minimize pseudarthrosis and instrumentation failure. However, increased ROM in adjacent levels and the shift of maximal von Mises stress to adjacent areas might cause complications elsewhere.

Surgical corrections of degenerative lumbar scoliosis and sagittal malalignment are associated with significant complications, such as rod fractures and pseudarthrosis, particularly in the lumbosacral junction. Finite element studies can provide relevant insights to improve performance of spinal implants. The aim of the present study was to present the development of non-instrumented and instrumented Finite Element Models (FEMs) of the lumbopelvic spine and to compare numerical results with experimental data available in the literature. The lumbo-pelvic spine FEM was based on a CT-scan from an asymptomatic volunteer representing the 50th percentile male. In a first step a calibration of mechanical properties was performed in order to obtain a quantitative agreement between numerical results and experimental data for defect stages of spinal segments. Then, FEM results were compared in terms of range of motion and strains in rods to in-vitro experimental data from the literature for flexible non-instrumented and instrumented lumbar spines. Numerical results from the calibration process were consistent with experimental data, especially in flexion. A positive agreement was obtained between FEM and experimental results for the lumbar and sacroiliac segments. Instrumented FEMs predicted the same trends as experimental in-vitro studies. The instrumentation configuration consisting of double rods and an interbody cage at L5-S1 maximally reduced range of motion and strains in main rods and thus had the lowest risk of pseudarthrosis and rod fracture. The developed FEMs were found to be consistent with published experimental results; therefore they can be used for further post-operative complication investigations.