Maurer (Germany)

Figure"That night she laid herself down most sorrowful and afraid upon her bed and this night she said openly to her own heart that none knew if he would ever come back again."—Pearl S. Buck, The Mother This 17-year-old boy is here for his annual physical examination. He'll be a senior this year, the last season of his wrestling career. I ask him if he has any plans after high school graduation. He tells me that he plans to enlist in the Marines. Evidently, it's something he's always wanted to pursue—a career in the military service. I note the extensive sunburn on his back, shoulders, and face. He tells me that he fell asleep on the beach over the weekend. He can't stand sunblock on his skin. This is a major problem, because he's blond, blue-eyed, and fair-skinned. I banter back and forth with him, asking him about his girlfriend and his car. When I ask him what he's been doing with his summer, he says he's been "sitting in, moving out, and working as a day laborer on a farm." I ask him what sitting in means, and he tells me it means lying on the couch and watching TV. I ask him what moving out means, and he tells me it means moving out of the house to get an apartment of his own or live with another family. When I ask him why he would want to do that at the beginning of his senior year of high school, he tells me that he's been at loggerheads with his parents for some time—"maybe years"—and that he doesn't want to talk about it beyond that, because talking about it only makes him angry. I decide to respect his wish and move on to the physical examination. He's gained close to 15 pounds since last winter, nearly all of it solid muscle. Apart from the extensive sunburn on his skin, there are no other physical findings of note. I talk with him about avoiding excessive sun exposure; I administer his tetanus booster and complete the paperwork for his school sports participation. "Good luck!" I say, as he saunters down the hallway. His younger brother is waiting in the adjacent room, also here for a routine physical examination. I take the opportunity to ask him how things are going at home. "Fine," he says, tight-lipped, and leaves it at that. Afterwards, I complete his paperwork and walk it out to the front desk. When I call his mother back from the waiting room to review the results of the examinations, she immediately bursts into tears. Quickly, I usher her into a side room and motion for her to sit down. I offer her a box of tissues and wait. "My oldest son, did he say anything to you?" she asks, wiping her eyes. "He said things weren't going well at home, and he didn't want to talk about it, because talking about it only makes him angry." She nods her head. "He's got a lot of anger pent up inside. He wants to move out of the house. He says that there's a couple of families that offered to take him in, but I'm having a difficult time letting him go." "These things are never easy," I tell her. I pause momentarily to gather the thoughts running through my head. "Look, you've entrusted me with his medical care since he was a baby. He's always been a good kid. You've brought him up right. Sometimes in these instances the best thing you can do is let them go. Eventually, he'll find his way, and one day he'll come back on his own." "You think so?" I nod my head. "My wife and I raised four kids. One of our sons was just like your boy. We went through some tough times with him. He ended up leaving home to enlist in the service and got himself straightened out. Now he's self-sufficient, holding down a good job. Life has a way of coming around and working itself out." "My husband says the same thing: 'Let him go, he'll come around on his own.' I guess sometimes that's all you can do." She wipes her eyes one last time and rises to go. "Thanks for your time." The American humorist Garrison Keillor once remarked that every child is born to break his parents' hearts. I suppose in some sense that's true. Like this mother's son, like my son. Sometimes at the end of the day, the best you can do before you crawl into bed is to leave the back door unlocked and make sure the porch light is on.

Objective: To compare the complications between the Peripherally Inserted Central Catheter with length adjustment with cut and without cut. Method: Randomized controlled trial. Composed the sample 46 neonates admitted to a Neonatal Intensive Care Unit service in Paraná, Brazil, between April and July 2021, with catheter indication. Participants were electronically randomized and divided into a control group, whose catheter length was adjusted by cutting it, and an experimental group, whose catheter was kept uncut. Data were analyzed by Mann-Whitney test and Fisher's test. Results: The mean length of catheter stay was ten days in both groups (p=0.79). No relevant difference was identified regarding complications, such as infiltration, obstruction, and infection. Conclusion: Catheter cutting for length adjustment does not interfere in the complications presented. REBEC Register: RBR-2w4dpg5.

The relative motion of transverse cable dampers is smaller than predicted by the taut string model because of the effects of bending stiffness and fixed support conditions. As a result of the reduced damper motion, the dissipated energy per cycle is reduced as well, which may explain why damping measurements on real stay cables with transverse dampers often show lower cable damping ratios than expected from the taut string theory. To compensate for the reduced damper motion and damper efficiency, respectively, a semi-active cable damper is proposed. The controllable damper is realized by a hydraulic oil damper with real-time controlled bypass valve whereby the resulting damper force is purely dissipative. The proposed control law is clipped viscous damping with negative stiffness. The viscous coefficient is adjusted in real time to the actual frequency of vibration to generate optimum modal damping while the negative stiffness component partially compensates for the reduced damper motion due to the flexural rigidity and fixed support conditions of the cable. The measurements of the prototype semi-active hydraulic damper are used to derive a precise model of the semi-active damper force including the control force constraints due to the fully open and fully closed bypass valve. This model is used to compute the cable damping ratios of the first four cable modes, for typical damper positions, for a taut string model and for a cable model with flexural rigidity and fixed supported ends. The obtained cable damping ratios are compared to those resulting from the passive linear viscous damper being optimized to the first four cable modes. The results demonstrate that the proposed semi-active cable damper with the consideration of the minimum and maximum control force constraints significantly enhances the cable damping of the first four modes compared to the linear viscous damper.

Figure“Your first patient is ready in Room 7,” the nurse informs me. I check my morning schedule: this 1-month newborn well-child check, with no additional patients booked for the next half-hour, is certainly a satisfactory start—but in this business, without warning, things can go south in the blink of an eye. Quickly, I review the infant's growth parameters, scan the nursing notes, and step into the room. The father stands by the examination table, arms folded across his chest; the mother is seated on one of the chairs at the far end of the room. She rises to her feet as I extend a greeting. An empty infant carrier rests on the examination table. “And the patient?” I ask, with a playful look of feigned concern. Momentarily, the father shifts his body, exposing the infant wrapped in a baby blanket fast asleep on the table behind him. “Ah, there she is!” I say. “For a minute I thought we had lost her!” A slight smile forms on the father's lips; less so on the mother's. Today she's wearing ruby red lipstick; her thick black hair has been cropped short, just above the shoulder. I motion the mother to sit down, then proceed with my questions. “So tell me, how have things been going?” I ask. The father turns to the mother; they trade a fleeting glance, then the mother says: “She's gassy, a bit fussy; especially in the evenings. She stools once every 3 days and seems to be quite uncomfortable before she passes her bowel movements.” “I see. What do the stools look like?” “They are soft and green; a good amount.” “Any vomiting?” “No.” I show the parents the growth chart and point out the plots. “She's gaining appropriate weight,” I say. “She's growing well.” “I have some questions,” the father says. He proceeds to ask about taking the child outside for walks, the use of a motorized infant swing, when she will develop better head control, how much tummy time is appropriate for this age. Point by point, I address his concerns. He listens quietly, nodding his head. “So we don't have to worry—everything is fine?” the mother says. “You've got a healthy baby,” I say in my most reassuring voice. Both parents smile, albeit briefly. “By the way,” I say, “did the nurse give you a form to fill out—the EPDS?” Silently, the mother hands me the completed Edinburgh Postnatal Depression Scale form. I glance at the entries, mentally adding up the score. “How are you feeling about things these days?” I ask her. She offers a quick nod. “Better,” she says. “I have spoken with my obstetrician, and she has prescribed me a small dose of Zoloft, which seems to be helping. She has also advised me to go out for walks by myself, which I do.” “Has she suggested that you see a counselor?” I ask. “No, nothing like that. I am better now. It's just that—” she steals a glance at the father “—just that, well, I like to be home by myself with my baby; I don't like to have other people interfere, telling me how to handle the baby or what to do; because it is my baby; I know how to care for her, because I am her mother.” Once again her eyes glance at the father, then return to meet mine. “It is perfectly natural for a mother to want to care for her baby,” I say, “and you are doing a good job. I know your husband has been concerned about you because of everything you have been going through—” “He and his mother,” she says. I pause, somewhat taken aback. “Everyone has an opinion as to how you should mother your child,” she says. “That is why I prefer to be alone with my baby; and that is why I take long walks by myself when I can't be alone with my child.” In this business, things can go south without warning in the blink of an eye. Cultural norms go deep; so does postpartum depression. In a new country, a new culture, there are always growing pains—not only in infancy, but in adulthood as well. Pediatrics, that arbitrarily defined branch of medical practice that purports to deal with the care of children, sometimes encompasses much more than the feeding and nurturing of the infant.

Requirements for battery housings in e-vehicles are extensive: regulatory requirements; functional requirements; consideration of the installation conditions, transformation of forces and torques into the vehicle structure as well as wishes and demands of the end customer for trouble-free operation under a wide variety of climatic conditions.

With Gallium (Ga)-prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) as emerging imaging technique offering superior detection rates in biochemical recurrent prostate cancer, salvage lymph node dissection has gained increasing interest in localized oligometastatic prostate cancer. Currently, PSMA-targeting small molecules cannot only be linked to positron-emitting isotopes for imaging but also be labelled with γ-radiation emitting isotopes. These modified PSMA agents are evaluated for intraoperative guidance for resection of metastatic lymph nodes. This review aims to review current knowledge on the novel technique of PSMA-radioguided surgery. Recently radiolabeling of PSMA ligands with Indium and Technetium as γ emitter has been established. After preoperative intravenous injection of these novel PSMA agents single photon emission computed tomography/CT imaging can be performed using the γ-emitting properties. Although its diagnostic performance seems to be inferior to Ga-PSMA PET/CT, intraoperative guidance by the use of a γ probe was reported to facilitate detection and resection of tumour-infiltrated soft tissue. First follow-up data suggests favourable outcomes concerning prostate-specific antigen progression and treatment-free survival in a subset of patients. Although current knowledge is still limited and published data is sparse salvage surgery in recurrent prostate cancer facilitated by γ-emitting PSMA agents seems feasible. However, careful identification of ideal candidates for those procedures is mandatory.

FigureAnd I remember sitting there on the steps, looking up at him in his rocking chair and talking about my daddy, saying that I thought the worst thing that had happened in my life was his early death, that never having known him, I knew that I would, one way or another, be looking for him the rest of my life. —Harry Crews, A Childhood: The Biography of a Place “This 17-year-old boy is here for a physical exam,” the nurse says, handing me the chart. “He hasn't been in for 2 years. He needs his meningitis vaccine to start college this fall. His mother's out in the waiting room. Oh, and there's a sticky note posted inside: looks like his father died this past spring.” I let the chart fall open in my hands. Two words appear on a Post-It note, scrawled by an unknown hand: “Dad deceased” followed by the date of death, just 4 months ago. The boy sits on the examination table, clad in a plaid work shirt and faded blue jeans. He's got the beginnings of a downy blond beard on his narrow chin. A swath of pimples covers his forehead. His steely blue eyes meet mine. His lips draw back over a set of crooked teeth into some semblance of a smile as I extend him my hand. “I don't believe we've met,” I say, introducing myself. “Naw, I ain't seen you before,” he says. “It's been a while since I come in. I need a physical for college.” “I see. Where will you be going?” He names a local community college. “What do you want to study?” “Computers,” he says. “That's a good field to get into these days,” I say. He gives a slight nod of his head. “How has your health been?” The boy shrugs his shoulders. “Okay,” he says. “Any after-hours visits to the hospital? Any injuries? Taking any medications?” He shakes his head no. “Any major upheavals in your life since you came in last?” The steely blue eyes meet mine. “My daddy died a couple of months ago.” His words hover in the air. I let them settle. Then I say: “I'm sorry.” He nods his head slightly. “Had your father been ill?” “Naw. He had a heart attack, died in a car crash.” “How old was he?” “Fifty-six,” the boy says. “Were you close to him?” The boy nods his head. “I was livin' with him since he and my mom got divorced 3 years ago. Now I'm back with my mom and her friend again.” I study his steeled face. There is no hint of emotion. “Have you had an opportunity to talk to anyone—a counselor, perhaps—about all this?” “No. I'm not much for talkin'. I talk if I need to, but I usually keep to myself.” “Sometimes people feel better after they talk things out,” I say. “If you felt a need to do that, do you have a go-to person, someone you trust, someone you could talk to?” Slowly, he nods his head. “Yeah, I got my older brother,” he says. “He lives with his girlfriend, works two jobs, but he's around.” “Good,” I say. “I'm glad to hear that.” We proceed with the boy's examination. Afterward, I complete his paperwork, sign the forms, and hand them to the boy. “That should do it,” I say. “The nurse will be in shortly to finish up with your vaccine.” “Then I'm all set?” he asks. “All set,” I say. I offer him my hand. “Come back and see us anytime; the door's always open.” He nods his head. I think of my father, who lost his dad when he was a boy; a grandfather I never knew. I think of a boyhood friend, whose daddy died when he was 2. And I think of another good friend, a physician colleague, who never knew who his father was until he read the obituary his mother sent him one Fathers Day. Somehow they managed to surmount overwhelming odds to grow up to become solid salt-of-the-earth men. Perhaps this boy will follow in their footsteps; perhaps one day he will find his daddy again, I muse, as I make my way down the long hallway to an empty chair at the sparse steel desk in the back office.

<p>Viscous dampers are energy dissipators to be employed in particular for protection of structures against earthquake and/or certain service load cases. Designers specify design parameters and thus the characteristics of viscous dampers that shall be required as seismic protection of a certain structure. While it seems to be relatively simple to determine the theoretical design parameters by way of a computer simulation, the reality is often a different one when viscous dampers in the structure do not perform as specified as either the basic function needs were neglected or the real occurring function is different to the desired one.</p><p>It will be shown that the four standard design parameters of a viscous damper, to be “response force”, “stroke”, “damping constant” and “damping exponent” will be insufficient for a qualified specification, and that additional design parameters such as compressibility as well as function and geometric tolerances will make a deciding difference.</p>