High spatial resolution underwater confocal LiDAR: reduction of optical aberrations in air-water interfaces using a dome port.

We study the impact of optical aberrations in underwater scanning confocal inelastic imaging arising from refraction at oblique incidences on a refractive index-mismatched air-glass-water interface. We experimentally demonstrate that optical aberrations at non-normal incidence drastically reduce the intensity of the inelastic signal and deteriorate the system resolution. At a 2.5° incidence angle, the return signal decreases to about 20% of its peak value at normal incidence. We implement passive correction using a spherical glass dome that is co-centered with the pivot point of the scanning mirror to ensure near-normal incidence on the interface irrespective of the scanning angle and depth. This configuration provides a drastic reduction in the optical aberrations within an angular range from -20° to 20°. The optical system is modeled in ray tracing software for validation. The interfacing of a scanning confocal system with a dome port unlocks near-diffraction-limited underwater imaging over wide areas without resorting to complex adaptive wavefront manipulation.

Rationale and design of a double-blinded, randomized placebo-controlled trial of 40 Hz light neurostimulation therapy for depression (FELIX).

BACKGROUND: Major depressive disorder (MDD) is a debilitating condition that affects more than 300 million people worldwide. Current treatments are based on a trial-and-error approach, and reliable biomarkers are needed for more informed and personalized treatment solutions. One of the potential biomarkers, gamma-frequency (30-80 Hz) brainwaves, are hypothesized to originate from the excitatory-inhibitory interaction between the pyramidal cells and interneurons. The imbalance between this interaction is described as a crucial pathological mechanism in neuropsychiatric conditions, including MDD, and the modulation of this pathological interaction has been investigated as a potential target. Previous studies attempted to induce gamma activity in the brain using rhythmic light and sound stimuli (GENUS - Gamma Entrainment Using Sensory stimuli) that resulted in neuroprotective effects in Alzheimer's disease (AD) patients and animal models. Here, we investigate the antidepressant, cognitive, and electrophysiological effects of the novel light therapy approach using 40 Hz masked flickering light for patients diagnosed with MDD. METHODS AND DESIGN: Sixty patients with a current diagnosis of a major depressive episode will be enrolled in a randomized, double-blinded, placebo-controlled trial. The active treatment group will receive 40 Hz masked flickering light stimulation while the control group will receive continuous light matched in color temperature and brightness. Patients in both groups will get daily light treatment in their own homes and will attend four follow-up visits to assess the symptoms of depression, including depression severity measured by Hamilton Depression Rating Scale (HAM-D17), cognitive function, quality of life and sleep, and electroencephalographic changes. The primary endpoint is the mean change from baseline to week 6 in depression severity (HAM-D6 subscale) between the groups.

Daylight quality: high-transmittance glass versus low transmittance glass - effects on daylight quality, health, comfort and energy consumption.

Introduction: This study investigated the health effects of two different architectural glass types: A two-layered low-iron high transmittance glass and a three-layered low energy glass with lower transmittance. The study investigated how these glass types affected daylight conditions in 72 residential apartments, as well as health and satisfaction of the residents.Methods: The study installed high transmittance glass (light transmittance LT:0.82) in 36 apartments and low transmittance (LT:0.74) in 36 identical apartments. The study then analyzed the light transmittance of each glass type in the laboratory and analyzed the indoor environmental quality (IEQ) in eight representative apartments before and after renovation. Self-reported questionnaires were handed out and collected before and after renovation.Results: The results showed that the glass types differed significantly in measured daylight transmittance. The two-layered high transmittance glass transmitted 15% more visual light (380-750 nm) and 20% more light in the spectral range (460-480 nm), stimulating ipRGCs and circadian rhythm, when compared to three-layered low energy glass. In addition, significant differences were observed in the UV-B spectrum (280-315 nm). While two-layered high transmittance glass transmitted UV-B, three-layered low transmittance glass did not. During the 12-month study period, residents in apartments with three-layered low energy glass reported more difficulties sleeping (p = 0.05), higher satisfaction with daylight (p = 0.03) and higher satisfaction with ventilation (p = 0.04). Residents in apartments with three-layered low energy glass experienced fewer days with too cold indoor temperatures (p = 0.02), compared to residents with two-layered low-iron glass. The results of energy consumption for heating showed that two-layered low-iron glass reduced the energy consumption by 11.0%, while three-layered low energy glass reduced the energy consumption by 9.4%, compared to the year prior to renovation.Conclusion: The results contribute to a discussion about potential energy savings on one hand and potential non-energy benefits, such as daylight quality, overall health, and total economy/life cycle assessment of the built environment on the other hand. The results suggest further research performed in randomized large-scale studies.

Brain stimulation with 40 Hz heterochromatic flicker extended beyond red, green, and blue.

Alzheimer's disease (AD) is associated with electrophysiological changes in the brain. Pre-clinical and early clinical trials have shown promising results for the possible therapy of AD with 40 Hz neurostimulation. The most notable findings used stroboscopic flicker, but this technique poses an inherent barrier for human applications due to its visible flickering and resulting high level of perceived discomfort. Therefore, alternative options should be investigated for entraining 40 Hz brain activity with light sources that appear less flickering. Previously, chromatic flicker based on red, green, and blue (RGB) have been studied in the context of brain-computer interfaces, but this is an incomplete representation of the colours in the visual spectrum. This study introduces a new kind of heterochromatic flicker based on spectral combinations of blue, cyan, green, lime, amber, and red (BCGLAR). These combinations are investigated by the steady-state visually evoked potential (SSVEP) response from the flicker with an aim of optimising the choice of 40 Hz light stimulation with spectrally similar colour combinations in BCGLAR space. Thirty healthy young volunteers were stimulated with heterochromatic flicker in an electroencephalography experiment with randomised complete block design. Responses were quantified as the 40 Hz signal-to-noise ratio and analysed using mixed linear models. The size of the SSVEP response to heterochromatic flicker is dependent on colour combinations and influenced by both visual and non-visual effects. The amber-red flicker combination evoked the highest SSVEP, and combinations that included blue and/or red consistently evoked higher SSVEP than combinations only with mid-spectrum colours. Including a colour from either extreme of the visual spectrum (blue and/or red) in at least one of the dyadic phases appears to be more important than choosing pairs of colours that are far from each other on the visual spectrum. Spectrally adjacent colour pairs appear less flickering to the perceiver, and thus the results motivate investigations into the limits for how alike the two phases can be and still evoke a 40 Hz response. Specifically, combining a colour on either extreme of the visual spectrum with another proximal colour might provide the best trade-off between flickering sensation and SSVEP magnitude.

Integrative Lighting Aimed at Patients with Psychiatric and Neurological Disorders.

The purpose of this paper is to investigate the impact of circadian lighting-induced melatonin suppression on patients with psychiatric and neurological disorders in hospital wards by using an ad-hoc metrology framework and the subsequent metrics formalized by the CIE in 2018. A measurement scheme was conducted in hospital ward rooms in the Department of Neurology, Zealand University Hospital, at Roskilde in Denmark, to evaluate the photometric and colorimetric characteristics of the lighting system, as well as its influence on the circadian rhythm of the occupants. The measurement scheme included point measurements and data logging, using a spectrophotometer mounted on a tripod with adjustable height to assess the newly installed circadian lighting system. The measured spectra were uploaded to the Luox platform to calculate illuminance, CCT, MEDI, etc., in accordance with the CIE S026 standard. Furthermore, the MLIT based on MEDI data logging results was calculated. In addition to CIE S026, we have investigated the usefulness of melatonin suppression models for the assessment of circadian performance regarding measured light. From the results, the lighting conditions in the patient room for both minimal and abundant daylight access were evaluated and compared; we found that access to daylight is essential for both illumination and circadian entrainment. It can be concluded that the measurement scheme, together with the use of the Luox platform and Canva template, is suitable for the accurate and satisfactory measurement of integrative lighting that aligns with CIE requirements and recommendations.

Study on the effect of 40 Hz non-invasive light therapy system. A protocol for a randomized, double-blinded, placebo-controlled clinical trial.

Introduction: With no cure or effective treatment, the prevalence of patients with Alzheimer's disease (AD) is expected to intensify, thereby increasing the social and financial burden on society. Light-based 40 Hz brain stimulation is considered a novel treatment strategy for patients with AD that may alleviate some of this burden. The clinical trial ALZLIGHT will utilize a novel Light Therapy System (LTS). The LTS uses Invisible Spectral Flicker for non-invasive induction of 40 Hz neural activity. This protocol describes a trial evaluating the efficacy and safety of a light-based 40 Hz brain stimulation in patients with mild-to-moderate AD. Methods: 62 patients with mild-to-moderate AD will participate in a randomized, double-blinded, placebo-controlled, parallel-group, and single-center trial. The participants will partake in an enrollment period of 1 month, an intervention period of 6 months, and a 1.5-month post-interventional follow-up period. Prior to the baseline measurement (week 0), the patients will be randomized to either active or placebo intervention from baseline (week 0) to post-intervention follow-up (week 26). Discussion: This protocol describes a randomized, double-blinded, placebo-controlled clinical trial that may increase the understanding of the effect of gamma oscillations in the human brain and how it could be utilized as a novel and important tool for the treatment of AD. The effect is measured through a large, multidisciplinary assessment battery.Clinical trial registration:www.ClinicalTrials.gov, (NCT05260177). Registered on March 2, 2022.

Unresolved mental health trauma: The languishing of public safety and public health professionals.

The collective awareness and acknowledgment of mental health challenges affecting all of us across our society is a trend that can inform targeted future interventions. Mental health conditions have only worsened during the past three years, secondary to the COVID-19 (SARS-CoV-2) pandemic. In the workplace, 67 percent of those surveyed reported at least one mental health symptom over the past year, demonstrating an increase from 59 percent in 2019.1 Recent findings approximate that first responders have a higher incidence (>30 percent) of developing mental health conditions, including depression, suicidal ideation, alcohol/drug abuse, and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population.2 A 2021 survey of more than 26,000 members of the public health workforce highlighted that 53 percent of respondents reported mental health symptoms, including PTSD, depression, anxiety, and suicidal ideation.3 A repeat survey in 2022 showed similar troubling trends.4 The hospital-based workforce has found increased mental health concerns as well, with employees leaving these professional settings to get a better hold on their mental health and support their work-life balance.

Confocal LiDAR for remote high-resolution imaging of auto-fluorescence in aquatic media.

Spatially resolved in situ monitoring of plankton can provide insights on the impacts of climate change on aquatic ecosystems due to their vital role in the biological carbon pump. However, high-resolution underwater imaging is technically complex and restricted to small close-range volumes with current techniques. Here, we report a novel inelastic scanning confocal light detection and ranging (LiDAR) system for remote underwater volumetric imaging of fluorescent objects. A continuous wave excitation beam is combined with a pinhole in a conjugated detection plane to reject out-of-focus scattering and accomplish near-diffraction limited probe volumes. The combination of bi-directional scanning with remote focusing enables the acquisition of three-dimensional data. We experimentally determine the point spread and axial weighting functions, and demonstrate selective volumetric imaging of obstructed layers through spatial filtering. Finally, we spatially resolve in vivo autofluorescence from sub-millimeter Acocyclops royi copepods to demonstrate the applicability of our novel instrument in non-intrusive morphological and spectroscopic studies of aquatic fauna. The proposed system constitutes a unique tool e.g. for profiling chlorophyll distributions and for quantitative studies of zooplankton with reduced interference from intervening scatterers in the water column that degrade the the performance of conventional imaging systems currently in place.

Safety, Feasibility, and Potential Clinical Efficacy of 40 Hz Invisible Spectral Flicker versus Placebo in Patients with Mild-to-Moderate Alzheimer's Disease: A Randomized, Placebo-Controlled, Double-Blinded, Pilot Study.

BACKGROUND: Recent studies suggested induction of 40 Hz neural activity as a potential treatment for Alzheimer's disease (AD). However, prolonged exposure to flickering light raises adherence and safety concerns, encouraging investigation of tolerable light stimulation protocols. OBJECTIVE: To investigate the safety, feasibility, and exploratory measures of efficacy. METHODS: This two-stage randomized placebo-controlled double-blinded clinical trial, recruited first cognitive healthy participants (n = 3/2 active/placebo), and subsequently patients with mild-to-moderate AD (n = 5/6, active/placebo). Participants were randomized 1:1 to receive either active intervention with 40 Hz Invisible Spectral Flicker (ISF) or placebo intervention with color and intensity matched non-flickering white light. RESULTS: Few and mild adverse events were observed. Adherence was above 86.1% of intended treatment days, with participants remaining in front of the device for >51.3 min (60 max) and directed gaze >34.9 min. Secondary outcomes of cognition indicate a tendency towards improvement in the active group compared to placebo (mean: -2.6/1.5, SD: 6.58/6.53, active/placebo) at week 6. Changes in hippocampal and ventricular volume also showed no tendency of improvement in the active group at week 6 compared to placebo. At week 12, a potential delayed effect of the intervention was seen on the volume of the hippocampus in the active group compared to placebo (mean: 0.34/-2.03, SD: 3.26/1.18, active/placebo), and the ventricular volume active group (mean: -0.36/2.50, SD: 1.89/2.05, active/placebo), compared to placebo. CONCLUSION: Treatment with 40 Hz ISF offers no significant safety or adherence concerns. Potential impact on secondary outcomes must be tested in larger scale clinical trials.

A Tunable Hyperspectral Imager for Detection and Quantification of Marine Biofouling on Coated Surfaces.

Fouling control coatings (FCCs) are used to prevent the accumulation of marine biofouling on, e.g., ship hulls, which causes increased fuel consumption and the global spread of non-indigenous species. The standards for performance evaluations of FCCs rely on visual inspections, which induce a degree of subjectivity. The use of RGB images for objective evaluations has already received interest from several authors, but the limited acquired information restricts detailed analyses class-wise. This study demonstrates that hyperspectral imaging (HSI) expands the specificity of biofouling assessments of FCCs by capturing distinguishing spectral features. We developed a staring-type hyperspectral imager using a liquid crystal tunable filter as the wavelength selective element. A novel light-emitting diode illumination system with high and uniform irradiance was designed to compensate for the low-filter transmittance. A spectral library was created from reflectance-calibrated optical signatures of representative biofouling species and coated panels. We trained a neural network on the annotated library to assign a class to each pixel. The model was evaluated on an artificially generated target, and global accuracy of 95% was estimated. The classifier was tested on coated panels (exposed at the CoaST Maritime Test Centre) with visible intergrown biofouling. The segmentation results were used to determine the coverage percentage per class. Although a detailed taxonomic description might be complex due to spectral similarities among groups, these results demonstrate the feasibility of HSI for repeatable and quantifiable biofouling detection on coated surfaces.

Novel Invisible Spectral Flicker Induces 40 Hz Neural Entrainment with Similar Spatial Distribution as 40 Hz Stroboscopic Light.

BACKGROUND: Exposure to 40 Hz stroboscopic light, for one hour a day, has previously been published as a potential treatment option for Alzheimer's disease in animal models. However, exposure for an hour a day to 40 Hz stroboscopic light can be strenuous and examining other types of 40 Hz inducing stimuli is paramount if chronic treatment is wanted. OBJECTIVE: A core assumption behind ensuring a therapeutic outcome is that the visual stimuli can induce 40 Hz gamma entrainment. Here, we examine whether a specific visual stimulus, 40 Hz invisible spectral flicker (ISF), can induce gamma entrainment and how it differs from both continuous light (CON) and 40 Hz stroboscopic light (STROBE). METHODS: The study included non-simultaneous EEG-fMRI neuroimaging of 13 young healthy volunteers during light exposure. Each light condition (i.e., CON, ISF, or STROBE) was active for 30 seconds followed immediately by the next. RESULTS: Entrainment of 40 Hz neural activity were significantly higher signal-to-noise ratio during exposure to ISF (mean: 3.03, 95% CI 2.07 to 3.99) and STROBE (mean: 12.04, 95% CI 10.18 to 13.87) compared to CON. Additionally STROBE had a higher entrainment than ISF (mean: 9.01, 95% CI 7.16 to 12.14). CONCLUSION: This study presents a novel method of 40 Hz entrainment using ISF. This enables the possibility of future randomized placebo-controlled clinical trials with acceptable double blinding due to the essentially imperceivable flicker, which is expected to substantially reduce discomfort compared to interventions with stroboscopic flicker.

Bio-Fortified Pork Cracklings with UVB LED Tailored Content of Vitamin D3.

Since few foods are naturally rich in vitamin D, novel food products with a high content of vitamin D are needed to decrease the prevalence of vitamin D deficiency. Pork cracklings are Danish snacks with high contents of protein and fat. They are consumed mostly during wintertime when sun exposure cannot fulfil human needs for vitamin D3. Pork cracklings were produced in an industrially friendly manner from UVB LED illuminated pork rind, using a combination of sous vide (85 °C, 60 min) and roasting in the oven (200 °C, 20 min). Thermal processing resulted in a significant loss of vitamin D3 (>90%). Thus, the process was optimized by the UVB exposure of pork cracklings, i.e., after thermal processing. The produced pork cracklings had a vitamin D3 level of ~10 µg/100 g, with a possibility of tailoring its final content. Furthermore, the fat content at 15−20% was a reduction of 50% compared to marketed products in 2021. No significant difference was found in the content of vitamin D3 during 31 days of storage in the air. A consumer preference test (n = 53) indicated that >80% of participants liked the product and saw its potential as a new food source of vitamin D3.

Microsecond pulse-mode operation of a micro-integrated high-power external-cavity tapered diode laser at 808 nm.

We investigate microsecond pulse-mode operation of a micro-integrated high-power diode laser based on volume Bragg grating external-cavity feedback around 808 nm. The laser system contains a tapered amplifier consisting of a ridge-waveguide section and a tapered section with separated electrical contacts. Thus, the diode laser system can be pulsed by modulating the injected current either to the ridge waveguide section (IRW) or to the tapered amplifier section (ITA). With a trigger signal of a 50 µs pulse width and a 10 kHz repetition rate, comparing the modulation depth, peak output power, beam propagation factor, and spectral bandwidth, we conclude that the pulse-mode operation achieved by modulating the ITA gives better results than by modulating the IRW due to the decreased thermal effect. At a constant IRW of 0.2 A and a modulated ITA of 6.0 A, 4.3 W of peak output power is obtained with an emission spectral bandwidth with an upper bound of 0.2 nm, and a beam propagation factor in the slow axis, Mslow2, of 2.6 (1/e2). The modulation depth is almost 100%. The results show that the tapered diode laser system may be a good candidate for microsecond pulse-mode solid-state lasers.

Micro-integrated high-power narrow-linewidth external-cavity tapered diode laser at 808 nm.

A novel compact micro-integrated high-power narrow-linewidth external-cavity diode laser around 808 nm is demonstrated. The laser system contains a tapered amplifier consisting of a ridge-waveguide section and a tapered section with separated electrical contacts. Thus, the injection currents to both sections can be controlled independently. An external volume Bragg grating is utilized for spectral narrowing and stabilization. The diode laser system is integrated on a 5mm×13mm aluminum nitride micro-optical bench on a conduction cooled package mount with a footprint of 25mm×25mm. The diode laser system is characterized by measuring the output power and spectrum with the injection currents to the ridge-waveguide section (IRW) and tapered amplifier section (ITA) changed in steps of 25 and 50 mA, respectively. At IRW=200mA and ITA=6.0A, 3.5 W of output power is obtained with an emission spectral linewidth with an upper bound of 6 pm, and a beam propagation factor in the slow axis, M2, of 2.6 (1/e2). The characterization of the temperature stabilization of the laser system shows an increase of the wavelength at a rate of 6.5 pm/K, typical for the applied volume Bragg grating.

Phosphor material dependent spot size limitations in laser lighting.

In laser lighting, a major benefit over other lighting techniques is the possibility to achieve very high luminous exitance. Focusing the exciting laser to a very small spot size on the phosphor, however, does not necessarily provide a very small emitting area for the white light. In this study we investigate experimentally and numerically the relationship between the white light spot size and the incident blue laser spot size. We show that the specific phosphor material properties have significant impact on this relationship and on the achievable minimum spot size. This constitutes a limitation on the minimum spot size achievable in laser lighting and has important implications in applications.

Dynamic LED light versus static LED light for depressed inpatients: results from a randomized feasibility trial.

BACKGROUND: Retrospective studies conducted in psychiatric wards have indicated a shorter duration of stay for depressed inpatients in bright compared to dim daylight-exposed rooms, pointing to a possible antidepressant effect of daylight conditions. Dynamic LED lighting, aiming to mimic daylight conditions, are currently been installed in several hospitals, but their feasibility is poorly investigated. METHODS: To investigate the feasibility of these systems, we developed and installed a LED-lighting system in four rooms in a psychiatric inpatient ward. The system could function statically or dynamically regarding light intensity and colour temperature. The system consisted of (A) a large LED luminaire built into the window jamb mimicking sunlight reflections, (B) two LED light luminaires in the ceiling and (C) a LED reading luminaire. In the static mode, the systems provided constant light from A and B. In the dynamic mode, the system changed light intensity and colour temperature using A, B and C. Patients with unipolar or bipolar depression were randomised to dynamic or static LED lighting for 4 weeks, in addition to standard treatment. Primary outcome was the rate of patients discontinuing the trial due to discomfort from the lighting condition. Secondary outcomes were recruitment and dropout rates, visual comfort, depressive symptoms and suicidal ideation. RESULTS: No participants discontinued due to discomfort from the LED lighting. Recruitment rate was 39.8%, dropout from treatment rates were 56.3% in the dynamic group and 33.3% in the static group. 78.1% in the dynamic group were satisfied with the lighting compared with 71.8% in the static group. Discomfort from the light (glare) was reported by 11.5% in the dynamic group compared to 5.1% in the static group. Endpoint suicidal scores were 16.8 (10.4) in the dynamic and 16.3 (14.9) in the static group. The lighting system was 100% functional. The light sensor system proved unstable. CONCLUSION: Dropout from treatment was high primarily due to early discharge and with a lack of endpoint assessments. The feasibility study has influenced an upcoming large-scale dynamic lighting efficacy trial where we will use a shorter study period of 3 weeks and with more emphasis on endpoint assessments. The lighting was well tolerated in both groups, but some found intensity too low in the evening. Thus, we will use higher intensity blue-enriched light in the morning and higher intensity amber (blue-depleted) light in the evening in the upcoming study. The light sensor system needs to be improved. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03363529.

Dynamic LED-light versus static LED-light for depressed inpatients: study protocol for a randomised clinical study.

INTRODUCTION: Retrospective studies conducted in psychiatric inpatient wards have shown a relation between the intensity of daylight in patient rooms and the length of stay, pointing to an antidepressant effect of ambient lighting conditions. Light therapy has shown a promising antidepressant effect when administered from a light box. The emergence of light-emitting diode (LED) technology has made it possible to build luminaires into rooms and to dynamically mimic the spectral and temporal distribution of daylight. The objective of this study is to investigate the antidepressant efficacy of a newly developed dynamic LED-lighting system installed in an inpatient ward. METHODS AND ANALYSIS: In all, 150 inpatients with a major depressive episode, as part of either a major depressive disorder or as part of a bipolar disorder, will be included. The design is a two-arm 1:1 randomised study with a dynamic LED-lighting arm and a static LED-lighting arm, both as add-on to usual treatment in an inpatient psychiatric ward. The primary outcome is the baseline adjusted score on the 6-item Hamilton Depression Rating Scale at week 3. The secondary outcomes are the mean score on the Suicidal Ideation Attributes Scale at week 3, the mean score on the 17-item Hamilton Depression Rating Scale at week 3 and the mean score on the World Health Organisation Quality of Life-BREF (WHOQOL-BREF) at week 3. The spectral distribution of daylight and LED-light, with a specific focus on light mediated through the intrinsically photosensitive retinal ganglion cells, will be measured. Use of light luminaires will be logged. Assessors of Hamilton Depression Rating Scale scores and data analysts will be blinded for treatment allocation. The study was initiated in May 2019 and will end in December 2021. ETHICS AND DISSEMINATION: No ethical issues are expected. Results will be published in peer-reviewed journals, disseminated electronically and in print and presented at symposia. TRIAL REGISTRATION NUMBER: NCT03821506; Pre-results.

Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department.

Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and "peeing air." CT scan revealed air extending from the left renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Bedside point-of-care ultrasound (POCUS) subsequently revealed dirty shadowing and reverberation artifacts in the left kidney and the bladder consistent with gas in the urinary collecting system. By understanding the identifying artifacts seen with EPN, reflective shadow and reverberation artifact, the emergency physician may be alerted to the diagnosis sooner. Often this illness presents similarly to simple, acute pyelonephritis or undifferentiated sepsis. Therefore, POCUS allows for real time consideration of this condition while in the emergency department and thus prompter time to treatment.

The aesthetic nature of the birthing room environment may alter the need for obstetrical interventions - an observational retrospective cohort study.

The concept of sensory delivery rooms was introduced in 2013. These rooms offer programmable calming lights, restful blurred pictures displayed on a wall-sized big screen, and sound effects. The primary aim of this observational study was to analyse the risk of obstetrical interventions among women giving birth for the first-time in a sensory delivery room vs. a standard delivery room. We included nulliparous, term pregnant women having a single baby with a cephalic presentation who were in spontaneous labour and gave birth between March 1st 2014 and July 1st 2015 in North Zealand Hospital, Hillerød. A total of 789 women were included in the study, 313 gave birth in a sensory room and 476 in a standard delivery room. The risk of a caesarean delivery was significantly decreased when giving birth in a sensory room compared with a standard delivery room (OR, multiple adjusted: 0.44; 95% CI 0.22-0.87); furthermore, the use of oxytocin infusion was also reduced (OR, multiple adjusted: 0.71; 95% CI 0.50-1.03). This observational cohort study suggests that giving birth in a sensory delivery room could lower the risk of caesarean delivery, potentially reducing the number of such deliveries by one for every 23 patients.