Determinants of the Implementation of Telemedicine in the German Navy-A Mixed Methods Study.

INTRODUCTION: The history of the use of telemedicine in maritime medicine dates back to the 1930s. In the early 2000s, the German Navy built up a telemedicine network which today is installed in all ships and provides a connection to the medical infrastructure ashore. The objective of this study was to optimize the implementation of telemedicine based on the experience gained in the German Navy. For this purpose, qualitative and quantitative methods were used to identify determinants which affect the use of telemedicine in order to determine whether there is any need for optimization. METHODS: The study was conducted using a mixed methods design. First, guideline-based interviews were conducted with Navy medical officers who had been recruited via various email distribution lists. The interviews were then transcribed and coded. In an analysis, deductive and inductive categories were derived from the codes. Hypotheses were deduced from the interviews, too, and used to develop a questionnaire.Besides the medical officers, other Navy medical personnel with experience in the field of telemedicine took part in the survey. The study was concluded by a descriptive analysis of the quantitative data. RESULTS: The analysis of the interviews revealed that a regular use of telemedicine workstations increased the users' confidence and, in their opinion, improved medical treatment. Technical and organizational problems posed obstacles, which increased the use of partly insecure alternatives. A proper technical support was regarded as a precondition for effectively using telemedicine.The results of the quantitative analysis showed that consultation was mainly sought for dermatological (46%), surgical (24%), and internal (22%) conditions. CONCLUSION: The study revealed determinants for the use of telemedicine in the German Navy. Factors improving the motivation of the users should be strengthened in order to optimize the use of telemedicine. Furthermore, it can be assumed that a successful implementation will be supported by reducing or eliminating obstacles. The findings on the main reasons for seeking medical advice could be taken into account in the further planning of specific training.

Voltage-Induced Rearrangements in Atomic-Size Contacts.

We study voltage-induced conductance changes of Pb, Au, Al, and Cu atomic contacts. The experiments are performed in vacuum at low temperature using mechanically controllable break junctions. We determine switching histograms, i.e., distribution functions of switching voltages and switching currents, as a function of the conductance. We observe a clear material dependence: Au reveals the highest and almost conductance-independent switching voltage, while Al has the lowest with a pronounced dependence on the conductance. The theoretical study uses density functional theory and a generalized Langevin equation considering the pumping of particular phonon modes. We identify a runaway voltage as the threshold at which the pumping destabilizes the atomic arrangement. We find qualitative agreement between the average switching voltage and the runaway voltage regarding the material and conductance dependence and contact-to-contact variation of the average characteristic voltages, suggesting that the phonon pumping is a relevant mechanism driving the rearrangements in the experimental contacts.

iNALU: Improved Neural Arithmetic Logic Unit.

Neural networks have to capture mathematical relationships in order to learn various tasks. They approximate these relations implicitly and therefore often do not generalize well. The recently proposed Neural Arithmetic Logic Unit (NALU) is a novel neural architecture which is able to explicitly represent the mathematical relationships by the units of the network to learn operations such as summation, subtraction or multiplication. Although NALUs have been shown to perform well on various downstream tasks, an in-depth analysis reveals practical shortcomings by design, such as the inability to multiply or divide negative input values or training stability issues for deeper networks. We address these issues and propose an improved model architecture. We evaluate our model empirically in various settings from learning basic arithmetic operations to more complex functions. Our experiments indicate that our model solves stability issues and outperforms the original NALU model in means of arithmetic precision and convergence.

Detection of slow port scans in flow-based network traffic.

Frequently, port scans are early indicators of more serious attacks. Unfortunately, the detection of slow port scans in company networks is challenging due to the massive amount of network data. This paper proposes an innovative approach for preprocessing flow-based data which is specifically tailored to the detection of slow port scans. The preprocessing chain generates new objects based on flow-based data aggregated over time windows while taking domain knowledge as well as additional knowledge about the network structure into account. The computed objects are used as input for the further analysis. Based on these objects, we propose two different approaches for detection of slow port scans. One approach is unsupervised and uses sequential hypothesis testing whereas the other approach is supervised and uses classification algorithms. We compare both approaches with existing port scan detection algorithms on the flow-based CIDDS-001 data set. Experiments indicate that the proposed approaches achieve better detection rates and exhibit less false alarms than similar algorithms.

Charge Transport through Ferrocene 1,1'-Diamine Single-Molecule Junctions.

The charge transport through ferrocene 1,1'-diamine (FDA) molecules between gold electrodes is investigated using the mechanically controllable break junction technique combined with a theoretical framework of density functional theory simulations to understand the physics of these molecular junctions. The characteristic conductances of the molecule are measured at low bias as well as current-voltage (IV) characteristics. By fitting the IV characteristics to the single-level model, the values for the position of the molecular level, mainly responsible for the transport, and its coupling to the leads, are obtained. The influence of the binding sites, molecular conformation, and electrode distance are systematically studied from a theoretical perspective. While a strong dependence of conductance on the adsorption geometry is found, the decrease of conductance as a function of electrode distance arises mainly from a decrease of coupling strength of the molecular electronic orbitals through a reduced overlap and, to a lesser extent, from a shift of their alignment with respect to the Fermi energy.

Ten-year follow-up of endovascular aneurysm treatment with Talent stent-grafts.

The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 +/- 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 +/- 34.2 months (range, 0-123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 +/- 4.7 months. Mean survival and freedom from any event was 66.7 +/- 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P < 0.01). Patients in whom all aneurysm side branches were occluded prior to stent-grafting showed a significantly reduced incidence of large endoleaks. Endoleaks >10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks (Delta at 3 years, -1.8% vs. -12.0%; P < 0.05). In conclusion, endovascular aneurysm treatment with Talent stent-grafts demonstrated encouraging long-term results with moderate secondary intervention rates. Primary occlusion of all aortic side branches reduced the incidence of large endoleaks. Large endoleaks significantly impaired aneurysm shrinkage, whereas small endoleaks did not.