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The United States (US) is experiencing a maternal health crisis, with high rates of maternal morbidity and mortality. The US has the highest rates of pregnancy-related mortality among industrialized nations. Maternal mortality has more than quadrupled over the last decades. Rural areas and minoritized populations are disproportionately affected. Increased pregnancy-care workforce with greater participation from family medicine, greater collaborative care, and adequate postpartum care could prevent many maternal deaths. However, more than 40% of birthing people in the US receive no postpartum care. No singular solutions can address the complex contributors to the current situation, and efforts to address the crisis must address workforce shortages and improve care during and after pregnancy. This essay explores the role family medicine (FM) can play in addressing the crisis. We discuss pregnancy care training in FM residencies as well as the threats posed by financial and medico-legal climates to the maternal health workforce. We explore how collaborative care models and comprehensive postpartum care may impact the maternal health workforce. Efforts and resources devoted to high impact solutions for which FM has considerable autonomy, including collaborative and postpartum care, are likely to have greatest impact.
In the current state of information technology and service provisioning techniques, containers are the leading technology for a stable, reliable and well-serviceable infrastructure. However, many containers simply put next to each other will lead to a mess of problems that containers were employed to solve originally. To overcome such challenges, container orchestrators are being used. Kubernetes is the leading container orchestrator through its extensive feature set, enabling e.g. self-healing capabilities and fast scaling with immense value for infrastructure operations.
This thesis looks at a few key aspects that arise when setting up a container-orchestrated landscape using Kubernetes such as what Kubernetes distributions are, how Kubernetes configuration is managed and what GitOps is.
In order to answer those questions, two requirements analyses were undertaken to find suitable software solutions for the Business Solutions department of Akkodis. All aspects were further answered with extensive research, resulting in lists of recommendations and suggested workflows. Using this method, a Kubernetes distribution and a backup solution were chosen. The Kubernetes distribution with the highest score is K3s mainly due to its use of ease and Batteries included approach. The backup solution with the highest score is Trilio Backup. GitOps with Infrastructure as Code is a very powerful approach that should be utilized in a Kubernetes cluster paired with Helm charts and Kustomize overlays.
To show the recommendations given being useful, a demonstration setup was created. It utilizes the results of the two requirements analyses and uses insights of the other sections to build a small proof of concept using the K3s Kubernetes distribution. An instance of the Kubernetes Dashboard utility was successfully provided using with the ArgoCD GitOps operator. A backup solution was to be implemented using Trilio Backup, but unexpected errors came up which could
not be solved in the thesis’ time frame. A few possibilities on the error’s source are suggested with potential solutions.
The main objective of this thesis is to evaluate the performance of a fixed time signal control system on a four-legged intersection at Glauchaer Platz, Halle. Stadt Halle has plans for a new design to replace the current flyover, which is set to expire in 2040. Two options are being considered: a roundabout and a four-legged intersection. This study explores the four-legged intersection to determine its performance under forecasted traffic conditions in 2040. Using traffic data provided by local authorities, a signal time plan for traffic light systems was developed with LISA+ and simulated using VISSIM microsimulation to evaluate the signalised intersection.
The study applies German guidelines (RiLSA & HBS) to evaluate the impact of the proposed fixed-time signal control system on traffic flow efficiency. The findings indicate that while the four-legged intersection can deliver a reasonable level of service (LOS), it may result in high waiting times on some routes and for pedestrians. This research provides valuable insights into urban traffic management by adapting signal control systems to the intersection's dynamics. The
findings have implications for improving traffic safety and efficiency and offer recommendations for developing optimal signal control systems.
Keywords: Signal control optimisation, LOS, LISA+, VISSIM, Urban traffic management,
RiLSA.
Purpose: The introduction of HER2-targeting antibody drug conjugates (ADCs) offers new treatment options for female breast cancer patients (FBC) expressing low levels of HER2 (HER2 low). No evidence was found that HER2 low describes a new FBC subtype. There is a lack of studies determining the impact of HER2 low in male breast cancer (MBC). In this study, we evaluate the prevalence of HER2 low in primary MBC and correlate the results with patient characteristics.
Patients and Methods: In this study, histological specimens were obtained from 120 male patients diagnosed and treated for primary invasive breast cancer from 1995 to 2022 at Breast Cancer Units in Bergisch Gladbach, Chemnitz, and Zwickau, Germany. HER2 immunostaining and in situ hybridization were performed by central pathology and evaluated based on the ASCO/CAP guidelines. The correlation of expression of HER2 low with tumor biological characteristics and patient outcomes was investigated.
Results: Out of all cases, four patients (3.3%) showed HER2 positivity (3+), 39 (32.5%) patients were classified as HER2 low, 7 (5.8%) were HER2 2+ (no amplification), 32 (26.7%) were HER2 1+, and 77 (64.2%) were classified as HER2 zero. Out of 77 HER2 zero cases, 47 tumors (61.0%) showed incomplete staining, with < 10% of tumor cells classified as HER2 ultralow. No statistical correlation between HER2 low and tumor biological characteristics and patients’ survival was found.
Conclusion: Our findings show a notable, albeit lower, prevalence of HER2 low expression in primary MBC. However, tumors expressing HER2 low do not show specific tumor biological features to define a new breast cancer subtype in MBC. Our results suggest that a significant number of MBC patients could benefit from ADCs, as shown in FBC. Further studies are required to better understand HER2 low breast cancer, both generally and in MBC.
In this work, iron hexacyanoferrate (FeHCF—Prussian blue) particles have been grown onto a reduced graphene oxide substrate through a pulsed electrodeposition process. Thus, the prepared FeHCF electrode exhibits a specific volumetric capacitance of 88 F cm−3 (specific areal capacitance of 26.6 mF cm−2) and high cycling stability with a capacitance retention of 93.7% over 10,000 galvanostatic charge–discharge cycles in a 1 M KCl electrolyte. Furthermore, two identical FeHCF electrodes were paired up in order to construct a symmetrical supercapacitor, which delivers a wide potential window of 2 V in a 1 M KCl electrolyte and demonstrates a large energy density of 27.5 mWh cm−3 at a high power density of 330 W cm−3.
Background: Hypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings.
Aim: The present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients.
Methods: A cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension.
Results: Among 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18–44 (2.05 [1.90–2.21]), Hispanic/Latino ethnicity (1.13 [1.03–1.23]), Medicaid (1.43 [1.29-1.58]) or self-pay (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41–6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08–1.34]), male (1.24 [1.17–1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62]) or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]).
Conclusion: The results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations.
