Search

This article investigates the extent to which parents believe they are better than average parents using data from the UK Millennium Cohort Study. The article builds on a long tradition of sociological research focusing on the interconnections between parenting, class, education and inequality. We find that mothers with low levels of education are more likely to say they are average or worse than average parents. Relatedly, we show that those who are highly educated are more likely to consider themselves as being better than average, even when a range of child and mother characteristics such as mother’s mental health and child’s cognitive and socio-emotional development are considered. These findings are linked to research showing how certain groups of parents are stigmatised or valorised in popular and political discourse. Our article also extends scholarship by examining the connection between parental mental health and parental competence beliefs.

Investigators commonly offer payments to research participants to promote recruitment and retention. Yet the ethics of offering monetary incentives to research participants continues to be debated. Prior conceptual work has addressed some of these concerns; there is, however, also a need for empirical evidence to understand the effects of payment on participants. Here, we report the results of a qualitative study comprising (1) discourse analysis of recruitment conversations between study coordinators and potential participants for an actual clinical trial and (2) semistructured interviews with participants addressing the effects of an incentive on their decision-making. Many participants reported that money had been a motivation for enrolling in the clinical trial but did not use reasoning that suggested undue influence or unjust inducement. These findings add to a growing body of literature suggesting that payment is an ethically acceptable tool for promoting recruitment and retention in clinical trials.

Like a mobile phone camera, optical microscopy typically relies on optical lenses that convert a plane wave to a spherical wave or vice versa. In such conventional imaging scheme, light from an object point propagates through a set of lenses and creates a tight focus on a camera, resulting in 1 to 1 relation between the object point and the camera pixel. Recently, this conventional imaging paradigm has been challenged by a new paradigm where computational algorithms replace the role of lenses. Here, I will introduce the concept of computational optics and some novel microscopy techniques based on algorithms.

Introduction: The association between triamcinolone hexacetonide (TH) and gold nano-particles (GNPs) represents a promising treatment due to the potential anti-inflammatory and anti-oxidant effects of these compounds. In this study, we evaluated the effects of intra-articular treat-ment of TH associated with GNPs in a mechanical model of osteoarthritis (OA). Methods: Fifty Wistar rats were divided into five groups: Sham; OA; OA+TH; OA+GNPs; OA+TH-GNPs. Both applications were performed 30 and 60 days after the model was induced. Af-ter 30 days of the last application, the animals were euthanized. Results: Only the combined treatment with TH and GNPs promoted a reduction in pro-inflammatory cytokines and an increase in anti-inflammatory cytokines. The OA+TH-GNPs group obtained a significant reduction in the production of oxidants and oxidative damage markers while an increase in antioxidants. Histologically, all treated groups showed results of a significant increase in cartilage thickness and chondrocyte count, the OA+TH-GNPs group had similar behavior to the group without osteoarthritis, with significantly smaller amounts of chondrocytes than the OA group. Conclusion: The intra-articular use of TH associated with GNPs may be able to prevent the pro-gression of the pathology and minimize joint degradation.

We compute numerical solutions to a linearly constrained phase separation problem and a nonlinearly constrained phase separation problem on compact surfaces. Results are presented for oblate and prolate ellipsoids and Cassinian ovals. We implement a finite element, phase field method to determine solutions in the form of patches that are approximately geodesic disks for some values of the parameters. Our patches are numerical solutions to diffuse interface problems, and they exhibit qualitative features of solutions to corresponding sharp interface problems that are often studied in a $ \Gamma $-convergence setting. Our use of a nonlinear conservation constraint is motivated by a desire to sharpen the interface between two distinct regions: the patch and the rest of the surface. To this end, we explore features of the patches arising in both problems. A "geodesic protocol" is implemented to generate various statistics concerning the patch that are useful for measuring patch deviation from a geodesic disk shape. We then perform the Student's $ t $-test on paired differences of these statistics to determine whether or not there is a significant statistical difference between the linear constraint and nonlinear constraint approaches. The novel use of statistical analysis to compare these two methods reveals noteworthy differences. We show that the two approaches yield significantly different results for some of the statistics. The statistical results are found to depend on both the type of geometry and the patch size in some situations. Small patches are difficult to compute numerically, but we find that the use of a nonlinear constraint aids in their computation.

Li-vacant layered surface structures and reduced Li residuals achieved by water treatment boost transport kinetics of Ni-rich layered oxide cathodes.

COVID-19 is an independent risk factor for pulmonary embolism (PE). Little is known about alteplase therapy in this patient group. A retrospective study analyzed 74 patients with PE and acute respiratory distress syndrome (ARDS) due to COVID-19 who were hospitalized in the intensive care unit in 2021. Patients with or without confirmed right heart thrombi (RHT) were treated with unfractionated heparin or alteplase. The mortality rate in patients with RHT treated with heparin was 100% compared to 37.9% and 55.2% in those treated with alteplase without RHT and alteplase with RHT, respectively. The risk of death in the alteplase group increased with delayed thrombolysis (p = 0.009, odds ratio (OR) = 1.73 95% CI (confidence interval) 1.14–2.62), increased D-dimer concentration (p = 0.02, OR = 1.43 95% CI 1.06–1.93), and decreased PaO2/FiO2 ratio (p = 0.001, OR = 0.56 95% CI 0.41–0.78). The receiver operating characteristic method determined that a 1-day delay in thrombolytic treatment, D-dimer concentration >5.844 mg/L, and PaO2/FiO2

Encefalopatia traumática crônica (ETC) é uma neuropatia expressada como um quadro demencial cuja clínica envolve declínio cognitivo e mudanças graves comportamentais. A ETC pode se estabelecer após concussões repetitivas que costumeiramente ocorrem em esportes com alto índice de contato; dentre esses os de maiores riscos se enquadram o boxe e o futebol americano. A ETC, assim como sua gravidade, são proporcionais à idade e quantidade de impactos. Portanto, sugere-se que essa moléstia e seus déficits sejam causados pelo efeito acumulativo de traumatismos cranioencefálicos (TCEs) leves que causam up-regulation da proteína precursora do peptídeo beta amilóide e da proteína TAU, que consequentemente forma emaranhados neurofibrilares. O acúmulo de ambas substâncias geram modificações anatômicas estruturais (macro e microscópicas) e desencadeiam os sinais e sintomas neuropsiquiátricos. Dessa forma, a ETC pode ser confundida com outros tipos de demências, entre elas a Doença de Alzheimer. Visto que se trata de uma condição clínica complexa, é importante estabelecer um diagnóstico precoce e promover uma conduta clínica de maneira precisa, com o intuito de amenizar os danos e os prejuízos cognitivos gerados. A gravidade e a irreversibilidade da ETC deveriam nortear a prática esportiva com cuidados de múltiplas perspectivas, prevenindo, assim, as consequências geradas por essa condição.

O coma mixedematoso (CM) é uma condição clínica rara resultante do hipotireoidismo descompensado com fator precipitante subjacente. Ele ocorre principalmente no inverno e atinge principalmente mulheres e idosos, apresentando altas taxas de mortalidade, podendo chegar a aproximadamente 25%. Por isso, visando reduzir esses valores e aumentar a sobrevida do paciente, o diagnóstico precoce é imprescindível, juntamente com o controle dos fatores precipitantes, manejo terapêutico e suporte adequado. Diante desse quadro, o profissional de saúde deve atentar-se para as alterações sistêmicas que essa doença pode causar, como insuficiência respiratória, hipernatremia, hipoglicemia, hipotermia e hipertensão diastólica. Ademais, visto que essa enfermidade apresenta dificuldades de manejo, por resultar em uma série de alterações orgânicas expressivas, o tratamento deve ser iniciado mesmo que empiricamente: estabilizar o paciente com medidas de suporte, reconhecer a sintomatologia, iniciar o tratamento com Levotiroxina e, por fim, identificar o fator causal da descompensação metabólica. De fato, a taxa de mortalidade pela crise mixedematosa é alta, perante tal situação, é fundamental o estabelecimento de um gama de múltiplas perspectivas e cuidados multidisciplinares com a finalidade de aumentar a sobrevida daqueles afetados pela enfermidade.

ZusammenfassungDie Versorgung des oberen Sprunggelenks (OSG) mithilfe einer Totalprothese (TP) ist heutzutage eine etablierte und sichere operative Therapie der Arthrose am OSG. Moderne Implantate haben geringe Revisionsraten und sind der Arthrodese des Sprunggelenks hinsichtlich des von Patienten berichteten Ergebnisses überlegen. Der Stellenwert der primären endoprothetischen Versorgung von Frakturen am OSG ist unklar. Aktuell finden sich diesbezüglich in der Literatur keine Studien. In Anbetracht der steigenden Fallzahlen instabiler Sprunggelenkfrakturen, insbesondere bei älteren Patienten und aufgrund wachsender funktioneller Ansprüche auch bis ins hohe Lebensalter, gilt es zukünftig beim Management dieser Frakturen auch eine endoprothetische Versorgung zu berücksichtigen. Klinische Studien sind notwendig, um die Versorgung von Frakturen des OSG mithilfe einer TP zu evaluieren.

The burnout literature is replete with burnout score results from quantitative surveys. There is a paucity of qualitative research that seeks to understand the impact of physician stressors on work-life balance and burnout. This study aimed to identify factors that support and disrupt work-life balance, drivers of burnout, and potential solutions among academic dermatologists. The objective was to better understand factors that promote wellness and ameliorate burnout. Concurrent explanatory mixed methods consisted of scores on the Abbreviated Maslach Burnout Inventory and open-ended semi-structured telephone interviews. The results were that positive factors, such as supportive home life and satisfaction derived from academic endeavors, compete with ongoing feelings of exhaustion, frustration, and apathy. Negative stressors include the electronic medical record, insufficient staffing, administrative and clinical task burden, and perceived lack of interest from mid-level and senior health system leadership in addressing clinicians' needs. This was a single-center academic study. As with all qualitative studies, these results may not be generalizable to all dermatologists. In addition, some participants were concerned about their anonymity. Modifiable root causes of burnout require institutional commitment to sustain the pace required by academic dermatologists.

This work presents a research agenda addressing the needs of adults with complex health and social needs (ACHSN) formulated through an engagement process fostering cross-stakeholder group communication, shared understanding of identified issues, and mutual commitment to improving care for ACHSN. Nominal group technique and stakeholder interviews were used to develop prioritized stakeholder consensus regarding health issues, barriers, and solutions affecting ACHSN. The engagement process culminated in two stakeholder meetings with all stakeholders to review, process, and develop a shared understanding of the findings. Issues prioritized for future research included the conditions of mental health, diabetes, and addiction; and interventions addressing the barriers of comorbidities, support for mental health, and cost of care/logistics. Notable areas of alignment and variance existed across stakeholder perspectives. Emphasized themes especially relevant to future research included the importance of grounding interventions in multi-stakeholder shared understanding and active inclusion of the patient voice.

Summary The entomopathogenic nematode (EPN), Heterorhabditis bacteriophora, is an important biological control agent worldwide. Industrially produced EPN need to meet the climatic requirements for the control of pests in field agriculture in autumn and spring when temperatures are low. For this trait (virulence at low temperature), previous EPN improvement attempts relied on phenotypic selection and the selected trait had low stability. The use of molecular markers can increase the efficacy of EPN breeding by tracking traits associated with specific genotypes. To date, fewer than 200 polymorphic and reproducible sequence-tagged molecular markers in H. bacteriophora have been reported. Here, we enhanced the palette of highly polymorphic genetic markers for this EPN by applying genotyping by sequencing (GBS). By analysing 48 H. bacteriophora homozygous wild-type inbred lines from different origins, we determined 4894 single nucleotide polymorphisms (SNPs) with at least one polymorphism along the tested set. For validation, we designed robust PCR assays for seven SNPs, finding 95% correspondence with the expected genotypes along 294 analysed alleles. We phenotyped all lines for their virulence at low temperature (15°C) against mealworm and observed infectivity ranging from 38 to 80%. Further, we carried out association analyses between genotypic and phenotypic data and determined two SNPs yielding potential association with H. bacteriophora virulence at low temperature. The use of these candidate SNPs as breeding markers will speed up the generation of strains better adapted to low temperature in this species. The generated set of lines and SNP data are a versatile tool applicable for further traits in this EPN.

Background: Although correction of ankle and hindfoot deformity after supramalleolar osteotomy has been investigated extensively, the specific effect on the subtalar joint alignment remains elusive. This can be attributed to the limitations of 2-dimensional measurements, which impede an exact quantification of the 3-dimensional subtalar joint alignment. Therefore, we determined both the ankle, hindfoot, and subtalar joint alignment before and after supramalleolar osteotomy using autogenerated 3-dimensional measurements based on weightbearing CT imaging. Methods: Twenty-nine patients with a mean age of 50.4±10.6 years were retrospectively analyzed in a pre-post study design using weightbearing CT. Inclusion criteria were correction of ankle varus deformity by an opening wedge (n = 22) or dome osteotomy (n = 7). Exclusion criteria consisted of an additional inframalleolar arthrodesis or osteotomy. Corresponding 3-dimensional bone models were reconstructed to compute following autogenerated measurements of the ankle- and hindfoot alignment: tibial anterior surface (TAS), tibiotalar surface (TTS), talar tilt (TT) angle, hindfoot angle (HA). In addition, the talocalcaneal angle (TCA) in the axial (TCAax), sagittal (TCAsag), and coronal (TCAcor) plane were measured to assess the subtalar joint alignment. Results: The preoperative radiographic parameters of the ankle joint alignment (TAS=88±4 degrees, TTS=82±7 degrees, TT=5.8±4.9 degrees) improved significantly relative to their postoperative equivalents (TAS = 93±5 degrees, TTS = 88±7 degrees, TT=4.2±4.5 degrees; P < .05). The following radiographic parameters of the hindfoot and subtalar joint alignment improved significantly from preoperatively (8.7±8.9 degrees, TCAax = 41±10 degrees, TCAsag = 48±10 degrees) to postoperatively (HA=4.5±8.6 degrees, TCAax = 38±9 degrees, TCAsag = 44±11 degrees; P < .05). No significant differences could be detected in the coronal plane alignment of the subtalar joint (TCAcor) pre- compared to postoperatively ( P > .05). Conclusion: This study quantified the 3-dimensional ankle, hindfoot, and subtalar joint alignment after a solitary supramalleolar osteotomy. We found alterations in the subtalar joint alignment, which occurred by 2 to 3 degrees in each anatomic plane. However, before recommendations can be given related to inframalleolar procedures in conjunction to supramalleolar osteotomies, further studies on the variation of subtalar joint alignment change are needed.

Background: Posterior malleolar fractures are found in almost 50% of all ankle fractures. The high clinical relevance of these joint fractures is explained by the significantly worse clinical and functional outcome. There is still a lack of unified opinion regarding the classification and treatment of these fractures. Objective: The aim of this article is to provide a systematic literature review of clinical studies that investigated posterior malleolar fractures and classified them using one of the three established classifications according to Haraguchi, Bartonicek/Rammelt, or Mason. Material and methods: PubMed was searched without time limits. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score. Results: A total of 27 studies with a total of 2220 patients were included in this systematic literature review. Trimalleolar fractures showed a significantly less favorable prognosis than other ankle fractures. The quality of reduction was the most important prognostic factor for the clinical outcome. Conclusion: None of the three classifications examined has become established in the literature. Most of the classifications are weak or should not be used with respect to a derivable treatment algorithm or a prognosis with respect to the outcome. Only the classification according to Bartonicek/Rammelt is suitable to become established in the literature and in clinical practice due to its derivable treatment algorithm.

Tarsometatarsal joint arthrodesis is used to treat a variety of injuries and deformities in the midfoot. However, the surgical technique has not been optimized, in part due to limited knowledge of morphologic features and variation in the related joints. Previous research has relied primarily on dissection-based anatomical analysis, but quantitative imaging may allow for a more sophisticated description of this complex. Here, we used quantitative micro-CT imaging to examine dimensions, distance maps, and curvature of the four articular surfaces in the first and second tarsometatarsal joints. Image segmentation, articular surface identification, and anatomic coordinate systems were all done with semi or fully automatic methods, and distance and size measurements were all taken utilizing these anatomic planes. Surface curvature was studied using Gaussian curvature and a newly defined measure of curvature similarity on the whole joint and on four subregions of each surface. These data show larger articular surfaces on the cuneiforms, rather than metatarsals, and define the generally tall and narrow articular surfaces seen in these joints. Curvature analysis shows minimally curved opposing convex surfaces. Our results are valuable for furthering knowledge of surgical anatomy in this poorly understood region of the foot.

this paper presents a new design method of the DC inductor using the unique air gap equation. The uniqueness of the air gap equation is demonstrated using different mathematical methods. The equation used in the literature for the air gap calculation is ambiguous and can easily lead to misconceptions of its dependency on the core cross section. Furthermore, this paper investigates the effect of changing the relative permeability and the inductance value on the number of turns and the air gap. An advantage of the proposed method is it gives a good understanding of the interdependence between the inductance variables. Its main features are: (1) straightforward design flow of the DC inductor, (2) low optimization time and (3) better accuracy.

PURPOSE: Research eliciting patients' illness concerns has typically focused later in the cancer continuum, rather than during cancer treatments. Family caregiver concerns are overlooked during this time. Less is known about how patients and caregivers prioritize concerns during cancer treatments, which holds potential for improving supportive oncology care (ie, primary palliative care). The purpose of this study was to elicit and compare which domains of supportive oncology are of highest importance to patients and caregivers during cancer treatments. METHODS: Freelisting, a cognitive anthropology method, was used to elicit concerns in order of importance. Freelist data were analyzed using Smith's salience index. Qualitative interviews were conducted with a caregiver subsample to add explanatory insights. RESULTS: In descending order, pain, death, fear, family, and awful were salient Freelist items for patients (n = 65), whereas sadness, time-consuming, support, anger, tired, death, and frustration were salient for caregivers (n = 24). When integrated with supportive oncology domains, patients' concerns reflected a prioritization of the physical (pain) and emotional (death, fear, and awful) domains, with less emphasis on social (family) aspects. Caregivers' prioritized the emotional (sadness, anger, death, and frustration) and social (time-consuming and support) domains, with less emphasis on the physical (tired) aspects. CONCLUSION: Our findings suggest that enhancing primary palliative care delivery by oncology teams requires systems thinking to support both the patient and caregiver as the primary unit of care. Primary palliative care may be improved by prioritizing interventions that address physical concerns among patients as well as key social concerns among caregivers to support the complex caregiving role while patients undergo cancer treatments.

Introduction. To build up an effective system for distributing information about ambient air quality it requires taking into accounts certain peculiarities related to people perceiving specific data. Purpose. To describe population’s information interests in ambient air quality to make information spreading more effective. Materials and methods. Our empirical base included the following items: a) publicly available data on search requests in Yandex provided by “Wordstat.yandex.ru” service over the period from February 01, 2020 to January 31, 2021; b) one hundred seventy six forum posts from October 2018 to June 2020 with comments to them which dwelled on ambient air quality and related issues and were placed on Internet forums of Russian cities. Results. We established that Internet users in Russia didn’t have any significant interest in issues related to ambient air pollution. People in most cities which were considered “large industrial centers” tended to be more interested in ambient air quality. Such an interest most frequently occurs due to environmental factors being perceived as certain threats for human health and wellbeing. Consequently, this topicality of environmental issues results in different intensity of information interests in the sphere which tend to be greater among people living in industrially developed cities than among those living in smaller settlements. Limitations. This study has limitations related to the time period of the studied search queries and territorial specifics. Conclusion. A system for information distribution should give a possibility to react operatively to ‘emotional signals’ given by population in electronic communications. Information messages should be composed relying on key semantic constructions of a simple everyday language.

Obstetric anal sphincter injures (OASIS) have long-term implications on women's health. Administration of antibiotic prophylaxis and treatment following OASIS repair is controversial. We conducted a national survey to provide data about practice routines regarding antibiotic prophylaxis and treatment following OASIS repair in Israeli labor and delivery units.A national survey was performed among obstetricians and gynecologists from 24 university-affiliated delivery centers within the jurisdiction of the Israeli Ministry of Health during 2020. Representatives from each center completed the "Google form" electronic survey. For each questionnaire item, the most common answer was chosen to represent the center's answer.The number of physicians who responded per center varied from 1 to 14 (median, 3.5). Preoperative and postoperative antibiotic treatment was given in 75% and 92% of the centers, respectively. While most centers (58.3%) recommend pelvic floor physical therapy on release, recommendations about functional radiologic tests vary. In all centers, there is a designated clinic for postpartum follow-up of OASIS. Most centers (83%) allow trial of vaginal delivery in the subsequent pregnancy, on an individual basis.Heterogeneity exists in managing OASIS in Israel, particularly regarding administration of antibiotics. Further studies are needed to examine the consequences of different management protocols.

Soft tissue sarcomas are malignant diseases with a complex classification and various histological subtypes, mostly clinically inconspicuous appearance, and a rare occurrence. To ensure safe patient care, the European Society of Musculoskeletal Radiology (ESSR) issued a guideline for diagnostic imaging of soft tissue tumors in adults in 2015. In this study, we investigated whether implementation of these guidelines resulted in improved MRI protocol and report quality in patients with soft tissue sarcomas in our cancer center. All cases of histologically confirmed soft tissue sarcomas that were treated at our study center from 2006 to 2018 were evaluated retrospectively. The radiological reports were examined for their compliance with the recommendations of the ESSR. Patients were divided into two groups, before and after the introduction of the 2015 ESSR guidelines. In total, 103 cases of histologically confirmed sarcomas were studied. The distribution of, age, gender, number of subjects, performing radiology, and MRI indication on both groups did not show any significant differences. Only using the required MRI sequences showed a significant improvement after the introduction of the guidelines (p = 0.048). All other criteria, especially the requirements for the report of findings, showed no improvement. The guidelines of the European Society for Musculoskeletal Radiology are not regularly followed, and their establishment did not consistently improve MRI quality in our study group. This poses a risk for incorrect or delayed diagnosis and, ultimately, therapy of soft tissue tumors. However, this study is the first of its kind and involves a limited collective. A European-wide multicenter study would be appreciated to confirm these results.

There is a growing demand by the civil society for relevant information on the environment quality and related health risks. The state should be able to satisfy this demand and this makes the present research truly vital. It concentrates on correlating expert and non-expert opinions expressed when perceiving risk quantification. Our goal was to answer two following questions: 1) How does an average unprofessional person quantify a probability and severity when he or she hears certain verbal expressions that denominate them? 2) How can we possibly identify the assessment of health risks associated with environmental pollution factors given by the population in general or specific social groups? To find answers to these questions, we applied quantitative methods for data collection and analysis. The first stage involved collecting data on subjective correlation of a verbal probability scale with its numeric expression among people living in industrial cities. The second stage focused on testing the methodology for studying assessments of health risks associated with ambient air pollution given by the population/social groups. This methodology relied on the results obtained at the previous stage. We established that only 70 % of people actually correlated words with figures. We determined that experts tended to rate probabilities approximately by 10 % higher than “average people” did when it came down to such words as “Virtually certain” and “Very likely”. Such words as “Likely”, “Similarly likely” and “Unlikely” were also rated differently but with a smaller gap between the opinions. The study also provides a method for determining the public assessment of health associated with ambient air pollution. The research results give an opportunity to solve a practical task related to informing the population about health risks and to overcome a so-called language barrier between experts and ordinary people. For example, messages aimed for decision-makers can be adapted considering all the identified perception peculiarities.

Despite its clinical relevance in the context of ankle fractures, little is known about the bone microarchitecture and strength of the distal fibula, especially regarding age-, sex-, and subregion-specific effects. To address this gap of knowledge, we obtained fibulae from 30 skeletally intact donors at autopsy (each 15 male and female), which were analyzed by high-resolution peripheral quantitative computed tomography including micro-finite element analysis. Scans were performed in a 7-cm volume of interest and evaluated in three subregions according to the Danis-Weber fracture classification. Group comparisons and linear regression analyses were applied to evaluate the effects of age, sex, and subregion. From distal to proximal, we observed an increase of cortical parameters and a decrease of trabecular parameters. Age was primarily associated with a cortical decrease in all subregions (Danis-Weber type A, B, and C) in women. While women showed a greater magnitude of decline, men also exhibited an age-associated decrease for some parameters, including cortical area and cortical thickness in the type C subregion. Stiffness and failure load were highest in the type C subregion in both women and men. A critical age-related decline in bone strength parameters in the type B subregion was observed in women, providing an explanation for the increased incidence of low-traumatic type B fractures in the elderly. Together, these findings extend the current understanding of distal fibular microarchitecture, likely explaining the epidemiologic features of distal fibula fractures and emphasizing the need for age-adapted treatment algorithms.

Zusammenfassung Hintergrund Frakturen des posterioren Malleolus finden sich bei fast 50 % aller Sprunggelenkfrakturen. Die hohe klinische Relevanz dieser Gelenkfrakturen erklärt sich durch das deutlich schlechtere klinische sowie funktionelle Outcome. Bis heute mangelt es an einer einheitlichen Lehrmeinung bezüglich Klassifikation und Behandlung dieser Frakturen. Ziel der Arbeit Intention dieser Arbeit war eine systematische Literaturübersicht über klinische Studien, welche posteriore Malleolus-Frakturen untersucht und mit einer der 3 etablierten Klassifikationen nach Haraguchi, Bartonicek/Rammelt oder Mason klassifiziert haben. Material und Methoden Die Datenbank PubMed wurde vollständig am 01.07.2021 durchsucht. Nur Publikationen in englischer und deutscher Sprache wurden eingeschlossen. Die systematische Literatursuche wurde entsprechend den aktuellen Kriterien von „Preferred Reporting Items for Systematic Review and Meta-Analyses“ (PRISMA) durchgeführt. Die methodologische Qualität der eingeschlossenen Studien wurde anhand des modifizierten Coleman-Scores quantifiziert. Ergebnisse Insgesamt 27 Studien mit insgesamt 2220 Patienten konnten in die systematische Literaturübersicht eingeschlossen werden. Trimalleolarfrakturen zeigten dabei eine deutlich ungünstigere Prognose als andere OSG-Frakturen. Prognostisch entscheidend für das klinische Outcome war v. a. die Qualität der Reposition. Diskussion Keine der 3 untersuchten Klassifikationen konnte sich bisher in der Fachliteratur durchsetzen. Speziell im Hinblick auf einen ableitbaren Therapiealgorithmus oder auf eine Prognose hinsichtlich des Outcome sind die untersuchten Klassifikationen schwach oder nicht zu verwenden. Einzig die Klassifikation nach Bartonicek/Rammelt ist geeignet, sich aufgrund des ableitbaren Therapiealgorithmus in der Literatur sowie im klinischen Alltag durchzusetzen.

Children’s developing brains are susceptible to pesticides. Less is known about the effect of exposure to chlorpyrifos and pyrethroids on executive functions (EF). We measured urinary 3,5,6-trichloro-2-pyridinol (TCPy), a metabolite of chlorpyrifos, and urinary 3-phenoxybenzoic acid (3-PBA), a general, nonspecific metabolite of pyrethroids in first-grade children from Montevideo, Uruguay (n = 241, age 80.6 ± 6.4 months, 58.1% boys). EFs were assessed with the Intra-dimensional/Extra-dimensional shift (IED), Spatial Span (SSP), and Stockings of Cambridge (SOC) tests from the Cambridge Neuropsychological Test Automated (CANTAB) Battery. General intellectual ability (GIA) was assessed using the Woodcock–Muñoz Cognitive battery. Median (range) urinary TCPy and 3-PBA levels were 16.7 (1.9, 356.9) ng/mg of creatinine and 3.3 (0.3, 110.6) ng/mg of creatinine, respectively. In multivariable generalized linear models, urinary TCPy was inversely associated with postdimensional errors on the IED task β [95% CI]: −0.11 [−0.17, −0.06]. Urinary 3-PBA was inversely associated with the total number of trials −0.07 [−0.10, −0.04], and the total number of errors −0.12 [−0.18, −0.07] on the IED task. When TCPy and 3-PBA were modeled together, the associations did not differ from single-metabolite models. We found no evidence of effect modification by blood lead level (BLL). Pesticide exposure may affect EF performance in urban children.

The early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included. Three-dimensional DM and CM of the ankle and syndesmotic joints, as well volumetric assessment of the distal tibiofibular syndesmosis was performed as possible WBCT markers of early PCFD. Measurements were compared between PCFD and controls. Significant overall reductions in syndesmotic incisura distances were observed in PCFD patients when compared to controls, with no difference in the overall syndesmotic incisura volume at 1, 3, 5 and 10 cm proximally to the ankle joint. CMs showed significantly decreased articular coverage of the anterior regions of the tibiotalar joint as well as medial/lateral ankle joint gutters in PCFD patients. This study showed syndesmotic narrowing and decreased articular coverage of the anterior aspect of the ankle gutters and talar dome in stage I PCFD patients when compared to controls. These findings are consistent with early plantarflexion of the talus within the ankle Mortise, and absence of true syndesmotic overload in early PCFD, and support DM and CM as early 3D PCFD radiological markers.

2021 wurden in der Kernstadt Fulda 2000 Personen über 65 Jahren postalisch zu ihrem Alltag und ihrer Lebensgestaltung befragt. In einem Überblick über unterschiedliche Lebensbereiche wird das Bild der Alltagsversorgungsmöglichkeiten und -hindernisse älterer Menschen deutlich. Handlungsempfehlungen für soziale und kommunale Unterstützung ergänzen die Zahlen.

Soft and flexible conductors are essential in the development of soft robots, wearable electronics, as well as electronic tissue and implants. However, conventional soft conductors are inherently characterized by a large change in conductance upon mechanical deformation or under alternating environmental conditions, e.g., humidity, drastically limiting their application potential and performance. Here, we demonstrate a novel concept for the development of strain-invariant, fatigue resistant and highly water stable soft conductor. By combining different thin film technologies in a three-dimensional fashion, we develop nano- and micro-engineered, multi-layered (< 50 nm), ultra-lightweight (< 15 mg/cm$^3$) foam-like composite framework structures based on PEDOT:PSS and PTFE. The all-organic composite framework structures are characterized by conductivities of up to 184 S/m, remaining strain-invariant between 80 % compressive and 25 % tensile strain. We further show, that the multi-layered composites are characterized by properties that surpass that of framework structures based on the individual materials. Both, the initial electrical and mechanical properties of the composite framework structures are retained during long-term cycling, even after 2000 cycles at 50 % compression. Furthermore, the PTFE functionalization renders the framework structure highly hydrophobic, resulting in stable electrical properties, even when immersed in water for up to 30 days. The here presented concept overcomes the previous limitations of strain-invariant soft conductors and demonstrates for the first time a versatile approach for the development of innovative multi-scaled and multi-layered functional materials, for applications in soft electronics, energy storage and conversion, sensing, catalysis, water and air purification, as well as biomedicine., Corresponding authors: Dr.-Ing. Fabian Sch\"utt (fas@tf.uni-kiel.de) and Dr.-Ing. Stefan Schr\"oder (ssch@tf.uni-kiel.de); Shared senior authorship: Dr.-Ing. Fabian Sch\"utt and Dr.-Ing. Stefan Schr\"oder

We introduce a framework for constructing quantum codes defined on spheres by recasting such codes as quantum analogues of the classical spherical codes. We apply this framework to bosonic coding, obtaining multimode extensions of the cat codes that can outperform previous constructions while requiring a similar type of overhead. Our polytope-based cat codes consist of sets of points with large separation that at the same time form averaging sets known as spherical designs. We also recast concatenations of qubit CSS codes with cat codes as quantum spherical codes., 4 + 7 pages, 1 figure, 4 tables

PURPOSE: We undertook a study to examine how stigma influences the uptake of training on medication for opioid use disorder (MOUD) in primary care academic programs. METHODS: We conducted a qualitative study of 23 key stakeholders responsible for implementing MOUD training in their academic primary care training programs that were participants in a learning collaborative in 2018. We assessed barriers to and facilitators of successful program implementation and used an integrated approach to develop a codebook and analyze the data. RESULTS: Participants represented the family medicine, internal medicine, and physician assistant fields, and they included trainees. Most participants described clinician and institutional attitudes, misperceptions, and biases that enabled or hindered MOUD training. Perceptions included concerns that patients with OUD are “manipulative” or “drug seeking.” Elements of stigma in the origin domain (ie, beliefs by primary care clinicians or the community that OUD is a choice and not a disease), the enacted domain (eg, hospital bylaws banning MOUD and clinicians declining to obtain an X-Waiver to prescribe MOUD), and the intersectional domain (eg, inadequate attention to patient needs) were perceived as major barriers to MOUD training by most respondents. Participants described strategies that improved the uptake of training, including giving attention to clinician concerns, clarifying the biology of OUD, and ameliorating clinician fears of being ill equipped to provide care for patients. CONCLUSIONS: OUD-related stigma was commonly reported in training programs and impeded the uptake of MOUD training. Potential strategies to address stigma in the training context, beyond providing content on effective evidence-based treatments, include addressing the concerns of primary care clinicians and incorporating the chronic care framework into OUD treatment.

INTRODUCTION: Growing use of life-sustaining measures in patients with poor long and middle-term expectation of survival concerns health practitioners with disproportionate care. We aim to report prevalence of perceived inappropriate care among intensive care unit (ICU) staff physicians, training physicians, nurses and nursing auxiliaries in a public Brazilian hospital. METHODS: Cross-sectional study of medical and nursing team at the 34-bed multidisciplinary ICU of a tertiary teaching hospital in southern Brazil from January to July 2019. In total, 151 professionals completed an anonymous electronic survey. RESULTS: Response rate was 49.5%. One-hundred and eighteen (78.1%) respondents pointed out disproportional care in working environment. Both nurses and nurse auxiliaries were less likely than doctors to receive formal training on communication of end-of-life information (10.6% vs 57.6%, p< 0.001). Twenty-nine (28.1%) nurses and nurse auxiliaries versus 4 (0.08%) doctors claimed there was no palliative care deliberations in ICU (p= 0.006). Forty-three out of 48 (89.5%) senior and junior doctors believed collaboration between physicians and nurses was good, whereas 58 out of 103 (56.3%) of nurses and nurses auxiliaries disagreed on that (p< 0.001). CONCLUSIONS: This is the first survey regarding perception of inappropriate care conducted in Latin America, and included junior doctors and nursing auxiliares. Despite being a unicentric population sample, it represents view of health care providers who work at a high complexity medical center in a public health system., INTRODUÇÃO: O aumento progressivo de medidas avançadas para manutenção da vida em pacientes com pouca expectativa de sobrevida gera percepção de cuidado desproporcional. Objetivamos averiguar a prevalência de cuidado desproporcional em equipe médica e enfermagem que atuam na Unidade de Terapia Intensiva (UTI) em um hospital público do Brasil. MATERIAL E MÉTODOS: Estudo transversal envolvendo equipe médica e enfermagem em uma UTI multidisciplinar de 34 leitos de um hospital terciário no sul do Brasil de janeiro a julho de 2019. Ao total 151 profissionais responderam a um questionário eletrônico anônimo. RESULTADOS: A taxa de resposta foi de 49,5%. Cento e dezoito (78,1%) profissionais identificaram cuidado desproporcional no ambiente de trabalho. Enfermeiros e técnicos de enfermagem receberam menos treinamento formal em comunicação de fim de vida do que médicos (10,6% versus 57,6%, p

Supplemental material, sj-pdf-1-soc-10.1177_00380385231159005 for Maternal Occupation-Specific Skills and Children’s Cognitive Development by Katherin Barg and Markus Klein in Sociology

Background. MicroRNAs are endogenous, small noncoding RNA molecules that play a pivotal role in the regulation of gene expression. MicroRNAs are involved in many biological processes such as proliferation, cell differentiation, neovascularization, and apoptosis. Studies on microRNA expression may contribute to a better understanding of the pathomechanism of chronic inflammatory demyelinating polyneuropathy (CIDP) and consequently enable the development of new therapeutic measures using antisense miRNAs (antagomirs). In this study, we evaluated the level of miR-31-5p in the serum of patients with CIDP and its correlation with the miR-31-5p level and clinical presentation and electrophysiological and biochemical parameters. Methods. The study group consisted of 48 patients, mean age 61.60 ± 11.76 , who fulfilled the diagnostic criteria of a typical variant of CIDP. The expression of miR-31-5p in patient serum probes was investigated by droplet digital PCR. The results were correlated with neurophysiological findings and the patient’s clinical and biochemical parameters. Results. The mean copy number of miRNA-31 in 100 μl serum was 1288.64 ± 2001.02 in the CIDP group of patients, while in the control group, it was 3743.09 ± 4026.90 . There was a significant positive correlation (0.426) between IgIV treatment duration and miR-31-5p expression. Patients without IgIV treatment showed significantly lower levels of miR-31 compared to the treated group ( 259.44 ± 304.02 vs. 1559.48 ± 2168.45 ; p = 0.002 ). The group of patients with body weight > 80 kg showed statistically significantly lower levels of miRNA-31-5p than the patients with lower body weight ( 934.37 ± 1739.66 vs. 1784.62 ± 2271.62 , respectively; p = 0.014 ). Similarly, the patients with elevated cerebrospinal fluid (CSF) protein levels had significantly higher miRNA-31-5p expression than those with normal protein levels ( 1393.93 ± 1932.27 vs. 987.38 ± 2364.10 , respectively; p = 0.044 ). Conclusion. The results may support the hypothesis that miR-31-5p is strongly involved in the autoimmune process in CIDP. The positive correlation between higher miR-31-5p levels and duration of IVIg treatment may be an additional factor explaining the efficacy of prolonged IVIg therapy in CIDP.

Phosphatidylinositol(4,5)bisphosphate (PI(4,5)P2) is an important signaling phospholipid that is required for regulated exocytosis and some forms of endocytosis. The two processes share a topologically similar pore structure that connects the vesicle lumen with the outside. Widening of the fusion pore during exocytosis leads to cargo release, while its closure initiates kiss&run or cavicapture endocytosis. We show here, using live-cell total internal reflection fluorescence (TIRF) microscopy of insulin granule exocytosis, that transient accumulation of PI(4,5)P2 at the release site recruits components of the endocytic fission machinery and stalls the late fusion pore expansion that is required for peptide release. The absence of clathrin differentiates this mechanism from clathrin-mediated endocytosis. Knockdown of phosphatidylinositol-phosphate-5-kinase-1c or optogenetic recruitment of 5-phosphatase reduces PI(4,5)P2 transients and accelerates fusion pore expansion, suggesting that acute PI(4,5)P2 synthesis is involved. Thus, local phospholipid signaling inhibits fusion pore expansion and peptide release through an unconventional endocytic mechanism. De två första författarna delar förstaförfattarskapet