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Blumeria graminis f. sp. tritici (Bgt) is a globally important fungal pathogen of wheat that can rapidly evolve to defeat wheat powdery mildew (Pm) resistance genes. Despite periodic regional deployment of the Pm1a resistance gene in U.S. wheat production, Bgt strains that overcome Pm1a have been notably non-persistent in the U.S., while on other continents they are more widely established. A genome-wide association study (GWAS) was conducted to map sequence variants associated with Pm1a virulence in 216 Bgt isolates from six countries, including the U.S. A virulence variant apparently unique to Bgt isolates from the U.S. was detected in the previously mapped gene AvrPm1a (BgtE-5612) on Bgt chromosome 6; an in-vitro growth assay suggested no fitness reduction associated with this variant. A gene on Bgt chromosome 8, Bgt-51526, was shown to function as a second determinant of Pm1a virulence and despite 85% of their secondary structure. A co-expression study in Nicotiana benthamiana showed that BGTE-5612 and BGT-51526 each produce a PM1A-dependent hypersensitive response. More than one member of a B. graminis effector family can be recognized by a single wheat immune receptor, and a two-gene model is necessary to explain virulence to Pm1a.

Este artículo tiene como objetivo analizar el impacto que el ámbito regional tuvo en la manera en la que las personas vivieron los discursos, las prácticas y los conflictos que caracterizaron el periodo de la larga Guerra Fría en México. El artículo se centra en la historia regional de Puebla, un estado marcado por la prevalencia de ideologías anticomunistas y conservadoras, así como por una relación estrecha entre la iglesia católica, la élite económica y los grupos políticos dominantes. Con base en literatura secundaria y el análisis de fuentes archivísticas y publicaciones periódicas correspondientes al periodo de 1930 a 1979, el artículo busca ir más allá de una visión que subsume la historia de la Guerra Fría en el país dentro del juego de fuerzas protagonizado por las dos grandes potencias —Unión Soviética y Estados Unidos— y subrayar la importancia de lo local en las ideas y prácticas que definieron este periodo.

Background The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg. Methods Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients’ reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations. Results Patient-centredness of all consultations on average was 64% (95% CI 60–67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65–94), the lowest in respiratory ones with 55% (49–61). Longer consultations resulted in higher MPCC scores. Conclusions The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness. Practice implications We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.

Background: Homeless people in Germany are generally entitled to health care within the regular care system. However, due to their specific living conditions, they make little use of these services. In 2013, three specialist medical centres for the homeless (MCH) were opened in Hamburg to provide general health care. The aim of this abstract is to offer an overview of the specific health conditions and health care needs prevalent among the homeless and to discuss whether it is possible to link these patients up with the regular health care system. Methods: Medical data from 840 homeless patients as well as from a total of 1,982 consultations was obtained from 2013 until the end of 2014. In addition, the study evaluated data obtained in a questionnaire on the use of the regular health care system. Health insurance status and diagnosis were routinely documented and categorised using ICD 10 and ICPC-2. Subsequently, the diagnoses and reasons for consultations of homeless patients were compared with data from general practices (GP). Questionnaires on the use of the regular health care system were also evaluated. Results: The most frequent reasons for consultations in the first year were skin conditions (24%), musculoskeletal conditions (16%) and psychological disorders (14%). By comparison, the most frequent reasons for consultations in a general practice were musculoskeletal conditions (22%), conditions affecting the digestive system (14%) and skin conditions (12%). 35% of the homeless patients mentioned a lack of health insurance as the reason for “not making use of” the regular health care system, while ten percent reported that they were unable to visit a GP due to physical or psychological reasons. The longitudinal analysis over six years (2015–2020) showed that 53% of the patients attending the medical centre for the homeless had no medical insurance. Conclusion: The MCH mainly sees patients with medical conditions typical for the homeless cohort, namely skin diseases, wounds and injuries and behavioural disorders due to alcohol abuse. Health care for homeless patients is time-consuming and expensive. Chronic diseases that are equally present in general practice and specialist medical centres, such as diabetes mellitus, pose a great challenge. The lack of health insurance poses the greatest hurdle to the integration of the homeless into the regular health care system.

Protocols for managing dwarf mongooses (Helogaleparvula) in zoological institutions do not currently account for the introduction of separate social groups. The Association of Zoo and Aquarium Dwarf Mongoose Species Survival Program

This article examines the cultural and political repertoire that contributed to Catholics’ understanding of violence as a legitimate means to resist the secular state in 1930s Mexico. Following the end of the Cristero War (1926-29), the Church officially and overtly rejected the use of violence by Catholics as a means to defend religious freedom. However, many Catholic militants and organizations continued to support violence as a last but necessary recourse to resist the country's so-called tyrannical government and to build a Catholic nation that would recognize the kingship of Christ on earth. Informed by noncanonical understandings of martyrdom, sacrifice, and redemptive violence, as well as by an intransigent view of politics, these Catholics regarded violence as a moral response against the injustices and dangers posed by what they considered an oppressive and blasphemous state. The article is based on the examination of a series of violent events perpetrated by Catholic militants during the 1930s, as well as on the analysis of several newspapers, official documents, and Catholic publications. Contrary to government portrayals of Catholicism as a top-down, monolithic, and unchanging set of institutions and practices that promoted recalcitrant forms of religious militancy, Catholics were in fact deeply divided regarding the legitimacy of violence along theological, moral, and practical grounds.

What are the factors behind citizen support for the use of extralegal violence in Latin America? The prevailing argument is that, in countries overwhelmed by skyrocketing levels of criminal violence, people endorse the use of extralegal violence as a way to cope with insecurity. Other scholars believe that support for extralegal violence is the result of state withdrawal and failure. Few empirical studies, however, have tested any of these arguments. In this article, using regional data from the 2012 AmericasBarometer, we examine different explanations regarding citizen support for the utilization of extralegal violence in Latin America and the Caribbean. We developed a multi-item scale that gauges support for different forms of extralegal violence across the Americas, and we hypothesize that support for extralegal violence is higher not only in countries with extreme levels of violence but especially in countries in which people distrust the political system. Results indicate that support for extralegal violence is significantly higher in societies characterized by little support for the existing political system. Resumen ?Cuales son los factores que determinan el apoyo ciudadano al uso de la violencia extralegal en America Latina? El argumento predominante es que en paises con niveles altos de violencia criminal, las personas apoyan el uso de la violencia extralegal como un mecanismo para hacer frente a la inseguridad. Otros trabajos consideran que el apoyo a la violencia extralegal es el resultado del fracaso o ausencia del Estado. Pocos estudios empiricos, sin embargo, han tratado de probar dichos argumentos. En este articulo, utilizando datos regionales de la encuesta de 2012 del Barometro de las Americas, analizamos las diferentes explicaciones detras del apoyo ciudadano al uso de la violencia extralegal en America Latina y el Caribe. Desarrollamos una escala que contiene multiples items, la cual estima el apoyo a distintas formas de violencia ilegal en las Americas y planteamos la hipotesis de que el apoyo a la violencia extralegal no es solo alto en paises con niveles de violencia extrema, sino que lo es especialmente en aquellos en los cuales las personas no creen en el sistema politico. Los resultados obtenidos indican que el apoyo a la violencia extralegal es significativamente mas alto en sociedades caracterizadas por bajos niveles de apoyo al sistema politico existente.

This article examines the role of rumors in the collectivization of violence in twentieth-century Mexico. By focusing on a series of cases of lynching driven by rumors of child theft and the stealing of children’s bodily fluids and organs, the article reveals the hierarchies of credibility that make rumors an effective tool to trigger and escalate violence. The article’s main argument is that rumors become deadly or “weaponized” in the form of lynchings in contexts where anxieties and fears regarding processes of modernization and economic exploitation intersect with citizens’ perception of the state as unable or unwilling to provide security and justice. In twentieth-century Mexico, what made rumors vectors of lethal violence was not only a context of collective fear and economic uncertainty, but also their credibility vis-à-vis other forms of knowledge. Such credibility was grounded on citizens’ keen sense of distrust in state authorities and on people’s belief that without recourse to lynching, crimes would go unpunished. Adding to the credibility of these rumors was also the lynched victim’s actual or perceived condition as foreign or external to the community where the lynching took place, a condition that made them more likely to be the subject of rumors involving the extraction and exploitation of local resources. Child-theft rumors occupy a central place in Mexico’s contemporary context of insecurity. This article provides a historical reflection on the connections between hearsay, mob violence, and citizens’ long-term experiences of exploitation, state neglect, and impunity.

Background It has been shown previously that a relevant proportion of childhood cancer survivors suffers from late effects, which are often directly related to the cancer itself or its therapy, resulting in particular follow-up needs, additionally burdening healthcare systems. Being diagnosed with cancer at a vulnerable stage of development, this group of cancer survivors is at comparatively higher risk of relapse or subsequent cancer. Although national and international follow-up guidelines based on treatment modalities have been developed, their implementation seems to leave room for improvement. Additionally, they lack a sufficient consideration of the survivors’ psychosocial needs, affecting their adherence to them. The aim of the VersKiK study is to provide representative information on late effects in childhood and adolescence cancer survivors in Germany. The main research objectives are: (1) to describe the state of follow-up care among survivors after a cancer diagnosis in childhood or adolescence; (2) to quantify the occurrence of late effects among this group of survivors; (3) to examine the adherence to selected audiological and cardiological follow-up guidelines and to identify factors affecting it; (4) to explore actual follow-up needs of paediatric cancer survivors; (5) to review selected follow-up guidelines with the aim to improve and expand them. Methods VersKiK is designed as a mixed-methods non-interventional study. We will use claims data from statutory health insurance companies in combination with individually linked population-based registry data from the German Childhood Cancer Registry (GCCR). This data base will permit us to quantify diagnoses and procedures in comparison to the general population as well as the adherence to existing follow-up guidelines. Additional information will be obtained through interviews with childhood and adolescence cancer survivors and their informal caregivers, as well as in focus groups with healthcare professionals. Discussion The present study aims to research the actual needs of individuals after cancer diagnosis and treatment in childhood or adolescence – physical, psychological and organisational – in order to improve existing follow-up guidelines. These improvements might further positively affect not only actual care provided to paediatric cancer survivors, but also benefit healthcare systems in general while decreasing consequent medical visits in this group of patients. Trial registration Registered at German Clinical Trial Register (ID: DRKS00025960 and DRKS00026092).

Hintergrund: In der hausärztlichen Versorgung treten soziale Probleme wie finanzielle Schwierigkeiten oder Einsamkeit (Kapitel Z: ICPC-3 und ICD-11) oft in Wechselwirkung mit medizinischen Symptomen auf. Hausärzt:innen sehen sich dabei als feste Ansprechpersonen beim Umgang mit sozialen Problemen. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Die DECADE-Studie zur Verbesserung der kardiovaskulären Risikoprävention ist eine cluster-randomisierte kontrollierte Studie (cRCT). Die komplexe Intervention mit edukativem Anteil beinhaltet den Einsatz des Herz-Kreislauf-Risiko-Rechners „arriba“, patient:innenzentrierte [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Der Klimawandel ist wissenschaftlich nachgewiesen und stellt aktuell die größte Bedrohung für die Gesundheit der Menschen dar. Trotz steigender Wahrnehmung der Problematik, ist die kritische Masse noch nicht erreicht, um eine Trendwende zu erzeugen. Wissenschaftler:innen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Im Jahr 2018 konnten wir in einer Fragebogenerhebung zeigen, dass fast die Hälfte von 489 befragten Hausärzt:innen pro Woche mit mindestens 5 sozialen Problemen ihrer Patient:innen konfrontiert war. Durch die Auswirkungen der Infektionsschutzmaßnahmen während der Covid-19-Pandemie [zum vollständigen Text gelangen Sie über die oben angegebene URL]

The globally distributed causal agent of powdery mildew on wheat, Blumeria graminis f. sp. tritici (Bgt), is one of the most rapidly adapting plant pathogens and requires monitoring for shifts in virulence to wheat resistance (Pm) genes. Virulence frequencies were assessed in a total of 346 Bgt isolates from several countries that had either lately recorded increasing powdery mildew epidemics (Brazil, South Africa, and Australia) or not recently been surveyed (Turkey and Russia). The results were compared to previously published surveys of United States and Egyptian Bgt (390 isolates). Many of the Pm genes that have potentially been employed longer (Pm1a–Pm17) were shown to have lost effectiveness, and the complexity of virulence to those genes was higher among Brazilian isolates than those from any other country. Some cases of high virulence frequency could be linked to specific Pm gene deployments, such as the widespread planting of cultivar Wyalkatchem (Pm1a) in Australia. Virulence was also assessed to a set of Pm genes recently introgressed from diploid and tetraploid wheat relatives into a hexaploid winter wheat background and not yet commercially deployed. The isolate collections from Fertile Crescent countries (Egypt and Turkey) stood out for their generally moderate frequencies of virulence to both the older and newer Pm genes, consistent with that region’s status as the center of origin for both host and pathogen. It appeared that the recently introgressed Pm genes could be the useful sources of resistance in wheat breeding for other surveyed regions.

The Afirma GSC aids in the clinical decision making for patients with indeterminate thyroid nodule cytology (ITN). The 2018 GSC validation study was a prospective, multi-center study, conducted on a patient cohort with ITN. All patients underwent surgery without known genomic information and were assigned a histopathology diagnosis by an expert panel blinded to all genomic information. The results showed a sensitivity (SN) of 91%, specificity (SP) of 68%, positive predictive value (PPV) of 47%, and negative predictive value (NPV) of 96% at a cancer prevalence of 24%. Since then, 13 independent GSC post-validation studies have been published. This study's objective is to compare the real world (RW) GSC performance to the validation study metrics. Rules and assumptions applying to this analysis include: 1. At least one patient with molecular benign results must have surgery for that study to be included in SN, SP and NPV analysis and in these studies, molecular benign results without surgical histology are considered true negatives (TN) (as are the molecular benign results with benign surgical histology) 2. Patients with suspicious results that do not have surgery are either excluded from the analysis (generating an observed PPV (oPPV) and observed SP (oSP)) or assumed as histology negatives (false positives - generating a conservative PPV (cPPV) and conservative SP (cSP)) 3. NIFTP is considered malignant. Rule #1 excluded two studies from SN, SP and NPV analysis. Data from all studies were pooled using a random-effects model. All analyses were done using R package meta (version 4.18-2). In the RW, the GSC demonstrates a SN, oSP, oPPV and NPV of 97%, 88%, 65%, 99% respectively, and conservative RW performance of cSP at 80% and cPPV at 49%. A statistically significant improvement is observed for oSP, cSP, oPPV, and NPV (p Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

IntroductionCardiovascular diseases are the most common cause of death in Germany and among the most frequent reasons for encounters in primary care. Most patients with cardiovascular risks (CVRs) have difficulties implementing health-promoting behavioural changes. In this study, a complex intervention containing evidence-based patient materials and structured follow-up consultations are intended to strengthen patients’ self-management to improve health behaviour.Methods and analysisIn this cluster randomised controlled trial, we investigate the effects of the intervention "Decision aid, action planning and follow-up support for patients to reduce the 10-year risk of cardiovascular diseases" (DECADE) using a 2×2 design. All patients, including the control group (CG), receive a CVR calculation. Three intervention groups (IGs) receive one or both of two different components of the DECADE intervention: IG1 (patient materials), IG2 (follow-up consultations) and IG3 (patient materials and follow-up consultations). The study was planned to be conducted with 77 general practitioners in 3 German regions and a target sample size of 924 patients. The observation period for each patient amounts to 12 months with three patient surveys: baseline (t0), after 6 and 12 months (t1 and t2). The primary outcome is patient activation (Patient Activation Measure 13 (PAM13-D)) at t1. Secondary outcomes include PAM13-D at t2 and further patient-reported and clinical outcomes at t1 and t2. We will also analyse the cost-effectiveness of the intervention, the degree of usage and satisfaction with the intervention.Ethics and disseminationThe study was first approved by the lead ethics committee of the University of Freiburg on 15 April 2021 (vote number: 21-1078) and subsequently by the other ethics committees in the study regions (Ethics committee of medical association Baden-Württemberg (B-F-2021-078), Ethics Committee of the Technische Universität Dresden, Dresden (BO-EK-251052021), Ethics Committee of the State Chamber of Physicians of Saxony (EK-BR-92/21-1), Ethics Committee of the Hamburg Medical Association (2021-200013-BO-bet)). Informed consent is required for patients to participate in the study. The results of this study will be published in peer-reviewed journals and presented at congresses by the DECADE team. The DECADE lead management will communicate the results to the funder of this study.Trial registration numberGerman Clinical Trials Register, DRKS00025401 (registration date: 21 June 2021); International Clinical Trials Registry Platform, DRKS00025401.

The prevalence of aortic valve stenosis is increasing due to the continuously growing geriatric population. Data on procedural success and mortality of very old patients are sparse, raising the question of when this population may be deemed as "too old even for transcatheter aortic valve replacement (TAVR)." We, therefore, sought to evaluate the influence of age on outcome after TAVR and the impact of direct implantation.The data of 394 consecutive patients undergoing TF-TAVR were analyzed. Patients were divided into four age groups: ≤75 (group 1, n = 28), 76-80 (group 2, n = 107), 81-85 (group 3, n = 148), and85 (group 4, n = 111) years. Direct implantation was performed when possible according to current recommendations. Survival was evaluated by Kaplan-Meier analysis.Mortality at 30 days and 1 year was not significantly different between the four age groups (3.6 vs. 6.7 vs. 5.4 vs. 2.7% and 7.6 vs. 17 vs. 14.5 vs. 13%m respectively, log-rank p = 0.59). Direct implantation without balloon aortic valvuloplasty was more frequently performed on patients aged85 vs. ≤85 years (33.3 vs. 14.1%, p 0.001). the incidence of procedural complications frequently associated with advanced age (stroke, vascular complications) was not significantly increased in group 4.Outcome after TF-TAVR is comparable among different age cohorts, even in very old patients. Direct implantation simplifies the procedure and could therefore play a role in reducing the incidence of peri-interventional complications in patients of advanced age.HINTERGRUND: Die Prävalenz der Aortenklappenstenose steigt durch eine kontinuierlich wachsende geriatrische Bevölkerung. Daten über prozeduralen Erfolg sowie Mortalität von sehr alten Patienten sind gering, sodass sich die Frage stellt, wann diese Population „als bereits zu alt“ für einen Transkatheter-Aortenklappenersatz (TAVR) anzusehen wäre. Ziel dieser Studie war es, den Einfluss der direkten Implantation auf die Ergebnisse nach transfemoraler (TF-)TAVR bei Patienten in fortgeschrittenem Alter zu evaluieren.Dazu wurden die Daten von 394 konsekutiven Patienten nach TF-TAVR ermittelt. Die Patienten wurden in 4 Altersgruppen eingeteilt: ≤75 Jahre (Gruppe 1, n = 28), 76–80 Jahre (Gruppe 2, n = 107), 81–85 Jahre (Gruppe 3, n = 148) und85 Jahre (Gruppe 4, n = 111). Sofern es die aktuellen Empfehlungen erlaubten, wurde eine direkte Implantation durchgeführt. Das Überleben wurde mittels Kaplan–Meier-Analyse evaluiert.Zwischen den 4 Altersgruppen waren keine signifikanten Unterschiede der Mortalität nach 30 Tagen und nach einem Jahr zu verzeichnen (entsprechend 3,6 vs. 6,7 vs. 5,4 vs. 2,7 % und 7,6 vs. 17 vs. 14,5 vs. 13 %; p = 0,59 für Log-Rank-Test). Eine direkte Implantation ohne Ballonvalvuloplastie wurde bei Patienten85 Jahre häufiger durchgeführt als ≤85 Jahre (33,3 vs. 14,1 %; p 0,001). Die Inzidenz von häufig mit fortgeschrittenem Patientenalter assoziierten prozeduralen Komplikationen (Schlaganfall, vaskuläre Komplikationen) war in der Gruppe 4 nicht signifikant erhöht.In verschiedenen Alterskollektiven zeigen sich vergleichbare Ergebnisse nach TF-TAVR, dies gilt sogar für Patienten sehr hohen Alters. Die direkte Implantation kann die Prozedur vereinfachen und zu einer konsekutiven Reduktion der Inzidenz von periprozeduralen Komplikationen bei Patienten mit fortgeschrittenem Alter führen.

Fehlfunktionen bei implantierten Schrittmacher- und Defibrillatorsystemen konnen alle Bauteile des Gerats betreffen (Batterie, Kondensator, „central processing unit“ (CPU), Konnektor, Lotstellen, Elektroden). Die daraus entstehenden Probleme konnen sich als inadaquate Therapie, eine unterbleibende Therapie trotz Notwendigkeit einer Stimulation oder Schockabgabe bei aufgetretener ventrikularer Tachyarrhythmie oder als eine ineffektive Therapieabgabe manifestieren. Die hohe Anzahl von implantierten Schrittmacher- und Defibrillatorsystemen, die gestiegene Lebenserwartung sowie der technische Fortschritt der kardialen Device-Therapie konfrontiert den nachsorgenden Arzt mit zunehmend komplexeren Problemen im Follow-up. Neben der Kenntnis der basalen Funktion dieser Gerate wird ein strukturiertes Vorgehen gefordert, um Fehlfunktionen rechtzeitig zu erkennen und zu behandeln. In dieser Ubersicht werden haufige Fehlfunktionen von Schrittmachern und Defibrillatoren dargestellt, auf einzelne Probleme hingewiesen und Losungsansatze sowie Therapieoptionen gezeigt.

This article analyzes the impact that religion had on the act of lynching and its legitimation in postrevolutionary Mexico. Basing its argument on the examination of several cases of lynching that took place after the religiously motivated Cristero War had ended, the article argues that the profanation of religious objects and precincts revered by Catholics, the propagation of conservative and reactionary ideologies among Catholic believers, and parish priests’ implicit or explicit endorsement of belligerent forms of Catholic activism all contributed to the perpetuation of lynching from the 1930s through the 1950s. Taking together, these three factors point at the relationship between violence and the material, symbolic, and political dimensions of Catholics’ religious experience in postrevolutionary Mexico. The fact that lynching continued well into the 1940s and 1950s, when Mexican authorities and the Catholic hierarchy reached a closer, even collaborative relationship, shows the modus vivendi between state and Church did not bring an end to religious violence in Mexico. This continuity in lynching also illuminates the centrality that popular – as opposed to official or institutional - strands of Catholicism had in construing the use of violence as a legitimate means to defend religious beliefs and symbols, and protect the social and political orders associated with Catholic religion at the local level. Victims of religiously motivated lynchings included blasphemous and anticlerical individuals, people that endorsed socialist and communist ideas, as well as people that professed Protestant beliefs and practices.

Kvalifikācijas darba tēma ir “Eksplozīvā spēka attīstība U16-U17 basketbolistiem”. Papildus veicot pietupienus ar svaru stieni uz muguras un svaru stieņa vilkmi no zemes, uzlabosies ne tikai lēcienu attīstība, bet arī jauniešu pārliecība pašiem par sevi, kas veicinās lielāku motivāciju un gandarījumu trenēties, jo šajā vecumā ir būtiski katram jaunietim nezaudēt pārliecību pār savām spējām. Lēciens tiek uzskatīts par viens no būtiskākajiem tehnikas elementu basketbolā. Kvalifikācijas darba mērķis pētīt un analizēt U16-U17 basketbolistu eksplozīvā spēka attīstības ietekmi uz lēcienu dinamiku. Pētījuma gaitā tika veikts eksperiments, kā uzlabosies lēcienu attīstība U16-U17 basketbolistiem trenējot pietupienus ar svaru stieni uz muguras un svaru stieņu vilkmi no zemes. Pētījumā piedalījās 5 audzēkņi kontrolgrupā un 5 audzēkņi eksperimentālajā grupā. Pētījuma rezultātā darba autors secina, ka eksperimentālās grupas rezultāti vertikālajam lēcienam no vietas uzlabojās par 6 cm, kā arī vertikālais lēciens no ieskrējiena uzlabojās par 6 cm, bet kontrolgrupas vertikālais lēciens no vietas uzlabojās par 2 cm, kā arī vertikālais lēciens ar ieskrējienu uzlabojās par 2 cm. Atslēgas vārdi: vertikālais lēciens, pietupieni, svaru stieņu vilkme no zemes, eksplozīvais spēks, 16-17 gadus veci pusaudži, muskuļu spēks., The topic of the qualification paper is “Explosive strenght development for U16-U17 Basketball Players”. Squats and deadlift will improve not only the development of jumps, but also young people's self-confidence, which will promote greater motivation and satisfaction to train, because at this age it is important for every young person not to lose confidence. Jump is considered to be one of the most important technical elements in basketball. The aim of the qualification paper is to find out the influence of the development of the explosive strenght of U16-U17 basketball players on the dynamics of jumps. In the course of the research, an experiment was performed on how the development of jumps U16-U17 will improve by training the squats and the deadlift. 5 students in the control group and 5 students in the experimental group participated in the study. As a result of the experiment, the author concludes that the results of the experimental group for the vertical jump from the spot improved by 6 cm, as well as the vertical jump from the run improved by 6 cm, but the vertical jump from the control group improved by 2 cm, and the vertical jump with the run improved by 2 cm. Keywords: vertical jump, squats, deadlift, explosive strenght, 16-17 years old teenagers, muscle strength

Durch die globale Erwarmung wird weltweit eine Zunahme der Haufigkeit und Intensitat von Hitzeperioden prognostiziert. Im Rahmen der insgesamt steigenden Einsatzzahlen im Rettungsdienst haben wetterbedingte Auswirkungen auf die Einsatzzahlen eine hohe Relevanz. Als primare Fragestellung wurde der Einfluss von Extremwerten der gefuhlten Temperatur (GT) am Einsatztag und den 3 vorangehenden Tagen auf die Diagnosegruppe der kardiovaskularen Erkrankungen untersucht. Retrospektive Analyse samtlicher Notarzteinsatze in der Ruhrgebietsstadt Bochum aus den Jahren 2014 und 2015. Als Temperaturparameter wurden die Lufttemperatur, die GT sowie die physiologisch aquivalente Temperatur (PET) als Indikator fur die thermische Belastung verwendet. Die Minimal- bzw. Maximalwerte der Tageswerte wurden sortiert und die entsprechenden oberen und unteren 5 % dem mittleren Bereich gegenubergestellt. Insgesamt wurden 16.767 Einsatze ausgewertet. Die Grenzwerte (obere und untere 5 %) der GT lagen bei − 8,7 und 32,5 °C und fur die Lufttemperatur bei − 0,7 und 26,7 °C. Bei Betrachtung der GT fand sich eine signifikant erhohte Einsatzrate bei Auftreten von Kalteepisoden am Einsatztag selbst (relatives Risiko [RR] = 1,14; p = 0,033) sowie mit einem Lag-Effekt von 3 Tagen (RR = 1,1, p = 0,049). Die Vorliegende Untersuchung zeigt, dass es bei Kalteepisoden zu einer gehauften Einsatzrate aufgrund von kardiovaskularen Erkrankungen kommt. Dieser Effekt besteht nicht nur fur den Extremtag selbst, sondern tritt erneut mit einer Zunahme 3 Tage verspatet auf.

AIMS: The objective of this paper is to assess whether cardiac contractility modulation (via the Optimizer System) plus standard of care (SoC) is a cost-effective treatment for people with heart failure [New York Heart Association (NYHA) III, left ventricular ejection fraction of 25-45%, and narrow QRS] compared against SoC alone from the perspective of the English National Health Service. METHODS AND RESULTS: We developed a regression equation-based cost-effectiveness model, using individual patient data from three randomized control trials (FIX-HF-5 Phases 1 and 2, and FIX-HF-5C) to populate the majority of parameters. A series of regression equations predicted NYHA class over time, mortality, all-cause hospitalization rates, and health-related quality of life. We conducted the analysis in line with the National Institute for Health and Care Excellence reference case, modelling costs from an English National Health Service perspective, and considering outcomes in quality-adjusted life years (QALYs) over a patient lifetime perspective. Our base case analysis produced an incremental cost per additional QALY of GBP22 988 (€25 750) when comparing Optimizer + SoC to SoC alone. This result was not sensitive to parameter uncertainty but was sensitive to the time horizon over which costs and QALYs were captured and the duration over which a survival benefit with Optimizer + SoC can be assumed to apply. CONCLUSIONS: Cardiac contractility modulation is likely to be cost-effective in people with heart failure with reduced ejection fraction, NYHA III, and narrow QRS, provided that the treatment benefit can be maintained beyond the duration of the existing clinical trial follow-up. This analysis supports the current recommendations of the European Society of Cardiology that this therapy may be considered for such patients. peerReviewed

Background: Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead dislodgment. This study sought to report the long-term safety and performance of a BipolarAFL, Medtronic Attain Stability 20066, compared to QuadPFL.Methods: We performed a single-operator retrospective analysis of 81 patients receiving cardiac resynchronization therapy (CRT) (36 BipolarAFL, 45 QuadPFL). Immediate implant data and electrical and clinical data during follow-up (FU) were analyzed.Results: BipolarAFL has been chosen in patients with significantly larger estimated vein diameter (at the lead tip: 7.2 ± 4.1 Fr vs. 4.1 ± 2.3 Fr, p < 0.001) without significant time difference until the final lead position was achieved (BipolarAFL: 20.9 ± 10.5 min, vs. QuadPFL: 18.9 ± 8.9 min, p = 0.35). At 12 month FU no difference in response rate to CRT was recorded between BipolarAFL and QuadPFL according to left ventricular end-systolic volume (61.1 vs. 60.0%, p = 0.82) and New York Heart Association (66.7 vs. 62.2%, p = 0.32). At median FU of 48 months (IQR: 44–54), no lead dislodgment occurred in both groups but a significantly higher proportion of PNS was recorded in QuadPFL (13 vs. 0%, p < 0.05). Electrical parameters were stable during FU in both groups without significant differences.Conclusion: BipolarAFL can be implanted with ease in challenging coronary venous anatomy, shows excellent electrical performance and no difference in clinical outcome compared to QuadPFL.

Background: Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead dislodgment. This study sought to report the long-term safety and performance of a BipolarAFL, Medtronic Attain Stability 20066, compared to QuadPFL. Methods: We performed a single-operator retrospective analysis of 81 patients receiving cardiac resynchronization therapy (CRT) (36 BipolarAFL, 45 QuadPFL). Immediate implant data and electrical and clinical data during follow-up (FU) were analyzed. Results: BipolarAFL has been chosen in patients with significantly larger estimated vein diameter (at the lead tip: 7.2 ± 4.1 Fr vs. 4.1 ± 2.3 Fr, p < 0.001) without significant time difference until the final lead position was achieved (BipolarAFL: 20.9 ± 10.5 min, vs. QuadPFL: 18.9 ± 8.9 min, p = 0.35). At 12 month FU no difference in response rate to CRT was recorded between BipolarAFL and QuadPFL according to left ventricular end-systolic volume (61.1 vs. 60.0%, p = 0.82) and New York Heart Association (66.7 vs. 62.2%, p = 0.32). At median FU of 48 months (IQR: 44–54), no lead dislodgment occurred in both groups but a significantly higher proportion of PNS was recorded in QuadPFL (13 vs. 0%, p < 0.05). Electrical parameters were stable during FU in both groups without significant differences. Conclusion: BipolarAFL can be implanted with ease in challenging coronary venous anatomy, shows excellent electrical performance and no difference in clinical outcome compared to QuadPFL., Graphical Abstract Study design and important results.

Hintergrund: Bei Patient:innen in der hausärztlichen Versorgung zählen neben den medizinischen häufig auch soziale Probleme, wie z.B. Probleme bei der Arbeit oder Einsamkeit, zu den Beratungsanlässen. Verschiedene Professionen, insbesondere die Soziale Arbeit, halten für [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Bei Patientinnen und Patienten in der hausärztlichen Versorgung finden sich neben den medizinischen Beratungsanlässen häufig auch soziale Probleme. Häufig gesehene Problembereiche wie finanzielle Schwierigkeiten, Probleme mit Arbeit- und Arbeitslosigkeit sowie Einsamkeit [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Soziale Probleme sind häufige Begleitumstände in der hausärztlichen Versorgung. Arbeitslosigkeit, Finanzsorgen, Partnerschaftskonflikte, der Tod oder die Erkrankung von Angehörigen können Erkrankungszustände auslösen, den Verlauf und die hausärztliche [zum vollständigen Text gelangen Sie über die oben angegebene URL]

BACKGROUND Optimization of cardiac resynchronization therapy (CRT) is often time-consuming and therefore underused in a clinical setting. Novel device-based algorithms aiming to simplify optimization include a dynamic atrioventricular delay (AVD) algorithm (SyncAV, Abbott) and multipoint pacing (MPP, Abbott). This study examines the acute effect of SyncAV and MPP on electrical synchrony in patients with newly and chronically implanted CRT devices. METHODS Patients with SyncAV and MPP enabled devices were prospectively enrolled during implant or scheduled follow-up. Blinded 12-lead electrocardiographic acute measurements of QRS duration (QRSd) were performed for intrinsic QRSd (Intrinsic), bi-ventricular pacing (BiV), MPP, BiV with SyncAV at default offset 50 ms (BiVSyncAVdef ), BiV with SyncAV at patient-specific optimised offset (BiVSyncAVopt ), MPP with SyncAV at default offset 50 ms (MPPSyncAVdef ), and MPP with SyncAV at patient-specific optimised offset (MPPSyncAVopt ). RESULTS Thirty-three patients were enrolled. QRSd for Intrinsic, BiV, MPP, BiVSyncAVdef , BiVSyncAVopt , MPPSyncAVdef , MPPSyncAVopt were 160.4 ± 20.6 ms, 141.0 ± 20.5 ms, 130.2 ± 17.2 ms, 121.7 ± 20.9 ms, 117.0 ± 19.0 ms, 121.2 ± 17.1 ms, 108.7 ± 16.5 ms respectively. MPPSyncAVopt led to greatest reduction of QRSd relative to Intrinsic (-31.6 ± 11.1%; p

Despite the formal end of civil war and armed conflict, Mexico continued to experience significant levels of violence during the 1930s and 1940s. This period has traditionally been associated with the process of pacification, institutionalization, and centralization of power that enabled the consolidation of rule in postrevolutionary Mexico, a process epitomized by the marked national decline in levels of homicide that began during the 1940s and continued during the second half of the 20th century. The dynamics of coercion and resistance that characterized state-society relations at the regional and local levels reveal, however, that violence pervaded all aspects of society and that it was perpetrated by a multiplicity of actors, including vigilantes, pistoleros, private militias, lynch mobs, military, police, and other violent entrepreneurs. Violence was used as both a means to contest the legitimacy of the postrevolutionary state project as well as an instrument of control and coercion on behalf of political elites and local power brokers. Conversely, violence superseded the realm of traditional politics and constituted a central force shaping Mexican society. Violence against women in the public and private spheres, violence driven by economic interests, and citizens’ attempts to control crime and social transgressions reveal that citizens—and not only state actors—contributed to the reproduction of violence. Although violence in postrevolutionary Mexico was neither centralized nor exercised in a top-down manner, impunity and collusion between criminal and political elements were central in the production and perpetuation of violence both within the state and within civil society. When examined in light of these two decades of the postrevolutionary period, the character and levels of violence in contemporary Mexico appear less as an aberration and more as the latest expression of a longer, though uneven and nonlinear, historical trajectory of decentralized, multifaceted, and multi-actor forms of violence.

Multipoint pacing [Multipoint™ Pacing (MPP), Abbott] via a single left ventricular lead (Quartet™ LV lead, Abbott) improves acute left ventricular (LV) function and response to cardiac resynchronization therapy (CRT). Aim of this study was to examine additional benefits in terms of LV reverse remodeling and CRT response by activating MPP in responders and non-responders to conventional biventricular pacing (CONV). 43 consecutive patients receiving CRT (Quadra Assura MP™, Abbott) received LV dP/dtmax optimized CONV programming for 6 months. MPP programming with large anatomical electrode separation (> 30 mm) and basal LV1 pacing location was activated afterwards. Echocardiographic and clinical parameters were obtained at baseline, 6- and 12-month follow-up (FU). The response was defined as an improvement of LVESV ≥ 15% and super-response as improvement ≥ 30% relative to baseline. 41 patients completed FU (one died of non-cardiac cause and one was lost to FU) and after 6 months CONV, 26 patients (63%) were classified as CRT responders. With MPP, the response rate increased to 90% (p

A number of scholars have analysed lynching in Latin America as a response to the recent upsurge in insecurity and crime in the region. This article turns our attention to historical and deeper socio-political undercurrents behind this practice. Drawing on several cases of lynching that took place in post-revolutionary Puebla, the article argues that, rather than signalling state absence, the occurrence of lynching expressed communities’ reactions towards a state presence that was perceived as intrusive and illegitimate. It furthermore shows that lynchings emulated the brutality and visibility of extralegal forms of violence perpetrated by public officials at the local level.

Background:Late-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective.Methods:This study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed.Results:In total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively.Conclusion:Evidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.

Der unverzugliche Beginn der kardiopulmonalen Reanimation (CPR) ist nach einem Herz-Kreislauf-Stillstand der prognoseentscheidende Faktor. Bei fruhem Beginn der CPR durch Laien und mithilfe des Einsatzes von automatisierten externen Defibrillatoren (AED) kann bei Kammerflimmern oder einer ventrikularen Tachykardie der Rhythmus zeitnah wiederhergestellt werden. Mit der vorliegenden Untersuchung wurden Ort und Zeit der Reanimation bei Herz-Kreislauf-Stillstand in einer deutschen Grosstadt untersucht und die strategische Vorhaltung von Rettungswagen und AED evaluiert. In einer retrospektiven Analyse wurden alle prahospitalen Notfalleinsatze durch den Bochumer Rettungsdienst aus dem Jahr 2011 analysiert. Hierzu wurde das Stadtgebiet in Planquadrate unterteilt, anhand derer die Lokalisationen der Notfalleinsatze gemeinsam mit ihrer jeweiligen Tageszeit sowie die durchgefuhrten Masnahmen abgebildet und untersucht wurden. Die Herz-Kreislauf-Stillstande mit Reanimation (insgesamt 299) ereigneten sich uberwiegend in der hauslichen Umgebung und wahrend der Tagstunden. Das mittlere Alter betrug 74,2 ± 12,47 Jahre, wobei 59% der Patienten mannlich waren. Von 47 Einsatzen im offentlichen Raum traten 16 (34%) in Stadtteilzentren auf. In 72 % der Falle war initial ein nichtdefibrillierbarer Rhythmus vorhanden; in 41 % der Falle konnte primar eine Ruckkehr des Spontankreislaufs (ROSC) erreicht werden. Da die vorgelegten Daten eine erhohte Frequenz von Herz-Kreislauf-Stillstanden mit Reanimationen in Stadtteilzentren zeigen, erscheint an diesen Orten eine strategische Vorhaltung von Rettungswagen und AED sinnvoll. Dies beinhaltet auch z. B. die Etablierung von „mobilen Rettungswachen“ (v. a. wahrend der Tagstunden). Hierdurch kann moglicherweise die Zeit bis zum Beginn der Reanimationsmasnahmen verkurzt werden. Zudem sollten Laien durch konkrete Anweisungen der Rettungsleitstellendisponenten fruhzeitig in den Prozess der Reanimation eingebunden werden.

\(\bf Background\) The prevalence of aortic valve stenosis is increasing due to the continuously growing geriatric population. Data on procedural success and mortality of very old patients are sparse, raising the question of when this population may be deemed as "too old even for transcatheter aortic valve replacement (TAVR)". We, therefore, sought to evaluate the influence of age on outcome after TAVR and the impact of direct implantation. \(\bf Methods\) The data of 394 consecutive patients undergoing TF-TAVR were analyzed. Patients were divided into four age groups: ≤75 (group 1, \(\it n\) = 28), 76–80 (group 2, \(\it n\) = 107), 81–85 (group 3, \(\it n\) = 148), and >85 (group 4, \(\it n\) = 111) years. Direct implantation was performed when possible according to current recommendations. Survival was evaluated by Kaplan–Meier analysis. \(\bf Results\) Mortality at 30 days and 1 year was not significantly different between the four age groups (3.6 vs. 6.7 vs. 5.4 vs. 2.7% and 7.6 vs. 17 vs. 14.5 vs. 13%m respectively, log-rank \(\it p\) = 0.59). Direct implantation without balloon aortic valvuloplasty was more frequently performed on patients aged >85 vs. ≤85 years (33.3 vs. 14.1%, \(\it p\) 85 Jahre (Gruppe 4, \(\it n\) = 111). Sofern es die aktuellen Empfehlungen erlaubten, wurde eine direkte Implantation durchgeführt. Das Überleben wurde mittels Kaplan–Meier-Analyse evaluiert. \(\bf Ergebnisse\) Zwischen den 4 Altersgruppen waren keine signifikanten Unterschiede der Mortalität nach 30 Tagen und nach einem Jahr zu verzeichnen (entsprechend 3,6 vs. 6,7 vs. 5,4 vs. 2,7 % und 7,6 vs. 17 vs. 14,5 vs. 13 %; \(\it p\) = 0,59 für Log-Rank-Test). Eine direkte Implantation ohne Ballonvalvuloplastie wurde bei Patienten >85 Jahre häufiger durchgeführt als ≤85 Jahre (33,3 vs. 14,1 %; \(\it p\)

The trial was financed by Ministerio de Sanidad y Consumo Español through their call for independent clinical research, Orden Ministerial SAS/2377, 2010 (EC10-115, EC10-116, EC10-117, EC10-119, EC10-122); CAIBER—Spanish Clinical Research Network, Instituto de Salud Carlos III (ISCIII) (CAI08/010044); and Gerencia Asistencial de Atención Primaria de Madrid. This study is also supported by the Spanish Clinical Research Network (SCReN), funded by ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, project number PT13/0002/0007, within the National Research Program I+D+I 2013-2016 and co-funded with European Union ERDF funds (European Regional Development Fund). This project received a grant for the translation and publication of this article from the Foundation for Biomedical Research and Innovation in Primary Care (FIIBAP) Call 2017 for grants to promote research programs. Objectives To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. Design Pragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain). Participants 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm. Interventions The IM arm received 1 mg VB12 on alternate days in weeks 1–2, 1 mg/week in weeks 3–8 and 1 mg/month in weeks 9–52. The oral arm received 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. Main outcomes Serum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction. Results The follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were −0.7% (133 out of 135 vs 129 out of 130; 95% CI: −3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: −1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were −6.3% (103 out of 112 vs 115 out of 117; 95% CI: −11.9 to −0.1; p=0.025) and −6.8% (103 out of 140 vs 115 out of 143; 95% CI: −16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>−10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route. Conclusions Oral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low. Publisher PDF

Background: Treatment of depressive disorders in old age is hindered by several barriers. Most common are time pressure in primary care and latency for specialized therapeutic care. To improve treatment, the collaborative care approach GermanIMPACT was evaluated in a cluster-randomized controlled trial. Care managers offered a complex stepped-care intervention of monitoring, psychoeducation, and behavioral activation techniques. Twenty-six percent of the intervention group responds with a remission of depressive symptoms compared with 11% who received treatment as usual (TAU). The low-threshold intervention was more successful than TAU. Nevertheless, three-quarters did not respond with a remission. The aim of this study is to identify and describe the different types of utilization and of treatment response to understand what constitutes an effective intervention. Methods: Of 64 patients from the intervention group, we carried out problem-centered interviews with 26 patients from the intervention group. We analyzed the interviews using a qualitative type-building content analysis. For type construction, we performed a contrasting case comparison, regarding inductive and deductive categories of the intervention utilization and the symptom development. Results: The 26 participants' ages ranged from 62 to 87 years (mean = 72 years). Three participants were male. We identified five types of utilization, which differ primarily in the realization of pleasant activations, depending on own activity at the beginning and during the therapy: "activatable relief seekers," "active relief seekers," "active relaxation seekers," "passive problem-solving seekers," and "passive relief seekers." In the second typology, we analyzed four deductively determined types of treatment response responders, slight improvers, constant moderates, and non-responders. Patient-specific characteristics are a recent history of depression, an affinity for activities, supportive contacts, and limited comorbidity. In contrast, non-responders report contrary characteristics. Conclusion: Our two typologies emphasize that an effective intervention requires a match between intervention components and patient characteristics. We saw no intersections between utilization and treatment response. GermanIMPACT is an effective low-threshold intervention for moderately burdened patients, who are still capable of self-activation. An expansion of the intervention, especially for depression with a long history and comorbidities impairing mobility, could increase the effectiveness and improve the care situation of older people suffering from depression.

Highlights • Transcatheter heart valve size selection is still challenging. • The overlap between two different prosthesis sizes for borderline annuli remains. • Undersizing but overfilling improves sizing in borderline annulus cases. • Undersizing but overfilling decreases the postprocedural THV-pressure gradient. • Prospective studies are needed considering the TAVR expansion to younger patients., Background Current recommendations for valve size selection are based on multidimensional annular measurements, yet the overlap between two different transcatheter heart valve (THV) sizes remains. We sought to evaluate whether undersizing but overfilling eliminates the gray zones of valve sizing. Methods Data of 246 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable bioprosthesis with either conventional sizing and nominal filling (group 1 (NF-TAVR), n = 154) or undersizing but overfilling under a Less Is More (LIM)-Principle (group 2 (LIM-TAVR), n = 92) were compared. Paravalvular leakage (PVL) was graded angiographically and quantitatively using invasive hemodynamics. Results Annulus rupture (AR) occurred only in group 1 (n = 3). Due to AR adequate evaluation of PVL was possible in 152 patients of group 1. More than mild PVL was found in 13 (8.6%) patients of group 1 and 1 (1.1%) patient of group 2 (p = 0.019). Postdilatation was performed in 31 (20.1%) patients of group 1 and 6 patients (6.5%) of group 2 (p = 0.003). For patients with borderline annulus size in group 1 (n = 35, 22.7%) valve size selection was left to the physiciańs choice resulting in selection of the larger prosthesis in 10 (28.6%). In group 2 all patients with borderline annulus (n = 36, 39.1%) received the smaller prosthesis (LIM-TAVR). The postprocedural mean transvalvular pressure gradient was significantly higher in the NF-TAVR-group (11.7 ± 4 vs. 10.1 ± 3.6 mmHg, p = 0.005). Conclusion LIM-TAVR eliminates the gray zones of sizing and associated PVL, can improve THV-performance, reduce incidence of annular rupture and simplify the procedure especially in borderline cases.

Malfunctions in implanted pacemaker and defibrillator systems can affect all components of the device (battery, capacitor, central processing unit (CPU), connector, soldering points, electrodes). The resulting problems can manifest themselves as inadequate therapy, a lack of therapy despite the need for stimulation or shock release in case of ventricular tachyarrhythmia, or as an ineffective delivery of therapy. The high number of implanted pacemaker and defibrillator systems, the increased life expectancy and the technical progress of cardiac "device" therapy mean that the treating physician is confronted with increasingly complex problems in the follow-up. In addition to the knowledge of the basic function of these devices, a structured procedure to detect and treat malfunctions in a timely manner is required. In this review, frequent malfunctions of pacemaker and defibrillators are presented, individual problems are pointed out, and solutions and treatment options are shown.

Introduction The Medtronic Attain Stability Quad lead is a quadripolar left ventricular (LV) lead with an active fixation helix assembly designed to fixate the lead within the coronary sinus and pace nonapical regions of the LV. The primary objective of this study was to determine the safety and effectiveness of this novel active fixation quadripolar LV lead. Methods Patients with standard indications for cardiac resynchronization therapy (CRT) were enrolled. All patients were followed at 3 and 6 months post-implant and every 6 months thereafter until study closure. Pacing capture thresholds (PCTs) were measured at implant and each follow-up and adverse events (AEs) were recorded upon occurrence. Results Of the 440 patients who underwent implant procedures, placement of the Attain Stability Quad lead was successful in 426 (96.8%). LV lead-related complications occurred in 10 patients (2.3%), including LV lead dislodgement in three patients (0.7%). The percentage of patients with at least one LV pacing vector with a PCT ≤2.5 V at a 6-month follow-up was 96.3%. The LV lead was successfully fixated to the prespecified pacing location in 97.4% of cases. Conclusions This large, multinational study of the Attain Stability Quad lead demonstrated a high rate of implant success with a low complication rate. The active fixation mechanism allowed precise placement of the pacing electrodes at the desired target region with good PCTs and a very low dislodgement rate.

Objectives This study sought to evaluate the effects of programming a long detection in single-chamber (VVI) implantable cardioverter-defibrillators (ICDs) in the multicenter prospective ADVANCE III (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III) trial. Background Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs. Methods A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length Results A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm. Conclusions Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175)

This article provides a technical description of common implant practice for delivery of cardiac contractility modulation (CCM) therapy to heart failure patients. As of September 2016, the authors of this article collectively have been involved with more than 400 system implantations in five medical centers, beginning with the advent of CCM therapy approximately 12 years ago. CCM therapy has been evaluated in a variety of studies, and was shown to be safe and effective and of benefit to patient quality of life and exercise capacity. As the use of CCM therapy continuously expands among medical centers in Europe, this article describes the technical and practical aspects of the implant procedure, and additional special technical cases based on our cumulative experience.

Background Dislodgements of left ventricular (LV) leads are still a challenging problem in cardiac resynchronization therapy (CRT). The Attain Stability Quad (ASQuad) MRI SureScan 4798 steroid-eluting, quadripolar LV lead has a side-helix to enable the lead to be actively fixated to the vessel wall. The uniquely designed active fixation can be advantageous in vessels that are wide or have short take-offs. Further, the helix easily elongates to allow for future extraction. Purpose To report on the handling, performance and safety of ASQuad LV lead in a large clinical study. Methods The ASQuad clinical study is a prospective clinical trial from 50 centers in 10 countries enrolling CRT candidates implanted with the ASQuad LV lead. Aside from evaluating safety and effectiveness of the LV lead, the trial specifically collected data on parameters related to lead stability during and post implant. Results Of 440 enrolled patients (74.8% male, average age 70±11 years) that underwent an implant attempt, 426 (96.8%) were successfully implanted. The helix was mostly affixed in the mid to basal lateral position (62%), followed by mid to basal posterior position (29%). The lead tip placement was most often mid lateral or mid posterior (77%), and in a vein with diameter greater than the pacing electrode diameter (>5.1 French) in the majority (60%) of procedures. Among all subjects (n=421) who underwent pacing capture thresholds (PCT) tests before and immediate after guide catheter slitting, 98% reported ≤1 V difference in PCT, and 86% were within 0.5 V. The interquartile range for the difference in PCT was −0.1 to 0.1 V. The mean PCT at implant for all subjects at the final selected LV pacing vector was 1.15±0.70 V at 0.5 ms pulse width. The average LV lead implant time was 16±21 minutes. Targeted pacing location was achieved in 97% of successful implants, and 98% of implanters reported good or fair stability after guidewire removal. The overall handling of the LV lead was rated as acceptable by implanters in 99% of cases. Three patients (0.7%) experienced LV lead dislodgement post implant, and these complications were resolved by repositioning of the lead (0 and 1-day post implant) in two and by lead replacement when noted at 90 days follow-up in one. Conclusions The ASQuad LV lead was implanted with a high rate of success and ability to achieve the targeted pacing location. Lead handling and stability following guidewire removal were rated as acceptable by nearly all implanters. The side-helix likely improved LV lead stability since 98% of the subjects had ≤1 V difference in PCT before and after catheter slitting during implant procedures, and by demonstrating a low post implant lead dislodgement rate. Acknowledgement/Funding Sponsored by Medtronic

Introduction Cardiac Contractility Modulation (CCM) is a treatment for patients with heart failure with reduced ejection fraction (HFrEF) providing improved myocardial molecular and biochemical characteristics and thus improved exercise tolerance and quality of life by application of electrical signals during the absolute refractory period. Cardiopulmonary exercise testing is an integrative method to assess exercise tolerance in heart failure patients providing insights in circulatory, respiratory and metabolic reactions during exercise. The VE/VCO2-Slope (minute ventilation/carbon dioxide production) and an oscillatory breathing pattern have widely been demonstrated to have strong prognostic value for patients with chronic heart failure. Methods Between February 2017 and January 2019 15 patients (mean age 64.4±7.9 years, NYHA 2.93±0.58) with standard indication for CCM-therapy have been enrolled in a single center in Germany. Prior to implantation of the Optimizer Smart System, symptom-limited cardiopulmonary exercise testing was performed using a bicycle ramp protocol (25W+10W/min). The Follow-up was conducted 6 weeks post implantation. The control group consisted of 45 patients (mean age 64.8±7.9 years, NYHA 2.2±0.72) with stable systolic heart failure and reduced ejection fraction. Statistical Analysis was performed by paired and unpaired t tests. Results 6 weeks after CCM-implantation the VE/VCO2-Slope showed a significant decrease (39.6±11.1 vs. 36.6±8.9, p In contrast, subjects showed no significant changes in watt-measurements (72.67 W ± 19.2 W vs. 76.57 W ± 18.5 W) or maximal oxygen uptake (1034 ml/min ± 247 ml/min vs. 1104 ml/min ± 256 ml/min) compared to baseline. Similarly, the control-group showed stable measurements for external load (79.9 W ± 16.4 W vs. 77.1 W ± 17.5 W) and peak oxygen uptake (1097 ml/min ± 225 ml/min vs. 1116 ml/min ± 330 ml/min). Conclusion Cardiac Contractility Modulation provides improved ventilatory efficiency measures by VE/VCO2-slope and reduces oscillatory breathing pattern during exercise at follow up. As the low ventilatory efficiency observed in patients with heart failure constitutes an important predictor of cardiovascular mortality these results provide an interesting insight of therapeutic effects of Cardiac Contractility Modulation apart from VO2-measurements.

Due to global warming a worldwide increase in the frequency and intensity of heat waves have been forecast. In the context of the overall increasing number of emergency service calls, weather-induced effects on the number of calls are highly relevant. We evaluated the influence of extreme temperatures on emergency medical services.The study was conducted in Bochum, Germany. The authors examined the data from 16,767 emergency calls. In addition, the daily updated temperature data were collected for each emergency doctor call. Data were collected from 01 January 2014 until 31 December 2015. The primary question was the influence of extremes of the perceived temperature (PT; on the day of the call and the three previous days) on the diagnosis group of cardiovascular diseases. A secondary question was the influence of extremes of the temperature parameters (air temperature, PT, physiological equivalent temperature [PET]) on the day of call and the three previous days.A total of 16,767 calls were assessed. The threshold values (upper and lower 5%) were -8.7 and 32.5 °C for PT and -0.7 and 26.7 °C for air temperature. Examination of the PT indicated a significantly increased rate of calls for cold spells on the day of the call (RR = 1.14; p = 0.033) as well as a lag effect of 3 days (RR = 1.1; p = 0.049).The present study shows that during cold spells there is an increased rate of calls for cardiovascular diseases. This effect is not only observable on the extreme day itself but also 3 days later.HINTERGRUND: Durch die globale Erwärmung wird weltweit eine Zunahme der Häufigkeit und Intensität von Hitzeperioden prognostiziert. Im Rahmen der insgesamt steigenden Einsatzzahlen im Rettungsdienst haben wetterbedingte Auswirkungen auf die Einsatzzahlen eine hohe Relevanz. Als primäre Fragestellung wurde der Einfluss von Extremwerten der gefühlten Temperatur (GT) am Einsatztag und den 3 vorangehenden Tagen auf die Diagnosegruppe der kardiovaskulären Erkrankungen untersucht.Retrospektive Analyse sämtlicher Notarzteinsätze in der Ruhrgebietsstadt Bochum aus den Jahren 2014 und 2015. Als Temperaturparameter wurden die Lufttemperatur, die GT sowie die physiologisch äquivalente Temperatur (PET) als Indikator für die thermische Belastung verwendet. Die Minimal- bzw. Maximalwerte der Tageswerte wurden sortiert und die entsprechenden oberen und unteren 5 % dem mittleren Bereich gegenübergestellt.Insgesamt wurden 16.767 Einsätze ausgewertet. Die Grenzwerte (obere und untere 5 %) der GT lagen bei − 8,7 und 32,5 °C und für die Lufttemperatur bei − 0,7 und 26,7 °C. Bei Betrachtung der GT fand sich eine signifikant erhöhte Einsatzrate bei Auftreten von Kälteepisoden am Einsatztag selbst (relatives Risiko [RR] = 1,14; p = 0,033) sowie mit einem Lag-Effekt von 3 Tagen (RR = 1,1, p = 0,049).Die Vorliegende Untersuchung zeigt, dass es bei Kälteepisoden zu einer gehäuften Einsatzrate aufgrund von kardiovaskulären Erkrankungen kommt. Dieser Effekt besteht nicht nur für den Extremtag selbst, sondern tritt erneut mit einer Zunahme 3 Tage verspätet auf.