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Für den Qualitätsindikator „Präoperative Verweildauer“ wird im Rahmen der externen stationären Qualitätssicherung bei der operativen Versorgung hüftgelenknaher Femurfrakturen über 48 h nach stationärer Aufnahme ein Toleranzbereich von ≤15 % angegeben. Anhand des Strukturierten Dialogs Rheinland-Pfalz (2014) wurden die Ursachen einer verzögerten Frakturversorgung über 48 h hinaus untersucht. Es wurden insgesamt 331 Einzelanfragen analysiert. In 60,7 % wurden patientenbezogene, in 13,3 % logistische Gründe angegeben. In 9,1 % wurde die Begründung als nicht plausibel gewertet. Bei 7,3 % wurden aufgrund softwarebedingt fehlender Spezifikationen falsche präoperative Verweildauern generiert. In 6,6 % lag ein EDV-Problem oder eine fehlerhafte Kodierung vor. Häufigster Verzögerungsgrund war die Antikoagulation (25,7 %). Die Aussagekraft des Qualitätsindikators „Präoperative Verweildauer“ ohne Aufgliederung in patientenbezogene und logistische Gründe ist kritisch zu betrachten. For the “preoperative stay” quality indicator , which is part of the external quality assurance for proximal femoral fractures (module 17/1), a tolerance range for surgery within 48 h after admission of ≤15 % is given. The structured dialog (2014) in Rheinland-Pfalz was analyzed with respect to reasons for delaying surgery for more than 48 h after admission. A total of 331 cases were analyzed. In 60.7 % patient-related reasons and in 13.3 % administrative reasons were found. In 9.1 % the statements were not feasible. Due to a lack of software-related specifications in 7.3 % a wrong preoperative length of stay was generated. Wrong coding or a computer-related problem was found in 6.6 %. The most common reason for delay was the intake of an anticoagulant (25.7 %). The significance of the quality indicator “Preoperative stay” without division into whether this was administrative or patient-related must be considered critically.

Under increasing anthropogenic impacts, the hydrology, weathering, turbidity, and biogeochemistry of the Amazon and Pará river catchments are changing, potentially affecting the concentration and speciation of nitrogen (N) entering the estuary, as well as the subsequent primary productivity. Primary production and several N‐cycling rates have been studied in the northern river plume, and new studies focusing on specific processes in the river mouth emerged. Yet, a general overview is still lacking. For the first time, we provide an overview of primary production along with nitrification, ammonium (NH4+), nitrate (NO3−), and amino acid uptake rates in the Amazon and Pará river mouths which exhibit different degrees of catchment land use. Our results indicate that the Amazon supplies tenfold more NH4+and NO3−, and its nitrification rates are four times higher than in the Pará River. The stable isotope composition of ambient water and NO3−confirmed that nitrification is a dominant pathway, with fluxes reaching 8.5 × 108mol N d−1in the Amazon. Nutrients are transported to regions with reduced turbidity and little nitrification, facilitating NH4+(0.2–2.4 × 108mol N d−1) and carbon uptake (4.6 and 14.0 × 108mol C d−1in the Pará and the Amazon, respectively) by phytoplankton. The lower N‐cycling rates measured in the Pará relative to the Amazon River mouth likely originate from differences in river discharge and watershed characteristics. Riverine nitrogen can support intense production at the base of the food web in coastal oceans. Such productive ecosystems often show flourishing life and act as a strong atmospheric carbon sink. Since the extent of this nitrogen source is greatly influenced by the status of the river catchment area, it is crucial to have a good understanding of the amount and reactivity of riverine nitrogen at a given study site. Here, we used nitrogen isotope tracers to measure nitrogen assimilation and nitrification rates in the Amazon and Pará river mouths. We found that nitrification was happening at high rates in the Amazon River Mouth. In both estuaries, nitrate production is greater than consumption, allowing nitrate export beyond the turbid waters of the river mouths. Because the Amazon and Pará drainage basins are facing drastic changes, this nitrogen budget gives a baseline for nitrogen cycle pathways and export that will help to monitor the effect of these changes on estuarine nitrogen processes. Nitrogen uptake and nitrification measurements reveal intense nitrification of autochthonous ammonium in the Amazon and Pará estuariesIn the turbid parts, nitrate produced via nitrification is not entirely consumed by primary production, leading to its exportRates of nitrogen cycle processes are 10 times higher in the Amazon River mouth, likely due to higher riverine nitrogen discharged Nitrogen uptake and nitrification measurements reveal intense nitrification of autochthonous ammonium in the Amazon and Pará estuaries In the turbid parts, nitrate produced via nitrification is not entirely consumed by primary production, leading to its export Rates of nitrogen cycle processes are 10 times higher in the Amazon River mouth, likely due to higher riverine nitrogen discharged

Background/Objectives:Growing evidence suggests that antibiotic use is associated with childhood body mass index (BMI), potentially via mechanisms mediated by gut microbiome alterations. Less is known on the potential role of prenatal antimicrobial use in offspring obesity risk. We examined whether prenatal antibiotic or antifungal use was associated with BMI at the age of 2 years in 527 birth cohort participants.Methods/Subjects:Antimicrobial use was obtained from the prenatal medical record. Height and weight were measured at the age of 2 years. Overweight/obesity was defined as a BMI ⩾85thpercentile.Results:A total of 303 (57.5%) women used antibiotics and 101 (19.2%) used antifungals during pregnancy. Prenatal antifungal use was not associated with child BMI at the age of 2 years. In the fully adjusted model, prenatal antibiotic use was associated with a 0.20±0.10 (P=0.046) higher mean BMI Z-score at the age of 2 years. Associations between prenatal antibiotic use and childhood BMI varied by trimester of exposure, with first or second-trimester exposure more strongly associated with larger BMI at the age of 2 years for both BMI Z-score (interaction P=0.032) and overweight/obesity (interaction P=0.098) after covariate adjustment.Conclusions:Prenatal antibiotic, but not antifungal, use is associated with larger BMI at the age of 2 years; associations were stronger for antibiotic exposures in earlier trimesters. Future studies examining whether these associations are due to alterations in the maternal and/or infant microbiome are necessary. Children who are overweight at the age of 2 years are at higher risk for being overweight as they age; prenatal antibiotic use is a potentially modifiable exposure that could reduce childhood obesity.

Among the topics of considerable interest concerning our understanding of the unusual biology of schistosomes is the sexual maturation of the female. The identification of genes coding for signal transduction proteins controlling essential steps of the pairing-dependent differentiation of the reproductive organs, vitellarium and ovary will help to substantiate our knowledge about this unique parasite. Furthermore, such signalling proteins could be potential targets to interfere with the development of this parasite to combat schistosomiasis since its pathology is caused by the eggs. This review summarises first post-genomic steps to elucidate the function of gonad-specific signalling molecules which were identified by homology- based cloning strategies, by in silico identification or by yeast two-hybrid interaction analyses, using a combination of novel techniques. These include the in vitro culture of adult schistosomes, their treatment with chemical inhibitors to block enzyme activity, the use of RNAi to silence gene function post-transcriptionally, and confocal laser scanning microscopy to study the morphological consequences of these experimental approaches. Finally, we propose a first model of protein networks that are active in the ovary regulating mitogenic activity and differentiation. Some of these molecules are also active in the testes of males, probably fulfilling similar roles as in the ovary. [ABSTRACT FROM AUTHOR]

The insertion reaction of bis(pinacolato)diborane(4) [(Me4C2O2)BB(O2C2Me4), 1] with various diazoalkanes provided novel representatives of a new class of substituted C1-bridged bis(pinacolato)diborane(4) derivatives 5a, 5b, 5c, and 5d in a range of 75−78% isolated yields. The reaction was efficiently catalyzed by Pt(PPh3)4 in toluene at 110 °C. Single-crystal X-ray diffraction, GCMS, and NMR multinuclear spectroscopies fully confirmed the structure and configuration of the new compounds. Crystals of 5a and 5c are centrosymmetric, while those of 5d are chiral. 5b crystallized with a somewhat unusual Fdd2 space symmetry. While its crystals are noncentrosymmetric, they contain mirror-related species. The degree of puckering of the five-membered C2O2B rings, as well as the dihedral angles between the mean planes of these rings, vary from one compound to another and to some extent from one ring to another within the same compound.