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BACKGROUND: The Munich Swallowing Score (MUCSS) is a clinician rated scale for the assessment of the functional level of swallowing saliva/secretions, food and liquids. The MUCSS consists of two eight-point subscales, MUCSS-Saliva and MUCSS-Nutrition. In a previous article, content validity and interrater reliability were described. OBJECTIVE: The aim of the present study was to investigate criterion validity and sensitivity to change of the MUCSS. METHODS: The research was conducted at a tertiary care academic hospital. Data were collected retrospectively in a cohort of 100 acute and subacute neurologic patients. Criterion validity was judged by comparison to the Gugging Swallowing Screen (GUSS), the Barthel Index (BI), Early Rehabilitation Barthel Index (ERI), Extended Barthel Index (EBI) and also by comparison to three physiological scales drawn from FEES videos: The Penetration - Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale (YPR) and the Murray Secretion Scale (MSS). Changes in oral intake and saliva swallowing were followed up for three months. RESULTS: Between MUCSS and scores directly reflecting dysphagic symptoms (GUSS, PAS, YPR, MSS, ERI), strong to moderate correlations were found, weaker but statistically significant associations were seen with global measures of disability (BI isolated, EBI-subscale cognitive functions). MUCSS was sensitive to positive change of saliva swallowing and oral intake during the recovery period. CONCLUSIONS: These preliminary data suggest that the MUCCS is a valid scale and may be appropriate for documenting clinical change in swallowing abilities of patients with neurogenic dysphagia.

This manuscript outlines various types of review articles as forms of evidence synthesis with special regard to their strengths and limitations. Review articles not only present summarised data, but also offer an evaluation of the quality of the individual studies included in it. The validity and the reliability of outcomes of reviews is strongly dependent on the quality of the data included. For this reason, a comprehensive literature selection process is paramount. Fundamental knowledge of bias and literature assessment is also necessary when reading reviews. This article presents selected tools for evidence appraisal and evaluation of bias risk.Der vorliegende Beitrag gibt einen Überblick über die verschiedenen Arten von Reviews (Übersichtsarbeiten) als Formen der Evidenzsynthese mit besonderem Hinblick auf deren Stärken sowie Limitationen. Reviews können Wissen in aggregierter Form beschreiben und erlauben zusätzlich eine Bewertung der Studienqualität eingeschlossener Arbeiten. Die Aussagekraft bzw. die Vertrauenswürdigkeit der Ergebnisse eines Reviews hängt stark von der Qualität der eingeschlossenen Daten ab, weswegen eine konsequente Auswahlstrategie notwendig ist. Ein Basiswissen zur Literaturbewertung und zu möglichen Verzerrungseffekten ist auch in der Betrachtung von Übersichtsarbeiten notwendig. Zu diesem Zweck werden in diesem Artikel auch ausgewählte Werkzeuge zur Evidenzbewertung und zur Beurteilung des Biasrisikos vorgestellt.

Bei einem 36-jahrigen Patienten wurde eine allogene Nierentransplantation durchgefuhrt (Match 1‑1‑0, Zytomegalievirus [CMV] Donor [D] +/Empfanger −, hohes Risiko). Elf Jahre zuvor war es zu einer Dialysepflichtigkeit im Rahmen einer bioptisch gesicherten tubulointerstitiellen Nephritis gekommen. Nach Transplantation ereignete sich im Verlauf des initialen stationaren Aufenthalts ein sukzessiver Hamoglobinabfall von 11,4 g/dl auf 7,3 g/dl. Initial war dies erklart durch die stattgehabte Nierentransplantation und einer chronisch fibrosierende Antrumgastritis mit Erosionen. Trotz wiederholter Transfusion von Erythrozytenkonzentraten bestand eine refraktare Anamie, weswegen sich der Patient mehrfach in unserer Klinik zur weiteren Diagnostik und Therapie vorstellte. Bei Darstellung von Riesenproerythroblasten im Knochenmark sowie dem quantitativen Nachweis von Parvovirus B19 (>900 Mio. IU/ml DNA-Replikationen) imponierte das Bild einer virusassoziierten Aplasie der Erythropoese. Eine intravenose Immunglobulinapplikation wurde etabliert und zeigte einen langfristigen therapeutischen Erfolg.

Objectives Older adults vary in their safe and unsafe sexual behaviors. While researchers are beginning to understand more about the sexual and intimate expression of older adults, only recently are they beginning to understand how older adults make decisions about sexual risk. Bandura's social cognitive theory offers a frame for understanding how self-efficacy, environmental factors, and goal motivation are related to sexual risk behaviors for older adults, including the interplay between these variables. Methods Using a diverse sample of older adults (n = 720) age 50+ years, social cognitive theory was modeled to determine the relationship between environment variables (age, gender, and sexual health conversations with practitioners), behavioral variables (self-efficacy), and cognitive variables (importance of sexual wellness goals) with the outcome variable of sexual risk behaviors. Results Self-efficacy had an indirect effect on sexual risk via sexual wellness goal motivation. Healthcare provider conversations had both direct and indirect effects on older adults' sexual risk through sexual wellness goal motivation. Models were similarly predictive for older men and women. Conclusions Sexual risk behaviors among older adults are more influenced by environmental factors in their healthcare settings and their perception and prioritization of sexual wellness goals. Clinical implications Providers play a key role in initiating and maintaining sexual health discussions with older patients, potentially mitigating sexual risk and bolstering self-efficacy.

Background and Objectives It is not fully understood how large-scale events affect well-being. Older adults showed the highest levels of resilience following the September 11th (9/11) terrorist attacks, but during the severe acute respiratory syndrome outbreak, there were no age-related differences in well-being. The current study examined the Coronavirus Disease 2019 (COVID-19) disruption on well-being throughout adulthood. Research Design and Methods Perceived stress and affect were examined in 166 community-dwelling adults (Mage = 35.65; SD = 15.53; range = 18–79) in relation to the perceived disruption of the COVID-19 pandemic to their lives. Results A significant moderation was found for age and COVID-19 disruption on perceived stress [F(5, 153) = 8.88, p < .05, R2 = .22] and negative affect [F(5, 154) = 4.91, p < .05, R2 = .14], but not for positive affect. For participants over 50, those who rated COVID-19 as a low or high disruption had similar scores on stress and negative affect, but with younger aged participants, perceiving high disruption corresponded with higher levels of stress and negative affect. Discussion and Implications Findings are consistent with the strength and vulnerability integration (SAVI) model, wherein older adults try to maintain positive emotional well-being, with middle-aged and older adults in the current study having experienced less negative impact on well-being. Middle-aged and older adults may be better able to regulate negative emotions from COVID-19 than younger adults. SAVI proposes a greater negative impact on older adults when they experience sustained stressors; as the challenges with COVID-19 continue, further data will need to be examined.

Demand to meet the needs of a rapidly aging population is high. Students outside of gerontology programs, however, remain resistant to enrolling in aging coursework, which are often electives within or outside their degree programs. A life-span development course, however, is likely to be a requirement in many disciplines. In a multigenerational workforce spanning five generations and with intergenerational conflict making media headlines, students must understand how to navigate age-diverse climates. We advocate that a course in life-span development can serve as both a recruitment tool for driving interest in aging-related careers and an access point for preparing students to enter a sometimes contentious, multigenerational workforce. We illustrate how knowledge of developmental influences across the lifespan may lead to a better understanding of individual similarities and differences in developmental experiences, fostering intergenerational cohesion throughout one’s career.

The new decision support tool Glucosafe 2 (GS2) is based on a mathematical model of glucose and insulin dynamics, designed to assist caregivers in blood glucose control and nutrition. This study aims to assess end-user acceptance and usability of this bedside decision support tool in an adult intensive care setting. Caregivers were first trained and then invited to trial GS2 prototype on bedside computers. Data for qualitative analysis were collected through semi-structured interviews from twenty users after minimum three trial days. Most caregivers (70%) rated GS2 as convenient and believed it would help improving adherence to current guidelines (85%). Moreover, most nurses (80%) believed that GS2 would be timesaving. Nurses' risk perceptions and manual data entry emerged as central barriers to use GS2 in routine practice. Issues emerged from the caregivers were compiled into a list of 12 modifications of the GS2 prototype to increase end-user acceptance and usability. This usability study showed that GS2 was considered by ICU caregivers as helpful in daily clinical practice, allowing time-saving and better standardization of ICU patient’s care. Important issues were raised by the users with implications for the development and deployment of GS2. Integrating the technology into existing IT infrastructure may facilitate caregivers’ acceptance. Further clinical studies of the performance and potential health outcomes are warranted.

Repeated injections of iodinated contrast media (CM) can lead to a deterioration of the renal blood flow, can redistribute blood from the renal cortex to other parts of the kidney and can cause small decreases of the blood flow in cortical capillaries, a significant reduction in blood flow in peritubular capillaries and a significant reduction in blood flow in the vasa recta. Therefore, a study in pigs was designed, to show whether the repeated injection of CM boli, alone, can cause a reduction of oxygenation in the cortico-medullar renal tissue – the region with the highest oxygen demand in the kidney - of pigs. While the mean pO2-value had only decreased by 0.3 mmHg from 29.9±4.3 mmHg to 29.6±4.3 mmHg (p = 0.8799) after the tenth Iodixanol bolus, it decreased by 5.9 mmHg from 34.0±4.3 mmHg to 28.1±4.3 mmHg after the tenth Iopromide bolus (p = 0.044). This revealed a remarkable difference in the influence of these CM on the oxygen partial pressure in the kidney. Repeated applications of CM had a significant influence on the renal oxygen partial pressure. In line with earlier studies showing a redistribution of blood from the cortex to other renal areas, this study revealed that Iodixanol – in contrast to Iopromide - induced no changes in the pO2 in the cortico-medullar region which confirms that Iodixanol did not hinder the flow of blood through the renal micro-vessels. These results are in favor of a hypothesis from Brezis that a microcirculatory disorder might be the basis for the development of CI-AKI.

Background and Aims Most amputation procedures at the shoulder joint, on patients suffering from pathological humerus fractures are performed under general anesthesia.Here we show a case of an American Society of Anesthesiologists classification (ASA) III patient, scheduled for amputation of the humerus, at the shoulder joint. Due to a high risk procedure under general anesthesia, we decided to apply interscalene and paravertebral blocks along with intravenous sedation. Methods A 55-year-old male, ASA III patient, was scheduled for amputation of his right humerus. The patient had a history of bladder cancer with multiple metastases on the lungs, lymph nodes and bones. He also suffered from a pathological fracture of left humerus, with presence of left-hand cellulitis. During preparation for surgery, an invasive blood pressure measurement was set up, while the interscalene and paravertebral spaces were identified using a nerve-stimulating needle and a linear ultrasound probe of 8 and 12 Hertz. An anesthetic solution of 0.5% levobupivacaine was applied at Thoracic (Th) 2 and Th3 levels (5 milliliters per level) and to the brachial plexus (20 milliliters). We used 1% lidocaine for skin infiltration and sedation was performed with a continuous infusion of 1% propofol. Results Sensory blockade occurred after 18 minutes and lasted for about 16 hours in the shoulder and 10 hours in the axilla region, with stable hemodynamic parameters and no perioperative complications. Conclusions Such precise administration of small doses of long-acting local anesthetic at multiple levels has resulted in a satisfactory anesthesia and analgesia without hemodynamic and respiratory complications.

Chain affiliation is widespread in the hotel industry. It has also attracted a lot of academic attention. While a large number of studies have examined whether affiliated hotels outperform independent hotels in terms of occupancy, ADR and RevPAR, research on the chain affiliation - guest satisfaction relationship is scarce. In this study, we explore the impact of chain affiliation on guest satisfaction and guest satisfaction extremeness, which is defined as the extent to which a hotel’s guest satisfaction deviates from the industry average. We also examine whether the relationships between chain affiliation, guest satisfaction and guest satisfaction extremeness are contingent on market segments. Using a large sample of 35.000 hotels, we find evidence that chain affiliation increases guest satisfaction, but decreases guest satisfaction extremeness. In addition, the positive chain affiliation - guest satisfaction relationship and the negative chain affiliation - guest satisfaction relationship are stronger in higher quality market segments. Taken together, our findings suggest that chain affiliation is a double-edged sword for hotels, particularly in higher quality market segments.

Automotive radar systems in automobiles are key for automated and connected driving. Conventionally, functional tests and safety validation of automotive radar systems are carried out in field-operational tests, but are very resource-expensive and they offer neither reproducibility nor reliability. To improve efficiency and reliability, though at the expense of a partial loss of realism, a controlled test environment is required in which repeatability is guaranteed. We proposed previously a system concept for over-the-air testing of radar systems with a vehicle-in-the-loop approach in a virtual environment. For the test in a controlled environment, a realistic simulation of the radar scenario-under-test is necessary. Technological achievements in hardware, software, and computational power have made powerful radar target simulators and real-time capable control computers available. However, for the spatial degrees-of-freedom, which are key to emulate relevant test cases with dynamic evolution in the virtual environment, the illumination antennas of the radar target simulator must be positioned with high speed, accuracy, and over sufficient angular ranges. This paper describes our hybrid electronic-mechanical antenna positioner, offering three motional degrees-of-freedom. Initial trials with a modern commercially available automotive radar installed in a passenger car are presented and they indicate very promising results.

Automotive millimeter-wave radar systems are key to automated and connected driving technologies. It is necessary to validate their functional performance in the installed state thoroughly, reliably, and efficiently under realistic conditions before deploying them in real-world traffic. Field-operational tests are the ultimate phase of verification and validation of radar sensors. This approach offers the highest degree of realism yet consuming enormous resources and associated risks. Additionally, these drive tests are neither sufficiently reproducible nor controllable. On the other hand, computer simulation-based closed-loop test approaches overcome these limitations, but lack physically realistic environments. Therefore, over-the-air testing approaches have gained great relevance in this context. In earlier work, we proposed an advanced system concept using an over-the-air vehicle-in-the-loop (OTA/ViL) approach for evaluating the installed performance of fully operational automotive radar systems. In this paper, we present the complete test system in a closed loop in a virtual electromagnetic environment with realistic radar target echoes. An exemplary traffic scenario is considered to validate the performance of the implemented test system. Initial measurements provide promising results.

Clinical trials; Liver transplant; Quality of life Ensayos clínicos; Trasplante de hígado; Calidad de vida Assaigs clínics; Trasplantament de fetge; Qualitat de vida Management of decompensated cirrhosis is currently geared towards the treatment of complications once they occur. To date there is no established disease-modifying therapy aimed at halting progression of the disease and preventing the development of complications in patients with decompensated cirrhosis. The design of clinical trials to investigate new therapies for patients with decompensated cirrhosis is complex. The population of patients with decompensated cirrhosis is heterogeneous (i.e., different etiologies, comorbidities and disease severity), leading to the inclusion of diverse populations in clinical trials. In addition, primary endpoints selected for trials that include patients with decompensated cirrhosis are not homogeneous and at times may not be appropriate. This leads to difficulties in comparing results obtained from different trials. Against this background, the LiverHope Consortium organized a meeting of experts, the goal of which was to develop recommendations for the design of clinical trials and to define appropriate endpoints, both for trials aimed at modifying the natural history and preventing progression of decompensated cirrhosis, as well as for trials aimed at managing the individual complications of cirrhosis.

We present the GastroDigitalShirt, a smart T-Shirt for capturing abdominal sounds produced during digestion. The garment prototype embeds an array of eight miniaturised microphones connected to a low-power wearable computer and is designed for long-term recording. We present the microphone integration and shirt wiring layout. With the GastroDigitalShirt we monitored the different digestion phases over six hours in four healthy participants with no prior gastro-intestinal diseases. The collected data were annotated by two independent raters to mark Bowel Sounds (BS) instances. The interrater agreement was substantial, with Cohen's Kappa of 0.7, confirming a consistent labeling approach. Overall 3046 BS instances were individually annotated. The extracted BS were structured by Hierarchical Agglomerative Clustering. The analysis highlighted the presence of 4 BS types. The results show that our prototype can capture the main BS types reported in literature.

Sexual violence or misconduct can occur at any age, yet sexual consent understanding is not well studied, especially beyond early adulthood. This project aimed to describe how sexual consent is conceptualized across the adult lifespan, drawing comparisons between young, middle-aged, and older adults. Additionally, we examined variables that may differ by age group and influence sexual consent conceptualization. In a survey, young adults (

BACKGROUND: Intra-arterial administration of radiographic contrast media (CM) is discussed to impair renal perfusion. The pathogenesis of contrast-induced Nephropathy (CIN) is still not clarified. OBJECTIVE: This trial was performed to prove the effects of two CM with different molecular structure on renal perfusion. METHODS: A prospective, randomized study on 16 pigs was designed to compare the outcome after application of a low-osmolar iodinated CM (770 mOsm/kg H2O-Group1) and an iso-osmolar iodinated CM (290 mOsm/kg H(2)o-Group2). Color Coded Doppler Sonography (LOGIQ E9, GE, Milwaukee, USA) was applied for measuring the Renal Resistive Index (RRI) before and after the first, fifth, and tenth bolus of CM. Statistics was performed using analysis of variance for repeated measurements with the Factor "CM". RESULTS: All flow spectra were documented free of artifacts and Peak Systolic Velocity (PSV), Enddiastolic Velocity (EDV) and RRI respectively could be calculated. Mean PSV in Group 1 led to a decrease while in Group 2 PSV showed a significant increase after CM (p = 0,042). The course of the mean EDV in both groups deferred accordingly (p = 0,033). Mean RRI over time significantly deferred in both groups (p = 0,001). It showed a biphasic course in Group 2 and a decrease over time in Group 2. CONCLUSION: While iso-osmolar CM induced an increase of PSV and EDV together with a decrease of RRI, low-osmolar CM could not show this effect or rather led to the opposite.

Right, left or biventricular assistance are currently used in severe heart failure as a bridge to cardiac transplant, long-term devices, myocardial recovering or destination therapy. Pneumatic assist devices provide a significant improvement of circulatory failure in acute myocardial depression (intra-aortic balloon pumping) and an adequate chronic support (Excor-Berlin Heart). Moreover, the SynCardia total artificial heart (pneumatic) is, as the Excor, indicated as an alternative therapy in patients waiting a cardiac transplant. Pneumatic assist devices used in severe heart failure are currently considered as a low-cost strategy to obtain a prompt recovery of blood circulation. In this research we analyzed the characteristics of three pneumatic assist devices commercially available and hypothesized about the possibility of manufacturing a multipurpose low cost console to drive them.

Conventional radiation therapy of brain tumors often produces cognitive deficits, particularly in children. We investigated the potential efficacy of merging Orthovoltage X-ray Minibeams (OXM). It segments the beam into an array of parallel, thin (~0.3 mm), planar beams, called minibeams, which are known from synchrotron x-ray experiments to spare tissues. Furthermore, the slight divergence of the OXM array make the individual minibeams gradually broaden, thus merging with their neighbors at a given tissue depth to produce a solid beam. In this way the proximal tissues, including the cerebral cortex, can be spared. Here we present experimental results with radiochromic films to characterize the method’s dosimetry. Furthermore, we present our Monte Carlo simulation results for physical absorbed dose, and a first-order biologic model to predict tissue tolerance. In particular, a 220-kVp orthovoltage beam provides a 5-fold sharper lateral penumbra than a 6-MV x-ray beam. The method can be implemented in arc-scan, which may include volumetric-modulated arc therapy (VMAT). Finally, OXM’s low beam energy makes it ideal for tumor-dose enhancement with contrast agents such as iodine or gold nanoparticles, and its low cost, portability, and small room-shielding requirements make it ideal for use in the low-and-middle-income countries.

Summary Rationale Accurate evaluation of the energy needs is required to optimize nutrition support of critically ill patients. Recent evaluations of indirect calorimeters revealed significant differences among the devices available on the market. A new indirect calorimeter (Q-NRG®, Cosmed, Roma, Italy) has been developed by a group of investigators supporting the international calorimetry study initiative (ICALIC) to achieve ultimate accuracy for measuring energy expenditure while being easy to use, and affordable. This study aims to validate the precision and the accuracy of the Q-NRG® in the in-vitro setting, within the clinically relevant range for adults on mechanical ventilation in the ICU. Mass spectrometry is the reference method for the gas composition analysis to evaluate the analytic performances of the Q-NRG®. Methods The accuracy and precision of the O2 and CO2 measurements by the Q-NRG were evaluated by comparing the measurements of known O2 and CO2 gas mixtures with the measurements by the mass spectrometer (Extrel, USA). The accuracy and precision of the Q-NRG® for measurements of VO2 (oxygen consumption) and VCO2 (CO2 production) at clinically relevant ranges (150, 250 and 400 ml/min STPD) were evaluated by measuring simulated gas exchange under mechanically ventilated setting at different FiO2 settings (21–80%), in comparison to the reference measurements by the mass spectrometer-based mixing chamber system. Results The measurements of gas mixtures of predefined O2 and CO2 concentrations by the Q-NRG® were within 2% accuracy versus the mass spectrometer measurements in Passing Bablok regression analysis. In a mechanically ventilated setting of FiO2 from 21 up to 70%, the Q-NRG® measurements of simulated VO2 and VCO2 were within 5% difference of the reference mass spectrometer measurements. Conclusion In vitro evaluation confirms that the accuracy of the Q-NRG® indirect calorimeter is within 5% at oxygen enrichment to 70%; i.e. maximum expected for clinical use. Further recommendations for the clinical use of the Q-NRG® by will be released once the ongoing multi-center study is completed.

Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.

Purpose Donation after circulatory death (DCD) could substantially improve donor heart availability. In DCD, the heart is not only exposed to a period of warm ischemia, but also to a damaging pre-ischemic phase after withdrawal of life support. We investigated the effects of different pre-ischemic lactate levels on post-ischemic recovery using an isolated rat heart model of DCD. Methods Isolated, working rat hearts underwent 20’ aerobic perfusion, 28.5’ global ischemia, and 60’ reperfusion. In addition to 11 mM glucose and 1.2 mM palmitate, three pre-ischemic lactate levels were tested: no lactate (0 Lac), physiologic lactate (0.5 mM; 0.5 Lac), or DCD-relevant lactate (1 mM; 1 Lac). Contractile function, mitochondrial integrity and potential mediators of injury were evaluated. Results During reperfusion, left ventricular work (heart rate-developed pressure product) was significantly greater in 0.5 Lac hearts compared to 0 Lac or 1 Lac. In 0.5 Lac vs 0 Lac hearts, in parallel with increased function, cytochrome c release and carbonylated protein levels were significantly reduced, indicating less mitochondrial damage and oxidative stress, respectively. In 1 Lac vs 0.5 Lac hearts, in parallel with decreased function, cytochrome c release tended to increase, but carbonylated protein levels tended to decrease. Conclusion DCD-relevant levels of pre-ischemic lactate (1 mM) reduce contractile recovery during reperfusion compared to physiologic levels. Although increased pre-ischemic lactate tends to lower oxidative stress during reperfusion; this, alone, is insufficient to maintain functional recovery at DCD-relevant levels. Further investigations are ongoing to clarify underlying mechanisms.

Contrary to societal beliefs, older adults residing in nursing homes continue to have sexual interests. However, the right and need to engage in intimate relationships are often ignored in nursing homes, erring on the side of safety and prohibiting intimacy. This is due to ageist sexual stigma, under-educated providers, complexities of care, and fear of retaliation. Nursing homes are not attending to resident preference/choice when it comes to sexuality and intimacy, which ignores the consumer of services and is wholly inconsistent with person-centered care. However, in order to craft resident-centered/informed policies and practices, we must understand the needs and preferences of the resident/consumer. The following presentation will highlight findings from three separate mixed-methods studies that address the consumer, or how now and future residents understand and evaluate intimacy and sexuality in long-term care. We will address potential challenges, areas for intervention, and a unique consumer-oriented solution— sexual advance directives.

Response to the lifelong educational needs and interests of the older adult population calls for new opportunities and innovative practices in teaching, research, and community engagement that universities need to be prepared to offer their students and community. This presentation provides information from an Age-Friendly University (AFU) that currently has no gerontology degree or certificate program, highlighting various campus wide programs and initiatives aligned with the AFU principles. In particular, collaborative strategies involving faculty and the Adult Learner Programs and Services to help promote campus buy-in and AFU endorsement will be emphasized. Practical strategies will be discussed to assist junior and senior level faculty and other university personnel wanting to achieve AFU endorsement at their institution of higher education in order to shape age-friendly programs and practices.

Background:Current pharmacotherapies to treat or prevent hand osteoarthritis are limited. Colchicine, an anti-inflammatory agent effective at reducing joint pain and swelling in gouty arthritis, may offer relief in hand osteoarthritis, though this has not been investigated before.1Objectives:To investigate the efficacy of colchicine compared to placebo on VAS pain scores over 12 weeks in adults with hand osteoarthritis in a randomised, double-blind controlled trial.Methods:64 community-dwelling adults with hand osteoarthritis (American College of Rheumatology criteria)2(54 females, 48-79 years) were randomised 1:1 to colchicine (0.5mg twice daily) or placebo for 12 weeks. VAS pain scores (worst affected hand) were obtained at baseline and weeks 6, 12, and after treatment withdrawal at week 16. Secondary outcome measures included grip strength, C-reactive protein (CRP) and tender and swollen joint count (TSJC). Grip strength, TSJC and CRP were obtained at baseline and week 12. Intention-to-treat analyses, adjusted for age and gender, were performed using constrained longitudinal data analysis models in Stata v16.3This study is registered with the Australia New Zealand Clinical Trials Registry, ACTRN12617001524381.Results:58 participants completed the study (N=27 colchicine, N=31 placebo, withdrawal rate 9%). Mean (S.D) VAS score of the affected hand at baseline was 71.4 (14.5) mm in the placebo and 65.4 (15.0) mm in the colchicine group (p = 0.11). VAS scores improved during treatment, but were comparable between groups at week 6, 12 and 16 (Table 1). There were no differences between groups at week 12 for CRP, TSJC or grip strength (Table 1). Adverse events related to study medications included nausea (n=4), diarrhoea (n=9), vomiting (n=3), bloating (n=1) and reflux (n=1).Table 1.COLAH study primary and secondary outcomes, from constrained longitudinal data analysis modelOutcomeTimepointColchicine (SE)Placebo (SE)Colchicine-Placebo(95% CI)p-valueVAS Pain (mm)6 weeks53.5 (4.5)53.9 (4.6)-0.4 (-12.3, 13.1)0.9512 weeks57.1 (4.4)48.4 (4.6)8.7 (-21.2, 3.9)0.1816 weeks62.0 (4.3)61.6 (3.7)-0.4 (-11.4, 10.5)0.94TSJC (0-20)12 weeks5.6 (0.7)3.8 (0.7)1.8 (-4.1, 0.5)0.13Grip strength (kg)12 weeks14.4 (0.8)15.3 (0.8)-0.9 (-0.2, 2.0)0.10CRP (mg/L)12 weeks4.5 (1.4)4.0 (1.3)0.5 (-3.8, 2.9)0.77Conclusion:Colchicine 1mg daily for 12 weeks was not effective in improving pain, tender and swollen joint count or grip strength in symptomatic hand osteoarthritis patients. This study does not support colchicine for treatment of symptoms of hand osteoarthritis.References:[1]Leung, YY, Hui, LLY, Kraus, VB 2015. Colchicine-Update on mechanisms of action and therapeutic uses.Seminars in Arthritis and Rheumatism; 45: 341-350.[2]Altman, R, Alarcon, G, Appelrouth, D et al, 1990. American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand.Arthritis Rheumatology;33(11): 1601-10.[3]Liu GF, Lu K, Mogg R, et al. 2009. Should baseline be a covariate or dependent variable in analyses of change from baseline in clinical trials?Stat Med; 28: 2509–30.Characters from table content including title and footnotes: 465Disclosure of Interests:None declared

Background: \ud Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial.\ud \ud Methods: \ud NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy.\ud \ud Findings: \ud Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity.\ud \ud Interpretation: \ud Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted.\ud \ud Funding: \ud Bayer and Janssen.

The Swiss supplemental parenteral nutrition (SPN) study demonstrated that optimised energy provision combining enteral nutrition (EN) and SPN reduces nosocomial infections in critically ill adults who fail to achieve targeted energy delivery with EN alone. To assess the economic impact of this strategy, we performed a cost-effectiveness analysis using data from the SPN study. Multivariable regression analyses were performed to characterise the relationships between SPN, cumulative energy deficit, nosocomial infection, and resource consumption. The results were used as inputs for a deterministic simulation model evaluating the cost-effectiveness of SPN administered on days 4-8 in patients who fail to achieve ≥60% of targeted energy delivery with EN by day 3. Cost data were derived primarily from Swiss diagnosis-related case costs and official labour statistics. Provision of SPN on days 4-8 was associated with a mean decrease of 2320 ± 338 kcal in cumulative energy deficit compared with EN alone (p

BIOFOS aims to further develop and validate a reusable and high-added value Lab-on-Chip (LoC) based, micro-biophotonic sensor platform for in situ monitoring of food contaminants. The Lab-on-Chip was tested on milk (aflatoxin M1, antibiotics and lactose), olive oil (pesticides and metals), nuts (aflatoxin B1) and dehydrated fruits (ochratoxin A). BIOFOS combines the most promising concepts from the photonic, biological, nanochemical and fluidic parts of Lab-on-Chip systems, aiming to achieve low sensitivity and high specificity, excellent reliability and compactness. Current methodologies for detection of food contamination based on heavy analytical tools cannot guarantee a safe and stable food supply. The reasons are the complexity, the long time-to-result (2-3 days) and the cost of these tools, which limit the number of samples that can be practically analyzed at food processing and storage sites. Preliminary results for almonds spiked with aflatoxin B1 are presented. First results suggest that BIOFOS has sensitivity enough for AFB1, even that the concentration is at ppb level. More data are still required, and many analyses are ongoing in the laboratory. Results are not enough to conclude about any characteristics of the device performance, even then repeatability seems very good (variation less than 3% at 25 ppb) and recovery is acceptable (78.4%), while decision limit and detection capability are still uncertain.

BACKGROUND & AIMS: Indirect calorimetry (IC) is the gold standard to measure energy expenditure (EE) in hospitalized patients. The popular 30 year-old Deltatrac II(®) (Datex) IC is no more commercialized, but other manufacturers have developed new devices. This study aims at comparing for the first time simultaneously, two new IC, the CCM express(®) (Medgraphics) and the Quark RMR(®) (Cosmed) with the Deltatrac II(®) to assess their potential use in intensive care unit (ICU) patients. METHODS: ICU patients on mechanical ventilation, with positive end-expiratory pressure

Purpose – Sexual education in adolescence may represent the only formal sexual information individuals ever receive. It is unclear whether this early educational experience is sufficient to promote lifelong sexual health literacy. The purpose of this paper is to examine the influence of the timing and source of sexual knowledge on current safe sex knowledge and risky sexual behaviours among middle-aged and older adults in the USA. Design/methodology/approach – Participants (n=410, mean age=53.9, 50.7 per cent female) reported whether and when they received sexual knowledge from various sources. They were asked about their current safe sex knowledge and their lifetime sexual risk behaviours. Findings – Most of the participants (61.5 per cent) received formal sexual education in adolescence and 20.2 per cent reported formal sexual education post-adolescence. Across the life span, friends were the most common source of sexual information. The sample scored in the upper mid-range on the scale indexing safe sex knowledge (M=6.69, SD=1.64, range=0-8). Participants reported engaging in an average of approximately four (out of 16) risky sexual behaviours across their lifetime. Those with formal sex education in adolescence scored significantly higher on safe sex knowledge. However, they also engaged in more risky sex behaviours. Originality/value – This study is among the first to situate the normative, formal sexual education experience of adolescence within a life span context that not only accounts for time, but also multiple sources of influence. It would appear that there are more things to learn about the long-term influence of sexual education programmes during the formative years by studying adult sexual health and knowledge.

As technology continues to grow and flourish, research methods are being adapted to take advantage of the many benefits online methods can offer. Compared to traditional methods, online methods tend to be cost and time effective, increase feelings of anonymity for participants, and reduce human error through prevention or accommodation. Mobile research methods—online research conducted through mobile devices using email or application technology—represent the newest frontier in online research methods, presumably increasing convenience for participants and accessibility to daily life for researchers. As with any new method, however, researchers must find the best way to engage with participants while weighing the pros and cons of the method. Mobile methods have not received critical attention in this way, despite the increase in research applications. Through examination of the extant literature and solicited feedback following an experiential sampling method study completed primarily using mobile methods, the current paper provides the perspectives of participants and researchers about utilizing mobile methods for research. We then synthesize those observations and end with a list of proposed best practices for use in future applications of mobile research methods. The primary takeaways include practicing caution in assuming the convenience of mobile research methods and the need for further examination of the limits and boundaries of the technology used. The promise is great, but the pitfalls are plentiful.

Early exercise of critically ill patients may have beneficial effects on muscle strength, mass and systemic inflammation. During pressure support ventilation (PSV), a mismatch between demand and assist could increase work of breathing and limit exercise. A better exercise tolerance is possible with a proportional mode of ventilation (Proportional Assist Ventilation, PAV+ and Neurally Adjusted Ventilatory Assist, NAVA). We examined whether, in critically ill patients, PSV and proportional ventilation have different effects on respiratory muscles unloading and work efficiency during exercise. Prospective pilot randomized cross-over study performed in a medico-surgical ICU. Patients requiring mechanical ventilation >48 h were enrolled. At initiation, the patients underwent an incremental workload test on a cycloergometer to determine the maximum level capacity. The next day, 2 15-min exercise, at 60% of the maximum capacity, were performed while patients were randomly ventilated with PSV and PAV+ or NAVA. The change in oxygen consumption (ΔVO2, indirect calorimetry) and the work efficiency (ratio of ΔVO2 per mean power) were computed. Ten patients were examined, 6 ventilated with PSV/PAV+ and 4 with PSV/NAVA. Despite the same mean inspiratory pressure at baseline between the modes, baseline VO2 (median, IQR) was higher during proportional ventilation (301 ml/min, 270–342) compared to PSV (249 ml/min, 206–353). Exercise with PSV was associated with a significant increase in VO2 (ΔVO2, median, IQR) (77.6 ml/min, 59.9–96.5), while VO2 did not significantly change during exercise with proportional modes (46.3 ml/min, 5.7–63.7, p

Methods to calculate energy expenditure (EE) based on COIndirect calorimetry measurements conducted for clinical purposes on 278 mechanically ventilated ICU patients were retrospectively analyzed. EEVCOMean biases for EEVCOCalculated EE based on CO

Summary Introduction The international ICALIC initiative aims at developing a new indirect calorimeter according to the needs of the clinicians and researchers in the field of clinical nutrition and metabolism. The project initially focuses on validating the calorimeter for use in mechanically ventilated acutely ill adult patient. However, standard methods to validate the accuracy of calorimeters have not yet been established. This paper describes the procedures for the in-vitro tests to validate the accuracy of the new indirect calorimeter, and defines the ranges for the parameters to be evaluated in each test to optimize the validation for clinical and research calorimetry measurements. Methods Two in-vitro tests have been defined to validate the accuracy of the gas analyzers and the overall function of the new calorimeter. 1) Gas composition analysis allows validating the accuracy of O2 and CO2 analyzers. Reference gas of known O2 (or CO2) concentration is diluted by pure nitrogen gas to achieve predefined O2 (or CO2) concentration, to be measured by the indirect calorimeter. O2 and CO2 concentrations to be tested were determined according to their expected ranges of concentrations during calorimetry measurements. 2) Gas exchange simulator analysis validates O2 consumption (VO2) and CO2 production (VCO2) measurements. CO2 gas injection into artificial breath gas provided by the mechanical ventilator simulates VCO2. Resulting dilution of O2 concentration in the expiratory air is analyzed by the calorimeter as VO2. CO2 gas of identical concentration to the fraction of inspired O2 (FiO2) is used to simulate identical VO2 and VCO2. Indirect calorimetry results from publications were analyzed to determine the VO2 and VCO2 values to be tested for the validation. Results O2 concentration in respiratory air is highest at inspiration, and can decrease to 15% during expiration. CO2 concentration can be as high as 5% in expired air. To validate analyzers for measurements of FiO2 up to 70%, ranges of O2 and CO2 concentrations to be tested were defined as 15–70% and 0.5–5.0%, respectively. The mean VO2 in 426 adult mechanically ventilated patients was 270 ml/min, with 2 standard deviation (SD) ranges of 150–391 ml/min. Thus, VO2 and VCO2 to be simulated for the validation were defined as 150, 250, and 400 ml/min. Conclusion The procedures for the in-vitro tests of the new indirect calorimeter and the ranges for the parameters to be evaluated in each test have been defined to optimize the validation of accuracy for clinical and research indirect calorimetry measurements. The combined methods will be used to validate the accuracy of the new indirect calorimeter developed by the ICALIC initiative, and should become the standard method to validate the accuracy of any future indirect calorimeters.

Background: Methods to calculate energy expenditure (EE) based on CO2 measurements (EEVCO2) have been proposed as a surrogate to indirect calorimetry. This study aimed at evaluating whether EEVCO2 could be considered as an alternative to EE measured by indirect calorimetry. Methods: Indirect calorimetry measurements conducted for clinical purposes on 278 mechanically ventilated ICU patients were retrospectively analyzed. EEVCO2 was calculated by a converted Weir's equation using CO2 consumption (VCO2) measured by indirect calorimetry and assumed respiratory quotients (RQ): 0.85 (EEVCO2_0.85) and food quotient (FQ; EEVCO2_FQ). Mean calculated EEVCO2 and measured EE were compared by paired t test. Accuracy of EEVCO2 was evaluated according to the clinically relevant standard of 5% accuracy rate to the measured EE, and the more general standard of 10% accuracy rate. The effects of the timing of measurement (before or after the 7th ICU day) and energy provision rates (

Aims of the study Patients with an acute or chronically negative nutritional balance are at nutritional risk. Oral nutritional supplements (ONS) are simple and effective medical treatments of nutritional risk. In the ambulatory setting, in Switzerland, ONS are reimbursed by public insurance under conditions defined by Swiss Society for Clinical Nutrition. The reimbursement requires a medical prescription for ONS and their delivery at the patient's home by a homecare service. The indication for the ONS, defined as a Nutritional Risk Screening-2002 (NRS-2002) score ≥3, must also be present. This survey aimed to document: (i) the existence of a medical prescription for ONS during hospitalisation and discharge for home, (ii) the adequacy of the indication for ONS during hospitalisation and at discharge for home, and (iii) the continuation or not of ONS treatment 1 month after discharge for home. Methods This prospective survey included adult patients hospitalised in the departments of surgery, medicine or rehabilitation and who were about to receive ONS for the first time. Patients already on ONS, with major consciousness disorders, who refused to take ONS or to participate to the survey were excluded. The existence of a medical prescription for ONS and the adequacy of the indication (Nutritional Risk Screening-2002 [NRS-2002] score ≥3) were evaluated at first ONS delivery and at hospital discharge. At home, the continuation of ONS consumption was evaluated by the homecare service 1 month after discharge. Results are presented as mean ± standard deviation or frequencies and percentages, and comparisons between patients with and without ONS at discharge for home. Results A total of 416 patients (age 71.7 ± 14.1 yr, 52.6% male, body mass index 23.6 ± 5.2 kg/m2) were included. At the first delivery of ONS, 44.5% (n = 185) of patients had no medical prescription for the supplements, and 82.7% (n = 344) had an NRS-2002 score ≥3. Out of 207 patients discharged for home, only 24.2% (n = 50) had an adequate homecare ONS prescription and 68% (n = 141) had a NRS-2002 score ≥3. One month after discharge for home, 76% (n = 29) were still taking ONS. Conclusions In our survey, only few patients receiving ONS during the hospital stay had a medical prescription for ONS during the hospitalisation and at discharge for home. For most patients receiving ONS during hospitalisation and at discharge for home, an NRS-2002 score of ≥3 was present. If a medical prescription was provided, ONS were generally continued one month after discharge for home. Clinical trial registration number NCT02476110.

Summary Background & aims Optimal nutritional care for intensive care unit (ICU) patients requires precise determination of energy expenditure (EE) to avoid deleterious under- or overfeeding. The reference method, indirect calorimetry (IC), is rarely accessible and inconstantly feasible. Various equations for predicting EE based on body weight (BW) are available. This study aims at determining the best prediction strategy unless IC is available. Methods Mechanically ventilated patients staying ≥72 h in the ICU were included, except those with contraindications for IC measurements. IC and BW measurements were routinely performed. EE was predicted by the ESPEN formula and other predictive equations using BW (i.e. anamnestic (AN), measured (MES), adjusted for cumulated water balance (ADJ), calculated for a body mass index (BMI) of 22.5). Comparisons were made using Pearson correlation and Bland & Altman plots. Results 85 patients (57 ± 19 y, 61 men, SAPS II 43 ± 16) were included. Correlations between IC and predicted EE using the ESPEN formula with different BW (BW AN , BW MES , BW ADJ , and BW BMI22.5 ) were 0.44, 0.40, 0.36, and 0.47, respectively. Bland & Altman plots showed wide and inconsistent variations. Predictive equations including body temperature and minute ventilation showed the best correlations, but when using various BWs, differences in predicted EE were observed. Conclusion No EE predictive equation, regardless of the BW used, gives statistically identical results to IC. If IC cannot be performed, predictive equations including minute ventilation and body temperature should be preferred. BW has a significant impact on estimated EE and the use of measured BW MES or BW BMI 22.5 is associated with the best EE prediction. Clinical trial registration number on ClinicalTrial.gov: NCT02552446. Ethical committee number: CE-14-070.

Dysphagien und ihre Folgeerkrankungen sind mit einem hochgradigen Verlust an Lebensqualitat fur die Patienten und hohen Kosten fur das Gesundheitswesen verbunden. Eine moglichst effektive Therapie ist daher dringend erforderlich. Als deren Voraussetzung im Rahmen einer pathophysiologisch orientierten Diagnostik hat sich die endoskopische Untersuchung der Schluckfunktion in den letzten 20 Jahren als unverzichtbare Standarduntersuchung mit hoher Sensitivitat und Spezifitat etabliert. Sie sollte daher jedem Hals-Nasen-Ohren(HNO)-Arzt und Phoniater gelaufig sein und eine flachendeckende Versorgung sowohl im stationaren als auch im ambulanten Bereich und in Pflegeeinrichtungen gewahrleisten. Im vorliegenden Artikel werden Voraussetzungen, Durchfuhrung und Bewertung der Endoskopie beschrieben und ihre Relevanz fur unmittelbare oder langfristig zu etablierende therapeutische Interventionen erortert.

This report describes the traverse planning process for the Desert Research and Technology Studies (D-RATS) 2010 field simulation of a conceptual 14-day planetary mission. This activity took place between August 23 and September 17, 2010 in the San Francisco Volcanic Field, Arizona. It focused on the utilization of two pressurized rovers and a ground-based communication system, as well as on the development of mission operation concepts for long duration, dual-rover missions. The early planning process began some 12 months prior to the actual field tests and defined the first order engineering-, flight operations, and science objectives. The detailed implementation and refinement of these objectives took place over the ensuing 10 months, resulting in a large number of technical and operational constraints that affected the actual traverse route or the cumulative Extravehicular Activity (EVA) time available for detailed field observations. The science planning proceeded from the generation of photogeologic maps of the test area, to the establishment of prioritized science objectives and associated candidate sites for detailed field exploration. The combination of operational constraints and science objectives resulted in the final design of traverse routes and time lines for each of the 24 traverses needed to support 12 field days by two rovers. Examples of daily traverses will be given that will hopefully illustrate that the design of long duration, long distance planetary traverses is a highly interdisciplinary and time-consuming collaboration between diverse engineers, flight operations personnel, human factors interests, and planetary scientists.

This study suggests that lodging properties with tangible attributes enabling them to be easily converted are more liquid than those that are specific to a limited number of contracts, and thus benefit from a price premium. Grounded in the integration of research on transaction cost and real estate in the hospitality context, this paper investigates the effects of non-normative physical characteristics of lodging properties on their price discounts. The deviation from the normative physical characteristics of an asset is the operational measure of asset specificity. We estimate the standardized residuals resulting from a hedonic valuation model on 10,722 lodging transactions in the U.S. from 1980 to 2008 to develop our measurement of price discount. Results show that deviations from the norm on the three physical characteristics used are significant determinants of the price discounts and that the significance of the normative characteristics of lodging properties varies across segments.

Patients with chronic laryngitis and T1 vocal cord cancer were compared using perceptual and text-based objective voice and speech analyses in order to determine which group is more affected in its ability to communicate and whether a distinction between the two pathologies is possible.In all, 13 patients with histologically proven chronic laryngitis and 13 patients with T1 vocal cord cancer were compared perceptually by five speech therapists on the basis of seven criteria and objectively by a speech recognition system and prosodic analysis.Both, the data of the five speech therapists and the results of the automatic analysis revealed no significant differences between the two patient groups.A distinction between chronic laryngitis and T1 vocal cord carcinoma by mere voice and speech analysis is not possible, because the patient groups do not show significant differences in their voice quality.

The simultaneous measurement of pressure and diameter in a central artery during 24 hours could bring new information about the variability of the arterial mechanical properties. In order to perform these measurements in an animal, it is essential to count with a device that could acquire the signals from the sensors with a proper preconditioning circuit and then transfer them wirelessly to be stored and processed remotely. In this paper we present the prototype of a new portable and autonomous device, capable of being hosted on the animal's back. Preliminary results obtained from a pilot experience in a sheep using the prototype are detailed and limitations are discussed. Fil: Bortolin, Lucas. Universidad Favaloro; Argentina Fil: Craiem, Damian. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Gorgolino, Jorge. Universidad de Buenos Aires; Argentina Fil: Santoriello, Gerardo Luis. Universidad de Buenos Aires; Argentina Fil: Lutenberg, Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentina Fil: Graf Caride, Diego Sebastián. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

This paper studies the motivation that drives NGO-firm collaborations, factors that contribute to their success and threats the partners face. It builds on existing literature that studies collaborations between firms and examines whether they differ from collaborations between NGOs and private-owned companies. Although they are similar in many aspects, they differ on others. For instance, firms often collaborate with NGOs to get access to the reputation and legitimacy of an NGO. In contrast, NGOs usually enter a collaboration with a corporate partner to advance its managerial skills and receive financial resources. There are also differences on how firms and NGOs measure the performance and success of a firm-NGO relationship: while firms primarily seek financial success, NGOs pursue more ideological goals and offer intangible assets such as reputation and authenticity that are more difficult to quantify. Finally, an NGO suffers more if a partner does not behave in a way that respects the partnership and damages the reputation and legitimacy of the NGO. This is problematic for NGOs, since reputation and legitimacy are their key resources.

Background Diarrhea as a common complication affects 14% patients in our intensive care unit. Risk factors for diarrhea and its clinical consequences for patients are well known, but the impact of diarrhea on caregivers' workload remains undocumented. Objectives This study aims at establishing the impact of diarrhea on costs and human burden in intensive care unit caregivers. Design A survey and observational study. Settings A mixed 36-bed medical and surgical intensive care unit. Participants All intensive care unit caregivers (nurses and nursing aides). Methods A questionnaire was designed by a multidisciplinary team and completed by intensive care unit caregivers analyzing the clinical and human impact of diarrhea on their workload. Time measurements for the management of liquid stools were performed. Human related costs of diarrhea were analyzed according to caregivers' years of clinical experience. Results Questionnaires were completed by 146 of 204 intensive care unit caregivers (75% nurses; 73% nursing aides). Dealing with diarrhea patients is a painful aspect of their work (69% nurses) with tiredness as main feeling and a source of conflict or misunderstanding among caregivers. The mean time measurement for managing one liquid stool in 50 diarrhea episodes was 17min and 33s, involving an average of 1.4 nurses and 0.8 nursing aides. Average human resources cost burden was 26.60 CHF per liquid stool. Conclusion Dealing with diarrhea increases workload for intensive care unit caregivers with consequences on their well-being. Human related costs of diarrhea are substantial and highlight the economic burden of diarrhea episodes in the intensive care unit. A multidisciplinary approach and specific protocols could positively impact the burden of diarrhea in the intensive care unit. Trial registration Clinical Trials gov NCT01922570.

Hintergrund und Fragestellung: Die Notwendigkeit einer szintigraphischen Abklarung von Schilddrusenknoten bei normalem TSH ist weiterhin Gegenstand nationaler und internationaler Diskussionen, die sich in unterschiedlichen Bewertungen von Leitlinien niederschlagen. Die amerikanische (ATA) und die europaische (ETA) Schilddrusengesellschaft empfehlen – im Gegensatz zu den Leitlinien der Sektion Schilddruse der Deutschen Gesellschaft fur Endokrinologie und der Deutschen Gesellschaft fur Nuklearmedizin – die Durchfuhrung eines Schilddrusenszintigramms nur noch bei erniedrigtem oder supprimiertem TSH, um eine vermutete Autonomie nachzuweisen. Ziel der vorliegenden prospektiven Studie war es, die funktionelle Aktivitat szintigraphisch gesicherter fokaler Autonomien zu ermitteln, um zu klaren, ob ein normaler TSH-Wert eine fokale Autonomie weitgehend ausschliesen kann. Daten aus Deutschland zu dieser Fragestellung gab es zum Zeitpunkt dieser Untersuchung nicht. Patienten und Methoden: Aus einer unausgewahlten Patientengruppe wurden Patienten mit Knotenstrumen (n = 476) kontinuierlich mittels Szintigramm auf das Vorliegen einer fokalen Autonomie untersucht. In dieser Patientengruppe wurde die studienmasig angestrebte Anzahl von 100 autonomen Adenomen mit einer Mindestgrose uber 1,0 cm ermittelt. Bei jedem Patienten wurden folgende Untersuchungen durchgefuhrt: Sonographie (inklusive Duplex), Szintigraphie und Labor (fT3, fT4, TSH, TPO-Antikorper). Der Referenzbereich des TSH lag zwischen 0,4–4,0 µU/ml. Ergebnisse: 21 % der Patienten (100/476) mit einer Knotenstruma hatten eine fokale Autonomie (> 1,0 cm). Bei 32 % aller fokalen Autonomien war das TSH erniedrigt ( Folgerung: Aufgrund dieser Daten besteht in der untersuchten Patientengruppe mit 100 autonomen Adenomen keine klinisch relevante Beziehung zwischen TSH-Spiegel und szintigraphisch erfassbarer fokaler Autonomie in einer Knotenstruma. Die TSH-Bestimmung ist daher ungeeignet, zwischen hyper- und hypofunktionellen Knoten zu unterscheiden. Die Punktion szintigraphisch nicht charakterisierter Knoten sollte unterbleiben, da autonome Adenome zytologisch haufig das Bild einer follikularen Neoplasie zeigen, einem Befund, der grundsatzlich eine OP-Indikation darstellt (Ausnahme: autonomes Adenom). Bei Schilddrusenknoten > 1,0 cm sollte daher auch weiterhin routinemasig bei der Erstdiagnostik eine Schilddrusenszintigraphie erfolgen.