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Our understanding about underlying mechanisms leading to Functional Neurological Disorders (FND) has changed in recent years. While in the past these disorders were presumed to be solely due to psychological issues we know now that their development is dependent on complex interactions between biological, psychological and social factors. We present an analysis of clinical presentations and psychological profiles of patients who were seen in our FND outpatient clinic over 3 years. We aim to review the prevalence of common symptoms in the patients seen within our clinic, and to identify any common psychological or psychiatric profiles that differentiated these symptom groups. This may help to elucidate underlying mechanisms leading to the development of functional symptoms and identify the predisposing, triggering and perpetuation factors.

Objectives To provide an outline for the delivery of an educational course or lecture about functional neurological disorders (FND) that is directed towards health professionals with varying clinical knowledge and to highlight the educational efficacy that can be derived from a well-designed educational platform.Method Through multidisciplinary collaboration, a course designed to develop the skills for diagnosis and management of FND was created. Elements essential to the delivery of education are: (A) knowledge creation; (B) facilitating multidisciplinary cross-pollination; (C) listening to patients’ experiences; (D) communication skills practice; (E) case studies; (F) discipline specific mentoring; (G) establishing and addressing participant learning goals and (H) developing collegial and referral networks. Changes in participants’ knowledge and clinical practice were assessed via anonymous questionnaires before and after the course.Results Dramatically improved knowledge and confidence in assessment and management of people with FND has been found both immediately following the course as well as on 6-month follow-up.Conclusion It is possible to make real change in the understanding and management of medical and allied health clinicians working with people with FND with a low-cost intervention. Also, the development of educational networks and multidisciplinary collaboration can lead to the creation of therapeutic platforms for the diagnosis, management and advocacy of this patient group.

BackgroundIron administration has been implicated as a cause of poor clinical outcome in maintenance hemodialysis (MHD) patients. However, the role of low iron levels in the clinical outcome of MHD patients is not clear.MethodsWe examined the predicting value of baseline serum iron level on prospective mortality and hospitalization in a cohort of all 1,283 MHD patients from 10 DaVita dialysis facilities in Los Angeles County, CA.ResultsPatients aged 57.8 +/- 15.2 years included 49% men, 45% Hispanics, 25% African Americans, and 53% patients with diabetes. During the first 3 months of the cohort, 97% of patients were administered erythropoietin (EPO) and 60% were administered intravenous iron (gluconate and/or dextran) at least once. During a 12-month follow-up, mortality was significantly greater (23%) in the lowest serum iron quartile (

BackgroundElements of malnutrition-inflammation complex syndrome (MICS) may blunt the responsiveness of anemia of end-stage renal disease (ESRD) to recombinant human erythropoietin (EPO).MethodsThe authors examined cross-sectional associations between the required dose of EPO within a 13-week interval as prescribed by practicing nephrologists who were blind to the study and several laboratory values known to be related to nutrition and/or inflammation, as well as the malnutrition-inflammation score (MIS), which is a fully quantitative assessment tool based on the subjective global assessment of nutrition.ResultsA total of 339 maintenance hemodialysis (MHD) outpatients, including 181 men, who were aged 54.7 +/- 14.5 years (mean +/- SD), who had undergone dialysis for 36.3 +/- 33.2 months, were selected randomly from 7 DaVita dialysis units in Los Angeles South/East Bay area. The average weekly dose of administered recombinant human EPO within a 13-week interval was 217 +/- 187 U/kg. Patients were receiving intravenous iron supplementation (iron gluconate or dextran) averaging 39.5 +/- 47.5 mg/wk. The MIS and serum concentrations of high-sensitivity C-reactive protein, interleukin 6 (IL-6), tumor necrosis factor-alpha, and lactate dehydrogenase had positive correlation with required EPO dose and EPO responsiveness index (EPO divided by hemoglobin), whereas serum total iron binding capacity (TIBC), prealbumin and total cholesterol, as well as blood lymphocyte count had statistically significant but negative correlations with indices of refractory anemia. Most correlations remained significant even after multivariate adjustment for case-mix and anemia factors and other relevant covariates. Similar associations were noticed across EPO per body weight tertiles via analysis of variance and after estimating odds ratio for higher versus lower tertile via logistic regression after same case-mix adjustment.ConclusionThe existence of elements of MICS as indicated by a high MIS and increased levels of proinflammatory cytokines such as IL-6 as well as decreased nutritional values such as low serum concentrations of total cholesterol, prealbumin, and TIBC correlates with EPO hyporesponsiveness in MHD patients.

ObjectivesNormalized protein nitrogen appearance (nPNA), also known as protein catabolic rate (nPCR), reflects the daily protein intake in maintenance hemodialysis (MHD) patients. Several studies indicate that nPNA and Kt/V correlate with clinical outcome and also with each other. Thus, the relationship between low nPNA and poor outcome could be due to uremia, low Kt/V or due to reported mathematical coupling between nPNA and Kt/V. We therefore investigated whether nPNA is associated with outcome in patients who have adequate or high Kt/V.DesignProspective cohort.SettingsOutpatient dialysis unit affiliated with a tertiary-care community medical center.PatientsFrom a pool of 135 MHD outpatients in one dialysis unit, 122 patients with a delivered, Kt/V(sp)>1.20, independent of their residual renal function, were evaluated. Patients (61 women, 61 men), aged from 23 to 89 years (53.4+/-14.0 years)(+/-SD), had been undergoing MHD for one month to 17 years.InterventionReview of laboratory values and clinical outcome.Main outcome measuresTwelve-month mortality and hospitalization.ResultsDelivered Kt/V(sp) ranged from 1.23 to 2.71 (1.77+/-0.34), nPNA from 0.5 to 2.15 (1.13+/-0.29 g/kg/day), and serum albumin, from 1.9 to 4.6 (3.76+/-0.37 g/dL). During the 12-month follow-up, 55 patients were hospitalized overnight at least once; 12 patients died; 5 patients underwent renal transplantation, and 6 patients left the study. The nPNA and Kt/V(sp) did not correlate significantly (r=.09) except when analysis was limited to Kt/V values < 1.5 (r=.54). Serum nPNA and albumin were the only variables with statistically significant correlations with both mortality and 3 measures of hospitalization (H): total days of H (H(D)), total number of H (H(F)), and time to first H (H(T)). The case-mix adjusted correlations for serum albumin and nPNA versus total days (r(HD)) and frequency of H (r(HF)) were significant, and Cox analysis based on H(T) and time to death resulted in significant odds ratios for each standard deviation decrement for both serum albumin and nPNA. Serum total iron binding capacity (TIBC) and creatinine concentrations also correlated with some but not all outcome measures: lower serum concentrations of these values were each significantly associated with poor clinical outcomes.ConclusionsBoth nPNA and serum albumin predict prospective hospitalization and mortality in MHD patients with Kt/V > 1.20. Serum TIBC and creatinine concentrations appear to have association with some outcome measures as well. These data are consistent with the possibility that protein intake affects the clinical course even in the setting of an adequate to high hemodialysis dose. Studies based on randomized assignments to different protein intakes would be helpful to confirm these conclusions.

The solution-phase stability of the hydronium ion catalyst significantly affects the rates of acid-catalyzed reactions, which are ubiquitously utilized to convert biomass to valuable chemicals. In this work, classical molecular dynamics simulations were performed to quantify the stability of hydronium and chloride ions by measuring their solvation free energies in water, 1,4-dioxane (DIOX), tetrahydrofuran (THF), γ-valerolactone (GVL), N-methyl-2-pyrrolidone (NMP), acetone (ACE), and dimethyl sulfoxide (DMSO). By measuring the free energy for transferring a hydronium ion from pure water to pure organic solvent, we found that the hydronium ion is destabilized in DIOX, THF, and GVL and stabilized in NMP, ACE, and DMSO relative to water. The distinction between these organic solvents can be used to predict the preference of the hydronium ion for specific regions in aqueous mixtures of organic solvents. We then incorporated the stability of the hydronium ion into a correlative model for the acid-catalyzed conversion of 1,2-propanediol to propanal. The revised model is able to predict experimental reaction rates across solvent systems with different organic solvents. These results demonstrate the ability of classical molecular dynamics simulations to screen solvent systems for improved acid-catalyzed reaction performance.

Der Kommentar zu Robert Feustels Beitrag „Substanz und Supplement – Mit Rechten reden, zu Rechten forschen? Eine Einladung zum Widerspruch“ stärkt die Methodenvielfalt der qualitativen Sozialforschung als Möglichkeit, in der Erforschung rechter Gruppierung neue Erkenntnisse und Hintergrundwissen zu gewinnen. Als forschungsethischer Kritikpunkt werden die fehlende Offenheit sowie der Ausschluss bestimmter Gruppen und Themen angemerkt.

Introduction: This article explores the influence of patient-specific and organisational factors on adherence to program guidelines in an integrated care program targeting older patients. Methods: The integrated care program aimed to offer post-discharge follow-up visits by a municipality nurse and the general practitioner to frail older patients after discharge from hospital. Adherence was measured as 'step 1') successful referral from the hospital and 'step 2') completed post-discharge follow-up visit. We followed a cohort of 1,659 patients who were selected to receive a post-discharge follow-up visit in 2014. We obtained unique data from hospitals, municipalities and from administrative registers. Results: We found substantial lack of adherence in both steps of the program: 69% adherence in step 1 and 54% adherence in step 2. In step 1, adherence was related to hospital, and receiving municipal home care prior to admission. In step 2, level of adherence varied according to municipality, the type of general practitioner and the patient’s gender. Conclusion: We found that adherence was strongly related to organisational factors. Adherence differed significantly at all organisational levels (hospital, municipality, general practice), thus indicating challenges in the vertical integration of care. Gender influenced adherence as the only patient-related factor.

This paper explores how constructions of pregnancy and birth have changed in policy documents in the period of 1976-2013. Through a discourse analysis of national policy documents and guidelines concerning the normal pregnancy and birth, this article demonstrates how health professionals’ internal relations and their relation to work, pregnant and birth-giving women have changed. The analysis points at a modified understanding of the midwife’s profession and practices regarding the management of normal birth, which produces new possible practices for the profession, as well as, for pregnant and birth giving women.

A β-cyclodextrin labeled with seven naphthoyloxy chromophores was studied by steady-state and time-resolved fluorescence spectroscopy in order to get information on the dynamics of energy hopping between chromophores. The steady-state fluorescence anisotropy was recorded as a function of excitation wavelength in a mixture of methanol and ethanol at 110 K (rigid glass). The fluorescence anisotropy decay was obtained under the same conditions by the multifrequency phase-modulation technique upon excitation at 290 nm. The data were analyzed and interpreted on the basis of a theoretical model involving a unique rate constant for energy hopping between nearest neighbors. In particular, this model predicts a long-time leveling-off of the emission anisotropy at 1/7th of the fundamental anisotropy, which is confirmed by both steady-state and time-resolved data and thus indicates that there is no preferred mutual orientation between the chromophores. As regards the rate of energy hopping, an average value of 2 × 109 s-1 can be deduced from the comparison between the theoretical and experimental decays. This value is shown to be consistent with a dipole-dipole mechanism of energy transfer. © 1996 American Chemical Society.

In this article, we offer some observations on the international standing of communicative constructivism (CoCo), as discussed in scholarship published largely in German over the past decade (e.g., KELLER, KNOBLAUCH & REICHERTZ, 2013; KNOBLAUCH, 2019a [2016]; REICHERTZ, 2009). We seek to explain why, in our view, CoCo has not thus far had a noticeable influence on academic discourse in international, particularly Anglo-American, sociology. Amongst others, we highlight issues regarding the name that was picked for the perspective and regarding the literal translation of German CoCo terminology into the English language. We also point to some theoretical and methodological choices that have made it difficult to link CoCo to interactionist sociology in general, and to ethnomethodology and ethnography in particular, i.e., perspectives that we are closely aligned with. We conclude with a summary of our observations and a few suggested steps communicative constructivists might consider taking to broaden and diversify the appeal of their program beyond German speaking sociology. [ABSTRACT FROM AUTHOR]

Pectus arcuatum is often mistaken for a type of pectus carinatum. However, pectus arcuatum is a unique clinical form of pectus caused by premature obliteration of the sternal sutures (manubrial sternum, four sternebrae and xiphoïd process), whereas pectus carinatum is due to abnormal growth of the costal cartilage. In order to better describe pectus arcuatum, we analysed the files of patients with pectus arcuatum followed in our centers. Multicenter retrospective study of young patients' files diagnosed with pectus arcuatum. The clinical diagnosis of pectus arcuatum was made in 34 patients with a mean age at diagnosis of 10.3 years (4–23 years). A chest profile X-ray or a CT scan was performed in 16 patients (47%) and confirmed the diagnosis of PA by the presence of a sternal fusion. It was complete in 12 patients. A malformation was associated in 35% of cases (Noonan syndrome 33%, scoliosis 25% or cardiopathy 16%). 11 patients (32%) had a family history of skeletal malformation. Orthopedic treatment was initiated in 3 patients without any success. 11 patients underwent surgical correction, which was completed in 7 of them. The diagnosis of pectus arcuatum is based on clinical experience and if necessary, on a profile chest X-ray showing the fusion of the sternal pieces. It implies the search for any associated malformations (musculoskeletal, cardiac, syndromic). Bracing treatment is useless for pectus arcuatum. Corrective surgery, based on a sternotomy associated with a partial chondro-costal resection, can be performed at the end of growth. IV. [ABSTRACT FROM AUTHOR]

"Photography and Society," edited by Thomas S. EBERLE contributes to the burgeoning debates about visuality and visual perception. The 25 chapters of the volume draw on Alfred SCHÜTZ's phenomenology to consider photography as a social phenomenon. They are concerned with the practice of taking and producing photographs as well as with the viewing and interpretation of photographs. Thus they deal with production and reception aesthetics. The analyses are also used to reflect on the status of photographs and their relationship to the Wirkwelt [world of working]. The book is notable for encompassing a wide range of theoretical and empirical analyses and including a large number of high-quality photographs. The inclusion of these photographs does not serve illustrative purposes but is critical to the analyses presented in the volume. I recommend "Photography and Society" to sociologists with an interest in debates about visuality and the analysis of visual perception. Some knowledge of the sociology of knowledge helps with the reading of the book. But the book can also be used to learn about the opportunities offered by the sociology of knowledge.