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The clinical implication of a residual flexion deformity following surgery for scaphoid nonunion is unclear. Sixty-three patients who underwent scaphoid nonunion surgery were assessed after a mean of 7 years (range 5–10) to analyse the outcomes based on the presence of residual scaphoid deformity. Primary outcome was Disabilities of the Arm, Shoulder and Hand score. Secondary outcomes were Patient-Rated Wrist Evaluation score, wrist range of motion and strength. Patients were dichotomized to residual deformity or no deformity. Scaphoid deformity was calculated from CT scans based on the median difference between the height–length ratio of the operated versus the uninjured scaphoid. There were no differences between residual deformity ( n = 33) and no deformity ( n = 30) in any outcome variables, except for wrist extension which was slightly worse in the deformity group. The deformity group had a greater number of radiographic osteoarthritis, but all cases were mild, and osteoarthritis did not correlate to a worse outcome. We conclude that residual scaphoid deformity has no relevant negative impact on mid-term wrist function. Level of evidence: IV

This study investigates present and future European heat wave magnitudes, represented by the Heat Wave Magnitude Index-daily (HWMId), for regional climate models (RCMs) and the driving global climate models (GCMs) over Europe. A subset of the large EURO-CORDEX ensemble is employed to study sources of uncertainties related to the choice of GCMs, RCMs, and their combinations. We initially compare the evaluation runs of the RCMs driven by ERA-interim reanalysis to E-OBS (observation-based estimates), finding that the RCMs can capture most of the observed spatial and temporal features of HWMId. With their higher resolution compared to GCMs, RCMs can reveal spatial features of HWMId associated with small-scale processes (e.g., orographic effects); moreover, RCMs represent large-scale features of HWMId satisfactorily (e.g., by reproducing the general pattern revealed by E-OBS with high values at western coastal regions and low values at the eastern part). Our results indicate a clear added value of the RCMs compared to the driving GCMs. Forced with the emission scenario RCP8.5, all the GCM and RCM simulations consistently project a rise in HWMId at an exponential rate. However, the climate change signals projected by the GCMs are generally attenuated when downscaled by the RCMs, with the spatial pattern also altered. The uncertainty in a simulated future change of heat wave magnitudes following global warming can be attributed almost equally to the difference in model physics (as represented by different RCMs) and to the driving data associated with different GCMs. Regarding the uncertainty associated with RCM choice, a major factor is the different representation of the orographic effects. No consistent spatial pattern in the ensemble spread associated with different GCMs is observed between the RCMs, suggesting GCM uncertainties are transformed by RCMs in a complex manner due to the nonlinear nature of model dynamics and physics. In summary, our results support the use of dynamical downscaling for deriving regional climate realization regarding heat wave magnitudes.

ZusammenfassungDie Qualifikation des Atmungstherapeuten wird von Pflegekräften und Therapeuten durch eine ca. 1,5jährige qualifizierende Weiterbildung erworben. Die Leistungen der Atmungstherapeuten in Bezug auf neurologische Erkrankungen umfassen die Diagnostik und die Therapie von Störungen der Atmung, des Hustens und des Schluckens sowie das Sekretmanagement. Der Bedarf an Atmungstherapeuten in der Neurologie steigt stetig, und sie werden insbesondere in der neurologisch-neurochirurgischen Frührehabilitation eingesetzt. Die 2021 eingeführte Zertifizierung von „Zentren für Beatmungsentwöhnung in der neurologisch-neurochirurgischen Frührehabilitation“ durch die Deutsche Gesellschaft für Neurorehabilitation umfasst den Einsatz von Atmungstherapeuten als Zertifizierungskriterium. Atmungstherapeuten arbeiten in neurologischen Organisationseinheiten der Versorgung von Schwer- und Schwerstkranken an einer wichtigen interdisziplinären Schnittstelle zwischen ärztlichem, pflegerischem und therapeutischem Team. Sie können die Schulung von Teams, Patienten, Angehörigen und persönlichen Assistenten übernehmen und die Etablierung von Versorgungsstrukturen für neurologisch schwer- und schwerstkranke Patienten unterstützen. Die Tätigkeit in neurologischen Einrichtungen erfordert angesichts der Komplexität der dort behandelten Krankheitsbilder allerdings eine spezifische Qualifizierung der dort tätigen Atmungstherapeuten. Die Professionalisierung des Berufsbilds kann durch den Abgleich der Curricula zwischen den verschiedenen Bildungsanbietern, die Einführung von Zusatzqualifikationen wie „Neurologie und Neurorehabilitation“, die Gründung einer eigenständigen Fachgesellschaft und die Akademisierung gefördert werden.

Objectives: It is unclear whether recurrent sputum culture with Pseudomonas aeruginosa from patients with chronic obstructive pulmonary disease (COPD) is caused by intermittent airway carriage by different P. aeruginosa lineages or persistent carriage by the same lineage, and whether lineages genetically adapt during carriage. Methods: Whole-genome sequencing was performed for P. aeruginosa isolates sampled longitudinally from sputum cultures in patients with COPD who were enrolled in an ongoing randomized controlled trial (clinicaltrials.gov: NCT03262142). Results: A total of 153 P. aeruginosa isolates were sequenced for 23 patients during 365 days of follow-up. Recurrent presence of P. aeruginosa was seen in 19 patients (83%) and was caused by persistence of the same clonal lineage in all but one patient. We identified 38 genes mutated in parallel in two or more lineages, suggesting positive selection for adaptive mutations. Mutational enrichment analysis revealed genes important in antibiotic resistance and chronic infections to be more frequently mutated. Discussion: Recurrent P. aeruginosa was common and carried for a prolonged time after initial detection in the airways of patients with COPD. Recurrence was caused by persistence of the same clonal lineage and was associated with genetic adaptation. Trial data on possible clinical benefits of attempting antibiotic eradication of P. aeruginosa in COPD are warranted.

Background: Myasthenia gravis (MG) affects individuals as a chronic paraneoplastic or autoimmune disease for many years. Commonly, chronic diseases significantly reduce the patients’ quality of life. Aiming to improve the future quality of life in MG, this study assessed the key determinants relevant for living with MG. As gender-specific medicine is becoming increasingly important, this study also focused on understanding gender differences in the outcome of MG. Methods: The study is a combined monocentric, retrospective and prospective database analysis of patient records based on 2,370 presentations of 165 patients with clinically, serologically and/or electrophysiologically confirmed MG over an observation period of up to 47 years. The data collection included the following parameters: antibody status, disease severity, age, medication use, gender, and disease duration. In addition, a prospective survey was conducted on the quality of life using the Myasthenia gravis-specific 15-item Quality of Life scale (MG-QoL15) and on the activities of daily living using the MG-specific Activities of Daily Living scale (MG-ADL). Results: Of the 165 patients, 85 were male (51.5%) and 80 were female (48.5%). The remaining baseline characteristics (e.g. age and antibody status) were consistent with other myasthenia gravis cohorts. A high body mass index (BMI) (p = 0.005) and a high disease severity (p

Bias adjustment of climate models is today normally performed with quantile mapping methods that account for the whole distribution of the parameter. The bulk of the distribution is well described as long as sufficient data records are used (Berg et al., 2012), however, the extreme tails will always suffer from large uncertainties. These uncertainties stem from both the climate model and the reference data set, which prevents a robust and detailed identification of bias in the extreme tail. Empirical quantile mapping methods are therefore prone to overfitting, and may introduce substantial bias when applied outside the calibration period. Commonly, a constant adjustment is applied for values outside the range of the calibration period, but there is room for improvements of the extrapolation method.While working with a climate service for Sweden, a clear offset was identified between data adjusted within and outside the calibration period for an extreme indicator of daily maximum precipitation. This study explores different extrapolation methods for the extreme tail of the distribution in the spline-based empirical quantile mapping method of the MIdAS bias adjustment method (Berg et al., 2022). By limiting the bias adjustment to the first 95% of the distribution, and thereafter applying a constant or a linear fit to the remaining 5% of data in the tail, the offset is strongly reduced and the adjusted extremes become more robust and plausible.Berg, P., Feldmann, H., & Panitz, H. J. (2012). Bias correction of high resolution regional climate model data. Journal of Hydrology, 448, 80-92.Berg, P., Bosshard, T., Yang, W., & Zimmermann, K. (2022). MIdASv0. 2.1–MultI-scale bias AdjuStment. Geoscientific Model Development, 15(15), 6165-6180.