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Dry-state microsampling techniques are convenient and advantageous for sample collection in resource-limited settings, including healthcare systems designed for the underserved population. In this work, a microsampling platform based on an embossed hydrophobic paper substrate is introduced together with three-dimensional (3D) printed cartridges that offer opportunities for rapid (30 min) drying of the collected samples while also preserving sample integrity when the embossed paper chip is shipped at room temperature. More importantly, a new pinhole paper spray ionization method was developed that facilitates direct mass spectrometry (MS) analysis of the dried blood samples without prior sample preparation. We compared the direct pinhole paper spray MS method with a liquid chromatographic (LC) MS approach that relied upon electrospray ionization (ESI) after analytes present in the blood sample were extracted through liquid-liquid extraction. Limits of detection as low as 0.12 and 0.49 ng/mL were calculated for cocaine and its metabolite benzoylecgonine, respectively, when using the direct pinhole paper spray MS method. Analytical merits such as precision and accuracy, recovery, carryover effects, and analyte stability were all quantified for this new paper spray method and compared to the traditional LC-ESI-MS. Although LC-ESI-MS was observed to be 10× more sensitive, the linear dynamic range for both methods was determined to be the same, in the range of 1-500 ng/mL for both cocaine and benzoylecgonine analytes. When fully developed, the current microsampling strategy could offer an easy-to-use kit that can enable a more effective MS analysis of 20 μL dried blood samples delivered by mail. Both sensitivity (10×) and sample stability are found to be more superior for blood prepared in the embossed hydrophobic paper compared to samples prepared in the planar hydrophilic paper.

Online, droplet-based in-source chemical derivatization is accomplished using a coaxial-flow contained-electrospray ionization (contained-ESI) source to enhance sensitivity for the mass spectrometric analysis of saccharides. Derivatization is completed in microseconds by exploiting the reaction rate acceleration afforded by electrospray microdroplets. Significant improvements in method sensitivity are realized with minimal sample preparation and few resources when compared to traditional benchtop derivatizations. For this work, the formation of easily ionizable phenylboronate ester derivatives of several mono-, di-, and oligosaccharides is achieved. Various reaction parameters including concentration and pH were evaluated, and a Design of Experiments approach was used to optimize ion source parameters. Signal enhancements of greater than two orders of magnitude were observed for many mono- and disaccharides using in-source phenylboronic acid derivatization, resulting in parts-per-trillion (picomolar) limits of detection. In addition, amino sugars such as glucosamine, which do not ionize in negative mode, were detected at low parts-per-billion concentrations, and isobaric sugars such as lactose and sucrose were easily distinguished. The new in-source derivatization approach can be employed to expand the utility of ESI-MS analysis for compounds that historically experience limited sensitivity and detectability, while avoiding resource-intensive, bulk-phase derivatization procedures.

The ability to identify abnormalities in the body's saccharide profile is a promising means for early disease detection but requires analytical tools capable of detecting saccharides at low concentrations and/or for volume-limited samples. The preferred analysis approach for these compounds, liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS), often lacks sensitivity due to poor ionization efficiency. In this work, we employ a modified electrospray interface-termed contained-electrospray (contained-ESI) to couple accelerated droplet chemistry to conventional LC-MS for the online and automated separation, derivatization, and detection of saccharides. The chromatographic component enables complex sample and mixtures analysis with low sample volume requirements, while the enhanced reaction kinetics afforded by electrosprayed microdroplets facilitates rapid, on-the-fly derivatization to boost sensitivity. Derivatization occurs during ion formation as analytes elute from the column, eliminating the need for superfluous post-column derivatization hardware or complicated benchtop protocols. A grounded coupler was incorporated to shield the LC from the high-voltage ion source, and method conditions were optimized to accommodate the low flow rates preferred for microdroplet reactions. The new LC-contained-ESI-MS/MS platform was demonstrated for the analysis of several mono-, di-, and oligosaccharides using in-source droplet-based phenylboronic acid derivatization. Femtomole limits of detection were achieved for a 1 μL injection, representing sensitivity enhancement of 1-2 orders of magnitude over conventional LC-ESI-MS/MS without derivatization. In addition, isobaric saccharides that are difficult to differentiate by MS alone were easily distinguished. Method precision, accuracy, and linearity were established, and the ability to detect oligosaccharides at trace levels in human urine and plasma was demonstrated.

Background Health policy research tends to focus on medical care practices and disease prevention while the emphasis on political determinants of health is thin at best. Within this case study, we look at Austria's Freedom Party (FPÖ), a Populist Radical Right (PRR) party, and their impact on health policies. Existing conceptualizations suggest three key dimensions of PRR parties: People centrism (nativism), vertical exclusion (ant-political elite), and horizontal exclusion (immigrants). We explore how these conceptualizations are applicable to the health policy choices of the FPÖ. Methods We conducted a review of available primary sources (legal and policy documents) and secondary literature (academic, press, and think-tank publications). Resulting data were analysed thematically. Results In the years 2000 to 2003 and 2017 to 2019, the FPÖ, in a coalition government with the ÖVP, was in charge of the health ministry. The biggest changes came about in 2017 where 1) the FPÖ reneged on the smoking ban set to have been implemented in May 2018. 2) the FPÖ led the consolidation of the 21 separate health insurance companies to five, stating that it would bring patients €1 billion. However, the current government is now confronted with a budget deficit of the ÖGK. 3) the FPÖ promoted social policies reducing the social benefits for immigrants who showed insufficient language skills. Conclusions The case analysis suggests that the FPÖ's health policy choices, described above, may be explained through the people centrist, nativist, and anti-elitist tendencies of PRR parties. 1) reneging on the smoking ban can be interpreted as an anti-scientific and pro “ordinary citizen” action. 2) the health insurance mergers, can be explained as being a strike against the economic and political elites, who allegedly used the complex structure for their own benefit (clientelism). 3) attacking the socio-economic status of immigrants, a social determinant of general health.

BACKGROUND Plantar pressure leads to stress on plantar tissue and can be seen as risk factor for metatarsal stress fractures or plantar ulcers and is associated with prolonged and complicated recurrence of existing tissue damages. A clear demarcation of a systematic raise of body load regarding its effect on plantar pressure has not been described. OBJECTIVE Assessing plantar pressure patterns in different conditions of body weight, comparing data to initial body weight. METHODS Seventeen healthy volunteers were asked to participate. Peak pressure values were assessed during walking with dynamic pedobarography and analysed from three foot sections. Body weight was loaded up gradually with 10%, 20% and 30% of the individual initial weight by using a weighted vest. RESULTS We were able to detect a statistically significant increase of plantar pressure for all foot regions in case of loaded body weight of 20% and 30% comparing to initial weight (p< 0.05). The midfoot area displays a significant increase for peak pressure for the preferred foot even for 10% body load. CONCLUSIONS Peak plantar pressure increases with loaded body weight. The midfoot area seems to be a sensitive area in case of adapting increasing foot load. Considering the clinical relevance, loaded body weight has to be seen as risk factor for increasing plantar pressure patterns and should be considered in recurrence of plantar ulcers or stress fractures.

Cartilage imaging of small joints is increasingly of interest, as early detection of cartilage damage may be relevant regarding individualized surgical therapies and long-term outcomes.The aim of this review is to explain modern cartilage imaging of small joints with emphasis on MRI and to discuss the role of methods such as CT arthrography as well as compositional and high-field MRI.A PubMed literature search was performed for the years 2008-2018.Clinically relevant cartilage imaging to detect chondral damage in small joints remains challenging. Conventional MRI at 3 T can still be considered as a reference for cartilage imaging in clinical routine. In terms of sensitivity, MR arthrography (MR-A) and computed tomography arthrography (CT-A) are superior to non-arthrographic MRI at 1.5 T in the detection of chondral damage. Advanced degenerative changes of the fingers and toes are usually sufficiently characterized by conventional radiography. MRI at field strengths of 3 T and ultrahigh-field imaging at 7 T can provide additional quantifiable, functional and metabolic information.Standardized cartilage imaging plays an important role in clinical diagnostics in the ankle joint due to the availability of different and individualized therapeutic concepts. In contrast, cartilage imaging of other small joints as commonly performed in clinical studies has not yet become standard of care in daily clinical routine. Although individual study results are promising, additional studies with large patient collectives are needed to validate these techniques. With rapid development of new treatment concepts radiological diagnostics will play a more significant role in the diagnosis of cartilage lesions of small joints.

Verletzungen der Skelettmuskulatur gehoren in Anbetracht der Inzidenz zu den haufigsten Sportverletzungen. In der klinischen Diagnostik nehmen neben der sorgfaltigen Anamneseerhebung und klinischen Untersuchung bildgebende Verfahren einen wichtigen Stellenwert ein. Eine exakte Diagnosestellung ist notwendig, um eine stadiengerechte Therapie einzuleiten und damit eine kurze Regenerationszeit und demzufolge die zeitnahe Re-Integration in den Sport zu gewahrleisten. In der Regel konnen die meisten Muskelverletzungen konservativ versorgt werden und heilen folgenlos aus. Eine verzogerte Diagnosestellung, eine inadaquate Therapie oder eine zu fruhe sportliche Belastung konnen jedoch zu komplizierten und frustranen Heilungsverlaufen fuhren. Therapeutisch stellen die initiale Akuttherapie am Spielfeldrand, adjuvante Therapieverfahren in Form von Infiltrationen und die Anwendung von Physiotherapie wichtige Therapiebausteine dar. Obgleich Verletzungen der Muskulatur in Anbetracht der Inzidenz weit verbreitet sind, ist die wissenschaftliche Grundlage der angewandten Therapieverfahren limitiert. Die vorliegende Arbeit soll eine aktuelle Ubersicht uber Klassifikation und diagnostische Verfahren geben und dem Leser aktuelle Behandlungsempfehlungen und deren Evidenzlage liefern.

Muscle injuries frequently occur during sport and are one of the commonest injuries. The diagnosis and treatment of muscle injuries impose high demands on medical treatment, in order to ensure successful regeneration and a rapid return to sport. Most of the injuries can be treated conservatively, as skeletal muscles have a high endogenous capacity for repair and regeneration. Conservative treatment includes initial on-field therapy. This is known as the "RICE" principle and is common and recommended for initial treatment for most sports injuries. The primary therapy target is to reduce pain, swelling and bleeding and thus to limit the initial inflammatory process and prevent further damage. During the first days after injury, brief immobilization helps to reduce the re-injury rate and accelerates the formation of granulation tissue. There are many possible additional treatments, including intramuscular injections, manipulation of the sacroiliac joint or rehabilitation programs, including stretching and strengthening. If the acute treatment phase is complete after 3 to 5 days, more active treatment, including trunk stabilisation, stretching and strengthening, can be started gradually. Despite their high prevalence, there have only been a few studies on the treatment and management of these injuries. The aim of this manuscript is to review the literature on the classification, pathobiology and treatment strategies for muscle injuries.