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OBJECTIVE: In gout, incompletely defined molecular factors alter recognition of dormant articular and bursal monosodium urate monohydrate (MSU) crystal deposits, thereby inducing self-limiting bouts of characteristically severe neutrophilic inflammation. To define primary determinants of cellular recognition, uptake, and inflammatory responses to MSU crystals, we conducted a study to test the role of Toll-like receptor 2 (TLR-2), TLR-4, and the cytosolic TLR adapter protein myeloid differentiation factor 88 (MyD88), which are centrally involved in innate immune recognition of microbial pathogens. METHODS: We isolated bone marrow-derived macrophages (BMDMs) in TLR-2-/-, TLR-4-/-, MyD88-/-, and congenic wild-type mice, and assessed phagocytosis and cytokine expression in response to endotoxin-free MSU crystals under serum-free conditions. MSU crystals also were injected into mouse synovium-like subcutaneous air pouches. RESULTS: TLR-2-/-, TLR-4-/-, and MyD88-/- BMDMs demonstrated impaired uptake of MSU crystals in vitro. MSU crystal-induced production of interleukin-1beta (IL-1beta), tumor necrosis factor alpha, keratinocyte-derived cytokine/growth-related oncogene alpha, and transforming growth factor beta1 also were significantly suppressed in TLR-2-/- and TLR-4-/- BMDMs and were blunted in MyD88-/- BMDMs in vitro. Neutrophil influx and local induction of IL-1beta in subcutaneous air pouches were suppressed 6 hours after injection of MSU crystals in TLR-2-/- and TLR-4-/- mice and were attenuated in MyD88-/- mice. CONCLUSION: The murine host requires TLR-2, TLR-4, and MyD88 for macrophage activation and development of full-blown neutrophilic, air pouch inflammation in response to MSU crystals. Our findings implicate innate immune cellular recognition of naked MSU crystals by specific TLRs as a major factor in determining the inflammatory potential of MSU crystal deposits and the course of gouty arthritis. [ABSTRACT FROM AUTHOR]

The 'banana peel' exposure is a novel technique for knee joint exposure that consists of partially peeling the patellar tendon off the tibia, leaving the extensor mechanism intact distally and laterally. Although good clinical results have been reported with this technique with no disruption of the extensor mechanism, concerns exist that it could cause extensor lag, quadriceps weakness, or patellar tendon rupture. We compared the banana peel exposure repair to tibial tubercle osteotomy repair, which we chose as our benchmark procedure because much is known about its associated healing and rehabilitation protocols. In our study of 16 paired, fresh-frozen human knee specimens, the 2 techniques were used alternately for the right and left knees. To measure acute strength, 10 pairs were tested. The patella was clamped and pulled superiorly at 25 mm/min until failure. For cyclical testing (6 pairs), the knee was extended from 90° of flexion to 0° for 2000 cycles at 0.25 Hz while we monitored the distance between the inferior pole of the patella and the tibial diaphysis using a passive optical kinematic measuring system. Mean failure strengths of the banana peel and osteotomy groups were 2642±1104 N and 2123±562 N, respectively, suggesting that the banana peel repair is not weaker than the osteotomy repair. Neither group had a significant increase (via paired Student t test, P>.05) in the distance between the inferior pole of the patella and the tibial diaphysis, suggesting that neither exposure would result in extensor lag. [ABSTRACT FROM AUTHOR]

(1) Background: Few teen driving safety programs focus on increasing parental engagement with high-risk teen drivers, specifically those with a traffic violation. This study explored parents'/guardians' ('parents') experiences with a teen driving safety program, ProjectDRIVE, including facilitators and barriers to program engagement. (2) Methods: We conducted virtual, semi-structured interviews with parents who completed ProjectDRIVE, which included in-vehicle driving feedback technology and individualized virtual training with parents on effective parent-teen communication. (3) Results: Twenty interviews (with 17 females and three males) were transcribed verbatim and independently coded by three coders using systematic, open, and focused coding. Three major themes were identified: factors influencing a parent's initial decision to participate, factors influencing continued engagement, and perceived benefits of participation. The decision to participate was influenced by these subthemes: parental motivation to help their teen, perceived program usefulness, program endorsement, program incentives, parents' busy schedules, and lack of access to a car/internet. Subthemes impacting continued engagement included enhanced communication skills, teen willingness to engage, strong parental engagement, and teens' other priorities. Perceived benefits included greater self-efficacy in communication, improved communication patterns and frequency, and enhanced parent-teen relationships. (4) Conclusions: These findings may set the foundation for developing and implementing future court-ordered parent-based teen safe driving programs for teens with traffic citations.

Background: Due to the SARS-CoV-2 pandemic, healthcare workers (HCWs) are experiencing tremendous levels of emotional and physical stress. Hospitals are trying to help personnel cope with work-related pressure. The aim of this study was to assess HCWs' awareness and utilization of counseling and support services during the pandemic, HCWs' unmet counseling and support needs, and the type and content of these services., Methods: A cross-sectional online survey was conducted from January to June 2021 through the German national research organization Network University Medicine (NUM). All participating hospitals (6 in total) were asked to inform their employees about the study., Results: A total of 1,495 HCWs were included in the analysis. Of these, 42.8% ( n  = 637) were frontline HCWs (who had contact with COVID-19 patients), 23.1% ( n  = 344) were second-line HCWs (who only had contact with non-COVID-19 patients) and 34.1% ( n  = 508) had no contact with any patients. Participating hospitals offer various counseling and support services for their staff. The percentage of respondents who were unaware of available counseling and support services ranged from 5.0 to 42.0%. Depending on the type of counseling and support services, 23.0-53.6% of the respondents indicated that counseling and support services were provided but not used, while 1.7-11.6% indicated that, despite the need for them, such services were not available. HCWs' overall satisfaction with the provided counseling and support services and their unmet support needs differed by patient contact: Frontline HCWs reported more unmet needs for counseling and support than second-line HCWs, while second-line HCWs reported more unmet needs than HCWs without patient contact., Conclusion: The results indicate that hospitals should make more efforts to inform HCWs about available counseling and support services. Hospitals could also create networks where HCWs could share information about the type and content of services and their experiences with various counseling and support services. These steps would enable hospitals to respond more quickly and effectively to the problems facing HCWs during pandemics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Diehl, Mülder, Imm, Kegel, Tolksdorf, Wiegand, Röthke, Tüscher, Lieb, Walter, Liebe, Maicher, Hellwig, Adorjan, Unterecker, Beutel and Rose.)

Introduction: Purchasing produce at farmers markets represents one method by which individuals can purchase and have access to healthful and seasonal fruits. Despite the extension of nutrition assistance programs to local farmers markets, fruit and vegetables consumption has remained below the recommended guidelines, specifically in rural geographical locations., Statement of Purpose: The purpose of the study was to explore the aspects of the Link Up Illinois Double Value SNAP Nutrition Incentives Program (DVCP) and its effects on food selection at rural farmers markets for individuals enrolled in nutrition assistance programs., Methods/approach: The current study uses a qualitative methodology in order to uncover barriers local health departments and farmers markets face to implementing the DVCP in their communities and to discover the perspectives of low-income individuals who utilize the DVCP. This paper explores the organizational and community member perceptions of the DVCP and its administration. Semi-structured interviews and one focus group were conducted with health educators from county health departments, DVCP stakeholders, farmers market managers, local farmers, and residents who used the DVCP. A purposeful sampling method was used, intentionally selecting individuals with lived experiences of the research objective. Data were analyzed using a three-cycle coding process, then categorized into overarching themes until thematic saturation was reached., Results: There were a total of 19 individuals who participated in the study. Five themes and four subthemes emerged from data analysis, including organizational capacity, exposure to the DVCP, purchasing power, DVCP advancements, and values., Conclusion/implications: These findings contextualize the facilitators and barriers of multiple stakeholders when implementing nutrition assistance programs at farmers markets. Other similar "double value" programs can utilize these lessons when seeking to increase participation of underrepresented populations at local farmers markets., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rose, Donahoo, McDaniel, Null, McLernon and Kruse-Diehr.)

Aim of this project was to assess occupational biological hazards with regard to the risk of hepatitis A (HAV) and hepatitis B (HBV) and the need for occupational health care in schools for pupils with special needs. Teachers and educational specialists were surveyed about activities potentially providing exposure to biological agents and their individual immune status regarding HAV and HBV by a detailed questionnaire. Descriptive analyses, group comparisons and logistic regression were performed to identify factors influencing the HAV and HBV immune status. 1398 teachers and educational specialists took part. 1381 respondents reported having physical contact with pupils at work (98%). Daily contact was reported by up to 84% of all employees. Being scratched, bitten or spat at was reported by up to 93%. Hazardous activities are performed by both teachers and educational specialists. The vaccination rate was reported to be 58% for HAV and 64% for HBV. In regression analyses, failing to receive vaccine counselling [HAV: aOR 0.36 (95% CI 0.28; 0.46; p < 0.001), HBV: aOR 0.43 (95% CI 0.33; 0.55; p < 0.001)] or non-participation in infection prevention instruction [HBV: aOR 0.54 (95% CI 0.39; 0.75; p < 0.001)] were found to be significant predictors of low vaccination rates. Employees who are at risk due to occupational exposure should be instructed about infection prevention and vaccination against HAV and HBV., (© 2022. The Author(s).)

Background: A critical factor in achieving widespread immunity against COVID-19 is the willingness of previously unvaccinated individuals to get vaccinated. Medical staff play a key role in this, as they ensure healthcare during the pandemic and for many serve as a source of information about vaccinations. Among the factors that negatively influence the general willingness to get vaccinated are conspiracy assumptions and the spread of misinformation., Objective: The willingness of hospital staff in Germany to get vaccinated and various influencing variables were examined to obtain indicators that could help increase the general willingness to get vaccinated., Methods: Between January and June 2021, a voluntary and anonymous online survey conducted as part of the egePan joint project of the national network for university medicine (funded by the Federal Ministry of Education and Research) was used to assess the willingness to be vaccinated, individual social characteristics, the belief in conspiracy assumptions, and communication items in German hospitals., Results: In comparison with the general population, physicians and scientific staff in particular indicated an increased willingness to get vaccinated. Conspiracy assumptions were not very widespread but most frequent among administrative and nursing staff. Conspiracy assumptions were negatively associated with the willingness to get vaccinated. Predictors for a higher willingness to get vaccinated were the perceived safety and effectiveness of vaccinations and a higher age., Discussion: Since the perceived safety and effectiveness of vaccinations have a positive effect on the willingness to get vaccinated, educational work and transparent information transfer could counteract the spread of conspiracy assumptions and increase vaccination rates among hospital staff., (© 2022. The Author(s).)

Improvements to the world's food supply chain are needed to ensure sufficient food is produced to meet increasing population demands. Growing food in soilless hydroponic systems constitutes a promising strategy, as this method utilizes significantly less water than conventional agriculture, can be situated in urban areas, and can be stacked vertically to increase yields per acre. However, further research is needed to optimize crop yields in these systems. One method to increase hydroponic plant yields involves adding plant growth-promoting bacteria (PGPB) into these systems. PGPB are organisms that can significantly increase crop yields via a wide range of mechanisms, including stress reduction, increases in nutrient uptake, plant hormone modulation, and biocontrol. The aim of this review is to provide critical information for researchers on the current state of the use of PGPB in hydroponics so that meaningful advances can be made. An overview of the history and types of hydroponic systems is provided, followed by an overview of known PGPB mechanisms. Finally, examples of PGPB research that has been conducted in hydroponic systems are described. Amalgamating the current state of knowledge should ensure that future experiments can be designed to effectively transition results from the lab to the farm/producer, and the consumer.

Background: The prevalence of dietary supplement (DS) and energy drink (ED) usage in military personnel differs from branch to branch and is between 55% and 76% (higher values in special operations forces). Aviators with highly demanding tasks might be especially interested in using dietary supplements. To date, there are only limited data available for this special profession inside the military., Methods: An internet-based survey was conducted on the prevalence of DS and ED usage, the reasons for their usage and the place of purchase for all wings of the German Armed Forces., Results: Of the 181 pilots who participated in the survey, 34% used DSs and 16% EDs. Usage was linked to sports activities but not to the type of aircraft. DSs were purchased on the internet by 50% of the respondents; mostly protein supplements, magnesium and omega-3fatty acids. Only 42% said they would feel an effect from taking DSs., Conclusions: Although the present study showed that the prevalence of usage was comparable to that of the civilian population, the sources of supply and the range of the substances taken give cause for concern. This calls for education and information campaigns to make the pilots aware of the possible risks to their health.

Kawasaki-like multisystem inflammatory syndrome related to SARS-CoV-2 infection is a well-described condition in children and adolescents (MIS-C) and now also in adults (MIS-A). We report a case of MIS-A in a previously well woman in her mid-30s who presented with vasopressor-dependent shock 2 weeks after initial recovery from suspected SARS-CoV-2 infection, accompanied by fever, vomiting, diarrhoea, weakness, arthralgia, rash, cough and headache. Examination was notable for fever, tachycardia, hypotension, cervical lymphadenopathy, mucocutaneous involvement, neck stiffness, pansystolic murmur and bilateral crepitations. Inflammatory markers were elevated. Echocardiogram showed mitral regurgitation with preserved ejection fraction. She was treated with vasopressors, admitted to the intensive care unit and subsequently required invasive mechanical ventilation. Both PCR and antibodies for SARS-CoV-2 were positive. Treatment with intravenous methylprednisolone and intravenous immunoglobulin was initiated with rapid improvement in clinical condition and inflammatory markers. She has since made a full recovery with normal echocardiogram 8 months later., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Health behavior is presumed to be influenced by organizational factors. This study analyzes how workplace characteristics influence health behavior in terms of participation at health measures., Methods: Employees of the German Federal Ministry of Defense were surveyed at the beginning (January / February 2015) and at the end (June 2015) of the trial phase of workplace health promotion (WHP). Differences in participation of characteristic groups were calculated using Pearson's Chi 2 -Test and T-Test, chances of participation were estimated using multilevel logistic regression., Results: Employees who reported higher satisfaction with work demand participated more often in health measures (aOR: 1.02, 95%-CI = 1.01, 1.04, p  < 0.001). Large amount of variance in participation can be attributed to department level., Conclusion: Participation at WHP varies significantly between settings after controlling for individuals' characteristics. Thus, working characteristics should be considered as a decisive factor for WHP effectiveness. There is consensus that behavioral prevention is most effective when conditional prevention is granted as behavior is presumed to be influenced by individuals´ environmental conditions. Though objective working conditions may seem similar further context characteristics which remain unconsidered may lead to different behavior patterns. This article shows that more attention must be payed to setting specific characteristics with regard to effective Occupational Health Promotion.This project is registered by the Federal Ministry of Defense (research number: E/U2AD/ED003/EF555)., Competing Interests: Competing interestsSammito is an active officer of the German Ministry of Defense., (© The Author(s) 2020.)

Aim of Study: An occupational health management system was initiated at 11 departments under the German Ministry of Defense (MoD) at the beginning of 2015. The departments were characterized by the heterogeneity of employees and the tasks of the departments. The aim of this pilot phase was to get experience and knowledge for implementation of this system in other departments. At the beginning of the pilot phase, an employee attitude survey was conducted to examine the situation., Methods: The survey included all 9,267 employees of the eleven departments. A combination of a web-based online survey and a paper-pencil survey was used., Results: In total, 2,076 (22.4%) of all employees took part in the survey. There were significant difference between the departments in all topics assessed ("leadership behaviour/social issues", "work habits", "job design", "work equipment", "environment conditions", "mental health", "stress", "diet", "exercise", "job responsibility") but not in "health behavior"., Conclusion: This study shows clearly that a department-based analysis is necessary for a goal-oriented meaningful occupational health management system, especially if only limited resources are available., Competing Interests: Sammito ist aktiver Sanitätsoffizier der Bundeswehr. Rose und das Institut für Arbeits-, Sozial- und Umweltmedizin erhalten Forschungsmittel aus dem BMVg., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Tobacco use, correlated with reduced physical fitness, is one of the leading causes of avoidable death worldwide. It increases the risk of dementia and can shorten the lifespan by 10 years. For the German Armed Forces (Bundeswehr), figures on smoking behavior have not been comprehensively captured. This study analyzes current data in a large sample from this population., Methods: Based on an employee survey as part of the Occupational Health Management System, data on smoking behavior from 13,326 participants were analyzed in relation to age, gender, professional status, education level and membership in military operational units versus other agencies., Results: Smoking behavior varied significantly (P < 0.001) by age group (younger > older), gender, professional status, military agency membership status, and education level (the lower the education level, the higher the smoking rates). With the exception of the downward trend in smoking behavior with increasing age among civilian employees, these results were all significant (P < 0.005)., Conclusions: This data analysis shows that smoking prevalence among personnel in the area of responsibility of the Federal Ministry of Defense is comparable to the current data from corresponding surveys of the German population. Depending on gender, they generally show values that are slightly above those of the German population. The well-known trend in the general population of decreasing smoking prevalence with increasing age is also seen in this analysis. However, there are considerable differences in the smoking prevalence among individual subgroups (professional status, agency, gender, education level). The data show that particular young soldiers in the armed forces should be the target group for further preventive measures.

We present a case of a 23-year-old woman with dysphagia. She was reportedly newly diagnosed with HIV and had been initiated on antiretroviral treatment and tuberculosis (TB) prophylaxis. Oesophagogastroduodenoscopy revealed an irregular, ulcerative oesophageal lesion. Subsequent histopathology revealed M ycobacterium tuberculosis as well as C andida albicans A CT scan demonstrated widespread disease with miliary TB. She was subsequently initiated on antituberculous and antifungal medications. TB is one of the most common and deadly infectious diseases in the world, with the highest rates seen in the developing countries. It commonly occurs as an opportunistic infection of HIV. Despite its potential for systemic infection, infection of the oesophagus is incredibly rare, more so as a co-infection with candida. This case highlights the need to have a high index of suspicion in high risk groups, as early treatment is crucial in addressing this global health crisis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To evaluate the effects of a chronic occupational exposure to toluene on color vision., Methods: Color vision was tested in 51 workers exposed to pure toluene and in 51 matched control subjects. Current exposure was determined by biological monitoring. Blood samples were taken at the end of a Friday shift. Color vision ability was assessed using the Ishihara plates (to screen for congenital dyschromatopsia), the Farnsworth panel D-15 test, the Lanthony panel D-15 desaturated test, the Velhagen plates, and the Standard Pseudoisochromatic Plates Part 2., Results: Median toluene concentration was 1.59 mg/l (quartiles 0.78 and 2.65). The whole group of workers did not perform worse than the controls. The same applies to 20 printers, who regularly assessed hues. Assessed with the most sensitive Lanthony panel D-15 desaturated test, color vision of 24 permanently exposed assistants was impaired (median color confusion index of the 1st eyes 1.08 vs. 1.02, p < 0.02; 2nd eyes 1.08 vs. 1.0, p < 0.05; sign test). The assistants made almost exclusively blue-yellow errors. The other color vision tests did not reveal any differences between the groups., Conclusion: Changes in the retina are a possible explanation for the observed blue-yellow dyschromatopsia.

The Kuiper Belt is a distant region of the outer Solar System. On 1 January 2019, the New Horizons spacecraft flew close to (486958) 2014 MU 69 , a cold classical Kuiper Belt object approximately 30 kilometers in diameter. Such objects have never been substantially heated by the Sun and are therefore well preserved since their formation. We describe initial results from these encounter observations. MU 69 is a bilobed contact binary with a flattened shape, discrete geological units, and noticeable albedo heterogeneity. However, there is little surface color or compositional heterogeneity. No evidence for satellites, rings or other dust structures, a gas coma, or solar wind interactions was detected. MU 69 's origin appears consistent with pebble cloud collapse followed by a low-velocity merger of its two lobes., (Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Aim: Teachers' suggestions to enhance their health at inclusive primary schools ("Schwerpunktgrundschulen") were analyzed by quantitative content analysis taking personal or job-related parameters of effort and strain into consideration., Method: The paper and pencil cross-sectional study was conducted by Institut für Lehrergesundheit (IFL) between August 2013 and April 2015 at 14 schools in Rhineland-Palatinate. Overall response rate was 46.3% (143/309 teachers). The answers to the open-ended question "Which concrete job-related measures would enhance your wellbeing or health situation at your work place?" was categorized and quantified. An analysis of the item-non-response was undertaken. The aim was to identify by logistic regression, personal or job-related parameters of effort or strain associated with a specific category., Results: Data from 143 teachers were analyzed. 79 teachers made 362 suggestions to enhance the health situation at their work place. Making a suggestion was not related to socio-demographic parameters. 33.6% of the teachers addressed physical environmental conditions of work, e. g., climatic or acoustic conditions or the availability of space for recreation. 29.4% of the teachers made suggestions concerning human resource strategy (e. g., "double teaching"). 9.1% of the teachers referred to aspects of relationships with colleagues. After regression analysis, there were relationships between suggestions of single categories and specific job-related parameters of effort. Furthermore, teachers under (high) strain - here: teachers who (very) strongly experienced their work as hazardous to health - showed significantly higher odds to make suggestions of the categories "Colleagues" (aOR 3.71; 95%CI 1.00-13.76) or "External Support" (e. g., "supervision") (aOR 3.92; 95%CI 1.15-13.41) than teachers experiencing less stress., Conclusions: Teachers of inclusive primary schools are ready to take active part in health-related organizational development. The development of problem- and group-specific measures of intervention will be facilitated by the combined analysis of qualitative and quantitative data., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: While work-related fatigue has become an issue of concern among European employees, the relationship between fatigue, depression and work-related stressors is far from clear. The purposes of this study were (1) to determine the associations of fatigue with work-related stressors, severe medical disease, health behavior and depression in the working population and (2) to determine the unique impact of work-related stressors on fatigue., Methods: We used cross-sectional data of N = 7,930 working participants enrolled in the Gutenberg Health Study (GHS) from 2007 to 2012 filled out the Personal Burnout Scale (PBS) of the Copenhagen Psychosocial Questionnaire (COPSOQ), the PHQ-9, and a list of work-related stressors., Results: A total of 27.5% reported increased fatigue, esp. women, younger persons with a lower social status and income, smokers, severely medically ill, previously and currently depressed participants. Fatigue was consistently associated with severe medical disease, health behavior and depression, which need to be taken into account as potential confounders when analyzing its relationship to work-related strains. Depression was consistently associated with work-related stressors. However, after statistically partialling out depression, fatigue was still significantly associated with work-related stress., Conclusions: Fatigue as an indicator of allostatic load is consistently associated with work-related stressors such as work overload after controlling for depression. The brief Personal Burn-out Scale is suitable for assessing work-related fatigue in the general population.

This study aims to assess serostatus and vaccination status of hepatitis A and B among staff at schools for the handicapped. We also wanted to investigate factors associated with serostatus, number of infections with hepatitis A/hepatitis B at work, and factors influencing being vaccinated or not. The cross-sectional study was carried out between August 2010 and August 2012 at 13 German schools for severely handicapped. Data were analyzed using blood samples, vaccination documents, and questionnaires. A total of 395 persons participated in our study (response: 59.7%), information on 367 could be used for analysis. Two respondents have been infected with HAV at work, 53.4% were anti-HAV seropositive. Vaccination against hepatitis A was influenced by information about infectious diseases before starting to work, level of education, and marital status. One person got infected with hepatitis B during work, 53.2% were anti-HBs-seropositive. Vaccination against hepatitis B depended on perceived burden by nursing activities, and vaccination costs being paid by employer. Immunity to hepatitis A and B in our sample is insufficient and does not correspond to the infectious risks. Two persons got infected with hepatitis A and one person with hepatitis B during work at school, indicating an urgent need for preventive actions. J. Med. Virol. 89:825-833, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Study Objective: To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in patients younger than 1 year with a ProSeal laryngeal mask airway (PLMA)., Design: Randomized prospective study., Setting: Tertiary care pediatric hospital., Patients: Thirty-nine American Society Anesthesiologists classifications 1 to 2, pediatric patients younger than 1 year., Interventions: Three different ventilation strategies (spontaneous ventilation [SV], pressure support ventilation [PSV], and pressure-controlled ventilation [PCV]) were randomly applied to patients who underwent a standardized mask induction with sevoflurane/oxygen and propofol 2 mg/kg and fentanyl 2 μg/kg administered intravenously followed by PLMA insertion. Patients were maintained on sevoflurane and N 2 O., Measurements: We measured the differences in end-tidal CO 2 (etco 2 ), tidal volume (TV), and respiratory rate (RR) over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals., Main Results: etco 2 (mm Hg) was not significantly higher in the SV vs PSV (P=2.11) and SV vs PCV (P=.24). TV (mL/kg) was significantly lower in SV vs PSV (P<.005) and SV vs PCV (P<.005). RR was not significantly higher in SV vs PSV (P=.43), but was significantly higher in SV vs PCV (P<.005). Three patients in the SV group and 1 patient in the PSV group failed to initiate SV and required PCV and were thus excluded from analysis., Conclusions: All 3 modes of ventilation using a PLMA were safe in children younger than 1 year. Although we did not observe a statistically significant increase in etco 2 , differences in TV and RR, and the small but significant incidence of apnea may make PSV or PCV more optimal ventilation strategies in children younger than 1 year when using a PLMA., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Study Objective: To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in pediatric patients with a ProSeal laryngeal mask airway (PLMA)., Design: Randomized prospective study., Setting: Pediatric hospital of a tertiary care academic medical center., Patients: Thirty-three, American Society of Anesthesiologists classification 1-2, pediatric patients (12 months to 5 years)., Interventions: Three different ventilation strategies: spontaneous ventilation (SV), pressure support ventilation (PSV), and pressure-controlled ventilation (PCV) were randomly applied to patients who underwent a standardized mask induction with sevoflurane/oxygen and propofol 3 mg/kg and morphine 0.05 mg/kg administered intravenously followed by PLMA insertion. Patients were maintained on sevoflurane and N2O., Measurements: We measured the differences in end-tidal CO2 (Etco2), tidal volume, and respiratory rate over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals., Main Results: Etco2 (mm Hg) was significantly higher in the SV vs PSV (P=.016) and vs PCV (P<.001). Tidal volume (mL/kg) was significantly lower in SV vs PSV (P<.001) and vs PCV (P<.001). Respiratory rate (breaths/min) was significantly higher in SV vs PSV (P<.001) and vs PCV (P=.005)., Conclusions: All 3 modes of ventilation using a PLMA were safely used. Our SV group was noted to have a significantly higher Etco2 when compared with PSV and PCV with a mean Etco2 over time in excess of 55 mm Hg. PSV and PCV were found to be more appropriate ventilation strategies to more optimally control Etco2 over time in these patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: The aim of the study was to describe measures suggested by staff at German schools for the severely handicapped regarding possibilities to improve their health situation and well-being at work. We further wanted to analyze whether sociodemographic, occupation-related, and health-related characteristics influence the type of measures proposed., Methods: The cross-sectional study was carried out between August 2010 and August 2012 at 13 schools for the handicapped focusing on motoric and/or holistic development of severely handicapped pupils. Data of teachers and educational staff were surveyed using written questionnaires. The analysis is based on free-text answers regarding the question: "What specific occupation-related measures would lead to an improvement of your well-being or health situation at the workplace?", Results: A total of 395 persons (response proportion: 59.7 %) with a mean age of 45 years and predominantly female (86.8 %) participated in our survey. A total of 205 persons answered the study question providing 456 improvement suggestions, which were classified into 6 main and 13 subcategories. The main categories were professional education and supervision, organization of working tasks and time, work safety and work equipment, social aspects of work, human resources and contractual framework, and other. Measures proposed were influenced by gender, burden by nursing activities, teaching, and administrative tasks, and frequency of deterioration in working atmosphere., Discussion: Proposed measures raise awareness for job-related health stressors and are a starting point to improve working conditions at these schools. Since suggestions vary widely by school and composition of staff, individual priorities have to be set and discussed with the school management.

Background: Teachers' mental health is commonly discussed in organizational health studies, but studies in special schools are rare. Work-related coping and experience patterns (WCEPs) have been shown to be associated with mental health and intentions to leave. The influence of organizational factors on coping patterns has not been examined., Aims: To assess the distribution of WCEPs in special school staff and to identify potential influencing factors., Methods: We surveyed a sample of teachers and educational staff in 13 German special schools using the WCEP questionnaire and COPSOQ (Copenhagen Psychosocial Questionnaire)., Results: Of 245 teachers and 417 educational staff contacted, 114 teachers (47%) and 252 educational staff (60%) responded, an overall response rate of 55% (366/662). Coping patterns of special school staff were classified as unambitious (30%), excessively ambitious (7%), resigned (17%), healthy-ambitious (12%) or unclassifiable (34%). Furthermore we found several significant relations with demographic and organizational factors. For example, the resigned pattern is associated with age [Exp(B) 1.12; 95% CI 1.05-1.19], emotional demands [Exp(B) 1.07; 95% CI 1.01-1.12], work-family conflict [Exp(B) 1.07; 95% CI 1.03-1.10] and bullying [Exp(B) 1.04; 95% CI 1.00-1.08]., Conclusions: Since emotional and social factors are associated with risky (excessively ambitious or resigned) and unambitious coping patterns in special school teachers and educational staff, interventions should focus on them. Further research could explore causal relations and observe the development of coping styles over time., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Patient-centredness is an accepted term and is perceived by healthcare professionals to be morally and ethically desirable. We are motivated by the belief that this approach will improve the patient-professional experience of the decision-making process and improve health outcomes. We acknowledge that patients, either as participants or as co-investigators, have positive contributions to make to research. As the idiopathic pulmonary fibrosis (IPF) community enters a new era of clinical research activity we consider that there is greater capacity for patient involvement and partnership.Patient involvement in research can be optimised through collaborations in the research design, study conduct, and dissemination. There is increasing interest in using patient- reported outcomes (PROs), such as health-related quality of life, and symptoms measures to inform decision-making and ensure patient perspectives are taken into account. PROs are an essential component of specialist IPF services, to monitor and improve care delivery and to measure and benchmark performance. In clinical trials, PROs can additionally be used to define entry criteria, evaluate efficacy of an intervention, and evaluate adverse events. We suggest that there is a much wider scope for including patient-centred PROs in clinical research and for creative thought in developing patient co-investigator roles.Participation in research activity requires highly refined decision-making processes, particularly in a condition such as IPF, which has an often unpredictable trajectory. The IPF research landscape has changed and the design and conduct of clinical trials in IPF requires some radical rethinking. It is accepted that involving patients in the role of co-investigators will impact the research questions we ask and result in study designs that are patient-centred. IPF clinical trials have been hindered by the lack of availability of validated, disease-specific questionnaires. A conservative approach appears to have been taken to the inclusion of generic symptom or quality of life measures as PRO endpoints. Thus, the impact of new drugs on the quality of life of research participants demonstrates only minimal benefit. It is time to refocus on a patient-centred approach with regards to the co-investigator role, PRO development, and research participants.

Inefficient T-cell homing to tissues limits adoptive T-cell immunotherapy of solid tumors. αLβ2 and α4β1 integrins mediate trafficking of T cells into tissues via engagement of ICAM-1 and VCAM-1, respectively. Inhibiting protein kinase A (PKA)-mediated phosphorylation of α4 integrin in cells results in an increase in αLβ2-mediated migration on mixed ICAM-1-VCAM-1 substrates in vitro, a phenomenon termed "integrin trans-regulation." Here, we created an α4(S988A)-bearing mouse, which precludes PKA-mediated α4 phosphorylation, to examine the effect of integrin trans-regulation in vivo. The α4(S988A) mouse exhibited a dramatic and selective increase in migration of lymphocytes, but not myeloid cells, to sites of inflammation. Importantly, we found that the α4(S988A) mice exhibited a marked increase in T-cell entry into and reduced growth of B16 melanomas, consistent with antitumor roles of infiltrating T cells and progrowth functions of tumor-associated macrophages. Thus, increased α4 trans-regulation of αLβ2 integrin function biases leukocyte emigration toward lymphocytes relative to myeloid cells and enhances tumor immunity., (©2015 American Association for Cancer Research.)

Biological complexity and the need for highly differentiated medicines means that drug discovery and development have become increasingly challenging and expensive. Thus, new paradigms for research and drug development need to be created that bring together a wide array of expertise. One potential solution is collaboration between bio-pharma and academic research centres. Two examples are discussed, one with a large pharma company (GlaxoSmithKline) and the other a small biotech (Genoa Pharmaceuticals). Patient advocacy organization can also have role in assisting in the creation of these partnerships by informing patients of ongoing research and clinical trials, and supporting the development of networks that can provide major benefit for both basic research and drug development. A major 'hurdle' for the creation of these relationships is the issue of intellectual property. Examples are provided of how this issue can be resolved., (© 2015 Asian Pacific Society of Respirology.)

Objectives: The present study aimed to describe the prevalence, type, and influencing factors of occupational injuries of staff working at special schools with multiple and severely handicapped pupils in Southwestern Germany., Methods: This cross-sectional study was carried out between August 2010 and August 2012 at 13 special schools with focus on motoric and/or holistic development of handicapped pupils in Rhineland-Palatinate (Germany). Participants were interviewed using a written questionnaire., Results: There were 395 participants (response proportion: 59.7%) in our study, with 390 being eligible for statistical analysis. Respondents were on average 45 years old and mainly female (86.9%). The 12-month injury prevalence was 16.9%. Joint dislocations, sprains, and torn ligaments (41.6%) were the main types of injuries. Pupils (59.8%) and auxiliary equipment (12.2%) were identified as the main causes of injury by the respondents. Multivariable logistic regression analysis showed that washing pupils (using auxiliary equipment) (aOR, 3.93; 95% CI, 1.66-9.31) and daily physical strain due to unexpected conduct of pupils (aOR, 3.70; 95% CI, 1.20-11.37) were the main influencing factors for an occupational injury., Conclusions: Almost one in five persons suffered an occupational injury in the previous 12 months. Nursing activities, including close contact with pupils, were identified as the most important factors for an injury. In order to prevent injuries at special schools, a multifaceted approach is necessary. This includes sufficient supply of auxiliary devices including proper technical maintenance. Furthermore, regular participation in training for manual handling of heavy loads and schooling on the technical use of auxiliary devices should be encouraged.

Background: In Germany, about 70,000 teachers and educational staff were teaching at more than 3,000 special schools during the school year 2010/2011. Nursing services like lifting pupils form a substantial part of the work content of the staff at special schools. Since nursing care often involves carrying and lifting pupils, there is a reason to assume an adverse effect on the musculoskeletal health of teachers and other professionals. With the present study we aimed to describe the prevalence and risk factors of chronic back pain among employees at this type of school., Methods: The cross-sectional survey was carried out between August 2010 and August 2012 at 13 special schools focusing on motoric and/or holistic development of handicapped children in Rhineland-Palatinate (Germany). Teachers and educational staff were interviewed using a questionnaire. We applied multivariable logistic regression analyses to identify influencing factors of chronic back pain., Results: Altogether 395 persons (response rate: 59.7%) participated in our study. Respondents were mostly female (86.8%) with a mean age of 45 years. The prevalence of chronic back pain was 38.7%. More than 40% reported frequently carrying and lifting heavy loads (>20 kg). Age [adjusted OR = 1.03 (95%-CI 1.00-1.05) for 1-year increase in age], current smoking [adjusted OR = 2.31 (95%-CI 1.27-4.23)], depression/depressive mood [adjusted OR = 1.85 (95%-CI 1.12-3.06)], frequently carrying and lifting heavy loads [adjusted OR = 2.69 (95%-CI 1.53-4.75)], and frequent exposure to environmental impacts [adjusted OR = 2.18 (95%-CI 1.26-3.76)] were influencing factors of chronic back pain in the final multivariable regression model., Conclusions: A large proportion of teachers and educational staff suffered from chronic back pain in our study, indicating a high need for treatment in this professional group. Increasing age, current smoking, a diagnosed depression/depressive mood, carrying and lifting heavy loads, and exposure to environmental impacts were associated with chronic back pain. Due to the sparse literature on the topic, further studies using a longitudinal design are necessary for a better understanding of the risk factors of chronic back pain.

Working memory is an essential component of higher cognitive function, and its impairment is a core symptom of multiple CNS disorders, including schizophrenia. Neuronal mechanisms supporting working memory under normal conditions have been described and include persistent, high-frequency activity of prefrontal cortical neurons. However, little is known about the molecular and cellular basis of working memory dysfunction in the context of neuropsychiatric disorders. To elucidate synaptic and neuronal mechanisms of working memory dysfunction, we have performed a comprehensive analysis of a mouse model of schizophrenia, the forebrain-specific calcineurin knock-out mouse. Biochemical analyses of cortical tissue from these mice revealed a pronounced hyperphosphorylation of synaptic vesicle cycling proteins known to be necessary for high-frequency synaptic transmission. Examination of the synaptic vesicle cycle in calcineurin-deficient neurons demonstrated an impairment of vesicle release enhancement during periods of intense stimulation. Moreover, brain slice and in vivo electrophysiological analyses showed that loss of calcineurin leads to a gene dose-dependent disruption of high-frequency synaptic transmission and network activity in the PFC, correlating with selective working memory impairment. Finally, we showed that levels of dynamin I, a key presynaptic protein and calcineurin substrate, are significantly reduced in prefrontal cortical samples from schizophrenia patients, extending the disease relevance of our findings. Our data provide support for a model in which impaired synaptic vesicle cycling represents a critical node for disease pathologies underlying the cognitive deficits in schizophrenia.

We sought to determine the effect anterior versus posterior in situ decompression with 360° external neurolysis on ulnar nerve subluxation. Ten cadaveric specimens were used, with anterior release performed on 5 specimens and posterior release the other 5 specimens. Each specimen was released for 4 cm centered over the cubital tunnel followed by 12 cm, 20 cm, and 20 cm with 360° external neurolysis. After release, the elbow was brought through a range of motion from 0° to 140° of flexion. Compared with posterior release, anterior release demonstrated significantly more total subluxation of the ulnar nerve for all release types from 80° to 120° of flexion (P<.05). At 140° of flexion, the 4-cm release, the 12-cm release, and the 20-cm release with 360° external neurolysis also demonstrated significantly more total subluxation with anterior release (P<.05). Ulnar nerve subluxation was significantly lower with posterior release, compared with anterior release for limited and complete in situ decompression.

This study systematically reviews the evidence-base for the use of expandable nails in the treatment of acute diaphyseal fractures of the lower limb. Both electronic and hand searches were undertaken of the published and grey literature to 1 December 2011. A total of 154 citations were identified, of which 15 were deemed suitable and assessed with the Critical Appraisals Skills Programme tool. A total of 625 nailing procedures were performed in 620 patients: 279 femoral and 346 tibial nails. The expandable nail was found to be significantly quicker to insert than interlocked nails (p < 0.05), and the total incidence of non-union or other complication was 13 and 14 % for expandable femoral and tibial nails, respectively. Notable complications with the expandable nail included fracture propagation on nail inflation in 2.5 % and post-operative shortening in 3.3 %. Device failure secondary to problems with the expansion mechanism was seen in 2.9 %. The rate of non-union and infection following expandable nailing was 3.1 and 1.4 %, respectively. Despite promising initial results, there remains a paucity of good quality studies to support the use of expandable nails over interlocked nails for the treatment of acute diaphyseal fractures of the lower limb.

The Fixion(™) system (Disc-O-Tech Medical Technologies, Herzeliya, Israel), which is currently the only expandable nailing system available for use in the humerus, has a number of purported advantages over the standard locked humeral nail, including a reduction in operating and fluoroscopy time since locking screws are not required. A systematic review was undertaken of all published (AMED, CINAHL, EMBASE and Medline via the Ovid platform) and unpublished or grey literature research databases from inception until 1st December 2010. Demographic data, clinical and radiological outcomes, and complications were extracted from each study by two independent investigators, and each study underwent independent critical appraisal using the CASP appraisal tool. Thirteen studies were deemed eligible for review, identified from a total of 154 citations. These included a total of 176 patients with 180 fractured humeri treated with expandable nails. Overall, 7.8% of humeral fractures treated with an expandable nail went on to non-union. Intra- and post-operative device failure rate was found to be 1.1 and 2.8%, respectively. These data compare favourably to published data on the outcome of locked humeral nails. However, there were numerous methodological flaws in the current evidence base; there were no comparative studies, treatment groups were heterogeneous, and there was no blinding of assessors or patients. Initial data indicate that the expandable humeral nail may be an acceptable form of treatment for humeral fracture or impending fracture, but high-quality comparative studies are needed to confirm these findings.

Eosinophilic lung diseases typically present as a triad of pulmonary symptoms, an abnormal chest radiograph, and elevated levels of eosinophils in the sputum and lung tissue. This article focuses on primary causes of eosinophilic lung disease including acute eosinophilic pneumonia, chronic eosinophilic pneumonia, Churg-Strauss syndrome, and hypereosinophilic syndromes. In these disorders elevated eosinophil levels in the tissue lead to inflammation and tissue damage. Peripheral eosinophilia can often be measured when tissue levels are elevated but this is not as reliable a marker as tissue biopsy. Because corticosteroids act through a variety of mechanisms to inhibit eosinophil function and induce apoptosis, they are first-line therapy for eosinophilic lung diseases. Targeted immunosuppressive therapies, such as monoclonal antibodies against key regulatory cytokines for eosinophil production and survival, are not formally approved for eosinophilic lung disease but have shown promising results in published research studies.

Background: Compressive and quadriceps forces have been associated with noncontact anterior cruciate ligament (ACL) injury. The purpose of this study was to quantify the relative importance of each load component during noncontact ACL injury., Hypothesis: We hypothesized that the introduction of a quadriceps force lowers the axial compressive force threshold to produce ACL injury., Study Design: Controlled laboratory study., Methods: Six pairs of fresh-frozen cadaveric knees, flexed to 15°, were loaded with axial compression (group A) or compression with a quadriceps force (group B) until failure. All specimens underwent axial compressive loading under displacement control with a time to peak load of 50 msec. The initial displacement of the MTS actuator was 8 mm and was increased in 2-mm increments with successive tests until catastrophic damage of the joint occurred. Failure was determined by a combination of clinical specimen examination and force-displacement data analysis and by dissection and direct visualization after failure was recognized. Differences in failure load between groups were examined using a paired t test (significance, P ≤ .05)., Results: In group A, there were 2 isolated ACL injuries, 2 ACL ruptures combined with a tibial plateau fracture, and 2 isolated tibial plateau fractures. In group B, there were 5 isolated ACL ruptures and 1 tibial plateau fracture. There was a significant difference in the average failure load between groups A and B: 10 832 N (95% confidence interval [CI], 9743-11,604 N) and 6119 N (95% CI, 4335-7903 N), respectively., Conclusion: Isolated compressive forces displayed an ability to produce an ACL injury in this cadaveric model, but the addition of a quadriceps load significantly reduced the compressive force required for ACL injury., Clinical Relevance: Compressive and quadriceps forces contribute to noncontact ACL injury and should be taken into account when developing ACL injury prevention programs and rehabilitation after ACL reconstruction.

Purpose: Previous studies that have encouraged early postoperative motion after distal biceps repair shows little agreement on exactly when activity should be resumed after surgery or on the level of weight restriction that should be used. The aim of the current study was to define a service load that would permit, without failure, 2,000 cycles of immediate motion after single-incision EndoButton distal biceps repair with FiberWire., Methods: In each of 15 cadaveric elbows, the distal biceps tendon was divided at its insertion and then repaired using a single-incision EndoButton technique with FiberWire. The repairs were then challenged according to the "staircase method" by cyclically loading the biceps tendon, so that the forearm flexed between 0° and 90°., Results: The mean failure load of the repair was 166.7 N (95% confidence interval, 132.6-200.8). The data suggested that a 0.9 kg (9-N) weight at the hand was the limit for a 2,000-cycle early rehabilitation protocol after repair of a ruptured distal biceps tendon via a single-incision EndoButton repair technique., Conclusion: Early active motion with a 0.9-kg weight restriction may therefore be possible in those patients undergoing distal biceps tendon repair using this technique.