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Proteze za djelomičnu amputaciju stopala su prijeko potrebne za nadomještanje izgubljene funkcije poluge prednjeg dijela stopala te izgubljene funkcije mišića čime je umanjen biomehanički disbalans, uspostavljena stabilna, dinamička ravnoteža te naposljetku omogućeno normalno kretanje korisnika. S obzirom da postoji više vrsta djelomičnih amputacija stopala, među njima postoje razlike u novonastalom biomehaničkom stanju stopala, ali i lokomotornog sustava, koje moraju biti uvažene pri konstrukcijskoj razradi kako bi što cjelovitije bilo omogućeno normalno kretanje korisnika. Postoji veliki broj konstrukcijskih rješenja proteza za pojedinu djelomičnu amputaciju stopala, no nadomještanje izgubljene funkcije poluge prednjeg dijela stopala kao i omogućavanje normalnog kretanja korisnika je omogućeno u određenom stupnju. Cilj ovoga rada je prikazati predloženo konstrukcijsko rješenje proteze za izabranu djelomičnu amputaciju stopala s kojom je moguće u potpunosti nadomjestiti izgubljenu funkciju poluge prednjeg dijela stopala kojom se postiže normalno kretanje korisnika. U ovome radu je obrađena osnovna građa funkcionalnih anatomskih elemenata stopala te je obuhvaćena biomehanika zdravog stopala. Kako postoje neusklađenosti uzrokovane raznim faktorima, izrađena je podjela djelomičnih amputacija stopala nad kojima je izvršena biomehanička analiza sa naznakom na međusobne biomehaničke razlike. Analizom tržišta su predstavljeni pojedini primjeri postojećih proizvoda proteza za djelomičnu amputaciju stopala prema funkcionalnosti proizvoda te su ustanovljene prednosti i nedostaci proizvoda. Pri koncipiranju su izrađeni tehnički upitnik i definicija cilja te su određeni očekivani uvjeti korištenja, konstrukcijski zahtjevi i ograničenja za izabranu vrstu djelomične amputacije stopala. Nadalje, izrađeni su te vrednovani i ocijenjeni koncepti, a prema najbolje, prema kriterijima, ocjenjenom konceptu je izvršena konstrukcijska razrada proteze za izabranu vrstu djelomične amputacije stopala, gdje je prikazano i konačno predloženo konstrukcijsko rješenje proteze sa opisom poboljšane funkcionalnosti. Vršenjem analize naprezanja proteze metodom konačnih elemenata u softverskom paketu Abaqus je ustanovljena nosivost proteze za izabranu vrstu djelomične amputacije stopala. Rezultati ovog rada ukazuju na mogućnost izrade proteze za izabranu vrstu djelomične amputacije stopala koja omogućuje nadomještanje izgubljene funkcije poluge prednjeg dijela stopala. Prostheses for partial amputation of the foot are necessary to replace the lost function of the lever of the forefoot and the lost muscle functions, which reduces biomechanical imbalance, establishes a stable, dynamic balance and ultimately enables normal movement of the user. Given that there are several types of partial amputations of the foot, among them there are differences in the newly established biomechanical state of the foot, but also of the locomotor system, which must be taken into account during the engineering design process in order to enable the normal movement of the user as completely as possible. There is a large number of designed solutions of prostheses for individual partial amputation of the foot, but the replacement of the lost function of the lever of the forefoot as well as enabling normal movement of the user is possible to a certain degree. The aim of this thesis is to present the proposed designed solution of the prosthesis for the selected partial amputation of the foot with which it is possible to completely replace the lost function of the lever of the forefoot which achieves normal movement of the user. This thesis deals with the basic structure of functional anatomical elements of the foot and includes the biomechanics of a healthy foot. As there are mismatches caused by various factors, a division of partial amputations of the foot was made and on which a biomechanical analysis was performed with an indication on mutual biomechanical differences. The market analysis presents some examples of existing products of prostheses for partial amputation of the foot according to the functionality of the product and the advantages and disadvantages of the product were established. During the conception, a technical questionnaire and a definition of the target were made and the expected conditions of use, structural requirements and restrictions for the selected type of partial amputation of the foot were determined. Furthermore, concepts were made, evaluated and graded, and according to the best, by criteria, graded concept was the engineering design of the prosthesis for the selected type of partial amputation of the foot carried out, where the final proposed design of the prosthesis with a description of improved functionality was presented. By performing a prosthesis stress analysis by finite element method in the Abaqus software package, the bearing capacity of the prosthesis for the selected type of partial amputation of the foot was established. The results of this work indicate the possibility of making a prosthesis for the selected type of partial amputation of the foot, which allows to replace the lost function of the lever of the front of the foot.

Integrative interpretation of cardiopulmonary exercise tests (CPETs) may improve assessment of cardiovascular (CV) risk. Here, we identified patient phenogroups based on CPET summary metrics and evaluated their predictive value for CV events. We included 2280 patients with diverse CV risk who underwent maximal CPET by cycle ergometry. Key CPET indices and information on incident CV events (median follow-up time: 5.3 years) were derived. Next, we applied unsupervised clustering by Gaussian Mixture modeling to subdivide the cohort into four male and four female phenogroups solely based on differences in CPET metrics. Ten of 18 CPET metrics were used for clustering as eight were removed due to high collinearity. In males and females, the phenogroups differed significantly in age, BMI, blood pressure, disease prevalence, medication intake and spirometry. In males, phenogroups 3 and 4 presented a significantly higher risk for incident CV events than phenogroup 1 (multivariable-adjusted hazard ratio: 1.51 and 2.19; p ≤ 0.048). In females, differences in the risk for future CV events between the phenogroups were not significant after adjustment for clinical covariables. Integrative CPET-based phenogrouping, thus, adequately stratified male patients according to CV risk. CPET phenomapping may facilitate comprehensive evaluation of CPET results and steer CV risk stratification and management.

Integrative interpretation of cardiopulmonary exercise tests (CPETs) may improve assessment of cardiovascular (CV) risk. Here, we identified patient phenogroups based on CPET summary metrics and evaluated their predictive value for CV events. We included 2280 patients with diverse CV risk who underwent maximal CPET by cycle ergometry. Key CPET indices and information on incident CV events (median follow-up time: 5.3 years) were derived. Next, we applied unsupervised clustering by Gaussian Mixture modeling to subdivide the cohort into four male and four female phenogroups solely based on differences in CPET metrics. Ten of 18 CPET metrics were used for clustering as eight were removed due to high collinearity. In males and females, the phenogroups differed significantly in age, BMI, blood pressure, disease prevalence, medication intake and spirometry. In males, phenogroups 3 and 4 presented a significantly higher risk for incident CV events than phenogroup 1 (multivariable-adjusted hazard ratio: 1.51 and 2.19; p ≤ 0.048). In females, differences in the risk for future CV events between the phenogroups were not significant after adjustment for clinical covariables. Integrative CPET-based phenogrouping, thus, adequately stratified male patients according to CV risk. CPET phenomapping may facilitate comprehensive evaluation of CPET results and steer CV risk stratification and management. ispartof: DIAGNOSTICS vol:13 issue:12 ispartof: location:Switzerland status: published

Pathogenic water-borne protozoa and helminths sometimes cause debilitating infections in children and immunocompromised people, and the poorest of the poor communities living adjacent to wildlife protected areas in sub-Saharan Africa are at risk. This study aimed to assess the existence of protozoan cysts/ trophozoites, and helminth eggs in fresh surface and piped tap water utilised by locals and tourists in the Queen Elizabeth Protected Area (QEPA) in western Uganda. Water samples were taken from natural (environmental) sources and domestic water sources (piped tap water). The samples were analysed for helminth eggs, free-living amoeba (FLA) trophozoites, Cryptosporidium oocysts, and Giardia cysts. The parasites were examined under the microscope, after which they were identified, counted, and recorded. The overall prevalence of the protozoan parasites, from highest to lowest, were: FLA (56.6%), Cryptosporidium spp. (38.2%), Giardia spp. (36.5%), Eimeria spp. (20.3%), and Paramecium spp. (2.7%). Similarly, helminth parasite prevalence was: Strongyle (38.2%), Ascaris spp. (33.3%), Trematodes (25%), Strongyloides (10.5), Toxocara spp. (8.3%), and Capillaria spp. (3.2%). Necessary steps should be taken to improve the water quality in QEPA.

Man’s quest for energy demands that fuel for running machines and cooking is vital for mankind. Oil and coal have served this energy quest for time immemorial. This oil quest has been present in the Albertine Graben since 1920, threatening biodiversity spots, terrestrial wildlife, and aquatic resources. The current book chapter provides insights into the spatial distribution of potentially toxic elements (Mercury) in terrestrial and marine species and the health risk posed to terrestrial and aquatic species due to oil exploitation.

Cilj urbanističkog rješenja bio je prožeti zelenilo kroz poslovne zgrade, odnosno, uključiti parter i svakodnevno kretanje ljudi. Cilj arhitektonskog rješenja bio je napraviti ravnotežu između zelenila i nezelenog, odnosno, prometnog dijela. Takvo rješenje dijeli zgrade na 2 oprečna dijela., The goal of the urban solution was to permeate the greenery through the office buildings, that is, to include the ground floor and the daily movement of people. The goal of the architectural solution was to create a balance between the greenery and the non-green, that is, the traffic area. Such a solution divides the buildings into 2 opposite parts.

Ličnost je skup svih osobina neke osobe u jednu cjelinu koja određuje aktivnost te osobe u promjenjivom okruženju i u tim okolnostima je sklona promjenama. Poremećaji ličnosti heterogena su skupina poremećaja, definicija opisuje ponašanja slična velikom broju ljudi. Poremećaj ličnosti je model dugotrajnog unutarnjeg ponašanja i doživljavanja i razlikuje se od očekivanog, početak mu je u adolescenciji ili ranoj odrasloj dobi. Prevalencija u općoj populaciji iznosi 10 do 13%. Najčešća dijagnoza u kliničkoj medicini je mješoviti poremećaj ličnosti. To ukazuje na preklapanje različitih tipova poremećaja i nedovoljnu specificiranost kategorijskih dijagnoza. Poremećaji ličnosti smatraju se rezultatom interakcije genske predispozicije i izloženosti nepovoljnim utjecajima i specifičnim traumatičnim iskustvima. Dijagnostički postupak počinje anamnezom te se koriste različite laboratorijske, elektrofiziološke, neuroradiološke metode i tehnike. Poremećaji ličnosti dijele se na tri podvrste: ekscentrične, dramatične i anksiozne poremećaje ličnosti. Ekscentrični poremećaji ličnosti (klaster A) obuhvaćaju paranoidne, shizoidne i shizotipne poremećaje ličnosti. Dramatični (klaster B) su disocijalni (antisocijalni), granični (borderline), narcistički i histrionski poremećaji ličnosti. U anksiozne poremećaje (klaster C) ubrajaju se opsesivno-kompulzivni, izbjegavajući i ovisni poremećaji ličnosti. Liječenje uključuje psihoterapiju, farmakoterapiju i socioterapiju. Psihoterapija psihološka je metoda liječenja temeljena na odnosu terapeuta i bolesnika, zahtijeva educiranog terapeuta. Sestrinska skrb psihijatrijskih pacijenata definicijom zdravstvene njege ne razlikujemo od skrbi za pacijenta s organskom bolešću. Razlika je u vodećim obilježjima problema, ciljevima i načinima na koji to želimo postići. Personality is a set of all the characteristics of a person in one whole, which determines the activity of that person in a changing environment and is prone to change in those circumstances. Personality disorders are a heterogeneous group of disorders, the definition describes behavior similar to a large number of people. Persistent personality disorder is a pattern of inner experience and behavior that deviates from what is expected, beginning in adolescence or early adulthood. The prevalence of personality disorders in the general population is 10 to 13%. The leading diagnosis from the circle of personality disorders in clinical medicine is mixed personality disorder, which indicates the overlap of various types of personality disorders and insufficient specificity of categorical diagnoses. Personality disorders are considered the result of the interaction of genetic predisposition and exposure to adverse influences and specific traumatic experiences. The diagnostic procedure begins with an anamnesis, and various laboratory, electrophysiological, neuroradiological methods and techniques are used. Personality disorders are divided into three subtypes: eccentric, dramatic and anxious personality disorders. Eccentric personality disorders (cluster A) include paranoid, schizoid and schizotypal personality disorders. Dramatic (cluster B) are dissocial (antisocial), borderline (borderline), narcissistic and histrionic personality disorders. Anxiety disorders (cluster C) include obsessive-compulsive, avoidant and dependent personality disorders. Treatment includes psychotherapy, pharmacotherapy and sociotherapy. Psychotherapy is a psychological method of treatment that is based on the relationship between the therapist and the patient, and requires an educated therapist. Nursing care of psychiatric patients is not distinguished by the definition of health care from the care of a patient with an organic disease. The difference is in the leading characteristics of the problem, the goals and the ways in which we want to achieve them.

BACKGROUND: Bacterial infections are associated with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but the mechanism is incompletely understood.METHOD: In a COPD observational study (NCT01360398), sputum samples were collected monthly at the stable state and exacerbation. Post-hoc analyses of 1307 non-typeable Haemophilus influenzae (NTHi) isolates from 20 patients and 756 Moraxella catarrhalis isolates from 38 patients in one year of follow-up were conducted by multilocus sequence typing (MLST). All isolates came from cultured sputum samples that were analyzed for bacterial species presence, apparition (infection not detected at the preceding visit), or acquisition (first-time infection), with the first study visit as a baseline. Strain apparition or new strain acquisition was analyzed by MLST. The odds ratio (OR) of experiencing an exacerbation vs. stable state was estimated by conditional logistic regression modelling, stratified by patient.RESULTS: The culture results confirmed a significant association with exacerbation only for NTHi species presence (OR 2.28; 95% confidence interval [CI]: 1.12-4.64) and strain apparition (OR 2.38; 95% CI: 1.08-5.27). For M. catarrhalis, although confidence intervals overlapped, the association with exacerbation for first-time species acquisition (OR 5.99; 2.75-13.02) appeared stronger than species presence (OR 3.67; 2.10-6.40), new strain acquisition (OR 2.94; 1.43-6.04), species apparition (OR 4.18; 2.29-7.63), and strain apparition (OR 2.78; 1.42-5.42). This may suggest that previous M. catarrhalis colonization may modify the risk of exacerbation associated with M. catarrhalis infection.CONCLUSIONS: The results confirm that NTHi and M. catarrhalis infections are associated with AECOPD but suggest different dynamic mechanisms in triggering exacerbations.

G protein–coupled receptors (GPCRs) recruit β-arrestins to coordinate diverse cellular processes, but the structural dynamics driving this process are poorly understood. Atypical chemokine receptors (ACKRs) are intrinsically biased GPCRs that engage β-arrestins but not G proteins, making them a model system for investigating the structural basis of β-arrestin recruitment. Here, we performed nuclear magnetic resonance (NMR) experiments on 13 CH 3 -ε–methionine–labeled ACKR3, revealing that β-arrestin recruitment is associated with conformational exchange at key regions of the extracellular ligand-binding pocket and intracellular β-arrestin–coupling region. NMR studies of ACKR3 mutants defective in β-arrestin recruitment identified an allosteric hub in the receptor core that coordinates transitions among heterogeneously populated and selected conformational states. Our data suggest that conformational selection guides β-arrestin recruitment by tuning receptor dynamics at intracellular and extracellular regions.