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This paper addresses the unsteady formation of secondary flow structures inside a turbine rotor passage. The first stage of a two-stage, low-pressure turbine is investigated at a Reynolds Number of 75,000. The design represents the third and the fourth stages of an engine-representative, low-pressure turbine. The flow field inside the rotor passage is discussed in the relative frame of reference using the streamwise vorticity. A multistage unsteady Reynolds-averaged Navier-Stokes (URANS) prediction provides the time-resolved data set required. It is supported by steady and unsteady area traverse data acquired with five-hole probes and dual-film probes at rotor inlet and exit. The unsteady analysis reveals a nonclassical secondary flow field inside the rotor passage of this turbine. The secondary flow field is dominated by flow structures related to the upstream nozzle guide vane. The interaction processes at hub and casing appear to be mirror images and have characteristic forms in time and space. Distinct loss zones are identified, which are associated with vane-rotor interaction processes. The distribution of the measured isentropic stage efficiency at rotor exit is shown, which is reduced significantly by the secondary flow structures discussed. Their impacts on the steady as well as on the unsteady angle characteristics at rotor exit are presented to address the influences on the inlet conditions of the downstream nozzle guide vane. It is concluded that URANS should improve the optimization of rotor geometry and rotor loss can be controlled, to a degree, by nozzle guide vane (NGV) design. [ABSTRACT FROM AUTHOR]

ABSTRACT Fatigue life reliability often is accounted for through minimal material data. To provide this information within structural calculation, experimental data from specimen testing needs to be processed with statistical methods. The results are either mean or worst case material data. However, in a robust design environment, scatter itself must be numerically available. In this paper, fatigue test results of a nickel-based super alloy at two temperatures are taken from literature. These data are processed according to ASTM standard E739 to identify median and standard deviation, based on a stress life curve ( S- N curve) in double logarithmic coordinates first proposed by Basquin. In addition, a new method for non-constant standard deviation is applied to the dataset. The S- N curve parameters are treated with a statistical distribution to account for scatter in the material data. The basic parameter set is perturbed by Monte Carlo simulation to generate pseudo-scatter in the life result, which can be plotted as a Wöhler field. This pseudo-scatter is analysed and compared to the ASTM constant standard deviation regression. Statistical methods are used to show that a realistic prediction of fatigue life is feasible using the Perturbation approach. Both models represent the literature fatigue data very well, whereas the Perturbation approach provides more flexibility. It is especially recommended for black box Monte Carlo studies of structural lifing. The Perturbation approach is additionally capable of including runouts and using other life curves than such of S- N type. [ABSTRACT FROM AUTHOR]

A mathematical model for the prediction of the maximum speed of a high pressure turbine following a shaft failure event was developed. The model predicts the high pressure compressor and ducting system pre- and poststall behaviors such as rotating stall and surge after the shaft breakage. The corresponding time-dependent high pressure turbine inlet conditions are used to calculate the turbine maximum speed, taking into account friction and blade and vane tip clearance variations as a result of the rearward movement of the turbine and destruction of the turbine blading. The compressor and ducting system is modeled by a one-dimensional, stage-by-stage approach. The approach uses a finite-difference numerical technique to solve the nonlinear system of equations for continuity, momentum, and energy including source terms for the compressible flow through inlet ducting, compressor, and combustor. The compressor blade forces and shaft work are provided by a set of quasisteady state stage characteristics being valid for prestall and poststall operations. The maximum turbine speed is calculated from a thermodynamic turbine stand-alone model, derived from a performance synthesis program. Friction and blade and vane tip clearance variations are determined iteratively from graphical data depending on the axial rearward movement of the turbine. The compressor and ducting system model was validated in prestall and poststall operation modes with measured high pressure compressor data of a modern two-shaft engine. The turbine model was validated with measured intermediate pressure shaft failure data of a three-shaft engine. The shaft failure model was applied on a modern two-shaft engine. The model was used to carry out a sensitivity study to demonstrate the impact of control system reactions on the resulting maximum high pressure turbine speed following a shaft failure event. [ABSTRACT FROM AUTHOR]

Chat-based cancer counseling in Switzerland: A reflexive thematic analysis of chat protocols focused on cancer survivors' needs Abstract: Background: The number of people diagnosed with cancer and continue to live as cancer survivors is growing. Together with their relatives, they have information and counseling needs during the illness trajectory. With Cancerline, the Swiss Cancer League offers a chat-based counseling service for cancer survivors. Research question/objective: For the first time, the qualitative study investigated which needs cancer survivors express in Cancerline to gain insights for the further development and quality assurance of chat-based cancer counseling. Methods: Based on the principles of Interpretive Description, 669 chat counseling transcripts were analyzed using Braun et al. (2018) reflexive thematic analysis in an iterative process in six analysis steps. Results: Cancer survivorship needs in Cancerline are multifaceted, and we have identified nine themes: need anonymous chat to communicate, get informed, weigh ethical dilemmas and make decisions, seek meaning and hope, find ways to manage burdensome emotions, resolve social conflict and not burden others, feel understood and give space to own needs, clarify role as significant other acting correctly and seeking security. Conclusions: Chat-based counseling may contribute to supporting cancer survivors with information needs about cancer in a flexible way that is close to everyday life. Professionals can sensitize survivors to chat-based counseling, which makes low-threshold counseling accessible.

Background and Objectives: Globally, a culture change in long-term residential care (LTRC) moving toward person-centered care (PCC) has occurred in an attempt to improve resident quality of life (QoL). However, a clear understanding of how different aspects contributing to a PCC approach are interrelated with resident QoL is still lacking. This review explores interrelating aspects between PCC and QoL in LTRC using qualitative synthesis., Research Design and Methods: Ten relevant primary studies were identified from a search of interdisciplinary research databases providing qualitative information. Studies were critically reviewed for key themes and concepts by the research team. We used a meta-ethnography approach to inductively interpret findings across multiple studies and reinterpreted the information using a constructivist approach., Results: We identified 5 second-order constructs sharing commonalities suggesting interrelations between PCC and QoL: (a) maintaining dignity, autonomy, and independence; (b) knowing the whole person; (c) creating a "homelike" environment; (d) establishing a caring culture; and (e) integrating families and nurturing internal and external relationships. Synthesis translation led to the following third-order constructs: (a) personalizing care within routines, (b) optimizing resident environments, and (c) giving residents a voice., Discussion and Implications: There are many interrelating aspects of PCC and QoL following a permanent transition into LTRC, but successful implementation of PCC, which enhances QoL, presents challenges due to organizational routines and constraints. However, by prioritizing resident voices to include their needs and preferences in care, QoL can be supported following a transition into LTRC., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Care provided by an advanced practice nurse: Experiences of patients with sarcoma and family members. A qualitative study Abstract. Background: Sarcomas are a rare, heterogeneous group of malignant tumors with different trajectories, which cause significant burden to patients and families. Due to the complex nature of treatment, an interprofessional team at the sarcoma center of a Swiss university hospital provides care to affected individuals. This interprofessional team includes an advanced practice nurse (APN) who cares for patients and family members throughout the trajectory of the disease. To date, there are limited descriptions within literature of APN care from the perspective of patients with sarcoma and their family members. Aim: To investigate how patients with sarcoma and their family members experienced APN care. Methods: For patients and family members, the time from diagnosis to therapy and follow-up was very stressful. They experienced the APN's care during this time as a great support and described her as a compassionate, trustworthy and continuous contact person who expertly provided information and advice while acting as a coordinator. Results: For patients and family members, the time from diagnosis to therapy and follow-up was very stressful. They experienced the APN's care during this time as a great support and described her as a compassionate, trustworthy and continuous contact person who expertly provided information and advice while acting as a coordinator. Conclusions: Patients with sarcoma and their family members require continuous contact with a person who is compassionate, while also professional, confident and competent. Providing APN care can meet all of these essential requirements.

Background: The rising global population of older persons with chronic conditions demands new primary care models. Advanced practice nurses (APNs) can help meet that need. In Switzerland, APNs have only recently been introduced in primary care and little is known about their daily practice. This study aims to describe APNs' activities and general roles at four sites with multi-professional primary care practices in the Swiss cantons of Bern and Solothurn., Methods: To study the practices of APNs at the study sites, we adopted a social constructivist perspective, lending methods from ethnographic field research. We interviewed, observed and accompanied participants over five months, generating rich data on their daily practices. The analysis followed Braun and Clarke's six-step thematic analysis process., Results: The APNs' daily practices cover three main themes. Their core activities are working with expanded clinical skills and being on-site specialists for patients and their relatives. These practices are surrounded by net activities, i.e., taking care of patients in tandem with the physicians and regular visits in residential long-term care facilities. The outer activity layer consists of cohesive activities, with which APNs anchor and facilitate their role and catalyze further development of the care model. APNs tailor their expanded medical knowledge and nursing practice to maximize the value they provide in patient care., Conclusions: This study extends our knowledge of APNs' daily practice within a Swiss multi-professional primary care practice. Our results indicate competencies that need to be integrated in APN education and point out the high potential of APN integration in such primary care practices., (© 2023. The Author(s).)

Toward a safe home: Experiencing the transition to an outpatient setting with home mechanical ventilation. A thematic analysis Abstract. Background: With the progress in medical options, the need for home mechanical ventilation increases. The transition from long-term ventilation in an institution to home mechanical ventilation in an outpatient setting is a difficult phase in terms of setting up the network of care, coordination of care for those with the ventilatory insufficiency and the financing. Aim: The study describes how patients with ventilatory insufficiency and family caregivers experience the transition from an institution to an ambulatory setting with invasive or non-invasive home mechanical ventilation. Methods: A qualitative research design with a social-constructivist approach was adopted using thematic analysis according to Braun and Clarke. We included seven German-speaking patients (≥ 18 years old) with ventilatory insufficiency and home mechanical ventilation (> 6 h/day) from the German part of Switzerland, with discharge from an institution to home, and five family caregivers who care for patients with the described criteria. Results: The institution was seen as a safe place. Affected persons and their family caregivers had to create a safe environment at home. Three themes were formed inductively: To gradually build trust with each other, to become experts as family caregivers, to align their own network with the new care needs. Conclusions: The transition home succeeds in the interplay of gaining trust, building expertise, and creating sustainable networks. Professionals can use this knowledge to provide targeted support to patients with home mechanical ventilation and their family caregivers.

Introduction: Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings., Methods: As part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021.  RESULTS: Following analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints., Conclusions: There are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity., (© 2022. The Author(s).)

Background: Designing intervention and implementation strategies with careful consideration of context is essential for successful implementation science projects. Although the importance of context has been emphasized and methodology for its analysis is emerging, researchers have little guidance on how to plan, perform, and report contextual analysis. Therefore, our aim was to describe the Basel Approach for coNtextual ANAlysis (BANANA) and to demonstrate its application on an ongoing multi-site, multiphase implementation science project to develop/adapt, implement, and evaluate an integrated care model in allogeneic SteM cell transplantatIon facILitated by eHealth (the SMILe project)., Methods: BANANA builds on guidance for assessing context by Stange and Glasgow (Contextual factors: the importance of considering and reporting on context in research on the patient-centered medical home, 2013). Based on a literature review, BANANA was developed in ten discussion sessions with implementation science experts and a medical anthropologist to guide the SMILe project's contextual analysis. BANANA's theoretical basis is the Context and Implementation of Complex Interventions (CICI) framework. Working from an ecological perspective, CICI acknowledges contextual dynamics and distinguishes between context and setting (the implementation's physical location)., Results: BANANA entails six components: (1) choose a theory, model, or framework (TMF) to guide the contextual analysis; (2) use empirical evidence derived from primary and/or secondary data to identify relevant contextual factors; (3) involve stakeholders throughout contextual analysis; (4) choose a study design to assess context; (5) determine contextual factors' relevance to implementation strategies/outcomes and intervention co-design; and (6) report findings of contextual analysis following appropriate reporting guidelines. Partly run simultaneously, the first three components form a basis both for the identification of relevant contextual factors and for the next components of the BANANA approach., Discussion: Understanding of context is indispensable for a successful implementation science project. BANANA provides much-needed methodological guidance for contextual analysis. In subsequent phases, it helps researchers apply the results to intervention development/adaption and choices of contextually tailored implementation strategies. For future implementation science projects, BANANA's principles will guide researchers first to gather relevant information on their target context, then to inform all subsequent phases of their implementation science project to strengthen every part of their work and fulfill their implementation goals., (© 2022. The Author(s).)

Green Care Farms (GCF) are innovative long-term care environments and an alternative to regular nursing homes in the Netherlands. Following a culture change movement, GCFs have radically altered the care environment. Research suggests positive effects on residents. However, knowledge is limited regarding their physical, social and organizational environment. This article explores the care environment of 24-h GCFs for people with dementia and its impact on residents and their daily life. An ethnographic study using mixed methods was carried out at a GCF in the Netherlands between June and October 2021. Researchers lived on the GCF and completed 28 days of participatory observations in three groups. During the day, informal conversations were held with residents ( n = 48), staff and family members. Twenty four semi-structured interviews were conducted with residents, their family members, staff and the managers, complemented by a focus group with staff. The physical environment was additionally assessed with the OAZIS-dementia tool. Data collection methods informed each other. Qualitative data was thematically analyzed, quantitative data descriptively. Four themes were identified as crucial during daily life on the GCF: stimulating the senses, engaging in purposeful activities, sharing responsibilities and creating a community in a new home. Realizing these topics in practice, physical, social and organizational environmental components were highly interrelated. The physical environment encouraged and facilitated meaningful in-/outdoor activities and social encounters. The organizational environment supported the use of the physical environment by aligning processes and transporting the vision. The social environment focused on collaboration and creating a home-like atmosphere by including residents in household- and farm chores. This community-building led to more meaningful activities and social interaction. In conclusion, this study revealed the central influence of the management in paving the way for a new form of care delivery. As leaders shape the three environments, the organization influences the design of the physical environment and the actions taking place within it. By creating a community, the care home benefits residents, their families and staff equally. The conscious interrelation and harmonization of the physical, social and organizational components of a long-term care environment has the potential to improve the daily life of residents., 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 © 2022 Rosteius, de Boer, Staudacher, Schols and Verbeek.)

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.

Context in implementation science includes not only characteristics of a setting in which an intervention will be delivered, but also social systems (e.g., interrelationships). Context is dynamic and interacts with both, the intervention and its implementation. Therefore, contextual analysis is recognized as an indispensable part of implementation science methodology: it provides the foundation for successful and sustainable implementation projects. Yet, driven by the prevailing post-positivist understanding of context, contextual analysis typically focuses on individual characteristics of context i.e., contextual dynamics and interactions go unnoticed. Conducting contextual analysis from a constructivist perspective promotes a multilayered approach, building a more comprehensive understanding of context, and thus facilitating successful implementation. In this article, we highlight the limitations of prevailing perspectives on context and approaches to contextual analysis. We then describe how contextual analysis can be enriched by working from a constructivist perspective. We finish with a discussion of the methodological and practical implications the proposed changes would entail. Emerging literature attempts to address both the concept of context and methods for contextual analysis. Various theories, models and frameworks consider context, however, many of these are reductionistic and do not acknowledge the dynamic nature of context or interactions within it. To complement recent conceptualizations of context, we suggest consider the following five constructivist concepts: 1) social space; 2) social place; 3) agency; 4) sensation; and 5) embodiment. We demonstrate the value of these concepts using COVID-19 vaccination uptake as an example and integrate the concepts in the Context and Implementation of Complex Interventions (CICI) framework- an implementation science framework that pays ample attention to context. To study context from a constructivist perspective, we also suggest additional considerations in view of methodologies for data collection and analysis, e.g., rapid ethnographic methods. A constructivist perspective contributes to a stronger conceptualization of contextual analysis. Considering the five constructivist concepts helps to overcome contextual analysis' current shortcomings, while revealing complex dynamics that usually go unnoticed. Thus, more comprehensive understanding of context can be developed to inform subsequent phases of an implementation project, thereby maximizing an intervention's uptake and sustainability., (Copyright © 2022 Mielke, De Geest, Zúñiga, Brunkert, Zullig, Pfadenhauer and Staudacher.)

Background: The complex care needs of people with chronic illnesses and multimorbidity pose a significant challenge to the Swiss primary care system. Ensuring efficient, high-quality care will require new care models. Internationally, the integration of advanced practice nurses (APNs) into primary care models has shown promising results. The current study investigates how general practitioners (GPs) in Switzerland experience the integration of APNs into their primary care teams with respect to their own professional roles., Methods: We used a qualitative, social-constructivist approach, focusing on six individual interviews with general practitioners within the frame of a larger study including GPs and APNs in a Swiss multiprofessional primary care practice. Data were analysed following Braun and Clarke's approach for reflexive thematic analysis., Setting and Participants: The study took place between August 2019 and February 2020 in a Swiss multiprofessional primary care practice that had been working with APNs for nine years. Participants included six general practitioners., Results: We identified three main themes characterising Swiss GPs' experiences with the integration of APNs into their primary care team: (1) trust as foundation for collaboration with APNs; (2) build-up of the APN role by delegation, teaching, and supervision, investing time particularly at the beginning of their collaboration with the APN - a time investment that declined significantly as the APNs' competencies grew - and (3) synergies of partnership-based collaboration with APNs. Physicians who were experienced teachers and supervisors, and who delegated tasks based on who would be able to fulfil them most efficiently and effectively, experienced not only a broad range of synergies, but also possibilities to further develop the range of their own activities. Comprehensive, high-quality patient care was perceived as a particular added value., Conclusion: Our analysis revealed that GPs experienced interprofessional synergies when working collaboratively with APNs. These were rooted in trust and relied on abilities in teaching, supervision and delegation to achieve maximum impact. Capitalising on the integration of APNs into primary care, this new care model can be adapted to diverse individual settings. We conclude this article by highlighting the potential of working collaboratively with APNs, who play increasingly important roles in the primary care of polymorbid patients with complex needs.

Objective: To describe and understand the challenges of patients with chronic critical illness (CCI), their families and healthcare providers during the disease trajectory., Methodology/design: This qualitative study follows Thorne's methodology of interpretive description and was guided by the ethnographic method of observation and participation. Five cases, each comprising one patient with chronic critical illness their family members and several healthcare providers, were followed from the intensive care unit of a university hospital in Switzerland across different settings. In total, five patients with chronic critical illness, 12 family members and 92 healthcare providers (nurses, nursing students, care assistants, physiotherapists and occupational therapists and physicians) were observed., Findings: Regardless of the medical diagnoses and disease trajectories of the patients with chronic critical illness, all cases faced three main challenges: 1. Dealing with the unpredictability of the disease trajectory beyond the underlying disease. 2. Coping with the complexity of care. 3. Perceiving communication challenges despite all involved parties' dependency on it., Conclusion: Unpredictability is not only a unique characteristic of the prolonged disease trajectory of patients with chronic critical illness, but also one of the main challenges of the participants. Therefore, the way unpredictability is handled is dependent on changes in the complexity of care and communication, highlighting the need for participation, information, empathy, clarity and honesty among all participants., (Copyright © 2021. Published by Elsevier Ltd.)

How nurse experts in Swiss nursing homes shape their role development: A qualitative secondary analysis Abstract. Background: In Swiss nursing homes, often registered nurses in expanded roles are responsible for developing and maintaining quality of care. These are qualified nurses with a heterogeneous educational background and extensive professional experience. However, little is known of how they develop their roles in nursing homes. Aim: The aim of this study is to show how nurses in expanded roles in nursing homes create the development of their professional roles. Method: Using a constructivist approach, we conducted a qualitative secondary data analysis of 14 semi-structured interviews with nurses in expanded roles from nursing homes in German-speaking Switzerland. The data were analyzed inductively using reflexive thematic analysis. Results: We found the constituent theme "vision as motivation" and a three-phase cycle of role development in the reports of the fourteen nurses in expanded roles. The vision of high-quality care of residents motivates nurses in expanded roles to shape and further develop their role in three phases: 1) Shaping their roles successively; 2) Developing their roles continuously; and 3) Realign their roles. Conclusions: Nursing professionals continuously adapt their roles to the shifting context to improve the quality of nursing care. To succeed, they and their supervisors need a shared vision for quality of care.

Abstract: Presentation and mortality of coronary artery disease (CAD) substantially differs in both sexes. Most of the existing data analyzing sex differences is older than 10 years and mostly was retrieved in clinical trials, which are potentially structured with a bias against the inclusion of women, leading to a potential selection-bias. Meanwhile, with better diagnostic and therapeutic options, actual data analyzing sex differences in emergency CAD patients is rare.Data on all emergency case numbers with CAD diagnosis in Germany 2017 was retrieved from the German Institute for Medical Documentation and Information. DRG, OPS, and ICD codes were used to determine comorbidities, in-hospital course, and outcome. Competing risk regression analysis for in-hospital mortality was performed analyzing age, European System for Cardiac Operative Risk Evaluation (EuroSCORE), severity of CAD, clinical presentation type and sex.264,742 patients were included. Female patients were older and had more comorbidities. Three-vessel CAD was significantly less present in female patients (36.5% vs 47.5%; P < .001). After adjusting for age, EuroSCORE and severity of CAD, female sex was an independent predictor of lower in-hospital mortality (subdistribution hazard ratio [sHR] 0.94, 95% CI: 0.90-0.98, P = .002) in the whole cohort and in non-ST-segment elevation myocardial infarction (NSTEMI) patients (sHR 0.85, 95% CI: 0.79-0.92, P < .001), whereas in ST-segment elevation myocardial infarction (STEMI) patients, female sex was associated with a higher in-hospital mortality (sHR 1.07, 95% CI: 1.01-1.14, P = .029).In all patients admitted as emergency with CAD diagnosis and in all NSTEMI patients, female sex is protective, whereas in STEMI patients, females show a higher in-hospital mortality risk., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Preventing the spread of COVID-19 in long-term care homes is critical for the health of residents who live in these institutions. As a result, broad policies restricting visits to these facilities were put in place internationally. While well meaning, these policies have exacerbated the ongoing social isolation crisis present in long-term care homes prior to the COVID-19 pandemic. This perspective highlights the dominant COVID-19 LTC policies from six countries, and proposes five strategies to address or mitigate social isolation during the COVID-19 pandemic that can also be applied in a post-pandemic world.

Support by an advanced nursing practice team - Experiences of patients with lymphoma and their family members. A qualitative study Abstract. Background: Patients with lymphomas who are treated with high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are confronted with a life-threatening disease and a stressful therapeutic procedure. An advanced nursing practice (ANP) team was established at the Inselspital, Bern University Hospital to provide continuous, need-based care to these patients and their family members throughout the entire course of therapy. Little is known about experiences of concerned persons. Objective: With this study, patients' with lymphomas treated with HDC and ASCT and their family members' experiences of the care provided by the ANP team were explored. Methods: The qualitative research approach "interpretive description" provided orientation. Eight couple interviews with patients and their family members were conducted and evaluated by means of reflexive thematic analysis. Results: The participants experienced continuous caring by the nurse consultants throughout the entire course of therapy and received professional, administrative, and emotional support. They felt competently informed as well as advised, and had an easily accessible contact person for questions to whom they had built up an emotional relationship. This not only encouraged and strengthened them, but also provided security and the feeling of being in good hands. Conclusion: It is recommended to offer an ANP service to those affected, as for them the continuous support of a proficient, compassionate, familiar and committed contact person was essential.

ACSL3 is the only long chain fatty acyl-CoA synthetase consistently found on growing and mature lipid droplets (LDs), suggesting that this specific localization has biological relevance. Current models for LD growth propose that triglycerides are synthesized by enzymes at the LD surface, with activated fatty acids provided by LD localized ACSL3, thus allowing growth independent of the ER. Here, we tested this hypothesis by quantifying ACSL3 on LDs from human A431 cells. RNAi of ACSL3 reduced the oleoyl-CoA synthetase activity by 83%, suggesting that ACSL3 is by far the dominant enzyme of A431 cells. Molar quantification revealed that there are 1.4 million ACSL3 molecules within a single cell. Metabolic labeling indicated that each ACSL3 molecule contributed a net gain of 3.1 oleoyl-CoA/s. 3D reconstruction of confocal images demonstrated that 530 individual lipid droplets were present in an average oleate fed A431 cell. A representative single lipid droplet with a diameter of 0.66 μm contained 680 ACSL3 molecules on the surface. Subcellular fractionation showed that at least 68% of ACSL3 remain at the ER even during extensive fatty acid supplementation. High resolution single molecule microscopy confirmed the abundance of cytoplasmic ACSL3 outside of LDs. Model calculations for triglyceride synthesis using only LD localized ACSL3 gave significant slower growth of LDs as observed experimentally. In conclusion, although ACSL3 is an abundant enzyme on A431 LDs, the metabolic capacity is not sufficient to account for LD growth solely by the local synthesis of triglycerides., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The mechanism of cellular fatty acid uptake is highly relevant for basic and clinical research. Previous work has demonstrated that fatty acid uptake is facilitated by cell surface membrane proteins as well as by intracellularly localized enzymes. Here, the exogenous expression of the CD36/FAT glycoprotein and the acyl-CoA synthetases FATP4 and ACSL1 in MDCK cells was quantified by comparison to recombinant proteins, and related to the corresponding increases of fatty acid uptake. At the molecular level, CD36/FAT was 30-fold more efficient than either FATP4 or ACSL1 in enhancing fatty acid uptake. Remarkably, co-expression of CD36/FAT with FATP4 or ACSL1 led to a higher increase of fatty acid uptake than expected from the combined individual contributions, whereas co-expression of FATP4 and ACSL1 did not. Immunofluorescence microscopy confirmed the plasma membrane localization of CD36/FAT and the intracellular localization of FATP4 to the endoplasmic reticulum, and of ACSL1 to mitochondria. Concluding, we suggest that fatty acid uptake in our model system is organized by two spatially distinct but synergistic mechanisms: the cell surface protein CD36/FAT directly facilitates fatty acid transport across the plasma membrane, whereas the intracellular acyl-CoA synthetases FATP4 and ACSL1 enhance fatty acid uptake indirectly by metabolic trapping., (Copyright © 2014 Elsevier Inc. All rights reserved.)