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Aging populations are gradually creating financial distress for governments, and Thailand is no exception. Effective policies for improving elderly welfare must be formulated since the population shift to older age is moving at a faster pace than economic growth. Older people prefer to live actively and independently in order to be less burdensome to their family members and are actively engaged in activities, either voluntarily or because of necessity, even after retirement age. The Thai government initiated a microcredit scheme for eligible older people in order to overcome the difficulty of gaining access to credit. The objective of this research is to explore and evaluate the effectiveness of the Older Persons Fund (OPF) organized by the Thai government to provide seed money for loans to promote active aging in Thailand. Data were collected nationwide using stratified sampling in urban and rural districts from members affiliated with the Older Persons Fund. Structured interviews were conducted with 578 loan recipients. The methodology includes inferential statistics and the multinomial logit choice probabilities model to determine the factors for successful active aging of the loan recipients. The results indicate that the purpose of the loan is a significant factor for a successful outcome. The results also imply that older people provide input into the economy and are not a burden on government expenditure in the long run by promoting active aging projects through microcredit schemes in Thailand.

Opioid use and misuse are understudied in Thailand despite evidence suggesting that a portion of young Thai male integrated drug users are initiating use of non-medical prescribed opioids with some transitioning to heroin. This study aims to capture and analyze the individual and social factors influencing these transitions. Twenty in-depth semi-structured interviews were conducted between December 2019 and January 2020 in the Bangkok metropolitan area with young male opioid users who transitioned to heroin. Sixteen respondents initiated opioid through a Tramadol cocktail named "YaPro" and tended to transition to heroin use within 21 months. The interaction of specific social and individual factors such as joining recreational activities, curiosity or experimentation gradually modified the opioid-related meanings, attitude and practices of Thai users, who ultimately transition to heroin use. These results indicate that drug prevention programs in Thailand should encompass young opioid users in their intervention and further research need to focus on nonmedical use of prescription opioids in Thailand.

The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.

To examine the association of different APOE alleles with type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) as well as the influence of high-sensitive C-reactive protein (hs-CRP) on these associations.We analyzed data from 3917 participants aged 20-81 years of the population-based Study of Health in Pomerania (SHIP) from Northeast Germany with a median follow-up time of 10.8 years. Linear and logistic mixed models were performed to test the association of APOE alleles with T2DM and MetS.We observed 393 T2DM and 1411 MetS events at baseline, and 576 T2DM and 1342 MetS events over the follow-up. The E4 carriers had a lower odds of developing T2DM (OR: 0.47 [0.24, 0.94]) than E3 homozygotes even after adjustment for potential confounders. The E2 carriers showed no associations. The inverse association between E4 alleles and T2DM moderately attenuated after adjustment for hs-CRP levels. The lower odds of developing T2DM in E4 carriers was more pronounced in participants without obesity, hypertension or MetS. However, both E2 and E4 carriers had higher odds of developing MetS (E2 OR: 1.45 [1.03, 2.03]; E4 OR: 1.56 [1.17, 2.09]) than E3 homozygotes.While the presence of APOE E4 allele might increase the chance of MetS through its major action on lipids, E4 allele might offer a protection towards T2DM through its influence on inflammation.

We analyzed symptoms and comorbidities as predictors of hospitalization in 710 outpatients in North-East Germany with PCR-confirmed SARS-CoV-2 infection. During the first 3 days of infection, commonly reported symptoms were fatigue (71.8%), arthralgia/myalgia (56.8%), headache (55.1%), and dry cough (51.8%). Loss of smell (anosmia), loss of taste (ageusia), dyspnea, and productive cough were reported with an onset of 4 days. Anosmia or ageusia were reported by only 18% of the participants at day one, but up to 49% between days 7 and 9. Not all participants who reported ageusia also reported anosmia. Individuals suffering from ageusia without anosmia were at highest risk of hospitalization (OR 6.8, 95% CI 2.5–18.1). They also experienced more commonly dyspnea and nausea (OR of 3.0, 2.9, respectively) suggesting pathophysiological connections between these symptoms. Other symptoms significantly associated with increased risk of hospitalization were dyspnea, vomiting, and fever. Among basic parameters and comorbidities, age > 60 years, COPD, prior stroke, diabetes, kidney and cardiac diseases were also associated with increased risk of hospitalization. In conclusion, due to the delayed onset, ageusia and anosmia may be of limited use in differential diagnosis of SARS-CoV-2. However, differentiation between ageusia and anosmia may be useful for evaluating risk for hospitalization.

This scoping review mapped out the relevant literature, identified gaps and made suggestions on the influence of cisgender on the health literacy (HL) of the elderly people. This scoping review was guided by the PRISMA-ScR checklist. The databases Wiley Online Library™ and Elsevier™ were searched for academic articles published in the English language between February 2011 and February 2021 that met a pre-set criteria of content. The process of selection of sources of evidence based on screening and eligibility of evidence reduced the initially identified 153 sources of evidence in the searched databases to 14 sources of evidence. The content of these 14 sources of evidence was mapped out on a charting table where data was summarised and synthesised individually and collectively by the authors. Repetitive and irrelevant data were deleted. Identified gaps include the lack of extensive exploration of male and female genders alone as a determinant of HL, how gender may be utilised to encourage elderly men and women to apply HL, how different sociocultural and sociodemographic backgrounds of elderly men and women would require separate academic research, the scarcity of social sciences based research and qualitative research methodologies on the subject as well as the use of mixed-methodologies and longitudinal studies. Future research directions were suggested and limitations of this scoping review are addressed in the discussion.

This scoping review mapped out the relevant literature, identified gaps and made suggestions on the subject of the health needs of family caregivers (FC) of elderly stroke survivors (ESS). The authors utilised the PRISMA-ScR checklist to guide the scoping review. The databases PubMed, Elsevier and BioMed Central were searched for academic articles published in the English Language between the years 2010 and 2020 that met a pre-set criteria of content on the health needs of FC of ESS. The process of selection of sources of evidence based on screening and eligibility of evidence reduced the initially identified 13,303 sources of evidence in the searched databases to five sources of evidence. The content of these five sources of evidence was mapped out on a charting table where data was summarised and synthesised first individually and then collectively by the authors. Repetitive and irrelevant data were removed collectively by the authors from the charting table. The gaps identified were a paucity of research on the subject of health needs of FC of ESS, lack of longitudinal and mixed-methods research on the health needs of FC of ESS, sparse use of social sciences perspectives and theories, research that addresses specific physical and mental health concerns beyond general descriptions and gaps in information, social networks, interventions, health policy and systems. Future research directions were suggested and a limitation of this scoping review are addressed in the discussion.

Aims The worldwide COVID-19 pandemic is directly impacting the field of orthopaedic surgery and traumatology with postponed operations, changed status of planned elective surgeries and acute emergencies in patients with unknown infection status. To this point, Germany's COVID-19 infection numbers and death rate have been lower than those of many other nations. Methods This article summarizes the current regimen used in the field of orthopaedics in Germany during the COVID-19 pandemic. Internal university clinic guidelines, latest research results, expert consensus, and clinical experiences were combined in this article guideline. Results Every patient, with and without symptoms, should be screened for COVID-19 before hospital admission. Patients should be assigned to three groups (infection status unknown, confirmed, or negative). Patients with unknown infection status should be considered as infectious. Dependent of the infection status and acuity of the symptoms, patients are assigned to a COVID-19-free or affected zone of the hospital. Isolation, hand hygiene, and personal protective equipment is essential. Hospital personnel directly involved in the care of COVID-19 patients should be tested on a weekly basis independently of the presence of clinical symptoms, staff in the COVID-19-free zone on a biweekly basis. Class 1a operation rooms with laminar air flow and negative pressure are preferred for surgery in COVID-19 patients. Electrocautery should only be utilized with a smoke suction system. In cases of unavoidable elective surgery, a self-imposed quarantine of 14 days is recommended prior to hospital admission. Conclusion During the current COVID-19 pandemic, orthopaedic patients admitted to the hospital should be treated based on an interdisciplinary algorithm, strictly separating infectious and non-infectious cases. Cite this article: Bone Joint Open 2020;1-6:309–315.

Summary Background Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest anti-ischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach. We aimed to investigate the safety and efficacy of early de-escalation of antiplatelet treatment from prasugrel to clopidogrel guided by platelet function testing (PFT). Methods In this investigator-initiated, randomised, open-label, assessor-blinded, multicentre trial (TROPICAL-ACS) done at 33 sites in Europe, patients were enrolled if they had biomarker-positive acute coronary syndrome with successful PCI and a planned duration of dual antiplatelet treatment of 12 months. Enrolled patients were randomly assigned (1:1) using an internet-based randomisation procedure with a computer-generated block randomisation with stratification across study sites to either standard treatment with prasugrel for 12 months (control group) or a step-down regimen (1 week prasugrel followed by 1 week clopidogrel and PFT-guided maintenance therapy with clopidogrel or prasugrel from day 14 after hospital discharge; guided de-escalation group). The assessors were masked to the treatment allocation. The primary endpoint was net clinical benefit (cardiovascular death, myocardial infarction, stroke or bleeding grade 2 or higher according to Bleeding Academic Research Consortium [BARC]) criteria) 1 year after randomisation (non-inferiority hypothesis; margin of 30%). Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT01959451, and EudraCT, 2013-001636-22. Findings Between Dec 2, 2013, and May 20, 2016, 2610 patients were assigned to study groups; 1304 to the guided de-escalation group and 1306 to the control group. The primary endpoint occurred in 95 patients (7%) in the guided de-escalation group and in 118 patients (9%) in the control group (p non-inferiority =0·0004; hazard ratio [HR] 0·81 [95% CI 0·62–1·06], p superiority =0·12). Despite early de-escalation, there was no increase in the combined risk of cardiovascular death, myocardial infarction, or stroke in the de-escalation group (32 patients [3%]) versus in the control group (42 patients [3%]; p non-inferiority =0·0115). There were 64 BARC 2 or higher bleeding events (5%) in the de-escalation group versus 79 events (6%) in the control group (HR 0·82 [95% CI 0·59–1·13]; p=0·23). Interpretation Guided de-escalation of antiplatelet treatment was non-inferior to standard treatment with prasugrel at 1 year after PCI in terms of net clinical benefit. Our trial shows that early de-escalation of antiplatelet treatment can be considered as an alternative approach in patients with acute coronary syndrome managed with PCI. Funding Klinikum der Universitat Munchen, Roche Diagnostics, Eli Lilly, and Daiichi Sankyo.

Der Inhalt dieser Arbeit ist die experimentelle Untersuchung von verdunstenen dünnen Filmen auf glatten Oberflächen, und die Anreicherung, das Kristallwachstum so wie Marangoni-Fluss in der Nähe der Dreiphasenlinie bei partiell benetzenden Mischungen aus flüchtigen und nichtflüchtigen Flüssigkeiten. Im Detail werden die Eigenschaften von planaren Flüssigkeitsfilmen und dünnen Flüssigkeitsabschnitten in der Nähe der dreiphasigen Kontaktlinie behandelt. In beiden Fällen verliert die Flüssigkeit kontinuierlich eine Komponente durch Verdampfung. Ein Thema ist das ntnetzungsveralten ultradünner Filme aus binären Mischungen eines flüchtigen Lösungsmittels und eines nichtflüchtigen Stoffes. Dabei wird analysiert wie die Dicke, bei der der Film reißt, mit der Kristallisation des gelösten Stoffes an der Grenzfläche zwischen Flüssigkeit und Substrat in Verbindung steht, sobald der gelöste Stoff seine Übersättigung erreicht. Die Resultate dieses Projektes zeigen eine universelle Beziehung zwischen der Entnetzungdicke und dem Sättigungsverhalten. Das zweite Forschungsgebiet sind einzelne Nanopartikel, die in molekular dünne Filme auf planaren Substraten eingebettet sind. Es zeigt sich, dass die Nanopartikel eine unerwartet große Filmoberflächenverzerrung (Meniskus) verursachen. Diese Verzerrung kann durch herkömmliche Reflexionsmikroskopie quantitativ gemessen werden, obwohl die Nanopartikel viel kleiner als die Rayleigh-Beugungsgrenze sind. Untersuchungen mit binären Mischungen flüchtiger Lösungsmittel und nichtflüchtiger Stoffe (Polymere) zielen auf ein besseres Verständnis/Vorhersage der finalen Schichtdicke, zeitaufgelösten Verdünnung, zeitaufgelösten Verdunstung und der Entwicklung der Konzentration des gelösten Stoffes innerhalb des verdünnenden Filmes. Eine quantitative theoretische Beschreibung der experimentellen Ergebnisse wird hergeleitet. Unerwarteterweise zeigen die Experimente, mit vollständig mischbarer binärer Mischungen flüchtiger Flüssigkeiten, die einzeln glatte Filme bilden, dass Filme dieser Mischungen nicht notwendigerweise kontinuierlich und glatt sind. Vielmehr können sie Oberflächenwellen bilden oder sogar aufreißen. Dies wird mit Oberflächen-Marangoni-Strömungen erklärt. Es wird eine neue Methode für die schnelle Herstellung von ultralang gerichtetn Diphenylalanin-Einkristallen (Dip- Casting) (mm/min) vorgestellt. Dabei viii wird gezeigt, wie die spezifischen Verdunstungsbedingen an der Dreiphasenlinie für einen kontrollierten Peptidkristallwachstumsprozess verwendet werden können. Abschließend wird gezeigt, wie die Beschränkung innerhalb einer kleinen Kapillare die Peptidkristallisation beeinflusst, diese verstanden und verwendet werden kann. The topic of this thesis is the experimental investigation of evaporating thin films on planar solid substrates and the enrichment, the crystal growth and Marangoni flows near the three phase line in the case of partially wetting mixtures of volatile and non volatile liquids. In short, it deals with the properties of planar liquid films and with those of thin liquid sections near the three phase contact line. In both cases the liquid looses continuously one component by evaporation. One topic is the rupture behavior of ultra-thin films of binary mixtures of a volatile solvent and a nonvolatile solute. It is studied how the thickness at which the film ruptures is related to the solute crystallization at the liquid/ substrate interface as soon as the solute reaches supersaturation. A universal relation between the rupture thickness and the saturation behaviour is presented. The second research subject are individual nanoparticles embedded in molecularly thin films at planar substrates. It is found that the nanoparticles cause an unexpectedly large film surface distortion (meniscus). This distortion can be measured quantitatively by conventional reflective microscopy although the nanoparticles are much smaller than the Rayleigh diffraction limit. Investigations with binary mixtures of volatile solvents and non-volatile solutes (polymers) aim at a better understanding/prediction of the final solute coverage, the timeresolved film thinning, the time-resolved solvent evaporation, and the evolution of the solute concentration within the thinning film. A quantiative theoretical description of the experimental findings is derived. Experiments of completely miscible binary mixtures of volatile liquids, which individually form continuous planar films show unexpectedly that films of mixtures are not necessarily continuous and planar. Rather, they may form surface undulations or even rupture. This is explained with surface Marangoni flows. A new method for the exceptionally fast fabrication (mm/min) of ultralong aligned diphenylalanin single crystals via dip casting is presented. It is shown how the specific evaporation conditions at the three phase line can be used for a controlled peptide crystal growth process. It is further demonstrated how the confinement inside a smalll capillary affects the peptide crystallization and how this can be understood (and used).

In der vorliegenden Arbeit wurde retroperspektiv der klinische Verlauf, die Rezidivraten und die funktionellen Auswirkungen nach chirurgischer Resektion intrinsischer intramedullärer Tumoren an der Neurochirurgischen Klinik am Universitätsklinikum Regensburg untersucht. Hierzu wurden die Daten von 53 Patienten in einem Zeitraum vom Juli 1995 bis zum Juli 2011 ausgewertet. Im Vergleich zu Studien mit einem größeren Patientenkollektiv, lassen sich die Ergebnisse in vielen Bereichen als vergleichbar bezeichnen. Aufgrund des retroperspektiven Charakters dieser Studie, fehlen einige wichtige Informationen, wie die Tumortextur oder die EOR bei einer gewissen Anzahl an Patienten. Trotz dieser Limitationen sollen unsere Daten einen Beitrag zur Einschätzung für das Rezidivrisiko der einzelnen erkrankten Patienten darstellen und einen Anhaltspunkt für das funktionelle Outcome und den neurologischen Status nach operativer Resektion des intrinsischen intramedullären Tumors geben. Die Ergebnisse dieser Arbeit zeigen, dass die mikrochirurgische Behandlung intramedullärer Rückenmarkstumoren- bei entsprechender Indikationsstellung- mit gutem Erfolg und einem vertretbaren Risiko möglich ist.

Stable isotope analysis is a valuable tool for origin assignment of animal products. This research quantified the discrimination of 13C between diet, faeces, milk and milk components. Four experiments with lactating dairy cows grazing an all-day pasture with continuous stocking were conducted during two years. Compared to the diet, there was depletion of 13C in whole milk caused by the strong depletion in milk fat which was not fully compensated by the enrichment in casein and lactose. Faeces also were depleted in 13C. Turnover and thus arrival of new carbon in products after a diet switch was fast. The study contributes to the use of stable isotope analysis to proof of origin and authenticity of dairy products. Die Stabilisotopenanalyse kann zur Authentizitäts- und Herkunftssicherung von tierischen Produkten dienen. Ziel war es, die Diskriminierung von 13C zwischen Futter, Kot, Milch und den einzelnen Milchbestandteilen bei Milchkühen im Stall und auf der Weide zu bestimmen. Gegenüber dem Futter war die Milch an 13C abgereichert, wegen der starken Abreicherung des Milchfettes, die nicht vollständig durch die Anreicherung von Kasein und Laktose kompensiert wurde. Auch der Kot war bezüglich 13C abgereichert. Der Turnover von C in der Kuh war schnell, wodurch sich ein Futterwechsel rasch auf die Milch auswirkt. Die Ergebnisse verbessern die Authentizitätsprüfung und Herkunftssicherung des Lebensmittels Milch.

von Rössl Stephan Felix Graz, Univ., Dipl.-Arb., 2009

Adhesion molecules like the members of the selectin family participate in the interaction between leukocytes and the endothelium. They are also involved in the pathogenesis of atherosclerotic processes. To contribute to the analysis of the genetic background of atherosclerosis we searched for DNA polymorphisms in the genes encoding adhesion molecules especially E-selectin which seems to be expressed only in activated endothelium. An adenine to cytosine substitution for cDNA position 561 resulting in an amino acid exchange from serine to arginine (position 128) was detected in the epidermal growth factor like domain. A significantly higher mutation frequency (P = 0.02) was observed in 97 patients aged 50 years or less with angiographically proven severe atherosclerosis (allele frequency of arginine 0.155) compared with an unselected population (allele frequency of arginine 0.088) as well as in 40 patients aged 40 years or less (allele frequency of arginine 0.21, P = 0.0025). These data suggest that the 128-serine/arginine polymorphism is associated with a higher risk for early severe atherosclerosis.

DCM is a heart disease characterized by ventricular chamber enlargement and systolic dysfunction. Autoantibodies against cardiac proteins have been described in DCM. Removing these IgG antibodies from the blood by immunoadsorption with subsequent IgG substitution (IA/IgG therapy) can improve the clinical outcome and heart function. To determine whether the increased number and survival of autoreactive B cells in DCM patients could be related to the overexpression of BAFF, we measured BAFF in the plasma of groups of 59 DCM patients and 37 age-matched controls by ELISA. Thereafter, DCM patients were treated with IA/IgG therapy, and left ventricular ejection fraction (LVEF) was measured directly after therapy and after 6 months to quantify heart function. BAFF was significantly elevated in DCM patients compared to controls [2333±124 pg/ml vs. 927±58 pg/ml (mean±SEM), p