[Sustainability in Outpatient Pulmonary Rehabilitation in Patients with Asbestosis - Results of an 8-Year Follow Up]. / Nachhaltigkeit in der ambulanten pneumologischen Rehabilitation bei Patienten mit Asbestose.

BACKGROUND: The aim of this study was to evaluate the effects of an outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis and focused on keeping up sustainability effects. METHODS: 157 male patients aged 65.2 ±â€Š5.7 years suffering from asbestosis carried out over a period of three weeks 5 times weekly 6 h at a time phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. In the immediately following phase 2, the patients completed once a week for 3 hours over 12 weeks further therapeutic applications with the main focus on exercise therapy and sports and were subsequently transferred to health sports groups near to residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 20 months (T5) after T3. 61 patients (73.5 years ±â€Š5.6) were re-examined 6 years after T5 (T6) without any interim care. RESULTS: 72.1 % of the 61 patients (n = 44) carried out health sports twice a week in T5 as well as in T6 eight years after T1 and were able to maintain their physical performance (6-minute walk test, hand force, PWC test) as well as the perceived quality of life (SF-36, baseline/transition dyspnea index) according to age, while the rehab effects of the 17 patients breaking off any sporting activities after T3 fell significantly (p < .01) below the starting condition in T1. CONCLUSIONS: In spite of a restrictive pulmonary disease specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized in the long term by a regular training. The results underline the necessity of integrating aftercare strategies into the concept of rehabilitation with special consideration of perceived self-efficacy.

A prospective 52-week randomized controlled trial of patient-initiated care consultations for patients with psoriasis.

BACKGROUND: Treatment and care of moderate-to-severe psoriasis require lifelong consultations with a dermatologist with close monitoring of systemic treatment. OBJECTIVES: To investigate the effect of patient-initiated care consultation (PICC) for patients with psoriasis in a dermatology outpatient clinic. METHODS: A prospective randomized controlled trial with patients on well-controlled systemic treatment randomized to either (i) the PICC group, where they participated in one annual consultation with a dermatologist but were able to initiate consultations when needed; or (ii) routine care, where they participated in a consultation every 12-16 weeks. The primary outcome was the Dermatology Life Quality Index (DLQI). Other outcomes were safety, patient adherence and satisfaction with healthcare assessed at baseline and after 52 weeks. The study was registered with clinical trials number NCT02382081. RESULTS: In total 150 patients were included, with 58·0% treated with biologics, 37·3% with methotrexate and 4·7% with acitretin. At week 52 no statistically significant mean difference between groups was detected in DLQI (0·28, 95% confidence interval -0·35 to 0·9) or Psoriasis Area and Severity Index (-0·24, 95% confidence interval -0·84 to 0·36). Patients in the PICC group requested 63% fewer consultations with a dermatologist: mean 2·5 ± 0·1 vs. 5·1 ± 0·6 (P = 0·001). Patient adherence and safety with treatment monitoring were equal between groups, but the PICC group was significantly better at attending consultations than the control group (P = 0·003). CONCLUSIONS: PICC offers additional clinical benefits over routine care, making patients less dependent on clinical visits. The intervention adds no harm to monitoring systemic treatment, and patients report high quality of life and satisfaction with healthcare.

[Knee school as a secondary preventive approach : The sustainable treatment of occupational gonarthrosis]. / Das Kniekolleg als sekundärpräventiver Ansatz : Die nachhaltige Behandlung berufsbedingter Gonarthrose.

BACKGROUND: 2-6 months after successful medical rehabilitation in gonarthrosis, the positive effects remit without the implementation of adequate aftercare strategies. OBJECTIVES: A prospective comparative study aimed to investigate whether and to what extent the sustainability model of knee school for the secondary preventive treatment of occupational gonarthrosis is able to maintain positive treatment effects in the medium term. MATERIAL AND METHODS: A total of 292 male employees from the building trade went through the three-week phase 1 of the biopsychosocial knee college with a focus on ergonomics and muscle strength training. In the following 12 months (Phase 2), the participants were contacted several times by telephone in order to motivate them to continue the training. While 178 employees voluntarily and locally continued their training in selected fitness centers with financial support (VG 1), and 38 employees opted for an individual home program (VG 2), 76 participants stopped all training (KG). RESULTS: After Phase 1, all groups showed significant improvements in the parameters mobility, as well as stretch ability and strength endurance of the thigh muscles, complaints of the knee and quality of life. While the parameters in VG 1 continued to develop positively after 12 months, the measured values in VG 2, with the exception of muscle strength, moderately remitted. By contrast, a significant decline in the measurement values partly below the status quo ante was observed for the KG. CONCLUSIONS: As part of the aftercare, financially supported training in a fitness center with accompanying regular telephone contacts for male construction workers with knee discomforts shows positive effects if the participation is voluntary. Organized training in the fitness center is superior to individual home programs.

Facing the dilemma of patient-centred psoriasis care: a qualitative study identifying patient needs in dermatological outpatient clinics.

BACKGROUND: Caregivers must be aware of patients' current needs by providing care responsive to patients' values and preferences and by identifying what approach improves and encourages patients to participate in their treatment and disease management. Patients with psoriasis healthcare needs perhaps change as medical knowledge improves, new drugs emerge and the healthcare system improves its efficiency as a result of constant structural development. OBJECTIVES: To explore the unmet needs and health perceptions of people with psoriasis, regarding interaction with clinicians and the structure inherent to consultations in a hospital outpatient dermatological clinic. METHODS: A qualitative investigation with data generated from semi-structured interviews. Transcriptions were subsequently analysed using the template analysis method. RESULTS: Sixteen patients with psoriasis were interviewed. Challenges and dilemmas of patient-centred psoriasis care were identified. Patients have a strong need to be met as individuals as the burden of living with psoriasis goes beyond the skin. Patients strive for efficient treatment and ultimately dream of being cured of psoriasis. They prefer individualized health education in order to adjust their knowledge and self-management skills. These central issues are as yet rarely addressed in clinical consultations. CONCLUSIONS: Consultations with a standardized structure do not match the individual challenges and healthcare needs of patients with psoriasis. In order to achieve a more patient-centred approach, health professionals should implement minor structural changes to dermatological services to meet patients' current needs and invite dialogue about the patients' emotional well-being and concerns that go beyond biomedical factors, as well as offer individualized health education.

Return of spontaneous circulation and long-term survival according to feedback provided by automated external defibrillators.

BACKGROUND: We aimed to investigate the effect of automated external defibrillator (AED) feedback mechanisms on survival in out-of-hospital cardiac arrest (OHCA) victims. In addition, we investigated converting rates in patients with shockable rhythms according to AED shock waveforms and energy levels. METHODS: We collected data on OHCA occurring between 2011 and 2014 in the Capital Region of Denmark where an AED was applied prior to ambulance arrival. Patient data were obtained from the Danish Cardiac Arrest Registry and medical records. AED data were retrieved from the Emergency Medical Dispatch Centre (EMDC) and information on feedback mechanisms, energy waveform and energy level was downloaded from the applied AEDs. RESULTS: A total of 196 OHCAs had an AED applied prior to ambulance arrival; 62 of these (32%) provided audio visual (AV) feedback while no feedback was provided in 134 (68%). We found no difference in return of spontaneous circulation (ROSC) at hospital arrival according to AV-feedback; 34 (55%, 95% confidence interval (CI) [13-67]) vs. 72 (54%, 95% CI [45-62]), P = 1 (odds ratio (OR) 1.1, 95% CI [0.6-1.9]) or 30-day survival; 24 (39%, 95% CI [28-51]) vs. 53 (40%, 95% CI [32-49]), P = 0.88 (OR 1.1 (95% CI [0.6-2.0])). Moreover, we found no difference in converting rates among patients with initial shockable rhythm receiving one or more shocks according to AED energy waveform and energy level. CONCLUSIONS: No difference in survival after OHCA according to AED feedback mechanisms, nor any difference in converting rates according to AED waveform or energy levels was detected.

Slow Interatomic Coulombic Decay of Multiply Excited Neon Clusters.

Ne clusters (∼5000 atoms) were resonantly excited (2p→3s) by intense free electron laser (FEL) radiation at FERMI. Such multiply excited clusters can decay nonradiatively via energy exchange between at least two neighboring excited atoms. Benefiting from the precise tunability and narrow bandwidth of seeded FEL radiation, specific sites of the Ne clusters were probed. We found that the relaxation of cluster surface atoms proceeds via a sequence of interatomic or intermolecular Coulombic decay (ICD) processes while ICD of bulk atoms is additionally affected by the surrounding excited medium via inelastic electron scattering. For both cases, cluster excitations relax to atomic states prior to ICD, showing that this kind of ICD is rather slow (picosecond range). Controlling the average number of excitations per cluster via the FEL intensity allows a coarse tuning of the ICD rate.

Magnetic moments of chromium-doped gold clusters: the Anderson impurity model in finite systems.

The magnetic moment of a single impurity atom in a finite free electron gas is studied in a combined x-ray magnetic circular dichroism spectroscopy, charge transfer multiplet calculation, and density functional theory study of size-selected free chromium-doped gold clusters. The observed size dependence of the local magnetic moment can be understood as a transition from a local moment to a mixed valence regime. This shows that the Anderson impurity model essentially describes finite systems even though the discrete density of states introduces a significant deviation from a bulk metal, and the free electron gas is only formed by less than 10 electrons. Electronic shell closure in the gold host minimizes the interaction of localized impurity states with the confined free electron gas and preserves the magnetic moment of 5 µ_{B} fully in CrAu_{2}^{+} and almost fully in CrAu_{6}^{+}. Even for open-shell species, large local moments are observed that scale with the energy gap of the gold cluster. This indicates that an energy gap in the free electron gas stabilizes the local magnetic moment of the impurity atom.

Hidden charge states in soft-x-ray laser-produced nanoplasmas revealed by fluorescence spectroscopy.

Highly charged ions are formed in the center of composite clusters by strong free-electron laser pulses and they emit fluorescence on a femtosecond time scale before competing recombination leads to neutralization of the nanoplasma core. In contrast to mass spectrometry that detects remnants of the interaction, fluorescence in the extreme ultraviolet spectral range provides fingerprints of transient states of high energy density matter. Spectra from clusters consisting of a xenon core and a surrounding argon shell show that a small fraction of the fluorescence signal comes from multiply charged xenon ions in the cluster core. Initially, these ions are as highly charged as the ions in the outer shells of pure xenon clusters with charge states up to at least 11+.

Novel collective autoionization process observed in electron spectra of He clusters.

The ionization dynamics of He nanodroplets irradiated with intense femtosecond extreme ultraviolet pulses of up to 1013 W/cm2 power density have been investigated by photoelectron spectroscopy. Helium droplets were resonantly excited to atomiclike 2p states with a photon energy of 21.4 eV, below the ionization potential (Ip), and directly into the ionization continuum with 42.8 eV photons. While electron emission following direct ionization above Ip is well explained within a model based on a sequence of direct electron emission events, the resonant excitation provides evidence of a new, collective ionization mechanism involving many excited atomiclike 2p states. With increasing power density the direct photoline due to an interatomic Coulombic decay disappears. It indicates that ionization occurs due to energy exchange between at least three excited atoms proceeding on a femtosecond time scale. In agreement with recent theoretical work the novel ionization process is very efficient and it is expected to be important for many other systems.

Efficacy of simulation-based trauma team training of non-technical skills. A systematic review.

Trauma resuscitation is a complex situation, and most organisations have multi-professional trauma teams. Non-technical skills are challenged during trauma resuscitation, and they play an important role in the prevention of critical incidents. Simulation-based training of these is recommended. Our research question was: Does simulation-based trauma team training of non-technical skills have effect on reaction, learning, behaviour or patient outcome? The authors searched PubMed, EMBASE and the Cochrane Library and found 13 studies eligible for analysis. We described and compared the educational interventions and the evaluations of effect according to the four Kirkpatrick levels: reaction, learning (knowledge, skills, attitudes), behaviour (in a clinical setting) and patient outcome. No studies were randomised, controlled and blinded, resulting in a moderate to high risk of bias. The multi-professional trauma teams had positive reactions to simulation-based training of non-technical skills. Knowledge and skills improved in all studies evaluating the effect on learning. Three studies found improvements in team performance (behaviour) in the clinical setting. One of these found difficulties in maintaining these skills. Two studies evaluated on patient outcome, of which none showed improvements in mortality, complication rate or duration of hospitalisation. A significant effect on learning was found after simulation-based training of the multi-professional trauma team in non-technical skills. Three studies demonstrated significantly increased clinical team performance. No effect on patient outcome was found. All studies had a moderate to high risk of bias. More comprehensive randomised studies are needed to evaluate the effect on patient outcome.

Spin coupling and orbital angular momentum quenching in free iron clusters.

Magnetic spin and orbital moments of size-selected free iron cluster ions Fe{n}{+} (n=3-20) have been determined via x-ray magnetic circular dichroism spectroscopy. Iron atoms within the clusters exhibit ferromagnetic coupling except for Fe{13}{+}, where the central atom is coupled antiferromagnetically to the atoms in the surrounding shell. Even in very small clusters, the orbital magnetic moment is strongly quenched and reduced to 5%-25% of its atomic value while the spin magnetic moment remains at 60%-90%. This demonstrates that the formation of bonds quenches orbital angular momenta in homonuclear iron clusters already for coordination numbers much smaller than those of the bulk.

Ultrafast x-ray scattering of xenon nanoparticles: imaging transient states of matter.

Femtosecond x-ray laser flashes with power densities of up to 10(14) W/cm(2) at 13.7 nm wavelength were scattered by single xenon clusters in the gas phase. Similar to light scattering from atmospheric microparticles, the x-ray diffraction patterns carry information about the optical constants of the objects. However, the high flux of the x-ray laser induces severe transient changes of the electronic configuration, resulting in a tenfold increase of absorption in the developing nanoplasma. The modification in opaqueness can be correlated to strong atomic charging of the particle leading to excitation of Xe(4+). It is shown that single-shot single-particle scattering on femtosecond time scales yields insight into ultrafast processes in highly excited systems where conventional spectroscopy techniques are inherently blind.

Explosions of xenon clusters in ultraintense femtosecond x-ray pulses from the LCLS free electron laser.

Explosions of large Xe clusters ( ~ 11,000) irradiated by femtosecond pulses of 850 eV x-ray photons focused to an intensity of up to 10(17) W/cm(2) from the Linac Coherent Light Source were investigated experimentally. Measurements of ion charge-state distributions and energy spectra exhibit strong evidence for the formation of a Xe nanoplasma in the intense x-ray pulse. This x-ray produced Xe nanoplasma is accompanied by a three-body recombination and hydrodynamic expansion. These experimental results appear to be consistent with a model in which a spherically exploding nanoplasma is formed inside the Xe cluster and where the plasma temperature is determined by photoionization heating.

Nanoplasma dynamics of single large xenon clusters irradiated with superintense x-ray pulses from the linac coherent light source free-electron laser.

The plasma dynamics of single mesoscopic Xe particles irradiated with intense femtosecond x-ray pulses exceeding 10(16) W/cm2 from the Linac Coherent Light Source free-electron laser are investigated. Simultaneous recording of diffraction patterns and ion spectra allows eliminating the influence of the laser focal volume intensity and particle size distribution. The data show that for clusters illuminated with intense x-ray pulses, highly charged ionization fragments in a narrow distribution are created and that the nanoplasma recombination is efficiently suppressed.

Communication: Highest occupied molecular orbital-lowest unoccupied molecular orbital gaps of doped silicon clusters from core level spectroscopy.

A method to determine band gaps of size-selected and isolated nanoparticles by combination of valence band and core-level photoionization spectroscopy is presented. This approach is widely applicable and provides a convenient alternative to current standard techniques for the determination of band gaps by optical or photoelectron spectroscopy. A first application to vanadium doped silicon clusters confirms a striking size-dependence of their highest occupied-lowest unoccupied molecular orbital gaps.

Meiobenthos provides a food resource for young cyprinids.

Young individuals of the bottom-biting (i.e. sediment-ingesting) common carp Cyprinus carpio and gudgeon Gobio gobio consumed significant amounts of nematodes in laboratory experiments, whereas the selective-feeding roach Rutilus rutilus did not. In mesocosm enclosure experiments in the field, C. carpio strongly decreased the nematode abundance within 4 days, whereas the bottom-biting bream Abramis brama did not affect the abundance until after 14 days. In controlled experiments with a known number of prey, C. carpio but not A. brama significantly reduced the number of nematodes, and G. gobio reduced the nematode abundance dependent on the size of the fish, with smaller fish causing a greater reduction. Cyprinus carpio consumed the nematodes and did not just mechanically kill them in the sediment, as shown by dissection of the fish intestine. Morphometric analysis of the branchial baskets indicated that the mesh width of C. carpio, but not of A. brama, is suitable for consuming meiobenthos. The results indicate that the meiobenthos is a food resource for certain bottom-feeding freshwater fishes.

[Improvement of lasting effects in outpatient pulmonary rehabilitation with special regard to exercise therapy and sports]. / Verbesserung von Nachhaltigkeitseffekten in der ambulanten pneumologischen Rehabilitation unter besonderer Berücksichtigung der Sporttherapie.

BACKGROUND: The aim of this study was to evaluate the effects of outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis. Following the Hamburg model, the OMR focuses on keeping up lasting effects. METHOD: In the frame of a pre-experimental study, 113 male asbestosis patients aged 66.1+/-5.8 years participated 6 hrs. a day five times a week over a period of three weeks in phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. Directly after that further therapeutic applications with the main focus on exercise therapy and sports were applied for 3 hrs. once a week over a period of twelve weeks (phase 2). After phase 2 the rehabilitation centre led the patients into sports groups near their places of residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 18 months (T5) after T3 by means of a suitable assessment. RESULTS: Compared to T1 physical fitness (6-minute Walk Test, Hand-Force Test) as well as health-related quality of life (SF-36), dyspnea (BDI/TDI) and oxygen partial pressure (pO2) were significantly improved in T2. These positive effects could be confirmed in T3. 89 patients (79%) were doing health-related sports regularly 6 and 18 months after T3 and could preserve their health outcome in T4 and T5, while the effects of rehabilitation of the 24 patients breaking off any sporting activities wore off again down to and even below the starting condition at T1. CONCLUSIONS: In spite of a restrictive pulmonary disease, specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized persistently by a regular training once a week. Thus, the results emphasize the necessity to include strategies of aftercare in the concept of rehabilitation.

The ambient dose equivalent at flight altitudes: a fit to a large set of data using a Bayesian approach.

The problem of finding a simple, generally applicable description of worldwide measured ambient dose equivalent rates at aviation altitudes between 8 and 12 km is difficult to solve due to the large variety of functional forms and parametrisations that are possible. We present an approach that uses Bayesian statistics and Monte Carlo methods to fit mathematical models to a large set of data and to compare the different models. About 2500 data points measured in the periods 1997-1999 and 2003-2006 were used. Since the data cover wide ranges of barometric altitude, vertical cut-off rigidity and phases in the solar cycle 23, we developed functions which depend on these three variables. Whereas the dependence on the vertical cut-off rigidity is described by an exponential, the dependences on barometric altitude and solar activity may be approximated by linear functions in the ranges under consideration. Therefore, a simple Taylor expansion was used to define different models and to investigate the relevance of the different expansion coefficients. With the method presented here, it is possible to obtain probability distributions for each expansion coefficient and thus to extract reliable uncertainties even for the dose rate evaluated. The resulting function agrees well with new measurements made at fixed geographic positions and during long haul flights covering a wide range of latitudes.

[Short- and long-term effects of the outpatient medical rehabilitation for patients with asbestosis]. / Kurz- und langfristige Effekte der Ambulanten Medizinischen Rehabilitation für Patienten mit Asbestose.

BACKGROUND: The aim of this study was to evaluate the effects of an outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis. Following the model of Hamburg the OMR focuses on keeping up lasting effects. METHODS: In the frame of a pre-experimental study 104 male patients aged 65.7 +/- 5.5 years suffering asbestosis carried out over a period of three weeks 5 times weekly 6 h at a time phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. Directly after that further therapeutic applications with the main focus on exercise therapy and sports were applied over a period of 12 weeks one time weekly 3 h at a time (phase 2). After phase 2 the rehabilitation centre led the patients into sports groups near at place of residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 18 months (T5) after T3 by means of a suitable assessment. RESULTS: Compared to T1 physical fitness (6-minute Walk Test, Hand-Force Test, PWC Test) as well as health-related quality of life (SF-36) of the patients were significantly improved in T2. Whereas the parameter "vital capacity" and "forced expiratory volume" showed no change over the period of investigation data of "oxygen partial pressure" was significantly increased, too. These positive effects could be confirmed in T3. 82 patients (79%) were doing sports due to health regularly still 6 and 18 months after T3 and could preserve their health outcome in T4 and T5, while the effects of rehabilitation of the 22 patients breaking off any sporting activities wore off again to and even below starting condition in T1. CONCLUSIONS: In spite of a restrictive pulmonary disease specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized persistently by a regular training one time weekly. That way the results emphasize the necessity to put strategies of aftercare into the concept of rehabilitation.