RESUMO
The reconstruction of long bone defects as a result of primary traumatic, secondary infection or tumor-related loss of substance continues to represent a surgical challenge. Callus distraction via segment transport, vascularized bone transfer and the induced membrane technique (IMT) are established methods of reconstruction. In recent decades IMT has experienced increasing popularity due to its practicability, reproducibility and reliability. At the same time, the original technique has undergone numerous modifications. The results are correspondingly heterogeneous. This overview is intended to explain the basic principles of IMT and to provide an overview of the various modifications and their complications.
RESUMO
PURPOSE: The aim of this study were the retrospective evaluation of the compressive effect and complication rates of transsacral stabilization of osteoporosis-associated sacral fragility fractures in 106 patients using three different implants (6.0 mm sacral bar, n = 32; 7.3 mm screw, n = 26; 7.5 mm ISG-Rod System, n = 48) with regard to the image morphological and clinical-perioperative outcome. METHODS: For this purpose, the sacral width was determined preoperatively and postoperatively using multiplanar CT reconstructions and correlated with the measured bone density (HU). The results were compared with each other on an implant-specific basis. RESULTS: A significant compressive effect was found for all implants (6.0 mm sacral bar 7.1 ± 3.4 mm, 7.3 mm screw 6.9 ± 1.8 mm, 7.5 mm ISG-Rod System 8 ± 2.4 mm). No implant-specific difference in compression could be detected. Overall, the washers broke into the iliac cortex in 9% of cases. The subgroups did not differ significantly in this respect (6.0 mm sacral bar: 4 [13%], 7.3 mm screw 1 [1%], 7.5 mm ISG-Rod System (5 [10%], p = 0.581). A correlation between the degree of osteoporosis and the compressive effect could not be demonstrated. Significant implant-specific differences were found in the incision-suture time, with only ø0:39 ± 0:13 h required for implantation of the 7.5 mm ISG Rod System (6.0 mm sacral bar: ø1:09 ± 0:22 h, 7.3 mm screw: ø0:55 ± 0:20 h). The fluoroscopy time was significantly lower with the 7.3 mm screw (ø0:57 ± 0:23 min) and the 7.5 mm ISG Rod System (ø0:42 ± 00:17 min) than with the 6.0 mm sacral bar (ø1:36 ± 0:46 min). CONCLUSION: A significant compressive effect was demonstrated with all three implants. No implant-specific complications or surgical site complications were identified in either the overall cohort or the subgroups. The 7.5 mm ISG Rod System shows advantages with regard to the duration of surgery and fluoroscopy.
RESUMO
PURPOSE: A large volume of literature suggests that timely integration of palliative care (PC) enhances the well-being, quality of life and satisfaction of patients and their families. It may also positively impact clinical outcomes and healthcare costs throughout the disease trajectory. Therefore, reviewing clinical practice to reflect real-life situations regarding timely PC integration is essential. METHODS: This study, conducted at the Vienna General Hospital between March 2016 and August 2022, retrospectively examined PC consultation (PCC) requests. It aimed to assess the timeliness of PC integration by analysing the duration between diagnosis and the first PCC request, as well as the interval between the first PCC request and death. RESULTS: This study included 895 PCCs. The median time from diagnosis to the first PCC was 16.6 (interquartile range (IQR): 3.9-48.4) months, while the median time from the first PCC to death was 17.2 (IQR: 6.1-50.7) days. The median time from diagnosis to first PCC was 10.4 months in females (confidence interval (CI): 6.0-14.8) compared to 10.6 months in males (CI: 8.1-13.1; p = 0.675). There were no gender disparities in the time from first PCC to death, with a median of 23.3 days (CI: 15.6-31.0) for females and 22.3 days (CI: 16.2-28.4) for males (p = 0.93). Fifty percent of patients died between 5 and 47 days after the first PCC. CONCLUSION: These findings highlight the discrepancy between the clinical perception of PC as end-of-life care and the existing literature, thereby emphasising the importance of timely PC integration.
Assuntos
Cuidados Paliativos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Fatores de Tempo , Qualidade de Vida , Áustria , Idoso de 80 Anos ou mais , Neoplasias/terapia , Encaminhamento e Consulta , AdultoRESUMO
BACKGROUND: The association between the pattern of cortical thickness (CT) and executive dysfunction (ED) in mild cognitive impairment (MCI) and subjective cognitive complaints (SCC) is still poorly understood. We aimed to investigate the association between CT and ED in a large French cohort (MEMENTO) of 2323 participants with MCI or SCC. METHODS: All participants with available CT and executive function data (verbal fluency and Trail Making Test [TMT]) were selected (n=1924). Linear regressions were performed to determine relationships between executive performance and the brain parenchymal fraction (BPF) and CT using FreeSurfer. RESULTS: The global executive function score was related to the BPF (sß: 0.091, P<0.001) and CT in the right supramarginal (sß: 0.060, P=0.041) and right isthmus cingulate (sß: 0.062, P=0.011) regions. Literal verbal fluency was related to the BPF (sß: 0.125, P<0.001) and CT in the left parsorbitalis region (sß: 0.045, P=0.045). Semantic verbal fluency was related to the BPF (sß: 0.101, P<0.001) and CT in the right supramarginal region (sß: 0.061, P=0.042). The time difference between the TMT parts B and A was related to the BPF (sß: 0.048, P=0.045) and CT in the right precuneus (sß: 0.073, P=0.019) and right isthmus cingulate region (sß: 0.054, P=0.032). CONCLUSIONS: In a large clinically based cohort of participants presenting with either MCI or SCC (a potential early stage of Alzheimer's disease [AD]), ED was related to the BPF and CT in the left pars orbitalis, right precuneus, right supramarginal, and right isthmus cingulate regions. This pattern of lesions adds knowledge to the conventional anatomy of ED and could contribute to the early diagnosis of AD.
RESUMO
Long-term potentiation (LTP)-like activity can be induced by stimulation protocols such as paired associative stimulation (PAS). We aimed to determine whether PAS-induced LTP-like activity (PAS-LTP) of the dorsolateral prefrontal cortex (DLPFC) is associated with cortical thickness and other structural measures impaired in Alzheimer's dementia (AD). We also explored longitudinal relationships between these brain structures and PAS-LTP response after a repetitive PAS (rPAS) intervention. Mediation and regression analyses were conducted using data from randomized controlled trials with AD and healthy control participants. PAS-electroencephalography assessed DLPFC PAS-LTP. DLPFC thickness and surface area were acquired from T1-weighted magnetic resonance imaging. Fractional anisotropy and mean diffusivity (MD) of the superior longitudinal fasciculus (SLF)-a tract important to induce PAS-LTP-were measured with diffusion-weighted imaging. AD participants exhibited reduced DLPFC thickness and increased SLF MD. There was also some evidence that reduction in DLPFC thickness mediates DLPFC PAS-LTP impairment. Longitudinal analyses showed preliminary evidence that SLF MD, and to a lesser extent DLPFC thickness, is associated with DLPFC PAS-LTP response to active rPAS. This study expands our understanding of the relationships between brain structural changes and neuroplasticity. It provides promising evidence for a structural predictor to improving neuroplasticity in AD with neurostimulation. This article is part of a discussion meeting issue 'Long-term potentiation: 50 years on'.
Assuntos
Doença de Alzheimer , Córtex Pré-Frontal Dorsolateral , Potenciação de Longa Duração , Plasticidade Neuronal , Humanos , Doença de Alzheimer/fisiopatologia , Masculino , Idoso , Feminino , Córtex Pré-Frontal Dorsolateral/diagnóstico por imagem , Córtex Pré-Frontal Dorsolateral/fisiopatologia , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Eletroencefalografia , Imageamento por Ressonância Magnética , Córtex Pré-Frontal/fisiopatologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiologiaRESUMO
The reconstruction of segmental bone defects after surgical treatment of infected delayed unions as well as nonunions, places the highest demands on the surgical technical implementation. After treating the fracture-related infection, guaranteeing biomechanical stability is crucial for the success of the treatment. The presented case describes the successful treatment of an infected delayed union after an open metadiaphyseal comminuted fracture of the proximal femur using a modified Masquelet technique. A solid allogeneic bone graft in combination with autologous cancellous bone were inserted into a 7â¯cm subtrochanteric defect zone and stabilized with a combined plate and nail osteosynthesis.
Assuntos
Fraturas Cominutivas , Fraturas Expostas , Humanos , Fraturas Cominutivas/cirurgia , Consolidação da Fratura , Fraturas Expostas/cirurgia , Fêmur , Extremidade InferiorRESUMO
Objective: To bridge the gap between evidence and clinical judgement, we defined scenarios appropriate for ureteral stent omission after uncomplicated ureteroscopy (URS) using the RAND/UCLA Appropriateness Method (RAM). We retrospectively assessed rates of appropriate stent omission, with the goal to implement these criteria in clinical practice. Methods: A panel of 15 urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) met to define uncomplicated URS and the variables that influence stent omission decision-making. Over two rounds, they scored clinical scenarios for Appropriateness Criteria (AC) for stent omission based on a combination of variables. AC were defined by median scores: 1 to 3 (inappropriate), 4 to 6 (uncertain), and 7 to 9 (appropriate). Multivariable analysis determined the association of each variable with AC scores. Uncomplicated URS cases in the MUSIC registry were assigned AC scores and stenting rates assessed. Results: Seven variables affecting stent decision-making were identified. Of the 144 scenarios, 26 (18%) were appropriate, 88 (61%) inappropriate, and 30 (21%) uncertain for stent omission. Most scenarios appropriate for omission were pre-stented (81%). Scenarios with ureteral access sheath or stones >10mm were only appropriate if pre-stented. Stenting rates of 5,181 URS cases correlated with AC scores. Stents were placed in 61% of cases appropriate for omission (practice range, 25% to 98%). Conclusion: We defined objective variables and AC for stent omission following uncomplicated URS. AC scores correlated with stenting rates but there was substantial practice variation. Our findings demonstrate that the appropriate use of stent omission is underutilized.
RESUMO
AIMS: Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system. METHODS: This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs - DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ. RESULTS: The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population. CONCLUSIONS: Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by 'text-based descriptions'.
Assuntos
Pesquisa sobre Serviços de Saúde , Saúde Mental , Viés , Necessidades e Demandas de Serviços de Saúde , Humanos , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To provide national guidelines for the management of women with severe preeclampsia. DESIGN: A consensus committee of 26 experts was formed. A formal conflict of interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: The last SFAR and CNGOF guidelines on the management of women with severe preeclampsia was published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analyzed according to the GRADE® methodology. RESULTS: The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1±), 9 have a moderate level of evidence (GRADE 2±), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations. CONCLUSIONS: There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe preeclampsia.
Assuntos
Anestesiologia , Médicos , Pré-Eclâmpsia , Consenso , Cuidados Críticos , Feminino , Humanos , Recém-Nascido , Pré-Eclâmpsia/terapia , GravidezRESUMO
With more than 1000 species, East African cichlid fishes represent the fastest and most species-rich vertebrate radiation known, providing an ideal model to tackle molecular mechanisms underlying recurrent adaptive diversification. We add high-quality genome reconstructions for two phylogenetic key species of a lineage that diverged about ~ 3-9 million years ago (mya), representing the earliest split of the so-called modern haplochromines that seeded additional radiations such as those in Lake Malawi and Victoria. Along with the annotated genomes we analysed discriminating genomic features of the study species, each representing an extreme trophic morphology, one being an algae browser and the other an algae grazer. The genomes of Tropheus moorii (TM) and Petrochromis trewavasae (PT) comprise 911 and 918 Mbp with 40,300 and 39,600 predicted genes, respectively. Our DNA sequence data are based on 5 and 6 individuals of TM and PT, and the transcriptomic sequences of one individual per species and sex, respectively. Concerning variation, on average we observed 1 variant per 220 bp (interspecific), and 1 variant per 2540 bp (PT vs PT)/1561 bp (TM vs TM) (intraspecific). GO enrichment analysis of gene regions affected by variants revealed several candidates which may influence phenotype modifications related to facial and jaw morphology, such as genes belonging to the Hedgehog pathway (SHH, SMO, WNT9A) and the BMP and GLI families.
Assuntos
Biodiversidade , Ciclídeos/classificação , Ciclídeos/genética , Genoma , Genômica , Lagos , Animais , Biologia Computacional , Genômica/métodos , Anotação de Sequência Molecular , Filogenia , Tanzânia , Sequenciamento Completo do GenomaAssuntos
Embolia , Cifoplastia , Derrame Pericárdico , Cimentos Ósseos/efeitos adversos , Dor no Peito/etiologia , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Humanos , Cifoplastia/efeitos adversos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Polimetil MetacrilatoRESUMO
As the frequency and intensity of extreme events such as droughts, heatwaves and floods have increased over recent decades, more extreme biological responses are being reported, and there is widespread interest in attributing such responses to anthropogenic climate change. However, the formal detection and attribution of biological responses to climate change is associated with many challenges. We illustrate these challenges with data from the Elbe River floodplain, Germany. Using community turnover and stability indices, we show that responses in plant, carabid and mollusc communities are detectable following extreme events. Community composition and species dominance changed following the extreme flood and summer heatwave of 2002/2003 (all taxa); the 2006 flood and heatwave (molluscs); and after the recurring floods and heatwave of 2010 and the 2013 flood (plants). Nevertheless, our ability to attribute these responses to anthropogenic climate change is limited by high natural variability in climate and biological data; lack of long-term data and replication, and the effects of multiple events. Without better understanding of the mechanisms behind change and the interactions, feedbacks and potentially lagged responses, multiple-driver attribution is unlikely. We discuss whether formal detection and/or attribution is necessary and suggest ways in which understanding of biological responses to extreme events could progress.
Assuntos
Mudança Climática , Ecossistema , Clima Extremo , Animais , Besouros/fisiologia , Alemanha , Moluscos/fisiologia , Fenômenos Fisiológicos Vegetais , Rios , Especificidade da Espécie , TemperaturaRESUMO
INTRODUCTION: Wild boar (i.e., Sus scrofa) are susceptible to a range of diseases that can be transmitted to domestic pigs. Assessing the potential risk of transmission-related events involves identifying where wild boar occur in Switzerland and where they still can colonize. It also involves identifying zones where piggeries are dense. In the work presented here, the distribution of wild boar in Switzerland was projected from grid data as probabilities of presence using an approach based on statistical modeling, separately for closed and open season for hunting. The predicted probabilities of wild boar presence were related to the density of piggeries in the six agricultural zones. The resulting maps show how the potential risk of transmission-related events, as a proxy for disease transmission, is distributed in Switzerland. Wild boar presence data consisted of hunting data and casual observations recorded from September 2011 to February 2018 at the coordinate level. They were obtained from all 16 Swiss cantons maintaining a license hunting system plus Solothurn (for 2017) and Zurich, as well as from info fauna. The probability of wild boar occurrence was high (> 0.7) in Jura, the valleys of the Southern Alps, the Rhone Valley down the river from Martigny, and the Rhine Valley down the river from Bündner Herrschaft; it was fair (0.5-0.7) in the Swiss Plateau. These regions broadly overlap agricultural zones with a high density of piggeries. Patches of perennially suitable, but currently not colonized habitat were found in the cantons of Berne, Obwalden, Uri, Schwyz, Glarus, and Grisons. The probability of wild boar occurrence across the entire study area, including the Alps, increased by 12% during closed season for hunting. The results were discussed with reference to similar studies.
INTRODUCTION: Le sanglier (Sus scrofa) est sensible à plusieurs maladies qui peuvent être transmises au cochon domestique. Afin d'estimer le risque potentiel de transmission, il est important d'identifier les zones occupées par le sanglier en Suisse ainsi que celles qu'il pourrait encore coloniser. De plus, cela implique également de pouvoir situer les secteurs où les élevages de cochons sont les plus abondant. Dans le présent travail, la distribution du sanglier a été projetée selon une grille à l'échelle de la Suisse à partir des présences confirmées en utilisant des méthodes statistiques, ceci en considérant la période d'ouverture de chasse d'une part et la période de fermeture d'autre part. Les probabilités de présence calculées ont été misent en relation avec la densité des porcheries dans les différentes zones agricoles. Les cartes résultant de cet exercice montrent comment le risque potentiel de transmission de maladies est distribué en Suisse. La base de données utilisée contenait des informations sur les sangliers tirés lors de la chasse, ainsi que des observations occasionnelles, rapportées à l'échelle de la coordonnée entre Septembre 2011 et Février 2018. Ces données ont étés obtenues de l'ensemble des 16 cantons maintenant un système de chasse à patente, plus Soleure (2017) et Zurich, et des données disponibles sur info fauna. La probabilité de trouver des sanglier est élevée (> 0.7) dans le Jura, les vallées du sud des Alpes, la vallée du Rhône en aval de Martigny et la vallée du Rhin en aval de Bündner Herrschaft. Elle est modérée (0.50.7) pour le Plateau Suisse. Ces régions correspondent à peu près aux zones agricoles possédant les plus grandes densités de porcheries. Des secteurs offrant des conditions favorables toute l'année, mais encore inoccupés par le sanglier ont été trouvés dans les cantons de Berne, Obwald, Uri, Schwyz, Glaris et les Grisons. Sur l'ensemble de la zone d'étude, la probabilité de présence des sangliers était supérieur de 12% en dehors de la période de chasse. Les résultats ont été discutés en les comparant à des études similaires.
Assuntos
Animais Selvagens , Modelos Biológicos , Doenças dos Suínos/transmissão , Animais , Animais Domésticos , Sus scrofa , Suínos , Doenças dos Suínos/epidemiologia , Suíça/epidemiologiaRESUMO
The quantification of forests available for wood supply (FAWS) is essential for decision-making with regard to the maintenance and enhancement of forest resources and their contribution to the global carbon cycle. The provision of harmonized forest statistics is necessary for the development of forest associated policies and to support decision-making. Based on the National Forest Inventory (NFI) data from 13 European countries, we quantify and compare the areas and aboveground dry biomass (AGB) of FAWS and forest not available for wood supply (FNAWS) according to national and reference definitions by determining the restrictions and associated thresholds considered at country level to classify forests as FAWS or FNAWS. FAWS represent between 75 and 95 % of forest area and AGB for most of the countries in this study. Economic restrictions are the main factor limiting the availability of forests for wood supply, accounting for 67 % of the total FNAWS area and 56 % of the total FNAWS AGB, followed by environmental restrictions. Profitability, slope and accessibility as economic restrictions, and protected areas as environmental restrictions are the factors most frequently considered to distinguish between FAWS and FNAWS. With respect to the area of FNAWS associated with each type of restriction, an overlap among the restrictions of 13.7 % was identified. For most countries, the differences in the FNAWS areas and AGB estimates between national and reference definitions ranged from 0 to 5 %. These results highlight the applicability and reliability of a FAWS reference definition for most of the European countries studied, thereby facilitating a consistent approach to assess forests available for supply for the purpose of international reporting.
RESUMO
To reach a high separation efficiency using Centrifugal Partition Chromatography (CPC), the fluid dynamical behavior of the liquid-liquid two-phase systems must be clearly understood. The fluid dynamics, namely the dispersion, the coalescence, and the stationary phase retention, have a high impact on a separation. Especially the mobile phase dispersion influences the mass transfer during a separation. In this study, the mobile phase dispersion of different aqueous-organic solvent systems was characterized for ascending and descending mode via video analysis. Thereby the influence of the physical properties of the solvent systems, the operating parameters, and the geometry of the chamber inlet was investigated systematically using dimensional analysis. With the help of the dimensionless numbers Ohnesorge number (OhCPC), Eötvös number (EoCPC), and Weber number (WeCPC) the impact of the solvent system, the plant parameters, and the operating parameters on the mobile phase dispersion could be described. Inside the three dimensional area, spanned by the dimensionless numbers, each state of mobile phase dispersion (undispersed, low dispersed, highly dispersed, and atomized) could be allocated to an individual region for both operating modes. Moreover, differences in mobile phase deflection depending on the operating mode and a possible reason for these were described.
Assuntos
Cromatografia Líquida , Centrifugação , Hidrodinâmica , Solventes/química , Água/químicaRESUMO
The prediction of the performance of a Centrifugal Partition Chromatography (CPC) is a difficult but desirable task. The partitioning of the sample, as well as the fluid dynamical phenomena dispersion, coalescence, and stationary phase retention have to be individually understood. Therefore, the phase settling behavior of different aqueous-organic solvent systems and with this, the dependency of the stationary phase retention in CPC was investigated in this study. On the one hand, batch settling experiments were performed, and the settling velocity of aqueous-organic solvent systems was investigated. With this it was possible to correlate the stationary phase retention in CPC in both operating modes. For descending mode operation a high settling velocity of the lower phase and for ascending mode a high settling velocity of the upper phase is needed for a stable operation and a high stationary phase retention. On the other hand, the dimensionless numbers Capillary number (Ca) and Morton number (Mo) were used to generate a universally applicable correlation for the stationary phase retention in ascending mode. It was shown, that a high stationary phase retention correlates with low values of Ca and Mo, whereas the influence of Mo is neglectable in the parameter space investigated. Within this correlation, the individual influence of each influencing parameter on the stationary phase retention was included. Moreover, this correlation was compared to descriptions for descending mode given in literature. With this it was shown that the minimal stationary phase retention is correlatable to the point of phase inversion.
Assuntos
Cromatografia Líquida/métodos , Solventes/química , Centrifugação , Hidrodinâmica , Água/químicaRESUMO
Atrial fibrillation (AF) is the most common form of cardiac tachyarrhythmia. It is estimated that in the Rhein-Neckar region approximately 40,000-50,000 out of 2â¯million people are affected. Due to demographic changes in the near future there will be a significant increase in the prevalence of AF within the next decades. The ARENA project was initiated by the Foundation Institute for Cardiac Infarction Research (IHF) Ludwigshafen in cooperation with cardiological and neurological departments of neighboring hospitals, resident doctors and pharmacies to improve the awareness and care of patients with AF. The particular aim is the prevention of stroke as one of the most dreaded complications. The project focusses on the following three subtopics: interventions, medication, migration. The aim of the intervention project is to raise awareness of AF as a risk factor for stroke and to improve the diagnostic work-up and care for patients with diagnosed or unknown AF. The subproject medication focusses on the adherence of patients with AF to the prescribed antithrombotic medication. To evaluate differences concerning patients with and without a migration background the subproject migration was initiated.
Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Antraquinonas , Anticoagulantes , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Humanos , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
Satellite telemetry is an increasingly utilized technology in wildlife research, and current devices can track individual animal movements at unprecedented spatial and temporal resolutions. However, as we enter the golden age of satellite telemetry, we need an in-depth understanding of the main technological, species-specific and environmental factors that determine the success and failure of satellite tracking devices across species and habitats. Here, we assess the relative influence of such factors on the ability of satellite telemetry units to provide the expected amount and quality of data by analyzing data from over 3,000 devices deployed on 62 terrestrial species in 167 projects worldwide. We evaluate the success rate in obtaining GPS fixes as well as in transferring these fixes to the user and we evaluate failure rates. Average fix success and data transfer rates were high and were generally better predicted by species and unit characteristics, while environmental characteristics influenced the variability of performance. However, 48% of the unit deployments ended prematurely, half of them due to technical failure. Nonetheless, this study shows that the performance of satellite telemetry applications has shown improvements over time, and based on our findings, we provide further recommendations for both users and manufacturers.
Assuntos
Animais Selvagens/fisiologia , Ecossistema , Monitoramento Ambiental , Sistemas de Informação Geográfica , Astronave , Telemetria , AnimaisRESUMO
BACKGROUND AND PURPOSE: Mycotic keratitis is a serious but relatively rare disease. No targeted data collection in Germany existed until the foundation of the German Pilz-Keratitis Register in 2015. PATIENTS AND METHODS: The inclusion of retrospective and prospective patients was carried out. INCLUSION CRITERIA: diagnosis confirmed by the polymerase chain reaction (PCR), culture, histology or confocal microscopy (IVCM). Collected parameters: date of symptom onset, date and method of diagnosis, risk factors, visual acuity and findings at admission and at follow-up, conservative and surgical treatment. RESULTS: By January 2018, a total of 102 eyes from the years 2000-2017 were reported from 16 centers (64.3% female, mean age 52 years, range 18-95 years). The initial diagnosis was made correctly in only 20.6% of cases. The mean time to correct diagnosis was 31.7⯱â¯46.9 (0-296) days. The diagnosis was confirmed in cultures in 74.5%, histologically in 30.4%, by PCR in 38.2% and IVCM in 27.4%. Fungal species identified were: 36.7% Fusarium spp., 35.8% Candida spp., 6.4% Aspergillus spp. and 21.1% other. The most important risk factor was the use of contact lenses. The most commonly used antifungal agent was voriconazole (64.7%) followed by amphotericin B (37.2%). Penetrating keratoplasty was performed in 65.7% of the cases and 8.8% of the affected eyes had to be enucleated. The visual acuity of the entire study population increased from the initial 0.16⯱â¯0.25 (0.001-1.0) decimal to 0.28⯱â¯0.34 (0-1.0) decimal. CONCLUSION: The correct diagnosis of fungal keratitis is often significantly delayed. The treatment can be very difficult and keratoplasty is often necessary. In order to gain a better understanding of this disease, to recognize previously unknown risk factors and, if necessary, a change in the spectrum of pathogens and to identify approaches to treatment optimization, the fungal keratitis registry will be continued.