Why time matters when it comes to resilience: how the duration of crisis affects resilience of healthcare and public health leaders.

The meaning of time, especially in crisis, where situations are likely to become even more complex, uncertain, and disruptive, is crucial. Incorporating previous research on organizational crises, organizational resilience, extreme context, and individual resilience, we know that leaders do play a crucial role when it comes to handle adversity in organizations but also that leaders might influence organizational resilience and employee resilience. Intensified by the COVID-19 pandemic, the leaders' ability to effectively deal with a critical situation becomes even more important in healthcare organizations. We argue that time is not only important when it comes to crisis management but also that it is highly significant when it comes to leaders' resilience. Considering the aspect of time implies that different temporal demands, especially regarding the persistence of adversity, require different resilience strategies applied by the leader. Therefore, we call for future research on examining how different leaders' resilience strategies (short term vs. long term) affect crisis management outcomes as well as the resilience in healthcare and public health organizations.

Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study.

BACKGROUND: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery. METHODS: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg-1 then 4 mg kg-1 h-1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists' working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue. RESULTS: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P=0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists' comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P=0.03) were significantly lower in the lidocaine group. CONCLUSIONS: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine. CLINICAL TRIAL REGISTRATION: NCT 02784860.

Developments in nanostructured LiMPO4 (M = Fe, Co, Ni, Mn) composites based on three dimensional carbon architecture.

Nanostructured materials lie at the heart of fundamental advances in efficient energy storage and/or conversion, in which surface processes and transport kinetics play determining roles. This review describes recent developments in the synthesis and characterization of composites which consist of lithium metal phosphates (LiMPO(4), M = Fe, Co, Ni, Mn) coated on nanostructured carbon architectures (unordered and ordered carbon nanotubes, amorphous carbon, carbon foams). The major goal of this review is to highlight new progress in using different three dimensional nanostructured carbon architectures as support for the phosphate based cathode materials (e.g.: LiFePO(4), LiCoPO(4)) of high electronic conductivity to develop lithium batteries with high energy density, high rate capability and excellent cycling stability resulting from their huge surface area and short distance for mass and charge transport.

The crystal structure of a Thermus thermophilus tRNA(Gly) acceptor stem microhelix at 1.6 Å resolution.

tRNAs are aminoacylated with the correct amino acid by the cognate aminoacyl-tRNA synthetase. The tRNA/synthetase systems can be divided into two classes: class I and class II. Within class I, the tRNA identity elements that enable the specificity consist of complex sequence and structure motifs, whereas in class II the identity elements are assured by few and simple determinants, which are mostly located in the tRNA acceptor stem. The tRNA(Gly)/glycyl-tRNA-synthetase (GlyRS) system is a special case regarding evolutionary aspects. There exist two different types of GlyRS, namely an archaebacterial/human type and an eubacterial type, reflecting the evolutionary divergence within this system. We previously reported the crystal structures of an Escherichia coli and of a human tRNA(Gly) acceptor stem microhelix. Here we present the crystal structure of a thermophilic tRNA(Gly) aminoacyl stem from Thermus thermophilus at 1.6Å resolution and provide insight into the RNA geometry and hydration.

[Calciphylaxis. A less well-known, clinically relevant disease]. / Kalziphylaxie. Ein wenig bekanntes, klinisch relevantes Krankheitsbild.

Calciphylaxis is a rare disease which has been increasingly reported in recent decades and has consequently shifted into the focus of clinical and scientific research. The clinical picture is characterized by extensive ischemic ulcerations of the skin and subcutis. Histologically, the small vessels in these lesions show prominent calcifications. Due to the extensive areas of ulceration and necrosis as well as frequently present comorbidities, patients with calciphylaxis are prone to infection and sepsis. In this work, we describe the case of a female kidney-transplant patient with vasculitis who, despite good graft function, developed a fulminant calciphylaxis of both thighs 4 years post transplantation and died of septic complications. The differential diagnoses as well as clinical procedures are described in detail in the case history. In the discussion, we give an overview of the current state of knowledge regarding the etiopathogenesis, risk factors, diagnostic measures and clinical management of calciphylaxis.

Women temporarily synchronize their menstrual cycles with the luminance and gravimetric cycles of the Moon.

Many species synchronize reproductive behavior with a particular phase of the lunar cycle to increase reproductive success. In humans, a lunar influence on reproductive behavior remains controversial, although the human menstrual cycle has a period close to that of the lunar cycle. Here, we analyzed long-term menstrual recordings of individual women with distinct methods for biological rhythm analysis. We show that women's menstrual cycles with a period longer than 27 days were intermittently synchronous with the Moon's luminance and/or gravimetric cycles. With age and upon exposure to artificial nocturnal light, menstrual cycles shortened and lost this synchrony. We hypothesize that in ancient times, human reproductive behavior was synchronous with the Moon but that our modern lifestyles have changed reproductive physiology and behavior.

Natural innate cytokine response to immunomodulators and adjuvants in human precision-cut lung slices.

Prediction of lung innate immune responses is critical for developing new drugs. Well-established immune modulators like lipopolysaccharides (LPS) can elicit a wide range of immunological effects. They are involved in acute lung diseases such as infections or chronic airway diseases such as COPD. LPS has a strong adjuvant activity, but its pyrogenicity has precluded therapeutic use. The bacterial lipopeptide MALP-2 and its synthetic derivative BPPcysMPEG are better tolerated. We have compared the effects of LPS and BPPcysMPEG on the innate immune response in human precision-cut lung slices. Cytokine responses were quantified by ELISA, Luminex, and Meso Scale Discovery technology. The initial response to LPS and BPPcysMPEG was marked by coordinated and significant release of the mediators IL-1ß, MIP-1ß, and IL-10 in viable PCLS. Stimulation of lung tissue with BPPcysMPEG, however, induced a differential response. While LPS upregulated IFN-γ, BPPcysMPEG did not. This traces back to their signaling pathways via TLR4 and TLR2/6. The calculated exposure doses selected for LPS covered ranges occurring in clinical studies with human beings. Correlation of obtained data with data from human BAL fluid after segmental provocation with endotoxin showed highly comparable effects, resulting in a coefficient of correlation >0.9. Furthermore, we were interested in modulating the response to LPS. Using dexamethasone as an immunosuppressive drug for anti-inflammatory therapy, we found a significant reduction of GM-CSF, IL-1ß, and IFN-γ. The PCLS-model offers the unique opportunity to test the efficacy and toxicity of biological agents intended for use by inhalation in a complex setting in humans.

Extranodal diffuse non hodgkin lymphoma in the thigh.

Diffuse large B-cell lymphoma usually starts as a rapidly growing mass in an internal lymph node and can grow in other areas such as the bone or intestines. About 1/3 of these lymphomas are confined to one part of the body when they are localized. In the case of a 78-year-old man, an extensive tumour was located on the right thigh. Biopsies of the tumour revealed diffuse proliferation of large lymphoid cells which have totally affected the normal architecture of striated muscle. The patient received multimodality treatment including chemotherapy of the CHOP regimen and adjuvant radiotherapy. Despite this being a fast growing lymphoma, about 3 out of 4 people will have no signs of disease after initial treatment, and about half of all people with this lymphoma are cured with therapy.

Fatal cowpox virus infection in captive banded mongooses (Mungos mungo).

Cowpox virus infections have been described in various domestic and exotic animal species. This report is the first on an outbreak of fatal generalized cowpox virus infection among captive banded mongooses (Mungos mungo, suborder Feliformia). All animals of a colony of 8 mongooses showed a fulminant course of disease. The whole population died (n=7) or was euthanized (n=1) within 11 days. Postmortem examinations were performed on 4 animals. All animals showed extensive necrotizing inflammation of retropharyngeal lymph nodes, typical poxviral skin lesions, and multiple necrotic foci in liver and spleen. Three animals exhibited an ulcerating stomatitis. Pulmonary lesions, a common feature of fatal cowpox virus infections in other feliform species, were not obvious. Histopathologically, characteristic cytoplasmic inclusion bodies were detected in all affected organs but the spleen. Based on transmission electron microscopy and cell culture, Orthopoxvirus was identified as the etiology. The virus was further characterized by polymerase chain reaction and sequence analysis, identifying it as cowpox virus. A survey in the habitat suggests wild brown rats (Rattus norvegicus) as the most likely source of infection.

The Ischigualasto Tetrapod Assemblage (Late Triassic, Argentina) and 40Ar/39Ar Dating of Dinosaur Origins.

(40)Ar/(39)Ar dating of sanidine from a bentonite interbedded in the Ischigualasto Formation of northwestern Argentina yielded a plateau age of 227.8 +/- 0.3 million years ago. This middle Carnian age is a direct calibration of the Ischigualasto tetrapod assemblage, which includes some of the best known early dinosaurs. This age shifts last appearances of Ischigualasto taxa back into the middle Carnian, diminishing the magnitude of the proposed late Carnian tetrapod extinction event. By 228 million years ago, the major dinosaurian lineages were established, and theropods were already important constituents of the carnivorous tetrapod guild in the Ischigualasto-Villa Unión Basin. Dinosaurs as a whole remained minor components of tetrapod faunas for at least another 10 million years.

Postural and dynamic masseter and anterior temporalis muscle EMG repeatability in serial assessments.

Electromyographic (EMG) assessment has been used as a non-invasive tool to objectively assess muscle function, although with controversial research and clinical potential. The aim of this study was to assess within-, inter-subject and between-day repeatability of serial EMG recordings. The study sample included 10 asymptomatic subjects with no history of temporomandibular disorders or muscle parafunctions. Bilateral masseter and anterior temporalis muscle EMG parameters were assessed in two standardized serial recordings (day 1 to day 2) using a portable EMG equipment (ME 6000 recorder, Mega Electronics, Kuopio, Finland). The functional tasks included postural/resting activities as pre- and post-recording series of 30 s each and jaw opening/closing, intercuspal and maximal voluntary clenching activities of 5 s, repeated three times. The assessed EMG parameters included the mean amplitude, s.d. and error. In addition, the power spectrum EMG parameter assessment included the median power frequencies and the averaged EMG spectrum data values. The results of the intraclass correlation coefficient analysis indicated reliability for nearly all of the intercuspal and all clenching EMG amplitude and power spectrum parameters. This was complemented by the repeated measures anova and post hoc analyses that indicated non-significant differences between day 1 and 2 in task- and muscle-related analyses. Most variability was noted in postural and some in opening/closing tasks. In conclusion this study assessed the reliability, repeatability and limitations of postural and various dynamic masseter and temporalis EMG recordings for serial assessment.

Association between urodynamic parameters and urine neutrophil gelatinase-associated lipocalin concentrations in children with neuropathic bladders.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a marker of acute kidney injury, and has been shown to be a sensitive marker of renal damage in urinary tract obstruction. Children with neurogenic bladders are at risk of renal damage as a result of increased pressure within the urinary system. A marker of upper tract deterioration in this population would be useful to guide management. OBJECTIVE: The aim of the study is to compare urinary NGAL (uNGAL) concentrations between children who have elevated and normal detrusor pressure and between those with low and normal compliance, on urodynamics. STUDY DESIGN: This is a cross-sectional study of children with neurogenic bladder who underwent routine urodynamics from August 2015 to March 2016. Patients with positive urine cultures from the time of urodynamics were excluded from analysis. Urine was obtained from the time of urodynamics for uNGAL measurement. Urodynamics were reviewed. High pressure is defined as a detrusor pressure of 40 cm of water or greater at the volume where catheterization is normally performed. Compliance was calculated at the volume where catheterization is performed. RESULTS: A total of 89 patients were included (low pressure, n = 73; high pressure, n = 16 and low compliance, n = 41; normal compliance, n = 40). Median uNGAL concentrations were not different between patients with low and high pressure, but there was a higher median uNGAL concentration in patients with normal compliance compared with those with low compliance. There was no correlation between maximum detrusor pressure and uNGAL concentration, but there was a moderate relationship between compliance and uNGAL concentration (rs = 0.43, p < 0.01 for non-normalized uNGAL and rs = 0.30, p < 0.01 for normalized uNGAL). DISCUSSION AND CONCLUSION: There is an increase in uNGAL concentrations in patients with normal compliance compared with those with low compliance, but no difference between patients with low or high pressure.

The circadian clock of fruit flies is blind after elimination of all known photoreceptors.

Circadian rhythms are entrained by light to follow the daily solar cycle. We show that Drosophila uses at least three light input pathways for this entrainment: (1) cryptochrome, acting in the pacemaker cells themselves, (2) the compound eyes, and (3) extraocular photoreception, possibly involving an internal structure known as the Hofbauer-Buchner eyelet, which is located underneath the compound eye and projects to the pacemaker center in the brain. Although influencing the circadian system in different ways, each input pathway appears capable of entraining circadian rhythms at the molecular and behavioral level. This entrainment is completely abolished in glass(60j) cry(b) double mutants, which lack all known external and internal eye structures in addition to being devoid of cryptochrome.

Drosophila CRY is a deep brain circadian photoreceptor.

cry (cryptochrome) is an important clock gene, and recent data indicate that it encodes a critical circadian photoreceptor in Drosophila. A mutant allele, cry(b), inhibits circadian photoresponses. Restricting CRY expression to specific fly tissues shows that CRY expression is needed in a cell-autonomous fashion for oscillators present in different locations. CRY overexpression in brain pacemaker cells increases behavioral photosensitivity, and this restricted CRY expression also rescues all circadian defects of cry(b) behavior. As wild-type pacemaker neurons express CRY, the results indicate that they make a striking contribution to all aspects of behavioral circadian rhythms and are directly light responsive. These brain neurons therefore contain an identified deep brain photoreceptor, as well as the other circadian elements: a central pace-maker and a behavioral output system.

Comparative X-ray structure analysis of human and Escherichia coli tRNA(Gly) acceptor stem microhelices.

tRNA identity elements assure the correct aminoacylation of tRNAs by the aminoacyl-tRNA synthetases with the cognate amino acid. The tRNA(Gly)/glycyl-tRNA sythetase system is member of the so-called 'class II system' in which the tRNA determinants consist of rather simple elements. These are mostly located in the tRNA acceptor stem and in the glycine case additionally the discriminator base at position 73 is required. Within the glycine-tRNA synthetases, the archaebacterial/human and the eubacterial sytems differ with respect to their protein structures and the required tRNA identity elements, suggesting a unique evolutionary divergence. In this study, we present a comparison between the crystal structures of the eubacterial Escherichia coli and the human tRNA(Gly) acceptor stem microhelices and their surrounding hydration patterns.

Crystal structure of a human tRNA(Gly) microhelix at 1.2A resolution.

The tRNA(Gly)/glycyl-tRNA synthetase (GlyRS) system belongs to the so-called 'class II aminoacyl-tRNA synthetase system' in which tRNA identity elements are assured by rather few and simple determinants mostly located in the tRNA acceptor stem. Regarding evolutionary aspects, the tRNA(Gly)/GlyRS system is a special case. There exist two different types of GlyRS, namely an archaebacterial/human type and a eubacterial type reflecting an evolutionary divergence within this system. Here we report the crystal structure of a human tRNA(Gly) acceptor stem microhelix at 1.2A resolution. The local geometric parameters of the microhelix and the water network surrounding the RNA are presented. The structure complements the previously published Escherichia coli tRNA(Gly) aminoacyl stem structure.

[Topical application of EGF for the therapy of persisting corneal erosion under cetuximab treatment]. / Topische EGF-applikation bei therapierefraktärer erosio corneae unter Cetuximab-Behandlung.

BACKGROUND: Cetuximab (Erbitux), a monoclonal epidermal growth factor receptor (EGFR) antibody, has been used for the treatment of advanced colorectal carcinoma over the last two years. Inhibition of EGFR also influences corneal wound healing as EGF stimulates the proliferation of epithelial cells. METHOD: Extensive corneal erosion was seen in both eyes of a 62-year-old patient under treatment with cetuximab for a metastasized colorectal carcinoma. Progression was fast despite vigorous conservative treatment. The application of autologous serum could not be considered because of the antibody treatment. Human EGF was applied topically several times daily in order to utilize the proliferative effect on corneal epithelial cells and to antagonize the inhibition of EGF receptors. RESULTS: Improvement was seen shortly after the onset of therapy with EGF eye drops.. The epithelial defect was closed 7 days (left eye) and 19 days (right eye), respectively, after the onset of therapy. During this time treatment with cetuximab was continued. CONCLUSIONS: Cetuximab (Erbitux) can cause persisting epithelial defects. Patients with an impairment of corneal wound healing under cetuximab treatment can benefit from the topical application of human EGF. Consequently, surgical measures or complications such as infections can be avoided.

Relationship between dental arch width and vertical facial morphology in untreated adults.

The objectives of this study were to investigate if a relationship exists between dental arch width and the vertical facial pattern determined by the steepness of the mandibular plane, and to examine the differences in dental arch widths between male and female untreated adults. Lateral cephalograms and dental casts were obtained from 185 untreated Caucasians (92 males, 93 females) between 18 and 68 years of age with no crossbite, minimal crowding, and spacing. The angle of the mandibular plane (MP) to the anterior cranial base (SN) was measured on cephalograms of each patient. Dental casts were used to obtain comprehensive dental measurements including maxillary and mandibular intercanine, interpremolar, and intermolar widths, as well as the amount of crowding or spacing. The arch widths of males and females were analysed and the differences between them were tested for significance using a Student's t-test. Regression analysis was used to determine the statistical significance of the relationships between MP-SN angle and dental arch width and crowding or spacing. The results showed that male arch widths were significantly larger than those of females (P < 0.05). For both males and females, there was a trend that as MP-SN angle increased, arch width decreased. It was concluded that dental arch width is associated with gender and facial vertical morphology. Thus, using individualized archwires according to each patient's pre-treatment arch form and width is suggested during orthodontic treatment.

Variation among subspecialists in the diagnosis of urinary tract infection in children with neurogenic bladders.

BACKGROUND: Children with neurogenic bladders who require clean intermittent catheterization (CIC) frequently have bacteriuria. However, there is no consensus on what constitutes at urinary tract infection (UTI) in this population. Multiple subspecialists are often involved in the management of these patients, although they are frequently cared for by hospitalists when admission is required. OBJECTIVE: The objective of this study was to describe the variability in opinion between subspecialists in the diagnosis of a UTI in CIC-dependent children. STUDY DESIGN: A scenario-based survey was distributed to physicians in the divisions of urology, nephrology, and hospital medicine at a single free-standing children's hospital. Respondents rated their degree of confidence on whether a specific scenario represented UTI or colonization on an 11-point Likert Scale. Median responses were compared with the Kruskal-Wallis test with pair-wise comparisons. RESULTS: Back/flank pain, abdominal pain, and vomiting were the most common symptoms that were suggestive of a UTI in a non-febrile child. There was no single symptom chosen that was the most suggestive of a UTI in CIC-dependent child. There was significant variability between specialists in the diagnosis of UTI in specific clinical scenarios on the survey. Hospitalists were significantly less confident about the diagnosis of a UTI than urologists in two of the clinical scenarios. CONCLUSIONS: Standardization and implementation of consensus criteria for UTI in this high-risk population is needed.