[Bed capacity management in times of the COVID-19 pandemic : A simulation-based prognosis of normal and intensive care beds using the descriptive data of the University Hospital Augsburg]. / Bettenkapazitätssteuerung in Zeiten der COVID-19-Pandemie : Eine simulationsbasierte Prognose der Normal- und Intensivstationsbetten anhand der deskriptiven Daten des Universitätsklinikums Augsburg.

BACKGROUND: Following the regional outbreak in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, presenting the healthcare systems with huge challenges worldwide. In Germany the coronavirus diseases 2019 (COVID-19) pandemic has resulted in a slowly growing demand for health care with a sudden occurrence of regional hotspots. This leads to an unpredictable situation for many hospitals, leaving the question of how many bed resources are needed to cope with the surge of COVID-19 patients. OBJECTIVE: In this study we created a simulation-based prognostic tool that provides the management of the University Hospital of Augsburg and the civil protection services with the necessary information to plan and guide the disaster response to the ongoing pandemic. Especially the number of beds needed on isolation wards and intensive care units (ICU) are the biggest concerns. The focus should lie not only on the confirmed cases as the patients with suspected COVID-19 are in need of the same resources. MATERIAL AND METHODS: For the input we used the latest information provided by governmental institutions about the spreading of the disease, with a special focus on the growth rate of the cumulative number of cases. Due to the dynamics of the current situation, these data can be highly variable. To minimize the influence of this variance, we designed distribution functions for the parameters growth rate, length of stay in hospital and the proportion of infected people who need to be hospitalized in our area of responsibility. Using this input, we started a Monte Carlo simulation with 10,000 runs to predict the range of the number of hospital beds needed within the coming days and compared it with the available resources. RESULTS: Since 2 February 2020 a total of 306 patients were treated with suspected or confirmed COVID-19 at this university hospital. Of these 84 needed treatment on the ICU. With the help of several simulation-based forecasts, the required ICU and normal bed capacity at Augsburg University Hospital and the Augsburg ambulance service in the period from 28 March 2020 to 8 June 2020 could be predicted with a high degree of reliability. Simulations that were run before the impact of the restrictions in daily life showed that we would have run out of ICU bed capacity within approximately 1 month. CONCLUSION: Our simulation-based prognosis of the health care capacities needed helps the management of the hospital and the civil protection service to make reasonable decisions and adapt the disaster response to the realistic needs. At the same time the forecasts create the possibility to plan the strategic response days and weeks in advance. The tool presented in this study is, as far as we know, the only one accounting not only for confirmed COVID-19 cases but also for suspected COVID-19 patients. Additionally, the few input parameters used are easy to access and can be easily adapted to other healthcare systems.

Evidence from paleosols for the geological antiquity of rain forest.

Kaolinitic claystones in Paleozoic paleokarst underlying the Middle Pennsylvanian Fort Scott Limestone near Drake, Missouri, contain abundant fossil root traces. These include a surficial root mat as well as stout, woody, deeply penetrating root traces: a rooting pattern similar to that under rain forest. Also similar to soils of rain forest is the deeply weathered clay of the paleosol, in which minimal amounts of nutrient bases remain. Forest communities adapted to oligotrophic clayey substrates in humid climates existed at least 305 million years ago.

The conformation around the peptide bond between the P1- and P2-positions is important for catalytic activity of some proline-specific proteases.

Proline-containing dipeptidyl-4-nitroanilides have been synthesised and subjected to dipeptidyl peptidase IV-catalysed hydrolysis at high enzyme concentrations to collect information on the conformational specificity of the enzyme active site for a nonscissile bond. Descriptions of the biphasic kinetics were carried out in terms of cis/trans interconversion of the substrates. The results show that the enzyme can cleave only the trans-conformation of the substrate. The competitive inhibition by Gly-Pro-OH and Ala-Pro-OH is also specific for the trans form of the dipeptides. The interpretation of the results obtained from these kinetic studies has led to proposals for the stepwise cleavage of biologically active peptides like substance P and beta-casomorphine by dipeptidyl peptidase IV.

Kinetic investigation of the hydrolysis of aminoacyl p-nitroanilides by dipeptidyl peptidase IV from human and pig kidney.

Dipeptidyl peptidase IV (dipeptidyl-peptide hydrolase, EC 3.4.14.5), an enzyme that participates in the catabolism of bradykinin and Substance P as well as the post-translational processing of various other peptides, has been purified from human and pig kidney. The assay reaction involved the cleavage of p-nitroaniline (pNA) from various dipeptidyl p-nitroanilides. The specific activities of the human and pig enzyme (with Gly-Pro-pNA at pH 7.6) were 49.2 and 45.8, respectively. The dependence of initial reaction velocity on substrate concentration was determined for a variety of dipeptidyl p-nitroanilides over the concentration range 0.05 to 2.0 mM. Most of the substrates tested produced significant non-hyperbolic behavior for the function v vs. S at concentrations above 0.5 mM. As to differences between the two enzymes, the pig enzyme exhibited featureless (i.e., hyperbolic) behavior with Glu-Pro-pNA concentrations as high as 2.0 mM, whereas the human enzyme produced significant non-hyperbolic behavior for the function v vs. S, beginning at S = 0.4 mM. Thus, the human and pig dipeptidyl peptidases IV are kinetically distinct enzyme forms.

Are diprotin A (Ile-Pro-Ile) and diprotin B (Val-Pro-Leu) inhibitors or substrates of dipeptidyl peptidase IV?

Dipeptidyl peptidase IV preferably hydrolyzes peptides and proteins with a penultimate proline residue. Umezawa and co-workers (Umezawa et al. (1984) J. Antibiotics 37, 422-425) reported that diprotin A (Ile-Pro-Ile) and diprotin B (Val-Pro-Leu) are inhibitors for dipeptidyl peptidase IV. We could show that both compounds as well as other tripeptides with a penultimate proline residue are substrates for dipeptidyl peptidase IV. An apparent competitive inhibition by those compounds is a kinetic artifact due to the substrate-like structure of such tripeptides.

Mechanism of proline-specific proteinases: (I) Substrate specificity of dipeptidyl peptidase IV from pig kidney and proline-specific endopeptidase from Flavobacterium meningosepticum.

The substrate specificity of dipeptidyl peptidase IV (dipeptidyl peptide hydrolase, EC 3.4.14.5) from pig kidney and proline-specific endopeptidase from Flavobacterium meningosepticum, was investigated with a series of N-terminal unprotected (dipeptidyl peptidases IV) and succinylated dipeptidyl-p-nitroanilides (proline-specific endopeptidase). Both enzymes are specific for the S configuration of the amino-acid residue in P1 and P2 position if the penultimate residue is proline. In the case of alanine substrates (Ala in P1, dipeptidyl peptidase IV hydrolyzes such compounds where the configuration of the P2 residue is R. The penultimate residue with dipeptidyl peptidase IV can be, beside proline and alanine, dehydroproline, hydroxyproline and pipecolic acid. Proline substrates (Pro in P1) with an R configuration in P2 are inhibitors of the hydrolysis of proline substrates with an S,S configuration in an uncompetitive (dipeptidyl peptide IV) or mixed inhibition type (proline-specific endopeptidase). Derivatives of Gly-Pro-pNA where the N-terminal amino group is methylated are hydrolyzed by dipeptidyl peptidase IV.

Establishing and sustaining state-of-the-art diabetes patient education programs: research and recommendations.

Frequently, diabetes educators in hospitals report meeting severe organizational barriers when attempting to implement advances in diabetes patient education (DPE). This paper reports on how eight successful diabetes patient education programs coped with potential barriers. The results are based on interviews of professionals who played central roles in introducing and sustaining the programs. Many of the identified problems centered around two issues--acquiring needed resources and communicating about the program to a variety of key groups.

Factors that influence the decision to receive treatment for proliferative diabetic retinopathy.

Educational messages aimed at health professionals have stressed the importance of regular eye examinations for people with diabetes and the value of early treatment. To investigate whether the messages need to be expanded or tailored in a specific way, we asked people with diabetes (N = 37) to describe their reactions to the diagnosis of proliferative diabetic retinopathy and the factors that influenced their decision to seek treatment. The findings reaffirm the importance of the physician's recommendation in pursuing treatment. Furthermore, a constructive response (eg, "knew it had to be taken care of") to the diagnosis was associated with prior knowledge of the consequences of proliferative diabetic retinopathy. Minimal racial and gender differences were observed. White women reported being influenced by the experiences of others, and African Americans reported being influenced by the diabetes educator. These findings emphasize the importance of providing patient education not only following a diagnosis but also in anticipation of probable complications.

A new teaching model to prolong breastfeeding among Latinos.

Latino women in Salt Lake City, Utah, have some of the lowest breastfeeding rates in the state. In an attempt to prolong breastfeeding duration in this population, the authors designed a new class to be taught by certified WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) personnel to pregnant Spanish-speaking participants. The class was designed after a literature review and onsite ethnographic research. The term la cuarentena del bebé was introduced to signify the recommended 40 days when mothers should exclusively breastfeed, avoiding bottles, pacifiers, and supplementation. As part of the teaching model, class participants prepare an infant-feeding plan. Preliminary interviews show that WIC participants and staff view the new approach as an improvement. A randomized controlled trial is under way to evaluate the effectiveness of the class.

Peer counselor program increases breastfeeding rates in Utah Native American WIC population.

Lack of breastfeeding promotion and support hinder successful breastfeeding. In this study, a breastfeeding peer counselor program improved both the initiation rate and duration of breastfeeding up to three months postpartum among Native American WIC participants. Trained peer counselors contacted subjects prenatally, and at one, two, and four to six weeks postpartum. Breastfeeding rates for the experimental group were compared to historical controls. Women in the peer counselor group who had complete data for three months (n = 41) had a higher rate of breastfeeding than the control group (n = 67) at initiation (84 percent vs. 70 percent; p = 0.05) and at three months postpartum (49 percent vs. 36 percent; p = 0.08).

pH-dependence of catalytic constants of the enzyme reaction--some remarks.

The influence of the hydrogen ion concentration on catalytic constants (kcat, KM and kcat/KM) was investigated under steady-state conditions where all steps of the Scheme, are taken into the consideration. The relative value of the rate constants has an influence on pH dependence of catalytic constants. The pH of intersection points of the tangents at the portion of functions pKM, Ig kcat, lg kcat/KM = f(pH) with different slopes are the values of true pKa of catalytically important ionizable groups in the free enzyme or in the enzyme-substrate complex(es), when the conditions k'-1, k'1, k'2 = 0 are valid. If e.g. k'-1, k'1 not equal to 0 the pH of the intersection points of the tangents is sometimes not the true value of the pKa. In this connection it is possible that more than one intersection point exists (in the plot lg kcat, pKM or lg kcat/KM versus pH) when only one ionizing group in the active site of an enzyme is present.

[Application of dipeptidylpeptidase IV in formation of the peptide bond]. / Die Verwendung der Dipeptidylpeptidase IV zur Knüpfung von Peptidbindungen.

According to the increasing importance of enzyme catalysed peptide synthesis the capability of the protease dipeptidyl peptidase IV is shown to form the peptide bond. To our best knowledge, it's the first time that has been used successfully proline as one of the amino acids. The formation of the peptide bond is kinetically controlled. Free amino acids have been used as nucleophiles. The reaction media contain 50 vol.-% glycerol. A first approach to a kinetic treatment is shown.

[Dipeptidyl peptidase activities in various organs of the Wistar rat]. / Dipeptidyl-Peptidase-Aktivitäten in verschiedenen Organen der Wistarratte.

Using Gly-Pro-pNa as a substrate, the authors photometrically determined the dipeptidyl peptidase activity in organic homogenates and serum of Wistar rats at two pH values. The activity of the serine peptidase DP IV was measured at pH = 7.6; a mixed activity (DP MA) which is composed of the activities of several dipeptidyl peptidases, at pH = 5.0. Particularly high DP IV activities were determined in the kidney, lung, adrenal gland, liver and aortic arch, the differences among the enzyme activities measured in the single organic homogenates at pH = 5.0 being smaller. The DP IV activities and the values found for DP MA in the structures of the nervous system were in general lower. Maximum DP IV values were measured in the spinal ganglion, cerebral cortex and spinal bulb; and maximum DP MA values, in the hypothalamus, cerebellum and cerebral cortex. The results obtained are discussed from the aspects of the participation of these enzymes in peptidergic regulatory mechanisms and of a possible relation to blood-pressure regulation.

Molecular interactions in intermediate and transition states in the self-stimulated inhibition of enzymes.

Di-isopropyl fluorophosphate (DFP) and other organophosphorus inhibitors recruit the catalytic power of their target enzymes: the enzyme catalyzes its own irreversible phosphorylation. The magnitude of the catalytic acceleration can approach the factor by which the enzyme catalyzes its own acylation by natural substrates. The reaction of DFP with five serine proteases [chymotrypsin, elastase, dipeptidyl peptidase IV (DP IV), subtilisin and thermitase] exhibits in all cases the same pH dependence as does enzyme acylation by natural substrates. Chymotrypsin and elastase form a "fast" class of enzymes which react about ten-fold faster than the other three "slow" enzymes. All enzymes show k(HOH)/k(DOD) of about 2 but the proton inventory indicates one-proton character for "slow" enzymes and multiproton character for "fast" enzymes. Enthalpies of activation are about 33 kJ/mol (subtilisin, "slow") and 10 kJ/mol (elastase, "fast"). Entropies of activation are about -120 J.T-1.mol-1 (subtilisin, "slow") and -175J.T-1.s-1 (elastase, "fast"; T = temperature in K).

Promoting low-fat entree choices in a public cafeteria.

Reductions in dietary fat have been recommended in the prevention of coronary heart disease. Because entrees contribute substantially to total meal fat content, we evaluated a cafeteria-based intervention for increasing the purchase rate of low-fat entrees (M = 6.83 g) relative to nonlow-fat entrees (M = 25.59 g). The intervention included a poster listing the benefits of a LF diet and the daily LF entrees (i.e., broiled or baked chicken and fish dishes). During 6 days per phase, food selections (N = 3,264) were monitored by trained observers. The intervention, which cost $80.00, produced significant increases (i.e., from 20% to 35%) in the purchase rate of LF entrees.

Dietary management in diabetes mellitus. A goal-setting process.

Diet is a cornerstone to the management of diabetes mellitus. A successful diet will provide the necessary elements for good nutrition, maintain near normal plasma glucose ranges, and be acceptable to the patient. Persons with diabetes have differing physiologic requirements and varying lifestyle needs; therefore, an individualized dietary management program should be designed for each patient. Teaching the person with diabetes about the dietary management protocol is an ongoing process that should include all members of the health care team. With an understanding and appreciation of the goals of the diabetic diet, the nurse can evaluate the management program and reinforce learning with an anticipation that adherence to the diet will enhance the health and quality of life of the diabetic patient.