Sulphur cycling in a Neoarchaean microbial mat.

Multiple sulphur (S) isotope ratios are powerful proxies to understand the complexity of S biogeochemical cycling through Deep Time. The disappearance of a sulphur mass-independent fractionation (S-MIF) signal in rocks <~2.4 Ga has been used to date a dramatic rise in atmospheric oxygen levels. However, intricacies of the S-cycle before the Great Oxidation Event remain poorly understood. For example, the isotope composition of coeval atmospherically derived sulphur species is still debated. Furthermore, variation in Archaean pyrite δ34 S values has been widely attributed to microbial sulphate reduction (MSR). While petrographic evidence for Archaean early-diagenetic pyrite formation is common, textural evidence for the presence and distribution of MSR remains enigmatic. We combined detailed petrographic and in situ, high-resolution multiple S-isotope studies (δ34 S and Δ33 S) using secondary ion mass spectrometry (SIMS) to document the S-isotope signatures of exceptionally well-preserved, pyritised microbialites in shales from the ~2.65-Ga Lokammona Formation, Ghaap Group, South Africa. The presence of MSR in this Neoarchaean microbial mat is supported by typical biogenic textures including wavy crinkled laminae, and early-diagenetic pyrite containing <26‰ µm-scale variations in δ34 S and Δ33 S = -0.21 ± 0.65‰ (±1σ). These large variations in δ34 S values suggest Rayleigh distillation of a limited sulphate pool during high rates of MSR. Furthermore, we identified a second, morphologically distinct pyrite phase that precipitated after lithification, with δ34 S = 8.36 ± 1.16‰ and Δ33 S = 5.54 ± 1.53‰ (±1σ). We propose that the S-MIF signature of this secondary pyrite does not reflect contemporaneous atmospheric processes at the time of deposition; instead, it formed by the influx of later-stage sulphur-bearing fluids containing an inherited atmospheric S-MIF signal and/or from magnetic isotope effects during thermochemical sulphate reduction. These insights highlight the complementary nature of petrography and SIMS studies to resolve multigenerational pyrite formation pathways in the geological record.

Routine second-look after surgical treatment of colonic peritoneal carcinomatosis.

BACKGROUND: Surgical procedures that combine both complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved the survival of patients with peritoneal carcinomatosis (PC). Current imaging and laboratory investigations are not very useful to diagnose PC. This prospective study sought to determine the usefulness of routine second-look surgery (RSLS) combined with HIPEC in the diagnosis and treatment of patients with PC at high-risk for recurrence. METHODS: From 2007 to 2011, RSLS was performed on 14 patients who had undergone a complete initial oncological resection for synchronous colonic PC and/or ovarian metastasis with PC discovered during primary colon cancer surgery after a course of 12 cycles of intravenous chemotherapy, eventually associated with HIPEC. RESULTS: Pathology confirmed PC in 71% of patients during RSLS, with a median peritoneal carcinomatosis index (PCI) of 10. There was no post-operative mortality, while 7% of patients exhibited Dindo Grade III-IV complications. The 2-year overall survival and disease-free survival rates were 91% and 38%, respectively. Following RSLS and CCRS, peritoneal recurrence was observed in only 8% of patients who had undergone HIPEC. CONCLUSION: RSLS combined with HIPEC after initial resection of synchronous colonic PC allows diagnosis and treatment of low-score PC, with limited post-operative complications and increased overall survival rates.

[Interprofessional education in pain management: development strategies for an interprofessional core curriculum for health professionals in German-speaking countries]. / Interprofessionelle Lehre in der Schmerzmedizin : Möglichkeiten und Strategien für die Entwicklung eines professionsübergreifenden Curriculums im deutschsprachigen Raum.

The care of patients, suffering from acute, chronic, or malignant pain, requires systematic and interprofessional collaboration between all team members to ensure a holistic approach to pain management. In doing so, the different professions are often in a competitive, tense, or dependent relationship resulting from a lack of precise definitions and concepts regarding their responsibilities in the wide field of pain management. Considering pain management as a whole, we can define numerous interfaces concerning competencies and tasks which may open up some new perspectives on concepts of interprofessional education (IPE). Internationally, there have been many attempts to establish concepts of interprofessional education, and it is considered a great challenge to improve continuing medical education. However, interdisciplinary subjects like pain management may benefit from it. Apart from enhancing specialized knowledge, interprofessional education aims to consider the different roles, skills, and responsibilities as well as interprofessional strategies of decision-making. In Germany, only a few efforts have been made with regard to interprofessional pain education. In the following paper, different challenges, tasks, and roles within the field of pain management are discussed in the sense of potential areas of collaboration in the context of interprofessional education. Against this background, the Regensburg model for interprofessional pain management education is described as one national program to enhance the effectiveness of pain management.

[Breast-feeding training programme as intervention approach at the hospital level: results of evaluation of the first phase of the STELLA study]. / Personalschulung als Interventionsansatz auf Klinikebene zur Stillförderung: Evaluationsergebnisse der ersten Phase der STELLA-Studie.

BACKGROUND: The health-promoting short- and long-term effects of breast-feeding are supported by a vast scientific literature. The Bavarian prospective cohort study 2005/2006 showed regional variations of breast-feeding rates. Furthermore, improvement in counselling mothers, particularly with regard to prevention and handling of breast-feeding problems, has a great potential for health promotion. The objective of this study is to promote breast-feeding in maternity clinics by improving the surrounding conditions. STUDY DESIGN: A clinic-based and community-related intervention trial was carried out in Lower Bavaria as a model region with below average breast-feeding rates. (1) INTERVENTION: an advanced training of maternity ward professionals of 10 hospitals and after-care midwives was performed from May until December 2008. The training programme was based on the WHO/UNICEF criteria of the "Ten Steps to Successful Breastfeeding" to deepen the breast-feeding knowledge and to improve the breast-feeding management. (2) EVALUATION: A singular assessment of the advanced training programme was undertaken concerning an increase of knowledge and the practicability in clinical everyday life by participants; improvements of the maternity wards were assessed via structural interviews with maternity ward staff before and after intervention. RESULTS: Approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training course. The survey after the training programme (response rate 83%) indicated that more than 80% of the participants stated to have learned something new and to be able to use the knowledge acquired for their own practice. Results of the clinic interviews showed a transfer of training contents into clinical work routines. Improvements at interview date were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each). CONCLUSION: Training of maternity ward professionals accounts for baby-friendly conditions in maternity clinics. Most willingness for improvements was shown by maternity ward staff particularly for bonding between mother and child as well as for additional feeding. Considerable differences between the hospitals were observed for the promotion of infant formulas before and after the intervention.

[Preventive crisis management in general outpatient palliative care - prospectively cross-sectional study of General Practitioners in Eastern Bavaria]. / Vorbeugendes Krisenmanagement in der allgemeinen ambulanten Palliativversorgung. Prospektive Querschnittstudie bei Hausärzten in Ostbayern.

BACKGROUND: General out-patient palliative care (GOPC) must be integrated into the care of patients with life-limiting diseases. Aim of the study was to evaluate experiences of general practitioners concerning advance directives and palliative emergency sheets. METHODS: A self-provided survey was mailed to all general practitioners in Regensburg (cross-sectional study). Main outcome measures included responses regarding a palliative emergency sheet (PES) and a palliative emergency plan (PEP). The investigation period was four months. The analysis was performed using defined criteria (e. g. professional experience concerning palliative care patients, patients treated in nursing homes, patients with dementia). RESULTS: Sixty-nine questionnaires from 259 were analysed (response rate 27 %). 86 % of respondents named practical experience in the care of palliative patients, 46 % named theoretical knowledge in this field. 41 % and 40 % consider creating an advance directive for their practical work as important/very important (p = 0.004 concerning the treatment of more than five palliative care patients per three months). 52 % and 49 % regard a PES or a PEP to be relevant (PES median: 6.5, SD ± 2.7; PEP median: 6.5 SD ± 2.9; inter-group analysis p < 0.05). 94 % of respondents name the general practitioner to be suitable for creating an advance directive. CONCLUSION: In Germany, GOPC in end-of-life care is very important. This study shows that advance directives were declared as an important instrument for patients? autonomy. The sense of PES and PEP to ensure patients? autonomy, especially for acute emergency medical palliative care, must be better recognized. However, the increase in acceptance in the GOPC for such instruments must be disclosed. Further studies to investigate this problem are necessary.

[Psychosocial aspects and body pain: results from an employee survey in the frame of the MAF-project "integrated health management in companies: employee survey about working conditions as management tool"]. / Psychosoziale Aspekte und körperliche Beschwerden - Ergebnisse einer Mitarbeiterbefragung im Rahmen des MAF-Projekts "Ganzheitliches betriebliches Gesundheitsmanagement: Mitarbeiterbefragung über Arbeitsbedingungen als Führungselement"

INTRODUCTION: The aim of the study is to present a compact employee attitude survey for companies within a health care management tool. Beside body pains work-related psychosocial risk factors as well as further influencing factors, are taken into consideration. The questionnaire was evaluated by 6 Bavarian companies. METHOD: Potential influencing factors on physical problems like back pain, neck- and shoulder tension, gastro-intestinal diseases and headache were examined by multiple analysis. Dissatisfaction with working conditions was also examined in the same way. All analyses were carried out age and sex adjusted. RESULTS: Statistical analyses are based on 3,720 employees of 3 companies out of a total of 6 companies who answered the questionnaires. Response rates of the different companies ranged from 34 to 60%. Psychomental demands and psychosocial strains were found to be the strongest predictors for body pains as well as for dissatisfaction with working conditions. CONCLUSIONS: The introduced questionnaire is easy to implement within the framework of a company health care management. It has an holistic approach. We could demonstrate that this instrument is able to reveal multiple aspects of work-related body pain as well as multiple aspects of dissatisfaction with working conditions. Thus it is a starting point for the development of necessary measures for health promotion.

Psoriasis: an epidemiological evaluation of disease burden in 590 patients.

BACKGROUND: There are limited data available on the economical burden of psoriasis and its impact on everyday life. OBJECTIVE: The aim of this study was to evaluate the impact of psoriasis on personal and professional life, and to evaluate the cost of psoriasis for the patient. METHODS: We performed a cross-sectional study in psoriasis patients. All patients aged >or=18 years with a diagnosis of plaque-psoriasis confirmed by a physician were included. A self-administered questionnaire evaluating everyday life was constructed with members of the French association of psoriasis patients. In addition, the Dermatology Life Quality Index (DLQI), Working Productivity and Activity Impairment and individual costs were assessed. RESULTS: A total of 590 patients completed the study. Mean age of the responders was 56 years. The mean DLQI score was 8.5 for patients with severe psoriasis vs. 6.4 for mild psoriasis. Global loss of productivity was 10.7% without significant difference according to the disease severity. Daily activities alteration was most important in patients with severe psoriasis. In this study, 36.8% of patients with severe psoriasis reported a negative impact on their professional life vs. 19.6% for patients with mild psoriasis (P = 0.002). Time devoted to phototherapy was on average 33 h/year/patient and the application of emollients took 25 h/year/patient; 47.3% of patients had a feeling to clean the house more often, in correlation with the severity of the disease. Mean out-of-pocket expenses for the disease was estimated to be 543 euro/year/patient. High impact of psoriasis on quality of life (DLQI >10), age <40 years and joint involvement were significantly associated with an increased risk of loss of work productivity. CONCLUSION: Psoriasis, particularly severe psoriasis, is a true burden for patients and impacts significantly everyday life and patient's economical resources.

Effects of level of condensed distillers solubles in corn dried distillers grains on intake, daily body weight gain, and digestibility in growing steers fed forage diets1.

Three experiments were conducted examining the effects of feeding different levels of dried distillers grains (DDG) and different proportions of condensed distillers solubles (CDS) added to DDG on performance and digestibility in forage-fed steers. In Exp. 1, a total of 120 individually fed crossbred steers (276 +/- 31 kg) were used in a randomized complete block design with a 4 x 5 factorial arrangement of treatments. Factors included DDG supplementation level (0.25, 0.50, 0.75, or 1.0% of BW daily) and proportion of CDS in DDG (0.0, 5.4, 14.5, 19.1, and 22.1% of DDG DM). A basal diet of 58.8% alfalfa hay, 39.2% sorghum silage, and 2% vitamin and mineral supplement (DM basis) was fed for ad libitum intake. As the level of DDG increased, intake of forage decreased linearly (P < 0.01), intake of DDG increased linearly (P < 0.01), and total DMI increased quadratically (P = 0.06). A DDG level x CDS level interaction (P < 0.01) was observed for ADG and G:F. The 0.0, 5.4, 14.5, 19.1, and 22.1% CDS treatments had the greatest ADG when DDG was supplemented at 0.75, 1.0, 1.0, 0.75, and 0.50% of BW daily, respectively. In Exp. 2, four crossbred steers (295 +/- 19 kg) were used in a 3-period switchback design. A basal diet of 58.8% alfalfa hay, 39.2% brome hay, and 2% vitamin and mineral supplement (DM basis) was fed at 95% of ad libitum intake. Treatments were DDG containing 0.0 or 22.1% CDS supplemented at 1.0% of BW daily. Apparent total tract digestibility was measured by total fecal collection. No differences between treatments were observed for digestibility of DM, OM, or NDF (P >/= 0.14). Digestibility of ether extract was greater (P = 0.02) in steers supplemented with DDG containing 22.1% CDS. In Exp. 3, two ruminally and duodenally cannulated Holstein steers (663 +/- 24 kg) were used to estimate DM and CP digestion of the DDG fed in Exp. 1 using the mobile bag technique. Basal diets were the same as fed in Exp. 1 and steers were supplemented with DDG at 0.5% of BW daily. Ruminal DM digestibility increased linearly (P < 0.01), and postruminal and total tract DM digestibility increased quadratically (P = 0.02 and P = 0.03, respectively) as the level of CDS increased. Level of CDS may affect growing steer performance because depressions in ADG and G:F were observed as intake of ether extract increased. A clear explanation for the interaction between the DDG supplementation level and the CDS level on growing steer performance was not evident in the digestion experiments.

A 1.1-Mb transcript map of the hereditary hemochromatosis locus.

In the process of positionally cloning a candidate gene responsible for hereditary hemochromatosis (HH), we constructed a 1.1-Mb transcript map of the region of human chromosome 6p that lies 4.5 Mb telomeric to HLA-A. A combination of three gene-finding techniques, direct cDNA selection, exon trapping, and sample sequencing, were used initially for a saturation screening of the 1.1-Mb region for expressed sequence fragments. As genetic analysis further narrowed the HH candidate locus, we sequenced completely 0.25 Mb of genomic DNA as a final measure to identify all genes. Besides the novel MHC class 1-like HH candidate gene HLA-H, we identified a family of five butyrophilin-related sequences, two genes with structural similarity to a type 1 sodium phosphate transporter, 12 novel histone genes, and a gene we named RoRet based on its strong similarity to the 52-kD Ro/SSA lupus and Sjogren's syndrome auto-antigen and the RET finger protein. Several members of the butyrophilin family and the RoRet gene share an exon of common evolutionary origin called B30-2. The B30-2 exon was originally isolated from the HLA class 1 region, yet has apparently "shuffled" into several genes along the chromosome telomeric to the MHC. The conservation of the B30-2 exon in several novel genes and the previously described amino acid homology of HLA-H to MHC class 1 molecules provide further support that this gene-rich region of 6p21.3 is related to the MHC. Finally, we performed an analysis of the four approaches for gene finding and conclude that direct selection provides the most effective probes for cDNA screening, and that as much as 30% of ESTs in this 1.1-Mb region may be derived from noncoding genomic DNA.

Nutrient support of the healing wound.

Wound healing is a series of complex physicochemical interactions that require various micronutrients at every step. In the critically ill or severely injured patient, wound healing is impaired by the protein-catabolic, hypermetabolic response to stress. The hypothalamus responds to cytokine stimulation by increasing the thermoregulatory set-point and by augmenting elaboration of stress hormones (catecholamines, cortisol, and glucagon). In turn, the stress hormones induce thermogenic futile substrate cycling, lipolysis, and proteolysis. Increased glucose production results at the expense of skeletal muscle degradation, producing amino acid substrate for hepatic gluconeogenesis. Nutritional support of the hypermetabolic state is an essential part of ensuring efficient wound healing in these patients. Protein catabolism cannot be reversed by increased amino acid availability alone, due partly to a defect in amino acid transport. This defect can be reversed by anabolic agents, such as growth hormone and insulin-like growth factor-1. Growth hormone treatment dramatically improves wound healing in severely burned children. Supplementation with protein and vitamins, specifically arginine and vitamins A, B, and C, provides optimum nutrient support of the healing wound.