Impact of Chlorine Dioxide on Pathogenic Waterborne Microorganisms Occurring in Dental Chair Units.

Bacterial contamination is a problem in dental unit water lines with the consequence of implementing regular disinfection. In this study, the short-term impact of chlorine dioxide (ClO2) treatment was investigated on the microorganisms Legionella pneumophila and L. anisa, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus. The environmental background was proven as an important factor regarding the tolerance to 0.4 mg/L ClO2 as saline and phosphate-buffered saline resulted in a higher bacterial reduction than tap water. Gram-positive microorganisms demonstrated higher robustness to ClO2 than Gram-negative, and microorganisms adapted to tap water showed increased stability compared to cultured cells. At high densities, substantial numbers of bacteria were able to withstand disinfection, whereby the use of 4.6 mg/L ClO2 increased the inactivation rate. A massive cell decrease occurred within the first 5 minutes with subsequent plateau formation or slowed cell reduction upon further exposure. This biphasic kinetics cannot be explained by a ClO2 depletion effect alone, because the probability of bacterial subpopulations with increased tolerance should be taken into account, too. Our results prove high disinfection efficiency to microorganisms that were rather found in correlation to the level of bacterial contamination and background solutions than the chosen concentration for ClO2 treatment itself.

Accuracy and repeatability of the Microsoft Azure Kinect for clinical measurement of motor function.

Quantitative assessment of motor function is increasingly applied in fall risk stratification, diagnosis, and disease monitoring of neuro-geriatric disorders of balance and gait. Its broad application, however, demands for low-cost and easy to use solutions that facilitate high-quality assessment outside laboratory settings. In this study, we validated in 30 healthy adults (12 female, age: 32.5 [22 - 62] years) the performance and accuracy of the latest generation of the Microsoft RGB-D camera, i.e., Azure Kinect (AK), in tracking body motion and providing estimates of clinical measures that characterise static posture, postural transitions, and locomotor function. The accuracy and repeatability of AK recordings was validated with a clinical reference standard multi-camera motion capture system (Qualisys) and compared to its predecessor Kinect version 2 (K2). Motion signal quality was evaluated by Pearson's correlation and signal-to-noise ratios while the accuracy of estimated clinical parameters was described by absolute and relative agreement based on intraclass correlation coefficients. The accuracy of AK-based body motion signals was moderate to excellent (RMSE 89 to 20 mm) and depended on the dimension of motion (highest for anterior-posterior dimension), the body region (highest for wrists and elbows, lowest for ankles and feet), and the specific motor task (highest for stand up and sit down, lowest for quiet standing). Most derived clinical parameters showed good to excellent accuracy (r .84 to .99) and repeatability (ICC(1,1) .55 to .94). The overall performance and limitations of body tracking by AK were comparable to its predecessor K2 in a cohort of young healthy adults. The observed accuracy and repeatability of AK-based evaluation of motor function indicate the potential for a broad application of high-quality and long-term monitoring of balance and gait in different non-specialised environments such as medical practices, nursing homes or community centres.

A Changing Home: A Cross-Sectional Study on Environmental Degradation, Resettlement and Psychological Distress in a Western German Coal-Mining Region.

Unwelcome environmental changes can lead to psychological distress, known as "solastalgia". In Germany, the open-pit mining of brown coal results in environmental changes as well as in the resettlement of adjacent villages. In this study, we investigated the risk of open-pit mining for solastalgia and psychological disorders (e.g., depression, generalized anxiety and somatization) in local communities. The current residents and resettlers from two German open-pit mines were surveyed concerning environmental stressors, place attachment, impacts and mental health status. In total, 620 people responded, including 181 resettlers, 114 people from villages threatened by resettlement and 325 people from non-threatened villages near an open-pit mine. All groups self-reported high levels of psychological distress, approximately ranging between 2−7.5 times above the population average. Respondents from resettlement-threatened villages showed the worst mental health status, with 52.7% indicating at least moderate somatization levels (score sum > 9), compared to 28% among resettlers. We observed a mean PHQ depression score of 7.9 (SD 5.9) for people from resettlement-threatened villages, 7.4 (SD 6.0) for people from not-threatened villages, compared to 5.0 (SD 6.5) for already resettled people (p < 0.001). In conclusion, the degradation and loss of the home environment caused by open-pit mining was associated with an increased prevalence of depressive, anxious and somatoform symptoms in local communities. This reveals a need for further in-depth research, targeted psychosocial support and improved policy frameworks, in favor of residents' and resettlers' mental health.

Approaches to mapping an undergraduate medical curriculum to a national competency-based catalogue of learning outcomes.

BACKGROUND: Curriculum mapping plays an increasing role in the design and implementation of competency-based medical education. We present an exemplary mapping of an institutional undergraduate medical curriculum to a national competency-based outcome framework to compare approaches to mapping procedures in their capacity to depict the relative coverage. METHODS: The mapping process was performed by a small working group that continuously reconciled its findings. In step 1, we mapped the course objectives of our programme (Charité Berlin, Germany) to the National Competency-Based Catalogue of Learning Outcomes Medicine (NKLM). In step 2, we employed three primarily quantitative approaches (single, multiple, and subordinate match) and one primarily qualitative approach (content comparison) to derive the degree of NKLM coverage. RESULTS: In step 1, we mapped a total of 4400 programme objectives to 2105 NKLM objectives. In step 2, the quantitative approaches provided a general overview of the pattern of coverage, while the qualitative approach required more effort but provided a better representation of the scope and depth of coverage. DISCUSSION: The mapping approach chosen markedly impacts on the results how of well an institutional curriculum covers a national standard. This study highlights the need for more rigour in the methodology and reporting of curriculum mapping.

Substantial direct fitness gains of workers in a highly eusocial ant.

Hamilton's theory of inclusive fitness suggests that helpers in animal societies gain fitness indirectly by increasing the reproductive performance of a related beneficiary. Helpers in cooperatively breeding birds, mammals and primitively eusocial wasps may additionally obtain direct fitness through inheriting the nest or mating partner of the former reproductive. Here, we show that also workers of a highly eusocial ant may achieve considerable direct fitness by producing males in both queenless and queenright colonies. We investigated the reproductive success of workers of the ant Temnothorax crassispinus in nature and the laboratory by dissecting workers and determining the origin of males by microsatellite analysis. We show that workers are capable of activating their ovaries and successfully producing their sons independently of the presence of a queen. Genotypes revealed that at least one fifth of the males in natural queenright colonies were not offspring of the queen. Most worker-produced males could be assigned to workers that were unrelated to the queen, suggesting egg-laying by drifting workers.

Instrumental Assessment of Stepping in Place Captures Clinically Relevant Motor Symptoms of Parkinson's Disease.

Fluctuations of motor symptoms make clinical assessment in Parkinson's disease a complex task. New technologies aim to quantify motor symptoms, and their remote application holds potential for a closer monitoring of treatment effects. The focus of this study was to explore the potential of a stepping in place task using RGB-Depth (RGBD) camera technology to assess motor symptoms of people with Parkinson's disease. In total, 25 persons performed a 40 s stepping in place task in front of a single RGBD camera (Kinect for Xbox One) in up to two different therapeutic states. Eight kinematic parameters were derived from knee movements to describe features of hypokinesia, asymmetry, and arrhythmicity of stepping. To explore their potential clinical utility, these parameters were analyzed for their Spearman's Rho rank correlation to clinical ratings, and for intraindividual changes between treatment conditions using standard response mean and paired t-test. Test performance not only differed between ON and OFF treatment conditions, but showed moderate correlations to clinical ratings, specifically ratings of postural instability (pull test). Furthermore, the test elicited freezing in some subjects. Results suggest that this single standardized motor task is a promising candidate to assess an array of relevant motor symptoms of Parkinson's disease. The simple technical test setup would allow future use by patients themselves.

Body size and sperm quality in queen- And worker-produced ant males.

Workers of many species of social Hymenoptera have functional ovaries and are capable of laying haploid, unfertilized eggs, at least in the absence of a queen. Except for honeybees, it remains largely unknown whether worker-produced males have the same quality as queen-produced males and whether workers benefit in direct fitness by producing their sons. Previous studies in the monogynous ant Temnothorax crassispinus revealed that a high proportion of males in natural and laboratory colonies are worker offspring. Here, we compare longevity, body size, sperm length and sperm viability between queen- and worker-produced males. We either split queenright colonies into queenright and queenless halves or removed the queen from a fraction of the queenright colonies and then examined the newly produced males. Male quality traits varied considerably among colonies but differed only slightly between queen- and worker-produced males. Worker-produced males outnumbered queen-produced males and also had a longer lifespan, but under certain rearing conditions sperm from queen-produced males had a higher viability.

Ancient symbiosis confers desiccation resistance to stored grain pest beetles.

Microbial symbionts of insects provide a range of ecological traits to their hosts that are beneficial in the context of biotic interactions. However, little is known about insect symbiont-mediated adaptation to the abiotic environment, for example, temperature and humidity. Here, we report on an ancient clade of intracellular, bacteriome-located Bacteroidetes symbionts that are associated with grain and wood pest beetles of the phylogenetically distant families Silvanidae and Bostrichidae. In the saw-toothed grain beetle Oryzaephilus surinamensis, we demonstrate that the symbionts affect cuticle thickness, melanization and hydrocarbon profile, enhancing desiccation resistance and thereby strongly improving fitness under dry conditions. Together with earlier observations on symbiont contributions to cuticle biosynthesis in weevils, our findings indicate that convergent acquisitions of bacterial mutualists represented key adaptations enabling diverse pest beetle groups to survive and proliferate under the low ambient humidity that characterizes dry grain storage facilities.

Maximum walking speed in multiple sclerosis assessed with visual perceptive computing.

BACKGROUND: Gait is often impaired in people with multiple sclerosis (PwMS), but detailed assessment of gait impairment in research and care remains challenging. In a previous pilot study we reported the feasibility of visual perceptive computing (VPC) for gait assessment in PwMS using the Short Maximum Speed Walk (SMSW), which assesses gait on recording distances confined to less than 4 meters. OBJECTIVE: To investigate the equivalence of SMSW to rater-based timed 25ft. walk (T25FW) in a large cohort of PwMS, and to investigate the association of SMSW-derived gait parameters with clinical disability, as well as subjective and objective gait impairment, in order to validate the SMSW as a quick and objective measure of clinical relevance possibly superior to T25FW. METHODS: 95 PwMS and 60 healthy controls (HC) performed the SMSW using a VPC system with Microsoft Kinect. All participants received two immediate retests to establish test-retest-reliability. Both PwMS and HC performed the T25FW. PwMS were rated according to the Expanded Disability Status Scale (EDSS) and answered the 12-item Multiple Sclerosis Walking Scale (MSWS-12) as a measure of self-perceived walking impairment. RESULTS: PwMS showed reduced average speed (p<0.001) and higher mediolateral deviation (p = 0.002) during SMSW than HC. Average speed was the most reliable SMSW parameter in PwMS and HC (intra-class correlation coefficient (ICC) in PwMS = 0.985, and in HC = 0.977). Average speed declined with age in PwMS and HC (r in PwMS = -0.648, and in HC = -0.452, both p<0.001). Correlation of SMSW average speed and T25FW speed was high in both groups (r in PwMS = 0.783, and in HC = 0.747, both p<0.001) and mean difference (0.0013 m/s) between methods was below smallest detectable change. Average speed correlated well with both clinical disability based on EDSS (r = -0.586, p<0.001) and self-perceived walking impairment based on MSWS-12 (r = -0.546, p<0.001). CONCLUSION: VPC-assessed walking parameters during SMSW can reliably detect gait disturbance in PwMS over very short distance. Specifically, maximum gait speed can be obtained with high accuracy in this simple test set-up. Cross-sectional associations with disability and self-perceived walking impairment support clinical relevance. Given its objectivity in a simple test set-up, SMSW is superior to T25FW.

Subjective and objective assessment of physical activity in multiple sclerosis and their relation to health-related quality of life.

BACKGROUND: Physical activity (PA) is frequently restricted in people with multiple sclerosis (PwMS) and aiming to enhance PA is considered beneficial in this population. We here aimed to explore two standard methods (subjective plus objective) to assess PA reduction in PwMS and to describe the relation of PA to health-related quality of life (hrQoL). METHODS: PA was objectively measured over a 7-day period in 26 PwMS (EDSS 1.5-6.0) and 30 matched healthy controls (HC) using SenseWear mini® armband (SWAmini) and reported as step count, mean total and activity related energy expenditure (EE) as well as time spent in PA of different intensities. Measures of EE were also derived from self-assessment with IPAQ (International Physical Activity Questionnaire) long version, which additionally yielded information on the context of PA and a classification into subjects' PA levels. To explore the convergence between both types of assessment, IPAQ categories (low, moderate, high) were related to selected PA parameters from objective assessment using ANOVA. Group differences and associated effect sizes for all PA parameters as well as their relation to clinical and hrQoL measures were determined. RESULTS: Both, SWAmini and IPAQ assessment, captured differences in PA between PwMS and HC. IPAQ categories fit well with common cut-offs for step count (p = 0.002) and mean METs (p = 0.004) to determine PA levels with objective devices. Correlations between specifically matched pairs of IPAQ and SWAmini parameters ranged between r .288 and r .507. Concerning hrQoL, the lower limb mobility subscore was related to four PA measures, while a relation with patients' report of general contentment was only seen for one. CONCLUSIONS: Both methods of assessment seem applicable in PwMS and able to describe reductions in daily PA at group level. Whether they can be used to track individual effects of interventions to enhance PA levels needs further exploration. The relation of PA measures with hrQoL seen with lower limb mobility suggests lower limb function not only as a major target for intervention to increase PA but also as a possible surrogate for PA changes.

Validity of visual perceptive computing for static posturography in patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) patients frequently have postural control impairment but quantitative posturography is difficult to perform in clinical care. Recent technology facilitates new posturography approaches. OBJECTIVE: To evaluate construct validity of visual perceptive computing (VPC) for static posturography to study postural control in MS patients. METHODS: A total of 90 MS patients and 59 healthy controls (HCs) performed three stance tests: open, closed and tandem stance. Static posturography was performed using a VPC system with Microsoft Kinect. Clinical assessments included Expanded Disability Status Scale (EDSS), Timed-25-Foot-Walk, Short-Maximum-Speed-Walk and 12-item MS Walking Scale (MSWS-12) questionnaire. Reliability was assessed with intra-class correlation coefficients at retest. RESULTS: As a group, MS patients performed worse than HCs in all tests. The closed stance test showed best applicability and reliability. With closed eyes, in 36.7% of patients, the three-dimensional mean angular sway velocity (MSV-3D) was above HCs' 95th percentile. Higher MSV-3D was associated with decreased walking speed (p < 0.001); worse clinical scores, mainly attributable to the cerebellar functional system score (p < 0.001); and reflected in self-reported walking disability (MSWS-12, p < 0.001). CONCLUSION: Postural control can be reliably assessed by VPC-based static posturography in patients with MS. Abnormal postural control seems to predominantly reflect involvement of cerebellar circuits with impact on gait and walking disability.