[Geriatric ophthalmologic co-management : A case report of interdisciplinary collaboration]. / Geriatrisch-ophthalmologisches Co-Management : Ein Fallbeispiel interdisziplinärer Zusammenarbeit.

This case report details the assessment and interdisciplinary collaboration in the management of an 81-year-old patient presenting with acute visual impairment, dizziness, general weakness, gait disturbances and fear of falling. A holistic geriatric evaluation revealed orthostatic dysregulation and an underlying multifactorial gait disorder exacerbated by visual impairment. Ophthalmological findings included left central retinal artery branch occlusion and cataracts. A comprehensive geriatric assessment showed frailty, impaired mobility and decreased functional abilities. Subsequent patient-centered interdisciplinary approaches included treatment for retinal ischemia, orthostatic testing, medication reconciliation, physiotherapy and occupational therapy. This case emphasizes how interdisciplinary collaboration between ophthalmology and geriatrics enables proactive assessment and intervention to reduce the risk of functional decline and loss of autonomy in visually impaired patients, which is of particular relevance considering the increasing prevalence of visual impairment in the ageing population.

[Fragility Fractures: Preoperative assessment and optimisation]. / Fragilitätsfraktur beim geriatrischen Patienten: Präoperative Abklärung und Optimierung.

Fragility fractures are associated with high morbidity and mortality. An interdisciplinary collaboration and an individualized, patient-centered approach are essential to ensure an optimized preoperative period and to improve perioperative safety. Preoperative responsibilities of trauma surgery include in the first step the identification of fragility fractures and the necessity for geriatric involvement. Orthogeriatric co-management (OCM) focuses on the identification of the medical, functional and social needs of the patient. In the preoperative period attention is focussed on acute diseases in need of treatment that have a negative impact on the course of further treatment and the prevention of delirium.

The reproduction process of Gram-positive protocells.

Protocells are believed to have existed on early Earth prior to the emergence of prokaryotes. Due to their rudimentary nature, it is widely accepted that these protocells lacked intracellular mechanisms to regulate their reproduction, thereby relying heavily on environmental conditions. To understand protocell reproduction, we adopted a top-down approach of transforming a Gram-positive bacterium into a lipid-vesicle-like state. In this state, cells lacked intrinsic mechanisms to regulate their morphology or reproduction, resembling theoretical propositions on protocells. Subsequently, we grew these proxy-protocells under the environmental conditions of early Earth to understand their impact on protocell reproduction. Despite the lack of molecular biological coordination, cells in our study underwent reproduction in an organized manner. The method and the efficiency of their reproduction can be explained by an interplay between the physicochemical properties of cell constituents and environmental conditions. While the overall reproductive efficiency in these top-down modified cells was lower than their counterparts with a cell wall, the process always resulted in viable daughter cells. Given the simplicity and suitability of this reproduction method to early Earth environmental conditions, we propose that primitive protocells likely reproduced by a process like the one we described below.

The reproduction of gram-negative protoplasts and the influence of environmental conditions on this process.

Bacterial protoplasts are known to reproduce independently of canonical molecular biological processes. Although their reproduction is thought to be influenced by environmental conditions, the growth of protoplasts in their natural habitat has never been empirically studied. Here, we studied the life cycle of protoplasts in their native environment. Contrary to the previous perception that protoplasts reproduce in an erratic manner, cells in our study reproduced in a defined sequence of steps, always leading to viable daughter cells. Their reproduction can be explained by an interplay between intracellular metabolism, the physicochemical properties of cell constituents, and the nature of cations in the growth media. The efficiency of reproduction is determined by the environmental conditions. Under favorable environmental conditions, protoplasts reproduce with nearly similar efficiency to cells that possess a cell wall. In short, here we demonstrate the simplest method of cellular reproduction and the influence of environmental conditions on this process.

[Frailty in the Emergency Department]. / Frailty in der Notaufnahme.

Frailty affects approximately one in two patients over 70 years of age in the emergency department. These are inadequately identified as high-risk patients using conventional triage tools. Frailty screening improves the identification of high-risk patients with increased hospitalisation and readmission rates, 30-day and one-year mortality. Unspecific complaints and geriatric syndromes should be recognised as red flags, and age-specific peculiarities of vital signs should be taken into account. A holistic evaluation should already be carried out in the emergency department, as focusing on individual problems is not target-oriented. All patients identified in the screening should be evaluated geriatrically in the course. For patients with frailty, the improvement of subjective well-being is in the foreground. Inpatient admission is partly avoidable, even if this is associated with health risks. This should be discussed with the patient within the framework of participatory decision-making. In advanced frailty, the needs correspond to those of palliative patients.

Mutual independence of water and n-nonane nucleation at low temperatures.

The interaction of water with different substances in the earth's atmosphere lies at the heart of many processes that influence our climate. However, it is still unclear how different species interact with water on the molecular level and in which ways this interaction contributes to the water vapor phase transition. Here, we report the first measurements of water-nonane binary nucleation in the 50-110 K temperature range, along with unary nucleation data of both. The time-dependent cluster size distribution in a uniform post-nozzle flow was measured by time-of-flight mass spectrometry coupled with single-photon ionization. From these data, we extract experimental rates and rate constants for both nucleation and cluster growth. The observed mass spectra of water/nonane clusters are not or only slightly affected by the introduction of the other vapor, and the formation of mixed clusters was not observed during nucleation of the mixed vapor. Additionally, the nucleation rate of either substance is not much affected by the presence (or absence) of the other species, i.e., the nucleation of water and nonane proceeds independently, indicating that hetero-molecular clusters do not play a role during nucleation. Only at the lowest temperature of our experiment (i.e., 51 K) do the measurements suggest that interspecies interaction slows water cluster growth. The findings here are in contrast to our earlier work in which we showed that vapor components in other mixtures, e.g., CO2 and toluene/H2O, can interact to promote nucleation and cluster growth in a similar temperature range.

Unraveling the hidden temporal range of fast ß2-adrenergic receptor mobility by time-resolved fluorescence.

G-protein-coupled receptors (GPCRs) are hypothesized to possess molecular mobility over a wide temporal range. Until now the temporal range has not been fully accessible due to the crucially limited temporal range of available methods. This in turn, may lead relevant dynamic constants to remain masked. Here, we expand this dynamic range by combining fluorescent techniques using a spot confocal setup. We decipher mobility constants of ß2-adrenergic receptor over a wide time range (nanosecond to second). Particularly, a translational mobility (10 µm²/s), one order of magnitude faster than membrane associated lateral mobility that explains membrane protein turnover and suggests a wider picture of the GPCR availability on the plasma membrane. And a so far elusive rotational mobility (1-200 µs) which depicts a previously overlooked dynamic component that, despite all complexity, behaves largely as predicted by the Saffman-Delbrück model.

Shells in CO2 clusters.

Abundance spectra of (CO2)N clusters up to N ≈ 500 acquired under a wide range of adiabatic expansion conditions are analyzed within the evaporative ensemble framework. The analysis reveals that the cluster stability functions display a strikingly universal pattern for all expansion conditions. These patterns reflect the inherent properties of individual clusters. From this analysis the size-dependent cluster binding energies are determined, shell and subshell closing sizes are identified, and cuboctahedral packing ordering for sizes above N ≈ 130 is confirmed. It is demonstrated that a few percent variation in the dissociation energies translates into significant abundance variations, especially for the larger clusters.

Design Features to Accelerate the Higher-Order Assembly of DNA Origami on Membranes.

Nanotechnology often exploits DNA origami nanostructures assembled into even larger superstructures up to micrometer sizes with nanometer shape precision. However, large-scale assembly of such structures is very time-consuming. Here, we investigated the efficiency of superstructure assembly on surfaces using indirect cross-linking through low-complexity connector strands binding staple strand extensions, instead of connector strands binding to scaffold loops. Using single-molecule imaging techniques, including fluorescence microscopy and atomic force microscopy, we show that low sequence complexity connector strands allow formation of DNA origami superstructures on lipid membranes, with an order-of-magnitude enhancement in the assembly speed of superstructures. A number of effects, including suppression of DNA hairpin formation, high local effective binding site concentration, and multivalency are proposed to contribute to the acceleration. Thus, the use of low-complexity sequences for DNA origami higher-order assembly offers a very simple but efficient way of improving throughput in DNA origami design.

New Particle Formation from the Vapor Phase: From Barrier-Controlled Nucleation to the Collisional Limit.

Studies of vapor phase nucleation have largely been restricted to one of two limiting cases-nucleation controlled by a substantial free energy barrier or the collisional limit where the barrier is negligible. For weakly bound systems, exploring the transition between these regimes has been an experimental challenge, and how nucleation evolves in this transition remains an open question. We overcome these limitations by combining complementary Laval expansion experiments, providing new particle formation data for carbon dioxide over a uniquely broad range of conditions. Our experimental data together with a kinetic model using rate constants from high-level quantum chemical calculations provide a comprehensive picture of new particle formation as nucleation transitions from a barrier-dominated process to the collisional limit.

How volatile components catalyze vapor nucleation.

Gas phase nucleation is a ubiquitous phenomenon in planetary atmospheres and technical processes, yet our understanding of it is far from complete. In particular, the enhancement of nucleation by the addition of a more volatile, weakly interacting gaseous species to a nucleating vapor has escaped molecular-level experimental investigation. Here, we use a specially designed experiment to directly measure the chemical composition and the concentration of nucleating clusters in various binary CO2-containing vapors. Our analysis suggests that CO2 essentially catalyzes nucleation of the low vapor pressure component through the formation of transient, hetero-molecular clusters and thus provides alternative pathways for nucleation to proceed more efficiently. This work opens up new avenues for the quantitative assessment of nucleation mechanisms involving transient species in multicomponent vapors.

An in situ and real time study of the formation of CdSe NCs.

Magic Size Clusters (MSCs) have been identified in the last few years as intermediates in the synthesis of nanocrystals (NCs), and ever since there has been increased interest in understanding their exact role in the NC synthesis. Many studies have been focused on understanding the influence of precursors or ligands on the stability of MSCs and on whether the presence of MSCs influences the reaction pathway. However, their kinetic nature calls for an in situ temporal evolution study of the reaction, from the first seconds until the formation of regular nanocrystals, in order to unravel the role of MSCs in the formation of NCs. We have studied the synthesis of CdSe nanocrystals (NCs) in a continuous-flow reactor with in situ optical and small angle X-ray scattering characterization (SAXS). Our results show that MSCs are always formed, regardless the temperature, as necessary intermediates in the formation of CdSe NCs, and that their accumulation in solution depends only on the reaction time. These results explain why MSCs were, in some cases, not observed in some previous studies.

Carbon dioxide and propane nucleation: the emergence of a nucleation barrier.

We investigate homogeneous gas-phase nucleation of CO2 and C3H8 in the uniform postnozzle flow of Laval expansions in the temperature range of 31.2 K to 62.9 K and 32.0 K to 42.1 K, respectively. Time-dependent cluster size distributions are recorded with mass spectrometry after single-photon ionization with vacuum ultraviolet light. Net monomer-cluster forward rate constants and experimental nucleation rates J are retrieved from the time-dependent cluster size distributions. The comparison of experimental enhancement factors derived from these net forward rates with calculated enhancement factors provides an indication for the transition from barrier-limited to barrierless nucleation. Our data suggest such a transition for CO2, but not for C3H8. The values of J lie in the range from 9 × 1014 cm-3 s-1 to 6 × 1015 cm-3 s-1. For CO2, the comparison of J with a modeled nucleation rate JQM based on quantum chemical calculations of the free energy barrier also hints at a transition from barrierless condensation to barrier-limited nucleation. Furthermore, we address the influence of the carrier gas pressure on the nucleation rate.

Extraction of monomer-cluster association rate constants from water nucleation data measured at extreme supersaturations.

We utilize recently reported data for water nucleation in the uniform postnozzle flow of pulsed Laval expansions to derive water monomer association rates with clusters. The nucleation experiments are carried out at flow temperatures of 87.0 K and 47.5 K and supersaturations of lnS ∼ 41 and 104, respectively. The cluster size distributions are measured at different nucleation times by mass spectrometry coupled with soft single-photon ionization at 13.8 eV. The soft ionization method ensures that the original cluster size distributions are largely preserved upon ionization. We compare our experimental data with predictions by a kinetic model using rate coefficients from a previous ab initio calculation with a master equation approach. The prediction and our experimental data differ, in particular, at the temperature of 87.0 K. Assuming cluster evaporation to be negligible, we derive association rate coefficients between monomer and clusters purely based on our experimental data. The derived dimerization rate lies 2-3 orders of magnitude below the gas kinetic collision limit and agrees with the aforementioned ab initio calculation. Other than the dimerization rate, however, the derived rate coefficients between monomer and cluster j (j ≥ 3) are on the same order of magnitude as the kinetic collision limit. A kinetic model based on these results confirms that coagulation is indeed negligible in our experiments. We further present a detailed analysis of the uncertainties in our experiments and methodology for rate derivation and specify the dependency of the derived rates on uncertainties in monomer and cluster concentrations.