[Using the DFree device for balanced bladder management]. / Der Einsatz des DFree-Ultraschallsensors für ein ausgewogenes Blasenmanagement.

BACKGROUND: Bladder dysfunctions, regardless of their origin, have significant psychosocial effects. Depending on the existing disorder and bladder functionality, behavioural therapy and supporting tools are the first choice of therapy but the need for medication, intervention and surgery is significant. OBJECTIVE: The DFree ultrasonic sensor enables sonographic measurement of bladder filling and feeds this back to the sensor wearer via an app. The primary outcome of the study was the influence of the DFree on the quality of life of the patients. Secondary endpoints were usefulness and user-friendliness of the DFree device as well as the self-reported degree of autonomy. METHODS: In the present pilot study, 18 urological patients with various bladder dysfunctions were equipped with the DFree ultrasonic sensor for at least 12 hours daily over a period of three months. The parameters were collected at baseline (T1) and at end of the study (T2) using the Kings Health Questionnaire (KHQ) and the German version of the Client Satisfaction Questionnaire (ZUF-8) (quantitative data) as well as guided interviews (qualitative data). RESULTS: Improvement in bladder dysfunction based on the KHQ could not be statistically confirmed. However, the average value based on the ZUF-8 showed satisfaction with the DFree. In the interviews at T2, the participants gave a positive feedback with specific suggestions for improving user-friendliness. The device was described as helpful and easy to use. CONCLUSIONS: The DFree ultrasonic sensor is a new technical tool in the treatment of bladder dysfunctions. Improving specific technical details could increase the user-friendliness as well as the usefulness of the device.

Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. / Akzeptanz und Wissenstransfer in einem Patienteninformationsgespräch vor MRT-Untersuchungen ­ Vergleich von humanoidem Roboter und Tablet-Computer: eine randomisiert-kontrollierte Studie.

PURPOSE: To investigate whether a humanoid robot in a clinical radiological setting is accepted as a source of information in conversations before MRI examinations of patients. In addition, the usability and the information transfer were compared with a tablet. METHODS: Patients were randomly assigned to a robot or tablet group with their consent prior to MRI. The usability of both devices was compared with the extended System Usability Scale (SUS) and the information transfer with a knowledge query. Reasons for refusal were collected by a non-responder questionnaire. RESULTS: At the University Hospital Halle 117 patients were included for participation. There was no statistically significant difference in gender and age. Of 18 non-responders, 4 refused to participate partly because of the robot; for another 3 the reason could not be clarified. The usability according to SUS score was different with statistical significance between the groups in the mean comparison and was one step higher for the tablet on the adjective scale. There was no statistically significant difference in knowledge transfer. On average, 8.41 of 9 questions were answered correctly. CONCLUSION: This study is the first application, in a clinical radiological setting, of a humanoid robot interacting with patients. Tablet and robot are suitable for information transfer in the context of MRI. In comparison to studies in which the willingness to interact with a robot in the health care sector was investigated, the willingness is significantly higher in the present study. This could be explained by the fact that it was a concrete use case that was understandable to the participants and not a hypothetical scenario. Thus, potentially high acceptance for further specific areas of application of robots in radiology can be assumed. The higher level of usability perceived in the tablet group can be explained by the fact that here the interface represents a form of operation that has been established for years in all population groups. More frequent exposure to robots could also improve the response in the future. KEY POINTS: · patients accept humanoid robots in clinical radiologic situations. · at present they can only convey information as well as an inexpensive tablet. · future systems can relieve the burden on personnel.. CITATION FORMAT: · Stoevesandt D, Jahn P, Watzke S et al. Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study. Fortschr Röntgenstr 2021; 193: 947 - 954.

Receptiveness Of GPs In The South Of Saxony-Anhalt, Germany To Obtaining Training On Technical Assistance Systems For Caregiving: A Cross-Sectional Study.

BACKGROUND: Challenges to general practitioners (GPs) as family doctors in Germany are growing because of the demographic situation. Technical assistance systems can improve the care for patients provided by GPs and care personnel to preserve autonomy. GPs are key persons in the health care team to recommend and facilitate access to technical solutions to influence their implementation into their patients' homes. AIM: Explore the general receptiveness of GPs in Germany regarding state-of-the-art and modern assistive technology, as well as their experiences, attitudes and expectations and their training demands. METHODS: A cross-sectional survey was conducted among GPs in Germany with a self-developed questionnaire sent by mail. RESULTS: Response rate was 34% (n=194). As expected computers and smartphones are widely used. Data glasses, digital pens and virtual reality and others are often "unknown". Experience with assistive technology was gained with emergency call systems, smart calendars and tablet dispensers. Self-reported receptiveness to use innovative technology is high but knowledge is low. The majority reported lack of access to training and support. The receptiveness for advanced education about technical solutions is high. In free-text response, some communicated their worries about the replacement of human interaction with technology. CONCLUSION: The survey showed an overall high receptiveness about assistance technology to GPs and strong demands for education and support. Education for GPs need greater efforts to master the process transforming the digital health care provision.

[Robotic systems for care at home: A scoping review]. / Robotische Systeme zur pflegerischen Versorgung im häuslichen Umfeld: ein Scoping Review.

BACKGROUND: In the future, modern technologies could make a significant contribution to a self-determined life in one's own environment when in need of care. Robots might alleviate everyday domestic life and promote participation. In the nursing science debate concerns have been raised over alienation through technology and loss of direct social and emotional contact. Robots are also being tested in nursing care, for example as social robots in the nursing home setting. The current state of knowledge regarding the domestic application of robotic systems has so far not been examined in systematic reviews. AIM: To examine the possibilities of the usage and application of robotic systems in the home healthcare setting. In addition to the functions of the systems, methodological issues and further research in this subject area are considered. METHODS: In this scoping review, an overview of the subject area and current research activities is produced. Five databases and the reference lists of the publications identified were searched. All study designs and publications since 2005 were eligible. We included studies investigating robotic interventions in the home care setting and their impact on outcomes relevant to patients or family members. The relevance of the robotic systems for nursing care was assessed according to the six dimensions of the new definition of care dependency in the Eleventh Book of the German Social Code (SGB XI). RESULTS: The search revealed 7,755 hits; 19 studies were included. Two studies used a control group. Further studies were feasibility studies and acceptance surveys. The majority of studies were conducted in EU countries. Three out of 13 robotic systems were commercially available. Nine studies did not report ethical approval, and seven studies did not mention whether informed consent was obtained. DISCUSSION: Robotic systems in home care have mainly been investigated in exploratory or pilot studies. Apart from technical aspects, the studies focussed on ease of use and, to this purpose, predominantly employed prototype robots. No reference was made to users' living environment, and there was no proof of effectiveness. The devices are far from being in the stage of broad practical application.

Bystander cells enhance NK cytotoxic efficiency by reducing search time.

Natural killer (NK) cells play a central role during innate immune responses by eliminating pathogen-infected or tumorigenic cells. In the microenvironment, NK cells encounter not only target cells but also other cell types including non-target bystander cells. The impact of bystander cells on NK killing efficiency is, however, still elusive. In this study we show that the presence of bystander cells, such as P815, monocytes or HUVEC, enhances NK killing efficiency. With bystander cells present, the velocity and persistence of NK cells were increased, whereas the degranulation of lytic granules remained unchanged. Bystander cell-derived H2O2 was found to mediate the acceleration of NK cell migration. Using mathematical diffusion models, we confirm that local acceleration of NK cells in the vicinity of bystander cells reduces their search time to locate target cells. In addition, we found that integrin ß chains (ß1, ß2 and ß7) on NK cells are required for bystander-enhanced NK migration persistence. In conclusion, we show that acceleration of NK cell migration in the vicinity of H2O2-producing bystander cells reduces target cell search time and enhances NK killing efficiency.

Numerical analysis of homogeneous and inhomogeneous intermittent search strategies.

Random search processes for targets that are inhomogeneously distributed in a search domain require spatially inhomogeneous search strategies to find the target as fast as possible. Here, we compare systematically the efficiency of homogeneous and inhomogeneous strategies for intermittent search, which alternates stochastically between slow, diffusive motion in which the target can be detected and fast ballistic motion during which targets cannot be detected. We analyze the mean first-passage time of homogeneous and inhomogeneous strategies for three paradigmatic search problems: (1) the narrow escape problem, i.e., the searcher looks for a small area on the boundary of the search domain, (2) reaction kinetics, i.e., the detection of an immobile target in the interior of a search domain, and (3) the reaction-escape problem, i.e., the searcher first needs to find a mobile target before it can escape through a narrow area on the boundary. Using families of inhomogeneous strategies, partially motivated by the organization of the cytoskeleton in cells with a centrosome, we show that they are almost always more efficient than homogeneous strategies.

Optimality of Spatially Inhomogeneous Search Strategies.

We consider random search processes alternating stochastically between diffusion and ballistic motion, in which the distribution function of ballistic motion directions varies from point to point in space. The specific space dependence of the directional distribution together with the switching rates between the two modes of motion establishes a spatially inhomogeneous search strategy. We show that the mean first passage times for several standard search problems-narrow escape, reaction partner finding, reaction escape-can be minimized with a directional distribution that is reminiscent of the spatial organization of the cytoskeleton filaments of cells with a centrosome: radial ballistic transport from the center to the periphery and back, and ballistic transport in random directions within a concentric shell of thickness Δ_{opt} along the domain boundary. The results suggest that living cells realize efficient search strategies for various intracellular transport problems economically through a spatial cytoskeleton organization that involves radial microtubules in the central region and only a narrow actin cortex rather than a cell body filled with randomly oriented actin filaments.

Cytoskeleton rotation relocates mitochondria to the immunological synapse and increases calcium signals.

Ca2+ microdomains and spatially resolved Ca2+ signals are highly relevant for cell function. In T cells, local Ca2+ signaling at the immunological synapse (IS) is required for downstream effector functions. We present experimental evidence that the relocation of the MTOC towards the IS during polarization drags mitochondria along with the microtubule network. From time-lapse fluorescence microscopy we conclude that mitochondria rotate together with the cytoskeleton towards the IS. We hypothesize that this movement of mitochondria towards the IS together with their functionality of absorption and spatial redistribution of Ca2+ is sufficient to significantly increase the cytosolic Ca2+ concentration. To test this hypothesis we developed a whole cell model for Ca2+ homoeostasis involving specific geometries for mitochondria and use the model to calculate the spatial distribution of Ca2+ concentrations within the cell body as a function of the rotation angle and the distance from the IS. We find that an inhomogeneous distribution of PMCA pumps on the cell membrane, in particular an accumulation of PMCA at the IS, increases the global Ca2+ concentration and decreases the local Ca2+ concentration at the IS with decreasing distance of the MTOC from the IS. Unexpectedly, a change of CRAC/Orai activity is not required to explain the observed Ca2+ changes. We conclude that rotation-driven relocation of the MTOC towards the IS together with an accumulation of PMCA pumps at the IS are sufficient to control the observed Ca2+ dynamics in T-cells during polarization.