Cultural Sensitivity and Challenges in Management of the Transgender Patient With ESRD in Transplantation.

Transgender patients with end-stage renal disease (ESRD) present with specific challenges during the transplant evaluation, perioperative management, and postoperative phase of care. Demographic information, health-care records, chosen name, and gender identity along with documentation of specific health-care needs can become a challenge when gender assigned at birth is incongruent with the patients gender identity. Medical care involves addressing the end-organ disease as well as addressing those aspects of care specific to the transgender patient. This review article provides information on defining transgender, the impact of ESRD, and transgender in the transplant process and considerations in the throughout phases of care. Current recommendations for management of this unique population are provided.

New insight of Arctic cloud parameterization from regional climate model simulations, satellite-based and drifting station data.

Cloud observations from the CloudSat and CALIPSO satellites helped to explain the reduced total cloud cover (Ctot) in the atmospheric regional climate model HIRHAM5 with modified cloud physics. Arctic climate conditions are found to be better reproduced with (1) a more efficient Bergeron-Findeisen process and (2) more generalized subgrid-scale variability of total water content. As a result, the annual cycle of Ctot is improved over sea ice, associated with an almost 14% smaller area average than in the control simulation. The modified cloud scheme reduces the Ctot bias with respect to the satellite observations. Except for autumn, the cloud reduction over sea ice improves low-level temperature profiles compared to drifting station data. The HIRHAM5 sensitivity study highlights the need for improving accuracy of low-level (< 700m) cloud observations, as these clouds exert a strong impact on the near-surface climate.

Established and emerging pathogens in Ixodes ricinus ticks collected from birds on a conservation island in the Baltic Sea.

Tick-borne pathogens such as Lyme borreliosis spirochaetes, Anaplasma phagocytophilum, Rickettsia spp. and Babesia spp. cause a great variety of diseases in animals and humans. Although their importance with respect to emerging human diseases is increasing, many issues about their ecology are still unclear. In spring 2007, 191 Ixodes ricinus (Acari: Ixodidae) ticks were collected from 99 birds of 11 species on a bird conservation island in the Baltic Sea in order to test them for Borrelia spp., A. phagocytophilum, Rickettsia spp. and Babesia spp. infections. Identification of the pathogens was performed by polymerase chain reaction (PCR), restriction fragment length polymorphism and sequence analysis. The majority of birds with ticks testing positive were European robins and thrushes. Borrelia DNA was detected in 14.1%, A. phagocytophilum in 2.6%, rickettsiae in 7.3% and Babesia spp. in 4.7% of the ticks. Co-infections with different pathogens occurred in six ticks (3.1%). The fact that 11 ticks (five larvae, six nymphs) were infected with Borrelia afzelii suggests that birds may, contrary to current opinion, serve as reservoir hosts for this species. Among rickettsial infections, we identified Rickettsia monacensis and Rickettsia helvetica. As we detected five Rickettsia spp. positive larvae and two birds carried more than one infected tick, transmission of those pathogens from birds to ticks appears possible. Further characterization of Babesia infections revealed Babesia divergens and Babesia microti. The occurrence of Babesia spp. in a total of five larvae suggests that birds may be able to infect ticks, at least with Ba. microti, a species considered not to be transmitted transovarially in ticks.

Prevalence of four species of Borrelia burgdorferi sensu lato and coinfection with Anaplasma phagocytophila in Ixodes ricinus ticks in central Germany.

A total of 305 Ixodes ricinus ticks collected from three areas of Thuringia in central Germany were investigated for infection with Borrelia burgdorferi sensu lato species and Anaplasma phagocytophila. Overall, 11.1% were infected with Borrelia burgdorferi and 2.3% with Anaplasma phagocytophila. Adult ticks showed a significantly higher rate of infection with both borreliae and Anaplasma phagocytophila. Borrelia garinii (55.9%) was detected most frequently, followed by Borrelia burgdorferi sensu stricto (32.4%), Borrelia afzelii (17.6%), and Borrelia valaisiana (5.9%). Four ticks had dual infection with Borrelia garinii and Borrelia burgdorferi sensu stricto. Two of the Borrelia-positive ticks were coinfected with Anaplasma phagocytophila.

Thermodynamic model for cold water survival.

A thermodynamic heat flow model for the human body gives survival time as a function of water temperature, assuming constant specific heat and thermal conductance.

New racing equation for championship performance.

A separate investigation of swimming endurance has led to a family of expressions relating maximal human locomotor activity to time and/or distance having such wide application to medicine, physiology, and sports as to merit independent publication. Specifically, variations of a single racing equation with one variable parameter suffice to predict record times, speeds, energy, power, and endurance accurately for cycling, running, and swimming, provided only that performance be categorized as steady-state, aerobic effort.

[Evaluation of methods for preparing chicken feces from the veterinary hygienic aspect]. / Bewertung von Verfahren der Aufbereitung von Hühnerkot aus veterinärhygienischer Sicht.

Fresh and dried faeces of laying hens from battery fattening and faeces from complete confinement rearing were investigated with bacteriological and physico-chemical methods. The comparison shows that ventilated faeces from conveyor belts with significantly higher values of the autochthonous faecal flora (endogerms, coliform germs, faecal streptococci) are most unfavourable from an epidemiological-bacteriological point of view. Salmonellae occurred very frequently both in fresh faeces (in 76.9% of the samples) and in ventilated faeces from conveyor belts (in 83.9% of the samples), whereas this agent was only detectable in 1.9% of the samples of faeces from complete refinement rearing. Fifteen serovar were isolated, most frequently S. enteritidis (29.4%), but S. typhimurium only once (1.96%). The highest amount of salmonellae germs was found with 105 g in faeces from conveyor belts. There are no objections to the direct utilization of faeces as fertilizers from an epidemiological point of view. For epidemiological reasons, ventilated faeces from conveyor belts should not be directly sprayed over the soil. After air-drying in henhouses, these faeces should be stored and composted before they are used in agriculture. It was not possible to cultivate salmonellae and E. coli in summer and winter after the composting of dried hens' faeces. The salmonellae were no longer detectable from the 4th day onwards, native salmonellae from the 7th day (summer) and the 25th day (winter) onwards, and E. coli from the 88th day onwards. If all parameters, particularly the grain size, are observed, an epidemiologically perfect product comes into being after the fast drying of faeces.

[Hygienic-bacteriologic evaluation of methods for production of dry poultry feces manure]. / Hygienisch-bakteriologische Bewertung von Verfahren zur Behandlung von Hühnertrockenkot.

The application of procedures with dry faeces and the technologies of utilizing faeces for the production of fertilizers on the basis of these procedures are gaining importance, particularly in the confinement of laying hens. However, homogeneous criteria for the assessment of these procedures from a hygienic point of view are not yet available. Since salmonellae are the highest infection risk in layer faeces, freedom from salmonellae is the decisive criterion for epidemic-hygienic harmlessness. The indicators salmonellae and E. coli are recommended for assessing the composting of layer faeces. The product should be free of salmonellae and E. coli. Furthermore, the temperature of the product, the dry substance and the pH value should be registered since these parameters correlated with the potential indicators of hygiene. S. enteritidis had a particularly high tenacity in layer faeces. Fresh and dried faeces and layer faeces from battery management and faeces from intensive floor management were investigated and compared with bacteriological and physicochemical methods. The chemical and bacteriological findings were in good accordance with data from the literature. However, the frequent occurrence of salmonellae in the faeces of clinically healthy flocks is described for the first time. Salmonellae were isolated from 83.9% of the samples from battery management and from 1.9% of the samples from floor management. A total number of 15 salmonellae serovars, most frequently of S. enteritidis, occurred in cage management. The production of dry faeces by means of the aeration of the conveyor belt seems to be less favourable than the production of dry faeces in intensive floor management. Salmonellae and E. coli could not be cultured any more after the clamp composting of layer faeces from the conveyor belt under summer and winter conditions. Minimum conditions which led to the death of native salmonellae were a rise of the pH value of > 9.0 over days, with the temperature of the product in the compost heaps amounting to at least 18.4 degrees C. Test salmonellae could not be cultured from compost heaps of dry layer faeces from the 4th day onwards, native salmonellae from the 7th day onwards (summer) and the 25th day onwards (winter) and E. coli from the 88th day onwards. Layer faeces from conveyor belts must be composted before their utilization as fertilizers since they can contain high concentrations of native salmonellae even in healthy flocks of laying hens. According to the available results, it is sufficient to store the faeces at least 12 weeks outdoors. The resetting of clamps is not necessary. This period might be shorter in summer.

[Case reports of Davos avalanche accidents 1972/73-1987/88]. / Kasuistik der Davoser Lawinenunfälle 1972/73-1987/88.

The main aim of this analysis was to study from different point of views the registered accidents in whom people were involved caused by avalanches during the winter-periods 1972/73 to 1987/88. As a result of this study a Swiss register for all accidents caused by avalanches was produced. The final goal of the register is to compile centralized a most complete database on all the details of either the avalanche victims or of the accidents themselves. This database is to be used for further analysis of the accidents in order to provide more background information to discuss and to improve the primary care of these patients.

[Acute carpal tunnel syndrome and tendon rupture of the long flexor muscle of the thumb as a rare complication of a scaphoid pseudoarthrosis. Case report]. / Akutes Karpaltunnelsyndrom und Ruptur der Sehne des M. flexor pollicis longus als seltene Komplikation einer Skaphoidpseudarthrose. Fallbericht.

The authors demonstrate a case of a scaphoid pseudarthrosis leading to an attrition rupture of the flexor pollicis longus tendon, tenosynovitis and haemorrhage into the carpal tunnel causing recurrent symptoms of an acute carpal tunnel syndrome. Every acute carpal tunnel syndrome is an emergency requiring instant decompression of the carpal tunnel. If success with conservative treatment of acute carpal tunnel syndrome is questionable, early operative relief of the median nerve is the safest procedure.

[On the problem of air activation in megavoltage therapy with 15 to 20 MeV (author's transl)]. / Zum Problem der Luftaktivierung bei der Megavolttherapie mit 15 bis 20 MeV.

During the operation of therapeutic linear accelerators using energies above 15 MeV the critical value of radioactive pollution in the exhaust air may be exceeded in case of extreme conditions. Methods for calculation and limitation of the activity in the air are described.

[Blood bactericidal activity in calves]. / Untersuchungen zur Serumbakterizidie beim Kalb.

Methodical aspects relating to determination of serum-bactericidal capacities were studied, with the view to using them to test the bearing of abiotic environmental factors on defence mechanisms against infections. Communicated are methodical experience by which to enhance the methods used to higher accuracy as well as experience regarding biological variance in calf and results obtained from follow-up checks in which antigens were systematically used. Reference is made also to other methodical issues. The method actually used to determine serum-bactericidal capacity was found to be suitable for an assessment of reactivity of infection defence in calf for its good accuracy. Follow-up checks, using antigens, will enable better assessment of the action of abiotic environmental factors on the complex defence system of calf.

[Blood bactericidal activity in calves under various lighting regimes]. / Untersuchungen zur Serumbakterizidie beim Kalb unter dem Einfluss verschiedener Lichtregime.

Reported in this paper are the effects of varying lighting regimes on serum-bactericide capacity of calves, aged between 3 and 15 weeks. The results, first of all, have shown that the serum-bactericide system is affected by visible light. The reactivity of the complex defence system is reduced by extremely short days, as compared to extremely long days, with the animals being exposed to something between 80 and 100 lx, round the clock. Extremely long days were found to have positive effects on adaptation to changing environmental conditions, but negative effects of other abiotic factors of the environment could not be offset by visible light. Substitution of artificial light for natural light did not bring about any disadvantageous effects upon immunological reactivity of calves, aged between 3 and 15 weeks, under the authors' experimental conditions. Therefore, production in windowless structures is possible without any risk, provided that the fattening animals are kept in a properly controlled artificial light regime.

Inhibition of catecholamine release from the adrenal medulla by halothane. Site and mechanism of action.

In isolated bovine adrenals perfused with Locke solution in a retrograde fashion we investigated the effects of halothane on the catecholamine release evoked by various secretagogues. 1. The catecholamine release induced by activation of the nicotinic receptors on the chromaffin cells with 1,1-dimethyl-4-phenylpiperazinium was almost completely inhibited (by about 90%) by 1.4 X 10(-3) M halothane. 2. It was shown by means of cumulative concentration-response curves of acetylcholine for its stimulating effect on catecholamine release (pD2 = 4.04) that halothane was a non-competitive antagonist (pD'2 = 3.17). 3. Halothane (1.4 X 10(-3) and 4.3 X 10(-3) M) did not decrease the catecholamine secretion in response to pilocarpine or histamine. 4. The 5-hydroxytryptamine-induced catecholamine release was not impaired by 1.4 X 10(-3) M halothane, but was significantly inhibited (by 44%) by 4.3 X 10(-3) M halothane. 5. At 1.4 X 10(-3) M halothane the catecholamine release induced by gamma-aminobutyric acid (GABA) was inhibited by 40%. 4.3 X 10(-3) M halothane completely blocked the secretion induced by GABA. 6. The catecholamine secretion in response to 56 mM KCl or to introduction of CaCl2 after perfusion with Locke solution deficient in CaCl2 was not reduced by halothane (1.4 X 10(-3) and 1.4 X 10(-2) M). 7. Halothane (1.4 X 10(-3) M) did not inhibit the catecholamine release evoked by acetaldehyde or tyramine from glands perfused with Ca2+ -free Locke solution throughout the experiments. It is concluded that the site of action of halothane is the cell membrane of the chromaffin cell. The anaesthetic does not impair the permeability of the membrane to calcium ions. Halothane may cause a conformational change of membrane proteins, particularly of the nicotinic receptor (and at higher concentrations of GABA and 5-hydroxytryptamine receptors); thus, stimulation may be prevented by an inhibition of agonist-receptor interaction.