Development and psychometric properties of a brief generic cancer knowledge scale for patients (BCKS-10).

PURPOSE: This study aims to introduce the development and psychometric properties of a brief generic cancer knowledge scale for patients (BCKS-10) that includes different elements of knowledge and skills (terminology, diagnosis, treatment, prevention, and numeracy). Although cancer knowledge is a central dimension of cancer literacy, most previous studies either investigated cancer knowledge among the general population, or among patients with a specific cancer diagnosis. METHODS: Qualitative interviews (n = 11) and a quantitative survey (n = 267) among peer support group leaders were conducted to further develop the BCKS-10 after literature screening. n = 500 patients with cancer were recruited across Germany between October 2020 and February 2021. Construct validity, item discrimination and reliability were tested. RESULTS: ANOVA revealed no significant differences of the knowledge score between various cancer sites, a significant positive association with education, and a negative association with migration background by trend supporting construct validity. In terms of item discrimination, the corrected item-total correlation of 8 out of 10 items were above the threshold of 0.3. Cronbach's alpha of about 0.68 revealed an acceptable internal consistency as the tool is brief and consists of different dimensions. CONCLUSION: Overall, the findings show that the BCKS-10 is a suitable tool to briefly assess cancer knowledge among patients independent of cancer site. However, further surveys have to be conducted to validate the psychometric properties and enhance the BCKS-10.

Function-structure connectivity in patients with severe brain injury as measured by MRI-DWI and FDG-PET.

A vast body of literature exists showing functional and structural dysfunction within the brains of patients with disorders of consciousness. However, the function (fluorodeoxyglucose FDG-PET metabolism)-structure (MRI-diffusion-weighted images; DWI) relationship and how it is affected in severely brain injured patients remains ill-defined. FDG-PET and MRI-DWI in 25 severely brain injured patients (19 Disorders of Consciousness of which 7 unresponsive wakefulness syndrome, 12 minimally conscious; 6 emergence from minimally conscious state) and 25 healthy control subjects were acquired here. Default mode network (DMN) function-structure connectivity was assessed by fractional anisotropy (FA) and metabolic standardized uptake value (SUV). As expected, a profound decline in regional metabolism and white matter integrity was found in patients as compared with healthy subjects. Furthermore, a function-structure relationship was present in brain-damaged patients between functional metabolism of inferior-parietal, precuneus, and frontal regions and structural integrity of the frontal-inferiorparietal, precuneus-inferiorparietal, thalamo-inferioparietal, and thalamofrontal tracts. When focusing on patients, a stronger relationship between structural integrity of thalamo-inferiorparietal tracts and thalamic metabolism in patients who have emerged from the minimally conscious state as compared with patients with disorders of consciousness was found. The latter finding was in line with the mesocircuit hypothesis for the emergence of consciousness. The findings showed a positive function-structure relationship within most regions of the DMN. Hum Brain Mapp 37:3707-3720, 2016. © 2016 Wiley Periodicals, Inc.

Asymmetric grazing incidence small angle x-ray scattering and anisotropic domain wall motion in obliquely grown nanocrystalline Co films.

Strong asymmetries have been observed in grazing incidence small angle x-ray scattering (GISAXS) in situ patterns obtained from 30 nm-thick nanocrystalline Co films prepared by oblique sputtering (15°-75° off-sample normal). These asymmetries have been qualitatively simulated by a simple model consisting of an ensemble of 8 nm-wide inclined Co nanocolumns. It is found that narrow inclined features appear in the diffuse background resembling those characteristic of faceted systems, which can be used to obtain straightforward non-destructive estimations of buried nanocolumnar grains inclination, even for oblique angles below 45°, when the stronger and broader asymmetric features of the pattern are not yet fully formed. Furthermore, using magneto-optical microscopy, a marked change in the magnetic domain's nucleation and growth process has been observed in the sample prepared at 75°, with the stronger GISAXS asymmetries. Easy axis magnetization reversal starts by a random and homogeneous nucleation of small (∼µm) elongated domains aligned with the nanocolumn's long axis and proceeds through the preferred propagation of head-to-head domain walls (DWs) along the applied field direction. This peculiar magnetic behavior indicates that the strongly anisotropic nanostructuring created by the oblique growth process is equivalent, from a magnetic point of view, to an array of self-assembled buried nanowires. These results show how GISAXS and magneto-optical microscopy can be combined as a powerful tool for correlating the morphology and magnetism of thin nanostructured systems.

Tunable two-color hard x-ray multilayer Bragg mirrors.

A tunable two-color multilayer Bragg coating capable of simultaneously reflecting the fundamental and the third harmonic of an x-ray free-electron laser at the same angle and with high reflectance R>0.70 is presented. The novel coating will enable two-color x-ray pump/x-ray probe experiments. This mirror consists of a Si substrate that is coated with two different types of multilayer systems, Mo/B4C layers with a periodicity of d=3. nm directly on the substrate and Ni/B4C layers with a periodicity of d=11.85 nm on top. Fundamental radiation with photon energies between 3 and 9 keV is reflected by a Ni/B4C multilayer system while the third harmonic (9 keV

Comparative study of multilayers used in monochromators for synchrotron-based coherent hard X-ray imaging.

A systematic study is presented in which multilayers of different composition (W/Si, Mo/Si, Pd/B(4)C), periodicity (from 2.5 to 5.5 nm) and number of layers have been characterized. In particular, the intrinsic quality (roughness and reflectivity) as well as the performance (homogeneity and coherence of the outgoing beam) as a monochromator for synchrotron radiation hard X-ray micro-imaging are investigated. The results indicate that the material composition is the dominating factor for the performance. By helping scientists and engineers specify the design parameters of multilayer monochromators, these results can contribute to a better exploitation of the advantages of multilayer monochromators over crystal-based devices; i.e. larger spectral bandwidth and high photon flux density, which are particularly useful for synchrotron-based micro-radiography and -tomography.

Evolution of surface morphology at the early stage of Al2O3 film growth on a rough substrate.

We present an experimental study of the evolution of the surface of a growing film as a function of the statistical parameters of the virgin substrate roughness. The growth of sputter-deposited Al(2)O(3) films onto Si substrates was followed in situ using an x-ray scattering technique. Despite the use of substrates presenting different roughness correlation length and crystallographic orientation, the evolution of the film roughness is demonstrated to obey the same scaling law, i.e., with the same static and dynamic exponents. Approaches to accurately determine the scaling exponents from x-ray scattering data are discussed.

Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition.

The number of surviving children born prematurely has increased substantially during the last 2 decades. The major goal of enteral nutrient supply to these infants is to achieve growth similar to foetal growth coupled with satisfactory functional development. The accumulation of knowledge since the previous guideline on nutrition of preterm infants from the Committee on Nutrition of the European Society of Paediatric Gastroenterology and Nutrition in 1987 has made a new guideline necessary. Thus, an ad hoc expert panel was convened by the Committee on Nutrition of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition in 2007 to make appropriate recommendations. The present guideline, of which the major recommendations are summarised here (for the full report, see http://links.lww.com/A1480), is consistent with, but not identical to, recent guidelines from the Life Sciences Research Office of the American Society for Nutritional Sciences published in 2002 and recommendations from the handbook Nutrition of the Preterm Infant. Scientific Basis and Practical Guidelines, 2nd ed, edited by Tsang et al, and published in 2005. The preferred food for premature infants is fortified human milk from the infant's own mother, or, alternatively, formula designed for premature infants. This guideline aims to provide proposed advisable ranges for nutrient intakes for stable-growing preterm infants up to a weight of approximately 1800 g, because most data are available for these infants. These recommendations are based on a considered review of available scientific reports on the subject, and on expert consensus for which the available scientific data are considered inadequate.

Increased mycophenolic acid exposure in stable kidney transplant recipients on tacrolimus as compared with those on sirolimus: implications for pharmacokinetics.

The pharmacokinetics of mycophenolic acid (MPA) was studied in 23 kidney transplant recipients with stable, long-term graft function who were receiving mycophenolate mofetil (MMF) in combination with either tacrolimus or sirolimus therapy. After 500 mg MMF, the mean MPA area under the curve (AUC) was significantly lower in sirolimus-treated patients than in those treated with tacrolimus (35.4 +/- 32.3 vs. 77.1 +/- 67.5 mg/l). MPA peak plasma concentration (C(max)) and MPA trough plasma concentration (C(min)) were significantly higher in patients who received tacrolimus than in those who received sirolimus. There were no significant differences between the two groups with respect to MPA time to maximum concentration (T(max)), MPA-glucuronide (MPAG) AUC, MPAG C(max), MPAG C(min), MPAG T(max), MPA-acyl-glucuronide (AcMPAG) AUC, AcMPAG C(max), AcMPAG C(min), and AcMPAG T(max). In conclusion, MPA exposure is greater in tacrolimus-treated patients than in those treated with sirolimus during maintenance immunosuppression after kidney transplant. It is suggested that the influence of tacrolimus on the pharmacokinetics of MPA reflects an interaction of the two agents at the level of their intestinal absorption.

Preterm infants fed fortified human milk receive less protein than they need.

OBJECTIVE: The aim of this study was to compare the actual nutrient intakes observed in a previously reported study with assumed nutrient intakes based on the customary assumptions about the composition of human milk. STUDY DESIGN: Fortified human milk is assumed to provide adequate amounts of nutrients for premature infants. This assumption holds if milk has the composition of milk expressed by mothers of premature infants during weeks 2 to 3 of lactation. The assumption does not necessarily hold for milk expressed after 2 to 3 weeks lactation. It also does not hold for donor milk, which is typically provided by mothers of term infants. The size of the disparity between assumed and actual nutrient intakes is not known. Actual nutrient intakes were available for 32 preterm infants participating in the study. Assumed nutrient intakes were calculated for these infants by substituting assumed nutrient concentrations for observed nutrient concentrations. Data were compared separately for each of the 3 study weeks. RESULT: Actual protein intakes were significantly and consistently lower than assumed protein intakes during each study week. The differences in mean intakes were large, ranging from 0.5 to 0.8 g kg(-1) per day. Differences in energy intake were small and not consistently significant. CONCLUSION: Actual intakes of protein by preterm infants fed fortified human milk are substantially lower than assumed intakes. The discrepancy may in part explain why preterm infants frequently show postnatal growth failure.

Enhancement of antiferromagnetic coupling in magnetic multilayers by low energy ion beam substrate nanopatterning.

Ion beam irradiation has been shown to be an interesting tool for tailoring the magnetic properties of thin films and multilayers. The modified properties include magnetic anisotropy, interlayer exchange coupling, exchange bias, magnetic domain structure and magnetization reversal. In this work, new results are shown concerning the enhancement, by one order of magnitude, of the antiferromagnetic coupling strength in amorphous CoSi/Si multilayers by irradiating Si(100) substrates with 1 keV Ar(+) ions. The ion beam exposure induces an increase of the substrate roughness, from 0.07 to 0.88 nm, which enhances antiferromagnetic coupling in the magnetic multilayers grown on top. One possible mechanism governing this enhancement is discussed, related to the formation of magnetic/non-magnetic regions where dipolar interactions could stabilize the antiferromagnetic alignment. The presence of non-magnetic regions is suggested by the observed trend to superparamagnetism, and is expected since the Curie temperature of the amorphous CoSi alloy used is slightly above but very close to room temperature. Accordingly, small fluctuations in the local composition, leading to an enrichment of Si, would produce non-magnetic regions enabling dipolar interactions to take place. Furthermore, the ion beam induced increase of roughness makes surface diffusion of the atoms arriving at the sample difficult, favoring the formation of local non-magnetic inhomogeneities. Finally, the role of other possible mechanisms to enhance antiferromagnetic coupling is also briefly discussed.

Reusable Laryngeal Mask Airways can be used more than 40 times.

STUDY OBJECTIVE: To compare the mechanical properties of classic, reusable Laryngeal Mask Airways (LMAs) that have been used more than 100 times with one unused LMA. DESIGN: Laboratory testing of devices used clinically. SETTING: Metropolitan university hospital. MEASUREMENTS: Cuff and tube specimens from LMAs that had been used at least 100 times were tested for elongation, tensile strength, stiffness, and tear strength using standard American Society of Testing and Materials protocols. Samples from an unused LMA were analyzed in the same manner for comparison. MAIN RESULTS: Tensile strength of the cuff samples was found to increase by approximately 25%. There was an increase in cuff stiffness and decreased tear strength similar to the manufacturer-reported trends. Cuff elongation decreased by 30%. Results for the LMA tube differed depending on whether the samples were taken in the machine direction or transverse direction. Tensile strength decreased by 30% in machine direction and, on average, very little in transverse direction. CONCLUSIONS: The material in reusable classic LMAs does not lose its strength after 100 uses to the extent that its manufacturer claims. At least 100 uses may be considered safe for these devices.

X-ray structure analysis of free-standing lipid membranes facilitated by micromachined apertures.

Silicon and Teflon substrates have been structured by wet etching and a focused ion beam (FIB) to obtain very defined, clean apertures. Planar, free-standing lipid membranes (black lipid membranes (BLM)) with enhanced long-term stability have been prepared on these apertures by the methods of Montal and Müller(1,2) as well as Müller and Rudin.(3) The stability and geometric control enables the use of X-ray analysis of free-standing single bilayers. With the presented setup, simultaneous structural and electrophysiological measurements will become feasible.

[Chronic renal failure and transplantation]. / Chronische Niereninsuffizienz und Transplantation.

Kidney transplantation is the best option for all patients with terminal renal failure. Kidney transplantation is not only associated with an improved quality of life in comparison to all other renal replacement therapies, this method also offers a significantly extended lifespan. Therefore, the option for transplantation has to be verified for every patient with renal failure. Graft and patient survival is best when transplantation is carried out just before starting dialysis treatment. Realistically, only living donor transplantation offers the option of sparing the recipient a long waiting period on dialysis. Although transplantation from living donors is superior to cadaveric kidney transplantation, a small risk remains for the donor. Kidney transplantation and the immunosuppressive therapy are associated with an increased risk for certain types of infection, an increased tumour risk and an increased risk for cardiovascular complications. To address these problems, specific recommendations for patient surveillance have been provided by different transplantation societies.

The paxpress airway causes more pharyngeal irritation than the reusable laryngeal mask airway.

This study aimed to determine whether the PAXpress airway (Vital Signs, Totawa, NJ) should replace the standard laryngeal mask airway (LMA Classic) in our practice. Records of patients who had been ventilated with a PAXpress airway or an LMA were examined. Responses of patients in the postanesthesia care unit (PACU) or from routine postoperative calls the following day were noted. Insertion of the airway was easy in all of the LMA patients but in only 20% of the PAXpress patients. Blood was noticed on 27% (4/15) of the PAXpress airways but on none of the LMAs. None of the LMA patients complained of pharyngeal soreness in the PACU, whereas 33% (5/15) in the PAXpress group had a sore throat. The next day, only 2 patients in the LMA group (13%) complained of a slightly sore throat. In the PAXpress group, all but 2 of the 13 patients interviewed (85%) reported a sore throat. The average degree of soreness for this group (4.5) was significantly higher than that reported in the LMA group (P < .001). The PAXpress airway is more likely to cause irritation (often severe) of the airway and, therefore, should not replace the standard LMA in our practice.

Temporospatial coupling of networked synaptic activation of AMPA-type glutamate receptor channels and calcium transients in cultured motoneurons.

AMPA-type glutamate receptor (GluR) channels provide fast excitatory synaptic transmission in the CNS, but mediate also cytotoxic insults. It could be shown that AMPA-type GluR channel-mediated chronic excitotoxicity leads to an increased intracellular calcium concentration and plays an important role in neurodegenerative diseases like for example amyotrophic lateral sclerosis (ALS). As calcium is an important mediator of various processes in the cell and calcium signals have to be very precise in the temporospatial resolution, excessive intracellular calcium increases can seriously impair cell function. It is still unclear if AMPA-type receptors can directly interact with the intracellular calcium homeostasis or if other mechanisms are involved in this process. The objective of this study was therefore to investigate the calcium homeostasis in rat motoneurons under physiological stimulation of AMPA-type GluR channels using calcium imaging techniques and patch-clamp recordings simultaneously. It was found that spontaneous excitatory postsynaptic currents of cultured motoneurons did not elicit significant intracellular calcium transients. Large intracellular calcium transients occurred only when preceding fast sodium currents were observed. Pharmacological experiments showed that activation of AMPA-type GluR channels during synaptic transmission has a great functional impact on the calcium homeostasis in motoneurons as all kinds of activity was completely blocked by application of the selective kainate- and AMPA-type GluR channel blocker 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). Furthermore we suggest from our experiments that calcium transients of several hundred milliseconds' duration result from release of calcium from the endoplasmic reticulum via activation of ryanodine receptors (calcium-induced calcium release, CICR). Our results help to understand the regulatory function of AMPA-type GluR channels in the intracellular calcium homeostasis which is known to be disturbed in neurodegenerative diseases.

Adjustable fortification of human milk fed to preterm infants: does it make a difference?

BACKGROUND: Inadequate nutrition leading to growth failure is common among premature infants. Although fortified breast milk (breast milk plus commercially prepared fortifier) is the preferred feeding, nutrient intakes achieved with fortified breast milk fall short of meeting nutrient needs. This is mainly due to inadequate protein content of fortifiers and variability in composition of expressed breast milk. OBJECTIVE: A new adjustable fortification regimen has been designed to ensure that protein needs of premature infants are met at all times. The new regimen encompasses increasing the amount of fortifier and adding extra protein to breast milk guided by periodic determinations of blood urea nitrogen (BUN). The study tested the hypothesis that infants fed according to the new regimen have higher protein intakes and improved weight gain compared to infants fed according to standard fortification regimen. METHODS: In a prospective, controlled trial, preterm infants with birth weights of 600-1750 g and gestational ages between 26 and 34 weeks were fed their own mother's milk or banked donor milk or both. Infants were randomly assigned before 21 days of age to either the new adjustable fortification regimen or the standard regimen. The study period began when feeding volume reached 150 ml/kg/day and ended when infants reached a weight of 2000 g. Standard fortification (STD) consisted in the use of the recommended amount of fortifier. Adjustable fortification (ADJ) consisted in the use, in addition to standard fortification, of extra fortifier and supplemental protein guided by twice-weekly BUN determinations. The primary outcome was weight gain, with serum biochemical indicators and nutrient intakes as secondary outcomes. RESULTS: Thirty-two infants completed the study as planned (16 ADJ, 16 STD). Infants receiving the ADJ regimen had mean protein intakes of 2.9, 3.2 and 3.4 g/kg/day, respectively, in weeks 1, 2 and 3, whereas infants receiving the STD regimen had intakes of 2.9, 2.9, 2.8 g/kg/day, respectively. Infants on the ADJ regimen showed significantly greater gain in weight (17.5+/-3.0 vs 14.4+/-3.0 g/kg/day, P<0.01) and greater gain in head circumference (1.4+/-0.3 vs 1.0+/-0.3; P<0.05) than infants on the STD regimen. Weight and head circumference gain were significantly (P<0.05) correlated with protein intake. No significant correlations were found between growth parameters and intake of fat and energy. There were no significant differences between groups in BUN and other serum chemical values. In the ADJ group, BUN concentrations increased significantly (P<0.001) over time but were not significantly higher than in the STD group. CONCLUSION: Premature infants managed with the new adjustable fortification regimen had significantly higher weight and head circumference gains than infants managed with standard fortification. Higher protein intake appears to have been primarily responsible for the improved growth with the adjustable regimen. The new fortification method could be a solution to the problem of protein undernutrition among premature infants fed human milk.

Reliability of cochlear implants.

BACKGROUND: The long-term reliability of cochlear implants over time is an important issue for patients and cochlear implant teams. The calculation of cumulative survival rates including all hard failures of cochlear implants is suitable to report objectively about cochlear implant reliability. METHODS: This is a report of 192 cochlear implants from different manufacturers in adults (n = 58) and children (n = 134). RESULTS: The overall cumulative implant survival rate was 91.7% for a period of 11 years. The main reasons for hard failures were design errors of the products and direct or indirect trauma to the cochlea implant site (especially in children) with consecutive breaks of the implant body or electrodes. CONCLUSIONS: To improve our knowledge about reliability of cochlear implants more studies on cumulative long time survival of cochlear implants are needed, where functional failures and complications for whatever reason (design, mechanical, electronic, medical) are included. Cochlear implant reliability data should be considered during the choice of an implant for each individual patient.

Immunohistochemical localization of cyclooxygenase isoforms in the organ of Corti and the spiral ganglion cells of guinea pig cochlea.

Prostaglandins have been used in experimental models and clinical studies for the therapy of sudden hearing loss and tinnitus with conflicting results. However, little is known about the rate-limiting enzymes of prostaglandin synthesis in the inner ear, the generally constitutively expressed cyclooxygenase 1 (COX-1) and the distress-inducible cyclooxygenase 2 (COX-2). To extend our knowledge concerning the physiological expression and localization of these two enzymes, immunohistochemical stainings of the guinea pig cochlea were performed. Light microscopical analysis revealed a homogenous distribution of COX-1 within nearly all cell types of the organ of Corti, but no COX-1 expression in the cuticular plates of pillar cells. COX-2 was found to be expressed in all cell types, with much stronger expression in Hensen cells, neighboring Deiters cells and cuticular plates of outer hair cells. Both COX-1 and COX-2 immunoreactions were also found in the spiral ganglion. We conclude that both COX subtypes are expressed in the guinea pig cochlea under physiological conditions. The prominent expression of the distress-inducible COX-2 isoform in cell types under mechanical stress during noise reception might support the hypothesis of a cytoprotective function of COX products in hearing and in cellular stress situations like intense noise exposure.