The aspects of sex, age and nationality in winter swimming performance.

OBJECTIVE: Winter swimming is a new sport discipline. Very little is known, however, about the sex differences, origin, participation and performance of the world's best winter swimmers. Therefore, the study aimed to investigate sex differences in performance and age. Furthermore, it should be determined which country has the fastest swimmers, the highest numbers of participants and the most successful age group athletes in winter swimming. SUBJECTS AND METHODS: A total of 6,477 results from the 25 m events of the IWSA (International Winter Swimming Association) World Cups from 2016-2020 was collected from the official website of IWSA. Data were analyzed using a generalized linear model (GLM) with a gamma probability distribution and identity link function. The 25 m events were carried out in head-up breaststroke style, freestyle and butterfly. The nationalities were grouped into six groups, the five nationalities with the highest number of participants in the 25 m competitions and one group with the other nationalities. The mean time of 25 m races by sex and country of the total sample was compared. For the top 10 comparisons, the best ten athletes from the six groups were selected. The mean time of each top 10 groups was compared by sex and nationality. RESULTS: Men were faster than women for all categories. Swimmers in age group 15-29 years were the fastest, where females were the fastest in age group 15-19 years and males in age group 20-29 years. Women from both Russia and Estonia and men from both Russia and China were the fastest. Both Russian and Chinese males were the fastest in all water categories in the top 10 section in the 25 m events. CONCLUSIONS: In summary, males were faster than females in the IWSA World Cups between 2016 and 2020. The age group of 15-29 years old athletes was the most successful while females had their age of peak performance earlier than males. Russian and Estonian males and Russian females were the overall fastest in the 25 m events in all water categories. Future studies should investigate the optimal anthropometric characteristics of male and female winter swimming sprint athletes and whether there are distinct areas in Russia, Estonia and China, where many international winter swimming athletes originate.

Shorter and sweeter: the 16-item version of the SRS questionnaire shows better structural validity than the 20-item version in young patients with spinal deformity.

PURPOSE: In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger (< 20y) patients, for whom the questionnaire was originally designed, is not currently known. METHODS: Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit. RESULTS: Compared with the 20-item version, the 16-item solution significantly increased the fit (p < 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French. CONCLUSION: In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged.

Comparison of clinical outcomes of edoxaban versus apixaban, dabigatran, rivaroxaban, and vitamin K antagonists in patients with atrial fibrillation in Germany: A real-world cohort study.

BACKGROUND: The aim of the study was to compare the real-world effectiveness and safety in atrial fibrillation (AF) patients treated with edoxaban versus other oral anticoagulants (OACs) (apixaban, dabigatran, rivaroxaban, and vitamin K antagonists [VKA]) in Germany. METHODS AND RESULTS: Using a representative database of 3.5 million statutory health-insured lives in Germany, a retrospective cohort study was conducted to examine ischemic stroke (IS) or systemic embolism (SE) and major bleeding in AF patients initiating anticoagulant therapy from January 2014 through June 2017. Inverse probability of treatment weighting using propensity score was applied for baseline covariate adjustment. Cox proportional hazards models were used to estimate the adjusted risk (hazard ratio [HR]) of each outcome comparing edoxaban versus other OACs. Among 21,038 patients treated with OACs, 1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA patients were included. The adjusted combined risks of IS or SE were lower (p < 0.05) for each edoxaban pairwise comparison with other OACs (HR: 0.83 vs. apixaban, 0.60 vs. dabigatran, 0.72 vs. rivaroxaban, 0.64 vs. VKA). Edoxaban favored lower risks of major bleeding compared with rivaroxaban (HR: 0.74) and VKA (HR: 0.47). No differences in the risk of major bleeding were found between edoxaban and apixaban (p = 0.33), and between edoxaban and dabigatran (p = 0.06). CONCLUSIONS: Edoxaban was associated with better effectiveness compared with other OACs in AF patients from Germany. Edoxaban also demonstrated a favorable safety profile.

Erratum: Increased blood pressure and impaired endothelial function after accelerated growth in IVF/ICSI children.

[This corrects the article DOI: 10.1093/hropen/hoz037.].

Socio-ecological determinants of lifestyle behavior of women with overweight or obesity before, during and after pregnancy: qualitative interview analysis in the Netherlands.

BACKGROUND: Maternal overweight and obesity are related to several health risks in the periods before, during and after pregnancy including a higher risk of gestational diabetes mellitus, preeclampsia and preterm birth. At the same time, women's daily life quickly changes in these periods. Therefore, we hypothesize that the value of determinants of lifestyle behavior within different levels of the socio-ecological model differ accordingly and influence lifestyle behavior. These dynamics of determinants of lifestyle behavior in the periods before, during and after pregnancy are unexplored and therefore evaluated in this study. These insights are needed to offer appropriate guidance to improve lifestyle in women of childbearing age. METHODS: Individual semi-structured interviews were conducted before, during or after pregnancy in 26 women with overweight or obesity living in the Netherlands. Questions covered all levels of the socio-ecological model, i.e. intrapersonal, interpersonal, institutional and environmental/societal. All interviews were transcribed and coded. RESULTS: Determinants at all levels of the socio-ecological model were perceived as relevant by women of childbearing age. Various determinants were mentioned including knowledge of a healthy lifestyle, social support, access to customized lifestyle guidance, and distance to healthy lifestyle supporting activities. The importance women attributed to determinants differed between the periods before, during and after pregnancy. Before pregnancy, child's wellbeing as motivator for adopting a healthy lifestyle was mentioned less frequently than during and after pregnancy. Women described that the interplay and balance between determinants varied on a daily basis, and not merely per period. This was often expressed as fluctuation in energy level per day which influences their willingness to put effort in making healthy choices. CONCLUSIONS: Findings of this study confirm the importance of determinants at multiple socio-ecological levels for shaping lifestyle behavior in women of childbearing age. The findings add to current insights that the perceived importance of determinants and their interplay differ before, during and after pregnancy. They influence lifestyle behavior decisions, not only per period but even on a daily basis, in particular in this phase of life. This perspective can be helpful in optimizing lifestyle guidance for women of childbearing age in order to prevent perinatal complications.

Increased blood pressure and impaired endothelial function after accelerated growth in IVF/ICSI children.

STUDY QUESTION: What is the effect of growth velocity (height and weight) in early infancy on metabolic end-points and endothelial function in children born after ART? SUMMARY ANSWER: Neonatal, infant and childhood growth is positively related to blood pressure in 9-year-old IVF/ICSI offspring, while growth in childhood was negatively associated with endothelial function. WHAT IS KNOWN ALREADY: Offspring of pregnancies conceived after ART are at risk for later cardiometabolic risk factors. It is well established that early growth is related to numerous later cardiometabolic risk factors such as high blood pressure. This concept is known as the Developmental Origin of Health and Disease theory. STUDY DESIGN SIZE DURATION: The relation between early growth and later cardiometabolic risk profile was studied in the MEDIUM-KIDS study, a prospective observational cohort study in children born after an IVF/ICSI treatment. In 131 children (48.1% males) at the average age of 9.4 years, cardiometabolic outcomes were assessed and growth data from birth until age 9 years were collected from child welfare centers. PARTICIPANTS/MATERIALS SETTINGS METHODS: The following cardiometabolic outcomes were assessed: blood pressure, skinfolds, lipid spectrum, hair cortisone and glucose and insulin levels. Data on maximum skin perfusion after transdermal delivery of acetylcholine as a measure of endothelial function were collected.Growth charts were obtained electronically from child welfare centers, which offer free consultations and vaccinations to all Dutch children. At these centers, height and weight are recorded at predefined ages. Growth was defined as z-score difference in weight between two time points. Multivariable linear regression analysis was used to model the relation between growth and cardiometabolic outcomes. The following growth windows were -studied simultaneously in each model: 0-1 month, 1-3 months, 3-6 months, 6-11 months, 11-24 months and 2-6 years. The model was adjusted for height growth in all intervals except for 0-1 month. MAIN RESULTS AND THE ROLE OF CHANCE: In multivariable linear regression analyses, multiple growth windows were positively associated with blood pressure, for example growth from 2-6 years was significantly related to systolic blood pressure: B = 4.13, P = 0.005. Maximum skin perfusion after acetylcholine was negatively associated with height-adjusted weight gain from 2 to 6 years: B = -0.09 (log scale), P = 0.03. Several growth windows (weight 1-3 months, 3-6 months, 6-11 months, 11-24 months, 2-6 years) were positively linked with total adiposity. Lipids, glucose tolerance indices and cortisone were not related to growth. LIMITATIONS REASONS FOR CAUTION: This study is of modest size and of observational nature, and we did not include a control group. Therefore, we cannot assess whether the observed associations are causal. It is also not possible to analyze if our observations are specific for, or exacerbated in, the ART population. Ideally, a control group of naturally conceived siblings of IVF/ICSI children should simultaneously be studied to address this limitation and to assess the impact of the ART procedure without the influence of parental (subfertility) characteristics. WIDER IMPLICATIONS OF THE FINDINGS: The results of this study contribute to our understanding of the reported increased risk for hypertension in ART offspring. We speculate that early, accelerated growth may be involved in the reported increased risk for hypertension in ART offspring, with endothelial dysfunction as a possible underlying mechanism. However, additional research into the mechanisms involved is required. STUDY FUNDING/COMPETING INTERESTS: The study was financially supported by the March of Dimes, grant number #6-FY13-153. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation or writing of the paper. The authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER: NTR4220.

[Influence of Teamwork on Wellbeing And Emotional Exhaustion of Staff in German Rehabilitation Clinics]. / Einfluss von Teamarbeit auf Wohlbefinden und emotionale Erschöpfung von Mitarbeitern in der medizinischen Rehabilitation.

AIM: In the context of high prevalence rates of mental and psychosomatic disorders in the medical staff, emotional exhaustion and wellbeing are often considered as important indicators. Teamwork can have a positive influence on wellbeing of staff members. In the sector of rehabilitation, however, this is not sufficiently investigated. The aim of this study was to investigate aspects of teamwork as predictors of wellbeing and emotional exhaustion in staff at rehabilitation clinics in Germany. METHODS: Data was collected in 10 rehabilitation clinics, 9 of them could be included in the data analysis (n=306, 70% female, 68% age 40-59). Data was analyzed with multiple linear regression analyses. RESULTS: Staff reported moderate rates of emotional exhaustion and good rates of overall wellbeing. Results of the regression analysis show that cohesion (ß=0.27, p<0,001), team organization (ß=0.19, p<0,01) and age (ß=0.13, p<0,05) could predict wellbeing (F[3, 244]=19.38, p<0,05). Emotional exhaustion was predicted by cohesion (ß=- 0.37, p<0,001, F[1, 244]=39.19). CONCLUSION: Consequences of interpersonal andstructural aspects of teamwork are discussed as well as the potential relevance of interventions to improve teamwork, in order to enhance wellbeing and counteract emotional exhaustion of staff members.

A patient-centred team-coaching concept for medical rehabilitation.

Team coaching enhances teamwork and subsequently improves patient-centredness in medical rehabilitation clinics. Even though interprofessional teamwork is regarded as a crucial factor in medical rehabilitation, to date no evaluated team-coaching approaches are available for improving interprofessional teamwork in medical rehabilitation in Germany. Based on a systematic literature search and interviews with staff, managers, and patients of rehabilitation clinics, we developed a team-coaching approach that is standardized in its process but based on the individual needs and requests of each clinic. It takes a systemic perspective and is goal-oriented and solution-focused. The approach mainly serves to provide impulses to make use of resources within the team and to support a self-directed organisational learning process. It is manualized and can, therefore, be used by professionals aiming to improve interprofessional teamwork in their clinic. A multi-centre, cluster-randomized controlled study that was conducted to evaluate the team-coaching approach showed positive results. Team organization, knowledge integration, and responsibility can be improved, and, therefore, the implementation of the patient-centred team-coaching approach in interprofessional rehabilitation teams can be recommended.

[Tobacco control policies and perinatal health]. / Tabaksontmoediging en perinatale gezondheid.

OBJECTIVE: Study the association between the introduction of tobacco control policies in the Netherlands and changes in perinatal outcomes. DESIGN: National quasi-experimental study. METHOD: We used Netherlands Perinatal Registry data (now called Perined) for the period 2000-2011. We studied whether the introduction of smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign in January 2004, and extension of the smoke-free law to the hospitality industry accompanied by another tax increase and media campaign in July 2008, was associated with changes in perinatal outcomes. We studied all singleton births (gestational age: 24+0 to 42+6 weeks). Our primary outcome measures were: perinatal mortality, preterm birth and being small-for-gestational-age (SGA). Interrupted time series logistic regression analyses were performed to investigate changes in these outcomes occurred after the introduction of the aforementioned tobacco control policies (ClinicalTrials.gov: NCT02189265). RESULTS: Among 2,069,695 singleton births, 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births were observed. The policies introduced in January 2004 were not associated with significant changes in any of the primary outcome measures. A -4.4% (95% CI: -6.4 to -2.4; p < 0.001) decrease in odds of a SGA birth was observed after the policy extension in July 2008 to include a smoke-free hospitality industry, a further tax increase and another media campaign. This translates to an estimated over 500 cases of SGA being averted per year. CONCLUSION: A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to include bars and restaurants, in conjunction with a tax increase and media campaign in 2008.

Acute West Nile Virus Meningoencephalitis Diagnosed Via Metagenomic Deep Sequencing of Cerebrospinal Fluid in a Renal Transplant Patient.

Solid organ transplant patients are vulnerable to suffering neurologic complications from a wide array of viral infections and can be sentinels in the population who are first to get serious complications from emerging infections like the recent waves of arboviruses, including West Nile virus, Chikungunya virus, Zika virus, and Dengue virus. The diverse and rapidly changing landscape of possible causes of viral encephalitis poses great challenges for traditional candidate-based infectious disease diagnostics that already fail to identify a causative pathogen in approximately 50% of encephalitis cases. We present the case of a 14-year-old girl on immunosuppression for a renal transplant who presented with acute meningoencephalitis. Traditional diagnostics failed to identify an etiology. RNA extracted from her cerebrospinal fluid was subjected to unbiased metagenomic deep sequencing, enhanced with the use of a Cas9-based technique for host depletion. This analysis identified West Nile virus (WNV). Convalescent serum serologies subsequently confirmed WNV seroconversion. These results support a clear clinical role for metagenomic deep sequencing in the setting of suspected viral encephalitis, especially in the context of the high-risk transplant patient population.

[Team Development in Medical Rehabilitation: Concept and Evaluation of a Team Intervention]. / Teamentwicklung in der medizinischen Rehabilitation: Konzept und Evaluation einer Teamintervention.

AIM OF THE STUDY: Interprofessional collaboration is a main precondition of successful treatment in rehabilitation. In order to improve interprofessional collaboration, a clinic-specific, goal- and solution-oriented and systemic team development approach was designed. The aim of the study is the evaluation of this approach. METHODS: A multi-centre cluster-randomized controlled study with staff questionnaires. RESULTS: The team development could be implemented successfully in 4 of 5 clinics and led to significant improvements in team organisation, willingness to accept responsibility and knowledge integration. The effects are small and are caused by the opposed development of intervention and control group. CONCLUSIONS: The team development approach can be recommended for rehabilitation practice. A train-the-trainer approach will be developed and further studies are planned in order to disseminate the approach and to investigate the conditions of implementation.

Sustained inflation: Prophylactic or rescue maneuver?

Application of nasal continuous positive airway pressure (nCPAP) in the delivery room is a valid alternative to mechanical ventilation in the management of respiratory failure of preterm infants, with reduced occurrence of bronchopulmonary dysplasia and death. nCPAP at birth is still burdened by a high failure rate. Sustained inflation appears to be an intriguing approach to allow the respiratory transition at birth by clearing the lung fluid, thus obtaining an adequate functional residual capacity. This may enhance nCPAP success. Sustained inflation reduces the need for mechanical ventilation in the first 72 h of life, with no changes in the incidence of bronchopulmonary dysplasia and death. The efficacy of sustained inflation seems to be related to the presence of open glottis with active breathing of the infant. Further studies are needed to recommend the application of sustained inflation during delivery room management of preterm infants at risk of respiratory distress or with clinical signs of respiratory failure.

Expectations and requests regarding team training interventions to promote interdisciplinary collaboration in medical rehabilitation--A qualitative study.

BACKGROUND: Interdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation. METHODS: Considering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis. RESULTS: The exploration of team members' and clinical managers' descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions). CONCLUSIONS: The synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.

LGI Proteins and Epilepsy in Human and Animals.

Leucine-rich glioma-inactivated (LGI) protein was first thought to have a suppressor effect in the formation of some cancers. Developments in physiology and medicine made it possible to characterize the function of the LGI protein family and its crucial role in different conditions more precisely. These proteins play an important role in synaptic transmission, and dysfunction may cause hyperexcitability. Genetic mutation of LGI1 was confirmed to be the cause of autosomal dominant lateral temporal lobe epilepsy in humans. The LGI2 mutation was identified in benign familial juvenile epilepsy in Lagotto Romagnolo (LR) dogs. Cats with familial spontaneous temporal lobe epilepsy have been reported, and the etiology might be associated with LGI protein family dysfunction. In addition, an autoimmune reaction against LGI1 was detected in humans and cats with limbic encephalitis. These advances prompted a review of LGI protein function and its role in different seizure disorders.

Predictors of Ominous Outcome in Infants Undergone to Cardiac Surgery and Cardiopulmonary by-Pass: S100B Protein.

S100B protein has been recently proposed as a consolidated marker of brain damage and death in adult, children and newborn patients. The present study evaluates whether the longitudinal measurement of S100B at different perioperative time-points may be a useful tool to identify the occurrence of perioperative early death in congenital heart disease (CHD) newborns. We conducted a case-control study in 88 CHD infants, without pre-existing neurological disorders or other co-morbidities, of whom 22 were complicated by perioperative death in the first week from surgery. Control group was composed by 66 uncomplicated CHD infants matched for age at surgical procedure. Blood samples were drawn at five predetermined time-points before during and after surgery. In all CHD children, S100B values showed a pattern characterized by a significant increase in protein's concentration from hospital admission up to 24-h after procedure reaching their maximum peak (P<0.01) during cardiopulmonary by-pass and at the end of the surgical procedure. Moreover, S100B concentrations in CHD death group were significantly higher (P<0.01) than controls at all monitoring time-points. The ROC curve analysis showed that S100B measured before surgical procedure was the best predictor of perioperative death, among a series of clinical and laboratory parameters, reaching at a cut-off of 0.1 µg/L a sensitivity of 100% and a specificity of 63.7%. The present data suggest that in CHD infants biochemical monitoring in the perioperative period is becoming possible and S100B can be include among a series of parameters for adverse outcome prediction.

[Facilitators and barriers to interprofessional collaboration in rehabilitation clinics--a survey of clinical executive managers]. / Förderfaktoren und Barrieren interprofessioneller Kooperation in Rehabilitationskliniken--Eine Befragung von Führungskräften.

PURPOSE: Interprofessional collaboration is an essential feature of quality and success in medical rehabilitation, a field which is influenced by a variety of factors. It is the objective of this study to identify beneficial factors that may promote team collaboration as well as barriers which may hinder it. METHODS: The facilitators and barriers of team collaboration were identified in a cross-sectional study. We conducted guided expert interviews with 18 managers aged between 36 and 62 years (M = 49.2) in a total of 5 inpatient rehabilitation clinics. Among the surveyed managers were 5 senior physicians and 13 department head managers of the health professionals (4 head nurses,6 head therapists and 3 heads of psychological departments). The qualitative analysis of interview transcripts was carried out according to Mayring's structured content analysis approach. RESULTS: From a total of 480 coded statements,337 are concerned with factors supporting interprofessional collaboration and 143 relate to barriers.The most common statements concerning supporting factors relate to the main category "Interprofessional Coordination of Treatment".Here, for example, the existence of an overall rehabilitation concept and planning of care services with rehabilitation goals in mind are regarded as facilitating. Variables such as interactive information exchange, multilateral communication,transparent team roles, defined tasks of the entire team or of individual team members play significant roles in this context. Hindering factors and barriers to interprofessional collaboration are mentioned in particular in relation to the organization.In terms of organization, heavy workload(time pressure, high treatment frequencies,altered severity of rehabilitation needs, considerable administration costs), inadequate pay Inter and insufficient time corridors to consult within the interprofessional team are rated as limiting factors. CONCLUSION: Influencing factors on interprofessional collaboration identified in our study are similar to those named in other studies. Facilitators and barriers of interprofessional collaboration should be taken into account when guiding and managing teams.

Method for verifying the air kerma strength of I-125 plaques for the treatment of ocular melanoma.

The purpose of this work was to develop a method for easily verifying that the activity or air kerma strength of pre-assembled eye plaques, used in the treatment of ocular melanomas, agrees with the activity or air kerma strength called for in the treatment plan. A Capintec CRC-7 Dose Calibrator with its standard vial/syringe sample holder was used to measure the activity of pre-assembled COMS and Eye Physics EP917 eye plaques using IsoAid Advantage I-125 seeds. Plaque activity measurements were made by placing the plaque face up in the center of a 5 cm tall Styrofoam insert in the source holder. Activity measurements were made with the source holder rotated to four angles (0°, 90°, 180°, and 270°). The average of these four values was converted to air kerma strength and divided by the assay air kerma strength, from the NIST traceable source calibration, and decayed to the plaque measurement date, to determine a plaque calibration factor. The average of the calibration factors for each plaque type was used to establish a calibration factor for each plaque type. Several partially loaded plaque configurations were included in this study and different methods were used to determine the effects of partial loading. This verification method is easy to implement with commonly available equipment and is effective in identifying possible errors. During this two-year study, the air kerma strength of 115 eye plaques was checked and 11 possible errors were identified.

Endogenous brain protection: what the cerebral transcriptome teaches us.

Despite efforts to reduce mortality caused by stroke and perinatal asphyxia, these are still the 2nd largest cause of death worldwide in the age groups they affect. Furthermore, survivors of cerebral hypoxia-ischemia often suffer neurological morbidities. A better understanding of pathophysiological mechanisms in focal and global brain ischemia will contribute to the development of tailored therapeutic strategies. Similarly, insight into molecular pathways involved in preconditioning-induced brain protection will provide possibilities for future treatment. Microarray technology is a great tool for investigating large scale gene expression, and has been used in many experimental studies of cerebral ischemia and preconditioning to unravel molecular (patho-) physiology. However, the amount of data across microarray studies can be daunting and hard to interpret which is why we aim to provide a clear overview of available data in experimental rodent models. Findings for both injurious ischemia and preconditioning are reviewed under separate subtopics such as cellular stress, inflammation, cytoskeleton and cell signaling. Finally, we investigated the transcriptome signature of brain protection across preconditioning studies in search of transcripts that were expressed similarly across studies. Strikingly, when comparing genes discovered by single-gene analysis we observed only 15 genes present in two studies or more. We subjected these 15 transcripts to DAVID Annotation Clustering analysis to derive their shared biological meaning. Interestingly, the MAPK signaling pathway and more specifically the ERK1/2 pathway geared toward cell survival/proliferation was significantly enriched. To conclude, we advocate incorporating pathway analysis into all microarray data analysis in order to improve the detection of similarities between independently derived datasets.

[The relevance of internal and external participation for patient satisfaction]. / Die Bedeutung der internen und externen Partizipation für die Patientenzufriedenheit.

AIM OF THE STUDY: Patient satisfaction is an essential quality and outcome criteria for patient-centered treatment of chronic diseases. For successful implementation of integrated patient-centered care it is important to take the needs and expectations of the patients into consideration in the treatment process and to involve them in decision-making (external participation), as well as establishing patient-centered collaboration within the team and organization (internal participation). This study examines in what respect patient satisfaction can be predicted through parameters that focus on the personal needs of the individual or internal and external participation. METHODS: To this end we used a multicenter cross-sectional study to collect evaluations from N=329 patients with different chronic diseases in 11 rehabilitation clinics. Patient satisfaction (ZUF-8) served as the criterion, and the predictors were external participation (PEF-FB-9), satisfaction with decision-making (Man-Son-Hing Scale) and internal participation (Internal Participation Scale), socio-demographic factors and rehabilitation status (IRES-24). The data were analyzed statistically using multiple linear regression. RESULTS: A high degree of variance of patient satisfaction could be explained by the parameters applied (Goodness-of-fit: R²corrected=47.3%). The strongest predictors of satisfaction were internal participation (Beta=0.44, p<0.001) and satisfaction with the decision-making (Beta=0.36, p<0.001). CONCLUSION: The study provides initial indications of the positive effects of internal and external participation. Further studies are necessary to substantiate the connection between internal and external participation and patient satisfaction.