Ergonomic comparison of different incontinence products and effects on time and physical demands on carers.

BACKGROUND: Caregivers are at a high risk of musculoskeletal injuries. Efficiency in handling and changing patients' absorbent incontinence products may reduce the burden of caring. AIMS: This study aimed to compare various types of absorbent incontinence products from an ergonomic perspective and assess the length of time required for handling these products and the physical demand on caregivers' backs, hands and fingers. METHODS: A within-subject design was selected for two studies involving 64 experienced nurses. The first study was conducted at a test centre in Germany, while the second was performed at a hospital in France. Objective data, such as the time required to apply or change a product and physical stress on the back and hands/wrists, as well as users' subjective assessment of product handling were investigated. FINDINGS: Both objective and subjective assessments showed that elastic slips were superior to other slip products. The traditional and belted slips were the second-best products in the objective and subjective assessments respectively. CONCLUSION: Choice of incontinence product influences the time required and the physical demands associated with handling. Both aspects can be considerably reduced with the use of appropriate absorbent incontinence products.

The role of metacognitive competences in the development of school achievement among gifted adolescents.

Gifted underachievers perform worse in school than would be expected based on their high intelligence. Possible causes for underachievement are low motivational dispositions (need for cognition) and metacognitive competences. This study tested the interplay of these variables longitudinally with gifted and non-gifted students from Germany (N = 341, 137 females) in Grades 6 (M = 12.02 years at t1) and 8 (M = 14.07 years). Declarative and procedural metacognitive competences were assessed in the domain of reading comprehension. Path analyses showed incremental effects of procedural metacognition over and above intelligence on the development of school achievement in gifted students (ß = .139). Moreover, declarative metacognition and need for cognition interactively predicted procedural metacognition (ß = .169), which mediated their effect on school achievement.

Plankton respiration in the Atacama Trench region: Implications for particulate organic carbon flux into the hadal realm.

Respiration is a key process in the cycling of particulate matter and, therefore, an important control mechanism of carbon export to the ocean's interior. Most of the fixed carbon is lost in the upper ocean, and only a minor amount of organic material sustains life in the deep-sea. Conditions are particularly extreme in hadal trenches, and yet they host active biological communities. The source of organic carbon that supports them and the contribution of these communities to the ocean carbon cycle, however, remain uncertain. Here we report on size-fractionated depth profiles of plankton respiration assessed from the activity of the electron transport system in the Atacama Trench region, and provide estimates of the minimum carbon flux (FC) needed to sustain the respiratory requirements from the ocean surface to hadal waters of the trench and shallower nearby sites. Plankton < 100 µm contributed about 90% to total community respiration, whose magnitude was highly correlated with surface productivity. Remineralization rates were highest in the euphotic zone and declined sharply within intermediate oxygen-depleted waters, remaining fairly constant toward the bottom. Integrated respiration in ultra-deep waters (> 1000 m) was comparable to that found in upper layers, with 1.3 ± 0.4 mmol C m-2 d-1 being respired in the hadopelagic. The comparison between our FC models and estimates of sinking particle flux revealed a carbon imbalance through the mesopelagic that was paradoxically reduced at greater depths. We argue that large fast-sinking particles originated in the overlying surface ocean may effectively sustain the respiratory carbon demands in this ultra-deep marine environment.

A differentiation program induced by bone morphogenetic proteins 4 and 7 in endodermal epithelial cells provides the molecular basis for efficient nutrient transport by the chicken yolk sac.

BACKGROUND: The mammalian yolk sac provides nutrients for the growing fetus during critical early developmental processes such as neural tube closure, which precedes the functional maturation of the placenta. In contrast, oviparous species such as the chicken rely solely on the yolk sac for transfer of nutrients from the yolk to the developing embryo. However, the molecular mechanisms that provide the yolk sac with nutrient transfer competence remain poorly understood. RESULTS: We demonstrate that the chicken endodermal epithelial cells (EEC), which are in close contact with the yolk, gain their nutrient-transport competence by a paracrine crosstalk with the blood-vessel forming mesodermal cell layer. Bone morphogenetic proteins (BMP) 4 and 7 produced by ectodermal and mesodermal cell layers likely initiate a differentiation program of EECs during the transition from the area vitellina to the area vasculosa. BMPs, by inducing SMAD signaling, promote the up-regulation of endocytic receptor expression and thereby provide the EECs with the molecular machinery to produce triglyceride-rich lipoprotein particles. CONCLUSION: This paracrine signaling cascade may constitute the basis for the EEC-mediated mechanism underlying the efficient uptake, degradation, resynthesis, and transfer of yolk-derived nutrients into the embryonic circulation, which assures proper energy supply and development of the growing fetus.

[New AWMF guidelines for medicolegal assessment of mental and psychosomatic disorders]. / Neue AWMF-Leitlinie zur Begutachtung psychischer und psychosomatischer Störungen.

The guidelines, which were first published in 2012, were fundamentally revised by a panel of experts from 9 medical and psychological societies and published on the website of the Association of the Scientific Medical Societies in Germany in December 2019 (AWMF registration number 051-029). The guidelines contribute to interdisciplinary quality assurance when assessing applicants for insurance or other compensation benefits who claim psychological or psychosomatic illnesses with resulting functional disorders. The guidelines are divided into 3 separate parts: part I describes specific aspects of the expert examination, part II describes the criteria for assessing occupational performance capacity in terms of different legal fields and part III deals with questions of causality in cases of claimed posttraumatic mental disorders.

Patients with hypokalemia develop WNK bodies in the distal convoluted tubule of the kidney.

Hypokalemia contributes to the progression of chronic kidney disease, although a definitive pathophysiological theory to explain this remains to be established. K+ deficiency results in profound alterations in renal epithelial transport. These include an increase in salt reabsorption via the Na+-Cl- cotransporter (NCC) of the distal convoluted tubule (DCT), which minimizes electroneutral K+ loss in downstream nephron segments. In experimental conditions of dietary K+ depletion, punctate structures in the DCT containing crucial NCC-regulating kinases have been discovered in the murine DCT and termed "WNK bodies," referring to their component, with no K (lysine) kinases (WNKs). We hypothesized that in humans, WNK bodies occur in hypokalemia as well. Renal needle biopsies of patients with chronic hypokalemic nephropathy and appropriate controls were examined by histological stains and immunofluorescence. Segment- and organelle-specific marker proteins were used to characterize the intrarenal and subcellular distribution of established WNK body constituents, namely, WNKs and Ste20-related proline-alanine-rich kinase (SPAK). In both patients with hypokalemia, WNKs and SPAK concentrated in non-membrane-bound cytoplasmic regions in the DCT, consistent with prior descriptions of WNK bodies. The putative WNK bodies were located in the perinuclear region close to, but not within, the endoplasmic reticulum. They were closely adjacent to microtubules but not clustered in aggresomes. Notably, we provide the first report of WNK bodies, which are functionally challenging structures associated with K+ deficiency, in human patients.

High-Ability Grouping: Benefits for Gifted Students' Achievement Development Without Costs in Academic Self-Concept.

Effects of full-time ability grouping on students' academic self-concept (ASC) and mathematics achievement were investigated in the first 3 years of secondary school (four waves of measurement; students' average age at first wave: 10.5 years). Students were primarily from middle and upper class families living in southern Germany. The study sample comprised 148 (60% male) students from 14 gifted classes and 148 (57% male) students from 25 regular classes (matched by propensity score matching). Data analyses involved multilevel and latent growth curve analyses. Findings revealed no evidence for contrast effects of class-average achievement or assimilation effects of class type on students' ASC. ASC remained stable over time. Students in gifted classes showed higher achievement gains than students in regular classes.

Determinants of memory development in childhood and adolescence.

Research on the development of memory has a long history and constitutes one of the most active research areas in the field of cognitive development. In this article, we first describe major historical developments in the literature on children's memory, focusing on systematic research that began in the late 1960s. We then examine new developments in the field, describing four important lines of inquiry: (a) the development of implicit memory, (b) short- and long-term memory development in infancy, (c) longitudinal research on memory strategies and metamemory, and (d) developmental cognitive neuroscience of memory. Finally, promising lines of future research on memory development are briefly discussed.

[Feasibility and effects of a psychotherapeutic group intervention for caregiving relatives of people with dementia]. / Machbarkeit und Effekte einer psychotherapeutischen Gruppenintervention für pflegende Angehörige von Menschen mit Demenz.

INTRODUCTION: Family caregivers of people with dementia (PwD) have a high burden and therefore are themselves at a high risk for psychiatric and somatic morbidities. Although individual psychotherapy has been shown to be a potentially effective treatment, it is rarely used by family caregivers. Possible reasons are poor accessibility and time restrictions on the side of the caregiver. AIM: To test the efficacy of a short-term and low threshold psychotherapeutic group intervention for family caregivers of PwD with respect to mental stability of the caregivers. MATERIAL AND METHODS: Data from a 12-week psychotherapeutic group intervention (10 participants each in the intervention and control groups) were analyzed. Main topics of the intervention were: personal limits, dysfunctional thoughts, emotions and resource activation. Primary endpoints were an increase of perceived self-efficacy and reduction of depressive symptoms using SWE and ADS questionnaires before, directly and 3 months after the end of the intervention. RESULTS: A gain in perceived self-efficacy did not reach statistical significance, whereas depressive symptoms showed a statistically significant increase in the intervention group over time compared to the control group. DISCUSSION: The intervention did not reach its primary endpoints. Possible reasons are the fact that the group was highly heterogeneous with respect to dementia etiology and the low number of participants. The short duration of the intervention may have reduced the potential of the program to address all urgent needs of the participants.

High-Level Ab Initio Calculations of Intermolecular Interactions: Heavy Main-Group Element π-Interactions.

This work reports high-level ab initio calculations and a detailed analysis on the nature of intermolecular interactions of heavy main-group element compounds and π systems. For this purpose we have chosen a set of benchmark molecules of the form MR3 , in which M=As, Sb, or Bi, and R=CH3 , OCH3 , or Cl. Several methods for the description of weak intermolecular interactions are benchmarked including DFT-D, DFT-SAPT, MP2, and high-level coupled cluster methods in the DLPNO-CCSD(T) approximation. Using local energy decomposition (LED) and an analysis of the electron density, details of the nature of this interaction are unraveled. The results yield insight into the nature of dispersion and donor-acceptor interactions in this type of system, including systematic trends in the periodic table, and also provide a benchmark for dispersion interactions in heavy main-group element compounds.

Soziale Probleme in der hausärztlichen Praxis.

Social problems in primary care Objectives: Social problems appear in clinical work as well as in expert opinions for courts and insurances as a major factor in frequently chronic psychosomatic diseases, both in the professional and private environment. On the assumption that unemployed individuals show a higher risk for the development of mental and psychosomatic diseases, we investigated our hypothesis that mostly social issues lie at the center of patients' motivation for consultations. METHODS: Our questionnaire was dispatched by the Medical Association of Mecklenburg-Vorpommern (MV) to all established general practitioners in that state (n = 1025). It collected information on how social problems were handled in primary-care practices. RESULTS: The large majority of social problems in MV arise from unemployment and job-related conflicts. Doctors often evaluate these problems using pathological dimensions (medicalization) and provide certificates of disability as a "dysfunctional" approach to the problem. CONCLUSIONS: The medicalization of social problems indicates a lack of alternatives in our medical system and highlights the inadequate handling up to early retirement based on dysfunctional behavior (incorrect diagnosis, certificate of disability).

A comparative study of vitellogenesis in Echinodermata: Lessons from the sea star.

The provision of yolk precursor proteins to the oviparous egg is crucial for normal embryo development. In Echinodermata, a transferrin-like yolk component termed major yolk protein (MYP) is a major precursor protein in Echinoidea and Holothuroidea. In contrast, in Asteroidea a single vitellogenin (Vtg) was recently identified, but its role as primary yolk protein remains unclear. To resolve the apparent MYP-Vtg dichotomy in sea stars and to understand the dynamics of candidate yolk protein gene expression during the reproductive cycle, we investigated the molecular structures of sea star Vtg and MYP and quantified their transcript levels during oogenesis. By combining protein sequencing of the predominant proteins in ovulated eggs of Patiriella regularis with ovarian transcriptome sequencing and molecular cloning, we characterized two cDNAs encoding two bona fide Vtgs (PrVtg1 and PrVtg2) and a partial cDNA encoding MYP (PrMYP). PrMYP mRNA was found in low abundance in growing oocytes, possibly as maternal transcripts for translation after ovulation. In contrast, PrVtg transcripts, whose levels varied during the reproductive cycle, were not found in developing oocytes - rather, they were detected in ovarian follicle cells and pyloric caeca, indicating an extra-oocytic origin. Vtg accumulating in oocytes was stored in the form of cleaved products, which constituted the most abundant yolk polypeptides in ovulated sea star eggs; their levels decreased during early embryonic and larval development. Together, these traits are the hallmarks of a classical yolk protein - and hence, we contend that Vtg, and not MYP, is the main yolk protein in asteroids.

Universal parent training as a supplement to inpatient psychiatric treatment for children and adolescents.

Parent trainings constitute an effective method to target aspects of parenting in child and adolescent psychiatric and psychotherapeutic care. Past research has mainly been conducted in outpatient contexts, with parents of children with externalizing disorders and often included only small sample sizes. The aim of the current study was first to assess the effectiveness of a novel parent training which is characterized by a universal approach, an open group concept, and short duration, and second to identify variables that have an influence on the effectiveness. A sample of n = 151 parent-child dyads treated in an inpatient clinic was included in the study and randomly assigned to a treatment group and a waiting-list control group. As dependent measures served child behavior problems, dysfunctional parenting, parental mental health, and parental self-efficacy measured with parent-rated questionnaires prior to the training, post training and 3 months after discharge of the clinic. Additionally, a parent-child-interaction observation was conducted and rated by blind raters. Results indicated a general inpatient treatment effect on all dependent measures assessed with questionnaires. An additional effect of the parent training was only shown for parenting and parental mental health with the treatment group revealing better outcomes post training and at follow-up. No effects were found for the measures assessed by interaction observation. Out of a number of variables, only a low monthly income was associated with a higher reduction of dysfunctional parenting. Results indicate that parent training does not contribute additionally to standard inpatient care with respect to child behavior, but does have an influence on parental well-being, which might have a positive effect on the long run.

Transection of the deep metatarsal transverse ligament in Morton's neuroma surgery does not increase risk of splayfoot development.

PURPOSE: Although operative excision is regarded as the treatment of choice in Morton's neuroma, it remains unclear whether transection of deep transverse metatarsal ligament (DTML) is a risk for metatarsal splaying and whether simultaneous surgery in adjacent intermetatarsal spaces is a risk for osteonecrosis of the adjacent metatarsals. METHODS: Fifty-seven feet in 47 patients had excision of a Morton's neuroma, with a mean follow-up of 15.3 years. Feet were categorised depending upon whether the DTML was or was not divided. Pre-operative and post-operative intermetatarsal angles were measured on standardised weightbearing radiographs and inspected for evidence of osteonecrosis. RESULTS: Comparison of pre- and post-operative intermetatarsal angles in patients with surgery in the second web space showed no significant increase (transected p = 0.659, preserved p = 0.142). In regards to comparison of pre- and post-operative radiographic intermetatarsal angles in patients with surgery in the third web space, statistical analysis also did not show a significance increase (transected p = 0.240, preserved p = 0.078). Radiological assessment showed no signs of osteonecrosis of metatarsal heads, not even in cases of double-space surgery. CONCLUSIONS: In conclusion, DTML transection does not increase the intermetatarsal angle or the risk of splayfoot development. Moreover, transection is recommended due to an enhanced overview during surgery and better clinical outcome. Our data could also prove that double-space surgery is not a risk for avascular osteonecrosis.

Normative data for the American Orthopedic Foot and Ankle Society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system.

PURPOSE: Despite some theoretical reservations, the AOFAS clinical rating system with its scales for ankle-hindfoot, midfoot, hallux and lesser toes is one of the most widely used assessment tools in foot and ankle surgery. This study was designed to generate age- and gender-related norm values for all four subscales. METHODS: Despite not being used in a self-administered manner, the AOFAS score underwent cross cultural adaptation to guarantee unrestricted comparability of data. A data pool was generated using the results of personal interviews and clinical examination of 625 individuals, including staff and visitors to our hospital, and excluding people scheduled for foot surgery or in after-treatment. These data served as a basis to calculate all four parts of the AOFAS clinical rating system. RESULTS: Mean value for the ankle-hindfoot scale was calculated as 91.6 points (±0.9 confidence interval), and 89.3 points for the midfoot scale (±1.0 CI), 88.3 for the hallux metatarsophalangeal-interphalangeal scale (± 0.9 CI) and 91.0 for the lesser metatarsophalangeal-interphalangeal scale (± 0.8 CI). Results showed a decrease with age in all four scales. Males showed better results than females. Individuals with previous surgery showed lower results in the respective score. CONCLUSIONS: While lowered scoring results prior to surgery reflect the degree of restrictions due to pain, function and alignment problems, post-operative increases in clinical scoring should indicate return to age-related norm values. Our data calculated these norm values for the first time for all four AOFAS scales, giving a basis for better interpretation of published results in foot and ankle surgery. Our data showed and quantified the decrease of norm values with age, especially for hallux and lesser toes scores, as well as lower norm values for females and for individuals that had had surgery of the foot. LEVEL OF EVIDENCE: Level I, diagnostic study.

[Effectiveness of an Educator Training about the Attention-Deficit-/Hyperactivity Disorder (ADHD)]. / Wirksamkeit eines Workshops für Lehrkräfte über die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS).

The purpose of the current study was to examine the effectiveness of a workshop for teachers focussing on ADHD. A total of 44 educators answered a short version of the Knowledge of Attention Deficit Disorders Scale (KADDS) and self-report questions before, shortly after, and three month subsequent (follow-up) to a 2.5 hour long workshop. Results showed a significant increase in the educators' knowledge at post-test, which remained stable in the follow-up. Whereas uncertainties ("don't-know"-answers) decreased, heterogeneous results were found concerning the number of misconceptions. Educators upgraded their knowledge perception as well as their certainty in dealing with an affected child at post-test. The results show that even a relatively short workshop had a positive and persistent impact on educators' ADHD expertise, which illustrates the potential of such workshops.

[Relationship Between Age of School Entry and Behaviour Problems]. / Zusammenhang zwischen Einschulungsalter und Verhaltensauffälligkeiten.

Relationship Between Age of School Entry and Behaviour Problems Recent studies demonstrated that children who are relatively young within a school year show more behaviour problems, are at greater risk of being diagnosed with attention- eficit/hyperactivity disorder (ADHD) and treated with stimulants compared to their older classmates. In this paper we examine the association of age at school entry and behavioural problems for a German sample of elementary school children, who were enrolled in 2009 (N = 928). We used teacher ratings on the Strengths and Difficulties Questionnaire (SDQ) as well as the prevalence of ADHD diagnosis and medication. Our analyses showed that those children with a relatively younger age at school entry were judged more hyperactive than their older peers when sex was controlled for. After stratifying for sex, the effect of age at school entry on hyperactivity was now only significant for boys. No association with age at school entry could be found for the other SDQ-subscales as well as for ADHD diagnosis and medication. Although we could only partially demonstrate a significant relationship between age at school entry and behavioral problems in German elementary school-children, understanding these associations may help to consider children´s maturity differences when evaluating the child´s behavior.