An Ergonomic Risk Assessment of Ophthalmology Residents Using the Rapid Entire Body Assessment (REBA) Scale

BACKGROUND

The healthcare industry has one of the highest rates of work-related injuries. Ophthalmologists are at particularly high risk for developing musculoskeletal disorders (MSDs), which are often the result of repetitive movements, such as performing slit lamp examinations. Previous studies used the Rapid Entire Body Assessment (REBA) scale to determine the ergonomic risk of a particular task. Higher REBA scores correlate with increased risk of injury, which ranges from negligible risk (1) to very high risk (11+).

OBJECTIVE

Given the long-term implications of repetitive examinations by ophthalmologists, this study aims to describe the average ergonomic risk posed to residents using the REBA scale.

METHODS

This descriptive case study assessed four ophthalmology residents performing slit lamp examinations between September 2022 and February 2023. Photographs were taken of residents performing slit lamp examinations. Total REBA scores, Score A, Score B, and the REBA scores for each participant were calculated and compared.

RESULTS

The average REBA score across all participants was 4.59 (SD±0.89). The highest score was 7.00 and the lowest was 3.00. The average Score A, representing posture for the head, leg, and trunk, was 3.54 (SD±0.74) and the average Score B, representing posture for the upper arm, lower arm, and wrist, was 3.18 (SD±1.22).

CONCLUSION

Our study found that residents are at increased risk for developing MSDs. Furthermore, variation in REBA scores between residents indicates that not all residents are at equal ergonomic risk. This highlights an opportunity for ophthalmology residency programs to implement ergonomics training into their curriculum.

Measurement of polarization observables T, P, and H in π0 and η photoproduction off quasi-free nucleons

The target asymmetry T, recoil asymmetry P, and beam-target double polarization observable H were determined in exclusive π 0 and η photoproduction off quasi-free protons and, for the first time, off quasi-free neutrons. The experiment was performed at the electron stretcher accelerator ELSA in Bonn, Germany, with the Crystal Barrel/TAPS detector setup, using a linearly polarized photon beam and a transversely polarized deuterated butanol target. Effects from the Fermi motion of the nucleons within deuterium were removed by a full kinematic reconstruction of the final state invariant mass. A comparison of the data obtained on the proton and on the neutron provides new insight into the isospin structure of the electromagnetic excitation of the nucleon. Earlier measurements of polarization observables in the γ p → π 0 p and γ p → η p reactions are confirmed. The data obtained on the neutron are of particular relevance for clarifying the origin of the narrow structure in the η n system at W = 1.68 GeV . A comparison with recent partial wave analyses favors the interpretation of this structure as arising from interference of the S 11 ( 1535 ) and S 11 ( 1650 ) resonances within the S 11 -partial wave.

[Pathological Lesions and Fractures of the Proximal Femur]

PURPOSE OF THE STUDY The aim of the study was to determine the incidence of primary malignancies metastasizing to the area of the proximal femur, to evaluate the localization of the lesions and fractures, to compare the results of the selected surgical therapy, survival time of the patients and postoperative complications. MATERIAL AND METHODS We retrospectively evaluated the group of patients operated on from 2012 to 2021. The study included 45 patients (24 women and 21 men) with a pathological lesion or a pathological fracture in the area of the proximal femur. The average age was 67 years (38-90). There were 30 (67%) cases of pathological fracture and 15 (33%) cases of pathological lesions in the cohort. In each patient, the perioperative biopsy or resected sample was sent for histological examination. The type of primary malignancy with the localization of lesions and fractures was assessed. Furthermore, we evaluated the outcomes of the surgical method chosen and its complications. We monitored the patients' functional score using the Karnofsky performance status and survival interval. RESULTS The most common primary malignancy was multiple myeloma in 10 cases (22%), followed by seven cases (16%) of breast and lung cancer and 6 cases (13%) of clear cell renal cell carcinoma. Internal fixation was used in 15 cases (33%). Tumor resection with hip joint replacement was performed in 29 patients (64%). One patient was treated with percutaneous femoroplasty. Out of a total of 45 patients, 10 patients (22%) survived for less than three months. The survival rate of more than one year was observed in 21 patients (47%). A total of seven complications occurred in six patients (15%). Fewer complications occurred in the group of patients with a pathological fracture compared to the group with an impending fracture. DISCUSSION Pathological lesions in the bone or an already existing pathological fracture are signs of advanced cancer. Better outcomes are reported in patients who underwent prophylactic surgery, which was, however, not confirmed by our study. The incidence of individual primary malignancies, the postoperative complications and the patient survival corresponded to the statistical data reported by the other authors. CONCLUSIONS In patients with a pathological lesion of the proximal femur, operative treatment will increase the quality of life, either when choosing osteosynthesis or joint replacement, while prophylactic treatment is usually associated with a better prognosis. As a less invasive procedure with lower blood loss, osteosynthesis is indicated for palliative therapy in patients with a limited expected survival time or in patients with a prognosis of healing of the lesion. Reconstruction of the joint with an arthroplasty is indicated in patients with a better prognosis or in cases excluding safe osteosynthesis. Our study confirmed good outcomes with the use of an uncemented revision femoral component. Key words: metastasis, osteolysis, pathological fracture, proximal femur.

Making a difference in the real world. User-centred impact evaluation of an eight-country, community-based early childhood programme

This paper presents a unique approach to the Impact Evaluation of a project that focused on low-threshold intergenerational play-based interactions in order to support young children from marginalised communities in eight European countries. The approach builds upon the work of Fetterman's Empowerment Evaluation and Patton's Utilization Focused Evaluation and brings them together to form an adapted model of evaluation. We outline in this paper how these two well developed methods of evaluation have been applied to a real world context, that is, the impact evaluation of a complex international project. Our approach highlights the complexities of differing contexts and allows for surprising and unintended consequences to emerge. It results, through double loop learning, a type of feedback loop with the internal stakeholders and implementers that is useful to the project coordination team, with a view to further upscaling of the initiative. Recommendations for policy at local, national and European Union levels were provided to the project and potential external users. However, the predominant feedback was provided at two crucial points along the way; during a stakeholder mapping exercise and during the further development of monitoring data tools.

Multimodal guided wave inversion for arterial stiffness: methodology and validation in phantoms

Arterial stiffness is an important biomarker for many cardiovascular diseases. Shear wave elastography is a recent technique aimed at estimating local arterial stiffness using guided wave inversion (GWI), i.e. matching the computed and measured wave dispersion. This paper develops and validates a new GWI approach by synthesizing various recent observations and algorithms: (a) refinements to signal processing to obtain more accurate experimental dispersion curves; (b) an efficient forward model to compute theoretical dispersion curves for immersed, incompressible cylindrical waveguides; (c) an optimization framework based on the recent observation that the measured dispersion curve is multimodal, i.e. it matches for not one but two different wave modes in two different frequency ranges. The resulting inversion approach is validated using extensive experimental data from rubber tube phantoms, not only for modulus estimation but also to simultaneously estimate modulus and wall thickness. The observations indicate that the modulus estimates are best performed with the information on wall thickness. The approach, which takes less than half a minute to run, is shown to be accurate, with the modulus estimated with less than 4% error for 70% of the experiments.

[Validation of a French version of the 16-item Prodromal Questionnaire (fPQ16) in adolescents and young adults seeking help]

INTRODUCTION

The duration of untreated psychosis has been largely associated with poor outcomes in psychosis. Actual diagnostic tools may be used by very specialized teams and need sustained evaluation. We present a French version of a self-report questionnaire: the 16-item Prodromal Questionnaire (fPQ16). Our objective was to evaluate its predictive value for an ultra-high-risk state (UHR) or psychosis. The population enrolled was consulting in a young adults and adolescents center in Sainte-Anne hospital, Paris, France.

METHODS

PQ16 had first been translated into French and independently back translated and validated by the original authors. Between November 2016 and May 2018, every C'JAAD consulting patient was proposed to fill in the fPQ16. Each patient was next evaluated with the French version of the comprehensive assessment of at-risk mental state (CAARMS), which detects UHR or psychosis. Statistical analysis of fPQ16 concurrent validity was performed using ROC curves. fPQ16 acceptability was studied by four additional questions especially designed for that purpose.

RESULTS

One hundred participants were included. Mean age was 19.85years (SD 3.3 y). Fifty-eight percent of patients included were diagnosed with UHR (40%) or psychotic (18%) state after CAARMS evaluation. Mean score at fPQ16 was 5.7 (SD 3.8). Best cut-off score was 4 positive items, with excellent sensibility (91%) and correct specificity (60%). Positive predictive value of fPQ16 was 76%. Area under the curve was 0.85 (P<0.0001). fPQ16 showed good acceptability.

DISCUSSION

fPQ16 had good screening performances in our population. Cut-off score was lower than in previous studies, but performances were equal or better. As a well-accepted and short questionnaire, the fPQ16 could be a great screening tool in primary care. A version with 18-items, including two items focused on thought content and disorganization that are missing in PQ16, is under evaluation.

Radiological Society of North America/Quantitative Imaging Biomarker Alliance Shear Wave Speed Bias Quantification in Elastic and Viscoelastic Phantoms

OBJECTIVES

To quantify the bias of shear wave speed (SWS) measurements between different commercial ultrasonic shear elasticity systems and a magnetic resonance elastography (MRE) system in elastic and viscoelastic phantoms.

METHODS

Two elastic phantoms, representing healthy through fibrotic liver, were measured with 5 different ultrasound platforms, and 3 viscoelastic phantoms, representing healthy through fibrotic liver tissue, were measured with 12 different ultrasound platforms. Measurements were performed with different systems at different sites, at 3 focal depths, and with different appraisers. The SWS bias across the systems was quantified as a function of the system, site, focal depth, and appraiser. A single MRE research system was also used to characterize these phantoms using discrete frequencies from 60 to 500 Hz.

RESULTS

The SWS from different systems had mean difference 95% confidence intervals of ±0.145 m/s (±9.6%) across both elastic phantoms and ± 0.340 m/s (±15.3%) across the viscoelastic phantoms. The focal depth and appraiser were less significant sources of SWS variability than the system and site. Magnetic resonance elastography best matched the ultrasonic SWS in the viscoelastic phantoms using a 140 Hz source but had a - 0.27 ± 0.027-m/s (-12.2% ± 1.2%) bias when using the clinically implemented 60-Hz vibration source.

CONCLUSIONS

Shear wave speed reconstruction across different manufacturer systems is more consistent in elastic than viscoelastic phantoms, with a mean difference bias of < ±10% in all cases. Magnetic resonance elastographic measurements in the elastic and viscoelastic phantoms best match the ultrasound systems with a 140-Hz excitation but have a significant negative bias operating at 60 Hz. This study establishes a foundation for meaningful comparison of SWS measurements made with different platforms.

Measurement of the helicity asymmetry E for the reaction γ p → π 0 p : The CBELSA/TAPS Collaboration

A measurement of the double-polarization observable E for the reaction γ p → π 0 p is reported. The data were taken with the CBELSA/TAPS experiment at the ELSA facility in Bonn using the Bonn frozen-spin butanol (C4 H9 OH) target, which provided longitudinally-polarized protons. Circularly-polarized photons were produced via bremsstrahlung of longitudinally-polarized electrons. The data cover the photon energy range fromE γ = 600 to 2310 MeV and nearly the complete angular range. The results are compared to and have been included in recent partial wave analyses.

Observation of the pη^{'} Cusp in the New Precise Beam Asymmetry Σ Data for γp→pη

Data on the beam asymmetry Σ in the photoproduction of η mesons off protons are reported for tagged photon energies from 1130 to 1790 MeV (mass range from W=1748  MeV to W=2045  MeV). The data cover the full solid angle that allows for a precise moment analysis. For the first time, a strong cusp effect in a polarization observable has been observed that is an effect of a branch-point singularity at the pη^{'} threshold [E_{γ}=1447  MeV (W=1896  MeV)]. The latest BnGa partial wave analysis includes the new beam asymmetry data and yields a strong indication for the N(1895)1/2^{-} nucleon resonance, demonstrating the importance of including all singularities for a correct determination of partial waves and resonance parameters.

Features of the Energy Spectrum of Cosmic Rays above 2.5×10^{18} eV Using the Pierre Auger Observatory

We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18}  eV based on 215 030 events. New results are presented: at about 1.3×10^{19}  eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19}  eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18}  eV is [5.66±0.03(stat)±1.40(syst)]×10^{53}  erg Mpc^{-3}.

[Statement of the Austrian Society of Pneumology (ASP)]

The COVID-19 pandemic is currently a challenge worldwide. In Austria, a crisis within the health care system has so far been avoided. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic. However, COVID-19-specific adjustments are useful. The treatment of patients with chronic lung diseases must be adapted during the pandemic, but must still be guaranteed.

Impact Ionization Induced by Terahertz Radiation in HgTe Quantum Wells of Critical Thickness

We report on the observation of terahertz (THz) radiation induced band-to-band impact ionization in HgTe quantum well (QW) structures of critical thickness, which are characterized by a nearly linear energy dispersion. The THz electric field drives the carriers initializing electron-hole pair generation. The carrier multiplication is observed for photon energies less than the energy gap under the condition that the product of the radiation angular frequency ω and momentum relaxation time τ _l larger than unity. In this case, the charge carriers acquire high energies solely because of collisions in the presence of a high-frequency electric field. The developed microscopic theory shows that the probability of the light-induced impact ionization is proportional to exp ( - E 0 2 / E 2 ) , with the radiation electric field amplitude E and the characteristic field parameter E ₀. As observed in experiment, it exhibits a strong frequency dependence for ω τ ≫ 1 characterized by the characteristic field E ₀ linearly increasing with the radiation frequency ω.

Surface Potential Simulation for Robust Electrode Placement by MRI Based Human Phantom with FEM Based Quasi-Static Solver for Bioimpedance Measurement

Estimating cardiac output (CO) and thoracic fluid content (TFC) by non-invasive measurement of thoracic electrical bioimpedance (TEB) is on the rise of becoming clinically established. Dynamic fluid management and detecting and trending excess quasi-static thoracic fluids are of particular interest to benefit the critically ill patient. While the advantages such as easy application and non-invasive assessment are intriguing, there are some challenges. In addition to artifacts due to the patient's movement, instability of the electrode-skin interfaces, the accuracy of the applied current and varying cable capacity because of motion, exact placement of electrodes - or lack thereof - must be considered. In particular the robustness of the electrode placement, i.e., the insensitivity to inaccuracy of electrode placement (actual sensor from the nominal). We propose a new technique for evaluation of electrode placement by simulation with MRI based human phantoms with FEM based quasi-static solver for bioimpedance measurement. Results: We identified alternative electrode positions which lead to an increase in robustness of bioimpedance measurements of up to 9.5 times compared to the standard electrode placement. Simulations suggested an improvement in ECG signal quality which was confirmed by a subject measurement.

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Introduction  Dural venous sinus thrombosis (DVST) is a relatively understudied complication of vestibular schwannoma (VS) surgery. Several studies have examined this topic; however, there is limited data on the incidence, clinical progression, and proper management of this patient population. Methods  A retrospective review was performed for patients undergoing surgery for VS at a single institution. All postoperative imaging was reviewed for incidence of DVST. Demographic data were collected including tumor and surgical characteristics along with postoperative course. Results  A total of 63 patients underwent resection of their VS. The incidence of DVST was 34.9%. The operative time was greater in the dural venous sinus thrombosis (DSVT) group, at an average of 6.69 hours versus 4.87 in the no DSVT cohort ( p  = 0.04). Tumor size was correlationally significant ( p  = 0.051) at 2.75 versus 2.12 cm greatest diameter. The translabyrinthine approach was most prevalent (68.2%). The side of the thrombosis was ipsilateral to the tumor and surgery in all patients. The sigmoid sinus was most commonly involved (95.5%). Of them, 85% patients had a codominant or thrombus contralateral to the dominant sinus. All patients were asymptomatic. No patients were treated with anticoagulation. Resolution of thrombus was seen in five (22.7%) of the patients on last follow-up imaging. There were no hemorrhagic complications. Conclusion  The overall incidence of DVST was (34.9%) of 63 patients who underwent VS surgery. All patients were asymptomatic and none were treated with anticoagulation. In our study, continuing to observe asymptomatic patients did not lead to any adverse events.

Evaluation of Electrode Setups by MRI Based Human Phantom with FEM Based Quasi-Static Solver for Bioimpedance Measurement. Annu Int Conf IEEE Eng Med Biol Soc 2019;2019:3978-3982. [PMID: 31946743 DOI: 10.1109/embc.2019.8856693]

Transthoracic electrical bioimpedance (TEB) measurement for acquiring of hemodynamic parameters e.g. stroke volume (SV) and cardiac output (CO) becomes commonly used. For precise and reliable measurement, a good understanding of the measurement system is needed to provide robust electrode placement, reproducible results, and large signal amplitudes. We propose an evaluation by MRI based human phantom with FEM based quasi-static solver for electrode placement in bioimpedance measurement. Placements according to Osypka, Cheetah and Bernstein et al. were simulated and compared with measurements taken from a (real) human subject. As a parameter for evaluation of signal quality, the percentage of current passing through the descending aorta from the overall injected current is measured. The placement according to Osypka results in 1.46 % of current flow through the descending aorta (Cheetah placement 1.12 %, Bernstein et al. placement 0.877 %) for the male human phantom DUKE. The simulation was compared with a real human subject (with comparable age, height, weight) by calculating the baseline impedance (Z₀). The simulation seems to fit at best with Osypka placement, where the deviation between simulated baseline impedance and real human subject is 19.9 % (deviation for Cheetah 34.1 %, deviation for Bernstein 62.5 %). The simulation with MRI based human phantoms seems to be a very good basis for further investigations of current injection and bioimpedance measurement comprehension.

Revisiting complexation thermodynamics of transplutonium elements up to einsteinium

Literature casts einsteinium as a departure from earlier transplutonium actinides, with a decrease in stability constants with aminopolycarboxylate ligands. This report studies transplutonium chemistry - including Am, Bk, Cf, and Es - with aminopolycarboxylate ligands. Es complexation follows similar thermodynamic and structural trends established by the earlier actinides, consistent with first-principle calculations.

The enantioselective addition of 1-fluoro-1-nitro(phenylsulfonyl)methane to isatin-derived ketimines

An asymmetric organocatalytic addition of fluorinated phenylsulfonylnitromethane to isatin-derived ketimines was developed. The reaction was efficiently catalyzed by a chiral tertiary amine, cinchonine. This methodology provides a new type of optically active compound with two adjacent quaternary carbon stereocenters in good yield (up to 96%), with moderate diastereoselectivity (up to 5.7 : 1 dr) and excellent enantioselectivity (up to 98/96% ee).

On the Origin of Covalent Bonding in Heavy Actinides

Recent reports have suggested the late actinides participate in more covalent interactions than the earlier actinides, yet the origin of this shift in chemistry is not understood. This report considers the chemistry of actinide dipicolinate complexes to identify why covalent interactions become more prominent for heavy actinides. A modest increase in measured actinide:dipicolinate stability constants is coincident with a significant increase in An 5f energy degeneracy with the dipicolinate molecular orbitals for Bk and Cf relative to Am and Cm. While the interactions in the actinide-dipicolinate complex are largely ionic, the decrease in 5f orbital energy across the series manifests in orbital-mixing and, hence, covalency driven by energy degeneracy. This observation suggests the origin of covalency in heavy actinide interactions stems from the degeneracy of 5f orbitals with ligand molecular orbitals rather than spatial orbital overlap. These findings suggest that the limiting radial extension of the 5f orbitals later in the actinide series could make the heavy actinides ideal elements to probe and tune effects of energy degeneracy driven covalency.

Characterization of berkelium(III) dipicolinate and borate compounds in solution and the solid state

Berkelium is positioned at a crucial location in the actinide series between the inherently stable half-filled 5f(7) configuration of curium and the abrupt transition in chemical behavior created by the onset of a metastable divalent state that starts at californium. However, the mere 320-day half-life of berkelium's only available isotope, (249)Bk, has hindered in-depth studies of the element's coordination chemistry. Herein, we report the synthesis and detailed solid-state and solution-phase characterization of a berkelium coordination complex, Bk(III)tris(dipicolinate), as well as a chemically distinct Bk(III) borate material for comparison. We demonstrate that berkelium's complexation is analogous to that of californium. However, from a range of spectroscopic techniques and quantum mechanical calculations, it is clear that spin-orbit coupling contributes significantly to berkelium's multiconfigurational ground state.

Testing Hadronic Interactions at Ultrahigh Energies with Air Showers Measured by the Pierre Auger Observatory

Ultrahigh energy cosmic ray air showers probe particle physics at energies beyond the reach of accelerators. Here we introduce a new method to test hadronic interaction models without relying on the absolute energy calibration, and apply it to events with primary energy 6-16 EeV (E_{CM}=110-170  TeV), whose longitudinal development and lateral distribution were simultaneously measured by the Pierre Auger Observatory. The average hadronic shower is 1.33±0.16 (1.61±0.21) times larger than predicted using the leading LHC-tuned models EPOS-LHC (QGSJetII-04), with a corresponding excess of muons.

Determination of two mercapturic acids related to crotonaldehyde in human urine: influence of smoking

Crotonaldehyde, an αβ-unsaturated aldehyde, and a potent alkylating agent, is present in many foods and beverages, ambient air and tobacco smoke. A previous study indicated that two metabolites, 3-hydroxy-1- methylpropylmercapturic acid (HMPMA) and 2-carboxy1-1-methylethylmercapturic acid (CMEMA), were excreted in rat urine after subcutaneous injection of crotonaldehyde. Herein, we report the development of a method based on liquid chromatography with tandem mass spectrometry (LC-MS/MS) and deuterated analytes as internal standards, for the determination of HMPMA and CMEMA in human urine. The limits of quantification of the method were 92 and 104 ng/mL for HMPMA and CMEMA, respectively. The calibration curves for both compounds were linear up to 7500 ng/mL with R2 >0.99. It was found that cigarette smokers excreted about three to five-fold more HMPMA, and only slightly elevated amounts of CMEMA, in their urine compared to non-smokers. In smokers, we also found significant correlations between the urinary excretion levels of HMPMA (but not CMEMA) and several markers of exposure for smoking, including the daily cigarette consumption, carbon monoxide in exhaled breath, salivary cotinine, and nicotine plus five of its major metabolites in urine. Smoking cessation or switching from smoking conventional cigarettes to experimental cigarettes with lower crotonaldehyde delivery led to significant reductions of urinary HMPMA excretion, but not CMEMA excretion. Alcohol consumption did not influence either urinary HMPMA or CMEMA excretion. We conclude that HMPMA is a potentially useful biomarker for smoking-related exposure to crotonaldehyde.

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8±0.7(stat)±6.7(syst)  MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principles calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.

The Influence of Asthma Exacerbations on Health-Related Quality of Life

The purpose of this study was to determine the influence of asthma on the quality of life (QoL) of patients hospitalized for an exacerbation of the disease and those with controlled asthma receiving outpatient treatment, and to establish the patients' somatic status and the level of health care utilization. This study involved 239 adults with asthma (123 hospitalized patients and 116 outpatients of family physicians). The authors used: WHOQOL-BREF questionnaire and a questionnaire measuring health care utilization. There were no differences in QoL levels between the patients with severe and controlled asthma. The psychological domain was assessed higher by hospitalized patients (p = 0.02). QoL levels correlated negatively with age, place of residence, and marital status, and positively with education. The general QoL level was most strongly influenced by gender, age, education, the number of home visits and interventions of a district nurse, and the somatic index (p < 0.05). Somatic symptoms were more severe in hospitalized patients. The QoL assessment of asthma patients in relation to somatic symptoms, health care services and socio-demographic variables allows better understanding of the complex health situation of patients at various stages of the disease, and tailoring the therapy to individual needs. Patients receiving outpatient treatment require professional psychotherapeutic support.

Benzene Dimer: High-Level Wave Function and Density Functional Theory Calculations

High-level OVOS (optimized virtual orbital space) CCSD(T) interaction energy calculations (up to the aug-cc-pVQZ basis set) and various extrapolations toward the complete basis set (CBS) limit are presented for the most important structures on the benzene dimer potential energy surface. The geometries of these structures were obtained via an all-coordinate gradient geometry optimization using the DFT-D/BLYP method, covering the empirical dispersion correction fitted exclusively for this system. The fit was carried out against two estimated CCSD(T)/CBS potential energy curves corresponding to the distance variation between two benzene rings for the parallel-displaced (PD) and T-shaped (T) structures. The effect of the connected quadruple excitations on the interaction energy was estimated using the CCSD(TQf) method in a 6-31G*(0.25) basis set, destabilizing the T and T-shaped tilted (TT) structures by ≈0.02 kcal/mol and the PD structure by ≈0.04 kcal/mol. Our best CCSD(T)/CBS results show, within the error bars of the applied methodology, that the energetically lowest-lying structure is the TT structure, which is nearly 0.1 kcal/mol more stable than the almost isoenergetic PD and T structures. The specifically parametrized DFT-D/BLYP method leads to a correct energy ordering of the structures, with the errors being smaller by 0.2 kcal/mol with respect to the most accurate CCSD(T) values.

Biomarkers of cellular apoptosis and necrosis in donor myocardium are not predictive of primary graft dysfunction

Primary graft dysfunction (PGD) is a life-threatening complication among heart transplant recipients and a major cause of early mortality. Although the pathogenesis of PGD is still unclear, ischemia/reperfusion injury has been identified as a predominant factor. Both necrosis and apoptosis contribute to the loss of cardiomyocytes during ischemia/reperfusion injury, and this loss of cells can ultimately lead to PGD. The aim of our prospective study was to find out whether cell death, necrosis and apoptosis markers present in the donor myocardium can predict PGD. The prospective study involved 64 consecutive patients who underwent orthotopic heart transplantation at our institute between September 2010 and January 2013. High-sensitive cardiac troponin T (hs-cTnT) as a marker of minor myocardial necrosis was detected from arterial blood samples before the donor's pericardium was opened. Apoptosis (caspase-3, active + pro-caspase-3, bcl-2, TUNEL) was assessed from bioptic samples taken from the right ventricle prior graft harvesting. In our study, 14 % of transplant recipients developed PGD classified according to the standardized definition proposed by the ISHLT Working Group. We did not find differences between the groups in regard to hs-cTnT serum levels. The mean hs-cTnT value for the PGD group was 57.4+/-22.9 ng/l, compared to 68.4+/-10.8 ng/l in the group without PGD. The presence and severity of apoptosis in grafted hearts did not differ between grafts without PGD and hearts that subsequently developed PGD. In conclusion, our findings did not demonstrate any association between measured myocardial cell death, necrosis or apoptosis markers in donor myocardium and PGD in allograft recipients. More detailed investigations of cell death signaling pathways in transplanted hearts are required.

CCSD(T) calculations of confined systems: in-crystal polarizabilities of F⁻, Cl⁻, O²⁻, and S²⁻

We explore dipole polarizabilities of the singly and doubly charged anions F(-), Cl(-), O(2-), and S(2-) in an external, harmonic oscillator (HO) confining potential ∑(i)½ω(2)r(i)(2). We find that in contrast to F(-) and Cl(-) those for O(2-) and S(2-) are unrealistically high due to the instability of the corresponding restricted Hartree-Fock (RHF) solutions. Yet, already a relatively weak HO confining potential stabilizes their RHF solutions and eliminates any possible broken-symmetry solutions. The coupled-cluster theory with single, double and noniterative triple excitations (CCSD(T)) then yields considerably reduced polarizabilities for O(2-) and S(2-) relative to their unconfined values. We showed that polarizabilities of O(2-) and S(2-) are more sensitive to the strength of a confinement potential than are those for F(-) and Cl(-). This enables us to relate the confining parameter ω with the known experimental polarizabilities for selected crystals (our "training set") and to find a specific confining parameter ω for which the CCSD(T) polarizability equals the experimental in-crystal polarizability of an anion in the training set. The latter may then be used as an alternative approach for determining the in-crystal polarizabilities of anions by exploiting the fact that the characteristic ω values depend linearly on the ionic radius of a cation participating in specific crystals containing these anions. Using this method we then calculate the isotropic dipole polarizabilities for F(-), Cl(-), O(2-), and S(2-) embedded in the LiF, LiCl, NaF, NaCl, KF, KCl, ZnO, ZnS, MgO, MgS, CaO, CaS, SrO, SrS, BaO, BaS, and other crystals containing halogen, oxygen, or sulphur anions. We compare our results with those obtained via alternative models of the in-crystal anionic polarizabilities.

Search for patterns by combining cosmic-ray energy and arrival directions at the Pierre Auger Observatory

Energy-dependent patterns in the arrival directions of cosmic rays are searched for using data of the Pierre Auger Observatory. We investigate local regions around the highest-energy cosmic rays with [Formula: see text] eV by analyzing cosmic rays with energies above [Formula: see text] eV arriving within an angular separation of approximately 15[Formula: see text]. We characterize the energy distributions inside these regions by two independent methods, one searching for angular dependence of energy-energy correlations and one searching for collimation of energy along the local system of principal axes of the energy distribution. No significant patterns are found with this analysis. The comparison of these measurements with astrophysical scenarios can therefore be used to obtain constraints on related model parameters such as strength of cosmic-ray deflection and density of point sources.