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Bindel L, Mühlberg C, Pfeiffer V, Nitschke M, Müller A, Wegscheider M, Rumpf JJ, Zeuner KE, Becktepe JS, Welzel J, Güthe M, Classen J, Tzvi E. Visuomotor Adaptation Deficits in Patients with Essential Tremor. Cerebellum 2023; 22:925-937. [PMID: 36085397 PMCID: PMC10485096 DOI: 10.1007/s12311-022-01474-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
Essential tremor (ET) is a progressive movement disorder whose pathophysiology is not fully understood. Current evidence supports the view that the cerebellum is critically involved in the genesis of the tremor in ET. However, it is still unknown whether cerebellar dysfunction affects not only the control of current movements but also the prediction of future movements through dynamic adaptation toward a changed environment. Here, we tested the capacity of 28 patients with ET to adapt in a visuomotor adaptation task known to depend on intact cerebellar function. We found specific impairments in that task compared to age-matched healthy controls. Adaptation to the visual perturbation was disrupted in ET patients, while de-adaptation, the phase after abrupt removal of the perturbation, developed similarly to control subjects. Baseline tremor-independent motor performance was as well similar to healthy controls, indicating that adaptation deficits in ET patients were not rooted in an inability to perform goal-directed movements. There was no association between clinical severity scores of ET and early visuomotor adaptation abilities. These results provide further evidence that the cerebellum is dysfunctional in ET.
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Affiliation(s)
- Laura Bindel
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christoph Mühlberg
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - Victoria Pfeiffer
- Department of Neurology, University of Lübeck, 23562, Lübeck, Germany
| | - Matthias Nitschke
- Department of Neurology, University of Lübeck, 23562, Lübeck, Germany
| | - Annekatrin Müller
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - Mirko Wegscheider
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - Jost-Julian Rumpf
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | | | - Jos S Becktepe
- Department of Neurology, Kiel University, 24105, Kiel, Germany
| | - Julius Welzel
- Department of Neurology, Kiel University, 24105, Kiel, Germany
| | - Miriam Güthe
- Department of Neurology, Kiel University, 24105, Kiel, Germany
| | - Joseph Classen
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - Elinor Tzvi
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.
- Syte Institute, 20354, Hamburg, Germany.
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2
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Muehlberg C, Fricke C, Wegscheider M, Wawrzyniak M, Tzvi E, Winkler D, Classen J, Rumpf JJ. Motor learning is independent of effects of subthalamic deep brain stimulation on motor execution. Brain Commun 2023; 5:fcad070. [PMID: 37006332 PMCID: PMC10065184 DOI: 10.1093/braincomms/fcad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/31/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
Abstract
Motor learning is defined as an improvement in performance through practice. The ability to learn new motor skills may be particularly challenged in patients with Parkinson's disease, in whom motor execution is impaired by the disease-defining motor symptoms such as bradykinesia. Subthalamic deep brain stimulation is an effective treatment in advanced Parkinson’s disease, and its beneficial effects on Parkinsonian motor symptoms and motor execution have been widely demonstrated. Much less is known about whether deep brain stimulation directly interacts with motor learning independent of modulation of motor execution.
We investigated motor sequence learning in nineteen patients with Parkinson’s disease treated with subthalamic deep brain stimulation and nineteen age-matched controls. In a cross-over design, patients performed an initial motor sequence training session with active and inactive stimulation, respectively (experiments separated by ≥ 14 days). Performance was retested after five minutes and after a 6-hour consolidation interval with active stimulation. Healthy controls performed a similar experiment once. We further investigated neural correlates underlying stimulation-related effects on motor learning by exploring the association of normative subthalamic deep brain stimulation functional connectivity profiles with stimulation-related differences in performance gains during training.
Pausing deep brain stimulation during initial training resulted in inhibition of performance gains that could have been indicative of learning at the behavioral level. Task performance improved significantly during training with active deep brain stimulation, but did not reach the level of learning dynamics of healthy controls. Importantly, task performance after the 6-hour consolidation interval was similar across patients with Parkinson’s disease independent of whether the initial training session had been performed with active or inactive deep brain stimulation. This indicates that early learning and subsequent consolidation were relatively intact despite severe impairments of motor execution during training with inactive deep brain stimulation. Normative connectivity analyses revealed plausible and significant connectivity of volumes of tissue activated by deep brain stimulation with several cortical areas. However, no specific connectivity profiles were associated with stimulation-dependent differences in learning during initial training.
Our results show that motor learning in Parkinson’s disease is independent of modulation of motor execution by subthalamic deep brain stimulation. This indicates an important role of the subthalamic nucleus in regulating general motor execution, whereas its role in motor learning appears negligible. Because longer-term outcomes were independent of performance gains during initial training, patients with Parkinson’s disease may not need to wait for an optimal motor state to practice new motor skills.
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Affiliation(s)
| | | | - Mirko Wegscheider
- Department of Neurology, University of Leipzig Medical Center , Germany
| | - Max Wawrzyniak
- Department of Neurology, University of Leipzig Medical Center , Germany
| | | | - Dirk Winkler
- Department of Neurosurgery, University of Leipzig Medical Center , Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig Medical Center , Germany
| | - Jost-Julian Rumpf
- Department of Neurology, University of Leipzig Medical Center , Germany
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3
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Gong R, Mühlberg C, Wegscheider M, Fricke C, Rumpf JJ, Knösche TR, Classen J. Cross-frequency phase-amplitude coupling in repetitive movements in patients with Parkinson's disease. J Neurophysiol 2022; 127:1606-1621. [PMID: 35544757 PMCID: PMC9190732 DOI: 10.1152/jn.00541.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bradykinesia is a cardinal motor symptom in Parkinson’s disease (PD), the pathophysiology of which is not fully understood. We analyzed the role of cross-frequency coupling of oscillatory cortical activity in motor impairment in patients with PD and healthy controls. High-density EEG signals were recorded during various motor activities and at rest. Patients performed a repetitive finger-pressing task normally, but were slower than controls during tapping. Phase-amplitude coupling (PAC) between β (13–30 Hz) and broadband γ (50–150 Hz) was computed from individual EEG source signals in the premotor, primary motor, and primary somatosensory cortices, and the primary somatosensory complex. In all four regions, averaging the entire movement period resulted in higher PAC in patients than in controls for the resting condition and the pressing task (similar performance between groups). However, this was not the case for the tapping tasks where patients performed slower. This suggests the strength of state-related β-γ PAC does not determine Parkinsonian bradykinesia. Examination of the dynamics of oscillatory EEG signals during motor transitions revealed a distinctive motif of PAC rise and decay around press onset. This pattern was also present at press offset and slow tapping onset, linking such idiosyncratic PAC changes to transitions between different movement states. The transition-related PAC modulation in patients was similar to controls in the pressing task but flattened during slow tapping, which related to normal and abnormal performance, respectively. These findings suggest that the dysfunctional evolution of neuronal population dynamics during movement execution is an important component of the pathophysiology of Parkinsonian bradykinesia. NEW & NOTEWORTHY Our findings using noninvasive EEG recordings provide evidence that PAC dynamics might play a role in the physiological cortical control of movement execution and may encode transitions between movement states. Results in patients with Parkinson’s disease suggest that bradykinesia is related to a deficit of the dynamic regulation of PAC during movement execution rather than its absolute strength. Our findings may contribute to the development of a new concept of the pathophysiology of bradykinesia.
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Affiliation(s)
- Ruxue Gong
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany.,Method and Development Group Brain Networks, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christoph Mühlberg
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Mirko Wegscheider
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Christopher Fricke
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Jost-Julian Rumpf
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Thomas R Knösche
- Method and Development Group Brain Networks, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
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4
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Gong R, Muehlberg C, Wegscheider M, Knoesche T, Classen J. P 40. β-γ phase-amplitude coupling during movements in Parkinson's disease. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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5
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Gong R, Wegscheider M, Mühlberg C, Gast R, Fricke C, Rumpf JJ, Nikulin VV, Knösche TR, Classen J. Spatiotemporal features of β-γ phase-amplitude coupling in Parkinson's disease derived from scalp EEG. Brain 2021; 144:487-503. [PMID: 33257940 DOI: 10.1093/brain/awaa400] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/09/2020] [Accepted: 09/08/2020] [Indexed: 01/21/2023] Open
Abstract
Abnormal phase-amplitude coupling between β and broadband-γ activities has been identified in recordings from the cortex or scalp of patients with Parkinson's disease. While enhanced phase-amplitude coupling has been proposed as a biomarker of Parkinson's disease, the neuronal mechanisms underlying the abnormal coupling and its relationship to motor impairments in Parkinson's disease remain unclear. To address these issues, we performed an in-depth analysis of high-density EEG recordings at rest in 19 patients with Parkinson's disease and 20 age- and sex-matched healthy control subjects. EEG signals were projected onto the individual cortical surfaces using source reconstruction techniques and separated into spatiotemporal components using independent component analysis. Compared to healthy controls, phase-amplitude coupling of Parkinson's disease patients was enhanced in dorsolateral prefrontal cortex, premotor cortex, primary motor cortex and somatosensory cortex, the difference being statistically significant in the hemisphere contralateral to the clinically more affected side. β and γ signals involved in generating abnormal phase-amplitude coupling were not strictly phase-phase coupled, ruling out that phase-amplitude coupling merely reflects the abnormal activity of a single oscillator in a recurrent network. We found important differences for couplings between the β and γ signals from identical components as opposed to those from different components (originating from distinct spatial locations). While both couplings were abnormally enhanced in patients, only the latter were correlated with clinical motor severity as indexed by part III of the Movement Disorder Society Unified Parkinson's Disease Rating Scale. Correlations with parkinsonian motor symptoms of such inter-component couplings were found in premotor, primary motor and somatosensory cortex, but not in dorsolateral prefrontal cortex, suggesting motor domain specificity. The topography of phase-amplitude coupling demonstrated profound differences in patients compared to controls. These findings suggest, first, that enhanced phase-amplitude coupling in Parkinson's disease patients originates from the coupling between distinct neural networks in several brain regions involved in motor control. Because these regions included the somatosensory cortex, abnormal phase-amplitude coupling is not exclusively tied to the hyperdirect tract connecting cortical regions monosynaptically with the subthalamic nucleus. Second, only the coupling between β and γ signals from different components appears to have pathophysiological significance, suggesting that therapeutic approaches breaking the abnormal lateral coupling between neuronal circuits may be more promising than targeting phase-amplitude coupling per se.
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Affiliation(s)
- Ruxue Gong
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany.,Method and Development Group Brain Networks, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Mirko Wegscheider
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Christoph Mühlberg
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Richard Gast
- Method and Development Group Brain Networks, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christopher Fricke
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Jost-Julian Rumpf
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Vadim V Nikulin
- Research Group Neural Interactions and Dynamics, Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Thomas R Knösche
- Method and Development Group Brain Networks, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
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6
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Gong R, Mühlberg C, Wegscheider M, Nikulin V, Knösche T, Classen J. P58 Increased phase-amplitude coupling in Parkinson’s disease: Evidence from source localized electroencephalography. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Cheng B, Boutitie F, Nickel A, Wouters A, Cho TH, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Puig J, Thijs V, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Gerloff C, Thomalla G, Golsari A, Alegiani A, Beck C, Choe CU, Voget D, Hoppe J, Schröder J, Rozanski M, Nave AH, Wollboldt C, van Sloten I, Göhler J, Herm J, Jungehülsing J, Lückl J, Kröber JM, Schurig J, Koehler L, Schlemm L, Knops M, Roennefarth M, Ipsen N, Harmel P, Bathe-Peters R, Fleischmann R, Ganeshan R, Geran R, Hellwig S, Schmidt S, Tütüncü S, Krause T, Gramse V, Röther J, Michels P, Michalski D, Pelz J, Schulz A, Hobohm C, Weise C, Weise G, Orthgieß J, Pomrehn K, Wegscheider M, Mueller AK, Hennerici M, Griebe M, Alonso A, Filipov A, Marzina A, Anders B, Bähr C, Hoyer C, Schwarzbach C, Weber C, Hornberger E, Pledl HW, Klockziem M, Stuermlinger M, Wittayer M, Wolf M, Meyer N, Eisele P, Steinert S, Sauer T, Held V, Ringleb P, Nagel S, Veltkamp R, Schwarting S, Schwarz A, Gumbinger C, Hametner C, Amiri H, Purrucker J, Ciatipis M, Menn O, Mundiyanapurath S, Schieber S, Kessler T, Reiff T, Panitz V, Singer O, Foerch C, Lauer A, Männer A, Seiler A, Guerzoglu D, Schäfer JH, Filipski K, Lorenz M, Kurka N, Zeiner P, Pfeilschifter W, Dziewas R, Minnerup J, Albiker C, Ritter M, Seidel M, Dittrich R, Kallmünzer B, Bobinger T, Madzar D, Stark D, Sembill J, Macha K, Winder K, Breuer L, Koehrmann M, Spruegel M, Gerner S, Kraft P, Mackenrodt D, Kleinschnitz C, Elhfnawy A, Heinen F, Gunreben I, Poli S, Ziemann U, Gaenslen A, Schlak D, Haertig F, Russo F, Richter H, Ebner M, Ribitsch M, Wolf M, Weimar C, Zegarac V, Chen HC, Althaus K, Neugebauer H, Jüttler E, Meier J, Stösser S, Puetz V, Bodechtel U, Ostergaard L, Møller A, Damgaard D, Dupont KH, Poulsen M, Hjort N, de Morales NR, von Weitzel P, Harbo T, Marstrand J, Hansen A, Christensen H, Aegidius K, Jeppesen L, Meden P, Rosenbaum S, Iversen H, Hansen J, Michelsen L, Truelsen T, Modrau B, Vestergaard K, Oppel L, Sygehus A, Aalborg S, Swinnen B, Smets I, Demeestere J, Dobbels L, Brouns R, De Smedt A, DeKeyser J, Yperzeele L, Van Hooff RJ, Peeters A, Dusart A, Etexberria A, Hanseeuw B, London F, Leempoel J, Hohenbichler K, Younan N, Maqueda V, Laloux P, De Coene B, De Maeseneire C, Turine G, Vandermeeren Y, De Klippel N, Willems C, de Hollander I, Soors P, Hermans S, Hemelsoet D, Desfontaines P, Vanacker P, Rutgers M, Druart C, Peeters D, Bruneel B, Vancaester E, Vanhee F, Meersman G, Bourgeois P, Vanderdonckt P, Benoit A, Derex L, Mechthouff L, Berhoune N, Ritzenthaler T, Amarenco P, Hobeanu C, Gancedo EM, Calvet D, Ladoux A, Machet A, Lamy C, Mellerio C, Oppenheim C, Rodriguez-Regent C, Bodiguel E, Turc G, Birchenall J, Legrand L, Morin L, Edjali-Goujon M, Naggara O, Raphaelle S, Godon-Hardy S, Domigo V, Guiraud V, Samson Y, Leger A, Rosso C, Baronnet-Chauvet F, Crozier S, Deltour S, Yger M, Sibon I, Renou P, Sagnier S, Zuber M, Tamazyan R, Rodier G, Morel N, Felix S, Vadot W, Wolff V, Aniculaesei A, Yalo B, Bindila D, Quenardelle V, Blanc-Lasserre K, Landrault E, Breynaert L, Cakmak S, Peysson S, Viguier A, Lebely C, Raposo N, Vallet AE, Vallet P, Brugirard S, Cheripelli B, Kalladka D, Moreton F, Dani K, Tawil SE, Ramachandran S, Huang X, Warburton E, Evans N, Perry R, Patel B, Cloud G, Pereira A, Moynihan B, Lovelock C, Choy L, Khan U, Roffe C, Tyrell P, Smith C, Dixit A, Louw S, Broughton D, Shetty A, Appleton J, Sprigg N, Acosta BR, van Eendenburg C, Leal JS, Mar Castellanos Rodrigo MD, Izaga MT, Guillamon OB, Arenillas J, Calleja A, Cortijo E, Mulero P, de la Ossa NP, Garrido A, Martinez A, Esperón CG, Guerrero C, Carrera D, Vilas D, Lopez-cancio E, Palomeras E, Lucente G, Gomis M, Isern I, Becerra JL, Vicente JH, Sánchez J, Dorado L, Grau L, Ispierto L, Prats L, Almendrote M, Hernández M, Jimenez M, Sánchez ML, Torne MM, Presas S, Ustrell X, Pellisé A, Navalpotro I, Luna A, Schonewille W, Nederkoorn P, Majoie C, van den Berg L, van den Berg S, Zonneveld T, Remmers M, Fazekas F, Pichler A, Fandler S, Gattringer T, Mutzenbach J, Weber J, Höfner E, Kohlfürst H, Weinstich K, Kellert L, Bayer-Karpinska A, Opherk C, Wollenweber F, Klein M, Neumann- Haefelin T, Pierskalla A, Harloff A, Bardutzky J, Buggle F, von Schrader J, Kollmar R, Schill J, Löbbe AM, Moulin T, Bouamra B, Bonnet L, Touzé E, Bonnet AL, Touze E, Cogez J, Li L, Guettier S, Kar A, Sivagnanaratham A, Geraghty O, Bojaryn U, Nallasivan A, Gonzales MB, Rodríguez-Yáñez M, Tembl J, Gorriz D, Oberndorfer S, Prohaska E. Quantitative Signal Intensity in Fluid-Attenuated Inversion Recovery and Treatment Effect in the WAKE-UP Trial. Stroke 2020; 51:209-215. [DOI: 10.1161/strokeaha.119.027390] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Relative signal intensity of acute ischemic stroke lesions in fluid-attenuated inversion recovery (fluid-attenuated inversion recovery relative signal intensity [FLAIR-rSI]) magnetic resonance imaging is associated with time elapsed since stroke onset with higher intensities signifying longer time intervals. In the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial), intravenous alteplase was effective in patients with unknown onset stroke selected by visual assessment of diffusion weighted imaging fluid-attenuated inversion recovery mismatch, that is, in those with no marked fluid-attenuated inversion recovery hyperintensity in the region of the acute diffusion weighted imaging lesion. In this post hoc analysis, we investigated whether quantitatively measured FLAIR-rSI modifies treatment effect of intravenous alteplase.
Methods—
FLAIR-rSI of stroke lesions was measured relative to signal intensity in a mirrored region in the contralesional hemisphere. The relationship between FLAIR-rSI and treatment effect on functional outcome assessed by the modified Rankin Scale (mRS) after 90 days was analyzed by binary logistic regression using different end points, that is, favorable outcome defined as mRS score of 0 to 1, independent outcome defined as mRS score of 0 to 2, ordinal analysis of mRS scores (shift analysis). All models were adjusted for National Institutes of Health Stroke Scale at symptom onset and stroke lesion volume.
Results—
FLAIR-rSI was successfully quantified in stroke lesions in 433 patients (86% of 503 patients included in WAKE-UP). Mean FLAIR-rSI was 1.06 (SD, 0.09). Interaction of FLAIR-rSI and treatment effect was not significant for mRS score of 0 to 1 (
P
=0.169) and shift analysis (
P
=0.086) but reached significance for mRS score of 0 to 2 (
P
=0.004). We observed a smooth continuing trend of decreasing treatment effects in relation to clinical end points with increasing FLAIR-rSI.
Conclusions—
In patients in whom no marked parenchymal fluid-attenuated inversion recovery hyperintensity was detected by visual judgement in the WAKE-UP trial, higher FLAIR-rSI of diffusion weighted imaging lesions was associated with decreased treatment effects of intravenous thrombolysis. This parallels the known association of treatment effect and elapsing time of stroke onset.
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Affiliation(s)
- Bastian Cheng
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Florent Boutitie
- Service de Biostatistique, Hospices Civils de Lyon, France (F.B.)
- Université Lyon 1, Villeurbanne, France (F.B.)
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France (F.B.)
| | - Alina Nickel
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Belgium (A.W., R.L.)
- Department of Neurosciences, Experimental Neurology, KU Leuven–University of Leuven, Belgium (A.W., R.L.)
- VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Leuven, Belgium (A.W., R.L.)
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, France (T.-H.C., N.N.)
- Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Neurologie der Rehaklinik Medical Park Humboldtmühle, Berlin, Germany (M. Ebinger)
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany (M. Endres)
| | - Jochen B. Fiebach
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin, Charité–Universitätsmedizin Berlin, Campus Mitte, Germany (M. Ebinger, M. Endres, J.B.F., I.G.)
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d’Investigació Biomèdica de Girona, Parc Hospitalari Martí i Julià de Salt, Girona, Spain (J.P., S.P.)
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, VIC, Australia (V.T.)
- Austin Health, Department of Neurology, VIC, Australia (V.T.)
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (A.W., R.L.)
- Department of Neurosciences, Experimental Neurology, KU Leuven–University of Leuven, Belgium (A.W., R.L.)
- VIB, Center for Brain and Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Leuven, Belgium (A.W., R.L.)
| | - Keith W. Muir
- Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom (K.W.M.)
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon, France (T.-H.C., N.N.)
- Hospices Civils de Lyon, France (T.-H.C., N.N.)
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image, Hospital Dr Josep Trueta, Institut d’Investigació Biomèdica de Girona, Parc Hospitalari Martí i Julià de Salt, Girona, Spain (J.P., S.P.)
| | - Claus Z. Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.)
| | - Christian Gerloff
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Götz Thomalla
- From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum (B.C., A.N., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
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Duta-Mare M, Radovic B, Schlager S, Wegscheider M, Kolb-Lenz D, Madl T, Stryeck S, Kratky D. Consequences of lysosomal acid lipase deficiency in macrophages. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Kiesewetter J, Gutmann J, Drossard S, Gurrea Salas D, Prodinger W, Mc Dermott F, Urban B, Staender S, Baschnegger H, Hoffmann G, Hübsch G, Scholz C, Meier A, Wegscheider M, Hoffmann N, Ohlenbusch-Harke T, Keil S, Schirlo C, Kühne-Eversmann L, Heitzmann N, Busemann A, Koechel A, Manser T, Welbergen L, Kiesewetter I. The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education--A Position Statement of the Committee for Patient Safety and Error Management of the German Association for Medical Education. GMS J Med Educ 2016; 33:Doc10. [PMID: 26958647 PMCID: PMC4766934 DOI: 10.3205/zma001009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 05/14/2023]
Abstract
BACKGROUND Since the report "To err is human" was published by the Institute of Medicine in the year 2000, topics regarding patient safety and error management are in the focal point of interest of science and politics. Despite international attention, a structured and comprehensive medical education regarding these topics remains to be missing. GOALS The Learning Objective Catalogue for Patient Safety described below the Committee for Patient Safety and Error Management of the German Association for Medical Education (GMA) has aimed to establish a common foundation for the structured implementation of patient safety curricula at the medical faculties in German-speaking countries. METHODS The development the Learning Objective Catalogue resulted via the participation of 13 faculties in two committee meetings, two multi-day workshops, and additional judgments of external specialists. RESULTS The Committee of Patient Safety and Error Management of GMA developed the present Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education, structured in three chapters: Basics, Recognize Causes as Foundation for Proactive Behavior, and Approaches for Solutions. The learning objectives within the chapters are organized on three levels with a hierarchical organization of the topics. Overall, the Learning Objective Catalogue consists of 38 learning objectives. All learning objectives are referenced with the National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education. DISCUSSION The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education is a product that was developed through collaboration of members from 13 medical faculties. In the German-speaking countries, the Learning Objective Catalogue should advance discussion regarding the topics of patient safety and error management and help develop subsequent educational structures. The Learning Objective Catalogue for Patient Safety can serve as a common ground for an intensified, constructive, subject-specific discussion about these topics at the medical faculties, and guide the implementation of hopefully multiple patient safety curricula in undergraduate medical education.
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Affiliation(s)
- Jan Kiesewetter
- Klinium der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
- *To whom correspondence should be addressed: Jan Kiesewetter, Klinium der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Ziemssenstraße 1, 80336 München, Deutschland, Tel.: +49 (0)89/4400-57207, E-mail:
| | - Johanna Gutmann
- Technische Universität München, Klinikum Rechts der Isar, München, Deutschland
| | - Sabine Drossard
- Klinium der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
- Klinikum Augsburg, Kinderchirurgische Klinik, Augsburg, Deutschland
| | | | - Wolfgang Prodinger
- Medizinische Universität Innsbruck, Sektion für Hygiene und medizinische Mikrobiologie, Innsbruck, Österreich
| | - Fiona Mc Dermott
- Universitätsklinikum Bonn, Institut für Patientensicherheit, Bonn, Deutschland
| | - Bert Urban
- Klinikum der Universität München, Institut für Notfallmedizin und Medizinmanagement (INM), München, Deutschland
| | - Sven Staender
- Spital Männedorf, Institut für Anästhesie und Intensivmedizin, Männedorf, Schweiz
| | - Heiko Baschnegger
- Klinikum der Universität München, Klinik für Anästhesiologie, München, Deutschland
| | - Gordon Hoffmann
- Klinikum der Universität München, Klinik für Anästhesiologie, München, Deutschland
| | - Grit Hübsch
- Technische Universität Dresden, Medizinische Fakultät, Medizinisches Interprofessionelles Trainingszentrum, Dresden, Deutschland
| | - Christoph Scholz
- Universitätsklinikum Ulm, Frauenheilkunde und Geburtshilfe, Ulm, Deutschland
| | - Anke Meier
- Universität Hamburg, Hamburg, Deutschland
| | - Mirko Wegscheider
- Universitätsklinikum Leipzig, Klinik für Neurologie, Leipzig, Deutschland
| | - Nicolas Hoffmann
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Anästhesiologie, Hamburg, Deutschland
| | - Theda Ohlenbusch-Harke
- Technische Universität Dresden, Medizinische Fakultät, Medizinisches Interprofessionelles Trainingszentrum, Dresden, Deutschland
| | - Stephanie Keil
- Universität Regensburg, Fakultät für Medizin, Zentrum für Lehre, Regensburg, Deutschland
| | | | - Lisa Kühne-Eversmann
- Universität München, Hormon- und Stoffwechselzentrum München, München, Deutschland
| | - Nicole Heitzmann
- Klinium der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Deutschland
| | - Alexandra Busemann
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Chirurgie, Greifswald, Deutschland
| | - Ansgar Koechel
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Deutschland
| | - Tanja Manser
- Universitätsklinikum Bonn, Institut für Patientensicherheit, Bonn, Deutschland
| | - Lena Welbergen
- Klinikum der Universität München, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, München, Deutschland
| | - Isabel Kiesewetter
- Klinikum der Universität München, Klinik für Anästhesiologie, München, Deutschland
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Przybylińska H, Springholz G, Lechner RT, Hassan M, Wegscheider M, Jantsch W, Bauer G. Magnetic-field-induced ferroelectric polarization reversal in the multiferroic Ge(1-x)Mn(x)Te semiconductor. Phys Rev Lett 2014; 112:047202. [PMID: 24580486 DOI: 10.1103/physrevlett.112.047202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 11/14/2013] [Indexed: 06/03/2023]
Abstract
Ge(1-x)Mn(x)Te is shown to be a multiferroic semiconductor, exhibiting both ferromagnetic and ferroelectric properties. By ferromagnetic resonance we demonstrate that both types of order are coupled to each other. As a result, magnetic-field-induced ferroelectric polarization reversal is achieved. Switching of the spontaneous electric dipole moment is monitored by changes in the magnetocrystalline anisotropy. This also reveals that the ferroelectric polarization reversal is accompanied by a reorientation of the hard and easy magnetization axes. By tuning the GeMnTe composition, the interplay between ferromagnetism and ferroelectricity can be controlled.
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Affiliation(s)
- H Przybylińska
- Institute of Physics, Polish Academy of Sciences, Al. Lotników 32/46, 02-668 Warsaw, Poland
| | - G Springholz
- Institut für Halbleiter-und Festkörperphysik, Johannes Kepler Universität, A-4040 Linz, Austria
| | - R T Lechner
- Institut für Halbleiter-und Festkörperphysik, Johannes Kepler Universität, A-4040 Linz, Austria and Institut für Physik, Montanuniversität Leoben, A-8700 Leoben, Austria
| | - M Hassan
- Institut für Halbleiter-und Festkörperphysik, Johannes Kepler Universität, A-4040 Linz, Austria and Department of Physics, University of the Punjab, Lahore-54590, Pakistan
| | - M Wegscheider
- Institut für Halbleiter-und Festkörperphysik, Johannes Kepler Universität, A-4040 Linz, Austria
| | - W Jantsch
- Institut für Halbleiter-und Festkörperphysik, Johannes Kepler Universität, A-4040 Linz, Austria
| | - G Bauer
- Institut für Halbleiter-und Festkörperphysik, Johannes Kepler Universität, A-4040 Linz, Austria
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Rumpf JJ, Wegscheider M, Fricke C, Weise D, Claßen J. Einfluss der offline-Applikation von transkranieller Gleichstromstimulation auf die Konsolidierung motorischen Lernens bei älteren gesunden Probanden. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Aflaki E, Doddapattar P, Radović B, Povoden S, Kolb D, Vujić N, Wegscheider M, Koefeler H, Hornemann T, Graier WF, Malli R, Madeo F, Kratky D. C16 ceramide is crucial for triacylglycerol-induced apoptosis in macrophages. Cell Death Dis 2012; 3:e280. [PMID: 22419109 PMCID: PMC3317349 DOI: 10.1038/cddis.2012.17] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 12/12/2022]
Abstract
Triacylglycerol (TG) accumulation caused by adipose triglyceride lipase (ATGL) deficiency or very low-density lipoprotein (VLDL) loading of wild-type (Wt) macrophages results in mitochondrial-mediated apoptosis. This phenotype is correlated to depletion of Ca(2+) from the endoplasmic reticulum (ER), an event known to induce the unfolded protein response (UPR). Here, we show that ER stress in TG-rich macrophages activates the UPR, resulting in increased abundance of the chaperone GRP78/BiP, the induction of pancreatic ER kinase-like ER kinase, phosphorylation and activation of eukaryotic translation initiation factor 2A, the translocation of activating transcription factor (ATF)4 and ATF6 to the nucleus and the induction of the cell death executor CCAAT/enhancer-binding protein homologous protein. C16:0 ceramide concentrations were increased in Atgl-/- and VLDL-loaded Wt macrophages. Overexpression of ceramide synthases was sufficient to induce mitochondrial apoptosis in Wt macrophages. In accordance, inhibition of ceramide synthases in Atgl-/- macrophages by fumonisin B1 (FB1) resulted in specific inhibition of C16:0 ceramide, whereas intracellular TG concentrations remained high. Although the UPR was still activated in Atgl-/- macrophages, FB1 treatment rescued Atgl-/- macrophages from mitochondrial dysfunction and programmed cell death. We conclude that C16:0 ceramide elicits apoptosis in Atgl-/- macrophages by activation of the mitochondrial apoptosis pathway.
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Affiliation(s)
- E Aflaki
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
- National Human Genome Research Institute/NIH Molecular Neurogenetics Section, 35 Convent Drive, Bethesda, MD, USA
| | - P Doddapattar
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - B Radović
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - S Povoden
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - D Kolb
- Institute of Cell Biology, Histology and Embryology, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
- Center for Medical Research, Medical University of Graz, Stiftingtalstrasse 24, 8010 Graz, Austria
| | - N Vujić
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - M Wegscheider
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - H Koefeler
- Institute of Cell Biology, Histology and Embryology, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - T Hornemann
- Institute of Clinical Chemistry, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - W F Graier
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - R Malli
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - F Madeo
- Institute of Molecular Biosciences, University of Graz, Humboldtstrasse 50, 8010 Graz, Austria
| | - D Kratky
- Institute of Molecular Biology and Biochemistry, Center of Molecular Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
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Ashraf T, Gusenbauer C, Stangl J, Hesser G, Wegscheider M, Koch R. Stress and interdiffusion during molecular beam epitaxy of Fe on As-rich GaAs(001). J Phys Condens Matter 2011; 23:042001. [PMID: 21406874 DOI: 10.1088/0953-8984/23/4/042001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Interdiffusion during growth of Fe on As-rich GaAs(001) substrates has been investigated by real time stress measurements. Compared to Ga-rich GaAs(001), interdiffusion processes are decisively reduced. The optimum growth temperature (characterized by abrupt interfaces, pseudomorphic growth and negligible intermixing) is found to lie below 50 °C. At higher growth temperatures interdiffusion effects increase and eventually lead to the formation of a compact crystalline alloy layer of presumably Fe(2 + x)Ga(1 - x), as evidenced by transmission electron microscopy and x-ray diffraction.
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Affiliation(s)
- T Ashraf
- Institut für Halbleiter- und Festkörperphysik, Johannes Kepler Universität, Altenbergerstrasse 69, A-4040 Linz, Austria
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Bonanni A, Navarro-Quezada A, Li T, Wegscheider M, Matĕj Z, Holý V, Lechner RT, Bauer G, Rovezzi M, D'Acapito F, Kiecana M, Sawicki M, Dietl T. Controlled aggregation of magnetic ions in a semiconductor: an experimental demonstration. Phys Rev Lett 2008; 101:135502. [PMID: 18851460 DOI: 10.1103/physrevlett.101.135502] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Indexed: 05/26/2023]
Abstract
The control on the distribution of magnetic ions into a semiconducting host is crucial for the functionality of magnetically doped semiconductors. Through a structural analysis at the nanoscale, we give experimental evidence that the aggregation of Fe ions in (Ga,Fe)N and consequently the magnetic response of the material are affected by the growth rate and doping with shallow impurities.
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Affiliation(s)
- A Bonanni
- Institute for Semiconductor and Solid State Physics, Johannes Kepler University, A-4040, Linz, Austria.
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Pacuski W, Kossacki P, Ferrand D, Golnik A, Cibert J, Wegscheider M, Navarro-Quezada A, Bonanni A, Kiecana M, Sawicki M, Dietl T. Observation of strong-coupling effects in a diluted magnetic semiconductor Ga1-xFexN. Phys Rev Lett 2008; 100:037204. [PMID: 18233033 DOI: 10.1103/physrevlett.100.037204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Indexed: 05/25/2023]
Abstract
The giant Zeeman splitting of free excitons is measured in Ga(1-x)Fe(x)N. Magneto-optical and magnetization data imply the ferromagnetic sign and a reduced magnitude of the effective p-d exchange energy governing the interaction between Fe(3+) ions and holes in GaN, N_{0}beta(app)=+0.5+/-0.2 eV. This finding corroborates the recent suggestion that the strong p-d hybridization specific to nitrides and oxides leads to significant renormalization of the valence band exchange splitting.
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Affiliation(s)
- W Pacuski
- Institute of Experimental Physics, University of Warsaw, Hoza 69, Warsaw, Poland.
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Lindqvist R, Andersson Y, Lindbäck J, Wegscheider M, Eriksson Y, Tideström L, Lagerqvist-Widh A, Hedlund KO, Löfdahl S, Svensson L, Norinder A. A one-year study of foodborne illnesses in the municipality of Uppsala, Sweden. Emerg Infect Dis 2001; 7:588-92. [PMID: 11485680 PMCID: PMC2631855 DOI: 10.3201/eid0707.010742] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surveillance was enhanced and a retrospective interview study performed in 1998-99 to determine incidence, causes, and costs of foodborne illnesses in Uppsala, Sweden. Sixty-eight percent of the detected foodborne illness incidents were single cases, and 32% were outbreaks. Most (85%) of the incidents came to the attention of the municipal authorities through telephone calls from affected persons. Calicivirus, Campylobacter spp., and Staphyloccocus aureus were the most common etiological agents; meat, meat products, and mixed dishes were the most implicated food categories. The incidence of foodborne illness was estimated to be 38 cases per 1,000 inhabitants per year. The estimated average costs per illness were 2,164 Swedish Krona (SEK) ($246) to society and 500 SEK ($57) to the patient. The annual cost of foodborne illnesses in Sweden was estimated to be 1,082 million SEK ($123 million).
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Affiliation(s)
- R Lindqvist
- National Food Administration, Uppsala, Sweden.
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