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Brenk-Franz K, Häuser W, Brähler E, Schneider N, Hoy M, Strauß B. Sexual Dysfunctions and Health-Related Impairment in Patients With Chronic Disease. Dtsch Arztebl Int 2024; 121:66-67. [PMID: 38427942 PMCID: PMC10979438 DOI: 10.3238/arztebl.m2023.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 03/03/2024]
Affiliation(s)
- Katja Brenk-Franz
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar of the Technical University Munich, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy University Medical Centre of the Johannes Gutenberg-University Mainz, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Nico Schneider
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Madita Hoy
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
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Brenk-Franz K, Brähler E, Hoy M, Schneider N, Strauss B. How Often Are Patients in Germany Asked About Their Sexual History? Dtsch Arztebl Int 2023; 120:811-812. [PMID: 38154050 PMCID: PMC10777308 DOI: 10.3238/arztebl.m2023.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Katja Brenk-Franz
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany,
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Germany
- Integrated Research and Treatment Center for Obesity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Germany
| | - Madita Hoy
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany,
| | - Nico Schneider
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany,
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany,
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Kalmukov IA, Schneider N, Miraldo D, Solano MA. Internal fixation of canine coccygeal vertebral fractures: four cases (2018-2022). J Small Anim Pract 2023; 64:642-649. [PMID: 37376751 DOI: 10.1111/jsap.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To describe the surgical technique and evaluate the outcome and complications after coccygeal vertebral fracture repair in dogs using internal fixation. MATERIALS AND METHODS Medical records and radiography of client-owned dogs were reviewed retrospectively. A lateral approach to the vertebral body was used, and a 1.5 or 1.0 mm plate was applied laterally. Initial follow-up included clinical and radiographic assessment at 6 to 8 weeks postoperatively. Short-term follow-up was assessed by the completion of an adapted functional questionnaire by owners. RESULTS Four dogs presented with mid-vertebral body fractures. The neurological function of the tail was preserved, and fracture repair was performed in all cases. One dog developed a surgical site infection, which was successfully treated with antimicrobial therapy. One dog experienced prolonged postoperative pain and delayed union. Fracture healing occurred in all patients at the final follow-up. Neither discomfort nor reduced function or mobility of the tails was noticed during the postoperative patient assessment. The questionnaire was completed by all owners with a mean follow-up time of 40 weeks. Excellent outcomes were established from subsequent clinical reviews and owner questionnaires, related to their dog's activity and comfort levels. CLINICAL SIGNIFICANCE Excellent outcomes can be achieved following the repair of coccygeal vertebral fractures in dogs using internal fixation, including a return to normal function of the tail.
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Affiliation(s)
| | | | - D Miraldo
- Southern Counties Veterinary Specialists, Ringwood, UK
| | - M A Solano
- The Ralph, Veterinary Referral Centre, Marlow, UK
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Brandt F, Schneider N, Altmann U, Strauß B, Hübner J, Keinki C. [Psychometric Properties of the Qualiskope-A for Measuring Patient Satisfaction with Outpatient Medical Treatment: Use in Oncology and Transferability to Inpatient Care]. Gesundheitswesen 2023; 85:732-740. [PMID: 37028417 DOI: 10.1055/a-2016-7948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
AIM The Qualiskope-A is a German-language PREM (Patient Reported Experience Measure) which, with the help of 27 items allocated to four scales, enables measurement of patient satisfaction with outpatient medical treatment along four dimensions of patient satisfaction. This study examined whether the questionnaire delivers reliable results in an oncological population and whether its application can be extended to inpatient care. METHOD Required data was collected as part of the PIKKO study. Initially, descriptive statistics and internal consistency (Cronbach's alpha) of the PREM's scales were analyzed. In addition, a sub-sample that assessed the same doctor at two consecutive measurement time points was observed with regard to test-retest reliability (Spearman correlation (rs) between both measurement time points). The measurement model of the Qualiskope-A was then examined using confirmatory factor analysis. To test the transferability to inpatient care, measurement invariance with regard to outpatients and inpatients was computed. RESULTS A total of 476 patients was included in the study. Every score of the Qualiskope-A showed a left-skewed distribution in the sample and revealed pronounced ceiling effects. Cronbach's alpha coefficients were consistently>0,8. Within the test-retest group (n=197), a strong correlation (rs>0,5) was observed between the measurement time points. The fit indices calculated using confirmatory factor analysis showed a good model fit (CFI=0,958; RMSEA=0,026; SRMR=0,040; every factor loadings>0,6). The fit indices, calculated as part of the investigation of measurement invariance, consistently met the defined threshold values. CONCLUSION The Qualiscope-A shows good reliability in the examined oncological sample. It can be used in both outpatient and inpatient settings (no indications of non-invariance were found). Due to pronounced ceiling effects, however, the item scaling should be revised.
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Affiliation(s)
- Florian Brandt
- Versorgungsmanagement/Verträge, IKK Südwest, Saarbrücken, Germany
| | - Nico Schneider
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Uwe Altmann
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Keinki
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
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Jakob B, Schneider N, Gengenbach L, Manolikakes G. Palladium-catalyzed enantioselective three-component synthesis of α-arylglycine derivatives from glyoxylic acid, sulfonamides and aryltrifluoroborates. Beilstein J Org Chem 2023; 19:719-726. [PMID: 37284589 PMCID: PMC10241097 DOI: 10.3762/bjoc.19.52] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
A palladium-catalyzed enantioselective three-component reaction of glyoxylic acid, sulfonamides and aryltrifluoroborates is described. This process provides modular access to the important α-arylglycine motif in moderate to good yields and enantioselectivies. The formed α-arylglycine products constitute useful building blocks for the synthesis of peptides or arylglycine-containing natural products.
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Affiliation(s)
- Bastian Jakob
- Department of Chemistry, RPTU Kaiserslautern-Landau, Erwin-Schrödinger-Str. Geb. 54, D-67663 Kaiserslautern, Germany
| | - Nico Schneider
- Department of Chemistry, RPTU Kaiserslautern-Landau, Erwin-Schrödinger-Str. Geb. 54, D-67663 Kaiserslautern, Germany
| | - Luca Gengenbach
- Department of Chemistry, RPTU Kaiserslautern-Landau, Erwin-Schrödinger-Str. Geb. 54, D-67663 Kaiserslautern, Germany
| | - Georg Manolikakes
- Department of Chemistry, RPTU Kaiserslautern-Landau, Erwin-Schrödinger-Str. Geb. 54, D-67663 Kaiserslautern, Germany
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Schneider N, Strauss B, Hübner J, Keinki C, Brandt F, Rubai S, Altmann U. The impact of the COVID-19 pandemic restrictions on the health care utilization of cancer patients. BMC Cancer 2023; 23:439. [PMID: 37189037 DOI: 10.1186/s12885-023-10945-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND COVID-19 has impacted both society and medical care. While Germany entered the first lockdown in spring 2020, the PIKKO study (Patient information, communication and competence empowerment in oncology) was still active. The intervention modules, patient navigator (PN), services of the Saarland Cancer Society (SCS), psycho-social counseling and different courses, and online knowledge database (ODB) continued to be offered, but in an adapted form. It was the aim of this supplementary survey to identify the restrictions and burdens of the pandemic containment strategies on the PIKKO patients and thus on the PIKKO study itself. Furthermore, this work shows how the PIKKO modules were used during the lockdown. METHODS All patients in the PIKKO intervention group (IG) were invited to complete a questionnaire, n = 503. Furthermore, utilization of the SCS and log files of the ODB were analyzed. For socio-demographic data and contacts with the PN, data from the regular PIKKO surveys were used. In addition to descriptive statistics, chi²-tests, F-tests and linear regression analyses were performed. RESULTS 356 patients participated in this supplemental survey. 37.6% reported restrictions. "Restrictions on accompanying persons", "ban on visits to the wards" and "protective mouth-nose-mask" were reported as the greatest burdens. 39.0% expressed fears that the restrictions would have an impact on the course of their disease. Linear regression analyses showed differences in feelings of burden among age groups (more among < 60-year-olds), gender (more among women), children in the household (more with children), and preexisting financial stress (more with financial worries). In April 2020, there was more patient contact with PNs by phone, more SCS psycho-social counseling by phone, adapted SCS course offering, but with significantly fewer participants, and high activity on the ODB. CONCLUSION Cancer patients in the IG reported restrictions from the pandemic containment strategies and feared an impact on their recovery. However, whether a burden is perceived as heavy depends more on gender, age, or pre-existing burdens than on whether the lockdown affects PIKKO or not. The utilization of counseling, courses or the ODB despite lockdown shows the need for such services, especially in times of crisis. TRIAL REGISTRATION This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21 Feb 2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703 .
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Affiliation(s)
- Nico Schneider
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology, Jena University Hospital, Stoystrasse 3, Jena, D-07740, Germany.
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology, Jena University Hospital, Stoystrasse 3, Jena, D-07740, Germany
| | - Jutta Hübner
- Department of Haematology and Medical Oncology, Jena University Hospital, Am Klinikum 1, Jena, D-07747, Germany
| | - Christian Keinki
- The German Cancer Society, Kuno-Fischer-Strasse 8, Berlin, D-14057, Germany
| | - Florian Brandt
- IKK Südwest, Europaallee 3-4, Saarbrücken, D-66113, Germany
| | - Sabine Rubai
- Saarland Cancer Society, Bruchwiesenstrasse 15, Saarbrücken, D-66111, Germany
| | - Uwe Altmann
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology, Jena University Hospital, Stoystrasse 3, Jena, D-07740, Germany
- Department of Psychology, MSB Medical School Berlin GmbH, Berlin, Germany
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Schneider N, Bäcker A, Strauss B, Hübner J, Rubai S, Wagner S, Schwarz-Fedrow D, Hager L, Brenk-Franz K, Keinki C, Brandt F, Altmann U. Patient information, communication and competence empowerment in oncology: Results and learnings from the PIKKO study. Support Care Cancer 2023; 31:327. [PMID: 37154985 PMCID: PMC10165303 DOI: 10.1007/s00520-023-07781-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Many concepts for accompanying and supporting cancer patients exist and have been studied over time. One of them was PIKKO (a German acronym for "Patient information, communication and competence empowerment in oncology"), which combined a patient navigator, socio-legal and psychological counseling (with psychooncologists), courses dealing with various supportive aspects, and a knowledge database with validated and easy-to-understand disease-related information. The aim was to increase the patients' health-related quality of life (HRQoL), self-efficacy as well as health literacy and to reduce psychological complaints such as depression and anxiety. METHODS To this purpose, an intervention group was given full access to the modules in addition to treatment as usual, while a control group received only treatment as usual. Over twelve months, each group was surveyed up to five times. Measurements were taken using the SF12, PHQ-9, GAD, GSE, and HLS-EU-Q47. RESULTS No significant differences were found in scores on the mentioned metrics. However, each module was used many times and rated positively by the patients. Further analyses showed a tendency higher score in health literacy with higher intensity of use of the database and higher score in mental HRQoL with higher intensity of use of counseling. CONCLUSION The study was affected by several limitations. A lack of randomization, difficulties in recruiting the control group, a heterogeneous sample, and the COVID-19 lockdown influenced the results. Nevertheless, the results show that the PIKKO support was appreciated by the patients and the lack of measurable effects was rather due to the mentioned limitations than to the PIKKO intervention. TRIAL REGISTRATION This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21.02.2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703.
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Affiliation(s)
- Nico Schneider
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology (IPMPP), Jena University Hospital, Jena, Germany.
| | - Anna Bäcker
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology (IPMPP), Jena University Hospital, Jena, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology (IPMPP), Jena University Hospital, Jena, Germany
| | - Jutta Hübner
- Department of Haematology and Medical Oncology, Jena University Hospital, Jena, Germany
| | | | | | | | - Lutz Hager
- SRH Fernhochschule - The Mobile University, Riedlingen, Germany
| | - Katja Brenk-Franz
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology (IPMPP), Jena University Hospital, Jena, Germany
| | | | | | - Uwe Altmann
- Institute of Psychosocial Medicine, Psychotherapy and Psychoonocology (IPMPP), Jena University Hospital, Jena, Germany
- Department of Psychology, MSB Medical School Berlin GmbH, Berlin, Germany
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Di Lorenzo E, Xu T, Zhao Y, Newman M, Capotondi A, Stevenson S, Amaya DJ, Anderson BT, Ding R, Furtado JC, Joh Y, Liguori G, Lou J, Miller AJ, Navarra G, Schneider N, Vimont DJ, Wu S, Zhang H. Modes and Mechanisms of Pacific Decadal-Scale Variability. Ann Rev Mar Sci 2023; 15:249-275. [PMID: 36112981 DOI: 10.1146/annurev-marine-040422-084555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The modes of Pacific decadal-scale variability (PDV), traditionally defined as statistical patterns of variance, reflect to first order the ocean's integration (i.e., reddening) of atmospheric forcing that arises from both a shift and a change in strength of the climatological (time-mean) atmospheric circulation. While these patterns concisely describe PDV, they do not distinguish among the key dynamical processes driving the evolution of PDV anomalies, including atmospheric and ocean teleconnections and coupled feedbacks with similar spatial structures that operate on different timescales. In this review, we synthesize past analysis using an empirical dynamical model constructed from monthly ocean surface anomalies drawn from several reanalysis products, showing that the PDV modes of variance result from two fundamental low-frequency dynamical eigenmodes: the North Pacific-central Pacific (NP-CP) and Kuroshio-Oyashio Extension (KOE) modes. Both eigenmodes highlight how two-way tropical-extratropical teleconnection dynamics are the primary mechanisms energizing and synchronizing the basin-scale footprint of PDV. While the NP-CP mode captures interannual- to decadal-scale variability, the KOE mode is linked to the basin-scale expression of PDV on decadal to multidecadal timescales, including contributions from the South Pacific.
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Affiliation(s)
- E Di Lorenzo
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, Rhode Island, USA;
| | - T Xu
- Physical Sciences Laboratory, National Oceanic and Atmospheric Administration, Boulder, Colorado, USA
| | - Y Zhao
- Deep-Sea Multidisciplinary Research Center, Pilot National Laboratory for Marine Science and Technology (Qingdao), Qingdao, China
| | - M Newman
- Physical Sciences Laboratory, National Oceanic and Atmospheric Administration, Boulder, Colorado, USA
- Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder, Boulder, Colorado, USA
| | - A Capotondi
- Physical Sciences Laboratory, National Oceanic and Atmospheric Administration, Boulder, Colorado, USA
- Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder, Boulder, Colorado, USA
| | - S Stevenson
- Bren School of Environmental Science and Management, University of California, Santa Barbara, California, USA
| | - D J Amaya
- Physical Sciences Laboratory, National Oceanic and Atmospheric Administration, Boulder, Colorado, USA
| | - B T Anderson
- Department of Earth and Environment, Boston University, Boston, Massachusetts, USA
| | - R Ding
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Beijing Normal University, Beijing, China
| | - J C Furtado
- School of Meteorology, University of Oklahoma, Norman, Oklahoma, USA
| | - Y Joh
- Atmospheric and Oceanic Sciences Program, Princeton University, Princeton, New Jersey, USA
| | - G Liguori
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
- School of Earth, Atmosphere, and Environment, Monash University, Melbourne, Victoria, Australia
| | - J Lou
- Physical Sciences Laboratory, National Oceanic and Atmospheric Administration, Boulder, Colorado, USA
- Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder, Boulder, Colorado, USA
| | - A J Miller
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
| | - G Navarra
- Program in Ocean Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - N Schneider
- International Pacific Research Center and Department of Oceanography, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - D J Vimont
- Department of Atmospheric and Oceanic Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - S Wu
- Laboratory for Climate and Ocean-Atmosphere Studies, Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing, China
| | - H Zhang
- Department of Earth and Atmospheric Sciences, University of Houston, Houston, Texas, USA
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Kirschner H, Arp A, Schneider N, Storch M, Rauschenbach M, Strauß B. [Biographical Interviews with GDR Psychotherapists - First Hypotheses on their Social Positioning and Professional Action]. Psychother Psychosom Med Psychol 2022; 72:564-571. [PMID: 36220096 DOI: 10.1055/a-1821-8889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJEKTIVE First results of a socio-historical analysis of the life stories of GDR psychotherapists are presented. Interviews, carried out as part of the project Seelenarbeit im Sozialismus, are intended to enable statements about social and family backgrounds, educational paths and social position. An exemplary case is presented in order to develop hypotheses for the design of professional behavior by GDR psychotherapists. METHODS Narrative/biographical interviews are processed as a source for historical and sociological research strategies. For a descriptive presentation of the topics described in the interviews, a cross-case category system was created inductively, which should enable statements about the frequency of certain characteristics. The individual case is analyzed by using the grounded theory method. RESULTS A first overview of the sample relates to the demographic characteristics of the interviewed persons, their level of awareness and professional qualifications. The interviewed psychotherapists can be assigned to different decades of the historical development of GDR psychotherapy with regard to their years of birth. They are further determined with regard to their social origin (parenting professions), their professional career (distribution of qualification paths), their party membership (SED or block party) and experience disadvantages by the state. In the case study, the dependence of the professional attitude on socializing influences is illustrated. DISCUSSION Ultimately, the study can show a heterogeneous group of psychotherapists from the GDR, whose biographies can be used to trace the historical development of psychotherapy in the GDR. A look at the actors' families shows that the profession from fathers were often located in the field of self-employed entrepreneurs or academics. In addition, only a few psychotherapists were members of the SED, but frequent disadvantages by the state are named. As a conclusion there is an advice of a high importance of personal reflexivity and a reflective professional self-image.Conclusions Further evaluations should prove the social and political positioning as well as the professional self-image of GDR psychotherapists.
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Affiliation(s)
- Hariet Kirschner
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Agnès Arp
- Neuere Zeitgeschichte und Geschichtsdidaktik, Universität Erfurt, Erfurt, Germany
| | - Nico Schneider
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Monika Storch
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Manuel Rauschenbach
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
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Winter K, Jung A, Ulrich HS, Schneider N, Brzank PJ. Belastungen, Ressourcen und Versorgungsbedarfe von ungewollt
Schwangeren mit Gewalterfahrungen in intimen Paarbeziehungen: ein Realist
Review. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753591] [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: 12/12/2022]
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Buhck M, Achenbach J, Wiese B, Tran AT, Stuhrmann M, Jaeger B, Bernateck M, Schneider N, Karst M. The interplay of chronic stress and genetic traits discriminates between patients suffering from multisomatoform disorder with pain as the leading symptom and matched controls. J Affect Disord 2022; 308:466-472. [PMID: 35460735 DOI: 10.1016/j.jad.2022.04.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Somatoform disorders and functional somatic syndromes (FSS) with symptoms that are not sufficiently explained by physical or technical examination are among the most challenging underlying causes. Many different somatoform disorders and FSS have overlapping symptoms, often with pain as the most prevalent one, leading to a high burden of disease. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We analyzed a group of 151 patients and 149 matched controls to identify interactions of genetic and environmental factors with a possible influence on the development of MSD. DESIGN In a retrospective case-control study, we performed a statistical analysis on 151 patients and 149 matched controls using logistic regression and a Classification and Regression Tree (CART) analysis. RESULTS The logistic regression analysis of genes and environmental factors demonstrated significant differences in the results of the Trier Inventory of Chronic Stress (TICS) questionnaire, the single nucleotide polymorphism rs1800955 of the dopamine receptor D4 and the single nucleotide polymorphism rs4818 of the enzyme catechol-O-methyltransferase between patients with MSD and healthy controls. The resulting decision tree of the CART analysis determined that the TICS questionnaire was able to differentiate patients and controls most accurately, followed by certain genotypes of the 5-hydroxytryptamine receptor 2A and a single nucleotide polymorphism of the enzyme catechol-O-methyltransferase. CONCLUSIONS The results of the statistical analysis identified a gene-environmental interaction possibly leading to MSD. The resulting identifiers could be used as a reference to inform diagnostic algorithms to easier identify patients suffering from MSD.
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Affiliation(s)
- M Buhck
- Department of Child and Adolescent Psychiatry, Children's Hospital Auf der Bult Hannover, 30173 Hannover, Germany
| | - J Achenbach
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Medicine, Nordstadt Krankenhaus Hannover, 30167 Hannover, Germany.
| | - B Wiese
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany
| | - A T Tran
- Department of Neurology und Neurophysiology, Hannover Medical School, 30625 Hannover, Germany
| | - M Stuhrmann
- Institute of Human Genetics, Hannover Medical School, 30625 Hannover, Germany
| | - B Jaeger
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - M Bernateck
- Center for Pain Medicine Hannover, 30159 Hannover, Germany
| | - N Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, 30625 Hannover, Germany
| | - M Karst
- Department of Anesthesiology and Intensive Care Medicine, Pain Clinic, Hannover Medical School, 30625 Hannover, Germany
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Fries B, Johnson V, Schneider N, Fraebel C, Doerr O, Mathew S, Hamm CW, Schmitt J. Electroanatomic visualization of coronary arteries: a case series to elicit safety, feasibility and diagnostic value in complex ablation procedures. Europace 2022. [DOI: 10.1093/europace/euac053.354] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although three dimensional (3D) electroanatomic mapping systems allow detailed assessment of anatomy and substrates, ablation still carries substantial risk when close proximity to coronary arteries is suspected. 3D integration of coronary anatomy in mapping systems is still cumbersome, highlighting the need for an option of ad hoc acquirement of coronary artery anatomy. The goal of this case series was to evaluate the feasibility of a wire-based approach to the live visualization of coronary arteries and to assess its diagnostic information regarding procedure guiding.
Methods
For this single center case series, we included procedures in which close proximity of an ablation site to an epicardial vessel had to be suspected. An uninsulated-tip wire was then introduced into the relevant coronaries via diagnostic catheters after exclusion of critical stenosis by coronary angiography. The wire was connected to an impedance based 3D mapping system using a clamp and standard pin connection. Integrating this setup in the mapping system allows for live visualization of the wire tip, as well as the assessment of local electrograms within the respective vessel.
Results
We included a total of 9 procedures (4 ventricular tachycardia (VT) ablation procedures and 5 procedures for the ablation of premature ventricular contractions (PVCs)). The left coronary arteries were mapped in 8 cases, the right coronary artery was mapped in one case. In the majority of cases, the arrhythmogenic substrate was found in the left ventricle (5/9) or left ventricular summit area and the distal coronary sinus respectively (3/9). In two cases, epicardial mapping was performed combined with visualization of the right or left coronary arteries, respectively. There were no complications attributed to coronary wiring and mapping in this case series.
In two cases, the diagnostic information from mapping of the coronary arteries could be used to rule out an epicardial origin of arrhythmia. In the majority of cases, coronary visualization was used to ascertain a proper distance between the ablation site and the vessel.
Discussion
In this case series, we could demonstrate the feasibility and safety of coronary artery visualization and its integration in a 3D mapping system. The data obtained was used for diagnostic, as well as safety aspects. The electrograms from the wire were used to quickly assess relative timing of arrhythmias, thus allowing for an estimation of possible epicardial origin.
Conclusion
Applying the same caveats as for any other wiring of coronary arteries, their electroanatomic visualization is achieved in a safe and straightforward manner, with minimal technical requirements. Mapping of the coronary arteries adds critical diagnostic information and their real-time visualization is feasible without exceeding costs or risks
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Affiliation(s)
- B Fries
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - V Johnson
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - N Schneider
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - C Fraebel
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - O Doerr
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - S Mathew
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - CW Hamm
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
| | - J Schmitt
- University Hospital Giessen And Marburg, Cardiology, Giessen, Germany
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Schmidt KFR, Huelle K, Reinhold T, Prescott HC, Gehringer R, Hartmann M, Lehmann T, Mueller F, Reinhart K, Schneider N, Schroevers MJ, Kosilek RP, Vollmar HC, Heintze C, Gensichen JS. Healthcare Utilization and Costs in Sepsis Survivors in Germany-Secondary Analysis of a Prospective Cohort Study. J Clin Med 2022; 11:jcm11041142. [PMID: 35207415 PMCID: PMC8879304 DOI: 10.3390/jcm11041142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized.
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Affiliation(s)
- Konrad F. R. Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Institute of General Practice and Family Medicine, Charité University Medicine, D-10117 Berlin, Germany;
- Correspondence: or ; Tel.: +49-3641-9395800 or +49-30-450-514-133; Fax: +49-3641-9395802 or +49-30-450-514-932
| | - Katharina Huelle
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine, D-10117 Berlin, Germany;
| | - Hallie C. Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-5368, USA;
- VA Center for Clinical Management Research, Ann Arbor, MI 48105, USA
| | - Rebekka Gehringer
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
| | - Michael Hartmann
- Hospital Pharmacy, Jena University Hospital, D-07747 Jena, Germany;
| | - Thomas Lehmann
- Institute of Medical Statistics, Information Sciences and Documentation, Jena University Hospital, D-07747 Jena, Germany;
| | - Friederike Mueller
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Thiem-Research GmbH, Carl-Thiem-Klinikum, D-03048 Cottbus, Germany;
| | - Konrad Reinhart
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, D-10117 Berlin, Germany;
| | - Nico Schneider
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, D-07743 Jena, Germany;
| | - Maya J. Schroevers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, NL-9700 AB Groningen, The Netherlands;
| | - Robert P. Kosilek
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336 Munich, Germany; (R.P.K.); (J.S.G.)
| | - Horst C. Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Department of Family Medicine, Ruhr-University Bochum Medical School, D-44801 Bochum, Germany;
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine, D-10117 Berlin, Germany;
| | - Jochen S. Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336 Munich, Germany; (R.P.K.); (J.S.G.)
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Storch M, Schneider N, Kirschner H, Arp A, Rauschenbach M, Gallistl A, Strauß B. [Psychotherapeutic Literature of the GDR and FRG: A Comparative Citation Analysis]. Psychother Psychosom Med Psychol 2022; 72:316-324. [PMID: 35114715 DOI: 10.1055/a-1718-4071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZIEL: Erste Hypothesen zur wissenschaftlichen Rezeption von psychotherapeutischer Literatur aus der DDR und der Sowjetunion in einem Psychotherapieliteratur-Korpus der BRD (Praxis der Psychotherapie und Psychosomatik 1979-1990) sollten geprüft werden. Außerdem sollten inhaltliche Schwerpunkte der identifizierten wissenschaftlichen Communities verglichen werden. METHODIK Es wurde eine bibliometrische und netzwerkanalytische Untersuchung von Zitationsbeziehungen sowie eine qualitative Inhaltsanalyse der Rezeption von DDR-Literatur und der thematischen Schwerpunkte der identifizierten wissenschaftlichen Communities in Literaturkorpora aus Ost und West durchgeführt. ERGEBNISSE Psychotherapeutische Literatur der DDR wird im untersuchten BRD-Korpus kaum zitiert. Inhaltlich wird diese Literatur nicht tiefergehend in die wissenschaftliche Argumentation des BRD-Korpus eingebunden. Die bekanntesten Vertreter*innen der DDR-Psychotherapie(-forschung) werden im BRD-Korpus gar nicht zitiert. Es lassen sich thematische Überschneidungen in beiden Korpora identifizieren, allerdings spielen DDR-spezifische Themen inhaltlich keine Rolle im BRD-Korpus. OBJECTIVE The aim this study was to test first hypotheses on the scientific reception of literature on psychotherapy from the GDR and the Soviet Union in a corpus of psychotherapy literature from the FRG and to compare content-related foci of the identified scientific communities. METHODS A bibliometric and network analysis of citation relations as well as a qualitative content analysis of the reception of GDR literature and the thematic foci of the identified scientific communities in both literature corpora were conducted. RESULTS Psychotherapeutic literature of the GDR was barely cited in the examined FRG corpus. In terms of content, this literature was not integrated more deeply into the scientific argumentation of the FRG corpus. The best-known representatives of GDR psychotherapy (research) were not at all cited in the FRG corpus. Thematic overlaps could be identified in both corpora, but GDR-specific topics did not play a role in the FRG corpus. CONCLUSION For the examined literature corpora it can be seen that publications from the GDR and Soviet Union are cited considerably less often in FRG literature than publications from the West in GDR literature. Thematically, original GDR psychotherapy content does not play a role in FRG literature either.
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Affiliation(s)
- Monika Storch
- Institut für Psychosoziale Medizin, Psychotherapie & Psychoonkologie, Universitätsklinikum Jena, Deutschland
| | - Nico Schneider
- Institut für Psychosoziale Medizin, Psychotherapie & Psychoonkologie, Universitätsklinikum Jena, Deutschland
| | - Hariet Kirschner
- Institut für Psychosoziale Medizin, Psychotherapie & Psychoonkologie, Universitätsklinikum Jena, Deutschland
| | - Agnès Arp
- Oral-History-Forschungsstelle, Universität Erfurt, Deutschland
| | - Manuel Rauschenbach
- Institut für Psychosoziale Medizin, Psychotherapie & Psychoonkologie, Universitätsklinikum Jena, Deutschland
| | - Adrian Gallistl
- Institut für Psychosoziale Medizin, Psychotherapie & Psychoonkologie, Universitätsklinikum Jena, Deutschland
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin, Psychotherapie & Psychoonkologie, Universitätsklinikum Jena, Deutschland
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Ullmann S, Strauß B, Tiesler F, Schneider N, Gensichen J, Brenk-Franz K. Patient characteristics as predictors of sleep disturbances in multimorbid primary care patients - A secondary analysis. J Psychosom Res 2022; 153:110705. [PMID: 34998104 DOI: 10.1016/j.jpsychores.2021.110705] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to identify patient characteristics (adult attachment, health status, number and severity of chronic conditions, social support) predictive sleep disturbances after 12 months. METHODS In a secondary analysis of a prospective longitudinal study dealing with adult attachment and self-management, attachment- and health-related characteristics, socio-demographic data at baseline and symptoms of insomnia at the follow up (12 month later) was recorded by 219 patients between the ages of 50 and 85 years with multimorbidity in primary care. Adult attachment was measured by the ECR-RD12. The overall health status was measured using a visual analogue scale (VAS) and a standardized list of chronic conditions. The number and severity of chronic diseases (CIRS-G) was assessed by general practitioners (GPs). Sleep disturbances was measured by the ISI 12 month later. RESULTS Approximately 19% of the respondents were found to have clinically relevant symptoms of insomnia, and a further 34% to be subclinical insomnia. Attachment-related anxiety, a poorer perceived social support, the number of chronic conditions and a better general health status could predict higher levels of sleep disturbance after 12 month. CONCLUSION Sleep disorders can play a major role in patients with multimorbidity. Attachment anxiety and lack of social support may also be possible risk factors for the development of sleep disturbances.
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Affiliation(s)
- Susanne Ullmann
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany.
| | - Bernhard Strauß
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
| | - Fabian Tiesler
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
| | - Nico Schneider
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University, Germany
| | - Katja Brenk-Franz
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
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Bausewein C, Hodiamont F, Berges N, Ullrich A, Gerlach C, Oechsle K, Pauli B, Weber J, Stiel S, Schneider N, Krumm N, Rolke R, Gebel C, Jansky M, Nauck F, Wedding U, van Oorschot B, Roch C, Werner L, Fischer M, Schallenburger M, Reuters MC, Schwartz J, Neukirchen M, Gülay A, Maus K, Jaspers B, Radbruch L, Heckel M, Klinger I, Ostgathe C, Kriesen U, Junghanß C, Lehmann E, Gesell D, Gauder S, Boehlke C, Becker G, Pralong A, Strupp J, Leisse C, Schloesser K, Voltz R, Jung N, Simon ST. National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project. BMC Palliat Care 2022; 21:10. [PMID: 35027041 PMCID: PMC8756412 DOI: 10.1186/s12904-021-00898-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). Methods Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. Discussion For a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00898-w.
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Schmücker K, Strauß B, Tiesler F, Schneider N, Gensichen J, Brenk-Franz K. [The Influence of Attachment Characteristics and Disease-Specific Predictors on Health-Related Quality of Life in Elderly Patients with Multimorbidity]. Psychiatr Prax 2021; 48:430-436. [PMID: 34741286 DOI: 10.1055/a-1676-3565] [Citation(s) in RCA: 1] [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] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Our aim was to further investigate factors influencing multimorbid primary care patients in relation to mental and physical quality of life. METHODS 219 elderly patients over 50 years with multiple chronic conditions were assessed for quality of life, attachment, depression, and health status at baseline and follow-up after 12 months. Multivariate analyses were performed to identify potential predictors. RESULTS Depression, age, and avoidance had a negative influence, and health a positive influence, on physical quality of life. Mental quality of life was negatively influenced by attachment-related anxiety and depression. Relevant predictors that predicted quality of life in one year were health status, depression, and attachment-related anxiety. CONCLUSION To maintain quality of life, mental health and attachment needs of multimorbid patients should be considered.
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Affiliation(s)
- Katja Schmücker
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena
| | - Fabian Tiesler
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena
| | - Nico Schneider
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena
| | - Jochen Gensichen
- Institut für Allgemeinmedizin, Ludwig-Maximilians-Universität München
| | - Katja Brenk-Franz
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena
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Abstract
This submission provides an important historical context for understanding the current challenge facing the Orthotic and Prosthetic community in Alberta including Alberta Aids to Daily Living (AADL), Suppliers, and Providers: maintaining sustainable access to Orthotic care for people with mobility disorders in the face of declining real rates of reimbursement combined with increasing costs and a shortage of skilled Clinicians. Under the Canada Health Act, the federal government delegates responsibility for providing health care to the provinces. This delegation of responsibility to the provinces results in a degree of variability of funding of Orthotics and Prosthetics between provinces across the country. Funding of Orthotics and Prosthetics in Alberta is characterized by structural inequities that favour Prosthetics at the expense of Orthotics. To the extent that the structural inequities that exist in Alberta are related to governance by volunteer-run, non-profit organizations, they may be generalized to the Canadian experience. Finally, in a Call to Action a number of recommendations are made to address the challenge of sustainable access to Orthotic care in Alberta serving as a model for other provinces across Canada.
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Affiliation(s)
- N Schneider
- Braceworks Custom Orthotics, 1-3500 24 Ave NW, Calgary, Alberta, Canada
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Saitua V, Schneider N, Libuy J. Electroconvulsive therapy practice in a general hospital in chile. Eur Psychiatry 2021. [PMCID: PMC9476058 DOI: 10.1192/j.eurpsy.2021.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionElectroconvulsive therapy (ECT) is a current, relevant treatment for severe mental illness. In this article we describe our experience on ECT in a public hospital in Chile.ObjectivesDescribe a 34 patients’ cohort who received ECT and their outcomes.MethodsData was extracted from ECT records between 2018-2020, patients’ evaluations before and after ECT, and case files. Data was then analyzed and described.ResultsECT was received by 18 males and 16 females. Age ranged from 19 to 73 years (41 average). More than 75% had 12 or more years of education. Patients’ diagnoses and indications for ECT are shown in Figures 1-2The CGI-SI scale was applied to subjects before treatment, and 85% had a score of 5 or more. On average, patients received 8.7 ECT sessions. Right unilateral electrode placement (RUL) was preferred initially for 94% of patients. Brief pulse width (0.3ms) was most commonly used (76%). Seizure duration averaged in 29 seconds. Adverse reactions presented on 32%, most being mild. One treatment had to be stopped due to confusional symptoms post ECT. After ECT, 91% of patients improved according to CGI-GI scale. 55% were assessed CGI-GI 1 “very much improved”. MoCA scale was also evaluated, showing a 2,1 point gain.ConclusionsSchizophrenia and psychosis were the most frequent diagnosis and indication for ECT. RUL and brief pulse width were the preferred settings. This cohort suggests that ECT had an impact on markedly ill patients, based on CGI and MoCA scales.
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Abstract
CLINICAL ISSUE The COVID 19 pandemic led to a profound adaptation of the German healthcare system in preparation of a massive increase of SARS-CoV-2-associated diseases. While general practitioners care for COVID patients who are less severely ill, hospitals are focused on the care of severely ill COVID-19 patients. STANDARD TREATMENT The role of emergency medicine (EM) is to rapidly detect the virus, to classify disease severity, and to initiate therapy. In addition, the flow of patients into the hospital must be directed in such a way that optimal care is provided without risk of infecting health care personnel and patients. Despite optimal intensive care treatment, the mortality of patients remains high if organ failure develops, especially in patients who are older or have pre-existing conditions. TREATMENT INNOVATIONS Rapid diagnosis of patients with SARS-CoV‑2 infection together with assessment of disease severity and awareness of organ failure are the mainstays of emergency care. Intensive care is needed for the treatment of SARS-CoV-2-induced organ failure, whereby lung failure in these patients requires differentiated ventilation therapies. DIAGNOSTIC WORK-UP The polymerase chain reaction (PCR) test is performed to diagnose SARS-CoV‑2 infection. Adjunctive diagnostic measures which enhance diagnostic specificity are lung ultrasound, x‑ray, and computed tomography of the lungs. This also allows categorization of the type of COVID-19 pneumonia. PRACTICAL RECOMMENDATIONS For early detection and appropriate treatment of SARS-CoV‑2 infection, PCR is needed. Adjunctive sonographic and radiological examinations allow the treatment of COVID-19 patients to be tailored according to the specific type of pneumonia.
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Affiliation(s)
- C Dodt
- Notfallzentrum, München Klinik Bogenhausen, Englschalkingerstraße 77, 81925, München, Deutschland.
| | - N Schneider
- München Klinik Schwabing, Kölner Platz 1, 80804, München, Deutschland
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21
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Schneider N, Bäcker A, Brenk-Franz K, Keinki C, Hübner J, Brandt F, von der Winkel G, Hager L, Strauss B, Altmann U. Patient information, communication and competence empowerment in oncology (PIKKO) - evaluation of a supportive care intervention for overall oncological patients. Study protocol of a non-randomized controlled trial. BMC Med Res Methodol 2020; 20:120. [PMID: 32414331 PMCID: PMC7227332 DOI: 10.1186/s12874-020-01002-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cancer patients have to undergo a difficult medical therapy and are also confronted with various psychological, social and economic problems. Support is available from many providers, but patients often gain no access to it. Accordingly, there is a need for a single point of contact that can provide advice, information and assistance. In the state of Saarland, Germany, a supportive new consulting and information path (PIKKO) for all types of cancer is currently evaluated by the German Cancer Society, the Cancer Society of the Saarland, three statutory health insurances and the Jena University Hospital. PIKKO is designed to improve quality of life, self-efficacy, health literacy and patient satisfaction and to reduce psychological distress, related health care costs and the days of inability to work. This methodical work presents the process and analysis planning of this evaluation. Methods The study population includes all cancer types, both new and existing diseases. PIKKO (with patient navigator, oncological knowledge database, specialized oncological counseling) is evaluated within a controlled, non-randomized, comparative, multicenter, longitudinal design. In addition to patient surveys, data from statutory health insurances and utilization data from the web database are collected, and interviews with patient navigators and doctors are carried out. Patients are assigned to a control (usual care) or an intervention group (u. c. + PIKKO). Primary outcome is the health related quality of life (SF-12) six months after baseline. Secondary outcomes are self-efficacy (GSE), psychological distress such as depression (PHQ-9) or anxiety (GAD-7), health literacy (HLS-EU-Q47) and patient satisfaction in health care (Qualiskope-A). Furthermore, the time course of direct costs of medical care (e.g. work disability days) and usage data of the intervention modules are analyzed. Among other statistical procedures, we use t-tests, univariate tests and growth curve models. Discussion If PIKKO proves to be effective, recommendations can be made to health organizations, which should lead to the concept being rolled out throughout Germany and included into oncological guidelines. We expect PIKKO to be a useful addition to usual cancer care, helping to improve the quality of life of cancer patients and reduce healthcare costs. Trial registration This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21.02.2019, the reason for the delay was the prioritization of the study management in the first year to establish the new approach into practice). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703
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Affiliation(s)
- Nico Schneider
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Stoystrasse 3, 07740, Jena, Germany.
| | - Anna Bäcker
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Stoystrasse 3, 07740, Jena, Germany
| | - Katja Brenk-Franz
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Stoystrasse 3, 07740, Jena, Germany
| | - Christian Keinki
- German Cancer Society, Kuno-Fischer-Strasse 8, 14057, Berlin, Germany
| | - Jutta Hübner
- Department of Hematology and Medical Oncology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Florian Brandt
- IKK Südwest, Berliner Promenade 1, 66111, Saarbrücken, Germany
| | | | - Lutz Hager
- ze:roPraxen, Bodelschwinghstrasse 10/3, 68723, Schwetzingen, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Stoystrasse 3, 07740, Jena, Germany
| | - Uwe Altmann
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Stoystrasse 3, 07740, Jena, Germany
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Schmidt KF, Schwarzkopf D, Baldwin LM, Brunkhorst FM, Freytag A, Heintze C, Reinhart K, Schneider N, von Korff M, Worrack S, Wensing M, Gensichen J. Long-Term Courses of Sepsis Survivors: Effects of a Primary Care Management Intervention. Am J Med 2020; 133:381-385.e5. [PMID: 31521666 DOI: 10.1016/j.amjmed.2019.08.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare. METHODS This study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German intensive care units. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews. RESULTS One hundred eighty-six (63.9%, 98 intervention, 88 control) of 291 patients completed the 24-month follow-up, showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (difference between baseline and 24-months follow-up values, mean [standard deviation] 3.7 [11.8] control vs -0.7 [12.1] intervention; P = .016). There were no significant differences in all other outcomes between the intervention and control groups. CONCLUSIONS Twelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.
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Affiliation(s)
- Konrad Fr Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany.
| | - Daniel Schwarzkopf
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington School of Medicine, Seattle
| | | | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany
| | - Konrad Reinhart
- Center of Sepsis Control and Care, Jena University Hospital, Germany; Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Germany
| | - Nico Schneider
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
| | | | - Susanne Worrack
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany
| | - Michel Wensing
- Institute of Family Medicine and Health Services Research, Heidelberg University Hospital, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany; Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
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23
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Pape L, Schneider N, Schleef T, Junius-Walker U, Haller H, Brunkhorst R, Hellrung N, Prokosch HU, Haarbrandt B, Marschollek M, Schiffer M. The nephrology eHealth-system of the metropolitan region of Hannover for digitalization of care, establishment of decision support systems and analysis of health care quality. BMC Med Inform Decis Mak 2019; 19:176. [PMID: 31477119 PMCID: PMC6720092 DOI: 10.1186/s12911-019-0902-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background Even though a high demand for sector spanning communication exists, so far no eHealth platform for nephrology is established within Germany. This leads to insufficient communication between medical providers and therefore suboptimal nephrologic care. In addition, Clinical Decision Support Systems have not been used in Nephrology until now. Methods The aim of NEPHRO-DIGITAL is to create a eHealth platform in the Hannover region that facilitates integrated, cross-sectoral data exchange and includes teleconsultation between outpatient nephrology, primary care, pediatricians and nephrology clinics to reduce communication deficits and prevent data loss, and to enable the creation and implementation of an interoperable clinical decision support system. This system will be based on input data from multiple sources for early identification of patients with cardiovascular comorbidity and progression of renal insufficiency. Especially patients will be able to enter and access their own data. A transfer to a second nephrology center (metropolitan region of Erlangen-Nuremburg) is included in the study to prove feasibility and scalability of the approach. Discussion A decision support system should lead to earlier therapeutic interventions and thereby improve the prognosis of patients as well as their treatment satisfaction and quality of life. The system will be integrated in the data integration centres of two large German university medicine consortia (HiGHmed (highmed.org) and MIRACUM (miracum.org)). Trial registration ISRCTN16755335 (09.07.2019).
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Affiliation(s)
- L Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
| | - N Schneider
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - T Schleef
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - U Junius-Walker
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - H Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - R Brunkhorst
- Department of Nephrology, Angiology and Rheumatology, KRH Regional Hospital Hannover Siloah, Hannover, Germany
| | | | - H U Prokosch
- Department of Medical Informatics, Biometrics and Epidemiology, Chair for Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - B Haarbrandt
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany
| | - M Marschollek
- Peter L. Reichertz Institute for Medical Informatics University of Braunschweig - Institute of Technology and Hannover Medical School, Hannover, Germany
| | - M Schiffer
- Department of Nephrology, University Hospital Erlangen, Erlangen, Germany
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24
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Treviño-Morales SP, Fuente A, Sánchez-Monge Á, Kainulainen J, Didelon P, Suri S, Schneider N, Ballesteros-Paredes J, Lee YN, Hennebelle P, Pilleri P, González-García M, Kramer C, García-Burillo S, Luna A, Goicoechea JR, Tremblin P, Geen S. Dynamics of cluster-forming hub-filament systems: The case of the high-mass star-forming complex Monoceros R2. Astron Astrophys 2019; 629:A81. [PMID: 31673163 PMCID: PMC6823053 DOI: 10.1051/0004-6361/201935260] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT High-mass stars and star clusters commonly form within hub-filament systems. Monoceros R2 (hereafter Mon R2), at a distance of 830 pc, harbors one of the closest such systems, making it an excellent target for case studies. AIMS We investigate the morphology, stability and dynamical properties of the Mon R2 hub-filament system. METHODS We employ observations of the 13CO and C18O 1→0 and 2→1 lines obtained with the IRAM-30m telescope. We also use H2 column density maps derived from Herschel dust emission observations. RESULTS We identified the filamentary network in Mon R2 with the DisPerSE algorithm and characterized the individual filaments as either main (converging into the hub) or secondary (converging to a main filament) filaments. The main filaments have line masses of 30-100 M ⊙ pc-1 and show signs of fragmentation, while the secondary filaments have line masses of 12-60 M ⊙ pc-1 and show fragmentation only sporadically. In the context of Ostriker's hydrostatic filament model, the main filaments are thermally supercritical. If non-thermal motions are included, most of them are trans-critical. Most of the secondary filaments are roughly transcritical regardless of whether non-thermal motions are included or not. From the morphology and kinematics of the main filaments, we estimate a mass accretion rate of 10-4-10-3 M ⊙ yr-1 into the central hub. The secondary filaments accrete into the main filaments with a rate of 0.1-0.4×10-4 M ⊙ yr-1. The main filaments extend into the central hub. Their velocity gradients increase towards the hub, suggesting acceleration of the gas.We estimate that with the observed infall velocity, the mass-doubling time of the hub is ~ 2:5 Myr, ten times larger than the free-fall time, suggesting a dynamically old region. These timescales are comparable with the chemical age of the Hii region. Inside the hub, the main filaments show a ring- or a spiral-like morphology that exhibits rotation and infall motions. One possible explanation for the morphology is that gas is falling into the central cluster following a spiral-like pattern.
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Affiliation(s)
- S P Treviño-Morales
- Chalmers University of Technology, Department of Space, Earth and Environment, SE-412 93 Gothenburg, Sweden
| | - A Fuente
- Observatorio Astronómico Nacional, Apdo. 112, 28803 Alcalá de Henares Madrid, Spain
| | - Á Sánchez-Monge
- I. Physikalisches Institut, Universität zu Köln, Zülpicher Str. 77, 50937 Köln, Germany
| | - J Kainulainen
- Chalmers University of Technology, Department of Space, Earth and Environment, SE-412 93 Gothenburg, Sweden
- Max-Planck-Institute for Astronomy, Königstuhl 17, 69117 Heidelberg, Germany
| | - P Didelon
- Laboratoire AIM, Paris-Saclay, CEA/IRFU/SAp - CNRS - Université Paris Diderot, 91191 Gif-sur-Yvette Cedex, France
| | - S Suri
- I. Physikalisches Institut, Universität zu Köln, Zülpicher Str. 77, 50937 Köln, Germany
- Max-Planck-Institute for Astronomy, Königstuhl 17, 69117 Heidelberg, Germany
| | - N Schneider
- I. Physikalisches Institut, Universität zu Köln, Zülpicher Str. 77, 50937 Köln, Germany
| | - J Ballesteros-Paredes
- Instituto de Radioastronomía y Astrofísica, Universidad Nacional Autónoma de México, P.O. Box 3-72, 58090 Morelia, Mexico
| | - Y-N Lee
- Institut de Physique du Globe de Paris, Sorbonne Paris Cité, Université Paris Diderot, UMR 7154 CNRS, 75005 Paris, France
| | - P Hennebelle
- Laboratoire AIM, Paris-Saclay, CEA/IRFU/SAp - CNRS - Université Paris Diderot, 91191 Gif-sur-Yvette Cedex, France
| | - P Pilleri
- IRAP, Université de Toulouse, CNRS, UPS, CNES, 9 Av. colonel Roche, BP 44346, 31028 Toulouse Cedex 4, France
| | - M González-García
- Instituto de Astrofísica de Andalucía, IAA-CSIC, Glorieta de la Astronomía s/n, 18008 Granada, Spain
| | - C Kramer
- Institut de Radioastronomie Millimétrique (IRAM), 300 rue de la Piscine, 38406 Saint Martin d'Hères, France
| | - S García-Burillo
- Observatorio Astronómico Nacional, Apdo. 112, 28803 Alcalá de Henares Madrid, Spain
| | - A Luna
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Luis Enrique Erro #1, 72840 Tonantzintla, Puebla, Mexico
| | - J R Goicoechea
- Instituto de Física Fundamental (CSIC). Calle Serrano 121, E-28006, Madrid, Spain
| | - P Tremblin
- Laboratoire AIM, Paris-Saclay, CEA/IRFU/SAp - CNRS - Université Paris Diderot, 91191 Gif-sur-Yvette Cedex, France
| | - S Geen
- Zentrum für Astronomie, Institut für Theoretische Astrophysik, Universität Heidelberg, Albert-Ueberle-Str. 2, 69120 Heidelberg, Germany
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Lukaschek K, Schneider N, Schelle M, Kirk UB, Eriksson T, Kunnamo I, Rochfort A, Collins C, Gensichen J. Applicability of Motivational Interviewing for Chronic Disease Management in Primary Care Following a Web-Based E-Learning Course: Cross-Sectional Study. JMIR Ment Health 2019; 6:e12540. [PMID: 31033446 PMCID: PMC6658265 DOI: 10.2196/12540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/30/2019] [Accepted: 02/18/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Motivational interviewing (MI) is an established communication method for enhancing intrinsic motivation for changing health behavior. E-learning can reduce the cost and time involved in providing continuing education and can be easily integrated into individual working arrangements and the daily routines of medical professionals. Thus, a Web-based course was devised to familiarize health professionals with different levels of education and expertise with MI techniques for patients with chronic conditions. OBJECTIVE The aim of this study was to report participants' opinion on the practicality of MI (as learned in the course) in daily practice, stratified by the level of education. METHODS Participants (N=607) of the MI Web-based training course evaluated the course over 18 months, using a self-administered questionnaire. The evaluation was analyzed descriptively and stratified for the level of education (medical students, physicians in specialist training [PSTs], and general practitioners [GPs]). RESULTS Participants rated the applicability of the skills and knowledge gained by the course as positive (medical students: 94% [79/84] good; PSTs: 88.6% [109/123] excellent; and GPs: 51.3% [182/355] excellent). When asked whether they envisage the use of MI in the future, 79% (67/84) of the students stated to a certain extent, 88.6% (109/123) of the PSTs stated to a great extent, and 38.6% (137/355) of GPs stated to a great extent. Participants acknowledged an improvement of communication skills such as inviting (medical students: 85% [72/84]; PSTs: 90.2% [111/123]; GPs: 37.2% [132/355]) and encouraging (medical students: 81% [68/84]; PSTs: 45.5% [56/123]; GPs: 36.3% [129/355]) patients to talk about behavior change and conveying respect for patient's choices (medical students: 72% [61/84]; PSTs: 50.0% [61/123]; GPs: 23.4% [83/355]). CONCLUSIONS Participants confirmed the practicality of MI. However, the extent to which the practicality of MI was acknowledged as well as its expected benefits depended on the individual's level of education/expertise.
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Affiliation(s)
- Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nico Schneider
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, University of Jena, Jena, Germany.,Institute of General Practice and Family Medicine, Jena University Hospital, University of Jena, Jena, Germany
| | - Mercedes Schelle
- Institute of General Practice and Family Medicine, Jena University Hospital, University of Jena, Jena, Germany
| | - Ulrik Bak Kirk
- European Society for Quality and Safety in Family Practice, København, Denmark
| | - Tina Eriksson
- European Society for Quality and Safety in Family Practice, København, Denmark
| | - Ilkka Kunnamo
- The Finnish Medical Society Duodecim, Helsinki, Finland
| | | | | | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute of General Practice and Family Medicine, Jena University Hospital, University of Jena, Jena, Germany
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Gensichen J, Hiller TS, Breitbart J, Brettschneider C, Teismann T, Schumacher U, Lukaschek K, Schelle M, Schneider N, Sommer M, Wensing M, König HH, Margraf J. Panic Disorder in Primary Care. Dtsch Arztebl Int 2019; 116:159-166. [PMID: 30995952 DOI: 10.3238/arztebl.2019.0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/04/2018] [Accepted: 01/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND We evaluated a team-based program of exercises for patients with panic disorder with or without agoraphobia (PDA) in primary care. METHODS 419 patients with PDA (mean age 46.2 years, standard deviation 14.4 years; 74% female) were included in this cluster-randomized, controlled intervention trial. The patients were blinded with respect to their group assignment at baseline. Patients in the intervention group (36 primary-care practices, 230 patients) underwent a 23-week exercise program combined with case management, while patients in the control group (37 practices, 189 patients) received standard care. Symptoms of anxiety (according to the Beck Anxiety Inventory, BAI) at six months were the primary endpoint. Patients were followed up at six months (n = 338, 81%) and at twelve months (n = 318, 76%). The analysis was by intention to treat. RESULTS Symptoms of anxiety improved to a significantly greater extent in the intervention group (p = 0.008). The intergroup dif- ference in the reduction of the BAI score (range: 0-63) was 3.0 points (95% confidence interval [-5.8; -0.2]) at six months and 4.0 points [-6.9; -1.2] at twelve months. In the intervention group, there was a significantly greater reduction in the frequency of panic attacks (p = 0.019), in avoidant behavior (p = 0.016), and in depressiveness (p<0.001), as well as a greater improvement of the quality of treatment (p<0.001). CONCLUSION In primary-care patients who have panic disorder with or without agoraphobia, a team-based exercise program combined with case management can improve symptoms to a greater extent than standard primary-care treatment.
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Affiliation(s)
- Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Munich, Germany,Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany,The two authors are co-first authors
| | - Thomas S Hiller
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany,The two authors are co-first authors
| | - Jörg Breitbart
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Christian Brettschneider
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Ulrike Schumacher
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Munich, Germany
| | - Mercedes Schelle
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Nico Schneider
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany,Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
| | - Michael Sommer
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Michel Wensing
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany,Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Helmut König
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,The two authors are co-last authors
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany,The two authors are co-last authors
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Moseev D, Stejner M, Stange T, Abramovic I, Laqua HP, Marsen S, Schneider N, Braune H, Hoefel U, Kasparek W, Korsholm SB, Lechte C, Leipold F, Nielsen SK, Salewski M, Rasmussen J, Weißgerber M, Wolf RC. Collective Thomson scattering diagnostic at Wendelstein 7-X. Rev Sci Instrum 2019; 90:013503. [PMID: 30709181 DOI: 10.1063/1.5050193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
A Collective Thomson Scattering (CTS) diagnostic is installed at Wendelstein 7-X for ion temperature measurements in the plasma core. The diagnostic utilizes 140 GHz gyrotrons usually used for electron cyclotron resonance heating (ECRH) as a source of probing radiation. The CTS diagnostic uses a quasi-optical transmission line covering a distance of over 40 m. The transmission line is shared between the ECRH system and the CTS diagnostic. Here we elaborate on the design, installation, and alignment of the CTS diagnostic and present the first measurements at Wendelstein 7-X.
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Affiliation(s)
- D Moseev
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - M Stejner
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - T Stange
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - I Abramovic
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - H P Laqua
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - S Marsen
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - N Schneider
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - H Braune
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - U Hoefel
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - W Kasparek
- University of Stuttgart, Stuttgart, Germany
| | - S B Korsholm
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - C Lechte
- University of Stuttgart, Stuttgart, Germany
| | - F Leipold
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - S K Nielsen
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - M Salewski
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - J Rasmussen
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - M Weißgerber
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
| | - R C Wolf
- Max-Planck-Institut für Plasmaphysik, Greifswald and Garching, Germany
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Braune H, Brunner K, Laqua H, Marsen S, Moseev D, Noke F, Purps F, Schneider N, Schulz T, Stange T, Uhren P, Wilde F. Concurrent operation of 10 gyrotrons at W7-X experience and improvement opportunities. EPJ Web Conf 2018. [DOI: 10.1051/epjconf/201818701003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
At the stellarator Wendelstein 7-X (W7-X) Electron Cyclotron Resonance Heating (ECRH) is the main heating system for steady-state operation and was the only available heating system during the operation phase OP1.2a in 2017. The ECRH, equipped with 10 operational 140 GHz gyrotrons [1], was used for different tasks at W7-X such as wall conditioning, controlled plasma start-up from the neutral gas up to steady state plasma control and different heating scenarios such as X2-mode and O2-mode heating as well as current drive (ECCD). The operational experiences and improvement opportunities of the ECRH plant will be discussed.
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Bäcker A, Schneider N, Strauß B, Altmann U. Evaluation der Optimierung der Versorgung krebskranker Patienten im Rahmen des Projekts „Patienteninformation, -kommunikation und Kompetenzförderung in der Onkologie (PIKKO)“. Psychother Psych Med 2018. [DOI: 10.1055/s-0038-1668024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Bäcker
- Universitätsklinikum Jena, Institut für Psychosoziale Medizin und Psychotherapie, Jena, Deutschland
| | - N Schneider
- Universitätsklinikum Jena, Institut für Psychosoziale Medizin und Psychotherapie, Jena, Deutschland
| | - B Strauß
- Universitätsklinikum Jena, Institut für Psychosoziale Medizin und Psychotherapie, Jena, Deutschland
| | - U Altmann
- Universitätsklinikum Jena, Institut für Psychosoziale Medizin und Psychotherapie, Jena, Deutschland
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Rayner TSM, Griffin MJ, Schneider N, Motte F, Kӧnyves V, André P, Di Francesco J, Didelon P, Pattle K, Ward-Thompson D, Anderson LD, Benedettini M, Bernard JP, Bontemps S, Elia D, Fuente A, Hennemann M, Hill T, Kirk J, Marsh K, Men’shchikov A, Nguyen Luong Q, Peretto N, Pezzuto S, Rivera-Ingraham A, Roy A, Rygl K, Sánchez-Monge Á, Spinoglio L, Tigé J, Treviño-Morales SP, White GJ. Far-infrared observations of a massive cluster forming in the Monoceros R2 filament hub ⋆. Astron Astrophys 2017; 607:A22. [PMID: 31844331 PMCID: PMC6914369 DOI: 10.1051/0004-6361/201630039] [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] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We present far-infrared observations of Monoceros R2 (a giant molecular cloud at approximately 830 pc distance, containing several sites of active star formation), as observed at 70 μm, 160 μm, 250 μm, 350 μm, and 500 μm by the Photodetector Array Camera and Spectrometer (PACS) and Spectral and Photometric Imaging Receiver (SPIRE) instruments on the Herschel Space Observatory as part of the Herschel imaging survey of OB young stellar objects (HOBYS) Key programme. The Herschel data are complemented by SCUBA-2 data in the submillimetre range, and WISE and Spitzer data in the mid-infrared. In addition, C18O data from the IRAM 30-m Telescope are presented, and used for kinematic information. Sources were extracted from the maps with getsources, and from the fluxes measured, spectral energy distributions were constructed, allowing measurements of source mass and dust temperature. Of 177 Herschel sources robustly detected in the region (a detection with high signal-to-noise and low axis ratio at multiple wavelengths), including protostars and starless cores, 29 are found in a filamentary hub at the centre of the region (a little over 1% of the observed area). These objects are on average smaller, more massive, and more luminous than those in the surrounding regions (which together suggest that they are at a later stage of evolution), a result that cannot be explained entirely by selection effects. These results suggest a picture in which the hub may have begun star formation at a point significantly earlier than the outer regions, possibly forming as a result of feedback from earlier star formation. Furthermore, the hub may be sustaining its star formation by accreting material from the surrounding filaments.
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Affiliation(s)
- T. S. M. Rayner
- Cardiff School of Physics and Astronomy, Cardiff University,
Queen’s Buildings, The Parade, Cardiff, Wales, CF24 3AA, UK
| | - M. J. Griffin
- Cardiff School of Physics and Astronomy, Cardiff University,
Queen’s Buildings, The Parade, Cardiff, Wales, CF24 3AA, UK
| | - N. Schneider
- I. Physik. Institut, University of Cologne, 50937 Cologne,
Germany
- Laboratoire d’Astrophysique de Bordeaux, Univ. Bordeaux,
CNRS, B18N, allée G. Saint-Hilaire, 33615 Pessac, France
| | - F. Motte
- Université Grenoble Alpes, CNRS, Institut de Planetologie et
d’Astrophysique de Grenoble, 38000 Grenoble, France
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
| | - V. Kӧnyves
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
| | - P. André
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
| | | | - P. Didelon
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
| | - K. Pattle
- Jeremiah Horrocks Institute, University of Central Lancashire,
Preston PR1 2HE, UK
| | - D. Ward-Thompson
- Jeremiah Horrocks Institute, University of Central Lancashire,
Preston PR1 2HE, UK
| | - L. D. Anderson
- Department of Physics and Astronomy, West Virginia University,
Morgantown, WV 26506, USA
| | - M. Benedettini
- INAF – Istituto di Astrofisica e Planetologia Spaziali, via
Fosso del Cavaliere 100, I-00133 Roma, Italy
| | - J-P. Bernard
- Université de Toulouse, UPS-OMP, IRAP, Toulouse,
France
| | - S. Bontemps
- Laboratoire d’Astrophysique de Bordeaux, Univ. Bordeaux,
CNRS, B18N, allée G. Saint-Hilaire, 33615 Pessac, France
| | - D. Elia
- INAF – Istituto di Astrofisica e Planetologia Spaziali, via
Fosso del Cavaliere 100, I-00133 Roma, Italy
| | - A. Fuente
- Observatorio Astronómico Nacional (OAN), Apdo 112, E-28803
Alcalá de Henares, Madrid, Spain
| | - M. Hennemann
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
| | - T. Hill
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
- Joint ALMA Observatory, 3107 Alonso de Cordova, Vitacura, Santiago,
Chile
| | - J. Kirk
- Jeremiah Horrocks Institute, University of Central Lancashire,
Preston PR1 2HE, UK
| | - K. Marsh
- Cardiff School of Physics and Astronomy, Cardiff University,
Queen’s Buildings, The Parade, Cardiff, Wales, CF24 3AA, UK
| | - A. Men’shchikov
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
| | - Q. Nguyen Luong
- Korea Astronomy and Space Science Institute, 776 Daedeokdae-ro,
Yuseong-gu, Daejeon, 305-348, Republic of Korea
- National Astronomical Observatory of Japan, Chile Observatory,
2-21-1 Osawa, Mitaka, Tokyo 181-8588, Japan
| | - N. Peretto
- Cardiff School of Physics and Astronomy, Cardiff University,
Queen’s Buildings, The Parade, Cardiff, Wales, CF24 3AA, UK
| | - S. Pezzuto
- INAF – Istituto di Astrofisica e Planetologia Spaziali, via
Fosso del Cavaliere 100, I-00133 Roma, Italy
| | | | - A. Roy
- Laboratoire AIM, CEA/IRFU – CNRS/INSU –
Université Paris Diderot, CEA-Saclay, 91191 Gif-sur-Yvette Cedex,
France
| | - K. Rygl
- INAF – Istituto di Radioastronomia, Via Gobetti 101, I-40129
Bologna, Italy
| | - Á. Sánchez-Monge
- I. Physik. Institut, University of Cologne, 50937 Cologne,
Germany
| | - L. Spinoglio
- INAF – Istituto di Astrofisica e Planetologia Spaziali, via
Fosso del Cavaliere 100, I-00133 Roma, Italy
| | - J. Tigé
- Aix-Marseille Université, CNRS, LAM (Laboratoire
d’Astrophysique de Marseille) UMR 7326, 13388 Marseille, France
| | - S. P. Treviño-Morales
- Instituto de Ciencia de Materiales de Madrid (ICMM-CSIC), Sor Juana
Inés de la Cruz 3, E-28049 Cantoblanco, Madrid, Spain
| | - G. J. White
- The Rutherford Appleton Laboratory, Chilton, Didcot OX11 0NL,
UK
- Department of Physics and Astronomy, The Open University, Milton
Keynes, UK
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Lechte C, Kasparek W, Plaum B, Zeitler A, Erckmann V, Laqua H, Schneider N, Weissgerber M, Bechtold A, Busch M, Szepaniak B. Remote-Steering Antennas for 140 GHz Electron Cyclotron Heating of the Stellarator W7-X. EPJ Web Conf 2017. [DOI: 10.1051/epjconf/201714704004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brenk-Franz K, Strauß B, Tiesler F, Fleischhauer C, Schneider N, Gensichen J. Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions. J Psychosom Res 2017; 97:131-135. [PMID: 28606493 DOI: 10.1016/j.jpsychores.2017.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/23/2017] [Accepted: 04/14/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. METHOD 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. RESULTS The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. CONCLUSION A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients.
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Affiliation(s)
- Katja Brenk-Franz
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany.
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
| | - Fabian Tiesler
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany; Institute of General Practice and Family Medicine, Jena University Hospital, Germany
| | | | - Nico Schneider
- Institute of General Practice and Family Medicine, Jena University Hospital, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Germany
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Sommer M, Hiller TS, Breitbart J, Schneider N, Teismann T, Freytag A, Gensichen J. [Usual Care for Panic Disorder with/without Agoraphobia in Primary Care]. Psychiatr Prax 2017; 45:160-163. [PMID: 28499315 DOI: 10.1055/s-0043-105058] [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: 10/19/2022]
Abstract
OBJECTIVE To describe therapy as usual (TAU) for panic disorder with/without agoraphobia (PDA) in primary care. METHOD Written survey of 38 general practitioners (GPs) who provided TAU to 189 patients with PDA as part of an interventional study. Data were analyzed descriptively. RESULTS The most common TAU-interventions were: exploration of psychosocial problems (83 %), recommendation not to avoid anxiety-provoking stimuli (72 %), prescription of SSRIs (62 %). Common reasons for referrals were various psychiatric comorbidities and treatment-refractory anxiety (77 %). GPs rarely used validated diagnostic tools such as structured interviews (18 %) or questionnaires (14 %). CONCLUSIONS TAU mostly involved guideline-recommended psychosocial and pharmacological interventions. Study-related procedures may limit the generalizability of findings.
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Affiliation(s)
- Michael Sommer
- Institut für Allgemeinmedizin, Universitätsklinikum Jena
| | | | - Jörg Breitbart
- Institut für Allgemeinmedizin, Universitätsklinikum Jena
| | - Nico Schneider
- Institut für Allgemeinmedizin, Universitätsklinikum Jena
| | - Tobias Teismann
- Fakultät für Psychologie, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena
| | - Jochen Gensichen
- Institut für Allgemeinmedizin, Universitätsklinikum Jena.,Institut für Allgemeinmedizin, Klinikum der Ludwig-Maximilians-Universität München
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O'Brien MA, Carroll JC, Manca DP, Miedema B, Groome PA, Makuwaza T, Easley J, Sopcak N, Jiang L, Decker K, McBride ML, Moineddin R, Permaul JA, Heisey R, Eisenhauer EA, Krzyzanowska MK, Pruthi S, Sawka C, Schneider N, Sussman J, Urquhart R, Versaevel C, Grunfeld E. Multigene expression profile testing in breast cancer: is there a role for family physicians? ACTA ACUST UNITED AC 2017; 24:95-102. [PMID: 28490923 DOI: 10.3747/co.24.3457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Family physicians (fps) play a role in aspects of personalized medicine in cancer, including assessment of increased risk because of family history. Little is known about the potential role of fps in supporting cancer patients who undergo tumour gene expression profile (gep) testing. METHODS We conducted a mixed-methods study with qualitative and quantitative components. Qualitative data from focus groups and interviews with fps and cancer specialists about the role of fps in breast cancer gep testing were obtained during studies conducted within the pan-Canadian canimpact research program. We determined the number of visits by breast cancer patients to a fp between the first medical oncology visit and the start of chemotherapy, a period when patients might be considering results of gep testing. RESULTS The fps and cancer specialists felt that ordering gep tests and explaining the results was the role of the oncologist. A new fp role was identified relating to the fp-patient relationship: supporting patients in making adjuvant therapy decisions informed by gep tests by considering the patient's comorbid conditions, social situation, and preferences. Lack of fp knowledge and resources, and challenges in fp-oncologist communication were seen as significant barriers to that role. Between 28% and 38% of patients visited a fp between the first oncology visit and the start of chemotherapy. CONCLUSIONS Our findings suggest an emerging role for fps in supporting patients who are making adjuvant treatment decisions after receiving the results of gep testing. For success in this new role, education and point-of-care tools, together with more effective communication strategies between fps and oncologists, are needed.
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Affiliation(s)
- M A O'Brien
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - J C Carroll
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - D P Manca
- Alberta: Department of Family Medicine, University of Alberta, Edmonton (Manca, Sopcak)
| | - B Miedema
- New Brunswick: Department of Family Medicine, Dalhousie University, Fredericton (Miedema, Easley)
| | - P A Groome
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - T Makuwaza
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - J Easley
- New Brunswick: Department of Family Medicine, Dalhousie University, Fredericton (Miedema, Easley)
| | - N Sopcak
- Alberta: Department of Family Medicine, University of Alberta, Edmonton (Manca, Sopcak)
| | - L Jiang
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - K Decker
- Manitoba: CancerCare Manitoba, Winnipeg (Decker); Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg (Decker)
| | - M L McBride
- British Columbia: BC Cancer Agency, Vancouver (McBride)
| | - R Moineddin
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - J A Permaul
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - R Heisey
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - E A Eisenhauer
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - M K Krzyzanowska
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - S Pruthi
- United States: General Internal Medicine, Mayo Clinic, Rochester, MN (Pruthi)
| | - C Sawka
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | | | - J Sussman
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
| | - R Urquhart
- Nova Scotia: Beatrice Hunter Cancer Research Institute, Halifax (Urquhart); Department of Surgery, Dalhousie University, Halifax (Urquhart)
| | | | - E Grunfeld
- Ontario: Department of Family and Community Medicine, University of Toronto, Toronto (Carroll, Grunfeld, Heisey, Makuwaza, Moineddin, O'Brien); Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto (Carroll, Makuwaza, Permaul); Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston (Groome, Jiang); Department of Family and Community Medicine, Women's College Hospital, Toronto (Heisey); Department of Oncology, Kingston General Hospital, Kingston (Eisenhauer); Department of Oncology, Queen's University, Kingston (Eisenhauer); Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto (Krzyzanowska); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Krzyzanowska, Sawka); Cancer Care Ontario, Toronto (Krzyzanowska); Department of Oncology, McMaster University, Hamilton (Sussman); Ontario Institute for Cancer Research, Toronto (Grunfeld)
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Kasparek W, Erckmann V, Laqua H, Stange T, Weißgerber M, Lechte C, Plaum B, Moseev D, Leipold F, Petelin M, Brunner K, Braune H, Marsen S, Schneider N, Wolf R. Optics for electron cyclotron resonance heating and collective Thomson scattering at the stellarator W7-X. EPJ Web Conf 2017. [DOI: 10.1051/epjconf/201714901013] [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: 11/14/2022] Open
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Lovestead TM, Burger JL, Schneider N, Bruno TJ. Comprehensive Assessment of Composition and Thermochemical Variability by High Resolution GC/QToF-MS and the Advanced Distillation-Curve Method as a Basis of Comparison for Reference Fuel Development. Energy Fuels 2016; 30:10029-10044. [PMID: 29706688 PMCID: PMC5915282 DOI: 10.1021/acs.energyfuels.6b01837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Commercial and military aviation is faced with challenges that include high fuel costs, undesirable emissions, and supply chain insecurity that result from the reliance on petroleum-based feedstocks. The development of alternative gas turbine fuels from renewable resources will likely be part of addressing these issues. The United States has established a target for one billion gallons of renewable fuels to enter the supply chain by 2018. These alternative fuels will have to be very similar in properties, chemistry, and composition to existing fuels. To further this goal, the National Jet Fuel Combustion Program (a collaboration of multiple U.S. agencies under the auspices of the Federal Aviation Administration, FAA) is coordinating measurements on three reference gas turbine fuels to be used as a basis of comparison. These fuels are reference fuels with certain properties that are at the limits of experience. These fuels include a low viscosity, low flash point, high hydrogen content "best case" JP-8 (POSF 10264) fuel, a relatively high viscosity, high flash point, low hydrogen content "worst case" JP-5 (POSF 10259) fuel, and a Jet-A (POSF 10325) fuel with relatively average properties. A comprehensive speciation of these fuels is provided in this paper by use of high resolution gas chromatography/quadrupole time-of-flight - mass spectrometry (GC/QToF-MS), which affords unprecedented resolution and exact molecular formula capabilities. The volatility information as derived from the measurement of the advanced distillation curve temperatures, Tk and Th, provides an approximation of the vapor liquid equilibrium and examination of the composition channels provides detailed insight into thermochemical data. A comprehensive understanding of the compositional and thermophysical data of gas turbine fuels is required not only for comparison but also for modeling of such complex mixtures, which will, in turn, aid in the development of new fuels with the goals of diversified feedstocks, decreased pollution, and increased efficiency.
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Affiliation(s)
- Tara M. Lovestead
- Applied Chemicals and Materials Division, National Institute of Standards and Technology, Boulder, CO
| | - Jessica L. Burger
- Applied Chemicals and Materials Division, National Institute of Standards and Technology, Boulder, CO
| | | | - Thomas J. Bruno
- Applied Chemicals and Materials Division, National Institute of Standards and Technology, Boulder, CO
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Jung IH, Kurnicka K, Enache R, Nagy AI, Martins E, Cereda A, Vitiello G, Magda SL, Styczynski G, Lo Iudice F, De Barros Viegas H, Shahab F, Trunina I, Mata Caballero R, De Barros Viegas H, Marques A, Shimoni S, Generati G, Generati G, Bendix Salkvist Jorgensen T, Chen TE, Andrianova A, Fernandez-Golfin C, Corneli MC, Ali M, Seo HS, Kim MJ, Lichodziejewska B, Goliszek S, Dzikowska-Diduch O, Zdonczyk O, Kozlowska M, Kostrubiec M, Ciurzynski M, Palczewski P, Pruszczyk P, Popa E, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Jurcut R, Venkateshvaran AI, Sola SC, Govind SC, Dash PK, Lund L, Manouras AI, Merkely B, Magne J, Aboyans V, Boulogne C, Lavergne D, Jaccard A, Mohty D, Casadei F, Spano F, Santambrogio G, Musca F, Belli O, De Chiara B, Bokor D, Giannattasio C, Corradi E, Colombo CA, Moreo A, Vicario ML, Castellani S, Cammelli D, Gallini C, Needleman L, Cruz BK, Maggi E, Marchionni N, Bratu VD, Mincu RI, Mihai CM, Gherghe AM, Florescu M, Cinteza M, Vinereanu D, Sobieraj P, Bielicki P, Krenke R, Szmigielski CA, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A, Trimarco B, Galderisi M, Mendes L, Dores H, Melo I, Madeira V, Patinha J, Encarnacao C, Ferreia Santos J, Habib F, Soesanto AM, Sedyawan J, Abdurrazak G, Sharykin A, Popova NE, Karelina EV, Telezhnikova ND, Hernandez Jimenez V, Saavedra J, Molina L, Alberca MT, Gorriz J, L Pais J, Pavon I, Navea C, Alonso JJ, Mendes L, Sonia S, Madeira V, Encarnacao C, Patinha J, Melo I, Ferreia Santos J, Cruz I, Joao I, Gomes AC, Caldeira D, Lopes L, Fazendas P, Pereira H, Edri O, Edri O, Schneider N, Schneider N, Abaye N, Abaye N, Goerge J, Goerge J, Gandelman G, Gandelman G, Bandera F, Alfonzetti E, Guazzi M, Bandera F, Villani S, Ferraro O, Alfonzetti E, Guazzi M, Ramberg E, Bhardwaj P, Nepper ML, Binko TS, Olausson M, Fink-Jensen T, Andersen AM, Roland J, Gleerup Fornitz G, Ong K, Suri RM, Enrique-Sarano M, Michelena HI, Burkhart HM, Gillespie SM, Cha S, Mankad SV, Saidova MA, Bolotova MN, Salido Tahoces L, Izurieta C, Villareal G, Esteban A, Urena Vacas A, Ayala A, Jimenez Nacher JJ, Hinojar Baydes R, Gonzalez Gomez A, Garcia A, Mestre JL, Hernandez Antolin R, Zamorano Gomez JJ, Perea G, Covelli Y, Henquin R, Ronderos R, Hepinstall MJ, Cassidy CS, Pellikka PA, Pislaru SV, Kane G. P569Diastolic dyssynchrony is associated with exercise intolerance in hypertensive patients with left ventricular hypertrophyP570Echocardiographic pattern of acute pulmonary embolism, analysis of consecutive 511 patientsP571Clinical significance of ventricular interdependence and left ventricular function in patients with pulmonary hypertension receiving specific vasodilator therapyP572Haemodynamic characteristics and ventricular mechanics in post-capillary and combined pre- and post-capillary pulmonary hypertensionP573Relationship between hematological response and echocardiographic features in patients with light chains systemic amyloidosisP574Myocardial changes in patients with anorexia nervosaP575Giant cell arteritis presenting as fever of unknown origin: role of clinical history, early positron emission tomography and ultrasound screeningP576Subclinical systolic dysfunction in systemic sclerosis is not influenced by standard rheumatologic therapy - a 4D echocardiographic studyP577Cardiac index correlates with the degree of hepatic steathosis in obese patients with obstructive sleep apneaP578Myocardial mechanics in top-level endurance athletes: a three-dimensional speckle tracking studyP579The athlete heart: what happens to myocardial deformation in physiological adaptation to sportsP580Association between left ventricle intrinsic function and urine protein-creatinine ratio in preeclampsia before and after deliveryP581Dilatation of the aorta in children with bicuspid aortic valveP582Cardiovascular functional abnormalities in patients with osteogenesis imperfectaP583Dobutamine stress test fast protocol: diagnostic accuracy and securityP584Prognostic value of non-positive exercise echocardiography in the patients submitted to percutaneous coronary interventionP585The use of myocardial strain imaging in the detection of coronary artery disease during stress echocardiographyP586Preserved O2 extraction exercise response in heart failure patients with chronotropic insufficiency: evidence for a central cardiac rather than peripheral oxygen uptake limitationP587Major determinant of O2 artero-venous difference at peak exercise in heart failure and healthy subjectsP588Stress echocardiography with contrast perfusion analysis for a more sensitive test for ischemic heart diseaseP589Assessment of mitral annular physiology in myxomatous mitral disease with 3D transesophageal echocardiography: comparison between early severe mitral regurgitation and decompensated groupP590Three-dimensional transesophageal echocardiographic assessment of the mitral valve geometry in patients with mild, moderate and severe chronic ischemic mitral regurgitationP591Left atrial appendage closure. Multimodality imaging in device size selectionP592Contributions of three-dimensional transesophageal echocardiography in the evaluation of aortic atherosclerotic plaquesP593Agitated blood-saline is superior to agitated air-saline for echocardiographic shunt studies. Eur Heart J Cardiovasc Imaging 2016; 17:ii102-ii109. [DOI: 10.1093/ehjci/jew248.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Background International guidelines recommend that physicians should be registered with a general practitioner (GP) and should avoid self-treatment. Adherence to these recommendations is mixed. Aims To describe illness behaviour and chronic medical conditions of GPs in Germany. Methods Cross-sectional, observational questionnaire study. We contacted 1000 GPs by mail in April 2014. We asked about registration with a GP, chronic conditions and self-treatment. We undertook descriptive statistical analysis and analysed associations using t-tests and chi-square test. Results Two hundred and eighty-five responses (29%) were eligible for analysis. Nineteen per cent of GPs were registered as patients of a GP, 58% reported at least one chronic condition, 68% disclosed self-diagnosis and 60% self-treatment. Self-therapy for chronic conditions was inversely correlated with subjective severity of the disease (r = −0.159; P < 0.05). Conclusions The high rates of self-treatment and the low rate of registration with a GP of German GPs are in contrast to international guideline recommendations. Further research is needed to analyse specific reasons.
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Affiliation(s)
- S Schulz
- Institute of General Practice and Family Medicine, Friedrich Schiller University, School of Medicine, Jena University Hospital, D-07743 Jena, Germany
| | - F Einsle
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - N Schneider
- Institute of General Practice and Family Medicine, Friedrich Schiller University, School of Medicine, Jena University Hospital, D-07743 Jena, Germany
| | - M Wensing
- Radboud University Nijmegen Medical Centre, Radboud Institute of Health Sciences, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - J Gensichen
- Institute of General Practice and Family Medicine, Friedrich Schiller University, School of Medicine, Jena University Hospital, D-07743 Jena, Germany.,Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Pettenkoferstr. 8a/10, 80336 München, Germany
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Woitha K, Schneider N, Wünsch A, Wiese B, Fimm S, Müller-Mundt G. [Integration and utilization of physiotherapy in hospice and palliative care : A survey on clinical practice in Germany]. Schmerz 2016; 31:62-68. [PMID: 27655409 DOI: 10.1007/s00482-016-0151-4] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role. AIM This study was carried out to examine the integration and utilization of physiotherapy in palliative and hospice care services in Germany. METHODS A cross-sectional survey including all palliative care units, specialized outpatient palliative care teams and hospices in Germany (n = 680) in 2013 was carried out. RESULTS The response rate was 43.5 % (n = 296). Physiotherapy is predominantly applied in palliative care units (79 %) but rarely in hospices (38 %) and outpatient palliative care teams (30 %). A structured physiotherapeutic assessment is rarely carried out even on palliative care units (26 %). Positive effects of physiotherapy are especially described for symptoms, such as edema, pain, constipation and dyspnea. CONCLUSION Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.
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Affiliation(s)
- K Woitha
- Institut für Allgemeinmedizin, Arbeitsgruppe Palliativversorgung, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - N Schneider
- Institut für Allgemeinmedizin, Arbeitsgruppe Palliativversorgung, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - A Wünsch
- Institut für Allgemeinmedizin, Arbeitsgruppe Palliativversorgung, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - B Wiese
- Institut für Allgemeinmedizin, Arbeitsgruppe Palliativversorgung, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - S Fimm
- Physiotherapie und Physikalische Therapie, Campus Kiel, Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Deutschland
| | - G Müller-Mundt
- Institut für Allgemeinmedizin, Arbeitsgruppe Palliativversorgung, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Schmidt K, Worrack S, Von Korff M, Davydow D, Brunkhorst F, Ehlert U, Pausch C, Mehlhorn J, Schneider N, Scherag A, Freytag A, Reinhart K, Wensing M, Gensichen J. Effect of a Primary Care Management Intervention on Mental Health-Related Quality of Life Among Survivors of Sepsis: A Randomized Clinical Trial. JAMA 2016; 315:2703-11. [PMID: 27367877 PMCID: PMC5122319 DOI: 10.1001/jama.2016.7207] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Survivors of sepsis face long-term sequelae that diminish health-related quality of life and result in increased care needs in the primary care setting, such as medication, physiotherapy, or mental health care. OBJECTIVE To examine if a primary care-based intervention improves mental health-related quality of life. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted between February 2011 and December 2014, enrolling 291 patients 18 years or older who survived sepsis (including septic shock), recruited from 9 intensive care units (ICUs) across Germany. INTERVENTIONS Participants were randomized to usual care (n = 143) or to a 12-month intervention (n = 148). Usual care was provided by their primary care physician (PCP) and included periodic contacts, referrals to specialists, and prescription of medication, other treatment, or both. The intervention additionally included PCP and patient training, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. MAIN OUTCOMES AND MEASURES The primary outcome was change in mental health-related quality of life between ICU discharge and 6 months after ICU discharge using the Mental Component Summary (MCS) of the 36-Item Short-Form Health Survey (SF-36 [range, 0-100; higher ratings indicate lower impairment; minimal clinically important difference, 5 score points]). RESULTS The mean age of the 291 patients was 61.6 years (SD, 14.4); 66.2% (n = 192) were men, and 84.4% (n = 244) required mechanical ventilation during their ICU stay (median duration of ventilation, 12 days [range, 0-134]). At 6 and 12 months after ICU discharge, 75.3% (n = 219 [112 intervention, 107 control]) and 69.4% (n = 202 [107 intervention, 95 control]), respectively, completed follow-up. Overall mortality was 13.7% at 6 months (40 deaths [21 intervention, 19 control]) and 18.2% at 12 months (53 deaths [27 intervention, 26 control]). Among patients in the intervention group, 104 (70.3%) received the intervention at high levels of integrity. There was no significant difference in change of mean MCS scores (intervention group mean at baseline, 49.1; at 6 months, 52.9; change, 3.79 score points [95% CI, 1.05 to 6.54] vs control group mean at baseline, 49.3; at 6 months, 51.0; change, 1.64 score points [95% CI, -1.22 to 4.51]; mean treatment effect, 2.15 [95% CI, -1.79 to 6.09]; P = .28). CONCLUSIONS AND RELEVANCE Among survivors of sepsis and septic shock, the use of a primary care-focused team-based intervention, compared with usual care, did not improve mental health-related quality of life 6 months after ICU discharge. Further research is needed to determine if modified approaches to primary care management may be more effective. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN61744782.
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Affiliation(s)
- Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraβe 18, 07743 Jena, Germany
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Susanne Worrack
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraβe 18, 07743 Jena, Germany
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Michael Von Korff
- Group Health Research Institute, Group Health Cooperative 1730 Minor Avenue, Suite 1600 Seattle, WA 98101, USA
| | - Dimitry Davydow
- Dpt. of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Box 356560 Seattle, WA 98195, USA
| | - Frank Brunkhorst
- Center of Clinical Studies, Dpt. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Salvador-Allende-Platz 27, 07747 Jena, Germany
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Ulrike Ehlert
- Dpt. of Psychology, University of Zuerich, Binzmuehlenstrasse 14, Box 26, CH-8050 Zuerich, Switzerland
| | - Christine Pausch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstraβe 16-18, 04107 Leipzig, Germany
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Juliane Mehlhorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraβe 18, 07743 Jena, Germany
| | - Nico Schneider
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraβe 18, 07743 Jena, Germany
| | - André Scherag
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraβe 18, 07743 Jena, Germany
| | - Konrad Reinhart
- Dpt. of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Michel Wensing
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraβe 18, 07743 Jena, Germany
- Radboud University Medical Centre, Radboud Institute of Health Sciences, Geert Grooteplein 9, PO Box 9101, 6500 HB Nijmegen, Netherlands
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraβe 18, 07743 Jena, Germany
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
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Afshar K, Müller-Mundt G, Schneider N. Wie können Patienten mit chronisch fortschreitenden nicht-onkologischen Erkrankungen erkannt werden, bei denen eine Palliativversorgung sinnvoll ist? Palliativmedizin 2016. [DOI: 10.1055/s-0042-103176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K. Afshar
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover
| | - G. Müller-Mundt
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover
| | - N. Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover
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Schleef T, Schneider N, Tecklenburg A, Junius-Walker U, Krause O. [General Practice in a University Emergency Department - Concept, Implementation and Evaluation]. Gesundheitswesen 2016; 79:845-851. [PMID: 27056713 DOI: 10.1055/s-0042-100730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Accident and emergency departments (A&E) are facing increasing numbers of patients. While hospitalization rates have remained nearly constant, there has been an increase in outpatient cases. Therefore, at Hannover Medical School (MHH), general practitioners (GPs) have been integrated in A&E. Methods: In 2014, all GP contacts within the A&E were evaluated on the basis of hospital routine data and by an additional questionnaire. It contained questions about who initiated the admission, about medical examinations and tests and the patient-related admission decisions. Results: In 2014, GPs in A&E treated 1 646 patients. 76% of the patients were self-referrals and 23% referrals from primary care physicians. The most prevalent diagnoses were back pain, gastroenteritis and hypertension. GPs in A&E did not need any additional specialist involvement in most cases. 81% of the patients were sent home, most of them with the advice to consult their GPs (59%), and 22% to consult a specialist. Repeated visits were scarce. Conclusion: Deploying GPs in A&E represents a promising concept to cope with the rising number of patients in A&E. However, further studies are needed to examine the accuracy of the GPs' diagnosis-related decisions and patient satisfaction.
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Affiliation(s)
- T Schleef
- Medizinische Hochschule Hannover, Institut für Allgemeinmedizin, Hannover
| | - N Schneider
- Medizinische Hochschule Hannover, Institut für Allgemeinmedizin, Hannover
| | - A Tecklenburg
- Medizinische Hochschule Hannover, Präsidium, Hannover
| | - U Junius-Walker
- Medizinische Hochschule Hannover, Institut für Allgemeinmedizin, Hannover
| | - O Krause
- Medizinische Hochschule Hannover, Institut für Allgemeinmedizin, Hannover
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Jakosky BM, Grebowsky JM, Luhmann JG, Connerney J, Eparvier F, Ergun R, Halekas J, Larson D, Mahaffy P, McFadden J, Mitchell DF, Schneider N, Zurek R, Bougher S, Brain D, Ma YJ, Mazelle C, Andersson L, Andrews D, Baird D, Baker D, Bell JM, Benna M, Chaffin M, Chamberlin P, Chaufray YY, Clarke J, Collinson G, Combi M, Crary F, Cravens T, Crismani M, Curry S, Curtis D, Deighan J, Delory G, Dewey R, DiBraccio G, Dong C, Dong Y, Dunn P, Elrod M, England S, Eriksson A, Espley J, Evans S, Fang X, Fillingim M, Fortier K, Fowler CM, Fox J, Gröller H, Guzewich S, Hara T, Harada Y, Holsclaw G, Jain SK, Jolitz R, Leblanc F, Lee CO, Lee Y, Lefevre F, Lillis R, Livi R, Lo D, Mayyasi M, McClintock W, McEnulty T, Modolo R, Montmessin F, Morooka M, Nagy A, Olsen K, Peterson W, Rahmati A, Ruhunusiri S, Russell CT, Sakai S, Sauvaud JA, Seki K, Steckiewicz M, Stevens M, Stewart AIF, Stiepen A, Stone S, Tenishev V, Thiemann E, Tolson R, Toublanc D, Vogt M, Weber T, Withers P, Woods T, Yelle R. MAVEN observations of the response of Mars to an interplanetary coronal mass ejection. Science 2015; 350:aad0210. [PMID: 26542576 DOI: 10.1126/science.aad0210] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Coupling between the lower and upper atmosphere, combined with loss of gas from the upper atmosphere to space, likely contributed to the thin, cold, dry atmosphere of modern Mars. To help understand ongoing ion loss to space, the Mars Atmosphere and Volatile Evolution (MAVEN) spacecraft made comprehensive measurements of the Mars upper atmosphere, ionosphere, and interactions with the Sun and solar wind during an interplanetary coronal mass ejection impact in March 2015. Responses include changes in the bow shock and magnetosheath, formation of widespread diffuse aurora, and enhancement of pick-up ions. Observations and models both show an enhancement in escape rate of ions to space during the event. Ion loss during solar events early in Mars history may have been a major contributor to the long-term evolution of the Mars atmosphere.
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Affiliation(s)
| | - J M Grebowsky
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - J G Luhmann
- University of California at Berkeley, Berkeley, CA, USA
| | - J Connerney
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - F Eparvier
- University of Colorado, Boulder, CO, USA
| | - R Ergun
- University of Colorado, Boulder, CO, USA
| | - J Halekas
- University of Iowa, Iowa City, IA, USA
| | - D Larson
- University of California at Berkeley, Berkeley, CA, USA
| | - P Mahaffy
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - J McFadden
- University of California at Berkeley, Berkeley, CA, USA
| | - D F Mitchell
- University of California at Berkeley, Berkeley, CA, USA
| | | | - R Zurek
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - S Bougher
- University of Michigan, Ann Arbor, MI, USA
| | - D Brain
- University of Colorado, Boulder, CO, USA
| | - Y J Ma
- University of California at Los Angeles, Los Angeles, CA, USA
| | - C Mazelle
- CNRS-Institut de Recherche en Astrophysique et Planétologie (IRAP), Toulouse, France. University Paul Sabatier, Toulouse, France
| | | | - D Andrews
- Swedish Institute of Space Physics, Uppsala, Sweden
| | - D Baird
- NASA/Johnson Space Center, Houston, TX, USA
| | - D Baker
- University of Colorado, Boulder, CO, USA
| | - J M Bell
- National Institute of Aerospace, Hampton, VA, USA
| | - M Benna
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Chaffin
- University of Colorado, Boulder, CO, USA
| | - P Chamberlin
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - Y-Y Chaufray
- Laboratoire atmosphères, milieux et observations spatiales (LATMOS)-CNRS, Paris, France
| | - J Clarke
- Boston University, Boston, MA, USA
| | - G Collinson
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Combi
- University of Michigan, Ann Arbor, MI, USA
| | - F Crary
- University of Colorado, Boulder, CO, USA
| | - T Cravens
- University of Kansas, Lawrence, KS, USA
| | - M Crismani
- University of Colorado, Boulder, CO, USA
| | - S Curry
- University of California at Berkeley, Berkeley, CA, USA
| | - D Curtis
- University of California at Berkeley, Berkeley, CA, USA
| | - J Deighan
- University of Colorado, Boulder, CO, USA
| | - G Delory
- University of California at Berkeley, Berkeley, CA, USA
| | - R Dewey
- University of Colorado, Boulder, CO, USA
| | - G DiBraccio
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - C Dong
- University of Michigan, Ann Arbor, MI, USA
| | - Y Dong
- University of Colorado, Boulder, CO, USA
| | - P Dunn
- University of California at Berkeley, Berkeley, CA, USA
| | - M Elrod
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - S England
- University of California at Berkeley, Berkeley, CA, USA
| | - A Eriksson
- Swedish Institute of Space Physics, Uppsala, Sweden
| | - J Espley
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - S Evans
- Computational Physics, Inc., Boulder, CO, USA
| | - X Fang
- University of Colorado, Boulder, CO, USA
| | - M Fillingim
- University of California at Berkeley, Berkeley, CA, USA
| | - K Fortier
- University of Colorado, Boulder, CO, USA
| | - C M Fowler
- University of Colorado, Boulder, CO, USA
| | - J Fox
- Wright State University, Dayton, OH, USA
| | - H Gröller
- University of Arizona, Tucson, AZ, USA
| | - S Guzewich
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - T Hara
- University of California at Berkeley, Berkeley, CA, USA
| | - Y Harada
- University of California at Berkeley, Berkeley, CA, USA
| | - G Holsclaw
- University of Colorado, Boulder, CO, USA
| | - S K Jain
- University of Colorado, Boulder, CO, USA
| | - R Jolitz
- University of California at Berkeley, Berkeley, CA, USA
| | - F Leblanc
- Laboratoire atmosphères, milieux et observations spatiales (LATMOS)-CNRS, Paris, France
| | - C O Lee
- University of California at Berkeley, Berkeley, CA, USA
| | - Y Lee
- University of Michigan, Ann Arbor, MI, USA
| | - F Lefevre
- Laboratoire atmosphères, milieux et observations spatiales (LATMOS)-CNRS, Paris, France
| | - R Lillis
- University of California at Berkeley, Berkeley, CA, USA
| | - R Livi
- University of California at Berkeley, Berkeley, CA, USA
| | - D Lo
- University of Arizona, Tucson, AZ, USA
| | | | | | - T McEnulty
- University of Colorado, Boulder, CO, USA
| | - R Modolo
- Laboratoire atmosphères, milieux et observations spatiales (LATMOS)-CNRS, Paris, France
| | - F Montmessin
- Laboratoire atmosphères, milieux et observations spatiales (LATMOS)-CNRS, Paris, France
| | - M Morooka
- University of Colorado, Boulder, CO, USA
| | - A Nagy
- University of Michigan, Ann Arbor, MI, USA
| | - K Olsen
- University of Michigan, Ann Arbor, MI, USA
| | - W Peterson
- University of Colorado, Boulder, CO, USA
| | - A Rahmati
- University of Kansas, Lawrence, KS, USA
| | | | - C T Russell
- University of California at Los Angeles, Los Angeles, CA, USA
| | - S Sakai
- University of Kansas, Lawrence, KS, USA
| | - J-A Sauvaud
- CNRS-Institut de Recherche en Astrophysique et Planétologie (IRAP), Toulouse, France. University Paul Sabatier, Toulouse, France
| | - K Seki
- Nagoya University, Nagoya, Japan
| | - M Steckiewicz
- CNRS-Institut de Recherche en Astrophysique et Planétologie (IRAP), Toulouse, France. University Paul Sabatier, Toulouse, France
| | - M Stevens
- Naval Research Laboratory, Washington, DC, USA
| | | | - A Stiepen
- University of Colorado, Boulder, CO, USA
| | - S Stone
- University of Arizona, Tucson, AZ, USA
| | - V Tenishev
- University of Michigan, Ann Arbor, MI, USA
| | - E Thiemann
- University of Colorado, Boulder, CO, USA
| | - R Tolson
- North Carolina State University, Raleigh, NC, USA
| | - D Toublanc
- CNRS-Institut de Recherche en Astrophysique et Planétologie (IRAP), Toulouse, France. University Paul Sabatier, Toulouse, France
| | - M Vogt
- Boston University, Boston, MA, USA
| | - T Weber
- University of Colorado, Boulder, CO, USA
| | | | - T Woods
- University of Colorado, Boulder, CO, USA
| | - R Yelle
- University of Arizona, Tucson, AZ, USA
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Bougher S, Jakosky B, Halekas J, Grebowsky J, Luhmann J, Mahaffy P, Connerney J, Eparvier F, Ergun R, Larson D, McFadden J, Mitchell D, Schneider N, Zurek R, Mazelle C, Andersson L, Andrews D, Baird D, Baker DN, Bell JM, Benna M, Brain D, Chaffin M, Chamberlin P, Chaufray JY, Clarke J, Collinson G, Combi M, Crary F, Cravens T, Crismani M, Curry S, Curtis D, Deighan J, Delory G, Dewey R, DiBraccio G, Dong C, Dong Y, Dunn P, Elrod M, England S, Eriksson A, Espley J, Evans S, Fang X, Fillingim M, Fortier K, Fowler CM, Fox J, Gröller H, Guzewich S, Hara T, Harada Y, Holsclaw G, Jain SK, Jolitz R, Leblanc F, Lee CO, Lee Y, Lefevre F, Lillis R, Livi R, Lo D, Ma Y, Mayyasi M, McClintock W, McEnulty T, Modolo R, Montmessin F, Morooka M, Nagy A, Olsen K, Peterson W, Rahmati A, Ruhunusiri S, Russell CT, Sakai S, Sauvaud JA, Seki K, Steckiewicz M, Stevens M, Stewart AIF, Stiepen A, Stone S, Tenishev V, Thiemann E, Tolson R, Toublanc D, Vogt M, Weber T, Withers P, Woods T, Yelle R. Early MAVEN Deep Dip campaign reveals thermosphere and ionosphere variability. Science 2015; 350:aad0459. [PMID: 26542579 DOI: 10.1126/science.aad0459] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The Mars Atmosphere and Volatile Evolution (MAVEN) mission, during the second of its Deep Dip campaigns, made comprehensive measurements of martian thermosphere and ionosphere composition, structure, and variability at altitudes down to ~130 kilometers in the subsolar region. This altitude range contains the diffusively separated upper atmosphere just above the well-mixed atmosphere, the layer of peak extreme ultraviolet heating and primary reservoir for atmospheric escape. In situ measurements of the upper atmosphere reveal previously unmeasured populations of neutral and charged particles, the homopause altitude at approximately 130 kilometers, and an unexpected level of variability both on an orbit-to-orbit basis and within individual orbits. These observations help constrain volatile escape processes controlled by thermosphere and ionosphere structure and variability.
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Affiliation(s)
- S Bougher
- CLaSP Department, University of Michigan, Ann Arbor, MI, USA.
| | - B Jakosky
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - J Halekas
- Department of Physics and Astronomy, University of Iowa, Iowa City, IA, USA
| | - J Grebowsky
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Luhmann
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - P Mahaffy
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Connerney
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - F Eparvier
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - R Ergun
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - D Larson
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - J McFadden
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - D Mitchell
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - N Schneider
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - R Zurek
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - C Mazelle
- CNRS/Institut de Recherche en Astrophysique et Planétologie, Toulouse, France. University Paul Sabatier, Toulouse, France
| | - L Andersson
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - D Andrews
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - D Baird
- NASA/Johnson Space Center, Houston, TX, USA
| | - D N Baker
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - J M Bell
- National Institute of Aerospace, Hampton, VA, USA
| | - M Benna
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - D Brain
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - M Chaffin
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - P Chamberlin
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - J-Y Chaufray
- Laboratoire Atmosphères, Milieux, Observations Spatiales /CNRS, Verrieres-le-Buisson, France
| | - J Clarke
- Department of Astronomy, Boston University, Boston, MA, USA
| | - G Collinson
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Combi
- CLaSP Department, University of Michigan, Ann Arbor, MI, USA
| | - F Crary
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - T Cravens
- Department of Physics and Astronomy, University of Kansas, Lawrence, KS, USA
| | - M Crismani
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - S Curry
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - D Curtis
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - J Deighan
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - G Delory
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - R Dewey
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - G DiBraccio
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - C Dong
- CLaSP Department, University of Michigan, Ann Arbor, MI, USA
| | - Y Dong
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - P Dunn
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - M Elrod
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - S England
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - A Eriksson
- Swedish Institute of Space Physics, Kiruna, Sweden
| | - J Espley
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - S Evans
- Computational Physics, Springfield, VA, USA
| | - X Fang
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - M Fillingim
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - K Fortier
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - C M Fowler
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - J Fox
- Department of Physics, Wright State University, Fairborn, OH, USA
| | - H Gröller
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - S Guzewich
- NASA/Goddard Space Flight Center, Greenbelt, MD, USA
| | - T Hara
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - Y Harada
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - G Holsclaw
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - S K Jain
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - R Jolitz
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - F Leblanc
- Laboratoire Atmosphères, Milieux, Observations Spatiales /CNRS, Verrieres-le-Buisson, France
| | - C O Lee
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - Y Lee
- CLaSP Department, University of Michigan, Ann Arbor, MI, USA
| | - F Lefevre
- Laboratoire Atmosphères, Milieux, Observations Spatiales /CNRS, Verrieres-le-Buisson, France
| | - R Lillis
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - R Livi
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - D Lo
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - Y Ma
- Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Mayyasi
- Department of Astronomy, Boston University, Boston, MA, USA
| | - W McClintock
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - T McEnulty
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - R Modolo
- Laboratoire Atmosphères, Milieux, Observations Spatiales /CNRS, Verrieres-le-Buisson, France
| | - F Montmessin
- Laboratoire Atmosphères, Milieux, Observations Spatiales /CNRS, Verrieres-le-Buisson, France
| | - M Morooka
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - A Nagy
- CLaSP Department, University of Michigan, Ann Arbor, MI, USA
| | - K Olsen
- CLaSP Department, University of Michigan, Ann Arbor, MI, USA
| | - W Peterson
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - A Rahmati
- Department of Physics and Astronomy, University of Kansas, Lawrence, KS, USA
| | - S Ruhunusiri
- Department of Physics and Astronomy, University of Iowa, Iowa City, IA, USA
| | - C T Russell
- Institute of Geophysics and Planetary Physics, University of California, Los Angeles, Los Angeles, CA, USA
| | - S Sakai
- Department of Physics and Astronomy, University of Kansas, Lawrence, KS, USA
| | - J-A Sauvaud
- CNRS/Institut de Recherche en Astrophysique et Planétologie, Toulouse, France. University Paul Sabatier, Toulouse, France
| | - K Seki
- Solar-Terrestrial Environment Laboratory, Nagoya University, Nagoya, Aichi, Japan
| | - M Steckiewicz
- CNRS/Institut de Recherche en Astrophysique et Planétologie, Toulouse, France. University Paul Sabatier, Toulouse, France
| | - M Stevens
- Naval Research Laboratory, Washington, DC, USA
| | - A I F Stewart
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - A Stiepen
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - S Stone
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - V Tenishev
- CLaSP Department, University of Michigan, Ann Arbor, MI, USA
| | - E Thiemann
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - R Tolson
- National Institute of Aerospace, Hampton, VA, USA
| | - D Toublanc
- CNRS/Institut de Recherche en Astrophysique et Planétologie, Toulouse, France. University Paul Sabatier, Toulouse, France
| | - M Vogt
- Department of Astronomy, Boston University, Boston, MA, USA
| | - T Weber
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - P Withers
- Department of Astronomy, Boston University, Boston, MA, USA
| | - T Woods
- Laboratory for Atmospheric and Space Physics, University. of Colorado, Boulder, CO, USA
| | - R Yelle
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
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Brenk-Franz K, Strauss B, Tiesler F, Fleischhauer C, Ciechanowski P, Schneider N, Gensichen J. The Influence of Adult Attachment on Patient Self-Management in Primary Care--The Need for a Personalized Approach and Patient-Centred Care. PLoS One 2015; 10:e0136723. [PMID: 26381140 PMCID: PMC4575213 DOI: 10.1371/journal.pone.0136723] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 07/16/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Self-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions. Methods In the apricare study (Adult Attachment in Primary Care) we used a prospective longitudinal design to examine the association between adult attachment and self-management in primary care patients with multimorbidity. The attachment dimensions avoidance and anxiety were measured using the ECR-RD. Self-management skills were measured by the FERUS (motivation to change, coping, self-efficacy, hope, social support) and self-management-behaviour by the DSMQ (glucose management, dietary control, physical activity, health-care use). Clinical diagnosis and severity of disease were assessed by the patients’ GPs. Multivariate analyses (GLM) were used to assess the relationship between the dimensions of adult attachment and patient self-management. Results 219 patients in primary care with multiple chronic conditions (type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 were included in the study. The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity. Avoidance was negatively associated with coping, self-efficacy, social support and health care use. Conclusion The two attachment dimensions anxiety and avoidance are associated with different components of self-management. A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care.
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Affiliation(s)
- Katja Brenk-Franz
- Institute of General Practice and Family Medicine, University Hospital, Jena, Germany
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
- * E-mail:
| | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Fabian Tiesler
- Institute of General Practice and Family Medicine, University Hospital, Jena, Germany
| | | | - Paul Ciechanowski
- Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, United States of America
| | - Nico Schneider
- Institute of General Practice and Family Medicine, University Hospital, Jena, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, Jena, Germany
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48
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Gerber M, Schneider N. Density of biogas digestate depending on temperature and composition. Bioresour Technol 2015; 192:172-176. [PMID: 26026294 DOI: 10.1016/j.biortech.2015.05.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 06/04/2023]
Abstract
Density is one of the most important physical properties of biogas digestate to ensure an optimal dimensioning and a precise design of biogas plant components like stirring devices, pumps and heat exchangers. In this study the density of biogas digestates with different compositions was measured using pycnometers at ambient pressure in a temperature range from 293.15 to 313.15K. The biogas digestates were taken from semi-continuous experiments, in which the marine microalga Nannochloropsis salina, corn silage and a mixture of both were used as feedstocks. The results show an increase of density with increasing total solid content and a decrease with increasing temperature. Three equations to calculate the density of biogas digestate were set up depending on temperature as well as on the total solid content, organic composition and elemental composition, respectively. All correlations show a relative deviation below 1% compared to experimental data.
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Affiliation(s)
- Mandy Gerber
- Ruhr-Universität Bochum, Thermodynamics, Universitätsstr. 150, D-44801 Bochum, Germany.
| | - Nico Schneider
- Ruhr-Universität Bochum, Thermodynamics, Universitätsstr. 150, D-44801 Bochum, Germany
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49
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Werdecker L, Kujawa M, Schneider N, Neitzke G. P-59 Advance care planning for older people with advanced heart failure: Typology of patients’ perception. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.189] [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: 11/04/2022]
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50
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Lhospice F, Brégeon D, Belmant C, Dennler P, Chiotellis A, Fischer E, Gauthier L, Boëdec A, Rispaud H, Savard-Chambard S, Represa A, Schneider N, Paturel C, Sapet M, Delcambre C, Ingoure S, Viaud N, Bonnafous C, Schibli R, Romagné F. Site-Specific Conjugation of Monomethyl Auristatin E to Anti-CD30 Antibodies Improves Their Pharmacokinetics and Therapeutic Index in Rodent Models. Mol Pharm 2015; 12:1863-71. [PMID: 25625323 DOI: 10.1021/mp500666j] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Antibody-drug conjugates (ADCs) have demonstrated clinical benefits that have led to the recent FDA approval of KADCYLA and ADCETRIS. Most ADCs that are currently in clinical use or development, including ADCETRIS, are produced by chemical conjugation of a toxin via either lysine or cysteine residues, inevitably leading to heterogeneous products with variable drug-to-antibody ratios (DARs). Here, we describe the in vitro and in vivo characterization of four novel ADCs that are based on the anti-CD30 antibody cAC10, which has the same polypeptide backbone as ADCETRIS, and compare the results with the latter. Bacterial transglutaminase (BTG) was exploited to site-specifically conjugate derivatives of monomethyl auristatin E (all comprising a cleavable linker) to the glutamine at positions 295 and 297 of cAC10, thereby yielding homogeneous ADCs with a DAR of 4. In vitro cell toxicity experiments using two different CD30-positive cell lines (Karpas 299 and Raji-CD30(+)) revealed comparable EC50 values for ADCETRIS (1.8 ± 0.4 and 3.6 ± 0.6 ng/mL, respectively) and the four cAC10-based ADCs (2.0 ± 0.4 to 4.9 ± 1.0 ng/mL). Quantitative time-dependent in vivo biodistribution studies (3-96 h p.i.) in normal and xenografted (Karpas 299 cells) SCID mice were performed with a selected (125)I-radioiodinated cAC10 ADC and compared with that of (125)I-ADCETRIS. The chemo-enzymatically conjugated, radioiodinated ADC showed higher tumor uptake (17.84 ± 2.2% ID/g 24 h p.i.) than (125)I-ADCETRIS (10.5 ± 1.8% ID/g 24 h p.i.). Moreover, (125)I-ADCETRIS exhibited higher nontargeted liver and spleen uptake. In line with these results, the maximum tolerated dose of the BTG-coupled ADC (>60 mg/kg) was significantly higher than that of ADCETRIS (18 mg/kg) in rats. These results suggest that homogeneous ADCs display improved pharmacokinetics and better therapeutic indexes compared to those of chemically modified ADCs with variable DARs.
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Affiliation(s)
- F Lhospice
- †Innate Pharma SA, F13276 Marseille, France
| | - D Brégeon
- †Innate Pharma SA, F13276 Marseille, France
| | - C Belmant
- †Innate Pharma SA, F13276 Marseille, France
| | - P Dennler
- ‡Center for Radiopharmaceutical Sciences, ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - A Chiotellis
- §Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - E Fischer
- ‡Center for Radiopharmaceutical Sciences, ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - L Gauthier
- †Innate Pharma SA, F13276 Marseille, France
| | - A Boëdec
- †Innate Pharma SA, F13276 Marseille, France
| | - H Rispaud
- †Innate Pharma SA, F13276 Marseille, France
| | | | - A Represa
- †Innate Pharma SA, F13276 Marseille, France
| | | | - C Paturel
- †Innate Pharma SA, F13276 Marseille, France
| | - M Sapet
- †Innate Pharma SA, F13276 Marseille, France
| | | | - S Ingoure
- †Innate Pharma SA, F13276 Marseille, France
| | - N Viaud
- †Innate Pharma SA, F13276 Marseille, France
| | | | - R Schibli
- ‡Center for Radiopharmaceutical Sciences, ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen, Switzerland.,§Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, 8093 Zurich, Switzerland
| | - F Romagné
- ∥MI-mAbs (C/0 CIML), Parc Scientifique et Technologique de Luminy, Avenue de Luminy case 906, F13288 Marseille Cedex 9, France
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