A Mobile Health Application to Enhance Self-Management Skills of Patients with Shoulder Impingement Syndrome During Rehabilitation

Especially in chronic diseases, such as shoulder impingement syndrome (SIS), good self-management is important for patients to take personal responsibility for their treatment and make informed decisions in rehabilitation processes. Mobile apps integrating game design elements have great potential to increase patients self-management skills. A total of 21 functionalities for a self-management app were derived from semi-structured interviews with six patients and three therapists. Thereby, welcome messages, a personalized home-screen, and training plans are rated as particular useful. Ten of these functionalities could be implemented in a first prototype of SISco: your shoulder impingement syndrome companion. SISco provides possibilities for creating and executing training programs, learning about SIS, checking daily challenges, and making diary entries. Thereby, SISco motivates patients via progress bars, collecting XP, unlocking content and Dr. SISco the virtual therapist. Future work includes the implementation of further functionalities and the evaluation of SISco for usability and user acceptance.

Mobile demersal megafauna at common offshore wind turbine foundations in the German Bight (North Sea) two years after deployment - increased production rate of Cancer pagurus

Within the next decades the construction of thousands of different types of large wind turbine foundations in the North Sea will substantially increase the amount of habitat available to reef fauna. To gain first insights which effect these substantial changes in habitat structure and diversity might have on faunal stocks settling on hard substrata, we compared the mobile demersal megafauna associated with the common types of wind turbine foundations ('jacket', 'tripod' and 'monopile with scour protections of natural rock') in the southern German Bight, North Sea. Monopiles with scour protection were mostly colonized by typical reef fauna. They were inhabited by an average of about 5000 edible crabs Cancer pagurus (per foundation), which is more than twice as much as found at the foundation types without scour protection. Strong evidence was found that all three foundation types not only function as aggregation sites, but also as nursery grounds for C. pagurus. Assuming equal shares of the three foundation types in future wind farms, we project that about 27% of the local stock of C. pagurus might be produced on site. When, for example, comparing the existing fauna at 1000 ship wrecks and on the autochthonous soft substrate with those which probably will establish at the foundations of 5000 hypothetically realized wind turbines, it becomes clear that the German Bight in the future will provide new artificial reef habitats for another 320% crabs (C. pagurus) and 50% wrasse (Ctenolabrus rupestris) representing substrata-limited mobile demersal hard bottom species. Further research is urgently required in order to evaluate this overspill as it would be an important ecological effect of the recent offshore wind power development.

[Emergency response management near the tracks of the public railway network: special aspects of missions connected with the German national railway system]

Emergency response management and rescue operations concerning the railway network in Germany need special attention and implementation in several ways. The emergency response concerning the German national railway network managed by Deutsche Bahn AG is subject to various rules and regulations which have to be followed precisely. Only by following these rules and procedures is the safety of all emergency staff at the scene ensured. The German national railway network (Deutsche Bahn AG) provides its own emergency response control center, which specializes in managing its response to emergencies and dispatches an emergency response manager to the scene. This person serves as the primary Deutsche Bahn AG representative at the scene and is the only person who is allowed to earth the railway electrical power lines. This article will discuss different emergency situations concerning railway accidents and the emergency medical response to them based on a near collision with a high speed train during a rescue mission close to the railway track. Injury to personnel could only be avoided by chance and luck. The dangers and risks for rescue staff are specified. Furthermore, the article details practical guidelines for rescue operations around the German national railway track system.

[Outpatient surgery in hospital. An instrument for resource optimization?]

The societies of western countries are facing enormous economic and social challenges. Despite a declining population size the number of elderly patients is growing and will lead to an increase in cases of trauma in the near future. In addition, the health care system will have to be financed by a reduced labor force. To realize the ambitious political goal of providing comprehensive medical care an economization of hospital treatment must be achieved. The bottleneck within the surgical specialties in case of efficient scheduling will be the capacity utilization of the operating theatres. Additional separate outpatient operating theatres adjacent to hospitals could be an efficient instrument for using resources and economizing medical procedures. Considering the socio-demographic alterations of our society an adequate discussion regarding the general medical conditions is essential.

Rational approach to fractionation, isolation, and characterization of polysaccharides from the lichen Cetraria islandica

Polysaccharides, isolated from the lichen Cetraria islandica, have antimicrobial effectiveness. For pharmaceutical applications the two glucan components lichenan and isolichenan as well as the galactomannan component are of actual interest. Especially the a-glucan isolichenan ist used as an active ingredient in cough lozenges. The conditions for the extraction of the raw material, mainly pH and temperature, have a strong influence on the yield of lichenan, isolichenan, and galactomannan, and also on the amount of tannins in the extract. Target products and also by-products give higher extraction yields with increasing extraction temperatures. Hot water extraction with subsequent fractionation of the extracted polysaccharides by multiple freezing/thawing steps and water removal applying ethanol and ether permitted the isolation of the target polysaccharides in preparative quantities. Tannins were removed by reversed phase chromatography. IR and NMR spectroscopy were used for structural characterization of lichenan and isolichenan. After optimization of the hot water extraction process no significant lower extraction and fractionation yields have been obtained compared to the established tricky DMSO extraction procedure.

[Cytokines in the diagnosis of amniotic infection syndrome]

Accumulating evidence indicates an association between intraamniotic infection and raising concentrations of amniotic cytokines, resulting in preterm labor and preterm rupture of fetal membranes, because these cytokines are able to stimulate prostaglandin biosynthesis. Therefore the purpose of our study was to investigate if quantitative determination of Il-1 beta, Il-6, Il-8 and TNF-a in amniotic fluid may be a practicable method to diagnose intraamniotic infection. Since invasive amniocentesis doesn't allow repeated cytokine detection, in case of preterm rupture of fetal membranes, amniotic fluid also was obtained by placing a sterile gauze and cotton pad into the women's vagina, absorbing draining amniotic fluid for cytokine detection. Our results clearly indicate that Il-1 beta and TNF-a are not detectable in normal pregnancy, while Il-6 and Il-8 are produced in low, but constant levels. In contrast, in amniotic fluid of patients with intraamniotic infection high amounts of Il-6 and Il-8 were found, while Il-1 beta and TNF-a bioactivity became measurable, indicating that biosynthesis was activated. These results demonstrate, that infection associated cytokines detectable in amniotic fluid are highly sensitive markers for intraamniotic infection. In case of preterm rupture of fetal membranes recovery of amniotic fluid from a vaginal pad allows monitoring of cytokine bioactivity in daily intervals to control success of antibiotic treatment.

Flow injection immunoanalysis (FIIA)--a new immunoassay format for the determination of pesticides in water

This paper presents the development of a new heterogeneous enzyme immunoassay format for the detection of pesticides. It uses the technique of a flow injection system and is named flow injection immunoanalysis (FIIA). Results are demonstrated for the measurements of the herbicide atrazine, which belongs to the triazines, and the potential of this method compared with another immunoassay format (ELISA) is discussed.

The energy distribution between the photosystems and light-induced changes in the stoichiometry of system I and II reaction centers in the chlorophyll b-containing alga Mantoniella squamata (Prasinophyceae)

The chlorophyll b-containing alga Mantoniella squamata was analyzed with respect to its capacity to balance the energy distribution from the light-harvesting antenna to photosystem I or photosystem II. It was shown, that this alga is unable to alter the absorption cross section of the two photosystems in terms of short-time regulations (state transitions). The energy absorbed by the LHC, which contains 60% of total photosynthetic pigments, is transferred to both photosystems without any preference. The stoichiometry of the two photosystems is found to be extremely unequal and variable during light adaptation. In high light, the molar ratio of P-680 per P-700 is found to be two, whereas under low light conditions this ratio accounts to nearly four. This very unbalanced stoichiometry of the reaction centers gives some new insights into the concept of the photosynthetic unit as well as in the importance of the regulation of the energy distribution. It is assumed that the high concentration of photosystem II can be understood as a mechanism to prevent the overexcitation of photosystem I. In addition, the changes im membrane protein pattern are not accompanied by variations in the ratio of appressed to nonappressed membranes as probed by ultrastructural analysis. It is suggested that the thylakoids are organized like a homogenous pigment bed. The lack of state transitions can be interpreted as a consequence of this unusual membrane morphology.

Restenosis is a common feature of the angiographic follow-up after balloon valvoplasty of calcified aortic stenoses

Balloon dilatation of calcified aortic stenosis was attempted in 12 patients, 6 men and 6 women, aged 38-82 years. Two patients underwent emergency surgery because of myocardial injury or pericardial tamponade. One patient with severe depressed left ventricular function in whom the procedure was attempted in cardiogenic shock died during the procedure. One patient experienced severe aortic insufficiency after dilatation. The remaining pressure gradient was higher than 50 mm Hg in another patient. Seven dilatations were considered to be successful with a remaining pressure gradient below 50 mm Hg and a mean gradient reduction of 53 mm Hg. In one of these 7 patients, who suffered from severe heart failure, valvoplasty had been carried out to make aortic valve replacement possible. The operation was performed 2 weeks later without complications. Five of 6 patients treated medically after successful valvoplasty had restenosis within 3 to 12 months. One of them exhibited a good result at 3 months but severe restenosis after one year. It is concluded that balloon valvoplasty of calcified aortic stenosis cannot be considered an alternative to surgery. If, however, left ventricular function improves after successful valvoplasty, valve replacement will then carry less risk.

[Catheter valvuloplasty in mitral valve stenosis]

Balloon dilatation of the mitral valve was performed, trans-septum via the femoral vein or retrogradely via the femoral artery, in 20 patients, aged 31-65 years, with post-rheumatic mitral stenosis. Haemodynamically insignificant mitral regurgitation occurred in two patients. In one patient a permanent atrial septal defect was produced by the transseptal puncture. In a fourth patient severe mitral regurgitation occurred which required operation. There were no other serious complications. No dilatation was possible in three patients for technical reasons. Successful dilatation was achieved in 16 of the 20 patients. The end-diastolic transvalvular pressure gradient was reduced from 12 +/- 5 to 4 +/- 3 mm Hg. At follow-up, after 3-6 months (12 patients) or after 1-1.5 years (5 patients), in one instant after a second dilatation, a lasting good result was confirmed, the mean end-diastolic gradient being 4 +/- 3 mm Hg.

[Long-term results of transluminal valvuloplasty in calcified aortic valve stenosis]

Transluminal valvuloplasty (TVP) was attempted in 11 patients, aged 38-82 years, with calcified aortic valve stenosis (AS). The transvalvular systolic pressure gradient was reduced from a mean of 91 +/- 28 to 44 +/-30 mm Hg. Two patients had needed an emergency with decompensated AS in cardiogenic shock, died during the operation, another died of the consequences of an endocarditis. One patient had an inadequate TVP: a renewed TVP was subsequently performed at another hospital, followed by an operation for severe aortic regurgitation produced by the second TVP. In four patients left-heart catheterization 3-12 months post-dilation demonstrated considerable restenosis. One patient was significantly improved clinically (but no angiography had as yet been performed) four months after the TVP. Doppler echocardiography in this patient, too, demonstrated renewed increase in transvalvular pressure gradient. The results demonstrate that, because of the high rate of recurrence, TVP is at present only rarely indicated for calcified AS.

Transmission in utero of microfilariae of Onchocerca volvulus

Skin snips from newborn children and biopsy material from the umbilical cord and placenta of their mothers were examined. Microfilariae of O. volvulus were found in the skin of 2 out of 11 babies and in the umbilical cords of 2 out of 11 babies born to ten mothers infected with O. volvulus in Bawku Hospital, Ghana.