Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024

Since the end of November 2023, the European Mortality Monitoring Network (EuroMOMO) has observed excess mortality in Europe. During weeks 48 2023-6 2024, preliminary results show a substantially increased rate of 95.3 (95% CI:  91.7-98.9) excess all-cause deaths per 100,000 person-years for all ages. This excess mortality is seen in adults aged 45 years and older, and coincides with widespread presence of COVID-19, influenza and respiratory syncytial virus (RSV) observed in many European countries during the 2023/24 winter season.

[Schirmer test for determining the moisture status of the nasal mucosa]

BACKGROUND

There is no established method to objectively measure the moisture status of nasal mucosa. In a pilot study it was shown that a nasal Schirmer test is a possible method. The aim of the current study was to check whether the nasal Schirmer test is suitable to define moisture status in cases with an expected pathological secretion.

MATERIALS AND METHODS

Initially, 154 subjects participated, of whom n = 112 were included (healthy n = 65, deviated septum n = 47, ♂ 60, ♀ 52, median age 33 years). After evaluation of various test strips, the most suitable one was placed on both sides of the mucosa of the anterior septum. Secretion running distance (SRD) was measured in mm after 10 min. In addition, rhinomanometry (AAR) and acoustic rhinometry (AR) were performed. Healthy volunteers and subjects with septum deviation were compared, and subjects were also compared in terms of smoking behavior and age (<60 and ≥60 years).

RESULTS

The total median SRD was 12 mm. SRDs between 9 and 14 mm were considered physiological. In non-smokers, SRD was significantly higher in all groups compared to smokers (p > 0.05). Nasal side, age, and deviated septum had no significant influence on SRD (p < 0.05). There were no correlations between SRD and AAR or AR.

CONCLUSION

Our results confirm that a statement about moisture of the nasal mucosa is possible based on a nasal Schirmer test. Standard values of SRD are relevantly influenced by the respective test strip. Smoking is associated with a drier mucosa. Further investigations on the nasal Schirmer test in patients with expected atrophy of the nose, e. g., Sjogren's or empty nose syndrome, should be performed.

g Factor of Boronlike Argon ^{40}Ar^{13+}

We have measured the ground-state g factor of boronlike argon ^{40}Ar^{13+} with a fractional uncertainty of 1.4×10^{-9} with a single ion in the newly developed Alphatrap double Penning-trap setup. The value of g=0.663 648 455 32(93) obtained here is in agreement with our theoretical prediction of 0.663 648 12(58). The latter is obtained accounting for quantum electrodynamics, electron correlation, and nuclear effects within the state-of-the-art theoretical methods. Our experimental result distinguishes between existing predictions that are in disagreement, and lays the foundations for an independent determination of the fine-structure constant.

Factors influencing the length of hospital stay of patients with anorexia nervosa - results of a prospective multi-center study

BACKGROUND

The length of stay (LOS) strongly influences anorexia nervosa (AN) inpatient weight outcomes. Hence, understanding the predictors of LOS is highly relevant. However, the existing evidence is inconsistent and to draw conclusions, additional evidence is required.

METHODS

We conducted a prospective, multi-center study including adult female inpatients with AN. Using stepwise linear regression, the following demographic and clinical variables were examined as potential predictors for LOS: admission BMI, AN-subtype, age, age of onset, living situation, partnership status, education, previous hospitalization, self-rated depression, anxiety and somatic symptoms (PHQ-9, PHQ-15, GAD-7), self-rated therapy motivation (FEVER) and eating disorder psychopathology (EDI-2 subscale scores).

RESULTS

The average LOS of the sample (n = 176) was 11.8 weeks (SD = 5.2). Longer LOS was associated with lower admission BMI (ß = -1.66; p < .001), purging AN-subtype (ß = 1.91; p = .013) and higher EDI-2 asceticism (ß = 0.12; p = .030). Furthermore, differences between treatment sites were evident.

CONCLUSIONS

BMI at admission and AN-subtype are routinely assessed variables, which are robust and clinically meaningful predictors of LOS. Health care policies might consider these variables. In light of the differences between treatment sites future research on geographical variations in mental health care seems recommended.

An internally and externally validated prognostic score for metastatic breast cancer: analysis of 2269 patients

BACKGROUND

The prognosis of metastatic breast cancer (MBC) is extremely heterogeneous. Although patients with MBC will uniformly die to their disease, survival may range from a few months to several years. This underscores the importance of defining prognostic factors to develop risk-adopted treatment strategies. Our aim has been to use simple measures to judge a patient's prognosis when metastatic disease is diagnosed.

PATIENTS AND METHODS

We retrospectively analyzed 2269 patients from four clinical cancer registries. The prognostic score was calculated from the regression coefficients found in the Cox regression analysis. Based on the score, patients were classified into high-, intermediate-, and low-risk groups. Bootstrapping and time-dependent receiver operating characteristic curves were used for internal validation. Two independent datasets were used for external validation.

RESULTS

Metastatic-free interval, localization of metastases, and hormone receptor status were identified as significant prognostic factors in the multivariate analysis. The three prognostic groups showed highly significant differences regarding overall survival from the time of metastasis [intermediate compared with low risk: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.36-2.27, P < 0.001; high compared with low risk: HR 3.54, 95% CI 2.81-4.45, P < 0.001). The median overall survival in these three groups were 61, 38, and 22 months, respectively. The external validation showed congruent results.

CONCLUSIONS

We developed a prognostic score, based on routine parameters easily accessible in daily clinical care. Although major progress has been made, the optimal therapeutic management of the individual patient is still unknown. Besides elaborative molecular classification of tumors, simple clinical measures such as our model may be helpful to further individualize optimal breast cancer care.

An internally and externally validated prognostic score for metastatic breast cancer: analysis of 2269 patients

BACKGROUND

The prognosis of metastatic breast cancer (MBC) is extremely heterogeneous. Although patients with MBC will uniformly die to their disease, survival may range from a few months to several years. This underscores the importance of defining prognostic factors to develop risk-adopted treatment strategies. Our aim has been to use simple measures to judge a patient's prognosis when metastatic disease is diagnosed.

PATIENTS AND METHODS

We retrospectively analyzed 2269 patients from four clinical cancer registries. The prognostic score was calculated from the regression coefficients found in the Cox regression analysis. Based on the score, patients were classified into high-, intermediate-, and low-risk groups. Bootstrapping and time-dependent receiver operating characteristic curves were used for internal validation. Two independent datasets were used for external validation.

RESULTS

Metastatic-free interval, localization of metastases, and hormone receptor status were identified as significant prognostic factors in the multivariate analysis. The three prognostic groups showed highly significant differences regarding overall survival from the time of metastasis [intermediate compared with low risk: hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.36-2.27, P < 0.001; high compared with low risk: HR 3.54, 95% CI 2.81-4.45, P < 0.001). The median overall survival in these three groups were 61, 38, and 22 months, respectively. The external validation showed congruent results.

CONCLUSIONS

We developed a prognostic score, based on routine parameters easily accessible in daily clinical care. Although major progress has been made, the optimal therapeutic management of the individual patient is still unknown. Besides elaborative molecular classification of tumors, simple clinical measures such as our model may be helpful to further individualize optimal breast cancer care.

Femtosecond stimulated Raman spectroscopy of flavin after optical excitation

In blue-light photoreceptors using flavin (BLUF), the signaling state is formed already within several 100 ps after illumination, with only small changes of the absorption spectrum. The accompanying structural evolution can, in principle, be monitored by femtosecond stimulated Raman spectroscopy (FSRS). The method is used here to characterize the excited-state properties of riboflavin and flavin adenine dinucleotide in polar solvents. Raman modes are observed in the range 90-1800 cm(-1) for the electronic ground state S(0) and upon excitation to the S(1) state, and modes >1000 cm(-1) of both states are assigned with the help of quantum-chemical calculations. Line shapes are shown to depend sensitively on resonance conditions. They are affected by wavepacket motion in any of the participating electronic states, resulting in complex amplitude modulation of the stimulated Raman spectra. Wavepackets in S(1) can be marked, and thus isolated, by stimulated-emission pumping with the picosecond Raman pulses. Excited-state absorption spectra are obtained from a quantitative comparison of broadband transient fluorescence and absorption. In this way, the resonance conditions for FSRS are determined. Early differences of the emission spectrum depend on excess vibrational energy, and solvation is seen as dynamic Stokes shift of the emission band. The nπ* state is evidenced only through changes of emission oscillator strength during solvation. S(1) quenching by adenine is seen with all methods in terms of dynamics, not by spectral intermediates.

Femtosecond pump/supercontinuum-probe spectroscopy: optimized setup and signal analysis for single-shot spectral referencing

A setup for pump/supercontinuum-probe spectroscopy is described which (i) is optimized to cancel fluctuations of the probe light by single-shot referencing, and (ii) extends the probe range into the near-uv (1000-270 nm). Reflective optics allow 50 μm spot size in the sample and upon entry into two separate spectrographs. The correlation γ(same) between sample and reference readings of probe light level at every pixel exceeds 0.99, compared to γ(consec)<0.92 reported for consecutive referencing. Statistical analysis provides the confidence interval of the induced optical density, ΔOD. For demonstration we first examine a dye (Hoechst 33258) bound in the minor groove of double-stranded DNA. A weak 1.1 ps spectral oscillation in the fluorescence region, assigned to DNA breathing, is shown to be significant. A second example concerns the weak vibrational structure around t=0 which reflects stimulated Raman processes. With 1% fluctuations of probe power, baseline noise for a transient absorption spectrum becomes 25 μOD rms in 1 s at 1 kHz, allowing to record resonance Raman spectra of flavine adenine dinucleotide in the S(0) and S(1) state.

Induction of telomere shortening and replicative senescence by cryopreservation

Cryopreservation can alter cellular function under certain conditions. In this report, we demonstrate the induction of cellular senescence after cells have been cryopreserved using a standard protocol. A retinal pigment epithelial cell line frozen at a specific freezing rate and subsequently thawed showed severely impaired proliferation compared to cells that were not cryopreserved. The induction of senescence was suggested by senescent associated beta-galactosidase activity and diminished bromo-deoxyuridine incorporation. A remarkable increase of single-strand DNA breaks in terminal restriction fragment (TRF) were found in cryopreserved cells immediately after thawing. The rate of mean TRF length shortening was accelerated after cryopreservation. Given this evidence, we hypothesize that cryopreservation may cause telomere shortening and cellular senescence under certain freezing conditions.

Mutagenicity of diesel exhaust particles from two fossil and two plant oil fuels

Particulate matter of diesel engine exhaust from four different fuels was studied for content of polynuclear aromatic compounds and mutagenic effects. Two so-called biodiesel fuels, rapeseed oil methylesters (RME) and soybean oil methylesters (SME), were compared directly with two fossil diesel fuels with the normal (DF) and a low sulfur content (LS-DF). Diesel exhaust particles were sampled on filters from the diluted and cooled exhaust of a test engine at five different speeds and loads. Filters were weighed for total particulate matter, Soxhlet extracted with dichloromethane and the content of insoluble material determined. The soluble organic fraction was analysed for polynuclear aromatic compounds. Mutagenicity was determined using the Salmonella typhimurium/mammalian microsome assay with strains TA98 and TA100. Compared with DF, the exhaust particles of LS-DF, RME and SME contained less insoluble material, which consisted mainly of the carbon cores of diesel exhaust particles. The concentrations of individual polynuclear aromatic compounds varied widely among the different exhaust extracts, but total concentrations of the compounds were approximately double for DF and SME compared with LS-DF and RME. In TA98 significant increases in mutation rates were obtained for the soluble organic fractions of all fuels for engines running at full speed (load modes A and D), but for DF revertants were 2- to 10-fold more frequent as compared with LS-DF, RME and SME. Revertant frequencies for DF and partly for LS-DF were also elevated in TA100, while RME and SME gave no significant increase in mutations. The results indicate that diesel exhaust particles from RME, SME and LS-DF contain less black carbon and total polynuclear aromatic compounds and are significantly less mutagenic in comparison with DF. A high sulfur content of the fuel and high engine speeds (rated power) and loads are associated with an increase in mutagenicity of diesel exhaust particles.

[Comparison of WISC-R and Raven's Progressive Matrices tests in a clinical consultation population]

OBJECTIVES

What are the differences between measuring intelligence with the WISC-R or with the Progressive Matrices Tests?

METHODS

702 children were tested as outpatients of the Child and Adolescent Department of the Psychiatric University Hospital Erlangen-Nuremberg by means of the WISC-R and the Progressive Matrices Tests (CPM and SPM).

RESULTS

Highly significant differences in the mean were found. The mean IQ was 10 points higher on the CPM than on the WISC-R but 6 points lower than the WISC-R on the SPM. At 0.67 the correlations between WISC-R and the Matrices Tests were each in the middle high range. Differences between the tests were substantial and remain unchanged despite the recently newly normed SPM.

[Conditions facilitating social behavior disorder in children and adolescents in a clinic referred sample]

The patients referred to our center from 1989 to 6/1994 (n = 1076) were divided into three groups: "conduct disorder" (n = 235), "none psychiatric diagnosis" (n = 324) and "other psychiatric diagnosis" (n = 517). These groups were compared with regard to frequency, age, sex, the frequency of specific developmental disorders, the IQ, and the frequency of abnormal psychosocial circumstances. Additional the religiosity of the families and the televiewing of the children were investigated. Abnormal psychosocial circumstances and enlarged televiewing of the children were significantly associated with conduct disorders.

[Follow-up of psychiatric disorders and specific developmental delay disorders in special education students]

In a prospective longitudinal study 72 children who were attending a special school for children with learning disabilities in Erlangen were examined in 1990 and again in 1992/93. At the first examination the children's mean age was 7 years 1 month and at the second 8 years 10 months. The sample contained many more boys than girls. Reported here are the findings on the course of the psychiatric disorders and the specific developmental disorders of speech and language and motor function. There was a marked decrease in the prevalence of psychiatric disorders. Of the 17 children with a psychiatric disorder at follow-up, 13 (76%) also had a disorder at the start of the study and of the 23 with a psychiatric disorder at the start 13 (57%) still had a disorder at follow-up. Children with enuresis and those with disturbances of activity or attention had the best prognosis. The special school had a positive effect on conduct. The prevalence of specific developmental disorders also decreased over the two-year period. As expected, specific speech articulation disorders had the best prognosis. All other disorders had a poor prognosis. Increases in prevalence were mainly the result of different cutoff points for a given diagnosis at different ages. The high number of specific disorders of motor function at both time points is especially noteworthy.

[Intelligence and language performance of special education children at 7 and 9 years of age]

Prospective longitudinal data from children at a school for learning disabled were obtained. Intelligence and language scores were assessed at first grade and two years later. The results of two samples from Erlangen and München showed a high stability of the intelligence scores but less stability of the language scores. There were remarkable improvements in language comprehension. Expressive language had a constant lag compared with the test-standard of children of the same age; the articulation did improve as expected. The children from this special school still had problems with verbal short term memory.

AED (automatic external defibrillators) algorithms. The "shocking" truth

Automatic external defibrillators (AEDs) have proven to be successful tools against sudden cardiac death since the 1970s. They operate on a simple premise--using a device with a built-in algorithm in a computer chip to "read" a persons's electrocardiogram (ECG) and, if necessary, advise or deliver a shock to bring the person back to a normal rhythm. When first introduced, these devices used various methods of collecting ECG's and detecting ventricular fibrillation (v fib) and ventricular tachycardia (v tach), two treatable dysrhythmias.

Influence of the histologic and cytologic grade and the clinical and postsurgical stage on the rate of endometrial carcinoma detection by cervical cytology

The influence of postsurgical stage, histologic grade and cytologic grade of the tumor on the rate of detection of endometrial carcinoma by cervical smear was examined in a retrospective study. Cervical smears from 220 patients with endometrial carcinoma seen in the years between 1965 and 1981 were reevaluated for the presence of normal, suspicious or frankly malignant endometrial cells. The smears were positive in 33.2% of the patients, suspicious in 25.5% and negative in 40%. In three cases (1.4%), the smear was technically inadequate. Positive or suspicious smears indicated the presence of a higher grade as well as a higher stage of the lesion. In this material, the presence of normal endometrial cells as an indicator of endometrial disease, as emphasized in the literature, proved useless since normal endometrial cells without accompanying malignant cells were not seen in a single case. It appears that the reason for the lower rate of detection of low-grade endometrial carcinoma is the complete absence of any exfoliation in these lesions.

Examining EMT education: a shift in emphasis

This article examines several aspects of EMT education in the United States. It deemphasizes the instructor's total dependence on objectives and examination results and encourages EMT educators to begin looking at the actual instructional process itself. This concept is encouraged through attainment by individual training programs of AMA accreditation (EMT-Paramedic level only), development of a spirit of collegiality and of inquiry about the practice of teaching, and utilization of formalized primary training and continuing education courses on improving instruction technique.