Ketamine-induced prevention of SD-associated late infarct progression in experimental ischemia

Spreading depolarizations (SDs) occur frequently in patients with malignant hemispheric stroke. In animal-based experiments, SDs have been shown to cause secondary neuronal damage and infarct expansion during the initial period of infarct progression. In contrast, the influence of SDs during the delayed period is not well characterized yet. Here, we analyzed the impact of SDs in the delayed phase after cerebral ischemia and the potential protective effect of ketamine. Focal ischemia was induced by distal occlusion of the left middle cerebral artery in C57BL6/J mice. 24 h after occlusion, SDs were measured using electrocorticography and laser-speckle imaging in three different study groups: control group without SD induction, SD induction with potassium chloride, and SD induction with potassium chloride and ketamine administration. Infarct progression was evaluated by sequential MRI scans. 24 h after occlusion, we observed spontaneous SDs with a rate of 0.33 SDs/hour which increased during potassium chloride application (3.37 SDs/hour). The analysis of the neurovascular coupling revealed prolonged hypoemic and hyperemic responses in this group. Stroke volume increased even 24 h after stroke onset in the SD-group. Ketamine treatment caused a lesser pronounced hypoemic response and prevented infarct growth in the delayed phase after experimental ischemia. Induction of SDs with potassium chloride was significantly associated with stroke progression even 24 h after stroke onset. Therefore, SD might be a significant contributor to delayed stroke progression. Ketamine might be a possible drug to prevent SD-induced delayed stroke progression.

[Frequency and characteristics of interventions by community paramedics on people in need of care : Analysis of 2,410 deployment protocols for people aged 65+ years]

BACKGROUND

The aim of this study was to obtain a differentiated view of interventions delivered by community paramedics (Gemeindenotfallsanitäter, G‑NFS) in older people in need of care living in nursing homes and at home.

MATERIALS AND METHODS

A retrospective analysis of G‑NFS documentation from 2021 with a focus on patients aged ≥65 years was performed. Data were grouped into callouts to nursing homes or private homes. Interventions, urgency, transport, and further recommendations were analyzed descriptively.

RESULTS

Of 5,900 G-NFS protocols, 43.0% (n = 2,410) were related to elderly people (mean age 80.8 years, 49.7% female). A total of 20.6% of these callouts involved nursing home residents, 38.4% (n = 926) were homecare patients, and 41% (n = 988) of callouts were to persons who did not rely on care. No specific interventions except advice were given to 48.4% of nursing home residents, and to even 82.1% of those in homecare and 83.7% of those without care needs. About 60% of the G‑NFS interventions were classified as non-urgent. Transport was waived for 63.1% of nursing home residents, for 58.1% in homecare, and for 60.6% of persons without care needs. A visit to the emergency department was recommended to 29.4% of nursing home residents, 37.6% of homecare patients, and 33.6% of persons without need of care. Measures related to urine catheters were documented much more often in nursing homes (38.5%) than in patients in homecare (15.1%) or without need of care (9.3%).

CONCLUSION

Community paramedics perform primary care tasks and can contribute to a reduction in unnecessary transport. It should be discussed whether the emergency medical service is responsible for such interventions and how older people in need of care can be cared for according to their needs in the future.

Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study

BACKGROUND

Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT).

METHODS

Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system.

RESULTS

Both the SPPB total score improved significantly (p =  < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p =  < 0.001), walk ratio (p = 0.011), step length (p =  < 0.001), stride length (p =  < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible.

CONCLUSIONS

SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care.

TRIAL REGISTRATION

DRKS00026191.

Vibrotactile enhancement of musical engagement

Sound is sensed by the ear but can also be felt on the skin, by means of vibrotactile stimulation. Only little research has addressed perceptual implications of vibrotactile stimulation in the realm of music. Here, we studied which perceptual dimensions of music listening are affected by vibrotactile stimulation and whether the spatial segregation of vibrations improves vibrotactile stimulation. Forty-one listeners were presented with vibrotactile stimuli via a chair's surfaces (left and right arm rests, back rest, seat) in addition to music presented over headphones. Vibrations for each surface were derived from individual tracks of the music (multi condition) or conjointly by a mono-rendering, in addition to incongruent and headphones-only conditions. Listeners evaluated unknown music from popular genres according to valence, arousal, groove, the feeling of being part of a live performance, the feeling of being part of the music, and liking. Results indicated that the multi- and mono vibration conditions robustly enhanced the nature of the musical experience compared to listening via headphones alone. Vibrotactile enhancement was strong in the latent dimension of 'musical engagement', encompassing the sense of being a part of the music, arousal, and groove. These findings highlight the potential of vibrotactile cues for creating intensive musical experiences.

[Characteristics of older versus younger emergency patients : Analysis of over 356,000 visits from the AKTIN German emergency department data registry]

BACKGROUND

This nationwide study aims to analyze age-specific differences and characteristics of emergency patients with a special focus on older patients.

METHOD

In 2019, data were obtained from 11 emergency departments (EDs), all part of the German Emergency Department Data (AKTIN) registry. All patients 18 years and older visiting the EDs were included. In addition to demographic data, variables such as referral, type of transport, primary assessment, diagnoses, length of stay and type of transfer were recorded and compared by age group and specifically by younger (18-64 years) and older patients (65+ years).

RESULTS

Data from 356,354 patients (39.1% were aged 65+ years) were included. Compared to younger patients, older ED patients were more likely to be accompanied by emergency medical services (15.4 vs. 34.3%) and almost twice as often by an emergency physician (6.4 vs. 12.2%). The need for treatment increased with age; 47.1% of younger and 66.1% of older people were classified as yellow, orange or red. The proportion of patients with internal diseases was higher for patients 65+ years (22.5 vs. 38.8%). Older patients were more often hospitalized (27.5 vs. 60.3%) and were more frequently transferred to an intensive care unit (4.5 vs. 11.9%).

CONCLUSION

About 40% of adult emergency patients are 65+ years. They require more urgent treatment and are more often hospitalized than younger patients. In older patients, internal diseases were more common.

Modulating the difficulty of a visual oddball-like task and P3m amplitude

It is often necessary to modulate the difficulty of an experimental task without changing physical stimulus characteristics that are known to modulate event-related potentials. Here, we developed a new, oddball-like visual discrimination task with varying levels of difficulty despite using almost identical visual stimuli. Gabor patches of one orientation served as frequent standard stimuli with 75% probability. Gabor patches with a slightly different orientation served as infrequent target stimuli (25% probability). Analyzing the behavioral outcomes revealed a successful modulation of task difficulty, i.e. the hard condition revealed decreased d' values and longer reaction times for standard stimuli. In addition, we recorded MEG and computed event-related fields in response to the stimuli. In line with our expectation, the amplitude of the P3m was reduced in the hard condition. We localized the sources of the P3m with a focus on those that are modulated by changes in task difficulty. The sources of P3m modulation by difficulty were found primarily in the centro-parietal regions of both hemispheres. Additionally, we found significant differences in source activity between the easy and hard conditions in parts of the pre and post-central gyrus and inferior parietal lobe. Our findings are in line with previous research suggesting that the brain areas responsible for the conventional P3m generators also contribute to a modulation by task difficulty.

A universal tool for marine metazoan species identification: towards best practices in proteomic fingerprinting

Proteomic fingerprinting using MALDI-TOF mass spectrometry is a well-established tool for identifying microorganisms and has shown promising results for identification of animal species, particularly disease vectors and marine organisms. And thus can be a vital tool for biodiversity assessments in ecological studies. However, few studies have tested species identification across different orders and classes. In this study, we collected data from 1246 specimens and 198 species to test species identification in a diverse dataset. We also evaluated different specimen preparation and data processing approaches for machine learning and developed a workflow to optimize classification using random forest. Our results showed high success rates of over 90%, but we also found that the size of the reference library affects classification error. Additionally, we demonstrated the ability of the method to differentiate marine cryptic-species complexes and to distinguish sexes within species.

Multidimensional and Longitudinal Approaches in Talent Identification and Development in Racket Sports: A Systematic Review

BACKGROUND

Better methods to support talent identification and development processes may contribute to more effective and efficient athlete development programs in racket sports. Both researchers and practitioners recommend multidimensional and longitudinal approaches to better understand the nature of talent (development). However, the added value of these 'innovative' approaches has not yet been clarified for racket sports. This systematic review intends to gain further insight into the outcomes of multidimensional and longitudinal approaches for talent identification and development in racket sports and to provide directions for future talent research.

METHODS

Electronic searches were conducted in PubMed, Scopus, SPORTDiscus, and Web of Science (January 2000-August 2022). Search terms covered the areas of racket sports and talent in sports. Studies using multidimensional and/or longitudinal talent approaches were included and analyzed regarding the methodology, included performance characteristics (i.e., anthropometrical, physiological, technical, tactical, psychological), and study findings.

RESULTS

A total of thirty-two studies were included using multidimensional (n = 15), unidimensional longitudinal (n = 3) or multidimensional longitudinal designs (n = 14). Most research covered physiological characteristics (n = 28), while fewer articles investigated anthropometrics (n = 21) and technical characteristics (n = 16). Only limited research investigated psychological (n = 4) and tactical characteristics (n = 1). Almost all studies measured physiological characteristics in combination with other characteristics. There was moderate to strong evidence that physiological and technical characteristics have value for athlete development programs in racket sports. Positive but limited evidence was found for psychological and tactical characteristics. Anthropometrical assessments were generally used as controlling variables for maturation. Study designs varied, and many studies used unidimensional statistical models and analyses within multidimensional study designs and datasets.

CONCLUSIONS

This review provides an overview of talent research using multidimensional and/or longitudinal approaches within racket sports and gives guidance on what characteristics to include in decision-making and monitoring processes. However, it remains difficult to draw conclusions about the added values of these approaches due to their variety in methodology. Future talent research should include more consistent study designs and conduct multidimensional and longitudinal studies using multivariate statistical approaches that benefit from the data's multidimensionality.

Recruiting patients for falls prevention in the emergency department - worth the challenge

BACKGROUND

Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited.

OBJECTIVE

Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study.

METHODS

The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics.

RESULTS

Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed.

CONCLUSION

ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory.

TRIAL REGISTRATION

DRKS00025949.

Pre-migratory flights in migrant songbirds: the ecological and evolutionary importance of understudied exploratory movements

Across the animal kingdom, from honeybees to cranes to beavers, exploratory movements to exploit resources, scout prospective territories, or otherwise gain valuable experiences and information that promote fitness have been documented. For example, exploratory movements to investigate potential dispersal targets have been observed in roe deer, Northern cardinals, and tigers alike. However, despite how widespread these movements are, a cohesive definition of exploratory movements has been lacking. We first provide a clear definition of exploratory movements, and use one particular group-migratory songbirds-to catalogue exploratory movements across the annual cycle. The exceptional mobility of migratory songbirds results in exploratory movements not only at a local scale, but also on a regional scale, both in and out of the breeding season. We review the extent to which these movements are made within this group, paying particular attention to how such movements confer fitness benefits, as by securing high-quality territories, prospecting for extra-pair paternity, or even exploiting ephemeral resources. We then zoom in one step further to a particular exploratory movement that has been, to date, almost completely overlooked within this group: that of pre-migratory flights. These flights, which occur during the transitional period between the stationary breeding period and the onset of migration, occur at night and may not be made by all individuals in a population-reasons why these flights have been heretofore critically understudied. We provide the first definition for this behaviour, summarise the current knowledge of this cryptic movement, and hypothesise what evolutionary/ecological advantages conducting it may confer to the individuals that undertake it. As these flights provide experience to the individuals that undertake them, we expect that birds that make pre-migratory flights are better equipped to survive migration (direct fitness benefits) and, due to orientation/navigation abilities, may also reach preferred territories on breeding and wintering grounds faster (indirect fitness benefits). We hope to encourage ecologists to consider such hidden movements in their research concepts and to enhance the framework of movement ecology by this behaviour due to its presumed high biological importance to the annual cycle of birds.

Ukrainian and Russian in the lexicon of Ukrainian Suržyk: reduced variation and stabilisation in central Ukraine and on the Black Sea coast

The subject of this study is the so-called "Surzhyk", a mixed Ukrainian-Russian variety used by millions of people in Ukraine, sometimes alongside Ukrainian and, less commonly, alongside Russian. More specifically, the focus here is on the lexicon, addressing the following questions: (i) To what extent is the mixed speech lexicon influenced by Ukrainian or Russian? (ii) Does the distribution of Ukrainian or Russian lexemes reveal a reduction in variation, i.e. patterns of stabilisation? In other words, are there tendencies for one of the two competing, synonymous, or functionally equivalent Ukrainian or Russian lexemes to prevail over the other? Many Ukrainian linguists have stereotypically claimed for years that the distribution of Ukrainian and Russian elements in Surzhyk is unpredictable, spontaneous, if not chaotic. It is worth noting that these opinions are not based on comprehensive, systematic empirical evidence and largely ignore theoretical developments in the field of code-mixing. In contrast, by means of a quantitative analysis of an extensive corpus and a focus on intra-sentential code-mixing, this study demonstrates that the majority of recorded lexical Ukrainian-Russian competitions exhibit a clear fixation on one of the two expressions, resulting in a reduction in variation. In these instances, one of the two expressions prevails extensively across the entire region of Central Ukraine and the Black Sea Coast. Surzhyk is evidently evolving towards a "fused lect". A smaller portion of the examined instances reveals such stabilisation only in certain parts of the survey area, and another equally small portion exhibits widespread variability. In general, Ukrainian and Russian lexemes are roughly balanced in quantity.

Serine 937 phosphorylation enhances KCC2 activity and strengthens synaptic inhibition

The potassium chloride cotransporter KCC2 is crucial for Cl- extrusion from mature neurons and thus key to hyperpolarizing inhibition. Auditory brainstem circuits contain well-understood inhibitory projections and provide a potent model to study the regulation of synaptic inhibition. Two peculiarities of the auditory brainstem are (i) posttranslational activation of KCC2 during development and (ii) extremely negative reversal potentials in specific circuits. To investigate the role of the potent phospho-site serine 937 therein, we generated a KCC2 Thr934Ala/Ser937Asp double mutation, in which Ser937 is replaced by aspartate mimicking the phosphorylated state, and the neighbouring Thr934 arrested in the dephosphorylated state. This double mutant showed a twofold increased transport activity in HEK293 cells, raising the hypothesis that auditory brainstem neurons show lower [Cl-]i. and increased glycinergic inhibition. This was tested in a mouse model carrying the same KCC2 Thr934Ala/Ser937Asp mutation by the use of the CRISPR/Cas9 technology. Homozygous KCC2 Thr934Ala/Ser937Asp mice showed an earlier developmental onset of hyperpolarisation in the auditory brainstem. Mature neurons displayed stronger glycinergic inhibition due to hyperpolarized ECl-. These data demonstrate that phospho-regulation of KCC2 Ser937 is a potent way to interfere with the excitation-inhibition balance in neural circuits.

Can contralateral lymph-node metastases be ruled out in prostate cancer patients with only unilaterally positive prostate biopsy?

PURPOSE

Our study evaluated the diagnostic benefits of bilateral pelvic lymphadenectomy in prostate cancer patients with unilaterally positive prostate biopsy.

METHODS

Our retrospective analysis included clinical, surgical, and histopathological data of 440 prostate cancer patients treated with radical prostatectomy and bilateral sentinel-guided and risk-adapted complementary extended pelvic lymphadenectomy at our hospital between 2015 and 2022. We performed multiparametric logistic regression analysis to identify the most relevant predictive factors for detecting lymph-node metastasis in this group of patients.

RESULTS

Overall, 373 patients (85%) had histopathologically bilateral tumours and 45 (10%) pN1 status, of which 22 (49%) also had lymph-node metastasis contralateral to the side of the positive prostate biopsy. In two patients with confirmed unilateral disease in prostatectomy specimens, bilateral lymph-node metastases were observed. Eight pN1 patients would have been missed by unilateral pelvic lymphadenectomy, resulting in a false-negative rate of 18%, 82% sensitivity, and 98% accuracy. Clinical tumour category, International Society of Urological Pathology grade, and percentage of prostate biopsy cores that are positive, as well as number of dissected lymph nodes contralateral to positive prostate biopsy, were determined as the most relevant predictive factors for detecting lymph-node metastasis. Our analysis was limited by its retrospective nature as well as by the fact that 80% of the patients did not receive MRI-targeted biopsy.

CONCLUSION

Our study highlights the diagnostic value of bilateral pelvic lymphadenectomy and the need for careful planning in surgery for prostate cancer patients with unilaterally positive prostate biopsy.

Metagenome-assembled genomes reveal greatly expanded taxonomic and functional diversification of the abundant marine Roseobacter RCA cluster

BACKGROUND

The RCA (Roseobacter clade affiliated) cluster belongs to the family Roseobacteracea and represents a major Roseobacter lineage in temperate to polar oceans. Despite its prevalence and abundance, only a few genomes and one described species, Planktomarina temperata, exist. To gain more insights into our limited understanding of this cluster and its taxonomic and functional diversity and biogeography, we screened metagenomic datasets from the global oceans and reconstructed metagenome-assembled genomes (MAG) affiliated to this cluster.

RESULTS

The total of 82 MAGs, plus five genomes of isolates, reveal an unexpected diversity and novel insights into the genomic features, the functional diversity, and greatly refined biogeographic patterns of the RCA cluster. This cluster is subdivided into three genera: Planktomarina, Pseudoplanktomarina, and the most deeply branching Candidatus Paraplanktomarina. Six of the eight Planktomarina species have larger genome sizes (2.44-3.12 Mbp) and higher G + C contents (46.36-53.70%) than the four Pseudoplanktomarina species (2.26-2.72 Mbp, 42.22-43.72 G + C%). Cand. Paraplanktomarina is represented only by one species with a genome size of 2.40 Mbp and a G + C content of 45.85%. Three novel species of the genera Planktomarina and Pseudoplanktomarina are validly described according to the SeqCode nomenclature for prokaryotic genomes. Aerobic anoxygenic photosynthesis (AAP) is encoded in three Planktomarina species. Unexpectedly, proteorhodopsin (PR) is encoded in the other Planktomarina and all Pseudoplanktomarina species, suggesting that this light-driven proton pump is the most important mode of acquiring complementary energy of the RCA cluster. The Pseudoplanktomarina species exhibit differences in functional traits compared to Planktomarina species and adaptations to more resource-limited conditions. An assessment of the global biogeography of the different species greatly expands the range of occurrence and shows that the different species exhibit distinct biogeographic patterns. They partially reflect the genomic features of the species.

CONCLUSIONS

Our detailed MAG-based analyses shed new light on the diversification, environmental adaptation, and global biogeography of a major lineage of pelagic bacteria. The taxonomic delineation and validation by the SeqCode nomenclature of prominent genera and species of the RCA cluster may be a promising way for a refined taxonomic identification of major prokaryotic lineages and sublineages in marine and other prokaryotic communities assessed by metagenomics approaches. Video Abstract.

To see or not to see: the parallel processing of self-relevance and facial expressions

The self, like the concept of central "gravity", facilitates the processing of information that is directly relevant to the self. This phenomenon is known as the self-prioritization effect. However, it remains unclear whether the self-prioritization effect extends to the processing of emotional facial expressions. To fill this gap, we used a self-association paradigm to investigate the impact of self-relevance on the recognition of emotional facial expressions while controlling for confounding factors such as familiarity and overlearning. Using a large and diverse sample, we replicated the effect of self-relevance on face processing but found no evidence for a modulation of self-relevance on facial emotion recognition. We propose two potential theoretical explanations to account for these findings and emphasize that further research with different experimental designs and a multitasks measurement approach is needed to understand this mechanism fully. Overall, our study contributes to the literature on the parallel cognitive processing of self-relevance and facial emotion recognition, with implications for both social and cognitive psychology.

Vision-related quality of life in patients with childhood-onset craniopharyngioma

Quality of life (QoL) is a critical component of aftercare in survivors of childhood-onset craniopharyngioma (CP). Visual impairment adversely affects QoL after CP. This study assessed the frequency of visual impairment in patients with CP and its association with QoL. This study analyzed vision-related QoL in patients recruited 2000-2019 in the prospective cohort studies KRANIOPHARYNGEOM 2000/2007. Ophthalmologic examinations were performed at diagnosis, three, 12, and 36 months, respectively after the diagnosis. The QoL (PEDQOL) scores, were also evaluated at three, 12, and 36 months, respectively after the CP diagnosis. Multivariable logistic regression was used to analyze factors associated with visual impairment during follow-up. One-hundred twenty patients were included in this study. On ophthalmological examination, visual impairment was observed in the majority of the patients (n = 84, 70%) at CP diagnosis. After surgery, vision was restored in 27 patients (32%) with visual impairment at diagnosis. In the first (p = 0.017) and third (p = 0.011) year after diagnosis, parents of patients with visual impairment reported lower social functioning (family). Reduced autonomy was found three years after diagnosis in self- (p = 0.029) and parental (p = 0.048) assessments. Next to visual impairment at diagnosis, no additional risk factors for visual impairment during follow-up could be identified. Visual impairment has a clinically relevant impact on QoL after CP. The visual status at CP diagnosis determines the visual outcome during follow-up. Early detection of visual impairment, regular QoL assessments, and risk-appropriate aftercare are recommended.Clinical Trial Registration KRANIOPHARYNGEOM 2000 (Clinical trial registration number: NCT00258453) and KRANIOPHARYNGEOM 2007 (Clinical trial registration number: NCT01272622).

Comparing two relaxation procedures to ease fatigue in multiple sclerosis: a single-blind randomized controlled trial

BACKGROUND

Various relaxation procedures have been proposed to reduce fatigue in multiple sclerosis (MS). However, it is unknown, which type of relaxation has the largest effect on fatigue reduction and on autonomic nervous system (ANS) activity.

OBJECTIVE

We aimed to compare two biofeedback-supported relaxation exercises: a deep breathing (DB) exercise and progressive muscle relaxation (PMR), which may ameliorate MS fatigue and alter ANS activity.

METHODS

We performed a single-blind randomized clinical trial, introducing MS patients (n = 34) to the DB or PMR exercise. We first tested cardiovagal integrity, reflected by changes in heart rate variability (HRV) in response to DB. Participants then performed a fatigue-inducing vigilance task, followed by the DB or PMR. State fatigue was recorded consecutively at baseline, after the vigilance task, and after the relaxation exercise, along with HRV reflecting ANS activity.

RESULTS

Only patients assigned to the PMR group experienced a significant drop in fatigue, whereas both relaxation exercises changed ANS activity. MS patients showed the expected autonomic response during the cardiovagal reflex test. The vigilance task elevated short-term feelings of fatigue and significantly reduced HRV parameters of parasympathetic activity. Trait fatigue was negatively correlated with HRV during the second half of the vigilance task.

CONCLUSION

PMR alleviates short-term feelings of fatigue in persons with MS. The vigilance task in combination with HRV measurements may be helpful for evaluating relaxation procedures as a treatment of fatigue. Hereby, future studies should ensure longer and more frequent relaxation exercises and focus on patients with weak to moderate fatigue.

TRIAL REGISTRATION

Trial Registry: DRKS00024358.

A side-by-side comparison of the new VITEK MS PRIME and the MALDI Biotyper sirius in the clinical microbiology laboratory

PURPOSE

This study aims to evaluate the performance of two latest generation matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems in routine laboratory settings, focusing on turnaround time (TAT), time to results (TTR), hands-on time, and identification rate.

METHODS

We conducted a time and motion study on three workflow scenarios to simulate different laboratory settings. Overall, 618 bacterial isolates from a tertiary hospital's laboratory were processed using the VITEK MS PRIME (bioMérieux) and the MALDI Biotyper sirius (Bruker Daltonics) and their corresponding databases VITEK IVD Database 3.2 and MBT reference library 12.

RESULTS

The target preparation process showed no significant difference in TAT, but the Biotyper workflow had a shorter hands-on time by 3 to 6 min. In the measurement process, TTR was three to five times shorter for the Biotyper sirius while hands-on time was significantly shorter for VITEK MS PRIME (approximately 1.5 min per target). The identification rate without retesting was 97.9% for VITEK MS PRIME and 98.9% for Biotyper sirius. Both systems achieved 100% agreement at genus and 96.2% at species level.

CONCLUSION

Both systems exhibited excellent identification rates for routine bacterial isolates. Due to its high speed, the Biotyper sirius is suited for laboratories with high sample throughput and a workflow designed for processing larger batches. The VITEK MS PRIME, with its "load and go" system accommodating up to 16 targets, reduces hands-on time, making it a reasonable choice for laboratories with fewer identifications overall but a higher number of targets and a workflow designed for parallel processing on different workstations.

[Emergency department visits by nursing home residents: analysis of routine data from an urban hospital]

BACKGROUND

The number of emergency department (ED) visits in Germany continues to increase, especially by older people and persons receiving care.

OBJECTIVES

We aimed to characterize ED visits by nursing home residents (NHR) in Germany.

MATERIALS AND METHODS

We analyzed routine data of a hospital without trauma surgery (Pius-Hospital Oldenburg). All ED visits by NHR in the period 06/2014-05/2017 were selected from the hospital information system.

RESULTS

Of 47,270 ED visits, 1676 (3.6%) were NHR (mean age: 78.8 years; 62.9% women; 40.3% were referred). Of them, 20.1% were on weekends and 80.6% occurred between 8 am-8 pm. A total of 84.2% visits led to hospitalization; the length of stay was 1 day for 21.1% and 2-3 days for another 14.6%. With longer length of stay, the proportion of admissions by referring physicians increased. Of those admitted, 10.3% died during hospitalization (28.2% on the day of admission; 47.9% within the first 3 days). People who died were older, their visits were more frequently on weekends, and they were less often referred.

CONCLUSION

Our study reveals problems in several areas. Improved interprofessional cooperation with general practitioners and strengthened palliative structures should be implemented in nursing homes. Furthermore, there is a need for establishing processes in EDs to realize continued outpatient care for these patients.

Morality in middle childhood: the role of callous-unemotional traits and emotion regulation skills

BACKGROUND

The development of morality is vital for fostering prosocial behavior and enhancing both individual and societal well-being. Clarifying what contextual and individual factors play a role in moral processes during childhood can contribute to our understanding of the development of morality. Given the previous acknowledgment of importance, yet lack of existing empirical findings, the study focused on the significance of callous-unemotional traits (i.e., an affective-interpersonal personality trait, related to psychopathy in adulthood) and emotion regulation (i.e., an essential part of socio-emotional competence, and a transdiagnostic factor in the development of psychopathology) for moral emotions and cognitions during middle childhood. The concrete aim was to examine direct and indirect effects of callous-unemotional trait dimensions (callousness, uncaring, unemotionality) onto immoral emotional attribution (i.e., feeling good after immoral decisions) and admissibility of immoral actions (i.e., evaluating immoral actions as being okay) via emotion regulation skills.

METHODS

A cross-sectional study was conducted with 194 children attending Grades 1 to 4, and their primary caregivers. The children completed the Inventory of Callous-Unemotional Traits and caregivers completed the Emotion Regulation Checklist. The children were also presented with a set of moral dilemma vignettes, and asked about the emotions of protagonists who acted immoral, and the admissibility of their actions.

RESULTS

Path-model analysis revealed (1) negative direct effects of emotion regulation skills onto immoral emotional attribution and admissibility of immoral actions, (2) positive direct effects of the dimensions callousness and uncaring onto immoral emotional attribution and admissibility of immoral actions, and (3) negative direct effects of dimensions callousness and uncaring onto emotion regulation skills. Indirect effects, indicating that emotion regulation skills mediate the association between the callous-unemotional trait dimensions and morality, were also found.

CONCLUSION

The findings address a knowledge gap and indicate that emotion regulation skills, callousness, and uncaring play an important role in morality in middle childhood and should be included in frameworks of moral decision-making and development.

A complex intervention on vaccination uptake among older adults (≥ 60 years) in Germany - a study protocol with a mixed methods design

BACKGROUND

The current uptake of many vaccinations recommended for persons aged 60 and older is unsatisfactory in Germany. Lack of confidence in the safety and efficacy of vaccinations, lack of knowledge and insecurities about possible side effects, and numerous pragmatic barriers are just some of the reasons to be mentioned. General practitioners (GPs) play a central role in the vaccination process. Therefore, effective interventions in this context are needed to address the various barriers and improve the vaccination uptake rates.

METHODS

A complex intervention will be implemented and evaluated in 1057 GPs' practices in two German federal states. The components include trainings for GPs and medical assistants on communication psychology, medical aspects, and organisational vaccination processes. The primary outcome influenza vaccination rate and the secondary outcomes vaccination uptake rate of other vaccinations as well as vaccine literacy of patients will be examined. The intervention will be evaluated in a mixed methods study with a controlled design. Survey data will be analysed descriptively and by using mean comparisons as well as multivariable multilevel analyses. The qualitative data will be analysed with qualitative content analysis. The secondary data will be analysed by using descriptive statistics, a pre-post comparison by performing mean comparisons, cluster analysis, and subgroup analyses.

DISCUSSION

In this study, a complex intervention to improve vaccination rates in GP practices for the vaccinations recommended for people aged 60 years and older will be implemented and evaluated. Additionally, improvements in patients' vaccine-related health literacy and knowledge, and patients' intention to get vaccinated are expected. The mixed methods design can deliver results that can be used to improve preventive health care for elderly people and to gain more knowledge on vaccination uptake and the intervention's effectiveness.

TRIAL REGISTRATION

Trial registration number: DRKS00027252 (retrospectively registered).

A systematic review of social classroom climate in online and technology-enhanced learning environments in primary and secondary school

Although the significance of a positive social classroom climate in face-to-face learning has been established, its role within online and technology-enhanced learning environments is unclear. The central aim of this systematic review was to synthesize the findings of empirical studies which have examined any aspect of the social classroom climate in online and technology-enhanced learning environments in primary and secondary schools. Appropriate search terms were entered into ACM Digital Library, Web of Science, Scopus, and ERIC in November 2021. Articles were included if they were relevant for the aim, reported primary data, sampled primary/secondary school students and/or teachers, and were published in journals, conference proceedings, or book chapters in English. Furthermore, articles were excluded if they focused on the development/testing of measurement tools. The thematic narrative synthesis includes 29 articles, comprising of qualitative, quantitative, and mixed-method studies. A quality assessment checklist was completed for all. The findings encompass examinations of the social classroom climate in online learning before and during the Covid-19 pandemic, in blended learning environments and a comparison between them. Furthermore, associations between the online social classroom climate and academic variables is explored, as is the fostering thereof through synchronous/asynchronous discussion groups and social media. We discuss the theoretical framing of the studies, the impact of a positive classroom climate in online and technology-enhanced learning environments on students, as well as practical approaches and new opportunities in leveraging technologies. Based on the findings and the studies' limitations we outline implications and future research, such as the need to consider students' voices and diversity, technology perspectives, a transdiciplinary approach and the reconceptualization of boundaries.

Stability and cross-lagged relations among callous-unemotional traits, moral identity, moral emotion attribution and externalizing behavior problems in adolescents

This study investigates the associations of adolescents callous-unemotional traits with moral constructs and the interplay of various outcomes. The present study builds on the lack of research and focuses on the longitudinal relationships between CU-traits, moral identity, moral emotion attribution and externalizing behavior problems in adolescence. The included variables were collected at test time points T1 and T2. To determine the predictive, and stability links among the variables, a cross-lagged model in SPSS AMOS 26 was conducted. Time stability path estimates were moderate to highly stable over time for all included variables. Significant cross lagged paths of moral identityT1 on moral emotion attributionT2, CU-traitsT1 on moral identityT2, externalizing behavior problemsT1 on moral emotion attributionsT2 and externalizing behavior problemsT1 on CU-traitsT2, could be found.

Dysfunction of the hypothalamic-pituitary adrenal axis and its influence on aging: the role of the hypothalamus

As part of the hypothalamic-pituitary adrenal (HPA) axis, the hypothalamus exerts pivotal influence on metabolic and endocrine homeostasis. With age, these processes are subject to considerable change, resulting in increased prevalence of physical disability and cardiac disorders. Yet, research on the aging human hypothalamus is lacking. To assess detailed hypothalamic microstructure in middle adulthood, 39 healthy participants (35-65 years) underwent comprehensive structural magnetic resonance imaging. In addition, we studied HPA axis dysfunction proxied by hair cortisol and waist circumference as potential risk factors for hypothalamic alterations. We provide first evidence of regionally different hypothalamic microstructure, with age effects in its anterior-superior subunit, a critical area for HPA axis regulation. Further, we report that waist circumference was related to increased free water and decreased iron content in this region. In age, hair cortisol was additionally associated with free water content, such that older participants with higher cortisol levels were more vulnerable to free water content increase than younger participants. Overall, our results suggest no general age-related decline in hypothalamic microstructure. Instead, older individuals could be more susceptible to risk factors of hypothalamic decline especially in the anterior-superior subregion, including HPA axis dysfunction, indicating the importance of endocrine and stress management in age.

Effectiveness and therapeutic validity of physiotherapeutic exercise starting within one year following total and unicompartmental knee arthroplasty for osteoarthritis: a systematic review

BACKGROUND

To determine the effectiveness and therapeutic validity of physiotherapeutic exercise after total and unicompartmental knee arthroplasty for osteoarthritis. It was hypothesized that interventions of high therapeutic validity result in superior functional recovery after total and unicompartmental knee arthroplasty versus interventions of low therapeutic validity.

METHODS

A systematic review incorporating a comprehensive database search of five major databases relevant to the topic was conducted. Randomized controlled trials were reviewed if they included studies that compared postoperative physiotherapeutic exercise with usual care or compared two types of postoperative physiotherapeutic interventions. All included studies were assessed for risk of bias (using the Cochrane Collaboration's tool) and therapeutic validity (using the Consensus on Therapeutic Exercise Training scale). The characteristics of the included articles and their results on joint and muscle function, functional performance, and participation were extracted.

RESULTS

Of the 4343 unique records retrieved, 37 articles were included. Six of them showed good therapeutic validity, suggesting low therapeutic validity in 31 studies. Three articles showed a low risk of bias, 15 studies scored some concerns for risk of bias and 19 studies scored high risk of bias. Only one article scored well on both methodological quality and therapeutic validity.

CONCLUSION

Due to heterogeneity of outcome measures and length of follow-up, as well as limited reporting of details of the physiotherapeutic exercises and control interventions, no clear evidence was found on effectiveness of physiotherapeutic exercises after total and unicompartmental knee arthroplasty. Homogeneity in intervention characteristics and outcome measures would enhance comparability of clinical outcomes between trials. Future studies should incorporate similar methodological approaches and outcome measures. Researchers are encouraged to use the Consensus on Therapeutic Exercise Training scale as a template to prevent insufficient reporting.

Photodegradation of a bacterial pigment and resulting hydrogen peroxide release enable coral settlement

The global degradation of coral reefs is steadily increasing with ongoing climate change. Yet coral larvae settlement, a key mechanism of coral population rejuvenation and recovery, is largely understudied. Here, we show how the lipophilic, settlement-inducing bacterial pigment cycloprodigiosin (CYPRO) is actively harvested and subsequently enriched along the ectoderm of larvae of the scleractinian coral Leptastrea purpura. A light-dependent reaction transforms the CYPRO molecules through photolytic decomposition and provides a constant supply of hydrogen peroxide (H₂O₂), leading to attachment on the substrate and metamorphosis into a coral recruit. Micromolar concentrations of H₂O₂ in seawater also resulted in rapid metamorphosis, but without prior larval attachment. We propose that the morphogen CYPRO is responsible for initiating attachment while simultaneously acting as a molecular generator for the comprehensive metamorphosis of pelagic larvae. Ultimately, our approach opens a novel mechanistic dimension to the study of chemical signaling in coral settlement and provides unprecedented insights into the role of infochemicals in cross-kingdom interactions.

Light and prey influence the abundances of two rhodopsins in the dinoflagellate Oxyrrhis marina

Antisera were raised against the C-terminal amino acid sequences of the two rhodopsins ADY17806 and AEA49880 of Oxyrrhis marina. The antisera and affinity-purified antibodies thereof were used in western immunoblotting experiments of total cell protein fractions from cultures grown either in darkness or in white, red, green, or blue light. Furthermore, the rhodopsin abundances were profiled in cultures fed with yeast or the prasinophyte Pyramimonas grossii. The immunosignals of ADY17806 and AEA49880 were similar when O. marina was grown in white, green, or blue light. Signal intensities were lower under conditions of red light and lowest in darkness. Higher amounts were registered for both rhodopsins when O. marina was fed with yeast compared to P. grossii. Furthermore, total cell protein of cultures of O. marina grown under all cultivation conditions was separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis, followed by tryptic in-gel digestion and mass spectrometric analysis of the 25-kDa protein bands. The rhodopsin ADY17809 was detected in all samples of the light quality experiments and in 14 of the 16 samples of the prey quality experiments. The rhodopsin ABV22427 was not detected in one sample of the light quality experiments. It was detected in 15 of the 16 samples of the prey quality experiments. Peptide fragments of the other rhodopsins were detected less often, and no clear distribution pattern was evident with respect to the applied light quality or offered prey, indicating that none of them was exclusively formed under a distinct light regime or when feeding on yeast or the prasinophyte. Fluorescence light microscopy using the affinity-purified antibodies revealed significant labeling of the cell periphery and cell internal structures, which resembled vacuoles, tiny vesicles, and rather compact structures. Immunolabeling electron microscopy strengthened these results and showed that the cytoplasmic membrane, putative lysosome membranes, membranes encircling the food vacuole, and birefringent bodies became labeled.

["Sending a signal of solidarity via bluetooth?"-A medical ethical analysis of the public debate on the Corona-Warn-App]

Definition of the problem

In the public debate in Germany on the Corona-Warn-App, the concept of solidarity is a prominent, but contested normative reference point. Thus, different uses of the concept with heterogeneous assumptions, normative implications and practical consequences stand next to each other and require medical ethical investigation. Against this backdrop, this contribution aims firstly to illustrate the spectrum of understandings of the concept of solidarity in the public debate on the Corona-Warn-App. Secondly, it elaborates the preconditions and normative implications of these uses and evaluates them from an ethical perspective.

Arguments

Starting with an introduction of the Corona-Warn-App and a general definition of the concept of solidarity, I present four examples for different uses of the concept of solidarity from the public discourse on the Corona-Warn-App that vary regarding the underlying identification, the group of solidarity, the solidarity contribution and the normative goal. They highlight the need for further ethical standards in order to assess their legitimacy. Hence, I use four normative criteria of a context-sensitive, morally substantial conception of solidarity (openness, malleable inclusivity, adequacy of the contribution, normative dependence) to ethically evaluate the solidarity recourses presented.

Conclusion

Critical remarks can be formulated for all presented notions of solidarity. On the one hand, the potentials and limitations of solidarity recourses in public debates become apparent. On the other, criteria can be derived for a solidarity-promoting use of the Corona-Warn-App.

[Between trivialization and pathologization: Healthcare in old age and the temporal structure of a good life]

Definition of problem

Modern medicine is challenging traditional views of age(ing). What was long considered a "normal" sign of old age is now often perceived and treated as a disease. As a result, age-related health standards and treatment goals are shifting. The resulting scope between trivialization and pathologization of age(ing) requires ethical reflection.

Argument

This article explores the question of how notions of age(ing) are to be understood ethically in the context of medicine. We first provide an overview of the state of research on the role of age stereotypes in the healthcare of older people. The notions of age(ing) identified in this context are then analyzed from the perspective of teleological ethics.

Conclusions

What kinds of healthcare are reasonable and appropriate in old age has to be discussed in the context of the temporal structure of a good life.

Strengthening agroecological resilience through commons-based seed governance in the Philippines

The Filipino agricultural sector is exposed to multiple climatic, economic, and social risks that will likely intensify in the near future. Building agroecological resilience has been proposed to protect small-scale farmers' livelihoods and improve food security in the context of (unexpected) shocks and disruptions, and slow system changes such as climate change. This paper argues that commons-based seed production, based on collective management and ownership of seeds and varieties, can play a central role in building resilience capacities in smallholder communities. I explore this by applying an indicator-based framework to assess the contribution of the Filipino farmer network Magsasaka at Siyentipiko para sa Pag-unlad ng Agrikultura (MASIPAG) to agroecological resilience. I find that the networks' commons-based seed governance builds agroecological resilience in various ways. By equipping small-scale farmers with the tools to regain control over seed production and breeding, they become stewards of an actively evolving collection of varieties. The in situ maintenance and development of traditional, open-pollinated varieties and a network of diversified trial and backup farms build up buffering capacities and foster agrobiodiversity and local adaptation. A focus on regionally available natural resources reduces vulnerabilities to external factors. Adaptive capacities are strengthened through a high degree of flexibility and responsiveness achieved by self-organization and polycentric organizational structures. Broad participation, shared learning and spaces for experimentation support the development of farmers' capacities to respond to diverse challenges. Commons-based approaches to seed governance can thus strengthen agroecological resilience and long-term food security in smallholder agricultural systems.

[Flame figures-eosinophils setting the skin on fire]

A 50-year-old female farmer was initially diagnosed with generalized granuloma annulare and treated with local steroids and ultraviolet (UV) light therapy for 10 years, albeit without success. A histopathological examination in our clinic changed the diagnosis to Wells' syndrome, based on the typical findings of eosinophilic cellulitis together with flame figures. A systemic approach with pulse steroid therapy resulted in complete remission of pruritus and skin manifestations. This case demonstrates successful treatment of a patient with eosinophilic cellulitis.

From LTL to rLTL monitoring: improved monitorability through robust semantics

Runtime monitoring is commonly used to detect the violation of desired properties in safety critical cyber-physical systems by observing its executions. Bauer et al. introduced an influential framework for monitoring Linear Temporal Logic (LTL) properties based on a three-valued semantics for a finite execution: the formula is already satisfied by the given execution, it is already violated, or it is still undetermined, i.e., it can still be satisfied and violated by appropriate extensions of the given execution. However, a wide range of formulas are not monitorable under this approach, meaning that there are executions for which satisfaction and violation will always remain undetermined no matter how it is extended. In particular, Bauer et al. report that 44% of the formulas they consider in their experiments fall into this category. Recently, a robust semantics for LTL was introduced to capture different degrees by which a property can be violated. In this paper we introduce a robust semantics for finite strings and show its potential in monitoring: every formula considered by Bauer et al. is monitorable under our approach. Furthermore, we discuss which properties that come naturally in LTL monitoring-such as the realizability of all truth values-can be transferred to the robust setting. We show that LTL formulas with robust semantics can be monitored by deterministic automata, and provide tight bounds on the size of the constructed automaton. Lastly, we report on a prototype implementation and compare it to the LTL monitor of Bauer et al. on a sample of examples.

The linguistic situation on the Ukrainian Black Sea coast - Ukrainian, Russian and Suržyk as "native language", "primary code", frequently used codes and codes of linguistic socialization during childhood

The study analyses the linguistic situation in the three Ukrainian oblasts on the Black Sea coast using survey data collected from 1,200 respondents before the Russian attack on Ukraine. At the end of the 18th century, this region was the core of a "new Russian" governate during Tsarist times. Previously, the region had been ruled by Tatars and there were neither Russian nor Ukrainian settlements. From the 19th century onwards, the Ukrainian and Russian population dominated. Since the annexation of the Crimea, these oblasts represent a crucial part of the Kremlin's plan to establish an "expanded New Russia (Novorossiya)" under Moscow's control - extending along the Ukrainian-Russian border and the northern Black Sea coast, reaching from Xarkiv to Odesa. This area is clearly at the forefront of Russia's current war goals since controlling it would allow them to establish the strategically important land bridge to Crimea. Linguistically, the area undoubtedly belongs to those regions of Ukraine where Russian was prominent, although apart from the Crimea at no time was there an ethnic Russian majority on the Black Sea coast - neither during Soviet times nor since Ukraine's independence. This means that the population with Ukrainian "nationality" also made strong use of Russian. This situation is being instrumentalized by Moscow as an argument for its military intervention to protect the Russian or Russian-speaking population. The study firstly describes the linguistic situation in the region, differentiating between the so-called mother tongue, the first language acquired and the principally-used language. It can be shown that the traditionally assumed dominance of Russian is actually far weaker when the population's "multicodality", including the mixed variety Suržyk, is included in the analysis. A differentiation is made between respondents with Ukrainian and Russian nationality throughout the analysis. Using statistical procedures such as principal component analysis and cluster analysis, the interdependencies between stated mother tongue, first language and multicodality are presented. Different motives for claiming a certain mother tongue can be identified among subgroups of respondents. The analysis focuses particularly on the questions of the extent to which central government measures to strengthen the position of Ukrainian since Ukraine's independence have changed respondents' preferences when choosing a code, and whether respondents have perceived social pressure for any form of shift. On the whole, it can be established that speakers with Ukrainian nationality who were primarily socialized in Russian have considerably increased their usage of Ukrainian, but without abandoning Russian. At best, this can also be established to a minimal extent for respondents with Russian nationality. Furthermore, since there is only extremely scant evidence that respondents encounter disapproval or censure from their environment for their choice of code (be it Russian, Suržyk or Ukrainian), Moscow's claim of persecution, if not genocide of the Russian-speaking population is exposed as a blatant lie.

Death in Advance? A critique of the "Zombification" of people with dementia

This contribution sets out to criticize the prominent metaphor of "death while alive" in the context of dementia. We first explain the historical origin and development as well as the philosophical premises of the image. We then take a closer look at its implications for understanding dementia and societal attitudes and behaviours towards those affected. In doing so, we adopt a life course perspective that seeks to account for the ethical significance of the temporal extension and structure of human life. According to this perspective, individual existence in time is characterized by normative standards of age-appropriate behavior, evaluative standards of a good life, and teleological notions of successful development which require theoretical analysis and ethical discussion. Such a perspective can contribute significantly to spelling out the implications of the metaphor of death while alive and to criticizing their problematic aspects. Indeed, it makes clear that this metaphor aligns dementia with a different point in the human life course, thus ultimately framing it as a kind of deviation from the biographical norm, a disruption in an assumed temporal order of existence. At the same time, the life course perspective can help to understand why this conception involves ethically problematic distortions and blind spots. The resulting considerations allow conclusions with regard to medical and care ethical debates about self-determination, surrogate decision making, and advance directives in the context of dementia. Furthermore, on a theoretical-conceptual level, they also illustrate the importance of a biography- and culture-sensitive approach to philosophical and ethical reasoning in biomedicine and the life sciences.

Gender and Age Stereotypes in Robotics for Eldercare: Ethical Implications of Stakeholder Perspectives from Technology Development, Industry, and Nursing

Social categorizations regarding gender or age have proven to be relevant in human-robot interaction. Their stereotypical application in the development and implementation of robotics in eldercare is even discussed as a strategy to enhance the acceptance, well-being, and quality of life of older people. This raises serious ethical concerns, e.g., regarding autonomy of and discrimination against users. In this paper, we examine how relevant professional stakeholders perceive and evaluate the use of social categorizations and stereotypes regarding gender and age in robotics for eldercare. Based on 16 semi-structured interviews with representatives from technology development, industry, and nursing science as well as practice, we explore the subjects' awareness, evaluations, and lines of argument regarding the corresponding moral challenges. Six different approaches of dealing with categorizations and stereotypes regarding gender and age in care robotics for older people are identified: negation, functionalistic relativization, explanation, neutralization, stereotyping, and queering. We discuss the ethical implications of these approaches with regard to professional responsibility and draw conclusions for responsible age tech in pluralistic societies.

Rhodopsins build up the birefringent bodies of the dinoflagellate Oxyrrhis marina

The ultrastructure of the birefringent bodies of the dinoflagellate Oxyrrhis marina was investigated by transmission electron microscopy. Ultrathin sectioning revealed that the bodies consist of highly ordered and densely packed lamellae, which show a regular striation along their longitudinal axis. A lattice distance of 6.1 nm was measured for the densely packed lamellae by FFT (Fast Fourier Transformation) analysis. In addition, a rather faint and oblique running striation was registered. Lamellae sectioned rather oblique or almost close to the surface show a honeycombed structure with a periodicity of 7.2-7.8 nm. Freeze-fracture transmission electron microscopy revealed that the lamellae are composed of highly ordered, crystalline arrays of particles. Here, FFT analysis resulted in lattice distances of 7.0-7.6 nm. Freeze-fracture transmission electron microscopy further revealed that the bodies remained intact after cell rupture followed by ascending flotation of the membrane fractions on discontinuous sucrose gradients. The birefringent bodies most likely are formed by evaginations of membranes, which separate the cytoplasm from the food vacuoles. Distinct, slightly reddish-colored areas, which resembled the birefringent bodies with respect to size and morphology, were registered by bright field light microscopy within Oxyrrhis marina cells. An absorbance maximum at 540 nm was registered for these areas, indicating that they are composed of rhodopsins. This was finally proven by immuno-transmission electron microscopy, as antisera directed against the C-terminal amino acid sequences of the rhodopsins AEA49880 and ADY17806 intensely immunolabeled the birefringent bodies of Oxyrrhis marina.

Effects of intensive physiotherapy on Quality of Life (QoL) after pancreatic cancer resection: a randomized controlled trial

BACKGROUND

Patients have significantly lower QoL scores after pancreatic resection due to cancer in the physical and psychological domains compared to healthy controls or other cancer patients. Intensified physiotherapy or physical training can increase QoL by reducing fatigue levels and improving physical functioning. However, data on the long-term effects of intensive or supervised physiotherapy is lacking. The aim of this exploratory study is the assessment of QoL in the intervention group, using various QoL questionnaires in their validated German translations and gather data on its feasibility in the context of chemotherapy with a follow-up of 12 months (and develop concepts to improve QoL after pancreatic cancer resection).

METHODS

Fifty-six patients (mean age: 66.4 ± 9.9 years) were randomized in this study to intervention (cohort A, n = 28) or control group (cohort B, n = 28). Intervention of intensified physiotherapy program consisted of endurance and muscle force exercises using cycle ergometer. In the control group physiotherapy was limited to the duration of the hospital stay and was scheduled for 20 min on 5 days per week. The clinical visits took place 2 days preoperatively, 1 week, 3 months, 6 months and 12 months postoperatively. Both groups attended the follow-up program. QoL was evaluated using the Short Physical Performance Battery (SPPB), Short Form-8 Health Survey (SF-8) and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and pancreatic cancer-specific module QLQ-PAN26 questionnaires. The course of QoL was evaluated using a repeated measures ANOVA and a per protocol design.

RESULTS

Of the initial 56 randomized patients, 34 finished the 12 months follow-up period. There were no adverse events due to the intervention and 80% of patients in the intervention group where adherent. There was no significant influence on physical performance as measured by SPPB and SF-8 questionnaire. However, after 6 months patients in the intervention group regained their prior physical condition, whereas the control group did not. Intensive physiotherapy significantly influenced various factors of QoL measured with the C30 questionnaire positively, such as physical functioning (p = 0.018), role functioning (p = 0.036), and appetite loss (p = 0.037), even after 6 months. No negative effects in patients undergoing chemotherapy compared to those without chemotherapy was observed.

CONCLUSION

This first randomized controlled study with a 12-month follow-up shows that supervised physiotherapy or prescribed home-based exercise after pancreatic cancer resection is safe and feasible and should be proposed and started as soon as possible to improve certain aspects of QoL.

TRIAL REGISTRATION

German Clinical Trials Register (No: DRKS00006786 ); Date of registration: 01/10/2014.

Feminist approach to geriatric care: comprehensive geriatric assessment, diversity and intersectionality

Despite being a collection of holistic assessment tools, the comprehensive geriatric assessment primarily focuses on the social category of age during the assessment and disregards for example gender. This article critically reviews the standardized testing process of the comprehensive geriatric assessment in regard to diversity-sensitivity. I show that the focus on age as social category during the assessment process might potentially hinder positive outcomes for people with diverse backgrounds of older patients in relation to other social categories, such as race, gender or socio-economic background and their influence on the health of the patient as well as the assessment and its outcomes. I suggest that the feminist perspective of intersectionality with its multicategorical approach can enhance the diversity-sensitivity of the comprehensive geriatric assessment, and thus improve the treatment of older patients and their quality of life. By suggesting an intersectional-based approach, this article contributes to debates about justice and diversity in medical philosophy and advocates for the normative value of diversity in geriatric medicine.

Predictive Value of Technical Throwing Skills on Nomination Status in Youth and Long-Term Career Attainment in Handball

BACKGROUND

Research on talent in sports aims to identify predictors of future performance. This study retrospectively investigated 1) relationships between young handball field players' technical throwing skills and (a) their potential nomination to youth national teams and (b) their long-term career attainment 10 years later, and 2) associations between nomination status and career attainment.

RESULTS

Results from retrospectively predicting nomination status and career attainment using logistic regression analyses show that technical throwing skills were partly able to explain players' nomination status (Nagelkerke R2: females 9.2%, males 13.1%) and career attainment (Nagelkerke R2: 9.8% for female players). Here, variables throwing velocity and time on exercise showed statistically significant effects. In addition, nomination status and career attainment were shown to be associated using chi-square tests (w of .37 and .23 for female and male players, respectively) and nomination status as a predictor increased the prediction of career attainment remarkably (Nagelkerke R2: females 20.3%, males 12.7%).

CONCLUSIONS

Given these results, basic technical throwing skills may serve rather as a prerequisite in this age group on national level, emphasizing its importance already on lower levels and in younger age groups. Furthermore, advantages from entering the national TID system early especially for females are discussed.

What shapes cognitions of climate change in Europe? Ideology, morality, and the role of educational attainment

Cognitions about climate change are of critical importance for climate change mitigation as they influence climate-relevant behaviors and the support of climate policy. Using about 30,000 observations from a large-scale representative survey from 23 European countries, this study provides two major findings. First, important policy-relevant climate change cognitions do not only differ by individuals' ideological identity (left versus right) but-independently-by their moral identity, that is, the pattern of endorsement of the moral foundations: Care, Fairness, Liberty, Loyalty, Authority, and Purity/Sanctity. In particular, controlling for ideological position, the cognitions that the world climate is changing, that climate change is human-made, and that climate change impacts are bad are significantly negatively related to stronger endorsement of the Authority and Sanctity foundations while being positively related to stronger endorsement of the Loyalty and Fairness foundations. Second, not only the ideology-related cognitive divide but the morality-related divide is larger in individuals with tertiary education, consistent with the idea that individuals with greater science literacy and numeracy use these skills to adjust their cognitions to their group identity. The finding that better education may amplify rather than attenuate the ideology and morality dependence of decision-relevant climate change cognitions sheds doubt on the proposition that better education unambiguously furthers the prospects for climate change mitigation.

Are vertical jumps able to predict 24-month follow-up functional geriatric assessment in a healthy community-dwelling older cohort?

BACKGROUND

When older adults fall below the thresholds of functional geriatric assessment (FGA), they may already be at risk of mobility impairment. A reduction in (jumping) power could be an indication of functional decline, one of the main risk factors for falls.

OBJECTIVE

This paper explores whether six-month delta (∆) values of muscle power can predict 24-month follow-up FGA in older adults.

METHODS

This observational study of independent, healthy, high-performing community-dwelling adults aged 70 + years involved FGA (mobility, balance, and endurance tests) at baseline (t₀), after 6 months (t₁), and after 24 months (t₂); maximum jumping power (max JP) was determined at t₀ and t₁. A predictive linear model was developed in which the percentage change of Δmax JP_0,1 was transferred to all FGA (t₀) values. The results were compared with measured FGA values at t₂ via sensitivity and specificity in terms of the clinically meaningful change (CMC) or the minimal detectable change (MDC).

RESULTS

In 176 individuals (60% female, mean age 75.3 years) the mean percentage (SD) between predicted and measured FGA ranged between 0.4 (51.3) and 18.11 (51.9). Sensitivity to identify the CMC or MDC of predicted FGA tests at t₂ ranged between 17.6% (Timed up and go) and 75.0% (5-times-chair-rise) in a test-to-test comparison and increased to 97.6% considering clinically conspicuousness on global FGA.

CONCLUSION

The potential of jumping power to predict single tests of FGA was low regarding sensitivity and specificity of CMC (or MDC). 6 months Δmax JP seem to be suitable for predicting physical function, if the measured and predicted tests were not compared at the test level, but globally, in the target group in the long term.

Adaptive auditory brightness perception

Perception adapts to the properties of prior stimulation, as illustrated by phenomena such as visual color constancy or speech context effects. In the auditory domain, only little is known about adaptive processes when it comes to the attribute of auditory brightness. Here, we report an experiment that tests whether listeners adapt to spectral colorations imposed on naturalistic music and speech excerpts. Our results indicate consistent contrastive adaptation of auditory brightness judgments on a trial-by-trial basis. The pattern of results suggests that these effects tend to grow with an increase in the duration of the adaptor context but level off after around 8 trials of 2 s duration. A simple model of the response criterion yields a correlation of r = .97 with the measured data and corroborates the notion that brightness perception adapts on timescales that fall in the range of auditory short-term memory. Effects turn out to be similar for spectral filtering based on linear spectral filter slopes and filtering based on a measured transfer function from a commercially available hearing device. Overall, our findings demonstrate the adaptivity of auditory brightness perception under realistic acoustical conditions.

Von der Geschichtsphilosophie zur Formalpragmatik

Die gegenwärtige Debatte über die normativen Grundlagen Kritischer Theorie lässt sich nur vor dem Hintergrund ihrer Geschichte verstehen: Die Defizite in den Konzeptionen der 1. und 2. Generation strukturieren das Feld der Optionen, die heute noch als aussichtsreich gelten können. Der Blick zurück schärft den Blick nach vorn. Im ersten Teil des Beitrags werde ich deshalb die Hauptthesen, ethischen Implikationen und Einseitigkeiten von Horkheimers Zur Kritik der instrumentellen Vernunft darstellen. Im zweiten Teil werde ich die (von Horkheimer beiläufig angedachte und) von Habermas ausgearbeitete These diskutieren, dass der Sprache das nicht-instrumentelle Telos der Verständigung innewohnt. Zudem werde ich zeigen, dass es Habermas nicht gelingt, den für seine Diskursethik zentralen Universalisierungsgrundsatz abzuleiten. Wie sich die Begründungsprobleme bei Horkheimer und Habermas auf die gegenwärtige Debatte auswirken, werde ich im dritten Teil besprechen.

[Care of older patients by community emergency paramedics : Comparison of community-dwellers and nursing home residents]

Hintergrund

Notaufnahmen und Rettungsdienste werden zunehmend durch nicht vital bedrohlich erkrankte Patienten belastet. Ein großer Anteil der Rettungsdiensteinsätze entfällt auf ältere Menschen. Um eine unnötige Disponierung höherwertiger Rettungsmittel zu reduzieren, wurde das Modellprojekt Gemeindenotfallsanitäter (G-NFS) entwickelt.

Ziel der Arbeit

Ziel dieser Arbeit war es herauszufinden, ob sich spezifische Einsatzschwerpunkte des G‑NFS in der Versorgung älterer Menschen in häuslicher Umgebung und im Pflegeheim zeigen.

Material und Methoden

Es handelt sich um eine retrospektive Beobachtungsstudie auf Basis der Einsatzdokumentation vom 01.07.2019 bis zum 30.06.2020. Es wurden G‑NFS Einsätze bei älteren Menschen (≥ 65 Jahre) analysiert, unterteilt nach den Einsatzorten Pflegeheim oder Häuslichkeit.

Ergebnisse

Es wurden 2358 Protokolle ausgewertet (Durchschnittsalter: 80,8 Jahre; 52,9 % weiblich). Vor Ort wurden 55 % der Patienten versorgt. Die durchgeführten Maßnahmen umfassten Beratungsgespräche (79,4 %), Hilfe bei Selbstmedikation (16,7 %) und Medikamentengabe (23,2 %). Auf Pflegeheimbewohner entfielen 329 (14,0 %) Einsätze. Maßnahmen in Bezug auf Urindauerkatheter wurden häufiger bei Pflegeheimbewohnern als in der Häuslichkeit durchgeführt (32,2 % bzw. 5,7 % aller Einsätze). Bei Patienten mit Katheterproblemen erfolgte im Vergleich zu anderen Einsätzen nahezu immer eine Versorgung vor Ort (84,3 % bzw. 52,2 %).

Diskussion

Durch G‑NFS können die Mehrzahl der älteren Patienten ambulant versorgt und andere Ressourcen entlastet werden. Allerdings führen G‑NFS auch Maßnahmen durch, die im Verantwortungsbereich der hausärztlichen Versorgung liegen, und gleichen somit strukturelle Defizite in der medizinisch-pflegerischen Versorgung aus.

Zusatzmaterial online

Die Onlineversion dieses Beitrags (10.1007/s00063-021-00863-8) enthält die Tabellen S1–S3.

Utilisation of outpatient physiotherapy in patients following total knee arthroplasty - a systematic review

OBJECTIVE

Data on the utilisation of outpatient physiotherapy (PT) in patients following total knee arthroplasty (TKA) are scarce, and available studies have not been systematically synthesised. This study aims to summarise the existing literature on outpatient PT following TKA as well as to identify factors associated with its use.

METHODS

A systematic literature search in MEDLINE (via PubMed), CINAHL, Scopus and PEDro was conducted in July 2020 without language restrictions. Two authors independently selected studies, extracted data and assessed study quality. The primary outcome was the proportion being treated with at least one session of outpatient PT (land- or water-based treatments supervised/provided by a qualified physiotherapist) during any defined period within 12 months following TKA. Furthermore, predictors for the use of PT were assessed. Studies including only revision surgeries or bilateral TKA were excluded.

RESULTS

After screening 1934 titles/abstracts and 56 full text articles, 5 studies were included. Proportions of PT utilisation ranged from 16.7 to 84.5%. There were large variations in the time periods after hospital discharge (4 weeks to 12 months) and in the reporting of PT definitions. Female sex was associated with higher PT utilisation, and compared to patients after total hip arthroplasty, utilisation was higher among those following TKA.

CONCLUSION

Despite using a broad search strategy, we found only 5 studies assessing the utilisation of PT after hospital discharge in patients with TKA. These studies showed large heterogeneity in PT utilisation, assessed time periods and PT definitions. Clearly, more studies from different countries with uniform PT definitions are needed to address this relevant public health question.

High taxonomic resolution surveys and trait-based analyses reveal multiple benthic regimes in North Sulawesi (Indonesia)

As coral reef communities change and reorganise in response to increasing disturbances, there is a growing need for understanding species regimes and their contribution to ecosystem processes. Using a case study on coral reefs at the epicentre of tropical marine biodiversity (North Sulawesi, Indonesia), we explored how application of different biodiversity approaches (i.e., use of major taxonomic categories, high taxonomic resolution categories and trait-based approaches) affects the detection of distinct fish and benthic communities. Our results show that using major categories fails to identify distinct coral reef regimes. We also show that monitoring of only scleractinian coral communities is insufficient to detect different benthic regimes, especially communities dominated by non-coral organisms, and that all types of benthic organisms need to be considered. We have implemented the use of a trait-based approach to study the functional diversity of whole coral reef benthic assemblages, which allowed us to detect five different community regimes, only one of which was dominated by scleractinian corals. Furthermore, by the parallel study of benthic and fish communities we provide new insights into key processes and functions that might dominate or be compromised in the different community regimes.

Vaccine alliance building blocks: a conjoint experiment on popular support for international COVID-19 cooperation formats

The design principles of institutions that visibly and significantly affect citizens' lives are likely to be politically salient. Popular support for these principles is in turn crucial for institutional viability and effectiveness. Transboundary pandemics are a case in point. Understanding citizens' preferences regarding the design of international alliances set up to mass-produce and distribute vaccines is likely to determine citizens' subsequent cooperation with vaccination campaigns. This study explores Germans' preferences for international COVID-19 vaccine alliance design principles. We conducted a conjoint experiment at a recurring cognitive moment in many pandemics' cycles, between the initial outbreak and a more devastating but still-unknown second wave, when infection rates were very low, yet no policy solutions had been developed. We analyzed preferences regarding four building blocks: (1) alliance composition (size; EU-centrism), (2) alliance distribution rules (joining cost; vaccine allocation), (3) vaccine nationalism (cost per German household; coverage in Germany) and (4) vaccine producer confidence (origin; type). Distribution rules, political ideology and personal perceptions of pandemic threat matter little. But a larger alliance size and dominant EU-country composition increase alliance support. And vaccine nationalism is key: support increases with both lower costs and larger coverage for own-nation citizens. Moreover, support goes down for Chinese and American producers and increases for Swiss and especially own-nation producers. In sum, a realist and technocratic outlook is warranted at the cognitive stage in pandemic cycles when no solutions have been found, yet the worst already seems to be over, as national self-interest reigns supreme in popular attitudes.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11077-021-09435-1.

Confinement, partial sleep deprivation and defined physical activity-influence on cardiorespiratory regulation and capacity

INTRODUCTION

Adequate cardiorespiratory fitness is of utmost importance during spaceflight and should be assessable via moderate work rate intensities, e.g., using kinetics parameters. The combination of restricted sleep, and defined physical exercise during a 45-day simulated space mission is expected to slow heart rate (HR) kinetics without changes in oxygen uptake ([Formula: see text]) kinetics.

METHODS

Overall, 14 crew members (9 males, 5 females, 37 ± 7 yrs, 23.4 ± 3.5 kg m^-2) simulated a 45-d-mission to an asteroid. During the mission, the sleep schedule included 5 nights of 5 h and 2 nights of 8 h sleep. The crew members were tested on a cycle ergometer, using pseudo-random binary sequences, changing between 30 and 80 W on day 8 before (MD-8), day 22 (MD22) and 42 (MD42) after the beginning and day 4 (MD + 4) following the end of the mission. Kinetics information was assessed using the maxima of cross-correlation functions (CCF_max). Higher CCF_max indicates faster responses.

RESULTS

CCF_max(HR) was significantly (p = 0.008) slower at MD-8 (0.30 ± 0.06) compared with MD22 (0.36 ± 0.06), MD42 (0.38 ± 0.06) and MD + 4 (0.35 ± 0.06). Mean HR values during the different work rate steps were higher at MD-8 and MD + 4 compared to MD22 and MD42 (p < 0.001).

DISCUSSION

The physical training during the mission accelerated HR kinetics, but had no impact on mean HR values post mission. Thus, HR kinetics seem to be sensitive to changes in cardiorespiratory fitness and may be a valuable parameter to monitor fitness. Kinetics and capacities adapt independently in response to confinement in combination with defined physical activity and sleep.

Finding Nemo's clock reveals switch from nocturnal to diurnal activity

Timing mechanisms play a key role in the biology of coral reef fish. Typically, fish larvae leave their reef after hatching, stay for a period in the open ocean before returning to the reef for settlement. During this dispersal, larvae use a time-compensated sun compass for orientation. However, the timing of settlement and how coral reef fish keep track of time via endogenous timing mechanisms is poorly understood. Here, we have studied the behavioural and genetic basis of diel rhythms in the clown anemonefish Amphiprion ocellaris. We document a behavioural shift from nocturnal larvae to diurnal adults, while juveniles show an intermediate pattern of activity which potentially indicates flexibility in the timing of settlement on a host anemone. qRTPCR analysis of six core circadian clock genes (bmal1, clocka, cry1b, per1b, per2, per3) reveals rhythmic gene expression patterns that are comparable in larvae and juveniles, and so do not reflect the corresponding activity changes. By establishing an embryonic cell line, we demonstrate that clown anemonefish possess an endogenous clock with similar properties to that of the zebrafish circadian clock. Furthermore, our study provides a first basis to study the multi-layered interaction of clocks from fish, anemones and their zooxanthellae endosymbionts.