Schienenbehandlung bei Spastizität nach einem Schlaganfall - ein (un)geklärtes Thema? : Literaturreview zur Wirksamkeit der Schienen und zu Einflussfaktoren bei der Schienenwahl in der Ergotherapie

Hintergrund: Spastizität ist das häufigste Folgesymptom eines Schlaganfalls und geht bei Betroffenen mit Beeinträchtigungen ihrer Handlungsfähigkeit einher. Ohne angemessene Behandlung können Folgekomplikationen auftreten. Um dem entgegenzuwirken werden, trotz uneinheitlicher Literatur und fehlender Richtlinien in der Ergotherapie, häufig Schienen eingesetzt. Ziel: Die aktuelle Evidenzlage über die Wirksamkeit der Schienenbehandlung bei Spastizität in den oberen Extremitäten wird dargestellt und Einflussfaktoren bei der Schienenwahl in der Ergotherapie aufgezeigt. Methode: Durch eine systematische Literaturrecherche wurde in gesundheitsspezifischen und ergotherapeutischen Datenbanken nach Studien gesucht, welche die vordefinierten Einschlusskriterien erfüllten. Die erlangten Ergebnisse wurden anhand des ICF-Modells in Bezug zum Alltag und zur Ergotherapie gesetzt. Relevante Ergebnisse: Statische und dynamische Schienen zeigen sich wirksam in der Reduktion von Spastizität. Des Weiteren haben sie einen Einfluss auf die Körperfunktionen der Gelenkbeweglichkeit und Schmerzen. Zudem wird die dynamische Schiene von den Klienten besser toleriert und zeigt sich förderlich bei der Durchführung von Aktivitäten des täglichen Lebens. Die Schienenwahl wird von diversen Faktoren beeinflusst wie zum Beispiel der Adherence. Schlussfolgerung: Die Schienenbehandlung bei Spastizität zeigt sich wirksam und unter-stützend im Alltag. Eine einheitliche und spezifische Schienungsleitlinie bei Spastizität wäre notwendig, um den Ergotherapeuten die Schienenwahl zu erleichtern

Identification, Geochemical Characterisation and Significance of Bitumen among the Grave Goods of the 7th Century Mound 1 Ship-Burial at Sutton Hoo (Suffolk, UK)

Acknowledgments: We would like to thank Antony Simpson for formatting the figures for publication. We are indebted to Dr Sonja Marzinzik and Dr Sue Brunning, former and current curators of the Department of Britain, Europe and Prehistory at the British Museum, for facilitating access to the Sutton Hoo finds. Carbon and hydrogen isotopic measurements were carried out by Iso-Analytical Limited. We are grateful to colleagues and others who read and commented on the manuscript in draft. Funding: This research was supported by funding from the European Commission Research Executive Agency (REA) via the Marie Curie Actions – Intra-European Fellowships for Career Development funding scheme (FP7-MC-IEF), Grant Agreement No. 253942, awarded to PB and RJS for project AMPT (Ancient Maritime Pitch and Tar: a multi-disciplinary study of sources, technology and preservation). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

A Clinical Guideline Driven Automated Linear Feature Extraction for Vestibular Schwannoma

Vestibular Schwannoma is a benign brain tumour that grows from one of the balance nerves. Patients may be treated by surgery, radiosurgery or with a conservative "wait-and-scan" strategy. Clinicians typically use manually extracted linear measurements to aid clinical decision making. This work aims to automate and improve this process by using deep learning based segmentation to extract relevant clinical features through computational algorithms. To the best of our knowledge, our study is the first to propose an automated approach to replicate local clinical guidelines. Our deep learning based segmentation provided Dice-scores of 0.8124 +- 0.2343 and 0.8969 +- 0.0521 for extrameatal and whole tumour regions respectively for T2 weighted MRI, whereas 0.8222 +- 0.2108 and 0.9049 +- 0.0646 were obtained for T1 weighted MRI. We propose a novel algorithm to choose and extract the most appropriate maximum linear measurement from the segmented regions based on the size of the extrameatal portion of the tumour. Using this tool, clinicians will be provided with a visual guide and related metrics relating to tumour progression that will function as a clinical decision aid. In this study, we utilize 187 scans obtained from 50 patients referred to a tertiary specialist neurosurgical service in the United Kingdom. The measurements extracted manually by an expert neuroradiologist indicated a significant correlation with the automated measurements (p < 0.0001).Comment: SPIE Medical Imagin

Nighttime resident supervision and education: results of a national survey of internal medicine residency program directors

Over the past several years, the Accreditation Council for Graduate Medical Education (ACGME) has issued new restrictions on resident duty hours while calling for increased supervision to ensure patient safety. To meet these requirements, some hospitals have hired overnight in-house hospitalist physicians, also called nocturnists, while others have continued a traditional model wherein a resident in-house can access a supervisor at home by phone as needed. This study examines the current state of internal medicine resident supervision and teaching at night.Christopher Bruti (Rush University Medical Center), Mathhew Tuck (Veterans Affairs Medical Center), Rebecca Harrison (Oregon Health and Science University School of Medicine), Dustin Smith (Atlanta VA Medical Center), Michael Kisielewski (Alliance for Academic Internal Medicine), Jillian S. Catalanotti (The George Washington University School of Medicine and Health Sciences), Alfred Burger (Icahn School of Medicine)Includes bibliographical reference

Features of successful academic hospitalist programs: Insights from the SCHOLAR (SuCcessful HOspitaLists in academics and research) project

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/1/jhm2603.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/2/jhm2603-sup-0004-suppinfo4.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/3/jhm2603-sup-0001-suppinfo1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/4/jhm2603-sup-0010-suppinfo10.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/5/jhm2603-sup-0006-suppinfo6.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/6/jhm2603-sup-0005-suppinfo5.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/7/jhm2603-sup-0009-suppinfo9.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/8/jhm2603-sup-0012-suppinfo12.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/9/jhm2603-sup-0003-suppinfo3.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/10/jhm2603-sup-0002-suppinfo2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/11/jhm2603_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/12/jhm2603-sup-0008-suppinfo8.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/13/jhm2603-sup-0011-suppinfo11.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134172/14/jhm2603-sup-0007-suppinfo7.pd

Survey of overnight academic hospitalist supervision of trainees

In 2003, Accreditation Council for Graduate Medical Education (ACGME) announced the first in a series of guidelines related to the residency training. The most recent recommendations include explicit recommendations regarding the provision of on‐site clinical supervision for trainees of internal medicine. To meet these standards, many internal medicine residency programs turned to hospitalist programs to fill that need. However, much is unknown about the current relationships between hospitalist and residency programs, specifically with regard to supervisory roles and supervision policies. We aimed to describe how academic hospitalists currently supervise housestaff during the on‐call, or overnight, period and hospitalist program leader their perceptions of how these new policies would impact trainee‐hospitalist interactions. Journal of Hospital Medicine 2012; © 2012 Society of Hospital MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93713/1/1961_ftp.pd

Rethinking Sustainability to Meet the Climate Change Challenge

A group of environmental law professors formed the Environmental Law Collaborative with the goal of engaging environmental law scholars in the thorny issues of the day. The members of the Collaborative gathered in the summer of 2012 to produce an intensive and collective assessment of sustainability in the age of climate change. Their writings examine the process of adapting the principles and application of sustainability to the demands of climate change, including framing the term sustainability in climate change discussions; coordinating sustainable practices across disciplines such as law, economics, ethics, and the hard sciences; and conceptualizing the role of sustainability in formulating adaptation and resiliency strategies. Their work also contemplates the role of law and legal systems in crafting effective climate change adaptation strategies and considers feasible strategies in the context of specific examples

Accumulating mutations in series of haplotypes at the KIT and MITF loci are major determinants of white markings in Franches-Montagnes horses.

Coat color and pattern variations in domestic animals are frequently inherited as simple monogenic traits, but a number are known to have a complex genetic basis. While the analysis of complex trait data remains a challenge in all species, we can use the reduced haplotypic diversity in domestic animal populations to gain insight into the genomic interactions underlying complex phenotypes. White face and leg markings are examples of complex traits in horses where little is known of the underlying genetics. In this study, Franches-Montagnes (FM) horses were scored for the occurrence of white facial and leg markings using a standardized scoring system. A genome-wide association study (GWAS) was performed for several white patterning traits in 1,077 FM horses. Seven quantitative trait loci (QTL) affecting the white marking score with p-values p≤10(-4) were identified. Three loci, MC1R and the known white spotting genes, KIT and MITF, were identified as the major loci underlying the extent of white patterning in this breed. Together, the seven loci explain 54% of the genetic variance in total white marking score, while MITF and KIT alone account for 26%. Although MITF and KIT are the major loci controlling white patterning, their influence varies according to the basic coat color of the horse and the specific body location of the white patterning. Fine mapping across the MITF and KIT loci was used to characterize haplotypes present. Phylogenetic relationships among haplotypes were calculated to assess their selective and evolutionary influences on the extent of white patterning. This novel approach shows that KIT and MITF act in an additive manner and that accumulating mutations at these loci progressively increase the extent of white markings

Hand2 delineates mesothelium progenitors and is reactivated in mesothelioma.

The mesothelium lines body cavities and surrounds internal organs, widely contributing to homeostasis and regeneration. Mesothelium disruptions cause visceral anomalies and mesothelioma tumors. Nonetheless, the embryonic emergence of mesothelia remains incompletely understood. Here, we track mesothelial origins in the lateral plate mesoderm (LPM) using zebrafish. Single-cell transcriptomics uncovers a post-gastrulation gene expression signature centered on hand2 in distinct LPM progenitor cells. We map mesothelial progenitors to lateral-most, hand2-expressing LPM and confirm conservation in mouse. Time-lapse imaging of zebrafish hand2 reporter embryos captures mesothelium formation including pericardium, visceral, and parietal peritoneum. We find primordial germ cells migrate with the forming mesothelium as ventral migration boundary. Functionally, hand2 loss disrupts mesothelium formation with reduced progenitor cells and perturbed migration. In mouse and human mesothelioma, we document expression of LPM-associated transcription factors including Hand2, suggesting re-initiation of a developmental program. Our data connects mesothelium development to Hand2, expanding our understanding of mesothelial pathologies