Is occupational exposure to solvents associated with an increased risk for developing systemic scleroderma?

BACKGROUND: Our study was aimed to investigate in a German collective if there are any hints for an increased occupational or environmental risk to develop systemic sclerosis, especially, focussing on work-related exposure to solvents. Moreover, we tried to evaluate the feasibility of a sampling method addressing support groups. METHODS: A standardised questionnaire was published in two journals subscribed by members of two different support groups and all members were asked to complete the questionnaire and to return it anonymously. The subjects were not informed on the scientific hypotheses, nor did they know who of them belonged to the case group (scleroderma) or to the control group (multiple sclerosis). RESULTS: 175 questionnaires could be included in the statistical analysis. As expected, a female predominance was in our collective. In the male subpopulation, the occupational exposure to solvents was higher in the case group than in the control-group (70% versus 45.8%). Based only on the male subgroup, a tendency for an association between occupational exposure to solvents and the risk to develop systemic sclerosis was found. CONCLUSION: According to our experience in this case-control-study exposure misclassification, qualitative or quantitative, was an eminent problem. Within such a setting, it is generally very difficult to establish an exact dose-response relationship due to incomplete, imprecise or missing data concerning duration of exposure, frequency of use and kind of solvent. Additionally, a well-known problem in studies based on self-reported questionnaires is the so-called volunteer bias. Unfortunately, but similar to other studies assessing epidemiologic factors in such a rare disease, our study was of limited power, especially in the subgroups defined by gender

Artificial intelligence in melanoma diagnosis: Three scenarios, shifts in competencies, need for regulation, and reconciling dissent between humans and AI

Tools based on machine learning (so-called artificial intelligence, AI) are increasingly being developed to diagnose malignant melanoma in dermatology. This contribution discusses (1) three scenarios for the use of AI in different medical settings, (2) shifts in competencies from dermatologists to non-specialists and empowered patients, (3) regulatory frameworks to ensure safety and effectiveness and their consequences for AI tools, and (4) cognitive dissonance and potential delegation of human decision-making to AI. We conclude that AI systems should not replace human medical expertise but play a supporting role. We identify needs for regulation and provide recommendations for action to help all (human) actors navigate safely through the choppy waters of this emerging market. Potential dilemmas arise when AI tools provide diagnoses that conflict with human medical expertise. Reconciling these conflicts will be a major challenge

Secondary prevention of allergic symptoms in a dairy farmer by use of a milking robot

BACKGROUND: Animal-derived allergens include lipocalins which play an increasing role in occupational respiratory sensitizations. The prevention of sensitization in stock farming is often difficult due to intense exposure, with traditional milking still requiring close animal contact. Complete avoidance of allergen exposure is only possible if stock farming is abandoned. This is, however, often not feasible in small dairy plants because of the resulting loss of income. CASE PRESENTATION: In a 37-year-old female farmer daily asthmatic complaints appeared, associated with cow dust-derived allergen exposure by milking with a conventional device. Respiratory symptoms increased during a period of 12 years. Allergic bronchial asthma was diagnosed, caused by sensitization against cow dust-derived allergens, as demonstrated by positive skin prick test and by detection of IgE antibodies. In a separate specific inhalation challenge test using a 10% extract of cow dust-derived allergens a 330% increase of airway resistance was detected. To enable further dairy farming, a milking robot was installed in 1999, i.e., an automatic milking system. The novel milking technique reduced the daily exposure from over 2 hours to approximately 10 min. The clinical course after the installation of the milking robot was favourable, with less frequent allergic and asthmatic symptoms. Furthermore, asthma medication could be reduced. Improvement was noted also in terms of lung-function and decreased total serum IgE. CONCLUSION: The case presented and the evidence from the literature indicates that the strategy of exposure minimization to allergens at workplaces can be an effective alternative to total elimination. In farmers with cow dust allergy a milking robot is an appropriate technical measure to minimize allergen-exposure

(+)-{1,2-Bis[(2R,5R)-2,5-diethyl­phospho­lan-1-yl]ethane-κ 2 P,P′}(η 4-cyclo­octa-1,5-diene)rhodium(I) tetra­fluoridoborate

The title compound, [Rh(C8H12)(C18H36P2)]BF4, exhibits a rhodium(I) complex cation with a bidentate bis­phosphine ligand and a bidentate η 2,η 2-coordinated cyclo­octa-1,5-diene ligand. The ligands form a slightly distorted square-planar coordination environment for the Rh(I) atom. An intra­molecular P–Rh–P bite angle of 83.91 (2)° is observed. The dihedral angle between the P—Rh—P and the X—Rh—X planes (X is the centroid of a double bond) is 14.0 (1)°. The BF4 anion is disordered over two positions in a 0.515 (7):0.485 (7) ratio

(+)-Chlorido[(1,2,3,4-η;κP 2′)-2′-diphenyl­phosphanyl-2-diphenyl­phosphoryl-1,1′-binaphth­yl]rhodium(I) methanol monosolvate

In the title complex, [RhCl(C44H32OP2)]·CH3OH, the RhI ion is coordinated by a naphthyl group of a partially oxidized 2,2′-bis­(diphenyl­phosphan­yl)-1,1′-binaphthyl (BINAP) ligand in a η4 mode, one P atom of the diphenyl­phosphanyl group and one Cl atom. The P=O group does not inter­act with the RhI ion but accepts an O—H⋯O hydrogen bond from the methanol solvent mol­ecule

Well prepared for work? Junior doctors' self-assessment after medical education

Background Apart from objective exam results, the overall feeling of preparedness is important for a successful transition process from being a student to becoming a qualified doctor. This study examines the association between self-assessed deficits in medical skills and knowledge and the feeling of preparedness of junior doctors in order to determine which aspects of medical education need to be addressed in more detail in order to improve the quality of this transition phase and in order to increase patient safety. Methods A cohort of 637 doctors with up to two years of clinical work experience was included in this analysis and was asked about the overall feeling of preparedness and self-assessed deficits with regard to clinical knowledge and skills. Three logistic regression models were used to identify medical skills which predict the feeling of preparedness. Results All in all, about 60% of the participating doctors felt poorly prepared for post-graduate training. Self-assessed deficits in ECG interpretation (aOR: 4.39; 95% CI: 2.012-9.578), treatment and therapy planning (aOR: 3.42; 95% CI: 1.366-8.555), and intubation (aOR: 2.10; 95% CI: 1.092-4.049) were found to be independently associated with the overall feeling of preparedness in the final regression model. Conclusions Many junior doctors in Germany felt inadequately prepared for being a doctor. With regard to the contents of medical curricula, our results show that more emphasis on ECG-interpretation, treatment and therapy planning and intubation is required to improve the feeling of preparedness of medical graduates

Activation, deactivation and reversibility phenomena in homogeneous catalysis : A showcase based on the chemistry of rhodium/phosphine catalysts

In the present work, the rich chemistry of rhodium/phosphine complexes, which are applied as homogeneous catalysts to promote a wide range of chemical transformations, has been used to showcase how the in situ generation of precatalysts, the conversion of precatalysts into the actually active species, as well as the reaction of the catalyst itself with other components in the reaction medium (substrates, solvents, additives) can lead to a number of deactivation phenomena and thus impact the efficiency of a catalytic process. Such phenomena may go unnoticed or may be overlooked, thus preventing the full understanding of the catalytic process which is a prerequisite for its optimization. Based on recent findings both from others and the authors’ laboratory concerning the chemistry of rhodium/diphosphine complexes, some guidelines are provided for the optimal generation of the catalytic active species from a suitable rhodium precursor and the diphosphine of interest; for the choice of the best solvent to prevent aggregation of coordinatively unsaturated metal fragments and sequestration of the active metal through too strong metal–solvent interactions; for preventing catalyst poisoning due to irreversible reaction with the product of the catalytic process or impurities present in the substrate. © 2019 by the authors

Over-indebtedness and its association with the prevalence of back pain

<p>Abstract</p> <p>Background</p> <p>Over-indebtedness is an increasing phenomenon worldwide. Massive financial strain, as found in over-indebted persons, might influence the occurrence of back pain. In this explorative study we examined the prevalence of back pain in over-indebted persons in Germany for the first time ever and compared it to the prevalence of back pain in the German general population.</p> <p>Methods</p> <p>A cross sectional study comprising 949 participants (52.6% women) was conducted to collect data on the point prevalence of back pain in an over-indebted collective. A representative sample of the German general population (N = 8318, 53.4% women) was used as non-indebted reference group.</p> <p>Results</p> <p>The point prevalence of back pain was 80% in the over-indebted collective, compared to 20% in the general population. The influence of socioeconomic factors on the prevalence of back pain differed partially between the general population and the over-indebted collective. Being over-indebted was identified as an independent effect modifier and was associated with an eleven times increased probability to suffer from back pain (aOR: 10.92, 95%CI: 8.96 - 13.46).</p> <p>Conclusion</p> <p>Until now, only little is known about the effects of intense financial strain like over-indebtedness on health. Our study suggests that over-indebted persons represent a risk group for back pain and that it might be sensible to take financial strain into account when taking a medical history on back pain. Over-indebtedness and private bankruptcy is of increasing importance in industrialized countries, therefore more research on the subject seems to be necessary.</p

(+)-{1,2-Bis[(2R,5R)-2,5-dimethyl­phospho­lan-1-yl]ethane-κ2 P,P′}(η4-cyclo­octa-1,5-diene)rhodium(I) tetra­fluorido­borate

The title compound, [Rh(C8H12)(C14H28P2)]BF4, exhibits a rhodium(I) complex cation with a bidentate bis­phosphine ligand and a bidentate η2,η2-coordinated cyclo­octa-1,5-diene. Together the ligands create a slightly distorted square-planar cordination environment for the Rh(I) atom. There are three mol­ecules in the asymmetric unit and intra­molecular P—Rh—P bite angles of 82.78 (5), 82.97 (6) and 83.09 (5)° are observed. The dihedral angles between the P—Rh—P and the X—Rh—X planes (X is the centroid of a double bond) are 14.7 (1), 14.8 (1) and 15.3 (1)°. The structure exhibits disorder of one cyclo­octa­diene ligand as well as one BF4 anion

Галльский пласт в современном немецком литературном языке: структурно-системный и функционально-динамический аспекты

Диссертационное исследование Меремкуловой Татьяны Игоревны выполнено в русле контактной лингвистики, стремительно развивающейся ветви исторического языкознания, и посвящено определению структурно-системных и функционально-динамических характеристик заимствованных лексических единиц галльского пласта в системе современного немецкого литературного языка и в синхронной немецкой литературной речи.The dissertation research of Meremkulova Tatyana Igorevna is carried out in the mainstream of the contact linguistics, the rapidly developing branch of historical linguistics, and is devoted to the determination of structural-systemic and functional-dynamic characteristics of the borrowed lexical units of the Gallic layer in the system of modern German literary language and in synchronous German literary speech