Podporna in paliativna oskrba bolnika z rakom glave in vratu

Bolniki z rakom glave in vratu potrebujejo, da proaktivno iščejo in lajšajo simptome vsi člani zdravstvenega tima. Tako bolezen kot zdravljenje (operacija, obsevanje in sistemsko zdravljenje) povzročata številne simptome, sočasno pa ti vplivajo tudi na videz in sposobnost požiranja, dihanja ter govora. Bolniki so za vzpostavljanje varne dihalne in prebavne poti pogosto odvisni od traheostome in gastrostome, ki zahtevata dodatno oskrbo. Poleg specifičnih telesnih simptomov imajo ti bolniki večje tveganje za anksioznost, depresijo in samomorilna nagnjenja. Simptome pogosto dodatno poslabšajo tudi pridružene bolezni, odvisnost od nikotina in alkohola ter nižji socioekonomski status. Ob pravočasnem prepoznavanju simptomov in pravilnem ukrepanju lahko bolnikovo kakovost življenja pomembno izboljšamo in vplivamo na preživetje, tudi ko bolezni ne moremo več zaustaviti. Bolniki zaradi zapletov (krvavitev, okužbe) pogosto umrejo v bolnišnici, kjer je treba zagotoviti klinično pot ukrepanja za vzpostavitev najbolj optimalnega okolja za bolnika, bližnje in zdravstveni tim

Совершенствование системы безопасности труда на предприятии

Система безопасности, охрана труда, условия труда, травматизм, аттестация рабочих,Safety system, occupation Safety and Health, working conditions, injury, operating certificatio

Dairying, diseases and the evolution of lactase persistence in Europe

Update notice Author Correction: Dairying, diseases and the evolution of lactase persistence in Europe (Nature, (2022), 608, 7922, (336-345), 10.1038/s41586-022-05010-7) Nature, Volume 609, Issue 7927, Pages E9, 15 September 2022In European and many African, Middle Eastern and southern Asian populations, lactase persistence (LP) is the most strongly selected monogenic trait to have evolved over the past 10,000 years(1). Although the selection of LP and the consumption of prehistoric milk must be linked, considerable uncertainty remains concerning their spatiotemporal configuration and specific interactions(2,3). Here we provide detailed distributions of milk exploitation across Europe over the past 9,000 years using around 7,000 pottery fat residues from more than 550 archaeological sites. European milk use was widespread from the Neolithic period onwards but varied spatially and temporally in intensity. Notably, LP selection varying with levels of prehistoric milk exploitation is no better at explaining LP allele frequency trajectoriesthan uniform selection since the Neolithic period. In the UK Biobank(4,5) cohort of 500,000 contemporary Europeans, LP genotype was only weakly associated with milk consumption and did not show consistent associations with improved fitness or health indicators. This suggests that other reasons for the beneficial effects of LP should be considered for its rapid frequency increase. We propose that lactase non-persistent individuals consumed milk when it became available but, under conditions of famine and/or increased pathogen exposure, this was disadvantageous, driving LP selection in prehistoric Europe. Comparison of model likelihoods indicates that population fluctuations, settlement density and wild animal exploitation-proxies for these drivers-provide better explanations of LP selection than the extent of milk exploitation. These findings offer new perspectives on prehistoric milk exploitation and LP evolution.Peer reviewe

Framework and baseline examination of the German National Cohort (NAKO)

The German National Cohort (NAKO) is a multidisciplinary, population-based prospective cohort study that aims to investigate the causes of widespread diseases, identify risk factors and improve early detection and prevention of disease. Specifically, NAKO is designed to identify novel and better characterize established risk and protection factors for the development of cardiovascular diseases, cancer, diabetes, neurodegenerative and psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases in a random sample of the general population. Between 2014 and 2019, a total of 205,415 men and women aged 19–74 years were recruited and examined in 18 study centres in Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires and a wide range of biomedical examinations. Biomaterials were collected from all participants including serum, EDTA plasma, buffy coats, RNA and erythrocytes, urine, saliva, nasal swabs and stool. In 56,971 participants, an intensified examination programme was implemented. Whole-body 3T magnetic resonance imaging was performed in 30,861 participants on dedicated scanners. NAKO collects follow-up information on incident diseases through a combination of active follow-up using self-report via written questionnaires at 2–3 year intervals and passive follow-up via record linkages. All study participants are invited for re-examinations at the study centres in 4–5 year intervals. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. NAKO is a major resource for population-based epidemiology to identify new and tailored strategies for early detection, prediction, prevention and treatment of major diseases for the next 30 years. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10654-022-00890-5

Digitalisierung beruflicher Lern- und Arbeitsprozesse. Impulse aus der Bauwirtschaft und anderen gewerblich-technischen Sektoren

Der Sammelband stellt aktuelle Ansätze zum digital unterstützten beruflichen Lernen dar. Die Beiträge geben Einblicke in die dynamische Entwicklung der Schnittstellen von Erwerbsarbeit und beruflicher Aus-, Fort- und Weiterbildung im Kontext der Digitalisierung Arbeits- und Lernmitteln. Der Band schließt damit an die 2019 ebenfalls im Universitätsverlag der Technischen Universität Berlin erschienene Publikation „Berufsbildung am Bau digital“ (hrsg. von Bernd Mahrin und Johannes Meyser) an. Das erste Kapitel erörtert grundsätzliche didaktische Fragen zu digital unterstütztem Lernen und Arbeiten einschließlich der Rahmenbedingungen. Im zweiten Kapitel schließen sich Beiträge zur Kapazitätsentwicklung, zu Standards und zu digitalen Werkzeugen an. Das dritte Kapitel widmet sich konkreten Einzellösungen mit starkem Praxisbezug und hohem Transferpotenzial zum digitalisierten Arbeiten und Lernen im Bausektor und im Metallbereich. Das abschließende vierte Kapitel präsentiert übergreifend nutzbare und frei zugängliche Online-Angebote wie einen Medienpool für Bildungszwecke, eine Lernmedien-Datenbank und ein hybrides Lernsystem mit virtuellem 3D-Gebäudemodell. Das Buch ist entstanden im Rahmen des durch das Bundesministerium für Bildung und Forschung und den Europäischen Sozialfonds geförderten Projektes DigiBAU – Digitales Bauberufliches Lernen und Arbeiten. (DIPF/Orig.)The anthology presents current approaches to digitally supported professional learning. The articles provide insights into the dynamic development of the interfaces between gainful employment and vocational training and further education in the context of digitization of work and learning aids. The volume is thus connected to the publication “Berufsbildung am Bau digital” (edited by Bernd Mahrin and Johannes Meyser), which was published in 2019 by the University Press of the Technische Universität Berlin. The first chapter discusses fundamental didactic questions about digitally supported learning and working, including the framework conditions. The second chapter picks contributions on capacity development, standards, and digital tools out as central themes. The third chapter is dedicated to concrete specific solutions with strong practical relevance and high transfer potential for digitized work and learning in the construction sector and in the metal sector. The final fourth chapter presents comprehensive and freely accessible online offers such as a media pool for educational purposes, a learning media database and a hybrid learning system with a virtual 3D building model. The book was created as part of the DigiBAU project - digital vocational learning and working in the field of construction - funded by the German Federal Ministry of Education and Research and the European Social Fund. (DIPF/Orig.

Overview of the MOSAiC expedition: Physical oceanography

Arctic Ocean properties and processes are highly relevant to the regional and global coupled climate system, yet still scarcely observed, especially in winter. Team OCEAN conducted a full year of physical oceanography observations as part of the Multidisciplinary drifting Observatory for the Study of the Arctic Climate (MOSAiC), a drift with the Arctic sea ice from October 2019 to September 2020. An international team designed and implemented the program to characterize the Arctic Ocean system in unprecedented detail, from the seafloor to the air-sea ice-ocean interface, from sub-mesoscales to pan-Arctic. The oceanographic measurements were coordinated with the other teams to explore the ocean physics and linkages to the climate and ecosystem. This paper introduces the major components of the physical oceanography program and complements the other team overviews of the MOSAiC observational program. Team OCEAN’s sampling strategy was designed around hydrographic ship-, ice- and autonomous platform-based measurements to improve the understanding of regional circulation and mixing processes. Measurements were carried out both routinely, with a regular schedule, and in response to storms or opening leads. Here we present alongdrift time series of hydrographic properties, allowing insights into the seasonal and regional evolution of the water column from winter in the Laptev Sea to early summer in Fram Strait: freshening of the surface, deepening of the mixed layer, increase in temperature and salinity of the Atlantic Water. We also highlight the presence of Canada Basin deep water intrusions and a surface meltwater layer in leads. MOSAiC most likely was the most comprehensive program ever conducted over the ice-covered Arctic Ocean. While data analysis and interpretation are ongoing, the acquired datasets will support a wide range of physical oceanography and multi-disciplinary research. They will provide a significant foundation for assessing and advancing modeling capabilities in the Arctic Ocean

NASH limits anti-tumour surveillance in immunotherapy-treated HCC.

Hepatocellular carcinoma (HCC) can have viral or non-viral causes1-5. Non-alcoholic steatohepatitis (NASH) is an important driver of HCC. Immunotherapy has been approved for treating HCC, but biomarker-based stratification of patients for optimal response to therapy is an unmet need6,7. Here we report the progressive accumulation of exhausted, unconventionally activated CD8+PD1+ T cells in NASH-affected livers. In preclinical models of NASH-induced HCC, therapeutic immunotherapy targeted at programmed death-1 (PD1) expanded activated CD8+PD1+ T cells within tumours but did not lead to tumour regression, which indicates that tumour immune surveillance was impaired. When given prophylactically, anti-PD1 treatment led to an increase in the incidence of NASH-HCC and in the number and size of tumour nodules, which correlated with increased hepatic CD8+PD1+CXCR6+, TOX+, and TNF+ T cells. The increase in HCC triggered by anti-PD1 treatment was prevented by depletion of CD8+ T cells or TNF neutralization, suggesting that CD8+ T cells help to induce NASH-HCC, rather than invigorating or executing immune surveillance. We found similar phenotypic and functional profiles in hepatic CD8+PD1+ T cells from humans with NAFLD or NASH. A meta-analysis of three randomized phase III clinical trials that tested inhibitors of PDL1 (programmed death-ligand 1) or PD1 in more than 1,600 patients with advanced HCC revealed that immune therapy did not improve survival in patients with non-viral HCC. In two additional cohorts, patients with NASH-driven HCC who received anti-PD1 or anti-PDL1 treatment showed reduced overall survival compared to patients with other aetiologies. Collectively, these data show that non-viral HCC, and particularly NASH-HCC, might be less responsive to immunotherapy, probably owing to NASH-related aberrant T cell activation causing tissue damage that leads to impaired immune surveillance. Our data provide a rationale for stratification of patients with HCC according to underlying aetiology in studies of immunotherapy as a primary or adjuvant treatment

Die Musikindustrie im Wandel - Untergang oder Chance? : eine Analyse der digitalen Revolution und deren Auswirkungen auf das Kaufverhalten der Konsumenten und die Live-Event-Kultur

Die Bachelorarbeit beschäftigt sich mit der Frage, ob die digitale Revolution die alleinige Schuld an der Krise in der Musikindustrie trifft oder andere Gegebenheiten den Absatzrückgang der Tonträger mit beeinflusst haben. Außerdem wird untersucht, was den Konsumenten zu einem Umdenken in Richtung Live-Events bewegt hat. Der Fokus wird ebenfalls auf neue Wege zur Vermarktung des Konsumguts Musik gelegt, die zukünftig eingeschlagen werden können