It is time to talk about people: a human-centered healthcare system

Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach [1] and b) User-centered design [2,3]. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system

Natriuretic Peptides, Antidiuretic Hormone and Hyponatraemia after Acute Craniocerebral Injury

We investigated the physiological mechanisms involved in central hyponatraemia in patients with acute craniocerebral injury (ACI). We measured blood concentrations of natriuretic peptides, antidiuretic hormone (ADH), and endogenous digitalis-like substance (EDLS), blood and urine sodium concentrations, and the plasma and urine osmolality in 68 patients with ACI and 24 healthy control subjects. A total of 27 ACI patients were hyponatraemic and the majority of these had grievous or severely grievous craniocerebral injuries. Blood concentrations of EDLS and ADH in hyponatraemic ACI patients were significantly higher compared with normonatraemic ACI patients and control subjects. Blood EDLS and sodium concentrations were negatively correlated with each other, whereas EDLS was positively correlated with urine sodium concentration and with urine osmotic pressure. Hyponatraemic ACI patients require different treatment based on the cause of their central hyponatraemia, so it is important to undertake a comprehensive analysis of each patient's physiological status

Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis

Copeptin is secreted in an equimolar amount to arginine vasopressin (AVP) but can easily be measured in plasma or serum with a sandwich immunoassay. The main stimuli for copeptin are similar to AVP, that is an increase in osmolality and a decrease in arterial blood volume and pressure. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation. Copeptin has, therefore, been evaluated as diagnostic biomarker in vasopressin-dependent disorders of body fluid homeostasis. Disorders of body fluid homeostasis are common and can be divided into hyper- and hypoosmolar circumstances: the classical hyperosmolar disorder is diabetes insipidus, while the most common hypoosmolar disorder is the syndrome of inappropriate antidiuresis (SIAD). Copeptin measurement has led to a "revival" of the direct test in the differential diagnosis of diabetes insipidus. Baseline copeptin levels, without prior thirsting, unequivocally identify patients with nephrogenic diabetes insipidus. In contrast, for the difficult differentiation between central diabetes insipidus and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is clearly superior to the classical water deprivation test. On the contrary, in the SIAD, copeptin measurement is of only little diagnostic value. Copeptin levels widely overlap in patients with hyponatraemia and emphasize the heterogeneity of the disease. Additionally, a variety of factors lead to unspecific copeptin elevations in the acute setting further complicating its interpretation. The broad use of copeptin as diagnostic marker in hyponatraemia and specifically to detect cancer-related disease in SIADH patients can, therefore, not be recommended

Nanodiamond-rich layer across three continents consistent with major cosmic impact at 12,800 cal BP

A major cosmic-impact event has been proposed at the onset of the Younger Dryas (YD) cooling episode at ≈12,800 ± 150 years before present, forming the YD Boundary (YDB) layer, distributed over 150 million km2 on four continents. In 24 dated stratigraphic sections in 10 countries of the Northern Hemisphere, the YDB layer contains a clearly defined abundance peak in nanodiamonds (NDs), a major cosmic-impact proxy. Observed ND polytypes include cubic diamonds, lonsdaleite-like crystals, and diamond-like carbon nanoparticles, called n-diamond and i-carbon. The ND abundances in bulk YDB sediments ranged up to ≈500 ppb (mean: 200 ppb) and that in carbon spherules up to ≈3700 ppb (mean: ≈750 ppb); 138 of 205 sediment samples (67%) contained no detectable NDs. Isotopic evidence indicates that YDB NDs were produced from terrestrial carbon, as with other impact diamonds, and were not derived from the impactor itself. The YDB layer is also marked by abundance peaks in other impact-related proxies, including cosmic-impact spherules, carbon spherules (some containing NDs), iridium, osmium, platinum, charcoal, aciniform carbon (soot), and high-temperature melt-glass. This contribution reviews the debate about the presence, abundance, and origin of the concentration peak in YDB NDs.We describe an updated protocol for the extraction and concentration of NDs from sediment, carbon spherules, and ice, and we describe the basis for identification and classification of YDB ND polytypes, using nine analytical approaches. The large body of evidence now obtained about YDB NDs is strongly consistent with an origin by cosmic impact at ≈12,800 cal BP and is inconsistent with formation of YDB NDs by natural terrestrial processes, including wildfires, anthropogenesis, and/or influx of cosmic dust