Studies on the promotion of nickel—alumina coprecipitated catalysts: I. Titanium oxide

A series of TiO2-promoted nickel—alumina catalysts has been prepared and characterized. The promoter was added in various proportions to a calcined coprecipitated nickel—alumina material by adsorption of the acetylacetonate complex of titanium, followed by further calcination and reduction. The structure of the resultant materials was similar to that of the unpromoted coprecipitated nickel—alumina. The chemisorption properties of the catalyst and its behaviour in the CO/H2 reaction were characteristic of a strong metal-support interaction (SMSI) reported in the literature for Ni/TiO2. The strong adsorption of both carbon monoxide and hydrogen were suppressed while the activity for carbon monoxide hydrogenation was increased, the activation energy being lowered. The higher activity, however, was relatively unstable under reaction conditions

Fatigue in adults with cerebral palsy: A three-year follow-up study.

OBJECTIVES: To describe the course of fatigue over a 3-year follow-up period in adults with cerebral palsy and to investigate the association of known determinants of fatigue (i.e. demographic characteristics and/or body composition) with change in fatigue. METHODS: Forty-one adults with cerebral palsy from a previous study of fatigue were invited to participate in a follow-up study. Twenty-three adults with cerebral palsy (Gross Motor Function Classification System (GMFCS) levels I-V; mean age 38 years 2 months, standard deviation (SD) 14 years 1 month)) agreed to participate (convenience sample). Fatigue was measured with the Fatigue Impact and Severity Self-Assessment (FISSA, range 31-157) questionnaire. The course of fatigue is described at group, subgroup (GMFCS) and individual levels. RESULTS: The mean FISSA score for all participants was 84.0 (SD 27.7) at baseline and 91.7 (SD 26.7) at follow-up. Despite variations among individuals in the change of fatigue, there was no statistically significant difference in FISSA score over time (p = 0.087, 95% confidence interval (95% CI) -16.7 to 1.22). No known determinants of fatigue predictive of change in FISSA scores were found. DISCUSSION: Fatigue appears to be relatively stable within adults with cerebral palsy over time, with a variable presentation between individuals and across GMFCS levels. Care providers should monitor and discuss fatigue in young individuals with cerebral palsy in order to attenuate fatigue later in life

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Introduction: Previous research showed that there is no agreement on a practically applicable model to use in the evaluation of trauma care. A modification of the Trauma and Injury Severity Score (modified TRISS) is used to evaluate trauma care in the Netherlands. The aim of this study w

Effect of a gum-based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

Altres ajuts: This work has been supported by Danone Nutricia Research, Fundació Salut del Consorci Sanitari del Maresme, Furega (Fundació per a la Recerca en Gastroenterologia) and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd).Background: Increasing viscosity with thickening agents is a valid therapeutic strategy for oropharyngeal dysphagia (OD). To assess the therapeutic effect of a xanthan gum-based thickener (Nutilis Clear) at six viscosities compared with thin liquid in poststroke OD (PSOD) patients. Methods: A total of 120 patients with PSOD were studied in this controlled, multiple-dose, fixed-order, and single-blind study using videofluoroscopy (VFSS). A series of boluses of 10 mL thin liquid and 2000, 1400, 800, 450, 250, and 150 mPa s viscosities were given in duplicate, interrupted in case of aspiration. We assessed the safety and efficacy of swallow and the kinematics of the swallow response. Key Results: A total of 41.2% patients had safe swallow at thin liquid which significantly increased for all viscosities from 71.9% at 150 mPa s to 95.6% at 1400 mPa s (P <.001). PAS score (3.7 ± 2.3) at thin liquid was also reduced by increasing bolus viscosity (P <.001). The prevalence of patients with aspiration at thin liquid was 17.5% and decreased at all viscosities (P <.01), except at 150 mPa s. Increasing viscosity shortened time to laryngeal vestibule closure (LVC) at all viscosities (P <.01) and reduced bolus velocity at ≥450 mPa s (P <.05). The prevalence of patients with pharyngeal residue at each viscosity 37.7%-44.7% was similar to that at thin liquid (41.2%). Conclusions and Inferences: The prevalence of unsafe swallow with thin liquids is very high in PSOD. Increasing shear bolus viscosity with this xanthan gum-based thickener significantly increased the safety of swallow in patients with PSOD in a viscosity-dependent manner without increasing the prevalence of pharyngeal residue

Impact of contractures on daily functioning in adolescents with spinal muscular atrophy: a qualitative study

PURPOSE: Exploring the impact of contractures in adolescents and young adults (AYA) with spinal muscular atrophy (SMA) on daily functioning and participation and the impact of received contracture management. METHODS: We included 14, non-ambulant AYA with SMA types 2/3 (10 females and 4 males), aged 16-30 years. Interviews focused on two topics: perceived impact of contractures on daily functioning and of previous contracture management. We used inductive thematic analysis for interview analysis. RESULTS: In general, participants experienced muscle weakness to be more of a hindrance than contractures; they had adapted to their contractures over time. Participants considered contracture treatment useful when goals were meaningful and realistic. Participants mentioned that their perspective on contracture management would change in light of a promise of improved motor function due to disease-modifying treatment. CONCLUSION: Despite the relatively low impact of contractures in comparison to the loss of muscle strength, non-ambulant AYA with SMA should be informed on the potential impact of contractures and benefits and potential adverse effects of their management. This information can support the shared decision-making process. While respecting individual choices, allows for incorporating interventions into daily life and the promotion of daily functioning and participation when children with SMA are growing up

Long-term changes in dysnatremia incidence in the ICU: a shift from hyponatremia to hypernatremia

Background: Dysnatremia is associated with adverse outcome in critically ill patients. Changes in patients or treatment strategies may have affected the incidence of dysnatremia over time. We investigated long-term changes in the incidence of dysnatremia and analyzed its association with mortality. Methods: Over a 21-year period (1992–2012), all serum sodium measurements were analyzed retrospectively in two university hospital ICUs, up to day 28 of ICU admission for the presence of dysnatremia. The study period was divided into five periods. All serum sodium measurements were collected from the electronic databases of both ICUs. Serum sodium was measured at the clinical chemistry departments using standard methods. All sodium measurements were categorized in the following categories: 160 mmol/L. Mortality was determined at 90 days after ICU admission. Results: In 80,571 ICU patients, 913,272 serum sodium measurements were analyzed. A striking shift in the pattern of ICU-acquired dysnatremias was observed: The incidence of hyponatremia almost halved (47–25 %, p  155 mmol/L) increased dramatically over the years. On ICU day 10 this incidence was 0.7 % in the 1992–1996 period, compared to 6.3 % in the 2009–2012 period (p < 0.001). More severe dysnatremia was associated with significantly higher mortality throughout the 21-year study period (p < 0.001). Conclusions: In two large Dutch cohorts, we observed a marked shift in the incidence of dysnatremia from hyponatremia to hypernatremia over two decades. As hypernatremia was mostly ICU acquired, this strongly suggests changes in treatment as underlying causes. This shift may be related to the increased use of sodium-containing infusions, diuretics, and hydrocortisone. As ICU-acquired hypernatremia is largely iatrogenic, it should be—to an important extent—preventable, and its incidence may be considered as an indicator of quality of care. Strategies to prevent hypernatremia deserve more emphasis; therefore, we recommend that further study should be focused on interventions to prevent the occurrence of dysnatremias during ICU stay

Potential for increased connectivity between differentiated wolverine populations

Information on genetic population structure provides important knowledge for species conservation. Yet, few studies combine extensive genetic data to evaluate the structure and population dynamics of transboundary populations. Here we used single nucleotide polymorphisms (SNPs), microsatellites and mitochondrial haplotypes to analyze the genetic population structure of wolverines (Gulo gulo) across Fennoscandia using a long-term monitoring dataset of 1708 individuals. Clear population subdivision was detected between the Scandinavian and the eastern Finnish population with a steep cline in the contact zone. While the Scandinavian population showed isolation by distance, large swaths of this population were characterized by high connectivity. Areas with high resistance to gene flow are likely explained by a combination of factors, such as historical isolation and founder effects. From a conservation perspective, promoting gene flow from the population in eastern Finland to the northwest of Scandinavia could augment the less variable Scandinavian population, and increase the demographic resilience of all subpopulations. Overall, the large areas of low resistance to gene flow suggest that transboundary cooperation with aligned actions of harvest and conflict mitigation could improve genetic connectivity across Finland, Sweden, and Norway

The Value of 3D Printed Models in Understanding Acetabular Fractures

Acetabular fractures are complex and difficult to classify. Although the Judet-Letournel classification is designed to increase the understanding of acetabular fractures, it remains prone to error when using conventional medical imaging. We hypothesize that three-dimensional (3D) printing, as a new diagnostic imaging tool, will lead to an increased understanding and knowledge of acetabular fractures and an optimal surgical approach. Digital data (DICOM) of 20 acetabular fractures were converted into 3D files [standard tessellation language (STL) data]. These STL files were used to prepare 3D prints of life-size hemipelvic models with acetabular fractures. Seven senior trauma surgeons specializing in pelvic and acetabular surgery, 5 young fellowship-trained trauma surgeons, 5 senior surgical residents, 5 junior surgical residents, and 5 interns classified 20 acetabular cases using X-ray/two-dimensional (2D) computed tomography (CT), 3D reconstructions, and 3D printed models according to the Judet-Letournel classification. Furthermore, all junior and senior surgeons were instructed to evaluate their surgical approach and the positioning of the patient during operation. Time to classify each case was recorded. Calculations were done using Fleiss' κ statistics. Only slight and fair interobserver agreements for senior surgeons (κ = 0.33) and interns (κ = 0.16) were found when using X-ray/2D CT. However, 3D printed models showed moderate and substantial interobserver agreements for senior surgeons (κ = 0.59), junior surgeons (κ = 0.56), senior surgical residents (κ = 0.66), junior surgical residents (κ = 0.51), and interns (κ = 0.61). Compared with X-ray/2D CT, the interobserver agreement regarding the surgical approach for junior surgeons using 3D printed models increased by κ = 0.04 and κ = 0.23, respectively. Except for the interns, a significant time difference for classification was found between X-ray/2D CT and 3D CT and 3D printed models for junior and senior surgical residents and junior and senior surgeons (p < 0.001). 3D printing is of added value in the understanding, classification, and surgical evaluation of acetabular fractures. We recommend the implementation of 3D printed models in trauma surgery training

Hippocampus Leads Ventral Striatum in Replay of Place-Reward Information

While the brain is asleep, the hippocampus plays first fiddle in the orchestra of memory; spatial information is reactivated in the hippocampus shortly in advance of emotional memory traces in the vental striatum

Health status and psychological outcomes after trauma: A prospective multicenter cohort study

Introduction Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up. Methods Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses. Results A total of 4,883 patients participated (median age 68 (Interquartile range 53–80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively. Discussion HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress. Trial registration ClinicalTrials.gov identifier: NCT02508675