A family-tailored early motor intervention (EMI-Heart) for infants with complex congenital heart disease: study protocol for a feasibility RCT

BACKGROUND Children with congenital heart disease (CHD) undergoing open-heart surgery are at risk for developmental impairments with motor delay manifesting first and contributing to parental concerns. Only a few interventional studies aim to improve neuromotor development in infants with CHD with inconclusive results. We thus developed a family-tailored early motor intervention (EMI-Heart), which aims to promote motor development and family well-being in the first year of life after open-heart surgery. The primary aim described in this protocol is to evaluate feasibility of EMI-Heart. The secondary aim is to describe the difference between the intervention and control group in motor outcomes and family well-being at baseline, post-treatment, and follow-up. METHODS This prospective, parallel single-center feasibility randomized controlled trial (RCT) will compare EMI-Heart with standard of care in infants with complex CHD. Sixteen infants and their families, randomly allocated to EMI-Heart or the control group, will participate within the first 5 months of life. Infants assigned to EMI-Heart will receive early motor intervention for 3 months. The intervention's key is to promote infants' postural control to enhance motor development and partnering with parents to encourage family well-being. Feasibility outcomes will be (a) clinical recruitment rate and percentage of families completing EMI-Heart, (b) average duration and number of sessions, and (c) acceptability of EMI-Heart using a parental questionnaire post-treatment, and descriptive acceptability of EMI-Heart to the pediatric physiotherapist. Secondary outcomes of the intervention and control group will be infants' motor outcomes and questionnaires assessing family well-being at 3-5 months (baseline), at 6-8 months (post-treatment), and at 12 months of age (follow-up). We will evaluate feasibility using descriptive statistics. Non-parametric statistical analysis of secondary outcomes will assess differences between the groups at baseline, post-treatment, and follow-up. DISCUSSION This feasibility RCT will provide information about a newly developed family-tailored early motor intervention in infants with complex CHD. The RCT design will provide a foundation for a future large-scale interventional trial for infants with CHD after open-heart surgery. TRIAL REGISTRATION This study protocol (version 1.3, 01.02.2022) was approved by the Cantonal Ethics Commission Zurich (BASEC-Nr. 2019-01,787) and is registered by Clinicaltrials.gov (NCTT04666857)

Diagnosis-Related Groups in Hand Surgery – a comparison of six European countries

Diagnosis-Related Group (DRG) is a classification system, which groups patients according to their diagnosis and resource consumption. Common hand surgical diagnoses and procedures were processed using national DRG-groupers of six European countries

The use of social networks within the European Higher Education Area

Este trabajo recoge la experiencia de tres profesores noveles y una profesora mentora tras su participación en el proyecto “Formación del Profesorado Novel”, organizado por el Instituto de Ciencias de la Educación (ICE) de la Universidad de Sevilla durante el curso académico 2011-2012. La incorporación de las redes sociales a la metodología docente universitaria, así como un uso intensivo de la plataforma virtual WebCT, se propusieron como dos de las actividades a desarrollar. El objetivo del artículo es analizar si se produce una mejora en la participación activa y los resultados académicos del alumnado al incorporar tecnologías de la información y las comunicaciones (TICs) como base de las metodologías docentes. Para ello, se ha realizado un experimento de campo utilizando los resultados de tres asignaturas diferentes durante el curso académico 2011-2012: Introducción a las Finanzas, de primer curso, y Mercados Financieros Derivados, de tercer curso, ambas del grado en Finanzas y Contabilidad, y Dirección Financiera, de cuarto curso de la Licenciatura en Administración y Dirección de Empresas. Con este análisis buscamos: (a) contribuir a un mejor conocimiento a la hora de aplicar nuevas tecnologías como metodología docente; y (b) comprobar en qué medida una participación activa del alumno puede pronosticar una buena nota en el examen. Tras la aplicación de estadística descriptiva y análisis de regresión logística (logit), nuestros resultados muestran que aquellos alumnos con una participación más activa en el seguimiento de la asignatura mejoran significativamente su rendimiento académico.This paper describes the experience of three novice lecturers and a mentor lecturer, after their participation in the project "Beginner Teacher Training" organized by the Institute of Education Sciences (ICE) at the University of Seville during the academic year 2011-2012. The incorporation of social networks to the university teaching methodology and an intensive use of the WebCT virtual platform were proposed as two of the activities to be developed. Our objective in this article is to determine if there is an improvement in the student results when new technologies that require active student participation are incorporated as the basis of the teaching methodology. To this end, a field experiment is carried out by using the results of three different subjects for the academic course 2011-2012: Introduction to Finance (first year), Derivatives Financial Markets (third year), both belong to the degree in Finance and Accounting, and Corporate Finance (fourth year) of the degree in Business Administration and Management. With this analysis we aim to: (a) contribute to a better understanding when implementing new technologies into the teaching methodology, and (b) verify to what extent a student's active participation can predict a good mark in the exam. By using descriptive statistics and logistic regression analysis, the results show a marked improvement in the academic performance of those students whose participation is more active in the pursuit of the subject

The genetic overlap between mood disorders and cardiometabolic diseases: a systematic review of genome wide and candidate gene studies

© The Author(s) 2017 This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material.Meta-analyses of genome-wide association studies (meta-GWASs) and candidate gene studies have identified genetic variants associated with cardiovascular diseases, metabolic diseases and mood disorders. Although previous efforts were successful for individual disease conditions (single disease), limited information exists on shared genetic risk between these disorders. This article presents a detailed review and analysis of cardiometabolic diseases risk (CMD-R) genes that are also associated with mood disorders. First, we reviewed meta-GWASs published until January 2016, for the diseases ‘type 2 diabetes, coronary artery disease, hypertension’ and/or for the risk factors ‘blood pressure, obesity, plasma lipid levels, insulin and glucose related traits’. We then searched the literature for published associations of these CMD-R genes with mood disorders. We considered studies that reported a significant association of at least one of the CMD-R genes and ‘depression’ or ‘depressive disorder’ or ‘depressive symptoms’ or ‘bipolar disorder’ or ‘lithium treatment response in bipolar disorder’, or ‘serotonin reuptake inhibitors treatment response in major depression’. Our review revealed 24 potential pleiotropic genes that are likely to be shared between mood disorders and CMD-Rs. These genes include MTHFR, CACNA1D, CACNB2, GNAS, ADRB1, NCAN, REST, FTO, POMC, BDNF, CREB, ITIH4, LEP, GSK3B, SLC18A1, TLR4, PPP1R1B, APOE, CRY2, HTR1A, ADRA2A, TCF7L2, MTNR1B and IGF1. A pathway analysis of these genes revealed significant pathways: corticotrophin-releasing hormone signaling, AMPK signaling, cAMP-mediated or G-protein coupled receptor signaling, axonal guidance signaling, serotonin or dopamine receptors signaling, dopamine-DARPP32 feedback in cAMP signaling, circadian rhythm signaling and leptin signaling. Our review provides insights into the shared biological mechanisms of mood disorders and cardiometabolic diseases

Stromal mesenteric lymph node cells are essential for the generation of gut-homing T cells in vivo

T cells primed in the gut-draining mesenteric lymph nodes (mLN) are imprinted to express α4β7-integrin and chemokine receptor CCR9, thereby enabling lymphocytes to migrate to the small intestine. In vitro activation by intestinal dendritic cells (DC) or addition of retinoic acid (RA) is sufficient to instruct expression of these gut-homing molecules. We report that in vivo stroma cells, but not DC, allow the mLN to induce the generation of gut tropism. Peripheral LN (pLN) transplanted into the gut mesenteries fail to support the generation of gut-homing T cells, even though gut-derived DC enter the transplants and prime T cells. DC that fail to induce α4β7-integrin and CCR9 in vitro readily induce these factors in vivo upon injection into mLN afferent lymphatics. Moreover, uniquely mesenteric but not pLN stroma cells express high levels of RA-producing enzymes and support induction of CCR9 on activated T cells in vitro. These results demonstrate a hitherto unrecognized contribution of stromal cell delivered signals, including RA, on the imprinting of tissue tropism in vivo

Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

Objective: To investigate efficacy and safety of enoxaparin for catheter-related arterial thrombosis in infants with congenital heart disease. Design: Prospective observational study. Setting: Pediatric Intensive Care and Cardiology Unit at the University Children's Hospital of Zurich. Patients: Acohort of 32 infants aged 0-12 months treated with enoxaparin for catheter-related arterial thrombosis from 2002 to 2005. Measurements: Dose requirements of enoxaparin, resolution of thrombosis by Doppler ultrasound, and bleeding complications. Results: Catheter-related arterial thrombosis was located in the iliac/femoral arteries in 31 (97%) infants and aorta in 1 infant, and was related to indwelling catheters and cardiac catheterization in 17 (53%) and 15 (47%) cases, respectively. Newborns required increased doses of enoxaparin to achieve therapeutic anti-FXa levels (mean 1.62 mg/kg per dose) compared with infants aged 2-12 months (mean 1.12 mg/kg per dose; p = 0.0002). Complete resolution of arterial thrombosis occurred in 29 (91%) infants at amean of 23 days after initiation of enoxaparin therapy. Partial or no resolution was observed in 1 (3%) and 2 (6%) infants, respectively, at amean follow-up time of 4.3 months. Bleeding complications occurred in 1 (3%) infant. Conclusion: Enoxaparin is efficient and safe for infants with congenital heart disease and catheter-related arterial thrombosis, possibly representing avalid alternative to the currently recommended unfractionated hepari

Way to increase the efficiency of a reactions: steady and unsteady state catalysis

In the lecture on the example of the process of benzene hydrogenation taking into account the presence of thiophene in the feed gas was discussed approaches to the developing of the unsteady state kinetic model and process optimization. On the base of the kinetic model the theoretical analysis of the reactor performance under unsteady state conditions and unsteady state was carried out.It is shown that for periodic reactor operation an average conversion was up to several times higher than the steady state value

Lücken schließen: Der verantwortungsbewusste Umgang mit IT-Sicherheitslücken

Praktisch ausnutzbare Sicherheitslücken bedrohen die IT-Sicherheit privater wie staatlicher Infrastrukturen. Die Beseitigung der Lücken ist daher für alle Akteure, wie Produktherstellerinnen und -hersteller, Betreiberinnen und Betreiber sowie Nutzerinnen und Nutzer, wünschenswert. Dennoch zeigten Konflikte zwischen Herstellerseite und unabhängigen, proaktiv tätigen Sicherheitsforschenden, dass ein auf Kooperation basierendes Schwachstellenmanagement oftmals fehlt. Obwohl sich Expertinnen und Experten überwiegend bezüglich der grundsätzlichen Notwendigkeit eines koordinierten Zusammenwirkens durch Coordinated-Vulnerability-Disclosure-Prozesse (CVD) einig sind, ist dieses aktuell weder rechtlich verpflichtend geregelt noch flächendeckend umgesetzt. Vielmehr sind durch die Rechtsunsicherheiten für Forschende Abschreckungseffekte zu beobachten. Der „bidt Impuls“ skizziert diesen Status quo und zeigt Lösungsansätze auf, um die konfligierenden Interessens- und Rechtspositionen zu entwirren. Neben der Beseitigung einiger rechtlicher Hemmnisse durch die Gesetzgebung wird von den Autorinnen und Autoren die Einrichtung einer koordinierenden und im Konfliktfall schlichtenden Meldestelle zur Unterstützung von Disclosure-Prozessen empfohlen