Conducting the emergency team:A novel way to train the team-leader for emergencies

Introduction: Worldwide, medical supervisors find it difficult to get students to rise to the occasion when called upon to act as leaders of emergency teams: many residents/rescuers feel unprepared to adopt the leadership role. The challenge is to address the residents very strong emotions caused by the extremely stressful context. No systematic leadership training takes this aspect into account. Aim: The overall aim of the course is to investigate whether, in an emergency, a clinical team leader could apply a conductor's leadership skills. Background: An orchestral conductor is a specialist in practicing leadership focusing on non-verbal communication. The conductor works with highly trained specialists and must lead them to cooperate and put his interpretation into effect. The conductor works purposefully in order to appear calm, genuine and gain authority. Method: A conductor and a consultant prepared a course for residents, medical students and nurses, n = 61. Ten × two course days were completed. The exercises were musical and thus safe for the students as there were no clinical skills at stake. The programme aimed to create stress and anxiety in a safe learning environment. Conclusion: The transfer of a conductor's skills improved and profoundly changed the participating students', nurses' and residents' behaviour and introduced a method to handle anxiety and show calmness and authority. Perspectives: If this course in leadership is to be introduced as a compulsory part of the educating of doctors, the ideal time would be after clinical skills have been acquired, experience gained and routines understood in the clinic

Highlight-line algorithm for realtime surface-quality assessment

A new method of surface-quality assessment is presented. The model of highlight lines is introduced, and its properties and applications in surface-quality evaluation are demonstrated. The differential equation of the highlight-line model is derived, and the difficulty involved in seeking its analytical solutions is discussed. Alternatively, the creation of highlight lines is formulated as a surface-plane intersection problem, and solved using surface-contouring techniques. A fast highlight-line algorithm is developed utilizing an efficient traced contouring technique. The algorithm is robust, fully automatic, and, therefore, well suited for realtime quality-assessment tasks.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31671/1/0000607.pd

Array-based analysis of genomic DNA methylation patterns of the tumour suppressor gene p16(INK4A) promoter in colon carcinoma cell lines

Aberrant DNA methylation at CpG dinucleotides can result in epigenetic silencing of tumour suppressor genes and represents one of the earliest events in tumourigenesis. To date, however, high-throughput tools that are capable of surveying the methylation status of multiple gene promoters have been restricted to a limited number of cytosines. Here, we present an oligonucleotide microarray that permits the parallel analysis of the methylation status of individual cytosines, thus combining high throughput and high resolution. The approach was used to study the CpG island in the promoter region of the tumour suppressor gene p16(INK4A). In total, 876 oligonucleotide probes of 21 nt in length were used to inspect the methylation status of 53 CpG dinucleotides, producing correct signals in colorectal cancer cell lines as well as control samples with a defined methylation status. The information was validated by established alternative methods. The overall methylation pattern was consistent for each cell line, while different between them. At the level of individual cytosines, however, significant variations between individual cells of the same type were found, but also consistencies across the panel of cancer cell lines were observed

Climate Impact and Model Approaches of Blue-Green Infrastructure Measures for Neighborhood Planning

Nowadays, most cities deal with the problem of “Urban Heat Islands”. Especially existing city districts cannot easily be adapted. In this paper, the effects of blue-green infrastructure elements (BGI) on air and surface temperature in courtyards are examined, based on on-site measurements and simulations. Recognizable effects on the temperature were observed: BGI lower the number of hot days in the courtyard, including a faster air temperature drop at night, but water elements increase the number of tropical nights due to their heat capacity. Model simulations with PALM-4U proved to be useful to analyze the effects of BGI on the microclimate. Besides analyzing existing structures, the effects of planned measures can be quantified by simulation. However, for this application, needs of improvement were recognized to evaluate the influence of BGI on the microclimate more realistically. For decision support, standard indicators such as the number of tropical nights and hot days are not differentiated enough to quantify specific climate stress of urban residents. It is suggested to consider summer days additionally, percentiles could be used instead of fixed thresholds and the entire course of the year should play a role in the evaluation of the elements and urban design

Extinction vortex dynamics of top predators isolated by urbanization

Extinction risk is elevated in small, isolated populations due to demographic and genetic interactions. Therefore, it is critical to model these processes realistically in population viability analyses (PVA) to inform local management and contribute to a greater understanding of mechanisms within the extinction vortex. We conducted PVA’s for two small mountain lion populations isolated by urbanization in southern California to predict population growth, extinction probability, and loss of genetic diversity with empirical data. Specifically, we (1) provide the first PVA for isolated mountain lions in the Santa Ana Mountains (SAM) that considers both demographic and genetic risk factors and (2) test the hypothesis that variation in abundance and mortality between the SAM and Santa Monica Mountains (SMM) result in differences in population growth, loss of heterozygosity, and extinction probability. Our models predicted 16–21% probability of local extinction in the SAM due purely to demographic processes over 50 yr with current low levels or no immigration. Our models also predicted that genetic diversity will further erode in the SAM such that concern regarding inbreeding depression is warranted unless gene flow is increased, and that if inbreeding depression occurs, rapid local extinction will be highly likely. Dynamics of the two populations were broadly similar, but they also exhibited differences driven by larger population size and higher mortality in the SAM. Density-independent scenarios predicted a rapidly increasing population in the SMM, whereas growth potential did not differ from a stable trend in the SAM. Demographic extinction probability and loss of heterozygosity were greater in the SMM for density-dependent scenarios without immigration. However, higher levels of immigration had stronger, positive influences on both demographic viability and retention of genetic diversity in the SMM driven by lower abundance and higher adult survival. Our results elucidate demographic and genetic threats to small populations within the extinction vortex, and how these vary relative to demographic structure. Importantly, simulating seemingly attainable increases in connectivity was sufficient to greatly reduce extinction probability. Our work highlights that conservation of large carnivores is achievable within urbanized landscapes, but requires land protection, connectivity, and strategies to promote coexistence with humans

Telemedizin, Herzinsuffizienz und der ewige Glaube an die Technik: eine konstruktive hausärztliche Analyse und Kritik ihrer Einführung in Deutschland

Hintergrund Menschen mit der Diagnose Herzinsuffizienz sind oft gebrechlich und haben eine schlechte Prognose. Jetzt begegnet ihnen die Medizin mit neuer digitaler Technik in Form der Telemedizin mit dem Ziel einer immer weiteren, im Ergebnis immer geringeren Verlängerung des Lebens. Ziel der Arbeit Bewertung der Einführung des Telemonitorings bei Herzinsuffizienz aus primärmedizinischer Perspektive. Material und Methoden Zusammenfassung der wissenschaftlichen und nichtwissenschaftlichen Literatur zum Thema im Sinne eines narrativen Reviews. Ergebnisse Die Evidenz zum Telemonitoring bei Herzinsuffizienz ist sehr umfangreich und heterogen. Der Nutzen ist schwer einschätzbar. Die wissenschaftliche Grundlage seiner Einführung in Deutschland wurde auf wenige Studien eingeschränkt, die jedoch als Begründung dafür ungenügend erscheinen. Diskussion Ein unkritischer Technikglaube und ein darauf beruhender politischer Wille scheinen die eigentliche Grundlage der Einführung von Telemonitoring bei Herzinsuffizienz zu sein. Statt sich durch immer mehr Technik in immer kleineren Bereichen zu verzetteln, wäre eine digital unterstützte Verbesserung der Dokumentation und Kommunikation der Patientinnen und Patienten mit ihren primären hausärztlichen Versorgungspraxen sowie deren telemedizinische Unterstützung durch Gebietsärztinnen und -ärzte der eigentlich notwendige Schritt

Transcatheter placement of a low-profile biodegradable pulmonary valve made of small intestinal submucosa: A long-term study in a swine model

ObjectiveWe sought to investigate a placement of a percutaneous low-profile prosthetic valve constructed of small intestinal submucosa in the pulmonary position in a swine model.MethodsTwelve female farm pigs were stented at the native pulmonary valve to induce pulmonary insufficiency. Once right ventricular dilation occurred, the small intestinal submucosa valve was implanted. The pigs were followed up with transthoracic echocardiographic Doppler scanning. One animal died of heart failure before valve replacement. Animals were euthanized at 1 day, 1 month, 3 months, 6 months, and 12 months after valve implantation.ResultsThe small intestinal submucosa pulmonary valve showed effective reversal of pulmonary regurgitation. There were no misplacements during deployment. There were no embolizations. One-year echocardiographic follow-up showed minimal regurgitation and no stenosis for a valve/vessel ratio of 0.78 or greater. Histologic examination demonstrated intensive remodeling of the small intestinal submucosal valve. Within 1 month, the surface was covered by endothelium, and fibroblasts invaded the interior. Over the following months, the small intestinal submucosal valve remodeled without apparent graft rejection.ConclusionThe small intestinal submucosa valve has the potential for graft longevity without the need for anticoagulation or immunosuppression. Histologic remodeling of the valve tissue provides a replacement capable of resembling a native valve that can be placed percutaneously with low-profile delivery systems

RNOP-09: Pegylated liposomal doxorubicine and prolonged temozolomide in addition to radiotherapy in newly diagnosed glioblastoma - a phase II study

BACKGROUND: Although Temozolomide is effective against glioblastoma, the prognosis remains dismal and new regimens with synergistic activity are sought for. METHODS: In this phase-I/II trial, pegylated liposomal doxorubicin (Caelyx, PEG-Dox) and prolonged administration of Temozolomide in addition to radiotherapy was investigated in 63 patients with newly diagnosed glioblastoma. In phase-I, PEG-Dox was administered in a 3-by-3 dose-escalation regimen. In phase-II, 20 mg/m2 PEG-Dox was given once prior to radiotherapy and on days 1 and 15 of each 28-day cycle starting 4 weeks after radiotherapy. Temozolomide was given in a dose of 75 mg/m2 daily during radiotherapy (60 Gy) and 150-200 mg/m2 on days 1-5 of each 28-day cycle for 12 cycles or until disease progression. RESULTS: The toxicity of the combination of PEG-Dox, prolonged administration of Temozolomide, and radiotherapy was tolerable. The progression free survival after 12 months (PFS-12) was 30.2%, the median overall survival was 17.6 months in all patients including the ones from Phase-I. None of the endpoints differed significantly from the EORTC26981/NCIC-CE.3 data in a post-hoc statistical comparison. CONCLUSION: Together, the investigated combination is tolerable and feasible. Neither the addition of PEG-Dox nor the prolonged administration of Temozolomide resulted in a meaningful improvement of the patient's outcome as compared to the EORTC26981/NCIC-CE.3 data