Großtagespflegestellen in Niedersachsen : Abschlussbericht des EFRE-Forschungsprojektes

Ein Forschungsteam unter Leitung von Prof. Dr. Romppel hat zwischen 1.8.2011 und 31.7.2014 die Betreuung von Kindern in der Großtagespflege untersucht. Mit der Neufassung des § 24 Abs. 2 SGB VIII zum 1. August 2013 besteht für alle Kinder ab dem 2. Lebensjahr ein Rechtsanspruch auf individuelle Förderung. Der erwarteten wachsenden Nachfrage nach Plätzen für Kinder unter 3 Jahren soll neben dem Krippenausbau auch mit einem Ausbau der Kindertagespflege, in Niedersachsen besonders auch der Großtagespflege, begegnet werden. Großtagespflegestellen sind rechtlich ein gleichwertiges Angebot zur Krippe. Die vorliegende Untersuchung in Niedersachsen geht zum einen der Frage nach, ob die Qualität der pädagogischen Arbeit in den Großtagespflegestellen diesem Anspruch genügen kann. Mit der TAS-R, einem Beobachtungs- und Bewertungsverfahren werden ausgewählte Großtagespflegestellen beurteilt und mit strukturierten Interviews zu ihrer Arbeit befragt. Zudem wird die telefonische und schriftliche Befragung aller Jugendämter Niedersachsens zur Organisation der Fachberatung sowie zur Struktur der finanziellen und fachlichen Unterstützung der Großtagespflegestellen vor Ort vorgestellt. Die Ergebnisse und Empfehlungen für die Verantwortlichen verweisen auf Handlungsbedarf

Reinforcement magnitudes modulate subthalamic beta band activity in patients with Parkinson's disease

We set out to investigate whether beta oscillations in the human basal ganglia are modulated during reinforcement learning. Based on previous research, we assumed that beta activity might either reflect the magnitudes of individuals' received reinforcements (reinforcement hypothesis), their reinforcement prediction errors (dopamine hypothesis) or their tendencies to repeat versus adapt responses based upon reinforcements (status-quo hypothesis). We tested these hypotheses by recording local field potentials (LFPs) from the subthalamic nuclei of 19 Parkinson's disease patients engaged in a reinforcement-learning paradigm. We then correlated patients' reinforcement magnitudes, reinforcement prediction errors and response repetition tendencies with task-related power changes in their LFP oscillations. During feedback presentation, activity in the frequency range of 14 to 27 Hz (beta spectrum) correlated positively with reinforcement magnitudes. During responding, alpha and low beta activity (6 to 18 Hz) was negatively correlated with previous reinforcement magnitudes. Reinforcement prediction errors and response repetition tendencies did not correlate significantly with LFP oscillations. These results suggest that alpha and beta oscillations during reinforcement learning reflect patients' observed reinforcement magnitudes, rather than their reinforcement prediction errors or their tendencies to repeat versus adapt their responses, arguing both against an involvement of phasic dopamine and against applicability of the status-quo theory

Cord Blood Vα24-Vβ11+ Natural Killer T Cells Display a Th2-Chemokine Receptor Profile and Cytokine Responses

Background: The fetal immune system is characterized by a Th2 bias but it is unclear how the Th2 predominance is established. Natural killer T (NKT) cells are a rare subset of T cells with immune regulatory functions and are already activated in utero. To test the hypothesis that NKT cells are part of the regulatory network that sets the fetal Th2 predominance, percentages of Vα24(+)Vβ11(+) NKT cells expressing Th1/Th2-related chemokine receptors (CKR) were assessed in cord blood. Furthermore, IL-4 and IFN-γ secreting NKT cells were quantified within the single CKR(+) subsets. Results: Cord blood NKT cells expressed the Th2-related CCR4 and CCR8 at significantly higher frequencies compared to peripheral blood NKT cells from adults, while CXCR3+ and CCR5+ cord blood NKT cells (Th1-related) were present at lower percentages. Within CD4negCD8neg (DN) NKT cells, the frequency of IL-4 producing NKT cells was significantly higher in cord blood, while frequencies of IFN-γ secreting DN NKT cells tended to be lower. A further subanalysis showed that the higher percentage of IL-4 secreting DN NKT cells was restricted to CCR3+, CCR4+, CCR5+, CCR6+, CCR7+, CCR8+ and CXCR4+ DN subsets in cord blood. This resulted in significantly decreased IFN-γ /IL-4 ratios of CCR3+, CCR6+ and CCR8+ cord blood DN NKT cells. Sequencing of VA24AJ18 T cell receptor (TCR) transcripts in sorted cord blood Vα24Vβ11 cells confirmed the invariant TCR alpha-chain ruling out the possibility that these cells represent an unusual subset of conventional T cells. Conclusions: Despite the heterogeneity of cord blood NKT cells, we observed a clear Th2-bias at the phenotypic and functional level which was mainly found in the DN subset. Therefore, we speculate that NKT cells are important for the initiation and control of the fetal Th2 environment which is needed to maintain tolerance towards self-antigens as well as non-inherited maternal antigens

Deep brain stimulation in patients on chronic antiplatelet or anticoagulation treatment

Background In the aging society, many patients with movement disorders, pain syndromes, or psychiatric disorders who are candidates for deep brain stimulation (DBS) surgery suffer also from cardiovascular co-morbidities that require chronic antiplatelet or anticoagulation treatment. Because of a presumed increased risk of intracranial hemorrhage during or after surgery and limited knowledge about perioperative management, chronic antiplatelet or anticoagulation treatment often has been considered a relative contraindication for DBS. Here, we evaluate whether or not there is an increased risk for intracranial hemorrhage or thromboembolic complications in patients on chronic treatment (paused for surgery or bridged with subcutaneous heparin) as compared to those without. Methods Out of a series of 465 patients undergoing functional stereotactic neurosurgery, 34 patients were identified who were on chronic treatment before and after receiving DBS. In patients with antiplatelet treatment, medication was stopped in the perioperative period. In patients with vitamin K antagonists or novel oral anticoagulants (NOACs), heparin was used for bridging. All patients had postoperative stereotactic CT scans, and were followed up for 1 year after surgery. Results In patients on chronic antiplatelet or anticoagulation treatment, intracranial hemorrhage occurred in 2/34 (5.9%) DBS surgeries, whereas the rate of intracranial hemorrhage was 15/431 (3.5%) in those without, which was statistically not significant. Implantable pulse generator pocket hematomas were seen in 2/34 (5.9%) surgeries in patients on chronic treatment and in 4/426 (0.9%) without. There were only 2 instances of thromboembolic complications which both occurred in patients without chronic treatment. There were no hemorrhagic complications during follow-up for 1 year. Conclusions DBS surgery in patients on chronic antiplatelet or anticoagulation treatment is feasible. Also, there was no increased risk of hemorrhage in the first year of follow-up after DBS surgery. Appropriate patient selection and standardized perioperative management are necessary to reduce the risk of intracranial hemorrhage and thromboembolic complications

A spatiotemporal stochastic climate model for benchmarking causal discovery methods for teleconnections

Teleconnections that link climate processes at widely separated spatial locations form a key component of the climate system. Their analysis has traditionally been based on means, climatologies, correlations, or spectral properties, which cannot always reveal the dynamical mechanisms between different climatological processes. More recently, causal discovery methods based either on time series at grid locations or on modes of variability, estimated through dimension-reduction methods, have been introduced. A major challenge in the development of such analysis methods is a lack of ground truth benchmark datasets that have facilitated improvements in many parts of machine learning. Here, we present a simplified stochastic climate model that outputs gridded data and represents climate modes and their teleconnections through a spatially aggregated vector-autoregressive model. The model is used to construct benchmarks and evaluate a range of analysis methods. The results highlight that the model can be successfully used to benchmark different causal discovery methods for spatiotemporal data and show their strengths and weaknesses. Furthermore, we introduce a novel causal discovery method at the grid level and demonstrate that it has orders of magnitude better performance than the current approaches. Improved causal analysis tools for spatiotemporal climate data are pivotal to advance process-based understanding and climate model evaluation

Reversal of Status Dystonicus after Relocation of Pallidal Electrodes in DYT6 Generalized Dystonia

Background: DYT6 dystonia can have an unpredictable clinical course and the result of deep brain stimulation (DBS) of the internal part of the globus pallidus (GPi) is known to be less robust than in other forms of autosomal dominant dystonia. Patients who had previous stereotactic surgery with insufficient clinical benefit form a particular challenge with very limited other treatment options available. Case Report: A pediatric DYT6 patient unexpectedly deteriorated to status dystonicus 1 year after GPi DBS implantation with good initial clinical response. After repositioning the DBS electrodes the status dystonicus resolved. Discussion: This case study demonstrates that medication-resistant status dystonicus in DYT6 dystonia can be reversed by relocation of pallidal electrodes. This case highlights that repositioning of DBS electrodes may be considered in patients with status dystonicus, especially when the electrode position is not optimal, even after an initial clinical response to DBS