Wild Swans

Tradução de: Sandra Negretti

Impacts of Information Quality on the Use and Effectiveness of Computerized Clinical Reminders

A computerized clinical reminder (CCR) system is a type of decision support system triggered by a set of Boolean rules and a knowledge base to remind healthcare providers of a recommended action. CCR system has received increasing attention as a tool to improve evidence-based practice and quality of care. This study laid out the methodology to improve CCR information quality by aligning information flow with clinicians\u27 mental model in decision making. The results concluded the modified CCR features were perceived useful and better. This information quality framework not only expedited decision making, but significantly impacted the way clinicians prioritized CCR by eighty percent

Retrospektive Vergleichsanalyse der Fusionsraten eines TLIF PEEK Cages in Abhängigkeit vom versorgten Wirbelsegment

Seit Beschreibung der TLIF Technik 1982 durch Harms und Rolinger1 sowie Erweiterung auf degenerative Wirbelsäulenerkrankung 19982 hat sich diese als Standard zur interkorporellen Fusion bei Spondylodesen etabliert. Die anatomischen und biomechanischen Gegebenheiten sind in jedem Wirbelsäulensegment unterschiedlich. Die tieferen Segmente sind mit einer größeren Wahrscheinlichkeit degenerativen Prozessen ausgesetzt. Auf Grund dessen ist es ebenfalls denkbar, dass die einzelnen Segmente ein unterschiedliches Fusionsverhalten zeigen. Hierüber existieren nach aktuellem Kenntnisstand der Verfasserin der vorliegenden Arbeit bisher jedoch keine Studien. Die vorliegende Studie untersuchte 48 Segmente (L3/4=15, L4/5=33), die durch eine TLIF adressiert worden sind, auf das segmentbezogene Fusionsverhalten mittels röntgenologischer Auswertung durch zwei unabhängige Untersucher anhand eines radiologischen Auswertungsbogens. Außerdem erfolgte die Evaluation des Zusammenhangs zwischen Fusionsergebnis und klinischem Outcome. Es zeigte sich eine Gesamtfusionsrate von 20,8 %. Ein signifikanter Unterschied im segmentabhängigen Fusionsverhalten konnte nicht gezeigt werden. Es deutete sich jedoch an, dass die Chance für eine Fusion im Segment L4/5 kleiner ist, als bei L3/4. Diese Fusionsraten sind im Vergleich zur bereits veröffentlichen Literatur sehr gering. Deshalb wurden die Einflussfaktoren herausgearbeitet, die das Fusionsergebnis negativ beeinflussen können. Diese konnten in die Rubriken Patientengut, Operationstechnik, Materialien und Komplikationen unterteilt werden. Ebenfalls ist es schwierig auf Grund der Vielzahl an Materialien, die für das Erreichen einer Fusion in Frage kommen, einen Vergleich mit der bereits bekannten und sehr inhomogenen Literatur durchzuführen. Hinzu kommt, dass die Definition der Fusion immer noch die größte Hürde in der Beurteilung von interkorporellen Fusion darstellt. Es existieren keine einheitlichen Scores und keine einheitliche Bildgebung, die als Standard hierfür in Frage kämen. In der vorliegenden Studie wurde in Anlehnung an bereits veröffentliche Fusionsdefinitionen eine neue, jedoch strengere Definition konstruiert wodurch die niedrigen Fusionsraten ebenfalls erklärt werden können. Zusätzlich wurden in der vorliegenden Arbeit sehr genaue Kriterien für eine Pseudarthrose definiert. Dies spiegelt sich in den vergleichsweise hohen Pseudarthroseraten (56,4 %) wider. Trotz der geringen Fusionsrate von 20,8% und der hohen Pseudarthroserate zeigte sich jedoch in der klinischen Auswertung eine durchschnittliche Verbesserung der VAS-Werte von 4,5 sowie der ODI Werte von 31,1 %. Das Fusionsergebnis zeigte hierbei keinen signifikanten Einfluss auf das klinische Ergebnis. Somit existiert laut dieser Studie kein Zusammenhang zwischen Fusionsergebnis und klinischem Outcome. Da diese Beobachtungen bereits in der Vergangenheit von Cloward3 gemacht worden sind wurde seine Theorie erneut aufgegriffen und bestätigt. Er deutete 1948 an, dass bereits fibröse Neubildungen ausreichten, dass die Patienten postoperativ asymptomatisch wurden. Somit ist ein negatives Fusionsergebnis, bzw. eine Pseudarthrose nicht automatisch mit einem negativen klinischen Outcome gekoppelt3–9. Dies konnte auch in der vorliegenden Arbeit gezeigt werden. 1. Harms J, Rolinger H: Die operative Behandlung der Spondyloisthese durch dorsale Aufrichtung und ventrale Verblockung. Z. Orthop. Ihre Grenzgeb. 120: 343–7, 2008 2. Harms JG, Jeszenszky D: Die posteriore, lumbale, interkorporelle Fusion in unilateraler transforaminaler Technik. Oper. Orthop. Traumatol. 10: 90–102, 1998 3. Cloward RB: Spondylolisthesis: treatment by laminectomy and posterior interbody fusion. Clin. Orthop. Relat. Res. 74–82, 1948 4. Mardjetko SM, Connolly PJ, Shott S: Degenerative Lumbar Spondylolisthesis. Spine (Phila. Pa. 1976). 19: 2256S–2265S, 1994 5. Herkowitz HN, Kurz LT: Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J. Bone Joint Surg. Am. 73: 802–8, 1991 6. DePalma AF, Rothman RH: The nature of pseudarthrosis. Clin. Orthop. Relat. Res. 59: 113–8, 1968 7. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT: 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila. Pa. 1976). 22: 2807–12, 1997 8. Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS: Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine (Phila. Pa. 1976). 29: 724–726, 2004 9. Faundez AA, Schwender JD, Safriel Y, Gilbert TJ, Mehbod AA, Denis F, Transfeldt EE, Wroblewski JM: Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients. Eur. Spine J. 18: 203–11, 200

Elektromobilität : Technologie mit Zukunft?

Elektromobilität bedeutet für die Gesellschaft eine technologische Zeitenwende. Die stufenweise Elektrifizierung der Straßenfahrzeuge - vom Hybrid bis zum reinen elektrisch betriebenen Auto - eröffnet Optionen auf eine zukunftsfähige Mobilität. Nachfolgend gilt es, die Herausforderungen zu betrachten und zu analysieren. Neben geschichtlichen und technischen Fakten wird der Hauptaugenmerk auf die Förderpolitik, die Marktdurchdringung und die damit verbundenen Chancen und Risiken gelegt

Análise do programa de benefícios da empresa Incopesa

Orientador: Joel Souza e SilvaMonografia (Especialização) - Universidade Federal do Paraná, Setor de Ciências Sociais Aplicadas, Curso de Especialização em Administração de PessoasResumo: Este trabalho foi realizado na área de Administração de Recursos Humanos, teve como objetivo analisar o programa de benefícios sociais e financeiros que a empresa lncopesa, oferece a seus funcionários. Buscando através da literatura pertinente, relatar sobre o programa de benefícios sociais e financeiros, pois não basta apenas remunerar os colaboradores da empresa, é preciso incentivá-los continuamente a fazer o melhor possível em busca de melhores resultados. A metodologia empregada foi estudos exploratórios - descritivos combinados, sendo que a população pesquisa foram os colaboradores da empresa em estudo, através de questionários com questões abertas e fechadas. Os resultados apresentaram o conhecimento significativo de como está o benefício da empresa, os pontos fortes e fracos e ao concluir o trabalho, sugeriu-se algumas melhorias advindas da coleta de dado

Loss of Cx43 in Murine Sertoli Cells Leads to Altered Prepubertal Sertoli Cell Maturation and Impairment of the Mitosis-Meiosis Switch.

Male factor infertility is a problem in today's society but many underlying causes are still unknown. The generation of a conditional Sertoli cell (SC)-specific connexin 43 (Cx43) knockout mouse line (SCCx43KO) has provided a translational model. Expression of the gap junction protein Cx43 between adjacent SCs as well as between SCs and germ cells (GCs) is known to be essential for the initiation and maintenance of spermatogenesis in different species and men. Adult SCCx43KO males show altered spermatogenesis and are infertile. Thus, the present study aims to identify molecular mechanisms leading to testicular alterations in prepubertal SCCx43KO mice. Transcriptome analysis of 8-, 10- and 12-day-old mice was performed by next-generation sequencing (NGS). Additionally, candidate genes were examined by qRT-PCR and immunohistochemistry. NGS revealed many significantly differentially expressed genes in the SCCx43KO mice. For example, GCspecific genes were mostly downregulated and found to be involved in meiosis and spermatogonial differentiation (e.g., Dmrtb1, Sohlh1). In contrast, SC-specific genes implicated in SC maturation and proliferation were mostly upregulated (e.g., Amh, Fshr). In conclusion, Cx43 in SCs appears to be required for normal progression of the first wave of spermatogenesis, especially for the mitosis-meiosis switch, and also for the regulation of prepubertal SC maturation

Characterization of the Elasticity of CD4+ T Cells: An Approach Based on Peak Force Quantitative Nanomechanical Mapping

CD4+ T cells are essential players in orchestrating the specific immune response against intracellular pathogens, and in inhibiting tumor development in an early stage. The activation of T cells is triggered by engagement of T cell receptors (TCRs). Here, CD3 and CD28 molecules are key factors, (co)stimulating signaling pathways essential for activation and proliferation of CD4+ T cells. T cell activation induces the formation of a tight mechanical bond between T cell and target cell, the so-called immunological synapse (IS). Due to this, mechanical cell properties, including stiffness, play a significant role in modulating cell functions. In the past, many approaches were made to investigate mechanical properties of immune cells, including micropipette aspiration, microplate-based rheometry, techniques based on deformation during cytometry, or the use of optical tweezers. However, the stiffness of T lymphocytes at a subcellular level at the IS still remains largely elusive. With this protocol, we introduce a method based on atomic force microscopy (AFM), to investigate the local cellular stiffness of T cells on functionalized glass/Polydimethylsiloxan (PDMS) surfaces, which mimicks focal stimulation of target cells inducing IS formation by T cells. By applying the peak force nanomechanical mapping (QNM) technique, cellular surface structures and the local stiffness are determined simultaneously, with a resolution of approximately 60 nm. This protocol can be easily adapted to investigate the mechanical impact of numerous factors influencing IS formation and T cell activation

T cell stiffness is enhanced upon formation of immunological synapse

T cells are activated by target cells via an intimate contact, termed immunological synapse (IS). Cellular mechanical properties, especially stiffness, are essential to regulate cell functions. However, T cell stiffness at a subcellular level at the IS still remains largely elusive. In this work, we established an atomic force microscopy (AFM)-based elasticity mapping method on whole T cells to obtain an overview of the stiffness with a resolution of ~60 nm. Using primary human CD4+ T cells, we show that when T cells form IS with stimulating antibody-coated surfaces, the lamellipodia are stiffer than the cell body. Upon IS formation, T cell stiffness is enhanced both at the lamellipodia and on the cell body. Chelation of intracellular Ca2+ abolishes IS-induced stiffening at the lamellipodia but has no influence on cell-body-stiffening, suggesting different regulatory mechanisms of IS-induced stiffening at the lamellipodia and the cell body

Progress Report on pH-Influenced Photocatalysis for Active Motion

Living systems use catalysis to achieve chemical transformations to comply with their needs in terms of energy and building blocks. The pH is a powerful means to regulate such processes, which also influences synthetic systems. In fact, the pH sensitivity of artificial photocatalysts, such as bismuth vanadate, bears the strong potential of flexibly influencing both the motion pattern and the speed of catalytic microswimmers, but it has rarely been investigated to date. In this work, we first present a comprehensive view of the motion behavior of differently shaped bismuth vanadate microswimmers, discuss influences, such as shape, pH, and conductivity of the solutions, and find that the motion pattern of the swimmers switches between upright and horizontal at their point of zero charge. We then apply an immobilizable hydroxypyrene derivative to our substrates to locally influence the pH of the solution by excited-state proton transfer. We find that the motion pattern of our swimmers is strongly influenced by this functionalization and a third motion mode, called tumbling, is introduced. Taking other effects, such as an increased surface roughness of the modified substrates, into account, we critically discuss possible future developments