Einfluss von Suggestion auf die psychophysiologische Entspannungsreaktion während Akupunktur bei Gesunden

In der randomisierten, kontrollierten, klinisch-experimentellen Grundlagen­untersuchung wurde der Einfluss verbaler Entspannungssuggestion auf die psycho­vegetative Wirkung einer Aku­punkturbehandlung untersucht. Hierzu wurde die Modulation der psychophysiologischen Aktivie­rung in vier verschiedenen Gruppen à 12 gesunden Versuchspersonen gemessen. In Gruppe A wurde an den Extrapunkten „Sishencong“ akupunktiert, in Gruppe B erfolgte ausschließlich eine verbale Entspannungssuggestion, in Gruppe C die Akupunktur plus zusätzlicher Suggestion, und in Gruppe D durften die Probanden eine vergleichbare Zeit ohne weitere Intervention ruhen. Als Parameter der psychophysiologischen Aktivierung wur­den der arterielle Blutdruck, die Herzfrequenz und die Atemfrequenz gemessen sowie die elektro­dermale Aktivität (EDA) als Indikator der sympathoadrenergen Aktivierung. Diese Parameter wurden vor, während und nach der Akupunkturbehandlung und/ oder der Suggestion unter­sucht. Zur Abbildung der introspektiven Dimension wurden die Befindlich­keit der Probanden durch Fragebogeninventarien, im Speziellen der Eigenschaftswörterliste und einem Kurzinterview zur Entspannungsfähigkeit vor und nach der Behandlung ermittelt. Im Rah­men einer multifaktoriellen Varianzanalyse wurden schließlich die Effekte von Akupunktur und Suggestion sowie deren Interaktionseffekt auf die psycho­physiologischen Parameter ermittelt. In allen vier Gruppen zeigte sich eine Entspannungsreaktion im Sinne einer signifikanten Deaktivierung der psychophysiologischen Parameter im Verlauf des Experimentes, die sich zwischen den Gruppen nicht signifikant unterschied. Im Vergleich zu den nicht-akupunktierten Probanden führte die Akupunktur darüber hinaus zu einem signifikanten initialen Anstieg der elektrodermalen Parameter während des Einstechens der Nadeln, welcher von einem signifikanten Abfall unter die Grundlinie gefolgt wurde. Die Kombination von Akupunktur und Suggestion zeigte keinen Interaktionseffekt. In der Kontrollgruppe war wie in allen anderen Gruppen eine ähnliche Entspannungsreaktion zu beobachten. In den vorliegenden Daten hatte die durchgeführte Entspannungssuggestion keinen Einfluss auf die psychophysiologische Reaktion unter Akupunktur. Die Veränderungen der EDA in den Akupunkturgruppen lassen sich im Rahmen eines erhöhten Symphathikotonus während des Einstechens der Nadeln, gefolgt von einer poststimulativen Symphathikolyse, erklären. Diese Beobachtung passt zu den Ergebnissen vorheriger Studien und könnte die Beobachtung erklären, dass Patienten sich nach Akupunktur häufig etwas müde fühlen. Aufgrund der guten spontanen Entspannungsfähigkeit der hier untersuchten gesunden Probanden lässt sich nicht entscheiden, ob die Entspannungsreaktion von den Nadelreizen an sich oder durch den Effekt des Ruhens während der Sitzung bedingt war

Falls prevention for the elderly

Background: An ageing population, a growing prevalence of chronic diseases and limited financial resources for health care underpin the importance of prevention of disabling health disorders and care dependency in the elderly. A wide variety of measures is generally available for the prevention of falls and fall-related injuries. The spectrum ranges from diagnostic procedures for identifying individuals at risk of falling to complex interventions for the removal or reduction of identified risk factors. However, the clinical and economic effectiveness of the majority of recommended strategies for fall prevention is unclear. Against this background, the literature analyses in this HTA report aim to support decision-making for effective and efficient fall prevention.Research questions: The pivotal research question addresses the effectiveness of single interventions and complex programmes for the prevention of falls and fall-related injuries. The target population are the elderly (> 60 years), living in their own housing or in long term care facilities. Further research questions refer to the cost-effectiveness of fall prevention measures, and their ethical, social and legal implications. Methods: Systematic literature searches were performed in 31 databases covering the publication period from January 2003 to January 2010. While the effectiveness of interventions is solely assessed on the basis of randomised controlled trials (RCT), the assessment of the effectiveness of diagnostic procedures also considers prospective accuracy studies. In order to clarify social, ethical and legal aspects all studies deemed relevant with regard to content were taken into consideration, irrespective of their study design. Study selection and critical appraisal were conducted by two independent assessors. Due to clinical heterogeneity of the studies no meta-analyses were performed.Results: Out of 12,000 references retrieved by literature searches, 184 meet the inclusion criteria. However, to a variable degree the validity of their results must be rated as compromised due to different biasing factors. In summary, it appears that the performance of tests or the application of parameters to identify individuals at risk of falling yields little or no clinically relevant information. Positive effects of exercise interventions may be expected in relatively young and healthy seniors, while studies indicate opposite effects in the fragile elderly. For this specific vulnerable population the modification of the housing environment shows protective effects. A low number of studies, low quality of studies or inconsistent results lead to the conclusion that the effectiveness of the following interventions has to be rated unclear yet: correction of vision disorders, modification of psychotropic medication, vitamin D supplementation, nutritional supplements, psychological interventions, education of nursing personnel, multiple and multifactorial programs as well as the application of hip protectors. For the context of the German health care system the economic evaluations of fall prevention retrieved by the literature searches yield very few useful results. Cost-effectiveness calculations of fall prevention are mostly based on weak effectiveness data as well as on epidemiological and cost data from foreign health care systems. Ethical analysis demonstrates ambivalent views of the target population concerning fall risk and the necessity of fall prevention. The willingness to take up preventive measures depends on a variety of personal factors, the quality of information, guidance and decision-making, the prevention program itself and social support. The analysis of papers regarding legal issues shows three main challenges: the uncertainty of which standard of care has to be expected with regard to fall prevention, the necessity to consider the specific conditions of every single case when measures for fall prevention are applied, and the difficulty to balance the rights to autonomous decision making and physical integrity. Discussion and conclusions: The assessment of clinical effectiveness of interventions for fall prevention is complicated by inherent methodological problems (esp. absence of blinding) and meaningful clinical heterogeneity of available studies. Therefore meta-analyses are not appropriate, and single study results are difficult to interpret. Both problems also impair the informative value of economic analyses. With this background it has to be stated that current recommendations regarding fall prevention in the elderly are not fully supported by scientific evidence. In particular, for the generation of new recommendations the dependency of probable effects on specific characteristics of the target populations or care settings should be taken into consideration. This also applies to the variable factors influencing the willingness of the target population to take up and pursue preventive measures. In the planning of future studies equal weight should be placed on methodological rigour (freedom from biases) and transferability of results into routine care. Economic analyses require input of German data, either in form of a “piggy back study“ or in form of a modelling study that reflects the structures of the German health care system and is based on German epidemiological and cost data

Bioäpfel - besser und gesünder? Eine Vergleichsstudie mit Standard- und Alternativmethoden der Qualitätserfassung

Die am FiBL auf drei Jahre angelegte Vergleichsstudie für Äpfel aus integrierter und biologischer Produktion weist nach dem ersten Versuchsjahr signifikante anbaubedingte Unterschiede nach

On the relationship between peptide adsorption resistance and surface contact angle: a combined experimental and simulation single-molecule study

The force-induced desorption of single peptide chains from mixed OH/CH3-terminated self-assembled monolayers is studied in closely matched molecular dynamics simulations and atomic force microscopy experiments with the goal to gain microscopic understanding of the transition between peptide adsorption and adsorption resistance as the surface contact angle is varied. In both simulations and experiments, the surfaces become adsorption resistant against hydrophilic as well as hydrophobic peptides when their contact angle decreases below θ ≈ 50°-60°, thus confirming the so-called Berg limit established in the context of protein and cell adsorption. Entropy/enthalpy decomposition of the simulation results reveals that the key discriminator between the adsorption of different residues on a hydrophobic monolayer is of entropic nature and thus is suggested to be linked to the hydrophobic effect. By pushing a polyalanine peptide onto a polar surface, simulations reveal that the peptide adsorption resistance is caused by the strongly bound water hydration layer and characterized by the simultaneous gain of both total entropy in the system and total number of hydrogen bonds between water, peptide, and surface. This mechanistic insight into peptide adsorption resistance might help to refine design principles for anti-fouling surfaces

Predictive Ability of the Stability and Workload Index for Transfer Score to Predict Unplanned Readmissions After ICU Discharge

Objective: Unplanned readmission of hospitalized patients to an ICU is associated with an increased mortality and hospital length of stay. The ability to identify patients at risk, who would benefit from prolonged ICU treatment, is limited. The aim of this study is to validate a previously published numerical index named the Stability and Workload Index for Transfer in a heterogeneous group of ICU patients. Design: In this retrospective data analysis, the Stability and Workload Index for Transfer score was calculated for all patients, and the ability of the score to predict readmission was compared with the original publication. Setting: Four ICUs, one intermediate care unit, and one postanesthesia care unit of the department of anesthesia and intensive care of a university hospital. Patients: All consecutive patients treated in one of the units. Interventions: None. Measurements and Main Results: Unplanned ICU readmissions or unexpected death within 7 days of ICU discharge. The data of 7,175 patients were included in the analysis. Five hundred ninety-six patients were readmitted or died within 7 days of discharge. The patients who are readmitted to the ICU are significantly older and have significantly higher scores that define the severity of disease at the time of admission and discharge of their first ICU stay. The source of admission for the initial ICU stay did not differ (p = 0.055), and the last Glasgow Coma Scale and the last Pao(2)/Fio(2) ratio before discharge from the ICU were higher in patients who did not need a readmission to the ICU. The performance of the Stability and Workload Index for Transfer score is poor with an area under the receiver operator curve of 0.581 (95% CI, 0.556-0.605; p < 0.001). Conclusions: Based on the data from our patients, the proposed Stability and Workload Index for Transfer score by Gajic et al is not ideal in aiding the clinician in the decision, if a patient can be discharged safely from the ICU and further research is necessary to define the patients at risk for readmission

Ultrafast linear array detector for real-time imaging

KALYPSO is a novel detector operating at line rates above 10 Mfps. It consists of a detector board connected to FPGA based readout card for real time data processing. The detector board holds a Si or InGaAs linear array sensor, with spectral sensitivity ranging from 400 nm to 2600 nm, which is connected to a custom made front-end ASIC. A FPGA readout framework performs the real time data processing. In this contribution, we present the detector system, the readout electronics and the heterogeneous infrastructure for machine learning processing. The detector is currently in use at several synchrotron facilities for beam diagnostics as well as for single-pulse laser characterizations. Thanks to the shot-to-shot capability over long time scale, new attractive applications are open up for imaging in biological and medical research

Ultra-fast detector for wide range spectral measurements

KALYPSO is a novel detector operating at line rates above 10 Mfps. The detector board holds a silicon or InGaAs linear array sensor with spectral sensitivity ranging from 400 nm to 2600 nm. The sensor is connected to a cutting-edge, custom designed, ASIC readout chip which is responsible for the remarkable frame rate. The FPGA readout architecture enables continuous data acquisition and processing in real time. This detector is currently employed in many synchrotron facilities for beam diagnostics and for the characterization of self-built Ytterbium-doped fiber laser emitting around 1050 nm with a bandwidth of 40 nm

Phylogenetic relationships of species of Raymunida (Decapoda: Galatheidae) based on morphology and mitochondrial cytochrome oxidase sequences, with the recognition of four new species

19 pages.-- RECEIVED: 10 April 2000, ACCEPTED: 8 November 2000.The species of the genus Raymunida from the Pacific and Indian oceans are revised using morphological characters and the mitochondrial cytochrome oxidase subunit I sequences. Four new species are described (R. confundens, R. dextralis, R. erythrina, and R. insulata), and the status of R. bellior and R. elegantissima are revised. The species of Raymunida can be identified by subtle morphological characters, which match differences in mitochondrial nucleotide sequences. Therefore, the sequence divergences confirm the specific and phylogenetic value of some morphological characters (e.g., length of the mesial spine on the basal antennal segment, length of the walking legs). Furthermore, they confirm the importance of the color pattern as a diagnostic character. The widespread species (R. elegantissima), known from the Philippines to Fiji, shows minimal divergence between specimens from different localities (maximum of 3 nucleotide differences or 0.2% mean divergence). The phylogenetic reconstruction agreed with the monophyletic condition of Raymunida and its differentiation with respect to the genus Munida (in which Raymunida species had previously been included) and Agononida.Peer reviewe

Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19