Evaluation der Wundinfiltration zur Reduktion der postoperativen Schmerzen bei der Sectio caesarea

Die Sectio caesarea zählt zu den schmerzhaftesten Operationen und in der Therapie akuter postoperativer Schmerzen besteht noch großer Handlungsbedarf. Das Ziel dieser Untersuchung ist die Evaluation der Wundinfiltration zur Reduktion postoperativer Schmerzen nach Sectio caesarea. Im Untersuchungszeitraum von April 2012 bis Mai 2013 wurden alle Patientinnen nach Sectio caesarea an der Universitätsfrauenklinik Jena eingeschlossen. Ab November 2012 wurde die Standardschmerztherapie um die intraoperative Wundinfiltration mit einer 0,75%-igen Ropivacain-Lösung erweitert. Diese Patientinnen bildeten die Studiengruppe (n=98). Als Kontrollgruppe dienten die vor Einführung der Intervention behandelten Patienten ohne Wundinfiltration(n=96). Die Datenerfassung erfolgte mittels eines validierten Fragebogens des QUIPS-Systems (Qualitätsverbesserung in der postoperativen Schmerztherapie). Hier wurden sowohl subjektive als auch objektive Ergebnisparameter mittels NRS erhoben. Zusätzlich ermöglichte QUIPS einen externen Qualitätsvergleich mit anderen Kliniken in Deutschland. Die maximale Schmerzintensität (p= 0,01) und der Schmerz bei Belastung (p=0,006) wurden signifikant reduziert, während der erfasste Minimalschmerz und die Zufriedenheit mit der Intervention nicht beeinflusst wurden. Frauen mit Wundinfiltration waren bei der Mobilisation weniger beeinträchtigt (p=0,037). Im QUIPS-Benchmarking von 17 Klinken verbesserte sich die Universitätsfrauenklinik Jena von Rang 15 auf Rang 8. Der frühe postoperative Verlauf nach Sectio caesarea ist mit einem großen Schmerzerleben verbunden. Die Wundinfiltration reduziert sowohl den postoperativen Maximal-als auch den Belastungsschmerz signifikant. Ebenso werden die funktionellen Beeinträchtigungen reduziert. Im externen Qualitätsvergleich ist eine deutliche Verbesserung im Benchmarksystem zu verzeichnen

Brand Personality Creation Through Advertising (Study Kfc on Television Commercial Break)

The perfect concept of Advertising and its application on the mass media cannot be separated with one central aspect from any sold product or certain service, named Brand personality and depends on five main aspects, which are Sincerity, Excitement, Competence, Ruggedness and Sophistication, especially for Kentucky Fried Chicken in Manado City.This researchs purposes are to figure out whether Brand Personality give significant influence to the Advertising of KFC at Manado City, simultaneously and to figure out whether Brand Personality give significant influence to the Advertising of KFC at Manado City, partially. To achieve those objectives, Multiple Regression Analysis is used. Its conclusions are Brand Personality generally give the significant influence for the Advertising of KFC and each Brand Personality partially give the significant influence for the Advertising of KFC. Based on the results, companys managers and employees must maintain and enhance the good understanding about three Brand Personality, must improve customers understanding about Sophistication and Excitement, and must give more concern about other influencing factors of the customers understanding about the advertising and its contents. Keywords : brand personality, advertisin

Attribution of chemistry-climate model initiative (CCMI) ozone radiative flux bias from satellites

The top-of-atmosphere (TOA) outgoing longwave flux over the 9.6 µm ozone band is a fundamental quantity for understanding chemistry–climate coupling. However, observed TOA fluxes are hard to estimate as they exhibit considerable variability in space and time that depend on the distributions of clouds, ozone (O3), water vapor (H2O), air temperature (Ta), and surface temperature (Ts). Benchmarking present-day fluxes and quantifying the relative influence of their drivers is the first step for estimating climate feedbacks from ozone radiative forcing and predicting radiative forcing evolution. To that end, we constructed observational instantaneous radiative kernels (IRKs) under clear-sky conditions, representing the sensitivities of the TOA flux in the 9.6 µm ozone band to the vertical distribution of geophysical variables, including O3, H2O, Ta, and Ts based upon the Aura Tropospheric Emission Spectrometer (TES) measurements. Applying these kernels to present-day simulations from the Chemistry-Climate Model Initiative (CCMI) project as compared to a 2006 reanalysis assimilating satellite observations, we show that the models have large differences in TOA flux, attributable to different geophysical variables. In particular, model simulations continue to diverge from observations in the tropics, as reported in previous studies of the Atmospheric Chemistry Climate Model Intercomparison Project (ACCMIP) simulations. The principal culprits are tropical middle and upper tropospheric ozone followed by tropical lower tropospheric H2O. Five models out of the eight studied here have TOA flux biases exceeding 100 mW m−2 attributable to tropospheric ozone bias. Another set of five models have flux biases over 50 mW m−2 due to H2O. On the other hand, Ta radiative bias is negligible in all models (no more than 30 mW m−2). We found that the atmospheric component (AM3) of the Geophysical Fluid Dynamics Laboratory (GFDL) general circulation model and Canadian Middle Atmosphere Model (CMAM) have the lowest TOA flux biases globally but are a result of cancellation of opposite biases due to different processes. Overall, the multi-model ensemble mean bias is −133±98  mW m−2, indicating that they are too atmospherically opaque due to trapping too much radiation in the atmosphere by overestimated tropical tropospheric O3 and H2O. Having too much O3 and H2O in the troposphere would have different impacts on the sensitivity of TOA flux to O3 and these competing effects add more uncertainties on the ozone radiative forcing. We find that the inter-model TOA outgoing longwave radiation (OLR) difference is well anti-correlated with their ozone band flux bias. This suggests that there is significant radiative compensation in the calculation of model outgoing longwave radiation

Effects of a parent training using telehealth: Equity and access to early intervention for rural families

Children living in geographically rural areas may have limited access to early, intensive evidence-based interventions suggesting children residing in these areas are less likely to experience positive outcomes than their urban-dwelling peers.  Telehealth offers an option to rural families seeking early intervention by using communication technologies where providers are able to consult and deliver services in real-time over geographical distances. To our knowledge, no other study has examined the implementation of P-ESDM in rural natural environments within the framework of the state’s early intervention program. Using a multiple baseline design across participants, the current study investigated the effects of the parent-Early Start Denver Model implemented within a rural northeastern state’s existing IDEA Part C early intervention program.  Parents demonstrated increased fidelity to intervention strategies and reported satisfaction with the program’s ease of implementation and observed child gains.  Statistically significant pre-to post- change in children’s ASD symptomatology were reported for the domains of communication, social reciprocity and repetitive and restricted behaviors.  Support for parent-mediated interventions, the importance of fidelity of implementation for sustainability of intervention strategies, and the need to explore telehealth as a viable service delivery option to improve developmental trajectories for toddlers with autism are discussed

Processes and Procedures for Data Publication: A Case Study in the Geosciences

The Peer REview for Publication and Accreditation of Research Data in the Earth sciences (PREPARDE) project is a JISC and NERC funded project which aims to investigate the policies and procedures required for the formal publication of research data, ranging from ingestion into a data repository, through to formal publication in a data journal. It also addresses key issues arising in the data publication paradigm, including, but not limited to, issues related to how one peer reviews a dataset, what criteria are needed for a repository to be considered objectively trustworthy, and how datasets and journal publications can be effectively cross-linked for the benefit of the wider research community. PREPARDE brings together a wide range of experts in the research, academic publishing and data management fields both within the Earth Sciences and in the broader life sciences with the aim of producing general guidelines applicable to a wide range of scientific disciplines and data publication types. This paper provides details of the work done in the first half of the project; the project itself will be completed in June 2013

Immunoadsorption for Treatment of Patients with Suspected Alzheimer Dementia and Agonistic Autoantibodies against Alpha1a-Adrenoceptor—Rationale and Design of the IMAD Pilot Study

Background: agonistic autoantibodies (agAABs) against G protein-coupled receptors (GPCR) have been linked to cardiovascular disease. In dementia patients, GPCR-agAABs against the α1- and ß2-adrenoceptors (α1AR- and ß2AR) were found at a prevalence of 50%. Elimination of agAABs by immunoadsorption (IA) was successfully applied in cardiovascular disease. The IMAD trial (Efficacy of immunoadsorption for treatment of persons with Alzheimer dementia and agonistic autoantibodies against alpha1A-adrenoceptor) investigates whether the removal of α1AR-AABs by a 5-day IA procedure has a positive effect (improvement or non-deterioration) on changes of hemodynamic, cognitive, vascular and metabolic parameters in patients with suspected Alzheimer’s clinical syndrome within a one-year follow-up period. Methods: the IMAD trial is designed as an exploratory monocentric interventional trial corresponding to a proof-of-concept phase-IIa study. If cognition capacity of eligible patients scores 19–26 in the Mini Mental State Examination (MMSE), patients are tested for the presence of agAABs by an enzyme-linked immunosorbent assay (ELISA)-based method, followed by a bioassay-based confirmation test, further screening and treatment with IA and intravenous immunoglobulin G (IgG) replacement. We aim to include 15 patients with IA/IgG and to complete follow-up data from at least 12 patients. The primary outcome parameter of the study is uncorrected mean cerebral perfusion measured in mL/min/100 gr of brain tissue determined by magnetic resonance imaging with arterial spin labeling after 12 months. Conclusion: IMAD is an important pilot study that will analyze whether the removal of α1AR-agAABs by immunoadsorption in α1AR-agAAB-positive patients with suspected Alzheimer’s clinical syndrome may slow the progression of dementia and/or may improve vascular functional parameters

TRANSIT Working Paper # 7

A previous version of this paper has been part of TRANSIT Deliverable 3.3 (July 2016), the second prototype of TSI theory.[Abstract] This working paper presents a set of propositions about the agency and dynamics of transformative social innovation (TSI) that have been developed as part of an EU-funded research project entitled “TRANsformative Social Innovation Theory” (TRANSIT; 2014-2017). These TSI propositions represent first steps towards the development of a new theory of TSI, taking the form of proto-explanations of the agency and dynamics of TSI, based on the bringing together of our empirical observations on TSI and the project's theoretical reviews and theoretical framings. Ideally this working paper should be read in conjunction with the working paper entitled “A framework for transformative social innovation” (Haxeltine et al 2016) which presents in skeletal terms the theoretical and conceptual framing of TSI developed in the TRANSIT project. This TSI framework builds on sustainability transition studies, social innovation research, social psychology studies of empowerment and other several other areas of social theory to deliver a bespoke theoretical and conceptual framework that is grounded in a relational ontology and which is being employed as a platform for the development of a middle-range theory of TSI. Next we provide a very brief overview of some key elements of the framework, in particular how we conceptualise social innovation, transformative change, and transformative social innovation. Propositions were developed for each of four relational dimensions implied by the TSI framework with also a brief statement of the topic addressed by each of the twelve propositions.This article is based on research carried out as part of the Transformative Social Innovation Theory (“TRANSIT”) project, which is funded by the European Union's Seventh Framework Programme (FP7) under grant agreement 61316

Recombinant plants provide a new approach to the production of bacterial polysaccharide for vaccines

Bacterial polysaccharides have numerous clinical or industrial uses. Recombinant plants could offer the possibility of producing bacterial polysaccharides on a large scale and free of contaminating bacterial toxins and antigens. We investigated the feasibility of this proposal by cloning and expressing the gene for the type 3 synthase (cps3S) of Streptococcus pneumoniae in Nicotinia tabacum, using the pCambia2301 vector and Agrobacterium tumefaciens-mediated gene transfer. In planta the recombinant synthase polymerised plant-derived UDP-glucose and UDP-glucuronic acid to form type 3 polysaccharide. Expression of the cps3S gene was detected by RT-PCR and production of the pneumococcal polysaccharide was detected in tobacco leaf extracts by double immunodiffusion, Western blotting and high-voltage paper electrophoresis. Because it is used a component of anti-pneumococcal vaccines, the immunogenicity of the plant-derived type 3 polysaccharide was tested. Mice immunised with extracts from recombinant plants were protected from challenge with a lethal dose of pneumococci in a model of pneumonia and the immunised mice had significantly elevated levels of serum anti-pneumococcal polysaccharide antibodies. This study provides the proof of the principle that bacterial polysaccharide can be successfully synthesised in plants and that these recombinant polysaccharides could be used as vaccines to protect against life-threatening infections

Economic downturn results in tick-borne disease upsurge

<p>Abstract</p> <p>Background</p> <p>The emergence of zoonoses is due both to changes in human activities and to changes in their natural wildlife cycles. One of the most significant vector-borne zoonoses in Europe, tick-borne encephalitis (TBE), doubled in incidence in 1993, largely as a consequence of the socio-economic transition from communism to capitalism and associated environmental changes.</p> <p>Methods</p> <p>To test the effect of the current economic recession, unemployment in 2009 and various socio-economic indices were compared to weather indices (derived from principal component analyses) as predictors for the change in TBE case numbers in 2009 relative to 2004-08, for 14 European countries.</p> <p>Results</p> <p>Greatest increases in TBE incidence occurred in Latvia, Lithuania and Poland (91, 79 and 45%, respectively). The weather was rejected as an explanatory variable. Indicators of high background levels of poverty, e.g. percent of household expenditure on food, were significant predictors. The increase in unemployment in 2009 relative to 2008 together with 'in-work risk of poverty' is the only case in which a multivariate model has a second significant term.</p> <p>Conclusion</p> <p>Background socio-economic conditions determine susceptibility to risk of TBE, while increased unemployment triggered a sudden increase in risk. Mechanisms behind this result may include reduced resistance to infection through stress; reduced uptake of costly vaccination; and more exposure of people to infected ticks in their forest habitat as they make greater use of wild forest foods, especially in those countries, Lithuania and Poland, with major marketing opportunities in such products. Recognition of these risk factors could allow more effective protection through education and a vaccination programme targeted at the economically most vulnerable.</p

Peroxisomal very long-chain fatty acid transport is targeted by herpesviruses and the antiviral host response

Very long-chain fatty acids (VLCFA) are critical for human cytomegalovirus replication and accumulate upon infection. Here, we used Epstein-Barr virus (EBV) infection of human B cells to elucidate how herpesviruses target VLCFA metabolism. Gene expression profiling revealed that, despite a general induction of peroxisome-related genes, EBV early infection decreased expression of the peroxisomal VLCFA transporters ABCD1 and ABCD2, thus impairing VLCFA degradation. The mechanism underlying ABCD1 and ABCD2 repression involved RNA interference by the EBV-induced microRNAs miR-9-5p and miR-155, respectively, causing significantly increased VLCFA levels. Treatment with 25-hydroxycholesterol, an antiviral innate immune modulator produced by macrophages, restored ABCD1 expression and reduced VLCFA accumulation in EBV-infected B-lymphocytes, and, upon lytic reactivation, reduced virus production in control but not ABCD1-deficient cells. Finally, also other herpesviruses and coronaviruses target ABCD1 expression. Because viral infection might trigger neuroinflammation in X-linked adrenoleukodystrophy (X-ALD, inherited ABCD1 deficiency), we explored a possible link between EBV infection and cerebral X-ALD. However, neither immunohistochemistry of post-mortem brains nor analysis of EBV seropositivity in 35 X-ALD children supported involvement of EBV in the onset of neuroinflammation. Collectively, our findings indicate a previously unrecognized, pivotal role of ABCD1 in viral infection and host defence, prompting consideration of other viral triggers in cerebral X-ALD