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Studies on the prevalence of burnout in professionals in service organizations who work in direct contact with the clients or users of the organization have concluded that burnout is a serious health disorder that has increased due to the COVID-19 pandemic. A significant advantage of the Spanish Burnout Inventory (SBI) over other instruments is that it provides a broader conceptualization of burnout by including feelings of guilt as a dimension of burnout to explain its development. However, the measurement invariance of the SBI across countries has not been investigated. The purpose of this study was to test the measurement invariance of the SBI among professionals across 17 countries and regions in Europe, Latin America, and Asia, and in different languages. All the countries showed a good fit to the four-factor model, except the Indian sample, which was excluded from the measurement invariance study. Using the alignment method, it was possible to verify the scalar measurement invariance of the four SBI factors across 15 countries and one Spanish region (16 samples). The comparison of estimated latent means indicates that France is the country with the lowest scores on the Enthusiasm factor and the highest scores on the negative factors (Exhaustion, Indolence, and Guilt). In contrast, the Andean countries, Colombia, Peru, and Ecuador, show the highest latent means on the Enthusiasm factor and the lowest means on the negative factors. These results support the validity of the SBI in the countries and regions in Europe and Latin America included in this study.

In older patients, sarcopenia is a prevalent disease associated with negative outcomes. Sarcopenia has been investigated in patients undergoing transcatheter aortic valve implantation (TAVI), but the criteria for diagnosis of the disease are heterogeneous. This systematic review of the current literature aims to evaluate the prevalence of sarcopenia in patients undergoing TAVI and to analyse the impact of sarcopenia on clinical outcomes. A comprehensive search of the literature has been performed in electronic databases from the date of initiation until March 2020. Using a pre-defined search strategy, we identified studies assessing skeletal muscle mass, muscle quality and muscle function as measures for sarcopenia in patients undergoing TAVI. We evaluated how sarcopenia affects the outcomes mortality at ≥1 year, prolonged length of hospital stay, and functional decline. We identified 18 observational studies, enrolling a total number of 9’513 patients. For assessment of skeletal muscle mass, all included studies used data from computed tomography. Cutoff points for definition of low muscle mass were heterogeneous, and prevalence of sarcopenia varied between 21.0% and 70.2%. In uni- or multivariate regression analysis of different studies, low muscle mass was found to be a significant predictor of mortality, prolonged length of hospital stay, and functional decline. No interventional study was identified measuring the effect of nutritional or physiotherapy interventions on sarcopenia in TAVI patients. Sarcopenia is highly prevalent among patients undergoing TAVI, and negatively affects important outcomes. Early diagnosis of this condition might allow a timely start of nutritional and physiotherapy interventions to prevent negative outcomes in TAVI patients.

Purpose To prospectively compare the diagnostic accuracy of radial breast ultrasound (r-US) to that of conventional meander-like breast ultrasound (m-US), patients of a consecutive, unselected, mixed collective were examined by both scanning methods. Methods Out of 1948 dual examinations, 150 revealed suspicious lesions resulting in 168 biopsies taken from 148 patients. Histology confirmed breast cancers in 36 cases. Sensitivity, specificity, accuracy, PPV, and NPV were calculated for r-US and m-US. The examination times were recorded. Results For m-US and r-US, sensitivity (both 88.9%), specificity (86.4% versus 89.4%), accuracy (86.9% versus 89.3%), PPV (64.0% versus 69.6%), NPV (both 98.3%), false-negative rate (both 5.6%), and rate of cancer missed by one method (both 5.6%) were similar. The mean examination time for r-US (14.8 min) was significantly (p Conclusion Because the diagnostic accuracy of r-US and m-US are comparable, r-US can be considered an alternative to m-US in routine breast US with the added benefit of a significantly shorter examination time.

Contains fulltext : 218566pub.pdf (Publisher’s version ) (Closed access) Contains fulltext : 218566pos.pdf (Author’s version postprint ) (Open Access) BACKGROUND: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. METHODS: We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. RESULTS: We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03; 95% CI, 1.02 to 1.04); lower GCS (OR 1.20; 95% CI, 1.14 to 1.16 for every point reduction in GCS); pupillary reactivity (OR 1.8; 95% CI, 1.09 to 3.23 for bilateral unreactive pupils); admission source (emergency room versus direct admission [OR 2.2; 95% CI, 1.3 to 3.75]; admission from a general ward versus direct admission [OR 5.85; 95% CI, 2.75 to 12.45; and admission from another ICU versus direct admission [OR 3.34; 95% CI, 1.27 to 8.8]); and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7; 95% CI, 1.04 to 2.47). CONCLUSION: PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.

Pleurofibrinolysis has been reported to be potentially beneficial in the management of complicated parapneumonic effusions (CPPE) and empyemas in the adult population. Prospective, controlled, randomized, and double-blind study, to evaluate intrapleural alteplase 10 mg (initially 20 mg was considered but bleeding events forced dose reduction) versus 100,000 UI urokinase every 24 h for a maximum of 6 days in patients with CPPE or empyemas. The primary aim was to evaluate the success rate of each fibrinolytic agent at 3 and 6 days. Success of therapy was defined as the presence of both clinical and radiological improvement, making additional fibrinolytic doses unnecessary, and eventually leading to resolution. Secondary outcomes included the safety profile of intrapleural fibrinolytics, referral for surgery, length of hospital stay, and mortality. A total of 99 patients were included, of whom 51 received alteplase and 48 urokinase. Success rates for urokinase and alteplase at 3 and 6 days were not significantly different, but when only the subgroup of CPPE was considered, urokinase resulted in a high proportion of cures. There were no differences in mortality or surgical need (overall, 3 %). Five (28 %) patients receiving 20 mg of alteplase and 4 (12 %) receiving 10 mg presented serious bleeding events. If intrapleural fibrinolytics are intended to be used, urokinase may be more effective than alteplase in patients with non-purulent CPPE and have a lower rate of adverse events.

Diuretic treatment for heart failure may lead to an increased urinary thiamine excretion and in long-term thiamine deficiency, which may further compromise cardiac function. This study evaluated the effect of high dose thiamine supplementation in heart failure patients. Nine patients with diuretic treatment for symptomatic chronic heart failure and a left ventricular ejection fraction (LVEF)

Inherited cardiomyopathies are caused by point mutations in sarcomeric gene products, including alpha-cardiac muscle actin (ACTC1). We examined the biochemical and cell biological properties of the alpha-cardiac actin mutations Y166C and M305L identified in hypertrophic cardiomyopathy (HCM). Untagged wild-type (WT) cardiac actin, and the Y166C and M305L mutants were expressed by the baculovirus/Sf9-cell system and affinity purified by immobilized gelsolin G4-6. Their correct folding was verified by a number of assays. The mutant actins also displayed a disturbed intrinsic ATPase activity and an altered polymerization behavior in the presence of tropomyosin, gelsolin, and Arp2/3 complex. Both mutants stimulated the cardiac beta-myosin ATPase to only 50 % of WT cardiac F-actin. Copolymers of WT and increasing amounts of the mutant actins led to a reduced stimulation of the myosin ATPase. Transfection of established cell lines revealed incorporation of EGFP- and hemagglutinin (HA)-tagged WT and both mutant actins into cytoplasmic stress fibers. Adenoviral vectors of HA-tagged WT and Y166C actin were successfully used to infect adult and neonatal rat cardiomyocytes (NRCs). The expressed HA-tagged actins were incorporated into the minus-ends of NRC thin filaments, demonstrating the ability to form hybrid thin filaments with endogenous actin. In NRCs, the Y166C mutant led after 72 h to a shortening of the sarcomere length when compared to NRCs infected with WT actin. Thus our data demonstrate that a mutant actin can be integrated into cardiomyocyte thin filaments and by its reduced mode of myosin interaction might be the basis for the initiation of HCM.

Over the past few years, the light-gated cation channel Channelrhodopsin-2 (ChR2) has seen a remarkable diversity of applications in neuroscience. However, commonly used wide-field illumination provides poor spatial selectivity for cell stimulation. We explored the potential of focal laser illumination to map photocurrents of individual neurons in sparsely transfected hippocampal slice cultures. Interestingly, the best spatial resolution of photocurrent induction was obtained at the lowest laser power. By adjusting the light intensity to a neuron's spike threshold, we were able to trigger action potentials with a spatial selectivity of less than 30 microm. Experiments with dissociated hippocampal cells suggested that the main factor limiting the spatial resolution was ChR2 current density rather than scattering of the excitation light. We conclude that subcellular resolution can be achieved only in cells with a high ChR2 expression level and that future improved variants of ChR2 are likely to extend the spatial resolution of photocurrent induction to the level of single dendrites.

Approximate entropy (ApEn) of blood pressure (BP) can be easily measured based on software analysing 24-h ambulatory BP monitoring (ABPM), but the clinical value of this measure is unknown. In a prospective study we investigated whether ApEn of BP predicts, in addition to average and variability of BP, the risk of hypertensive crisis. In 57 patients with known hypertension we measured ApEn, average and variability of systolic and diastolic BP based on 24-h ABPM. Eight of these fifty-seven patients developed hypertensive crisis during follow-up (mean follow-up duration 726 days). In bivariate regression analysis, ApEn of systolic BP (P

Raver1, a ubiquitously expressed protein, was originally identified as a ligand for metavinculin, the muscle-specific isoform of the microfilament-associated protein vinculin. The protein resides primarily in the nucleus, where it colocalises and may interact with polypyrimidine-tract-binding protein, which is involved in alternative splicing processes. During skeletal muscle differentiation, raver1 translocates to the cytoplasm and eventually targets the Z-line of sarcomeres. Here, it colocalises with metavinculin, vinculin and alpha-actinin, all of which have biochemically been identified as raver1 ligands. To obtain more information about the potential role of raver1 in muscle structure and function, we have investigated its distribution and fine localisation in mouse striated and smooth muscle, by using three monoclonal antibodies that recognise epitopes in different regions of the raver1 protein. Our immunofluorescence and immunoelectron-microscopic results indicate that the cytoplasmic accumulation of raver1 is not confined to skeletal muscle but also occurs in heart and smooth muscle. Unlike vinculin and metavinculin, cytoplasmic raver1 is not restricted to costameres but additionally represents an integral part of the sarcomere. In isolated myofibrils and in ultrathin sections of skeletal muscle, raver1 has been found concentrated at the I-Z-I band. A minor fraction of raver1 is present in the nuclei of all three types of muscle. These data indicate that, during muscle differentiation, raver1 might link gene expression with structural functions of the contractile machinery of muscle.

Visualizing the structure and dynamics of proteins, supramolecular assemblies and cellular components are often key to our understanding of biological function. Here, we focus on new approaches in imaging, measuring and manipulating biological matter across dimensions with the scanning force microscope.

Sport und Bewegung nehmen in unserer Gesellschaft einen zunehmend breiten Raum ein. Unsere Gesellschaft uberaltert in rasantem Tempo. Laut Weltgesundheitsorganisation (WHO) sind im Jahre 2025 in Industrielandern 65% der Bevolkerung alter als 65 Jahre.Die Verzogerung des naturlichen Alterungsprozesses und die Pravention von Tumorerkrankungen werden inzwischen von vielen Menschen angestrebt. Die korperliche Fitness stellt hierfur ein geeignetes Werkzeug dar [34,78].

We report on a 17-year-old patient with severe bronchiolitis due to Mycoplasma pneumoniae infection. Despite an early 10-day course of clarithromycin, she developed progressive dyspnea, cough, fever, and severe obstructive ventilatory impairment. Sixteen days after onset of the disease a severe hemolytic anemia developed with only cold agglutinins positive at serologic screening. Thoracoscopic lung biopsy revealed diffuse bronchiolitis with suppurative intrabronchiolar inflammation, lymphohistiocytic "cuffing" of the bronchioli, and foam cell aggregates within neighboring alveoli. The infiltrate consisted mainly of CD3+, CD8+ lymphocytes and CD68+ macrophages. The diagnosis of Mycoplasma pneumoniae bronchiolitis was based on repeated complement fixation tests, which turned strongly positive only at day 74 after onset of the disease. Pulmonary function improved slowly under long-term prednisone treatment.

To examine the impact of immediate concurrent feedback on dose adjustment in patients with renal failure.Prospective 12-month study in patients with various degrees of renal failure, with comparison to a retrospective control group.A 39-bed unit of a university hospital providing primary and tertiary care.Patients with renal failure (estimated creatinine clearanceor = 50 mL/min) receiving at least 1 pharmacologically active drug.Education of physicians and immediate concurrent feedback on the ward giving estimated creatinine clearance and dose recommendations for renally eliminated drugs adjusted to individual renal function.The percentage of dosage regimens adjusted to renal function and cost assessment of drug therapy were calculated. Overall, 17% of the patients had at least 1 estimated creatinine clearanceor = 50 mL/min. In the intervention group, the dose of 81% of renally eliminated drugs was adjusted to renal function, compared with 33% in the control group ( P.001). The mean difference in cost between standard and adjusted dose of renally eliminated drugs in the intervention and control groups was 5.3 +/- 12.3 and 0.75 +/- 2.8 Swiss francs (approximately US$3.5 and US$0.5), respectively ( P.001), accounting for 16.5% and 2.8%, respectively, of daily medication costs of all drugs.The proportion of doses of renally eliminated drugs adjusted to renal function can be substantially increased by immediate concurrent feedback. This saves drug costs and has the potential to prevent adverse drug reactions.

In a prospective, crossover study, we assessed the impact of a clinical pharmacist on identification and reporting of adverse drug events (ADEs) in hospitalized patients. The study was conducted on four units of a medical ward of a university hospital, with two units serving as test, the other two as control units. After 12 months, test and control units were switched. In the test units, a pharmacist participated in daily ward rounds, solicited additional information from physicians and nurses, and reviewed the charts of all patients. In control units, information on ADEs was based solely on voluntary reports from physicians and nurses. A total of 1,959 patients (941 in test, 1,018 in control units) were hospitalized during the study period. In 137 test units patients, 224 ADEs (14.6%; 95%-CI: 12.3%-16.9%) were detected (8 severe, 60 moderate, 156 mild), while 25 ADEs (1 severe, 11 moderate, 13 mild) occurring in 21 patients (2.1%; 95%-CI: 1.2%-3.0%) were reported from the control units (p < 0.0001). Of the ADEs in the test units, 51% were reported spontaneously, 39% were identified on rounds, and 10% by chart review. After changing the status of test and control units, the number of identified ADEs returned to preintervention levels. Clinical pharmacists as part of the medical care team can improve the identification of ADEs which may ultimately translate into improved quality of care.

Ein offenes, interventionelles MR-Gerat (0,5 Tesla) erlaubt durch eine 58 cm breite Offnung den Zugang zum im Gerat liegenden Patienten. Ein spezielles Punktionssystem ermoglicht es, unter Echtzeitbildgebung Punktionen vorzunehmen sowie auch Laserfasern im menschlichen Korper zu plazieren. Zur Bildgebung wird eine 2d-Gradientenechosequenz verwendet (TR 19 ms, TE 9 ms, Flipwinkel 30 °, FOV 24 × 24 cm, Schichtdicke 10 mm, Matrix 256 × 128). Die akquirierten Bilder werden dem punktierenden Radiologen auf 2 im Gerat angebrachten LCD-Monitoren angezeigt, wodurch eine interaktive Nadelfuhrung ermoglicht wird. Es wurden bereits zahlreiche Punktionen an Patienten durchgefuhrt. Wichtig wird die MR-gesteuerte Punktion von Lasionen in Kombination mit der Durchfuhrung thermosensitiver Therapien. Die der MR-Bildgebung inharente Temperatursensitivitat ermoglicht ein umfassendes Monitoring solcher Eingriffe in Echtzeit.

Railway tracks represent a highly interlinked habitat with numerous possibilities for accidental entry of oilseed rape due to seed spill during transportation. Moreover, glyphosate is regularly employed to control the vegetation, increasing the possibility of establishment for plants resistant to it. We surveyed the presence of genetically engineered glyphosate tolerant oilseed rape (Brassica napus) with a focus on the most important Swiss railway stations. Our objective was to detect accidental establishment of transgenic plants, since Switzerland does not import nor cultivate transgenic oilseed rape. Seventy-nine railway areas were sampled in Switzerland and the Principality of Liechtenstein, and the feral presence of oilseed rape was detected in 58 of them. A total of 2403 individuals were tested for genetic modification using commercially available immunologic test kits. In four localities, one located in Lugano and three in the area of Basel, a total of 50 plants expressing the CP4 EPSPS protein were detected. In two of the localities, survival of herbicide applications was observed. The populations were probably introduced through contaminated seed spills from freight trains, or during the transfer of goods from cargo ships to trains. Railways represent an ideal system for herbicide resistant transgenic plants to establish and spread as a result of high selective pressure in favour of herbicide resistance with consequent increased difficulties to keep the infrastructure free of weeds. Crop-to-wild gene flow can occur as several sexually compatible species which are congeneric or in allied genera to oilseed rape were found growing sympatrically. Moreover, the capillary presence of railways in the agricultural landscape provides a putative source of contamination of GE-free agriculture. Our results suggests that carefully adapted monitoring designs may be set in order to detect introduction events that can lead to rapid establishment and growing populations as the accepted contamination thresholds are likely to be biologically insufficient to prevent further environmental contamination.

Cells constantly encounter physical forces and respond to neighbors and circulating factors by triggering intracellular signaling cascades that in turn affect their behavior. The mechanisms by which cells transduce mechanical signals to downstream biochemical changes are not well understood. In their work, Salaita and coworkers show that the spatial organization of cell surface receptors is crucial for mechanotransduction. Consequently, force modulation that disrupts the mechanochemical coupling may represent a critical step in cancerogenesis.

Objective:To evaluate the accuracy of emergency room triage by general internists assigning medical patients to four different health care settings. Design:Prospective trial. Setting:Medical emergency room of a university hospital providing primary and referral care. Patients:974 consecutive patients admitted for acute medical care, excluding patients admitted to intensive care units. Intervention and measurements:After primary evaluation patients were assigned to one of four groups: A) acutely ill requiring acute care in a general medical ward (n=598); B)acutely ill requiring acute care limited to two to three days (n=201); C)chronically ill with realistic changes for rehabilitation (n=77);and D) chronically ill requiring definite referral to skilled nursing home care (n=98).Nine months later, outcome and placement after index hospitalization were evaluated in surviving patients. Main results:159 (16%) patients died; three (1%) were lost to follow-up. Evolution confirmed the appropriateness of the initial triage of 90% of the remaining 812 patients (83%). Allocations were correct in 96%, 95%, and 91% of cases in groups A, B, and C, respectively. In group D, only 44% were definitely transferred to nursing homes; 56% were rehabilitated and returned to their previous social settings or entered homes for the aged. Conclusions:Clinical judgemen of general internists in an emergency room adequately identifies patients requiring acute care of regular or short duration and chronically ill patients with realistic propsects for rehabilitation. But the need for nursing home placement is overestimated. To avoid patient misplacement the authors propose direct access to a specialized geriatric assessment facility.