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Abstract In the search for iron, an essential element in many biochemical processes, microorganisms biosynthesise dedicated chelators, known as siderophores, to sequester iron from their environment and actively transport the siderophore complex into the cell. This process has been implicated in bacterial pathogenesis and exploited through siderophore-antibiotic conjugates as a method for selective antibiotic delivery. Here we review this Trojan-horse approach including design considerations and potential in diagnostics and infection imaging.

Abstract Background Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. Objectives Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. Methods The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. Results The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20–60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. Conclusions Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting.

Este artigo objetiva tensionar a pesquisa com pessoas com deficiência, a partir do conceito de domínio por tutela, tomando a contraconduta como possibilidade de enfrentamento aos procedimentos de condução das condutas dos outros, inscritos, historicamente, na esteira das práticas de exclusão. Toma um conjunto de estudos que envolvem a ética na pesquisa com pessoas com deficiência, aliado a três pesquisas de Mestrado em Educação, produzidas por pessoas com deficiência, como superfície analítica, a partir do campo dos Estudos Foucaultianos. As análises mostram um afastamento das pessoas com deficiência de alguns exercícios de domínio por tutela, na pesquisa em Educação, sobretudo pela contraconduta que empreendem aos modos padronizados de exercer a pesquisa. Com isso, na atualidade, as pessoas com deficiência ocupam tanto a posição de participantes da pesquisa como de pesquisadores que, com as suas produções, contribuem para que a área da Educação avance na constituição de melhores condições para a inclusão, evidenciando seu protagonismo e contribuindo para a proposição de políticas de inclusão e de reconhecimento da diferença como uma questão ética, como uma forma de estar no mundo.

Lactate and glucose are widely used biochemical parameters in current predictive risk scores for cardiogenic shock. Data regarding the relationship between lactate and glucose levels in cardiogenic shock are limited. Thus, we aimed to analyze glucose and lactate as early markers for in-hospital mortality in cardiogenic shock. In this retrospective cohort study, 312 patients presenting with cardiogenic shock to a tertiary-care hospital between 2016 and 2018 were included. Apparent cardiogenic shock was defined as hypoperfusion with hemodynamic compromise and biochemical marker increase due to diminished tissue perfusion, corresponding to SCAI shock stages. In-hospital mortality was assessed as the primary endpoint. The median age of the study population was 71 (60-79) years and the etiology of cardiogenic shock was acute myocardial infarction in 45.8%. Overall in-hospital mortality was 67.6%. In the receiver operating curve analysis, the area under the receiver-operating curve (AUC) for prediction of in-hospital mortality was higher for lactate (AUC: 0.757) than for glucose (AUC: 0.652). Both values were significantly associated with outcome (groups created with best cutoff values obtained from the Youden index). Correlation analysis showed a significant non-linear association of both values. In a multivariable stepwise Cox regression analysis, lactate remained an independent predictor for in-hospital mortality, whilst glucose, despite being implicated in energy metabolism, was not independently predictive for mortality. Together, these data suggest that lactate at admission is superior for mortality prediction in patients with apparent cardiogenic shock. Glucose was not independently predictive for mortality.

Abstract Determining SARS-CoV-2 immunity is critical to assess COVID-19 risk and the need for prevention and mitigation strategies. We measured SARS-CoV-2 Spike/Nucleocapsid seroprevalence and serum neutralizing activity against Wu01, BA.4/5 and BQ.1.1 in a convenience sample of 1,411 patients receiving medical treatment in the emergency departments of five university hospitals in North Rhine-Westphalia, Germany, in August/September 2022. 62% reported underlying medical conditions and 67.7% were vaccinated according to German COVID-19 vaccination recommendations (13.9% fully vaccinated, 54.3% one booster, 23.4% two boosters). We detected Spike-IgG in 95.6%, Nucleocapsid-IgG in 24.0%, and neutralization against Wu01, BA.4/5 and BQ.1.1 in 94.4%, 85.0%, and 73.8% of participants, respectively. Neutralization against BA.4/5 and BQ.1.1 was 5.6- and 23.4-fold lower compared to Wu01. Accuracy of S-IgG detection for determination of neutralizing activity against BQ.1.1 was reduced substantially. We explored previous vaccinations and infections as correlates of BQ.1.1 neutralization using multivariable and Bayesian network analyses. Given a rather moderate adherence to COVID-19 vaccination recommendations, this analysis highlights the need to improve vaccine-uptake to reduce the COVID-19 risk of immune evasive variants. The study was registered as clinical trial (DRKS00029414).

Glacial hydraulic tremor (GHT) can be monitored to observe changes in location and distribution of water flow beneath glacial ice, allowing the spatiotemporal evolution of subglacial hydrology to be studied continuously and remotely. We use frequency-dependent polarization analysis (FDPA) to classify types of GHT and assess its spatio-temporal extent beneath Rhonegletscher, Switzerland, in a continuous seismic record through 2018 and 2019 at three ice-proximal bedrock-based seismometers. We determine the frequency bands composing the GHT and calculate back azimuth angles pointing to a previously known subglacial channel. We also inspect the relationship between GHT seismic power and water discharge from the glacier to compare daily and seasonal shifts with the observed GHT. We observed the seasonal shift from a distributed system to a channelized system, and our dataset allowed comparison of channel locations within and across seasons, with implications for sediment evacuation and bed erosion. The successful use of this method to assess GHT previously on Taku glacier (the methods of which this project follows) and now Rhonegletscher shows that existing ice-proximal passive seismic installations can be used to easily and continuously monitor subglacial hydraulic activity.

Introduction: The handover process in the emergency department (ED) is relevant for patient outcomes and lays the foundation for adequate patient care. The aim of this study was to examine the current prehospital to ED handover practice with regard to content, structure, and scope.Methods: We carried out a prospective, multicenter observational study using a specifically developed checklist. The steps of the handover process in the ED were documented in relation to qualification of the emergency medical services (EMS) staff, disease severity, injury patterns, and treatment priority.Results: We documented and evaluated 721 handovers based on the checklist. According to ISBAR (Identification, Situation, Background, Assessment, Recommendation), MIST (Mechanism, Injuries, Signs/Symptoms, Treatment), and BAUM (Situation [German: Bestand], Anamnesis, Examination [German: Untersuchung], Measures), almost all handovers showed a deficit in structure and scope (99.4%). The age of the patient was reported 339 times (47.0%) at the time of handover. The time of the emergency onset was reported in 272 cases (37.7%). The following vital signs were transferred more frequently for resuscitation room patients than for treatment room patients: blood pressure (BP)/(all comparisons p < 0.05), heart rate (HR), oxygen saturation (SpO2) and Glasgow Coma Scale (GCS). Physicians transmitted these vital signs more frequently than paramedics BP, HR, SpO2, and GCS. A handover with a complete ABCDE algorithm (Airway, Breathing, Circulation, Disability, Environment/Exposure) took place only 31 times (4.3%). There was a significant difference between the occupational groups (p < 0.05).Conclusion: Despite many studies on handover standardization, there is a remarkable inconsistency in the transfer of information. A “hand-off bundle” must be created to standardize the handover process, consisting of a uniform mnemonic accompanied by education of staff, training, and an audit process.

The englacial and subglacial drainage systems exert key controls on glacier dynamics. However, due to their inaccessibility, they are still only poorly understood and more detailed observations are important, particularly to validate and tune physical models describing their dynamics. By creating artificial glacier moulins – boreholes connected to the subglacial drainage system and supplied with water from surface streams – we present a novel method to monitor the evolution of an englacial hydrological system with high temporal resolution. Here, we use artificial moulins as representations for vertical, pressurised, englacial R-channels. From tracer and pressure measurements, we derive time series of the hydraulic gradient, discharge, flow speed and channel cross-sectional area. Using these, we compute the Darcy–Weisbach friction factor, obtaining values which increase from 0.1 to 13 within five days of channel evolution. Furthermore, we simulate the growth of the cross-sectional area using different temperature gradients. The comparison to our measurements largely supports the common assumption that the temperature follows the pressure melting point. The deviations from this behaviour are analysed using various heat transfer parameterisations to assess their applicability. Finally, we discuss how artificial moulins could be combined with glacier-wide tracer experiments to constrain parameters of subglacial drainage more precisely.

A memory engram is thought to be the physical substrate of the memory trace within the brain, which is generally depicted as a neuronal ensemble activated by learning to fire together during encoding and retrieval. It has been postulated that engram cell ensembles are functionally interconnected across multiple brain regions to store a single memory as an “engram complex”, but visualizing this engram complex across the whole brain has for long been hindered by technical limitations. With the recent development of tissue clearing techniques, advanced light-sheet microscopy, and automated 3D image analysis, it has now become possible to generate a brain-wide map of engram cells and thereby to visualize the “engram complex”. In this review, we first provide a comprehensive summary of brain-wide engram mapping studies to date. We then compile a guide on implementing the optimal tissue clearing technique for engram tagging approaches, paying particular attention to visualize engram reactivation as a critical mnemonic property, for which whole-brain multiplexed immunostaining becomes a challenging prerequisite. Finally, we highlight the potential of tissue clearing to simultaneously shed light on both the circuit connectivity and molecular underpinnings of engram cells in a single snapshot. In doing so, novel brain regions and circuits can be identified for subsequent functional manipulation, thus providing an opportunity to robustly examine the “engram complex” underlying memory storage.

O presente artigo tem como foco principal a formação de professores para o Atendimento Educacional Especializado (AEE). Tem o objetivo de compreender como os cursos de Educação Especial (EE), na modalidade de Pós-Graduação, estão sendo ofertados no município de Chapecó/SC. A pesquisa procurou identificar e analisar os cursos cuja estrutura curricular está disponível nas plataformas on-line. Foram selecionadas 4 instituições, com 11 cursos que atenderam aos critérios de seleção. As discussões foram articuladas aos resultados de busca no portal de periódicos da Capes, quando 4 artigos foram selecionados. Os resultados mostram que 100% dos cursos são ofertados na modalidade EAD – o que se justifica por não haver cursos presenciais e Graduação em Educação Especial no município de Chapecó. O estudo conclui que os cursos de Pós-Graduação analisados são destinados à Educação Especial, à Educação Inclusiva e ao AEE, contudo a matriz curricular é fragmentada, deixando de atender a áreas específicas da Educação Especial e a determinados públicos-alvo do AEE.

Daily variations in seismic S-wave anisotropy reveal the dynamic response of englacial fractures to changing meltwater supply, according to shear wave splitting measurements from a seismometer network on the Rhonegletscher, Switzerland.

Memory formation and storage rely on multiple interconnected brain areas, the contribution of which varies during memory consolidation. The medial prefrontal cortex, in particular the prelimbic cortex (PL), was traditionally found to be involved in remote memory storage, but recent evidence points toward its implication in early consolidation as well. Nevertheless, the inputs to the PL governing these dynamics remain unknown. Here, we first performed a brain-wide, rabies-based retrograde tracing screen of PL engram cells activated during contextual fear memory formation in male mice to identify relevant PL input regions. Next, we assessed the specific activity pattern of these inputs across different phases of memory consolidation, from fear memory encoding to recent and remote memory recall. Using projection-specific chemogenetic inhibition, we then tested their functional role in memory consolidation, which revealed a hitherto unknown contribution of claustrum to PL inputs at encoding, and of insular cortex to PL inputs at recent memory recall. Both of these inputs further impacted how PL engram cells were reactivated at memory recall, testifying to their relevance for establishing a memory trace in the PL. Collectively, these data identify a spatiotemporal shift in PL inputs important for early memory consolidation, and thereby help to refine the working model of memory formation.

Abstract Repeating earthquakes are a global phenomenon of tectonic faults. Multiple ruptures on the same fault asperities lead to nearly identical waveforms characteristic for these seismic events. We identify their microseismic counterparts beneath an Alpine glacier, where basal sliding accounts for a significant amount of ice flow. In contrast to tectonic faults, Alpine glacier beds are subject to large variations in sliding velocity and effective normal stresses. This leads to inter- and sub-seasonal variations in released seismic moment from stick–slip asperities, which we explain with the rate-and-state friction formalism. During summer, numerically modelled effective normal stresses at asperities are three times higher than in winter, which increases the local shear resistance by the same factor. Stronger summer asperities therefore tend to form in bed regions well connected to the efficient subglacial drainage system. Moreover, asperities organise themselves into a state of subcriticality, transferring stresses between each other. We argue that this seismic stick–slip behavior has potentially far-reaching consequences for glacier sliding and in particular for catastrophic failure of unstable ice masses.