While caregiver burden has been studied in various patient populations, it has not been addressed in caregivers of patients with epilepsy. This study investigated the incidence of perceived caregiver ...burden in caregivers of patients following surgical treatment for epilepsy, usually temporal lobectomy. The extent to which caregiver and patient variables were related to burden was explored. Data were collected on caregiver depression, caregiver coping skills, the caregiver's evaluation of the patient's functioning, demographic information, and the patient's seizure control for 34 caregiver-patient dyads. The occurrence of significant burden in this population was comparable with the literature for other populations; however, the frequency of item endorsement varied. Regression analysis suggests that depression and patient functioning, separate from seizure control, predicted caregiver burden. The use of emotion-focused coping styles predicted depression. There were no differences in the levels of burden or depression in caregivers over time. Additional research is required to evaluate whether these relationships reflect presurgical functioning or an adjustment to the postsurgical state. Aspects of patient functioning that are important in caregiver burden also need to be clarified. This research may lead to the development of intervention strategies designed to prevent or reduce caregiver burden.
Developmental ocular malformations, including anophthalmia-microphthalmia (AM), are heterogeneous disorders with frequent sporadic or non-Mendelian inheritance. Recurrent interstitial deletions of ...14q22-q23 have been associated with AM, sometimes with poly/syndactyly and hypopituitarism. We identify two further cases of AM (one with associated pituitary anomalies) with a 14q22-q23 deletion. Using a positional candidate gene approach, we analyzed the
BMP4 (Bone Morphogenetic Protein-4) gene and identified a frameshift mutation (c.226del2, p.S76fs104X) that segregated with AM, retinal dystrophy, myopia, brain anomalies, and polydactyly in a family and a nonconservative missense mutation (c.278A→G, p.E93G) in a highly conserved base in another family. MR imaging and tractography in the c.226del2 proband revealed a primary brain developmental disorder affecting thalamostriatal and callosal pathways, also present in the affected grandmother. Using in situ hybridization in human embryos, we demonstrate expression of
BMP4 in optic vesicle, developing retina and lens, pituitary region, and digits strongly supporting
BMP4 as a causative gene for AM, pituitary, and poly/syndactyly. Because
BMP4 interacts with
HH signaling genes in animals, we evaluated gene expression in human embryos and demonstrate cotemporal and cospatial expression of
BMP4 and
HH signaling genes. We also identified four cases, some of whom had retinal dystrophy, with “low-penetrant” mutations in both
BMP4 and
HH signaling genes:
SHH (
Sonic Hedgehog) or
PTCH1 (
Patched). We propose that
BMP4 is a major gene for AM and/or retinal dystrophy and brain anomalies and may be a candidate gene for myopia and poly/syndactyly. Our finding of low-penetrant variants in
BMP4 and
HH signaling partners is suggestive of an interaction between the two pathways in humans.
Zusammenfassung
Ziel des digitalen Notfallmanagements ist, dass alle Akteure der Rettungskette sich bei einem Notfalleinsatz elektronisch miteinander austauschen und auf alle Informationen, die für ...die optimale Versorgung der Patientin relevant sind, zugreifen und miteinander kommunizieren können. Für den Einsatz der Digitalisierung im Notfallmanagement existieren mittlerweile zahlreiche Konzepte mit vielversprechenden Studienergebnissen und Implementierungserfahrungen, die in einer (über)regionalen Behandlungsstrategie mit einem kontinuierlichen Verbesserungsprozess mit Nachdruck zu verstetigen sind. Unter Berücksichtigung aktueller Möglichkeiten der Digitalisierung der Rettungskette hat der Expertenrat des Zentrums für Telemedizin Bad Kissingen (ZTM) wesentliche Inhalte und Kernfunktionen des digitalen Notfallmanagements definiert.
Abstract
The objective of digital emergency management is to enable all involved parties to electronically share, access, and communicate pertinent information for optimal patient care during an emergency intervention. Considering the current digitalization potential in acute and emergency medicine, the expert council of the Zentrum für Telemedizin Bad Kissingen (ZTM) has delineated the core elements and functions of digital emergency management. Presently, numerous digitalization concepts in emergency management have shown promising study outcomes and insights regarding implementation. These should be robustly integrated into a (supra-)regional care strategy with a continuous improvement process.
We report the detection of the cool, Jovian-mass planet MOA-2007-BLG-400Lb. The planet was detected in a high-magnification microlensing event (with peak magnification A max = 628) in which the ...primary lens transited the source, resulting in a dramatic smoothing of the peak of the event. The angular extent of the region of perturbation due to the planet is significantly smaller than the angular size of the source, and as a result the planetary signature is also smoothed out by the finite source size. Thus, the deviation from a single-lens fit is broad and relatively weak (approximately few percent). Nevertheless, we demonstrate that the planetary nature of the deviation can be unambiguously ascertained from the gross features of the residuals, and detailed analysis yields a fairly precise planet/star mass ratio of , in accord with the large significance () of the detection. The planet/star projected separation is subject to a strong close/wide degeneracy, leading to two indistinguishable solutions that differ in separation by a factor of ~8.5. Upper limits on flux from the lens constrain its mass to be M < 0.75 M (assuming that it is a main-sequence star). A Bayesian analysis that includes all available observational constraints indicates a primary in the Galactic bulge with a mass of ~0.2-0.5 M and thus a planet mass of ~0.5-1.3 M Jup. The separation and equilibrium temperature are ~5.3-9.7 AU (~0.6-1.1 AU) and ~34 K (~103 K) for the wide (close) solution. If the primary is a main-sequence star, follow-up observations would enable the detection of its light and so a measurement of its mass and distance.
Während unlösliche Reagenzien, auslaugende Katalysatoren und heterogene Photokatalysatoren problemlos in Batch‐Verfahren verwendet werden können, ist deren Einsatz in der Durchflusschemie ...problematisch. Festbettreaktoren werden typischerweise für thermische Reaktionen mit heterogenen Katalysatoren verwendet, sind aber aufgrund schlechter Lichtdurchdringung für die Photochemie ungeeignet. Wir zeigen, dass serielle Mikro‐Batch‐Reaktoren (SMBRs) die kontinuierliche Verwendung von Feststoffen in Kombination mit Flüssigkeiten und Gasen ermöglichen. Das Potenzial dieser Technologie wurde anhand photokatalytischer Fluorierungen mit graphitischem Kohlenstoffnitrid anstatt teurer, homogener Metallkomplexe demonstriert. Die Kombination dieser billigen, wiederverwendbaren Materialien mit der SMBR‐Technologie ermöglicht nachhaltige, skalierbare Photokatalyse.
Durch den Einsatz von Pflanzenextrakten als Reaktionsmedium für chemische Synthesen können hocheffiziente und nachhaltige Prozesse erzielt werden. Dieses Prinzip wird auf die Partialsynthese von ...Artemisinin angewendet, ein sekundärer Metabolit der Pflanze Artemisia annua und eine wichtige Vorstufe von hochwirksamen Malariamedikamenten. Extrakte von A. annua enthalten außer Artemisinin auch als Abfallprodukte angesehene Komponenten, wie Dihydroartemisininsäure, die letzte Vorstufe von Artemisinin in der Biosynthese, und Chlorophyll, das als Photosensibilisator wirkt. Durch intensive Beleuchtung des unaufgearbeiteten Extrakts mit sichtbarem Licht wird Artemisinin in einem kontinuierlichen Durchflussreaktor in hoher Ausbeute aus dem Extrakt erzeugt. Dieser an der Biosynthese angelehnte Prozess ist dabei hocheffizient und nachhaltiger als etablierte Prozesse auf der Basis reiner Substanzen.
Es grünt so grün: Pflanzenextrakte enthalten viele chemisch aktive Substanzen, die für die Synthese von Naturstoffen eingesetzt werden können. Im Pflanzenextrakt des Beifußes enthaltene Chlorophylle fungieren als Photokatalysator bei der Partialsynthese von Artemisinin.
Essential reading for anyone involved in fiber optic cable applications, from installation engineers to IT professionals. Fiber Optic Cabling is a practical guide to all aspects of designing, ...specifying and installing systems for LANs and other data communications applications. The second edition has been completely revised and updated by Barry Elliott, taking into account the major developments in LAN and transmission technology over the past 10 years. The latest legislation is also dealt with, including standards relating to flammability. Cutting edge topics such as photonic switching, wavelength division multiplexing and plastic fiber, and their implications for the future are also explored. An international perspective of the subject is taken, with the author looking at all the practical implementations for fiber optic cabling, using American, European and International ISO standards. Barry Elliott has twenty years experience in the telecommunications business and became one of the first BICSI Registered Cabling Distribution Designers in Europe in 1999. He currently specializes in optical fiber and structured cabling with Brand-Rex Ltd. In 1991 Mike Gilmore established The Cabling Partnership, a leading cabling design consulting and training organization. Mike is chairman of the UK BSI Premises Cabling Experts Panels and Convenor of the equivalent CENELEC Working Group. Mike also acts as both the Technical and Standards Director of the UK Fibreoptic Industry Association. * A practical guide to design and installation of Fiber optic cabling * Provides key information on international standards * Up-to-date discussion of 'hot topics' in Fiber optic cabling: MCVD and new termination technologies
PDF
