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Junker C, Vakkalanka P, Wittrock C. Clinical Ultrasound Training in Emergency Medicine Advanced Practice Provider Residencies. J Physician Assist Educ 2023; 34:329-332. [PMID: 37787744 DOI: 10.1097/jpa.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Clinical ultrasound training is essential to any emergency medicine (EM) clinician's skill set. We aim to understand the current training patterns of clinical ultrasound training within Advanced Practice Provider (APP) residencies. METHODS In a survey sent electronically to 17 active EM APP residencies, data were obtained from 21 responses to questions about structure of ultrasound faculty, quality assessment, feedback, and competency evaluation. RESULTS We had a response rate of 88%. Of programs surveyed, 93% were associated with EM physician residencies with 87% led by an ultrasound fellowship-trained EM physician. Ninety-three percent of programs required proctored scanning. Sixty percent of programs do not have any required number of scans to graduate. CONCLUSION We found that most EM APP residencies share clinical ultrasound faculty, structures, and processes with associated EM physician residencies. We believe that quality training within clinical ultrasound is attainable; however, proficiency guidelines across EM APP residency programs are lacking.
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Affiliation(s)
- Christian Junker
- Christian Junker, PA-C, is a clinical assistant professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Priyanka Vakkalanka, PhD, is an associate research scientist, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Cory Wittrock, MD, is a clinical associate professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Priyanka Vakkalanka
- Christian Junker, PA-C, is a clinical assistant professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Priyanka Vakkalanka, PhD, is an associate research scientist, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Cory Wittrock, MD, is a clinical associate professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Cory Wittrock
- Christian Junker, PA-C, is a clinical assistant professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Priyanka Vakkalanka, PhD, is an associate research scientist, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Cory Wittrock, MD, is a clinical associate professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Güth U, Junker C, McMillan S, Elfgen C, Schneeberger AR. Long-term experience on assisted suicide in Switzerland: dementia, mental disorders, age-related polymorbidity and the slippery slope argument. Public Health 2023; 223:249-256. [PMID: 37690397 DOI: 10.1016/j.puhe.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES According to the Swiss medico-ethical guidelines valid between 2004 and 2018, the key criterion for assisted suicide (AS) was that the patients who wished to die suffered with a disease leading to death in the foreseeable future. Critics of AS fears that broadening of the medical indications will lead to an uncontrolled expansion to persons who are not terminally ill (slippery slope argument). We evaluated to what extent this broadening took place in practice over time. STUDY DESIGN Retrospective national cohort study. METHODS By using data of the Swiss Federal Statistical Office, we analyzed the long-term development of AS in Switzerland over a 20-year period (1999-2018; n = 8738 cases). We classified the cases into one of three categories regarding the aforementioned key criterion for AS. RESULTS In 43.6% of AS cases, the criterion 'end of life is near' was met. In 5.3% of cases, this criterion was not met (4.7%: mental disorders; 0.6%: dementia). In 51.1% of cases, the reason underlying AS comprised several, mostly age-related diseases and/or functional impairments; the aforementioned key criterion, however, was probably not met in most of the cases. Over time, the number of cases doubled over each 5-year period; this increase occurred similarly for the three categories. CONCLUSION The fact that many AS cases took place outside the valid medico-ethical guidelines might be interpreted as a development in the idea of the slippery slope argument. The fact that the percentage distribution of these cases remained unchanged over time argues against it.
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Affiliation(s)
- U Güth
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland; University of Basel, Faculty of Medicine, Klingelbergstrasse 61, Basel CH-4056, Switzerland.
| | - C Junker
- Federal Statistical Office, Espace de l'Europe 10, Neuchâtel CH-2010, Switzerland.
| | - S McMillan
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland.
| | - C Elfgen
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland; University of Witten/Herdecke, Faculty of Medicine; Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
| | - A R Schneeberger
- University of California San Diego, Department of Psychiatry, 8950 Villa La Jolla Drive, La Jolla, CA 92037, USA.
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Wubben BM, Oberbillig M, Wittrock C, Rytlewski K, Thirnbeck CK, Junker C, Stier A. Pediatric Residents' Perceptions of a Point-of-Care Ultrasound Collaboration With Emergency Medicine. Cureus 2023; 15:e41645. [PMID: 37565129 PMCID: PMC10411543 DOI: 10.7759/cureus.41645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Background Pediatric residencies expanding their point-of-care ultrasound (POCUS) education face barriers, including a lack of established curriculum and qualified educators. Prior studies report partnerships between pediatrics and pediatric emergency medicine (PEM); however, many non-PEM emergency medicine (EM) physicians with POCUS fellowship training also have experience with pediatric POCUS and represent an alternate educational partner. Objectives To improve pediatric residents' POCUS skills through collaborative education with EM and evaluate perceptions of the teaching format and instructors. Methods First through third-year pediatric residents attended a half-day didactic and hands-on session about renal, lung, and musculoskeletal (MSK) POCUS. These educational sessions were led by EM faculty with POCUS fellowship training and assisted by EM residents. Post-session surveys were administered to pediatric residents to assess prior POCUS experience, changes in confidence in acquiring and interpreting renal, lung, and MSK POCUS images, and opinions about the educational format. Statistical analyses of the post-session survey data were performed using SPSS. Results Thirty-nine pediatric residents attended the session and completed the survey of 45 total residents in the program (86.7%), with 89.7% completing 10 or fewer POCUS studies. Residents' comfort level with performing lung POCUS increased from 5.1% to 82.1% (p < .001), renal POCUS from 10.3% to 76.9% (p < .001), and MSK POCUS from 7.7% to 84.6% (p < .001). 87.2% rated the educational format as effective, and 94.9% (37/39) rated emergency medicine faculty as 'very effective' in providing ultrasound education relevant to the practice of pediatrics. Conclusion Pediatric resident POCUS education taught by EM faculty with POCUS fellowship training was well-received by pediatric residents and significantly improved confidence in acquiring and interpreting POCUS.
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Affiliation(s)
| | | | - Cory Wittrock
- Emergency Medicine, University of Iowa, Iowa City, USA
| | | | | | | | - Amy Stier
- Pediatrics, University of Iowa, Iowa City, USA
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4
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Montagna G, Junker C, Elfgen C, Schneeberger A, Güth U. Assisted suicide in patients with cancer. ESMO Open 2022; 7:100349. [PMID: 35066409 PMCID: PMC8789521 DOI: 10.1016/j.esmoop.2021.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background There are limited data on the long-term development and trends of assisted suicide (AS) among cancer patients. Patients and methods Using data of the Swiss Federal Statistical Office, we analyzed AS trends over an 18-year period (1999-2016; total number of cases = 6553). Results Among patients who underwent AS, cancer was the most common underlying disease (n = 2704, 41.3% of all AS cases). The most common cancer types were lung (14.0% of cancer-related AS cases), breast (11.0%) and prostate (10.1%). There was a slight preponderance of men compared with women (51.5% versus 48.5%). The proportion of AS cases within cancer types did not change over time. The ratio of cancer-related AS cases in relationship with all cancer-related deaths increased from 0.3% at the beginning of the study period (1999-2003) to 2.1% from 2014 to 2016 (change of age-standardized rates for men: +488%; for women: +417%). At the end of the study period (2014-2016), there were only minor differences between cancer-specific ratios, highest and lowest range: 1.1% (liver cancer) and 2.8% (breast, esophageal and lip/oral cavity/oropharynx cancer). Individuals who underwent AS because of cancer were considerably younger than those who choose AS on account of other diseases (73 years versus 80 years). The median age of people with cancer-related AS was similar to that of all cancer-related deaths (74 years): for women, the median age of cancer-related AS was 72, whereas for men it was 75. The median age at which AS took place increased over time. Conclusions During the study period, the proportion of people who chose cancer-related AS has approximately sextupled. However, AS among cancer patients remains rare and represents only ∼2% of all cancer-related deaths. Cancer was the most common underlying disease for AS (41.3% of all AS cases). The ratio of cancer-related AS to all cancer-related deaths has sextupled over time: from 0.3% (1991-2003) to 2.1% (2014-2016). There were only minor differences between the cancer-specific ratios; in 2014-2016, ranges were between 1.1% and 2.8%. Individuals with cancer-related AS were younger than those who choose AS due to other diseases (73 vs. 80 years). The median age of people with cancer-related AS (73 years) was similar to that of all cancer-related deaths (74 years).
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Findlay S, Swanson M, Junker C, Kinkor M, Harland KK, Buresh C. Adapted Helping Babies Breathe approach to neonatal resuscitation in Haiti: a retrospective cohort study. BMC Pediatr 2022; 22:7. [PMID: 34980010 PMCID: PMC8722303 DOI: 10.1186/s12887-021-02987-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022] Open
Abstract
Background Helping Babies Breathe (HBB) is an American Academy of Pediatrics neonatal resuscitation program designed to reduce neonatal mortality in low resource settings. The 2017 neonatal mortality rate in Haiti was 28 per 1000 live births and an estimated 85 % of Haitian women deliver at home. Given this, the Community Health Initiative implemented an adapted HBB (aHBB) in Haiti to evaluate neonatal mortality. Methods Community Health Workers taught an aHBB program to laypeople, which didn’t include bag-valve-mask ventilation. Follow-up after delivery assessed for maternal and neonatal mortality and health. Results Analysis included 536 births of which 84.3 % (n=452) were attended by someone trained in aHBB. The odds of neonatal mortality was not significantly different among the two groups (aOR=0.48 [0.16-1.44]). Composite outcome of neonatal health as reported by the mother (subjective morbidity and mortality) was significantly lower in aHBB attended births (aOR=0.31 [0.14-0.70]). Conclusion This analysis of the aHBB program indicates that community training to laypersons in low resource settings may reduce neonatal ill-health but not neonatal mortality. This study is likely underpowered to find a difference in neonatal mortality. Further work is needed to evaluate which components of the aHBB program are instrumental in improving neonatal health. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02987-4.
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Affiliation(s)
- Shannon Findlay
- Department of Emergency Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, IA, 52242, Iowa City, USA
| | - Morgan Swanson
- Department of Emergency Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, IA, 52242, Iowa City, USA
| | - Christian Junker
- Department of Emergency Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, IA, 52242, Iowa City, USA
| | - Mitchell Kinkor
- Department of Emergency Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, IA, 52242, Iowa City, USA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, IA, 52242, Iowa City, USA
| | - Christopher Buresh
- Department of Emergency Medicine, University of Washington, Harborview Medical Center, Box 359702, 325 Ninth Avenue, WA, 98104, Seattle, USA.
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King DM, Vakkalanka JP, Junker C, Harland KK, Nugent AS. Emergency Department Overcrowding Lowers Patient Satisfaction Scores. Acad Emerg Med 2021; 28:363-366. [PMID: 32578920 DOI: 10.1111/acem.14046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/06/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dana M. King
- From the Department of Emergency Medicine University of Iowa College of Medicine Iowa CityIAUSA
| | - J. Priyanka Vakkalanka
- From the Department of Emergency Medicine University of Iowa College of Medicine Iowa CityIAUSA
- and the Department of Epidemiology University of Iowa College of Public Health Iowa City IAUSA
| | - Christian Junker
- From the Department of Emergency Medicine University of Iowa College of Medicine Iowa CityIAUSA
| | - Karisa K. Harland
- From the Department of Emergency Medicine University of Iowa College of Medicine Iowa CityIAUSA
- and the Department of Epidemiology University of Iowa College of Public Health Iowa City IAUSA
| | - Andrew S. Nugent
- From the Department of Emergency Medicine University of Iowa College of Medicine Iowa CityIAUSA
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Keiser O, Giudici F, Müllhaupt B, Junker C, Dufour JF, Moradpour D, Bruggmann P, Terziroli B, Semela D, Brezzi M, Bertisch B, Estill J, Negro F, Spoerri A. Trends in hepatitis C-related mortality in Switzerland. J Viral Hepat 2018; 25:152-160. [PMID: 29159841 DOI: 10.1111/jvh.12803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/07/2017] [Indexed: 12/24/2022]
Abstract
In order to accurately assess the burden of hepatitis C (HCV) and develop effective interventions, we must understand the magnitude and trends of mortality related to the disease. In the United States, HCV-related mortality is continuously increasing. We have no comparable data for Switzerland and other European countries, although a modelling study predicted a similar increase. We analysed time trends (1 January 1995-31 December 2014) in HCV-specific mortality rates in the Swiss general population using the death registry of the Swiss Federal Statistical Office (SFSO). We compared HCV-related mortality to HIV-related and hepatitis B (HBV)-related mortality. To determine potential under-reporting in HCV-related mortality, we probabilistically linked the SFSO data to persons who died in the Swiss Hepatitis C Cohort Study (SCCS). SFSO data showed that HCV-related mortality more than doubled between 1995 and 2003, but has since stabilized at ~2.5/100 000 person-years. Since 2000, HCV-related mortality has been higher than HIV-related mortality and was about fivefold higher in 2014. HBV-related mortality remained low at ~0.5/100 000 person-years. Of 4556 persons in the SCCS, 421 have died and 86.2% could be linked to the death registry. According to the SCCS, 133 deaths were HCV-related. HCV was not mentioned on the SFSO death certificate of 45% of these (n = 60/133). In conclusion, HCV-related mortality remained constant, possibly because quality of care was high, or because of under-reporting or because mortality has not yet increased. However, HCV-related mortality is now much higher than HIV- and HBV-related mortality, and under-reporting was common.
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Affiliation(s)
- O Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - F Giudici
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - B Müllhaupt
- Gastroenterology and Hepatology University Hospital Zurich, Zurich, Switzerland
| | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - J-F Dufour
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.,University Clinic of Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - D Moradpour
- Division of Gastroenterology and Hepatology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - P Bruggmann
- Arud Centres for Addiction Medicine, Zurich, Switzerland
| | | | - D Semela
- Division of Gastroenterology and Hepatology, St Gallen, Switzerland
| | - M Brezzi
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - B Bertisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Checkpoint Zurich, Zurich, Switzerland
| | - J Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - F Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospitals Geneva, Geneva, Switzerland
| | - A Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Mølbak K, Espenhain L, Nielsen J, Tersago K, Bossuyt N, Denissov G, Baburin A, Virtanen M, Fouillet A, Sideroglou T, Gkolfinopoulou K, Paldy A, Bobvos J, van Asten L, de Lange M, Nunes B, da Silva S, Larrauri A, Gómez IL, Tsoumanis A, Junker C, Green H, Pebody R, McMenamin J, Reynolds A, Mazick A. Excess mortality among the elderly in European countries, December 2014 to February 2015. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.11.21065] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since December 2014 and up to February 2015, the weekly number of excess deaths from all-causes among individuals?≥?65 years of age in 14 European countries have been significantly higher than in the four previous winter seasons. The rise in unspecified excess mortality coincides with increased proportion of influenza detection in the European influenza surveillance schemes with a main predominance of influenza A(H3N2) viruses seen throughout Europe in the current season, though cold snaps and other respiratory infections may also have had an effect.
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Affiliation(s)
- K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
| | | | - J Nielsen
- Statens Serum Institut, Copenhagen, Denmark
| | - K Tersago
- Scientific Institute of Public Health, Brussels, Belgium
| | - N Bossuyt
- Scientific Institute of Public Health, Brussels, Belgium
| | - G Denissov
- National Institute for Health Devlopment, Tallinn, Estonia
| | - A Baburin
- National Institute for Health Devlopment, Tallinn, Estonia
| | - M Virtanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Fouillet
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - T Sideroglou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - K Gkolfinopoulou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Paldy
- National Institute of Environmental Health, Budapest, Hungary
| | - J Bobvos
- National Institute of Environmental Health, Budapest, Hungary
| | - L van Asten
- National Institute of Public Health and The Environment (RIVM), the Netherlands
| | - M de Lange
- National Institute of Public Health and The Environment (RIVM), the Netherlands
| | - B Nunes
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - S da Silva
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - A Larrauri
- National Centre of Epidemiology; CIBER Epidemiología y Salud Pública (CIBERESP) Institute of Health Carlos III, Madrid, Spain
| | - I L Gómez
- National Centre of Epidemiology; CIBER Epidemiología y Salud Pública (CIBERESP) Institute of Health Carlos III, Madrid, Spain
| | - A Tsoumanis
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - H Green
- Public Health England, London, United Kingdom
| | - R Pebody
- Public Health England, London, United Kingdom
| | - J McMenamin
- Health Protection Scotland, Glasgow, United Kingdom
| | - A Reynolds
- Health Protection Scotland, Glasgow, United Kingdom
| | - A Mazick
- Statens Serum Institut, Copenhagen, Denmark
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Kummerow C, Lyrmann H, Neef M, Backes C, Junker C, Schwarz EC, Kruse K, Hoth M. Modeling Killer Cell Migration and Search Strategies. Biophys J 2013. [DOI: 10.1016/j.bpj.2012.11.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Halimani M, Pattu V, Junker C, Marshall M, Matti U, Schwarz E, Krause E, Hoth M, Rettig J. Function of Syntaxin11 in cytotoxic T lymphocytes (121.9). The Journal of Immunology 2012. [DOI: 10.4049/jimmunol.188.supp.121.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Cytotoxic T Lymphocytes (CTLs) form immunological synapses (IS) with antigen presenting cells to kill them. Killing requires the fusion of lytic granules at the IS to release the containing cytotoxic molecules (perforin and granzymes). The fusion process is mediated by SNARE (soluble N-ethylmaleimide sensitive factor attachment protein receptor) proteins. Since mutations within the coding region of syntaxin11 lead to Familial Hemophagocytic Lymphohistiocytosis (FHL4), an immune disorder caused by impaired granule exocytosis. We have investigated the contribution of syntaxin11 to lytic granule release. Using CD3 specific antibodies as a marker for a functional IS, we show that syntaxin11 accumulates at the IS in CTLs. Syntaxin11 was also co-localized with Munc18-2, a docking factor in agreement with the role of Munc18-2 as a syntaxin chaperone in other cell types. Using high resolution nanoscopy (structured illumination microscopy) we determined the subcellular localization of syntaxin11 in CTLs with a syntaxin11 specific antibody. Syntaxin11 was associated with recycling endosomes and mannose 6-phosphate receptor (M6PR) positive compartments. Functional assays using Syntaxin11 specific siRNA (knockdown studies) show a reduction in degranulation and killing efficiency in contrast to control siRNA transfected CTLs. These results support the conclusion that syntaxin11 is required for lytic granule exocytosis.
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Affiliation(s)
| | - Varsha Pattu
- 1Physiology, Saarland University, Homburg, Germany
| | | | | | - Ulf Matti
- 1Physiology, Saarland University, Homburg, Germany
| | - Eva Schwarz
- 2Biophysics, Saarland University, Homburg Saar, Germany
| | - Elmar Krause
- 1Physiology, Saarland University, Homburg, Germany
| | - Markus Hoth
- 2Biophysics, Saarland University, Homburg Saar, Germany
| | - Jens Rettig
- 1Physiology, Saarland University, Homburg, Germany
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Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill 2012. [DOI: 10.2807/ese.17.14.20138-en] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark
| | - B Gergonne
- The National Board of Health and Welfare, Stockholm, Sweden
| | - J Nielsen
- Statens Serum Institut, Copenhagen, Denmark
| | - F Wuillaume
- Scientific Institute of Public Health, Brussels, Belgium
| | - M J Virtanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Fouillet
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - H Uphoff
- Hesse State Health Office, Dillenburg, Germany
| | - T Sideroglou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Paldy
- Hungary National Institute of Environmental Health, Budapest, Hungary
| | - A Oza
- Health Protection Surveillance Centre, Dublin, Ireland
| | - B Nunes
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - S A McDonald
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H K Green
- Health Protection Agency, Colindale, United Kingdom
| | - R Pebody
- Health Protection Agency, Colindale, United Kingdom
| | - K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
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12
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Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill 2012; 17:20138. [PMID: 22516003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark.
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Junker C, Luostarinen T. SP3-75 Training in epidemiology in Europe. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976o.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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15
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16
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Qu B, Pattu V, Junker C, Schwarz EC, Bhat SS, Kummerow C, Marshall M, Matti U, Neumann F, Pfreundschuh M, Becherer U, Rieger H, Rettig J, Hoth M. Docking of lytic granules at the immunological synapse in human CTL requires Vti1b-dependent pairing with CD3 endosomes. J Immunol 2011; 186:6894-904. [PMID: 21562157 DOI: 10.4049/jimmunol.1003471] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lytic granule (LG)-mediated apoptosis is the main mechanism by which CTL kill virus-infected and tumorigenic target cells. CTL form a tight junction with the target cells, which is called the immunological synapse (IS). To avoid unwanted killing of neighboring cells, exocytosis of lytic granules (LG) is tightly controlled and restricted to the IS. In this study, we show that in activated human primary CD8(+) T cells, docking of LG at the IS requires tethering LG with CD3-containing endosomes (CD3-endo). Combining total internal reflection fluorescence microscopy and fast deconvolution microscopy (both in living cells) with confocal microscopy (in fixed cells), we found that LG and CD3-endo tether and are cotransported to the IS. Paired but not single LG are accumulated at the IS. The dwell time of LG at the IS is substantially enhanced by tethering with CD3-endo, resulting in a preferential release of paired LG over single LG. The SNARE protein Vti1b is required for tethering of LG and CD3-endo. Downregulation of Vti1b reduces tethering of LG with CD3-endo. This leads to an impaired accumulation and docking of LG at the IS and a reduction of target cell killing. Therefore, Vti1b-dependent tethering of LG and CD3-endo determines accumulation, docking, and efficient lytic granule secretion at the IS.
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Affiliation(s)
- Bin Qu
- Department of Biophysics, Saarland University, 66421 Homburg, Germany
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Pattu V, Qu B, Marshall M, Becherer U, Junker C, Matti U, Schwarz EC, Krause E, Hoth M, Rettig J. Syntaxin7 is required for lytic granule release from cytotoxic T lymphocytes. Traffic 2011; 12:890-901. [PMID: 21438968 DOI: 10.1111/j.1600-0854.2011.01193.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
SNARE proteins are essential fusion mediators for many intracellular trafficking events. Here, we investigate the role of Syntaxin7 (Stx7) in the release of lytic granules from cytotoxic T lymphocytes (CTLs). We show that Stx7 is expressed in CTLs and is preferentially localized to the region of lytic granule release, the immunological synapse (IS). Interference of Stx7 function by expression of a dominant-negative Stx7 construct or by small interfering RNA leads to a dramatic reduction of CTL-mediated killing of target cells. Real-time visualization of individual lytic granules at the IS by evanescent wave microscopy reveals that lytic granules in Stx7-deprived CTLs not only fail to fuse with the plasma membrane but even fail to accumulate at the IS. Surprisingly, the accumulation defect is not caused by an overall reduction in lytic granule number, but by a defect in the trafficking of T cell receptors (TCRs) through endosomes. Subsequent high-resolution nanoscopy shows that Stx7 colocalizes with Rab7 on late endosomes. We conclude from these data that the accumulation of recycling TCRs at the IS is a SNARE-dependent process and that Stx7-mediated processing of recycling TCRs through endosomes is a prerequisite for the cytolytic function of CTLs.
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Affiliation(s)
- Varsha Pattu
- Institut für Physiologie, Universität des Saarlandes, Kirrberger Straße 8, Gebäude 59, 66421 Homburg, Saarland, Germany
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Halimani M, Pattu V, Junker C, Marshall M, Schwarz E, Krause E, Matti U, Hoth M, Rettig J. The role of syntaxin11 in cytotoxic T lymphocytes (109.26). The Journal of Immunology 2011. [DOI: 10.4049/jimmunol.186.supp.109.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Cytotoxic T Lymphocytes (CTLs) form immunological synapses (IS) with antigen presenting cells in order to kill them. Killing requires release of lytic granules which occurs via exocytosis, and is dependent on SNARE (Soluble N-ethylmaleimide sensitive factor attachment protein receptor) proteins. Syntaxin11 is a SNARE protein that is predicted to be involved in the fusion of lytic granules in CTLs, since mutations within the coding region of Syntaxin11 lead to Familial Hemophagocytic Lymphohistiocytosis (FHL4), an immune disorder caused by impaired granule exocytosis. We have investigated the contribution of Syntaxin11 to lytic granule release. We used live cell imaging to observe the trafficking of full length Syntaxin11. Using CD3 specific antibodies as a marker for a functional IS, we show that Syntaxin11 accumulates at the IS after CTL polarization and conjugation with the APC has occurred. Syntaxin11 was also associated with Munc18-2, consistent with the role of Munc18-2 as a syntaxin chaperone and as a docking factor. Using a Syntaxin11 antibody we also confirmed the subcellular localization of Syntaxin11 in fixed CTLs with confocal microscopy. Syntaxin11 was associated with Munc18-2 and CD3 at the IS in fixed CTLs, consistent with our observations in live cell imaging of CTLs. These results support the conclusion that Syntaxin11 is involved in lytic granule exocytosis.
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Affiliation(s)
| | - Varsha Pattu
- 1Physiology, Saarland University, Homburg, Germany
| | | | | | - Eva Schwarz
- 2Biophysics, University of Saarland, Homburg, Germany
| | - Elmar Krause
- 1Physiology, Saarland University, Homburg, Germany
| | - Ulf Matti
- 1Physiology, Saarland University, Homburg, Germany
| | - Markus Hoth
- 2Biophysics, University of Saarland, Homburg, Germany
| | - Jens Rettig
- 1Physiology, Saarland University, Homburg, Germany
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Mazick A, Gergonne B, Wuillaume F, Danis K, Vantarakis A, Uphoff H, Spiteri G, van 't Klooster T, Junker C, Holmberg M, Molbak K. Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries. Euro Surveill 2010; 15:19480. [PMID: 20144446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics. However, there was a cumulative excess mortality of 77 cases (1 per 100,000 population) in 5-14-year-olds, and possibly also among 0-4-year-olds.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark.
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Mazick A, Gergonne B, Wuillaume F, Danis K, Vantarakis A, Uphoff H, Spiteri G, van 't Klooster T, Junker C, Holmberg M, Mølbak K. Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries. Euro Surveill 2010. [DOI: 10.2807/ese.15.05.19480-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics. However, there was a cumulative excess mortality of 77 cases (1 per 100,000 population) in 5-14-year-olds, and possibly also among 0-4-year-olds.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark
| | - B Gergonne
- The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
- Statens Serum Institut, Copenhagen, Denmark
| | - F Wuillaume
- Scientific Institute of Public Health, Brussels, Belgium
| | - K Danis
- Department for Surveillance and Intervention, Hellenic Centre for Disease Control and Prevention, Greece
| | - A Vantarakis
- Department of Public Health, Medical School, University of Patras, Greece
| | - H Uphoff
- Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Dillenburg, Germany
| | - G Spiteri
- Infectious Disease Prevention and Control Unit, Department of Health Promotion and Disease Prevention, Msida, Malta
| | - T van 't Klooster
- Rijksinstituut voor Volksgezondheid en Milieu (RIVM, National Institute for Public Health and Environment), Bilthoven, Netherlands
| | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - M Holmberg
- The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
| | - K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
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Kummerow C, Junker C, Kruse K, Rieger H, Quintana A, Hoth M. The immunological synapse controls local and global calcium signals in T lymphocytes. Immunol Rev 2009; 231:132-47. [DOI: 10.1111/j.1600-065x.2009.00811.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Junker C, Quintana A, Kummerow C, Schwindling C, Hoth M. Cytoskeleton dependent T cell polarization modulates calcium signals (35.31). The Journal of Immunology 2009. [DOI: 10.4049/jimmunol.182.supp.35.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
The objective of the study was to analyze the role of T cell polarization and T cell shape changes for calcium (Ca) signals and Ca dependent T cell activation. We have used sophisticated live cell imaging technology to quantify cytoskeletal components, mitochondria and other organelle rearrangements during and after formation of the immunological synapse (IS) in parallel with Ca signals. We found that T cell polarization after formation of the IS was paralleled by drastic cell shape changes. These changes were dependent on the actin cytoskeleton and they induced a very intimate proximity between mitochondria and the plasma membrane at the IS. The mitochondrial translocation to the IS was Ca dependent but did not require local Ca influx at the IS. The shape change-dependent mitochondrial translocation to the plasma membrane prevented ORAI1 channel inactivation even in T cells in which dynein motor protein-dependent mitochondria movements towards the plasma membrane were completely abolished, highlighting the importance of the cell shape to control Ca influx. Our results suggest that cell shape changes do not only facilitate an efficient contact with antigen presenting cells but also strongly modulate Ca dependent T cell activation. Organelle polarization during IS formation is an important mechanism to modulate Ca dependent T cell activation.
This project was funded by the Deutsche Forschungsgemeinschaft (Graduate Research School 1326, SFB 530, project A3) and a HOMFOR grant from the Medical Faculty.
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Affiliation(s)
| | | | | | | | - Markus Hoth
- 1Biophysics, Saarland University, Homburg, Germany
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Qu B, Pattu V, Junker C, Becherer U, Matti U, Rieger H, Schwarz EC, Rettig J. T cell receptors mediate docking of cytotoxic granules at the immunological synapse (133.7). The Journal of Immunology 2009. [DOI: 10.4049/jimmunol.182.supp.133.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
TCR enrichment and cytotoxic granules accumulation at the immunological synapse are necessary for cytotoxic T lymphocyte-mediated killing. Using immunocytochemistry, confocal microscopy, 4D fast live cell imaging and total internal reflection fluorescence microscopy, we analyzed the localization and transport of recycling TCR vesicles and cytotoxic granules in parallel. We found that recycling TCR vesicles are very often connected with cytotoxic granules. Both are co-transported in a paired manner to the IS where recycling TCR enhance the docking and release of cytotoxic granules. Quantitative analysis of vesicluar transport revealed that pairing enables CTL to kill within a few minutes after synapse formation. These data not only highlight an important function of recycling TCR, but also show that pairing of different vesicles is an unexpected mechanism to target vesicles to a defined area within CTL.
This project was funded by the Deutsche Forschungsgemeinschaft (Graduate Research School 1326, DFG grant RE 1092/6-1 to J.R and M.H.) and a HOMFOR grant from the Medical Faculty (to J.R. and M.H).
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Affiliation(s)
| | - Varsha Pattu
- 2Physiology, University of Saarland, Homburg (Saar), Germany
| | | | - Ute Becherer
- 2Physiology, University of Saarland, Homburg (Saar), Germany
| | - Ulf Matti
- 2Physiology, University of Saarland, Homburg (Saar), Germany
| | - Heiko Rieger
- 3Theoretical Physics, University of Saarland, Saarbrücken, Germany
| | | | - Jens Rettig
- 2Physiology, University of Saarland, Homburg (Saar), Germany
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Quintana A, Kummerow C, Junker C, Becherer U, Hoth M. Morphological changes of T cells following formation of the immunological synapse modulate intracellular calcium signals. Cell Calcium 2008; 45:109-22. [PMID: 18789821 DOI: 10.1016/j.ceca.2008.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/08/2008] [Accepted: 07/09/2008] [Indexed: 10/21/2022]
Abstract
Sustained Ca(2+) influx through plasma membrane Ca(2+) released-activated Ca(2+) (CRAC) channels is essential for T cell activation. Since inflowing Ca(2+) inactivates CRAC channels, T cell activation is only possible if Ca(2+)-dependent inactivation is prevented. We have previously reported that sustained Ca(2+) influx through CRAC channels requires both mitochondrial Ca(2+) uptake and mitochondrial translocation towards the plasma membrane in order to prevent Ca(2+)-dependent channel inactivation. Here, we show that morphological changes following formation of the immunological synapse (IS) modulate Ca(2+) influx through CRAC channels. Cell shape changes were dependent on the actin cytoskeleton, and they sustained Ca(2+) entry by bringing mitochondria and the plasma membrane in closer proximity. The increased percentage of mitochondria beneath the plasma membrane following shape changes occurred in all 3 dimensions and correlated with an increase in the amplitude of Ca(2+) signals. The shape change-dependent mitochondrial localization close to the plasma membrane prevented CRAC channel inactivation even in T cells in which dynein motor protein-dependent mitochondria movements towards the plasma membrane were completely abolished, highlighting the importance of the shape change-dependent control of Ca(2+) influx. Our results suggest that morphological changes do not only facilitate an efficient contact with antigen presenting cells but also strongly modulate Ca(2+) dependent T cell activation.
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Affiliation(s)
- Ariel Quintana
- Department of Biophysics, University of Saarland, Homburg, Germany.
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Junker C, Sheahan JN, Jennings SG, O'Brien P, Hinds BD, Martinez-Twary E, Hansen ADA, White C, Garvey DM, Pinnick RG. Measurement and analysis of aerosol and black carbon in the southwestern United States and Panama and their dependence on air mass origin. ACTA ACUST UNITED AC 2004. [DOI: 10.1029/2003jd004066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C. Junker
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - J. N. Sheahan
- Department of Mathematics; National University of Ireland; Galway Ireland
| | - S. G. Jennings
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - P. O'Brien
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - B. D. Hinds
- US Army Research Laboratory; Adelphi Maryland USA
| | | | - A. D. A. Hansen
- Lawrence Berkeley National Laboratory; Berkeley California USA
| | - C. White
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - D. M. Garvey
- US Army Research Laboratory; Adelphi Maryland USA
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Jaggi A, Junker C, Minder C. [Does the structure of medical services affect the proportion of death in hospitals? An ecological analysis in the mobility regions of Switzerland?]. Soz Praventivmed 2002; 46:379-88. [PMID: 11851072 DOI: 10.1007/bf01321664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES With the discussion about measures to reduce over-capacities in the health services in mind, we examined the influence of medical supply structures and services on hospital utilisation directly before death. METHODS Based on the specification of the place of dying from the death certificates, we determined the proportions of deaths in hospitals in an ecological study. We analysed deaths of persons above age 65 in each of the 106 mobility regions of Switzerland in the years 1979 to 1980. RESULTS The proportion of deaths occurring in hospitals varied between 27% and 81%. Despite missing data regarding stationary and ambulatory care services, more than half of the variance could be explained by means of a multivariate regression analysis. Our results imply an inverse relation between the proportion of deaths in the hospital and the number of consultations provided by primary care physicians, as well as the number of nursing home beds. Further, we observe a direct relation to the number of hospital beds in a region. All indicators are calculated per inhabitant. CONCLUSIONS In health care supply planning, such systematic associations should be taken into account. We recommend to analyse regularly interregional differences in supply and outcome of medical performances with the best available data.
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Affiliation(s)
- A Jaggi
- Institut für Sozial- und Präventivmedizin, Universität Bern
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Junker C, Hoppe T, Horstmann W, Gerhards H, Matiasek K. Studies on head and collum of the horse by means of Magnetic Resonance Imaging with case reports. PFERDEHEILKUNDE 2002. [DOI: 10.21836/pem20020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PRINCIPLES Cigarette smoking causes an estimated 13% of all deaths in Switzerland. Though most smokers will eventually become ex-smokers of their own volition, physicians play an important role in accelerating the process of quitting among smoking patients. Even brief advice from physicians is effective in doing so. The purpose of this study was to investigate which smokers were asked about their smoking habits, and how often, whether they received advice to quit, and how this correlates with the patient's desire to quit. METHODS Telephone interviews were carried out with a random sample of smokers and ex-smokers from the German-speaking Swiss population (n = 993). We collected information on personal characteristics, smoking habits, and recall of physicians' advice. Data was analysed descriptively and by logistic regression. RESULTS 88% recalled being asked by a doctor about their smoking habits. In contrast, only 34% of smoking patients recalled being advised to stop. Women, older people and those in poor subjective health were asked more frequently. Heavier smokers and those in poor subjective health were advised more frequently. Current smokers more frequently express the desire to quit if they are heavier smokers and have been advised to quit by their physician, compared with those who have not received such advice. CONCLUSIONS Similarly to the international findings, smoking patients in Switzerland receive brief advice with insufficient frequency. Action should therefore be taken to encourage health professionals not only to question all smoking patients but to advise and motivate them to quit smoking.
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Affiliation(s)
- T Eckert
- Department of Social and Preventive Medicine, University of Berne.
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Eckert T, Junker C. Motivation for smoking cessation: what role do doctors play? Swiss Med Wkly 2001; 131:521-6. [PMID: 11727671 DOI: 10.4414/smw.2001.09762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PRINCIPLES Cigarette smoking causes an estimated 13% of all deaths in Switzerland. Though most smokers will eventually become ex-smokers of their own volition, physicians play an important role in accelerating the process of quitting among smoking patients. Even brief advice from physicians is effective in doing so. The purpose of this study was to investigate which smokers were asked about their smoking habits, and how often, whether they received advice to quit, and how this correlates with the patient's desire to quit. METHODS Telephone interviews were carried out with a random sample of smokers and ex-smokers from the German-speaking Swiss population (n = 993). We collected information on personal characteristics, smoking habits, and recall of physicians' advice. Data was analysed descriptively and by logistic regression. RESULTS 88% recalled being asked by a doctor about their smoking habits. In contrast, only 34% of smoking patients recalled being advised to stop. Women, older people and those in poor subjective health were asked more frequently. Heavier smokers and those in poor subjective health were advised more frequently. Current smokers more frequently express the desire to quit if they are heavier smokers and have been advised to quit by their physician, compared with those who have not received such advice. CONCLUSIONS Similarly to the international findings, smoking patients in Switzerland receive brief advice with insufficient frequency. Action should therefore be taken to encourage health professionals not only to question all smoking patients but to advise and motivate them to quit smoking.
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Affiliation(s)
- T Eckert
- Department of Social and Preventive Medicine, University of Berne.
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30
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Kunst AE, Groenhof F, Andersen O, Borgan JK, Costa G, Desplanques G, Filakti H, Giraldes MDR, Faggiano F, Harding S, Junker C, Martikainen P, Minder C, Nolan B, Pagnanelli F, Regidor E, Vågerö D, Valkonen T, Mackenbach JP. Occupational class and ischemic heart disease mortality in the United States and 11 European countries. Am J Public Health 1999; 89:47-53. [PMID: 9987464 PMCID: PMC1508498 DOI: 10.2105/ajph.89.1.47] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.
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Affiliation(s)
- A E Kunst
- Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
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Abstract
BACKGROUND Some randomised controlled trials (RCTs) done in German-speaking Europe are published in international English-language journals and others in national German-language journals. We assessed whether authors are more likely to report trials with statistically significant results in English than in German. METHODS We studied pairs of RCT reports, matched for first author and time of publication, with one report published in German and the other in English. Pairs were identified from reports round in a manual search of five leading German-language journals and from reports published by the same authors in English found on Medline. Quality of methods and reporting were assessed with two different scales by two investigators who were unaware of authors' identities, affiliations, and other characteristics of trial reports. Main study endpoints were selected by two investigators who were unaware of trial results. Our main outcome was the number of pairs of studies in which the levels of significance (shown by p values) were discordant. FINDINGS 62 eligible pairs of reports were identified but 19 (31%) were excluded because they were duplicate publications. A further three pairs (5%) were excluded because no p values were given. The remaining 40 pairs were analysed. Design characteristics and quality features were similar for reports in both languages. Only 35% of German-language articles, compared with 62% of English-language articles, reported significant (p < 0.05) differences in the main endpoint between study and control groups (p = 0.002 by McNemar's test). Logistic regression showed that the only characteristic that predicted publication in an English-language journal was a significant result. The odds ratio for publication of trials with significant results in English was 3.75 (95% CI 1.25-11.3). INTERPRETATION Authors were more likely to publish RCTs in an English-language journal if the results were statistically significant. English language bias may, therefore, be introduced in reviews and meta-analyses if they include only trials reported in English. The effort of the Cochrane Collaboration to identify as many controlled trials as possible, through the manual search of many medical journals published in different languages will help to reduce such bias.
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Affiliation(s)
- M Egger
- Department of Social Medicine, University of Bristol, UK
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32
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Junker C, Egger M, Schneider M, Zellweger T, Antes G. The CONSORT statement. JAMA 1996; 276:1876-7; author reply 1877. [PMID: 8968009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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33
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Affiliation(s)
- C Junker
- Department of Industrial Engineering, University College, Galway, Ireland
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34
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Grichting C, Junker C, Schaufelberger HJ. [Determinants in decisions for the utilization of an ambulatory medical service]. Soz Praventivmed 1986; 31:212-4. [PMID: 3765864 DOI: 10.1007/bf02083459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The purpose of this research is to know more about the factors determining the decision to see a doctor. Especially the influence of characteristics of the delivery system (e.g. differences between urban and rural regions) and characteristics of users (e.g. social class) are investigated. In this article the conceptual frame of the study is described. The model is based on assumptions of the action-decision-theory. It structures the process of decision and action into four phases: the first two, perception and interpretation, are summarized as "process of attention"; the subsequent ones, coping and evaluation, as "process of acting". The model describes the social system (the total of demographic, socio-structural and socio-economic variables) and the memory system (contained within the individual life history) as mediating factors influencing the decision to act.
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Cloetta B, Junker C. [Expectations concerning physician consultation]. Soz Praventivmed 1986; 31:214-5. [PMID: 3765865 DOI: 10.1007/bf02083460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Immediately prior to their consultation of a physician 259 ambulatory patients were interviewed concerning their expectations of the interaction with the physician, the course and results of the consultation. From the responses received to open and closed questions several quasi-scales were developed. These scales showed correlations to variables such as nature of the medical problem, type of practice and socio-economic indicators.
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Junker C, Junker H. [Experience with timolol in consulting patients (author's transl)]. Klin Monbl Augenheilkd 1980; 176:849-51. [PMID: 7442062 DOI: 10.1055/s-2008-1057568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Experience obtained in the treatment of 78 eyes of patients suffering from open-angle glaucoma with the beta-blocker Timolol 0.25% and 0.5%. Timolol was only given to patients whose intraocular pressure could no longer be adequately regulated by the medications previously employed. A synopsis is given of the medications used over many years. The intraocular pressures of the eyes that responded to Timolol remained below 23 mmHg even after prolonged use, so that a fistulizing operation was initially unnecessary.
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Sundmacher R, Junker C, Fanti P. [First experience with highly hydrophilic therapeutic soft contact lenses (With special reference to herpetic corneal disease) (author's transl)]. Klin Monbl Augenheilkd 1976; 169:422-30. [PMID: 994396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
74 therapeutic problem-cases of various corneal diseases were treated with the highly hydrophilic Weicon 72 (W 72) which proved to be a valuable therapeutic tool. Additional applications of hypertonic saline and of industrial preparations of steroids, antivirals and antibiotics were tolerated without observable side effects. Additional therapy is often inevitable to achieve an optimal therapeutic effect. Nearly all treated cases of chronic herpetic keratitis - mainly metaherpetic corneal diseases - responded well or excellently to W 72 therapy. If, however, the indication for soft lens therapy is somehow inadequate, if additional therapy is wrong or not applied at all and if the patient does not keep strictly to the therapeutic regime undesired side effects are likely to develop.
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Junker C. [Vision against the light as an aid to indication for cataract operation (author's transl)]. Klin Monbl Augenheilkd 1976; 169:348-51. [PMID: 1003825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The examination of visual acuity against the light may help the decision, whether or not a senile cataract should be operated on. We examined 84 eyes with different lens opacities, the visual acuity was analysed in relation to the axial, cortical and capsular cataract. We found in all cases a marked reduction of the visual acuity against the light. This has been general ophthalmological experience especially in the capsular cataract. This additional examination, we propose, is easily performed, and was given helpful information for all kinds of cataracts, where the indication for surgery was not clearcut.
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