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Pommerenke C, Poloczek S, Breuer F, Wolff J, Dahmen J. Automated and app-based activation of first responders for prehospital cardiac arrest: an analysis of 16.500 activations of the KATRETTER system in Berlin. Scand J Trauma Resusc Emerg Med 2023; 31:105. [PMID: 38124125 PMCID: PMC10731739 DOI: 10.1186/s13049-023-01152-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Bystander CPR is one of the main independent factors contributing to better survival after out-of-hospital cardiac arrest. Simultaneously, the rate of bystander CPR in Germany is below the European average. First responder applications (apps) contribute to reducing the time period without CPR (no-flow time) until professional help can arrive on-scene. METHODS The KATRETTER app was introduced in Berlin as one of the first apps in Europe which do not require any medical qualifications to register as a first responder. The activation of volunteer first responders for suspected cardiac arrest cases through the Berlin Emergency Medical Services integrated control center was evaluated based on data collected between 16 Oct 2020 and 16 Oct 2022. Our descriptive analysis includes the number of registered first responders, number of activations, the number and percentages of accepted activations, as well as all reports where first responders arrived at the scene. RESULTS As of 15 Oct 2022, a total of 10,102 first responders were registered in the state of Berlin. During this specified period, there were 16.505 activations of the system for suspected out-of-hospital cardiac arrest. In 38.4% of the accepted cases, first responders documented patient contact, and in 34.6% of cases with patient contact, CPR was performed. Only 2% of registered first responders did not have any medical qualifications. CONCLUSIONS Smartphone-based first responder applications should not be understood as a means of alerting professional help, but rather like a digitally amplified "call for help" in the vicinity of an emergency location. A large number of first responders can be recruited within 24 months, without large-scale public relations work necessary. No qualifications were required to become a first responder, contributing to a low-threshold registration process with the effect of a more widespread distribution of the app and cost reduction during implementation.
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Affiliation(s)
- C Pommerenke
- Charité University Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S Poloczek
- Chief Medical Director, Emergency Medical Services, Fire Department, Berlin, Germany
| | - F Breuer
- Emergency Medical Services Director, Rhine-Berg-District, Office for Fire Protection and Emergency Medical Service, Bergisch Gladbach, Germany
| | - J Wolff
- Department of Anesthesia, Intensive Care and Emergency Medicine, Military Hospital Berlin, Berlin, Germany
| | - J Dahmen
- Department of Medicine, Health Faculty, University Witten/Herdecke, Witten, Germany.
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Wolff J, Breuer F, von Kottwitz K, Poloczek S, Röschel T, Dahmen J. [Prehospital perimortem cesarean section during cardiopulmonary resuscitation for traumatic cardiac arrest : Case report and lessons learned]. Unfallchirurgie (Heidelb) 2023; 126:727-735. [PMID: 35947175 PMCID: PMC10449654 DOI: 10.1007/s00113-022-01220-w] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
The following case report discusses the resuscitation of a pregnant woman in traumatic cardiac arrest after a fall from a height with consecutive resuscitative hysterotomy for maternal and fetal salvage. The report illustrates all lessons learned from critical appraisal amid new guideline recommendations and gives an overview of the published literature on the matter. Despite extensive resuscitation efforts, ultimately both the mother and the newborn were pronounced life extinct at the scene. Prehospital treatment of (traumatic) cardiac arrest in a pregnant patient as well as performing a perimortem cesarean section remain infrequent but challenging scenarios.
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Affiliation(s)
- Justus Wolff
- Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Florian Breuer
- Ärztliche Leitung Rettungsdienst Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Bergisch Gladbach, Deutschland
| | | | - Stefan Poloczek
- Ärztliche Leitung Rettungsdienst Berlin, Berliner Feuerwehr, Berlin, Deutschland
| | - Tom Röschel
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - Janosch Dahmen
- Ärztliche Leitung Rettungsdienst Berlin, Berliner Feuerwehr, Berlin, Deutschland.
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten/Herdecke, Deutschland.
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Herr D, Bhatia S, Breuer F, Poloczek S, Pommerenke C, Dahmen J. Increasing emergency number utilisation is not driven by low-acuity calls: an observational study of 1.5 million emergency calls (2018-2021) from Berlin. BMC Med 2023; 21:184. [PMID: 37193989 DOI: 10.1186/s12916-023-02879-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/04/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The Emergency Medical Service (EMS) in Germany is increasingly challenged by strongly rising demand. Speculations about a greater utilisation for minor cases have led to intensive media coverage, but empirical evidence is lacking. We investigated the development of low-acuity calls from 2018 to 2021 in the federal state of Berlin and its correlations with sociodemographic characteristics. METHODS We analysed over 1.5 million call documentations including medical dispatch codes, age, location and time using descriptive and inferential statistics and multivariate binary logistic regression. We defined a code list to classify low-acuity calls and merged the dataset with sociodemographic indicators and data on population density. RESULTS The number of emergency calls (phone number 112 in Germany) increased by 9.1% from 2018 to 2021; however, the proportion of low-acuity calls did not increase. The regression model shows higher odds of low-acuity for young to medium age groups (especially for age 0-9, OR 1.50 [95% CI 1.45-1.55]; age 10-19, OR 1.77 [95% CI 1.71-1.83]; age 20-29, OR 1.64 [95% CI 1.59-1.68] and age 30-39, OR 1.40 [95% CI 1.37-1.44]; p < 0.001, reference group 80-89) and for females (OR 1.12 [95% CI 1.1-1.13], p < 0.001). Odds were slightly higher for calls from a neighbourhood with lower social status (OR 1.01 per index unit increase [95% CI 1.0-1.01], p < 0.05) and at the weekend (OR 1.02 [95% CI 1.0-1.04, p < 0.05]). No significant association of the call volume with population density was detected. CONCLUSIONS This analysis provides valuable new insights into pre-hospital emergency care. Low-acuity calls were not the primary driver of increased EMS utilisation in Berlin. Younger age is the strongest predictor for low-acuity calls in the model. The association with female gender is significant, while socially deprived neighbourhoods play a minor role. No statistically significant differences in call volume between densely and less densely populated regions were detected. The results can inform the EMS in future resource planning.
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Affiliation(s)
- David Herr
- Faculty of Medicine, School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2 AZ, UK.
| | - Sangeeta Bhatia
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Jameel Institute, Imperial College London, London, UK
| | - Florian Breuer
- Emergency Medical Services Director, Rhine-Berg District, Office for Fire Protection and Emergency Medical Service, Bergisch Gladbach, Germany
| | - Stefan Poloczek
- Office of the Medical Director, Emergency Medical Services, Berlin, Germany
| | | | - Janosch Dahmen
- Faculty of Health, Department of Medicine, Witten/Herdecke University, Witten, Germany
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Breuer F, Beckers SK, Dahmen J, Gnirke A, Pommerenke C, Poloczek S. [Pre-emptive emergency service-Preventive missions and promotion of health literacy at the intersections with emergency medical services]. Anaesthesiologie 2023; 72:358-368. [PMID: 36912990 PMCID: PMC10010211 DOI: 10.1007/s00101-023-01272-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
In the Emergency Medical Service Acts of the Federal States, the statements in these Acts have so far essentially been limited to the implementation of measures to maintain the health of emergency patients and to transport them to a suitable hospital. Preventive fire protection, on the other hand, is regulated in the Fire Brigade Acts or by statutory ordinances. Increasing numbers of emergency service missions and a lack of facilities for alternative care justify the need for a preventive emergency service. This includes all measures that take place before an event occurs in order to prevent emergencies from occurring. As a result, the risk of an emergency event leading to the emergency call 112 should be reduced or delayed. The preventive rescue service should also help to improve the outcome of medical care for patients. Furthermore, it should be made possible to provide those seeking help with a suitable form of care at an early stage.
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Affiliation(s)
- Florian Breuer
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland.
- Ärztliche Leitung Rettungsdienst, Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Am Rübezahlwald 7, 51469, Bergisch Gladbach, Deutschland.
| | - Stefan K Beckers
- Ärztliche Leitung Rettungsdienst Stadt Aachen, Fachbereich Feuerwehr und Rettungsdienst Stadt Aachen, Aachen, Deutschland
| | - Janosch Dahmen
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Andre Gnirke
- Ärztliche Leitung Rettungsdienst, Rettungsdienst-Kooperation in Schleswig-Holstein, Pinneberg, Deutschland
| | | | - Stefan Poloczek
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
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Breuer F, Dahmen J, Pommerenke C, Poloczek S. Frequent User mit Angststörung in der Berliner Notfallrettung: Analyse von Notrufverhalten, Diagnosegruppe und urbaner Verteilung. NOTARZT 2022. [DOI: 10.1055/a-1965-4013] [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: 12/23/2022]
Abstract
Zusammenfassung
Einleitung Patienten mit Angststörung machen einen wesentlichen Anteil derjenigen Anrufer aus, die den Rettungsdienst in Anspruch nehmen. Es ist davon auszugehen, dass viele
dieser Patienten als Frequent User wiederholt den Rettungsdienst alarmieren.
Methodik Als Frequent User mit Angststörung wurden diejenigen Patienten definiert, bei denen im Einsatzprotokoll die Kombination aus der (Verdachts-)Diagnose „Psychiatrischer
Notfall“ sowie dem psychiatrischen Befund „ängstlich“ dokumentiert wurde und es im betrachteten Zeitraum (01.1.2020 bis 31.5.2021) zu mindestens 2 Einsätzen der Notfallrettung kam
(n = 74).
Ergebnisse Die Alarmierung erfolgte in 31% zum psychiatrischen Notfall, aber auch zu Herzbeschwerden, Atembeschwerden oder Brustschmerzen. Bei 56,4% der Einsätze wurde als
Hauptdiagnose eine psychiatrische Erkrankung angegeben, bei 43,6% eine sonstige Erkrankung. Ein Zusammenhang zwischen der Einsatzhäufigkeit und dem Patientenalter oder dem
Wochentag bestand nicht. Im Stadtgebiet kam es zwar in einzelnen Bereichen mit Status-Index 4 (sehr niedriger sozialer Status) zu vermehrten Einsätzen, insgesamt zeigte sich jedoch
eine gleichmäßige Verteilung im Stadtgebiet.
Schlussfolgerung Der wiederholte Transport in ein Krankenhaus kann bei Frequent Usern mit Angststörung einen erneuten Notruf nach sich ziehen. Ein Case Management könnte dazu
beitragen, die Einsatzzahlen zu reduzieren und Frequent User mit Angststörung an geeignete Versorgungsformen anzubinden.
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Affiliation(s)
- Florian Breuer
- Ärztliche Leitung Rettungsdienst, Rheinisch Bergischer Kreis, Bergisch Gladbach, Deutschland
| | - Janosch Dahmen
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
| | | | - Stefan Poloczek
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Deutschland
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Malysch T, Breuer F, Wolff J, Poloczek S, Dahmen J. Präklinische Notfallthorakotomie in der Berliner Notfallrettung – Darstellung der Umsetzung im Land Berlin und Diskussion erster Erkenntnisse. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
ZusammenfassungIm Jahr 2015 fand das Thema „traumatisch bedingter Herz-Kreislauf-Stillstand“ erstmalig Einzug in die aktualisierten Reanimationsleitlinien des European Resuscitation Council. Neben dem speziell anzuwendenden Maßnahmenbündel mit Atemwegsmanagement, Therapie der Hypovolämie, externer Blutungskontrolle und beidseitiger Thoraxentlastung sollte auch eine Notfallthorakotomie bei geeigneten Patienten erwogen werden. Um dieses Vorgehen systematisch in der Berliner Notfallrettung zu etablieren und standardisieren, hat die Ärztliche Leitung Rettungsdienst der Berliner Feuerwehr verschiedene Maßnahmen unternommen, um die optimale Ausnutzung der Schlüsselfaktoren Expertise, „elapsed time“, Equipment und „environment“ sicherzustellen. Dabei konnten im Laufe der ersten 2,5 Jahre auch bereits wichtige Erfahrungen aus der neuen Versorgungsstruktur dieser schwerstverletzten Patienten gewonnen werden.
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Abstract
The call volume in emergency medical service (EMS) dispatch centers has seen a drastic increase for many years now, especially looking at urban regions of Germany. In this context, the control mechanisms of the EMS dispatch center can be utilized to break new ground regarding the handling of emergency calls and dispatch practice in order to manage incoming calls as efficiently as possible. This article clearly explains standardized protocol-based emergency medical call taking, internal structuring of control centers and pathways, also during the COVID-19 pandemic, using the Berlin EMS dispatch center as an example. The terms structured and standardized protocol-based emergency medical call taking should be differentiated, whereby the standardized call taking process is more binding and based on international standards with high reliability. Quality management measures ensure that the protocol is applied in accordance with the regulations. Improved collaboration and automated transfer of data between EMS dispatch centers and the control centers for non-life-threatening physician on-call services enable low-priority calls to be forwarded on a regular basis. Interprofessional teams in EMS can improve the care of specific patient groups in a targeted manner and avoid transport to emergency departments. Standardized protocol-based and software-based emergency call taking currently represents best practice according to medical science, supporting a nationwide implementation. Furthermore, an intensive collaboration between EMS control centers and control centers for non-life-threatening physician on-call services is recommended as well as the introduction of specialized EMS resources and app-based alerting of first responders.
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Affiliation(s)
- Florian Breuer
- Berliner Feuerwehr Einsatzvorbereitung Rettungsdienst, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Am Rübezahlwald 7, 51469 Bergisch Gladbach, Deutschland
| | | | - Stefan Poloczek
- Berliner Feuerwehr Einsatzvorbereitung Rettungsdienst, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst Berliner Feuerwehr, Berlin, Deutschland
| | | | - Justus Wolff
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Janosch Dahmen
- Berliner Feuerwehr Einsatzvorbereitung Rettungsdienst, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst Berliner Feuerwehr, Berlin, Deutschland
- Universität Witten/Herdecke, Fakultät für Gesundheit, Department Humanmedizin, Witten/Herdecke, Deutschland
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Breuer F, Pommerenke C, Poloczek S. Analyse von Einflussfaktoren auf die Transporthäufigkeit von Frequent Usern mit Angststörung. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Zusammenfassung
Einleitung
Frequent User wählen wiederholt den Notruf 112 und sind für eine Vielzahl von Einsätzen verantwortlich. In vielen Fällen ist eine Angststörung ursächlich für das Verhalten. Hierbei spielen vermutlich eine unzureichende Anbindung an eine geeignete Versorgungseinrichtung sowie eine mangelhafte Compliance eine wesentliche Rolle.
Methodik
Als Frequent User mit Angststörung wurden diejenigen Patientinnen definiert, bei denen im Einsatzprotokoll die Kombination aus der (Verdachts‑)Diagnose „psychiatrischer Notfall“ sowie dem psychiatrischen Befund „ängstlich“ dokumentiert wurde und es im betrachteten Zeitraum (01.10.2020 bis 31.05.2021) zu mindestens 2 Einsätzen der Notfallrettung kam (n = 74). Ergänzend erfolgte eine Auswertung aus den Daten aus dem Einsatzleitsystem. Die Einsätze (n = 326) wurden in Bezug auf die Transporthäufigkeit in Abhängigkeit von mNACA-Score, Einsatzort sowie der Notrufmeldung analysiert.
Ergebnisse
In 52,1 % handelte es sich um mNACA-II-Einsätze, in 42,3 % um mNACA-III-Einsätze und in 5,5 % um mNACA-IV-Einsätze. Neben dem mNACA-Score hatte weder der Einsatzort noch die Einsatzzeit noch die Dringlichkeit Einfluss auf die Transporthäufigkeit. Im Ergebnis zur Alarmierung zum „psychiatrischen Notfall“ wurden signifikant mehr Transporte durchgeführt. Das Alter war ebenfalls nicht maßgeblich.
Schlussfolgerung
Neben der Notwendigkeit der Verbesserung der Gesundheitskompetenz von vulnerablen Gruppen muss sich auch der Rettungsdienst in den kommenden Jahren vermehrt auf ein verändertes Einsatzspektrum einstellen. Damit einhergehend müssen Schnittstellen und die Anbindung an alternative Versorgungsformen optimiert werden. Neben einem Case Management sind Strukturen denkbar, die psychosoziale Hilfe unmittelbar an die Notfallrettung anbinden.
Graphic abstract
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Abstract
ZusammenfassungDie Voraussetzungen zum Einsatz im Notarztdienst sind in Deutschland unterschiedlich geregelt, allein die Rahmenbedingungen zur Erlangung der Zusatzbezeichnung Notfallmedizin variieren in den Bundesländern. Diese stellt nur die Mindestvoraussetzung zur ärztlichen Teilnahme am Rettungsdienst dar und ist nach aktueller Literatur und Rechtsprechung, ebenso wie die alleinige Teilnahme am Notarzt- oder Klinikdienst zum Kompetenzerhalt, längst nicht mehr ausreichend. Im Rahmen der erneuten Ausschreibung des Notarztdiensts im Land Berlin im Jahr 2020 wurden die Voraussetzungen zur Teilnahme am Notarztdienst an den Stand der medizinischen Wissenschaft und aktuellen Rechtsprechung angepasst, die Definition von ärztlichen Kompetenzniveaus und deren strukturierter Erwerb inklusive festgelegter Einarbeitungs- und Einsatzzeiten entsprechend definiert sowie supervidierende Komponenten festgelegt. Bereits existierenden ärztlichen Führungsfunktionen wie dem Oberarzt vom Dienst (OAVD) kommt als operativer Vertreter der Ärztlichen Leitung Rettungsdienst in der Notfallrettung der Hauptstadt eine zentrale Rolle bei der Etablierung und Sicherung dieser gebotenen Anpassungsmaßnahmen zu.
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Breuer F, Brettschneider P, Kleist P, Poloczek S, Pommerenke C, Dahmen J. [Knowledge gained from a 31-h power outage in Berlin Köpenick-medical problems and challenges]. Anaesthesist 2021; 70:507-514. [PMID: 33620509 PMCID: PMC8189958 DOI: 10.1007/s00101-021-00930-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/14/2022]
Abstract
On 19 February 2019 the severance of a 110kW cable caused an extensive electrical power cut in the Treptow-Köpenick district of Berlin. Subsequently, ca. 30,000 households were without electricity and ca. 70,000 people were affected. The power cut lasted more than 24h and all those involved were faced with a multitude of challenges. An operational command post was set up in which medical problems had to be continuously identified and re-evaluated. These included the identification of patients particularly at risk, such as home-ventilated patients and patients with artificial hearts. Furthermore, individual nursing homes had to be evacuated. During the procedure it was necessary to evacuate an intensive care ward or intermediate care ward with 23 patients due to the loss of power supply in the affected area. Hospitals must be prepared for such scenarios within the framework of preliminary planning. Furthermore, preliminary planning containing the special needs of vulnerable groups must be carried out on the part of the responsible authorities.
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Affiliation(s)
- Florian Breuer
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland.
- Ärztliche Leitung, Rettungsdienst im Land Berlin, Berlin, Deutschland.
| | | | - Per Kleist
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
| | - Stefan Poloczek
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
- Ärztliche Leitung, Rettungsdienst im Land Berlin, Berlin, Deutschland
| | | | - Janosch Dahmen
- Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
- Ärztliche Leitung, Rettungsdienst im Land Berlin, Berlin, Deutschland
- Fakultät für Gesundheit, Universität Witten Herdecke, Witten, Deutschland
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Breuer F, Brettschneider P, Pommerenke C, Poloczek S, Dahmen J. Notrufe und gemeldete Hauptbeschwerden während der COVID-19-Pandemie in der Leitstelle der Berliner Feuerwehr. Der Notarzt 2021. [DOI: 10.1055/a-1403-3347] [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: 10/21/2022]
Abstract
Zusammenfassung
Einleitung Die Notrufabfrage in Berlin erfolgt unter Anwendung des Priority Dispatch Systems. Ein spezielles Notrufabfrageprotokoll wird in der Leitstelle der Berliner Feuerwehr seit dem 28.02.2020 genutzt.
Methodik Es werden das Notrufaufkommen und Notrufverhalten zu Beginn der COVID-19-Pandemie sowie die Entwicklung und die Auslastung von Notverlegungen anhand von Daten aus dem Einsatzleitsystem dargestellt.
Ergebnisse Im betrachteten Zeitraum vom 21.02.2020 bis zum 30.04.2020 waren Anruf- und Einsatzzahlen kontinuierlich auf einem hohen Niveau. Ab dem 18.03.2020 (Lockdown) sind diese gesunken. Unter den in der standardisierten Notrufabfrage angewendeten Hauptbeschwerdeprotokollen wurde vermehrt das Protokoll „Pandemie/Epidemie/Ausbruch“ angewendet.
Schlussfolgerung Die andauernde Pandemie stellt sowohl die Rettungsleitstellen als auch die operativen Einsatzkräfte vor besondere Herausforderungen. Rettungsleitstellen haben als primäre ständig erreichbare Stelle eine zentrale Bedeutung, eine standardisierte Notrufabfrage bietet erweiterte Möglichkeiten, auf eine Pandemielage zu reagieren.
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Affiliation(s)
- Florian Breuer
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Berliner Feuerwehr, Berlin, Deutschland
| | | | | | - Stefan Poloczek
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Berliner Feuerwehr, Berlin, Deutschland
| | - Janosch Dahmen
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Berliner Feuerwehr, Berlin, Deutschland
- Fakultät für Gesundheit, Universität Witten Herdecke, Witten, Deutschland
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Breuer F, Pommerenke C, Ziemen B, Stiepak JK, Poloczek S, Dahmen J. [Introduction of emergency paramedic investigators in the context of the COVID-19 pandemic in the Berlin emergency medical service]. Notf Rett Med 2020; 24:1033-1042. [PMID: 33013194 PMCID: PMC7521198 DOI: 10.1007/s10049-020-00786-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been shown throughout the COVID-19 pandemic that the condition of a number of patients deteriorates acutely when not monitored. This is set against an increased demand for emergency medical services and the resulting scarcity of resources, which makes it necessary to prioritise inpatient treatment or ensure that patients are provided with appropriate outpatient care. In this context, the Berlin Fire Department has introduced emergency paramedic investigators (NotSan-Erkunder) as an additional operating resource. METHODOLOGY We assessed all operations from 28.03.2020 to 28.04.2020 during which Emergency Paramedic Investigators of the Berlin emergency services were deployed. A total of 341 operations were included from the 31 days. Alongside data from the dispatch system, all operational documentation was assessed. RESULTS In 57% of cases, mNACA II patients (outpatient treatment) were identified, in 42% of cases, mNACA III patients (inpatient treatment) were identified, and in 1% of cases, mNACA IV (imminent danger to life) patients were identified. In 51% of cases, the emergency services transported the patient to a hospital, and in 49%, alternative care measures were employed. These included referral to a local physician in 28% of cases. In 11% of cases, patients were referred to on-call services of the Association of Statutory Health Insurance Physicians (KV in German). In 4% of cases, the Berlin Fire Department emergency dispatch center deployed a physician of the KV (KV-ARE investigator). DISCUSSION The results show that additional operational resources serve an important function during a pandemic with regards to an initial assessment and pilot function. This can help relieve not only the emergency services but also the medical facilities responsible for providing further care. The standardised dispatch enquiry enables the linking with the appropriate codes from the low-priority operational spectrum and support by a Tele-emergency physician lends additional professional competency to the emergency paramedics.
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Affiliation(s)
- F. Breuer
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179 Berlin, Deutschland
| | - C. Pommerenke
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179 Berlin, Deutschland
| | - B. Ziemen
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179 Berlin, Deutschland
| | - J.-K. Stiepak
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179 Berlin, Deutschland
| | - S. Poloczek
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179 Berlin, Deutschland
| | - J. Dahmen
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179 Berlin, Deutschland
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
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Siminski N, Böhme S, Zeller JBM, Becker MPI, Bruchmann M, Hofmann D, Breuer F, Mühlberger A, Schiele MA, Weber H, Schartner C, Deckert J, Pauli P, Reif A, Domschke K, Straube T, Herrmann MJ. BNST and amygdala activation to threat: Effects of temporal predictability and threat mode. Behav Brain Res 2020; 396:112883. [PMID: 32860830 DOI: 10.1016/j.bbr.2020.112883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 12/28/2022]
Abstract
Recent animal and human studies highlight the uncertainty about the onset of an aversive event as a crucial factor for the involvement of the centromedial amygdala (CM) and bed nucleus of the stria terminalis (BNST) activity. However, studies investigating temporally predictable or unpredictable threat anticipation and confrontation processes are rare. Furthermore, the few existing fMRI studies analyzing temporally predictable and unpredictable threat processes used small sample sizes or limited fMRI paradigms. Therefore, we measured functional brain activity in 109 predominantly female healthy participants during a temporally predictable-unpredictable threat paradigm, which aimed to solve limited aspects of recent studies. Results showed higher BNST activity compared to the CM during the cue indicating that the upcoming confrontation is aversive relative to the cue indicating an upcoming neutral confrontation. Both the CM and BNST showed higher activity during the confrontation with unpredictable and aversive stimuli, but the reaction to aversive confrontation relative to neutral confrontation was stronger in the CM compared to the BNST. Additional modulation analyses by NPSR1 rs324981 genotype revealed higher BNST activity relative to the CM in unpredictable anticipation relative to predictable anticipation in T-carriers compared to AA carriers. Our results indicate that during the confrontation with aversive or neutral stimuli, temporal unpredictability modulates CM and BNST activity. Further, there is a differential activity concerning threat processing, as BNST is more involved when focussing on fear-related anticipation processes and CM is more involved when focussing on threat confrontation.
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Affiliation(s)
- N Siminski
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - S Böhme
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany; Department of Clinical Psychology and Psychotherapy, University of Erlangen, Erlangen, Germany
| | - J B M Zeller
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - M P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - M Bruchmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - D Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - F Breuer
- Fraunhofer Institute for Integrated Circuits (IIS), Development Center for X-ray Technology (EZRT), Wuerzburg, Germany
| | - A Mühlberger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - M A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Weber
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - C Schartner
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - J Deckert
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - P Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Wuerzburg, Wuerzburg, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - K Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in Neuro Modulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - M J Herrmann
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
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Herrmann MJ, Siminski N, Böhme S, Zeller JBM, Becker MPI, Bruchmann M, Hofmann D, Breuer F, Schiele MA, Weber H, Schartner C, Pauli P, Reif A, Domschke K, Deckert J, Mühlberger A, Straube T. Time unpredictability increases BNST and amygdala activity during threat processing. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0039-3403025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- MJ Herrmann
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - N Siminski
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - S Böhme
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - JBM Zeller
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - MPI Becker
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - M Bruchmann
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - D Hofmann
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - F Breuer
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - MA Schiele
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - H Weber
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - C Schartner
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - P Pauli
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - A Reif
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - K Domschke
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - J Deckert
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - A Mühlberger
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
| | - T Straube
- Universitätsklinikum Würzburg, Zentrum für Psychische Gesundheit, Germany
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15
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Breuer F, Pommerenke C, Wollenhaupt L, Brettschneider P, Poloczek S. Vorkommen von Frequent Usern und Frequent Callern in einem großstädtischen Rettungsdienst: Indikatoren eines unzureichenden Gesundheits- und Sozialsystems? Notf Rett Med 2020. [DOI: 10.1007/s10049-019-0600-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Zusammenfassung
Hintergrund Obdachlose stellen eine besonders vulnerable Gruppe dar. Mit
Obdachlosigkeit gehen viele zusätzliche Risiken einher, die auch Auswirkungen
auf die Gesundheit haben. Viele Obdachlose suchen vermehrt Notaufnahmen auf.
Eine Rolle spielt hier insbesondere die Kombination aus einer
Abhängigkeitserkrankung mit einem psychischen Leiden.
Methodik Die Arbeit untersucht das Vorkommen und die Eigenschaften von
obdachlosen Frequent Usern im Rettungsdienst. Weiterhin wird die räumliche
Verteilung betrachtet. Es wurde ein Zeitraum von einem Jahr anhand der Daten des
Einsatzleitsystems betrachtet und ausgewertet.
Ergebnisse In einem Zeitraum von 12 Monaten wurden 131 obdachlose
Patienten als High Frequent User (7 – 10 Einsätze/Jahr) und Super Frequent User
(≥ 11 Einsätze/Jahr) identifiziert, wobei der Anteil an Super Frequent Usern
überwiegt. Insgesamt wurden durch diese 2021 Einsätze verursacht. Die Patienten
waren im Durchschnitt 45,6 Jahre alt und zu 81% männlichen Geschlechts.
Alarmierungen erfolgten insbesondere zum Stichwort „Intoxikation“ oder zum
„Psychiatrischen Notfall“. Zu Einsätzen kam es wiederholt an bestimmten „Hot
Spots“, es konnte gezeigt werden, dass sich Einsätze insbesondere in bestimmten
lebensweltlich orientierten Räumen (LOR) konzentrieren.
Diskussion Einsätze in Zusammenhang mit obdachlosen Frequent Usern sind
zahlenmäßig durchaus relevant. Obwohl es verschiedene aufsuchende Systeme,
insbesondere durch Wohlfahrtsverbände, zur medizinischen Versorgung gibt,
scheinen sie diese Patientengruppe nicht zu erreichen. Eine Anbindung
aufsuchender Sozialarbeit an die Notfallrettung, wie bereits in anderen Ländern
erprobt, könnte insbesondere im Bereich von „Hot Spots“ zu einer Reduktion der
Einsätze beitragen.
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Pansuwan T, Breuer F, Gazder T, Lau Z, Cueva S, Swanson L, Taylor M, Wilson M, Morcom AM. Evidence for adult age-invariance in associative false recognition. Memory 2019; 28:172-186. [PMID: 31868124 DOI: 10.1080/09658211.2019.1705351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Older people are more prone to memory distortions and errors than young people, but do not always show greater false recognition in the Deese-Roediger-McDermott (DRM) task. We report two preregistered experiments investigating whether recent findings of age-invariant false recognition extend to designs in which studied items are blocked. According to (Tun, P. A., Wingfield, A., Rosen, M. J., & Blanchard, L. (1998). Response latencies for false memories: Gist-based processes in normal aging. Psychology and Aging, 13(2), 230-241.), age effects on false recognition in the DRM task are due to a greater reliance on gist processing which is enhanced under blocked study conditions. Experiment 1 assessed false recognition in an online variant of the DRM task where words were presented visually, with incidental encoding. The results showed Bayesian evidence against greater false recognition by older adults, whether lures were semantically associated with studied lists, or perceptually related (presented in the same distinctive font as studied lists) or both. Experiment 2 used a typical DRM procedure with auditory lists and intentional encoding, closely reproducing (Tun, P. A., Wingfield, A., Rosen, M. J., & Blanchard, L. (1998). Response latencies for false memories: Gist-based processes in normal aging. Psychology and Aging, 13(2), 230-241.) Experiment 2 but omitting an initial test of recall. The results showed evidence against an age-related increase in critical lure false recognition under these conditions. Together, the data suggest that older people do not make more associative memory errors in recognition tests than young people.
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Affiliation(s)
- T Pansuwan
- Psychology, University of Edinburgh, Edinburgh, UK
| | - F Breuer
- Psychology, University of Edinburgh, Edinburgh, UK
| | - T Gazder
- Psychology, University of Edinburgh, Edinburgh, UK
| | - Z Lau
- Psychology, University of Edinburgh, Edinburgh, UK
| | - S Cueva
- Psychology, University of Edinburgh, Edinburgh, UK
| | - L Swanson
- Psychology, University of Edinburgh, Edinburgh, UK
| | - M Taylor
- Psychology, University of Edinburgh, Edinburgh, UK
| | - M Wilson
- Psychology, University of Edinburgh, Edinburgh, UK
| | - A M Morcom
- School of Psychology, University of Sussex, Brighton, UK
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18
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Breuer F, Beckers SK, Poloczek S. [Mass casualty incidents and attacks involving a multitude of children and adolescents-Overview of policy recommendations and challenges]. Anaesthesist 2019; 68:476-482. [PMID: 31297543 DOI: 10.1007/s00101-019-0626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fortunately, mass casualty incidents involving a large number of children and adolescents are rare and the experience in this field, both in terms of medical as well as psychosocial emergency care is comparatively low. Children represent a vulnerable group and have a particularly high risk of developing posttraumatic stress disorder in the aftermath of experiencing disasters. A selective literature search was carried out in Medline. The peculiarity of damaging events with a large number of children and adolescents affected is that in addition to emergency medical care, an early approach to psychosocial emergency care must be provided. Accordingly, it makes sense to integrate such structures into the respective deployment concepts. A specific screening algorithm for children could so far not prevail but due to the physiological and anatomical characteristics appropriate emergency medical care concepts should be provided. Furthermore, hospitals must adapt to this patient group in a suitable manner.
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Affiliation(s)
- F Breuer
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland.
| | - S K Beckers
- Ärztliche Leitung Rettungsdienst Stadt Aachen, Berufsfeuerwehr Aachen, Aachen, Deutschland.,Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - S Poloczek
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
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Biller A, Reuter M, Patenaude B, Homola GA, Breuer F, Bendszus M, Bartsch AJ. Responses of the Human Brain to Mild Dehydration and Rehydration Explored In Vivo by 1H-MR Imaging and Spectroscopy. AJNR Am J Neuroradiol 2015; 36:2277-84. [PMID: 26381562 DOI: 10.3174/ajnr.a4508] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/06/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE As yet, there are no in vivo data on tissue water changes and associated morphometric changes involved in the osmo-adaptation of normal brains. Our aim was to evaluate osmoadaptive responses of the healthy human brain to osmotic challenges of de- and rehydration by serial measurements of brain volume, tissue fluid, and metabolites. MATERIALS AND METHODS Serial T1-weighted and (1)H-MR spectroscopy data were acquired in 15 healthy individuals at normohydration, on 12 hours of dehydration, and during 1 hour of oral rehydration. Osmotic challenges were monitored by serum measures, including osmolality and hematocrit. MR imaging data were analyzed by using FreeSurfer and LCModel. RESULTS On dehydration, serum osmolality increased by 0.67% and brain tissue fluid decreased by 1.63%, on average. MR imaging morphometry demonstrated corresponding decreases of cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus. These changes reversed during rehydration. Continuous fluid ingestion of 1 L of water for 1 hour within the scanner lowered serum osmolality by 0.96% and increased brain tissue fluid by 0.43%, on average. Concomitantly, cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus increased. Changes in brain tissue fluid were related to volume changes of the whole brain, the white matter, and hypothalamus/thalamus. Only volume changes of the hypothalamus/thalamus significantly correlated with serum osmolality. CONCLUSIONS This is the first study simultaneously evaluating changes in brain tissue fluid, metabolites, volume, and cortical thickness. Our results reflect cellular volume regulatory mechanisms at a macroscopic level and emphasize that it is essential to control for hydration levels in studies on brain morphometry and metabolism in order to avoid confounding the findings.
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Affiliation(s)
- A Biller
- From the Department of Neuroradiology (A.B., M.B., A.J.B.), University of Heidelberg, Heidelberg, Germany
| | - M Reuter
- Department of Radiology (M.R.), Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts Martinos Center for Biomedical Imaging (M.R.), Charlestown, Massachusetts Massachusetts Institute of Technology Computer Science and AI Lab (M.R.), Cambridge, Massachusetts
| | - B Patenaude
- Department of Psychiatry and Behavioral Sciences (B.P.), Stanford University, Stanford, California Department of Clinical Neurology (B.P., A.J.B.), FMRIB Centre, University of Oxford, Oxford, UK
| | - G A Homola
- Department of Neuroradiology (G.A.H., A.J.B.), University of Würzburg, Würzburg, Germany
| | - F Breuer
- Research Center for Magnetic-Resonance-Bavaria (F.B.), Würzburg, Germany
| | - M Bendszus
- From the Department of Neuroradiology (A.B., M.B., A.J.B.), University of Heidelberg, Heidelberg, Germany
| | - A J Bartsch
- From the Department of Neuroradiology (A.B., M.B., A.J.B.), University of Heidelberg, Heidelberg, Germany Department of Clinical Neurology (B.P., A.J.B.), FMRIB Centre, University of Oxford, Oxford, UK Department of Neuroradiology (G.A.H., A.J.B.), University of Würzburg, Würzburg, Germany
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Kunzmann V, Sehouli J, Schmalfeldt B, Wimberger P, Kurbacher CM, Tempelhoff GF, Vanhoefer UJ, Ebeling P, Breuer F, Schulz H, Welslau M, Finas D, Sagasser J, Kiehl M, Fruehauf S. Results of the first interim analysis of the CARMA study to investigate efficacy and safety profile of catumaxomab in clinical practice. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13100] [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: 11/20/2022] Open
Abstract
e13100^ Background: The trifunctional antibody catumaxomab is approved in the EU for intraperitoneal (i.p.) treatment of malignant ascites in patients (pts) with EpCAM-positive carcinomas. Clinical data for catumaxomab are based on the pivotal trial and several phase I/II trials. So far, the routine use of catumaxomab in clinical practice has not been evaluated systematically. Therefore, a large prospective observational study was started in 2010. The study investigates the administration of catumaxomab in a total of 160 pts with malignant ascites under routine conditions in daily clinical practice. Here we show the results of the first pre-planned interim analysis. Methods: The analysis included 49 pts with malignant ascites due to EpCAM-positive carcinomas treated with i.p. catumaxomab under routine conditions in clinical practice. Participating centres were hospitals and practices of oncologists in Germany. Primary endpoint was puncture-free interval (PFI), secondary endpoints included safety and overall survival (OS). Results: At inclusion into the study pts already had undergone a median number of 9 ascites punctures. Malignant ascites had been diagnosed for the first time 3.3 months before (median). Patients suffered from typical ascites symptoms as follows: swelling (79.6%), pain (44.9%), dyspnea (26.5%), anorexia (26.5%), obstipation (12.2%). 49 pts were treated with catumaxomab, of whom 30 pts received all 4 infusions (61.2%). Median PFI was 108 days (d), the median OS was 102 d. Most frequent adverse events were fever, nausea and diarrhoe. Conclusions: This is the first systematic report on routine use of catumaxomab in clinical practice.. Although The study population mainly comprised patients with advanced tumor diseaset a clinical benefit after catumaxomab therapy could be demonstrated. The treatment showed an acceptable safety profile Theseresults are consistent with the data of the pivotal trial. The data will be evaluated in further analyses including larger patient numbers.
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Affiliation(s)
- Volker Kunzmann
- Medizinische Klinik und Poliklinik II, Julius Maximilians University, Wuerzburg, Germany
| | - Jalid Sehouli
- Universtitätsklinikum Charité, Campus Virchow-Klinikum, Berlin, Germany
| | | | - Pauline Wimberger
- AGO and Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | | | | | | | - P. Ebeling
- Marienkrankenhaus Zentrum Innere Medizin, Hamburg, Germany
| | - F. Breuer
- Pioh, private practice for hematology and oncology, Frechen, Germany
| | - Holger Schulz
- Pioh, private practice for hematology and oncology, Cologne, Germany
| | | | | | | | - M. Kiehl
- Klinikum Frankfurt/Oder, Medizinische Klinik I, Frankfurt, Germany
| | - S. Fruehauf
- Paracelsus-Klinik, Hämatologie und Internistische Onkologie, Osnabrück, Germany
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21
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Kampf T, Fischer A, Basse-Lüsebrink TC, Ladewig G, Breuer F, Stoll G, Jakob PM, Bauer WR. Application of compressed sensing to in vivo 3D ¹⁹F CSI. J Magn Reson 2010; 207:262-273. [PMID: 20932790 DOI: 10.1016/j.jmr.2010.09.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 09/13/2010] [Accepted: 09/13/2010] [Indexed: 05/30/2023]
Abstract
This study shows how applying compressed sensing (CS) to (19)F chemical shift imaging (CSI) makes highly accurate and reproducible reconstructions from undersampled datasets possible. The missing background signal in (19)F CSI provides the required sparsity needed for application of CS. Simulations were performed to test the influence of different CS-related parameters on reconstruction quality. To test the proposed method on a realistic signal distribution, the simulation results were validated by ex vivo experiments. Additionally, undersampled in vivo 3D CSI mouse datasets were successfully reconstructed using CS. The study results suggest that CS can be used to accurately and reproducibly reconstruct undersampled (19)F spectroscopic datasets. Thus, the scanning time of in vivo(19)F CSI experiments can be significantly reduced while preserving the ability to distinguish between different (19)F markers. The gain in scan time provides high flexibility in adjusting measurement parameters. These features make this technique a useful tool for multiple biological and medical applications.
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Affiliation(s)
- T Kampf
- Department of Experimental Physics 5, University of Würzburg, Würzburg, Germany.
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Stäb D, Breuer F, Blaimer M, Hahn D, Köstler H. CAIPIRINHA-beschleunigte simultane Mehrschicht-Echtzeit-MR-Bildbebung mit TrueFISP. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221429] [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: 10/20/2022]
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Steinmetz HT, Rohrberg R, Tsamaloukas A, Forstbauer H, Tessen H, Breuer F, Röddiger R, Hinke A, Schmitz S, Thomas L. Hypochromic reticulocytes and ferritin index in the diagnosis of cancer- and chemotherapy-related anemia. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20705] [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: 11/20/2022] Open
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Abstract
In medical magnetic resonance imaging (MRI) it is standard to use MR scanners with a field strength of 1.5 Tesla. Recently, an ongoing development to higher field strength can be observed and a new clinical standard at 3.0 Tesla seems to be established. High field MRI with its intrinsic higher signal to noise ratio (SNR) can enable new applications of MRI in medical diagnosis, or can serve to improve existing methods. It is important to note, that the use of high field MRI is not without its limitations. Besides the SNR, other unwanted effects increase with a higher field strength. Without correction, these high field problems cause a serious loss in image quality. An elegant way to address these problems is the use of parallel imaging. In many clinical applications, parallel MRI (pMRI) is part of the standard protocol, because pMRI can enhance virtually every MRI application, without necessarily affecting the contrast behavior of the underlying imaging sequence. In high field MRI, besides the speed advantage of pMRI, the positive influence on high field specific problems and therefore on the image quality will be of major importance.
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Affiliation(s)
- R M Heidemann
- Physikalisches Institut-EP5, Universität Würzburg, Wuerzburg.
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Catena C, Conti D, Trenta G, Righi E, Breuer F, Melacrinis FF, Montesano T, Ventroni G, Ronga G. Micronucleus yield and colorimetric test as indicators of damage in patients' lymphocytes after 131I therapy. J Nucl Med 2000; 41:1522-4. [PMID: 10994733] [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: 02/17/2023] Open
Abstract
UNLABELLED To estimate the absorbed dose received by patients who underwent 131I therapy, a modified compartmental model of the International Commission on Radiological Protection (ICRP) was used. The activity in plasma and micronucleus (MN) frequency (MN test) were measured before and after therapy. To evaluate whether a correlation exists between lymphocytes and absorbed dose, a colorimetric test, based on the tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT test), was used. METHODS Twenty patients who underwent 131I therapy were studied. Activity was measured in plasma, and isolated lymphocytes were collected to perform the MN and MTT tests. RESULTS The mean MN frequency observed in unexposed patient lymphocytes was comparable with that of healthy subjects. 131I therapy induces a small increase in MN, and a good correlation with the bone marrow absorbed dose was obtained (P = 0.040). A consistent decrease in phytostimulation observed after therapy (MTT test) correlated significantly with bone marrow absorbed dose (P = 0.0085). CONCLUSION The MTT test appears to be more reliable than the MN test for evaluating lymphocyte damage induced by 131I therapy.
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Affiliation(s)
- C Catena
- Ambiente-Protezione-Tossicologia, Ente per le Nuove Tecnologie, l'Energia e l'Ambiente Centro Ricerche Casaccia, Rome
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Kleinow T, Bhalerao R, Breuer F, Umeda M, Salchert K, Koncz C. Functional identification of an Arabidopsis snf4 ortholog by screening for heterologous multicopy suppressors of snf4 deficiency in yeast. Plant J 2000; 23:115-22. [PMID: 10929106 DOI: 10.1046/j.1365-313x.2000.00809.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Yeast Snf4 is a prototype of activating gamma-subunits of conserved Snf1/AMPK-related protein kinases (SnRKs) controlling glucose and stress signaling in eukaryotes. The catalytic subunits of Arabidopsis SnRKs, AKIN10 and AKIN11, interact with Snf4 and suppress the snf1 and snf4 mutations in yeast. By expression of an Arabidopsis cDNA library in yeast, heterologous multicopy snf4 suppressors were isolated. In addition to AKIN10 and AKIN11, the deficiency of yeast snf4 mutant to grown on non-fermentable carbon source was suppressed by Arabidopsis Myb30, CAAT-binding factor Hap3b, casein kinase I, zinc-finger factors AZF2 and ZAT10, as well as orthologs of hexose/UDP-hexose transporters, calmodulin, SMC1-cohesin and Snf4. Here we describe the characterization of AtSNF4, a functional Arabidopsis Snf4 ortholog, that interacts with yeast Snf1 and specifically binds to the C-terminal regulatory domain of Arabidopsis SnRKs AKIN10 and AKIN11.
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Affiliation(s)
- T Kleinow
- Max-Planck Institut für Züchtungsforschung, Carl-von-Linné-Weg 10, D-50829 Köln, Germany
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Kacker A, April M, Markentel CB, Breuer F. Ectopic thymus presenting as a solid submandibular neck mass in an infant: case report and review of literature. Int J Pediatr Otorhinolaryngol 1999; 49:241-5. [PMID: 10519705 DOI: 10.1016/s0165-5876(99)00198-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Solid ectopic cervical thymus is an extremely uncommon etiology of a neck mass in an infant. It occurs in the line of descent of the thymus from the angle of the mandible to the superior mediastinum. Nine cases of ectopic cervical thymus in infants have been reported in the literature. Only two of nine cases were solid, the remaining seven were thymic cysts. A preoperative diagnosis is seldom considered and is often misdiagnosed as a possible malignancy or a lymph node. We present a case of a 2-month-old infant with an asymptomatic enlarging right neck mass. Patient underwent complete excision of the mass.
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Affiliation(s)
- A Kacker
- Department of Otolaryngology, Lenox Hill Hospital, New York, NY 10021, USA
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Abstract
Indium-111-oxine labeled leukocyte ((111)In-WBC) scintigraphy is well known for its ability to localize in areas of active infection, but not in areas of lymphomatous involvement. We present a case of Ki-1-positive anaplastic large-cell lymphoma that was initially thought to be a case of multifocal osteomyelitis because of positive uptake on a (111)In-WBC scan. The areas of abnormal uptake on the indium scan were demonstrated histopathologically to be sites of lymphomatous involvement in bone.
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Affiliation(s)
- W Chiu
- Department of Radiology, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10021, USA
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Gray GG, Voigt E, Breuer F, Rothman LM. Imaging quiz case 2. Intralingual mucocele. Arch Otolaryngol Head Neck Surg 1999; 125:593-5. [PMID: 10326822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Neifer S, Kremsner PG, Weinig M, Harms G, Sahlmüller G, Bienzle U, Heitmann M, Breuer F, Mehlhorn H. Interferon-gamma treatment in mice experimentally infected with Trichinella spiralis. Parasitol Res 1991; 77:437-42. [PMID: 1909790 DOI: 10.1007/bf00931641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 12/29/2022]
Abstract
Interferon-tau (IFN-tau) treatment of Trichinella spiralis-infected BALB/c mice was investigated. The therapeutic regimen consisted of daily intraperitoneal injection of 10(4) U murine IFN-tau for 7 days, starting at 2 weeks post-infection. Striated muscle samples (diaphragm, thigh) were collected at 4, 8 and 12 weeks after infection. The muscle larval burden, the degree of encystation and the digestion of T. spiralis larvae were investigated. Furthermore, immunohistochemical studies of the inflammatory cell infiltrate around encysted larvae were performed. The results demonstrated an influence of IFN-tau treatment on the CD4+ and CD8+ subset distribution during the immune response but revealed no difference in the degree of encystation or digestion of encapsulated larvae as compared with control values.
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Affiliation(s)
- S Neifer
- Landesinstitut für Tropenmedizin, Berlin, Federal Republic of Germany
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31
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Ingrao G, Breuer F, Santaroni GP. A method for the evaluation of the Cs-137 ingestion following the Chernobyl accident. J Radioanal Nucl Chem 1990. [DOI: 10.1007/bf02039848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Breuer F, Trenta G. [The Chernobyl accident. Dosimetric evaluation and estimation of the risks]. Radiol Med 1987; 73:137-8. [PMID: 3809630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Nutz V, Breuer F. [Endoscopic sphincterotomy in choledocholithiasis (author's transl)]. Leber Magen Darm 1981; 11:276-82. [PMID: 7321731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
43 patients had 51 endoscopic sphincterotomies within 4 years; there were 2 complications, 7 patients had to have surgery in spite of endoscopic sphincterotomy. Stones, which had been left unnoticed in the choledochus during surgery could be removed in all cases endoscopically. These results speak in favour of endoscopic sphincterotomy, if compared to results of other non-operative treatments of retained bile duct stones such as percutaneous stone extraction. Endoscopic sphincterotomy has been widely used meanwhile and may be apt now to be introduced as a routine procedure also in smaller hospitals.
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Lanzola E, Allegrini M, Breuer F, D'Arca Simonetti A. [Research on osseous deposits of Pb210 (Po210) and of Sr90]. Minerva Fisiconucl 1970; 14:132-6. [PMID: 5515281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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35
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Breuer F. [Relations between "maximum permissible concentrations" of radioactive substances for children and for adults, in food substances]. Minerva Fisiconucl 1968; 12:233-8. [PMID: 5729273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Breuer JA, Breuer F, Breuer H. [Metabolism of 16-oxo-estrone in humans]. Acta Endocrinol (Copenh) 1968; 58:673-84. [PMID: 5695784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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37
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Breuer F. [Elaboration of a mathematical function to facilitate the calculation of systemic retention and urinary excretion following inhalation of "low solubility" radioactive compounds]. Minerva Fisiconucl 1968; 12:155-162. [PMID: 5735152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Williams RJ, Rohrman E, Christensen BE, Hayman DF, Adler S, Spies JR, Harris TH, Breuer F, Brecher C, Scott JE, West ES, Kimball RH, Wittenburg HH, McFadyen DE. Quantitative organische Mikroanalyse. Elementaranalyse. Anal Bioanal Chem 1939. [DOI: 10.1007/bf01457476] [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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