[Clinical Judgement and Relational Competence in the Psychotherapy of Older Patients]

The negative attitude of psychotherapists towards the treatment of older patients in the past has weakened in the recent past. Nevertheless, the question remains as to how therapists perceive older patients in comparison to younger patients, what clinical judgements they arrive at and how they perceive the relationship with them. In the present study, which was conducted as part of the ÄPP study (Older Patients in Psychotherapy), therapists were asked to assess a self-selected younger (<40 years) or an older patient (>65) with regard to various variables. A total of 527 completed questionnaires were available. Two-factor analyses of variance were used to show, among other things, that younger therapists (compared to their older colleagues) rate older patients more negatively in terms of suitability for psychotherapy, the patient's ability to establish a therapeutic working relationship and other parameters. In comparison with their older colleagues, younger therapists perceive themselves as less competent in their relationships with older patients. There are only slight differences with younger patients.

Originalbeiträge (Originals). Unterscheidet sich der therapeutische Stil in altershomogenen und altersheterogenen therapeutischen Dyaden?

Does the therapeutic style differ in age-homogeneous and age-heterogeneous therapeutic dyads?

BACKGROUND AND AIMS

Differences between age-homogeneous and age-heterogeneous therapeutic dyads have rarely been the subject of research.The present study aimed to investigate differences in therapeutic style (Healing and Stressful Involvement).

METHOD

A sample of 527 questionnaires completed by therapists of different ages was available. Therapy style was compared between two patient groups (under 40 and over 65 years old) and three therapist groups (25-39, 40-59, ≥ 60).

RESULTS

The results show in particular more stress experienced by younger therapists in the treatment of older patients, while older therapists report less stress.There were no or fewer differences in the treatment of younger patients.The regression-analytical results show that the experience of stress in the therapy of older people is associated with a greater fear of old age.

CONCLUSION

Finally, some conclusions are discussed with regard to training and supervision of therapists in the treatment of older people.

Quantum Trajectories for Time-Local Non-Lindblad Master Equations

For the efficient simulation of open quantum systems, we often use quantum jump trajectories given by pure states that evolve stochastically to unravel the dynamics of the underlying master equation. In the Markovian regime, when the dynamics is described by a Gorini-Kossakowski-Sudarshan-Lindblad (GKSL) master equation, this procedure is known as Monte Carlo wave function approach. However, beyond ultraweak system-bath coupling, the dynamics of the system is not described by an equation of GKSL type, but rather by the Redfield equation, which can be brought into pseudo-Lindblad form. Here, negative dissipation strengths prohibit the conventional approach. To overcome this problem, we propose a pseudo-Lindblad quantum trajectory (PLQT) unraveling. It does not require an effective extension of the state space, like other approaches, except for the addition of a single classical bit. We test the PLQT for the eternal non-Markovian master equation for a single qubit and an interacting Fermi-Hubbard chain coupled to a thermal bath and discuss its computational effort compared to solving the full master equation.

Analysis of the elemental species-dependent uptake of lanthanide complexes in Arabidopsis thaliana plants by LA-ICP-MS

Gadolinium-based contrast agents (GBCAs) are found increasingly in different water bodies, making the investigation of their uptake and distribution behavior in plants a matter of high interest to assess their potential effects on the environment. Depending on the used complexing agent, they are classified into linear or macrocyclic GBCAs, with macrocyclic complexes being more stable. In this study, by using TbCl3, Gd-DTPA-BMA, and Eu-DOTA as model compounds for ionic, linear, and macrocyclic lanthanide species, the elemental species-dependent uptake into leaves of Arabidopsis thaliana under identical biological conditions was studied. After growing for 14 days on medium containing the lanthanide species, the uptake of all studied compounds was confirmed by means of laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). Furthermore, the uptake rate of TbCl3 and the linear Gd-DTPA-BMA was similar, with Tb and Gd hotspots colocated in the areas of hydathodes and the trichomes of the leaves. In contrast, in the case of the macrocyclic Eu-DOTA, Eu was mainly located in the leaf veins. Additionally, Eu was colocated with Tb and Gd in the hydathode at the tip of the leave. Removal of the lanthanide species from the medium led to a decrease in signal intensities, indicating their subsequent release to some extent. However, seven days after the removal, depositions of Eu, Gd, and Tb were still present in the same areas of the leaves as before, showing that complete elimination was not achieved after this period of time. Overall, more Eu was present in the leaves compared to Gd and Tb, which can be explained by the high stability of the Eu-DOTA complex, potentially leading to a higher transport rate into the leaves, whereas TbCl3 and Gd-DTPA-BMA could interact with the roots, reducing their mobility.

A salt stress-activated GSO1-SOS2-SOS1 module protects the Arabidopsis root stem cell niche by enhancing sodium ion extrusion

Soil salinity impairs plant growth reducing crop productivity. Toxic accumulation of sodium ions is counteracted by the Salt Overly Sensitive (SOS) pathway for Na⁺ extrusion, comprising the Na⁺ transporter SOS1, the kinase SOS2, and SOS3 as one of several Calcineurin-B-like (CBL) Ca^{2 +} sensors. Here, we report that the receptor-like kinase GSO1/SGN3 activates SOS2, independently of SOS3 binding, by physical interaction and phosphorylation at Thr16. Loss of GSO1 function renders plants salt sensitive and GSO1 is both sufficient and required for activating the SOS2-SOS1 module in yeast and in planta. Salt stress causes the accumulation of GSO1 in two specific and spatially defined areas of the root tip: in the endodermis section undergoing Casparian strip (CS) formation, where it reinforces the CIF-GSO1-SGN1 axis for CS barrier formation; and in the meristem, where it creates the GSO1-SOS2-SOS1 axis for Na⁺ detoxification. Thus, GSO1 simultaneously prevents Na⁺ both from diffusing into the vasculature, and from poisoning unprotected stem cells in the meristem. By protecting the meristem, receptor-like kinase-conferred activation of the SOS2-SOS1 module allows root growth to be maintained in adverse environments.

Bariatric surgery in liver cirrhosis

Introduction

Obesity is frequently associated with its hepatic manifestation, the nonalcoholic fatty liver disease (NAFLD). The most effective treatment for morbid obesity is bariatric surgery (BS) also improving NAFLD and liver function. In patients where NAFLD has already progressed to liver cirrhosis, BS can be considered a high-risk procedure. Hence, consideration of the procedure and the most appropriate timing is crucial.

Material and Methods

Obese patients suffering from NAFLD who underwent BS from two German University Medical Centers were retrospectively analyzed.

Results

Twenty-seven patients underwent BS. Most common procedures were laparoscopic Roux-en-Y-gastric (RYGB) and laparoscopic sleeve gastrectomy (SG). All patients suffered from liver cirrhosis Child A. A preoperative transjugular portosystemic shunt (TIPS) was established in three patients and failed in another patient. Postoperative complications consisted of wound healing disorders (n = 2), anastomotic bleeding (n = 1), and leak from the staple line (n = 1). This patient suffered from intraoperatively detected macroscopic liver cirrhosis. Excess weight loss was 73% and 85% after 1 and 2 years, respectively. Two patients suffered from postoperative aggravation of their liver function, resulting in a higher Child-Pugh score, while three could be removed from the waiting list for a liver transplantation.

Conclusion

BS leads to weight loss, both after SG and RYGB, and potential improvement of liver function in liver cirrhosis. These patients need to be considered with care when evaluated for BS. Preoperative TIPS implantation may reduce the perioperative risk in selected patients.

Canonically Consistent Quantum Master Equation

We put forth a new class of quantum master equations that correctly reproduce the asymptotic state of an open quantum system beyond the infinitesimally weak system-bath coupling limit. Our method is based on incorporating the knowledge of the reduced steady state into its dynamics. The correction not only steers the reduced system toward a correct steady state but also improves the accuracy of the dynamics, thereby refining the archetypal Born-Markov weak-coupling second-order master equations. In case of equilibrium, we use the exact mean-force Gibbs state to correct the Redfield quantum master equation. By benchmarking it with the exact solution of the damped harmonic oscillator, we show that our method also helps correct the long-standing issue of positivity violation, albeit without complete positivity. Our method of a canonically consistent quantum master equation opens a new perspective in the theory of open quantum systems leading to a reduced density matrix accurate beyond the commonly used Redfield and Lindblad equations, while retaining the same conceptual and numerical complexity.

Transforming Chemical Proteomics Enrichment into a High-Throughput Method Using an SP2E Workflow

Protein post-translational modifications (PTMs) play a critical role in the regulation of protein catalytic activity, localization, and protein-protein interactions. Attachment of PTMs onto proteins significantly diversifies their structure and function, resulting in proteoforms. However, the sole identification of post-translationally modified proteins, which are often cell type and disease-specific, is still a highly challenging task. Substoichiometric amounts and modifications of low abundant proteins necessitate the purification or enrichment of the modified proteins. Although the introduction of mass spectrometry-based chemical proteomic strategies has enabled the screening of protein PTMs with increased throughput, sample preparation remains highly time-consuming and tedious. Here, we report an optimized workflow for the enrichment of PTM proteins in a 96-well plate format, which could be extended to robotic automation. This platform allows us to significantly lower the input of total protein, which opens up the opportunity to screen specialized and difficult-to-culture cell lines in a high-throughput manner. The presented SP2E protocol is robust and time- and cost-effective, as well as suitable for large-scale screening of proteoforms. The application of the SP2E protocol will thus enable the characterization of proteoforms in various processes such as neurodevelopment, neurodegeneration, and cancer. This may contribute to an overall acceleration of the recently launched Human Proteoform Project.

Spacecraft sample collection and subsurface excavation of asteroid (101955) Bennu

Carbonaceous asteroids, such as (101955) Bennu, preserve material from the early Solar System, including volatile compounds and organic molecules. We report spacecraft imaging and spectral data collected during and after retrieval of a sample from Bennu’s surface. The sampling event mobilized rocks and dust into a debris plume, excavating a 9-m-long elliptical crater. This exposed material that is darker, spectrally redder, and more abundant in fine particulates than the original surface. The bulk density of the displaced subsurface material was 500–700 kg per cubic meter, about half that of the whole asteroid. Particulates that landed on instrument optics spectrally resemble aqueously altered carbonaceous meteorites. The spacecraft stored 250 ± 101 g of material, which will be delivered to Earth in 2023.

The potassium channel GhAKT2bD is regulated by CBL-CIPK calcium signaling complexes and facilitates K+ allocation in cotton

Efficient allocation of the essential nutrient potassium (K⁺ ) is a central determinant of plant ion homeostasis and involves AKT2 K⁺ channels. Here, we characterize four AKT2 K⁺ channels from cotton and report that xylem and phloem expressed GhAKT2bD facilitates K⁺ allocation and that AKT2-silencing impairs plant growth and development. We uncover kinase activity-dependent activation of GhAKT2bD-mediated K⁺ uptake by AtCBL4-GhCIPK1 calcium signaling complexes in HEK293T cells. Moreover, AtCBL4-AtCIPK6 complexes known to convey activation of AtAKT2 in Arabidopsis also activate cotton GhAKT2bD in HEK293T cells. Collectively, these findings reveal an essential role for AKT2 in the source-sink allocation of K⁺ in cotton and identify GhAKT2bD as subject to complex regulation by CBL-CIPK Ca²⁺ sensor-kinase complexes.

Involvement of CYP347W1 in neurotoxin 3-nitropropionic acid-based chemical defense in mustard leaf beetle Phaedon cochleariae

Chrysomelina beetlesstore 3-nitropropionic acid in form of a pretoxin, isoxazolin-5-one glucoside-conjugated ester, to protect themselves against predators. Here we identified a cytochrome P450 monooxygenase, CYP347W1, to be involved in the production of the 3-nitropropionic acid moiety of the isoxazolin-5-one glucoside ester. Knocking down CYP347W1 led to a significant depletion in the concentration of the isoxazolin-5-one glucoside ester and an increase in the concentration of the isoxazolin-5-one glucoside in the larval hemolymph. Enzyme assays with the heterologously expressed CYP347W1 showed free β-alanine was not the direct substrate. Homology modeling indicated that β-alanine-CoA ester can fit into CYP347W1's active site. Furthermore, we proved that Phaedon cochleariae eggs are not able to de novo synthesize 3-NPA, although both isoxazolin-5-one glucoside and its 3-NPA-conjugated ester are present in the eggs. These results provide direct evidence for the involvement of CYP347W1 in the biosynthesis of a P. cochleariae chemical defense compound.

Clickable report tags for identification of modified peptides by mass spectrometry

The identification and quantification of modified peptides are critical for the functional characterization of post-translational protein modifications (PTMs) to elucidate their biological function. Nowadays, quantitative mass spectrometry coupled with various bioinformatic pipelines has been successfully used for the determination of a wide range of PTMs. However, direct characterization of low abundant protein PTMs in bottom-up proteomic workflow remains challenging. Here, we present the synthesis and evaluation of tandem mass spectrometry tags (TMT) which are introduced via click-chemistry into peptides bearing alkyne handles. The fragmentation properties of the two mass tags were validated and used for screening in a model system and analysis of AMPylated proteins. The presented tags provide a valuable tool for diagnostic peak generation to increase confidence in the identification of modified peptides and potentially for direct peptide-PTM quantification from various experimental conditions.

AMPylation profiling during neuronal differentiation reveals extensive variation on lysosomal proteins

Protein AMPylation is a posttranslational modification with an emerging role in neurodevelopment. In metazoans two highly conserved protein AMP-transferases together with a diverse group of AMPylated proteins have been identified using chemical proteomics and biochemical techniques. However, the function of AMPylation remains largely unknown. Particularly problematic is the localization of thus far identified AMPylated proteins and putative AMP-transferases. We show that protein AMPylation is likely a posttranslational modification of luminal lysosomal proteins characteristic in differentiating neurons. Through a combination of chemical proteomics, gel-based separation of modified and unmodified proteins, and an activity assay, we determine that the modified, lysosomal soluble form of exonuclease PLD3 increases dramatically during neuronal maturation and that AMPylation correlates with its catalytic activity. Together, our findings indicate that AMPylation is a so far unknown lysosomal posttranslational modification connected to neuronal differentiation and it may provide a molecular rationale behind lysosomal storage diseases and neurodegeneration.

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Profiling of AMPylation during neuronal differentiation

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AMPylation is a potential PTM of luminal lysosomal proteins

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Phos-tag gel enables the separation of non-AMPylated and AMPylated proteins

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The modified lysosomal soluble form of PLD3 increases during neuronal maturation

Surgeon and surgical conference attendee views on live surgery events

Based on the principles of biomedical ethics, the authors conducted a survey focusing on the ethical aspects of, didactic benefits of and possible alternatives to live surgery events. This work provides an investigation of the ethics of live surgery events in an interdisciplinary and multicentre setting. Critical ethical concerns regarding the justification of such events are highlighted through evaluation of attendees and surgeons.

Ecological momentary intervention to reduce suicide risk among adolescents (EMIRA)

Suicide is among the leading causes of death among adolescents and suicide risk is particularly high after discharge from psychiatric inpatient care. Therefore, interventions to reduce suicidal thoughts and behaviours (STBs) among adolescents discharged from psychiatric inpatient care are integral for successful suicide prevention among this group. However, such interventions are scarce. EMIRA aims to close this important gap in mental health services by developing an ecological momentary intervention (i.e., intervention delivered in real-time and within one's natural setting) consisting of a personalized, automatically triggered crisis support smartphone app to reduce STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. First, we will conduct qualitative interviews with adolescents aged 14-21 years who previously experienced STBs, their parents and health care providers to identify their intervention needs and safety concerns regarding ecological momentary assessment (EMA). Next, we will investigate the short-term variability of STBs and their cognitive and physiological risk factors among adolescents aged 14-21 years using EMA (app-based self-report + wrist worn device). Based on our results and past research we will develop a personalized crisis support smartphone app (mobile safety planning) that is not only self-accessible but starts automatically based on the presence of pre-identified STB risk factors. Finally, we will conduct two consecutive studies to test the feasibility, efficacy and cost-effectiveness of the developed ecological momentary intervention in reducing STBs after discharge from psychiatric inpatient care among adolescents aged 14-21 years at risk for suicide. EMIRA has great potential to close a crucial gap in adolescent mental health services and significantly improve suicide prevention among this group.

Lindbladian approximation beyond ultraweak coupling

Away from equilibrium, the properties of open quantum systems depend on the details of their environment. A microscopic derivation of a master equation (ME) is therefore crucial. Of particular interest are Lindblad-type equations, not only because they provide the most general class of Markovian MEs, but also since they are the starting point for efficient quantum trajectory simulations. Lindblad-type MEs are commonly derived from the Born-Markov-Redfield equation via a rotating-wave approximation (RWA). However the RWA is valid only for ultraweak system-bath coupling and often fails to accurately describe nonequilibrium processes. Here we derive an alternative Lindbladian approximation to the Redfield equation, which does not rely on ultraweak system-bath coupling. Applying it to an extended Hubbard model coupled to Ohmic baths, we show that, especially away from equilibrium, it provides a good approximation in large parameter regimes where the RWA fails.

[Implementation of the principle of supported employment in Germany : Position paper of a task force of the DGPPN]

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.

Protein-AMPylierungs-Identifikation in lebenden Zellen

Protein AMPylation is a prevalent protein post-translational modification in human cells involved in endoplasmic reticulum stress regulation and neural development. In this article we describe the design, synthesis and application of a pronucleotide probe suitable for in situ fluorescence imaging and chemical protemics profiling of AMPylated proteins. Our probe utilizes straightforward strain-promoted azidealkyne click reaction for fluorescence labeling in living cells.

Renal Function in Patients with or without a Left Ventricular Assist Device Implant During Listing for a Heart Transplant

Background

Left ventricular assist device (LVAD) implantation may improve kidney function, but in patients awaiting heart transplantation, the long-term effects of LVAD implantation on renal function and subsequent clinical outcome are unclear.

Material/Methods

We analyzed data in patients with LVAD implants (n=139) and without LVAD implants (n=1038) who were listed for a heart transplant at our institution between 2000 and 2019. The primary endpoint was an impairment in renal function (decrease of creatinine-based estimated glomerular filtration rate [eGFR] by ≥30%) up to a maximum of 2 years after listing. Secondary endpoints were chronic kidney disease stage 4 or 5, heart transplantation, survival during listing, and 1-year survival after transplantation.

Results

Values for eGFR increased after LVAD implantation (P=0.001) and were higher at the time of waitlisting in the LVAD group than in the non-LVAD group (P=0.002), but were similar between groups at the end of waitlisting (P=0.75). Two-year freedom from renal impairment was 50.6% and 66.7% in the LVAD and non-LVAD groups, respectively, with a multivariable-adjusted hazard ratio for the LVAD versus the non-LVAD group of 1.78 (95% confidence interval 1.19–2.68; P=0.005). Two-year freedom from chronic kidney disease stages 4–5 was similar between study groups (LVAD group: 83.5%; non-LVAD group: 80.1%; =0.50). The 2-year probability of transplantation was slightly lower in the LVAD group than in the non-LVAD group (50.0% and 55.8%, respectively, P=0.017). However, 2-year survival on the waiting list and 1-year survival after transplantation did not differ significantly between study groups (P-values >0.20).

Conclusions

Our data indicate a transient improvement in creatinine-based eGFR values by LVAD implantation without influencing survival.

Clouds and Convective Self-Aggregation in a Multimodel Ensemble of Radiative-Convective Equilibrium Simulations

The Radiative-Convective Equilibrium Model Intercomparison Project (RCEMIP) is an intercomparison of multiple types of numerical models configured in radiative-convective equilibrium (RCE). RCE is an idealization of the tropical atmosphere that has long been used to study basic questions in climate science. Here, we employ RCE to investigate the role that clouds and convective activity play in determining cloud feedbacks, climate sensitivity, the state of convective aggregation, and the equilibrium climate. RCEMIP is unique among intercomparisons in its inclusion of a wide range of model types, including atmospheric general circulation models (GCMs), single column models (SCMs), cloud-resolving models (CRMs), large eddy simulations (LES), and global cloud-resolving models (GCRMs). The first results are presented from the RCEMIP ensemble of more than 30 models. While there are large differences across the RCEMIP ensemble in the representation of mean profiles of temperature, humidity, and cloudiness, in a majority of models anvil clouds rise, warm, and decrease in area coverage in response to an increase in sea surface temperature (SST). Nearly all models exhibit self-aggregation in large domains and agree that self-aggregation acts to dry and warm the troposphere, reduce high cloudiness, and increase cooling to space. The degree of self-aggregation exhibits no clear tendency with warming. There is a wide range of climate sensitivities, but models with parameterized convection tend to have lower climate sensitivities than models with explicit convection. In models with parameterized convection, aggregated simulations have lower climate sensitivities than unaggregated simulations.

An enhanced prognostic score for overall survival of patients with cancer derived from a large real-world cohort

BACKGROUND

By understanding prognostic biomarkers, we gain insights into disease biology and may improve design, conduct, and data analysis of clinical trials and real-world data. In this context, we used the Flatiron Health Electronic Health Record-derived deidentified database that provides treatment outcome and biomarker data from >280 oncology centers in the USA, organized into 17 cohorts defined by cancer type.

PATIENTS AND METHODS

In 122 694 patients, we analyzed demographic, clinical, routine hematology, and blood chemistry parameters within a Cox proportional hazard framework to derive a multivariable prognostic risk model for overall survival (OS), the 'Real wOrld PROgnostic score (ROPRO)'. We validated ROPRO in two independent phase I and III clinical studies.

RESULTS

A total of 27 variables contributed independently and homogeneously across cancer indications to OS. In the largest cohort (advanced non-small-cell lung cancer), for example, patients with elevated ROPRO scores (upper 10%) had a 7.91-fold (95% confidence interval 7.45-8.39) increased death hazard compared with patients with low scores (lower 10%). Median survival was 23.9 months (23.3-24.5) in the lowest ROPRO quartile Q1, 14.8 months (14.4-15.2) in Q2, 9.4 months (9.1-9.7) in Q3, and 4.7 months (4.6-4.8) in Q4. The ROPRO model performance indicators [C-index = 0.747 (standard error 0.001), 3-month area under the curve (AUC) = 0.822 (0.819-0.825)] strongly outperformed those of the Royal Marsden Hospital Score [C-index = 0.54 (standard error 0.0005), 3-month AUC = 0.579 (0.577-0.581)]. We confirmed the high prognostic relevance of ROPRO in clinical Phase 1 and III trials.

CONCLUSIONS

The ROPRO provides improved prognostic power for OS. In oncology clinical development, it has great potential for applications in patient stratification, patient enrichment strategies, data interpretation, and early decision-making in clinical studies.

EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination

BACKGROUND

The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services.

METHODS

We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases.

RESULTS

We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare.

CONCLUSIONS

Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.

Acute whole-body vibration reduces post-activation depression in the triceps surae muscle

PURPOSE

Acute whole-body vibration (WBV) is known to enhance neuromuscular activation. Especially mechanisms which act presynaptically are discussed to be involved in this modulation, but evidence is still limited. Therefore, this study aimed to investigate if 2 min of WBV might impact the premotoneuronal mechanism of post-activation depression (PAD).

METHODS

PAD in m. soleus was assessed by paired-pulse stimulation in 28 healthy participants prior, 2 min, 4 min and 10 min after 2 min of side-alternating WBV (10 Hz, 2 mm). Methodologies involved electromyography (m. soleus, m. tibialis anterior) and goniometric recordings (ankle, knee joint). H-reflexes were elicited with peripheral nerve stimulation and assessed by means of conditioned H-reflexes (ISI 1 s, H_cond) versus control H-reflexes (ISI₁₀, H).

RESULTS

H_cond/H was significantly enhanced by +55% (2 min), +32% (4 min) and +35% (10 min) following WBV (P < 0.05). Baseline muscle activity and joint positions were shown to be reliable (Cronbach's α values >0.990) throughout the testing procedure.

CONCLUSION

Vibratory-induced spinal inhibition is accompanied by diminished PAD at the presynaptic terminals which interconnect the Ia afferents with the α-motoneuron. Functionally, the PAD reduction might explain enhanced motor performance following vibration therapy, but future studies will be needed to verify this assumption.

Psychotherapie im höheren Lebensalter in der Psychotherapieausbildung

Zusammenfassung. Theoretischer Hintergrund: Psychotherapie im höheren Lebensalter (PihL) gewinnt in Deutschland in den letzten Jahrzehnten zunehmend an Bedeutung. Dennoch ist dieses Feld trotz des großen Bedarfs weiterhin unterrepräsentiert. Fragestellung: Wie werden angehende Psychotherapeut_innen aktuell in Bezug auf die psychotherapeutische Behandlung älterer Menschen ausgebildet? Methode: Sämtliche Ausbildungsinstitute in Deutschland mit dem Schwerpunkt Verhaltenstherapie sowie Dozierende mit Seminaren zu PihL wurden im Jahr 2018 zu einer Befragung eingeladen. Ergebnisse: Von 48 Instituten boten zum Zeitpunkt der Befragung 64.6 % gerontopsychlogische Unterrichtsstunden (M = 13.03 h) an (2.2 % des Theorieunterrichts). In den ausfindig gemachten Seminaren zeigen sich zu einem großen Teil die von Knight et al. (2009 ) vorgeschlagenen Themenschwerpunkte von allgemeinen und pathologischen Alterungsprozessen über diagnostische Besonderheiten bis hin zu konkreten Interventionsmethoden. Diskussion: Sowohl die Weiterbildungsstudiengänge als auch die neuen psychotherapeutischen Bachelor- und Masterstudiengänge sollten mehr Inhalte zum Thema PihL ähnlich wie die hier ausfindig gemachten Seminare berücksichtigen. Eine Orientierung für eine Basiswissensvermittlung bieten die vorgeschlagenen Themenschwerpunkte.

Prefrontal cognitive deficits in patients with schizophrenia treated with atypical or conventional antipsychotics

Forty-three patients with schizophrenia were investigated with a short neurocognitive screening battery focussing on working memory and executive functions. As compared to healthy controls, patients showed impairments in the modified card sorting test, in verbal fluency and all span tasks with exception of digit span forward. Patients who were treated with atypicals showed better performance in the digit ordering test (manipulation task) when compared to a group of patients who received conventional antipsychotics; this difference was not due to disease severity, age or education. Manipulation tasks might be useful for neurocognitive follow-up and intervention studies.

EPA guidance on the quality of mental health services

The main aim of this guidance of the European Psychiatric Association is to provide evidence-based recommendations on the quality of mental health services in Europe. The recommendations were derived from a systematic search of the best available evidence in the scientific literature, supplemented by information from documents retrieved upon reviewing the identified articles. While most recommendations could be based on empirical studies (although of varying quality), some had to be based on expert opinion alone, but were deemed necessary as well. Another limitation was that the wide variety of service models and service traditions for the mentally ill worldwide often made generalisations difficult. In spite of these limitations, we arrived at 30 recommendations covering structure, process and outcome quality both on a generic and a setting-specific level. Operationalisations for each recommendation with measures to be considered as denominators and numerators are given as well to suggest quality indicators for future benchmarking across European countries. Further pan-European research will need to show whether the implementation of this guidance will lead to improved quality of mental healthcare, and may help to develop useful country-specific cutoffs for the suggested quality indicators.

A Pronucleotide Probe for Live-Cell Imaging of Protein AMPylation

Conjugation of proteins to AMP (AMPylation) is a prevalent post‐translational modification (PTM) in human cells, involved in the regulation of unfolded protein response and neural development. Here we present a tailored pronucleotide probe suitable for in situ imaging and chemical proteomics profiling of AMPylated proteins. Using straightforward strain‐promoted azide–alkyne click chemistry, the probe provides stable fluorescence labelling in living cells.

Lazy Sundays: role of day of the week and reactivity on objectively measured physical activity in older people

Background

The aim of this study was to assess the effect of day of the week and wearing a device (reactivity) on objectively measured physical activity (PA) in older people.

Methods

Walking duration as a measure for PA was recorded from 1333 German community-dwelling older people (≥65 years, 43.8% women) over 5 days using accelerometers (activPAL). Least-square means of PA with 95%-confidence intervals (95%-CI) from multi-level analysis were calculated for each day of the week and each measurement day (days after sensor attachment).

Results

Walking duration on Sundays was significantly lower compared to working days (Sunday vs. Monday-Friday: − 12.8 min (95%-CI: − 14.7; − 10.9)). No statistically significant difference compared to working days was present for Saturdays. The linear slope for measurement day and walking duration was marginal and not statistically significant.

Conclusions

Studies using PA sensors in older people should assess Sundays and working days to adequately determine the activity level of the participants.

Expert consensus on a train-the-trainer curriculum for robotic colorectal surgery

AIM

Robotic techniques are being increasingly used in colorectal surgery. There is, however, a lack of training opportunities and structured training programmes. Robotic surgery has specific problems and challenges for trainers and trainees. Ergonomics, specific skills and user-machine interfaces are different from those in traditional laparoscopic surgery. The aim of this study was to establish expert consensus on the requirements for a robotic train-the-trainer curriculum amongst robotic surgeons and trainers.

METHOD

This is a modified Delphi-type study involving 14 experts in robotic surgery teaching. A reiterating 19-item questionnaire was sent out to the same group and agreement levels analysed. A consensus of 0.8 or higher was considered to be high-level agreement.

RESULTS

Response rates were 93-100% and most items reached high levels of agreement within three rounds. Specific requirements for a robotic faculty development curriculum included maximizing dual-console teaching, theatre team training, nontechnical skills training, patient safety, user-machine interface training and telementoring.

CONCLUSION

A clear need for the development of a train-the-trainer curriculum has been identified. Further research is needed to assess feasibility, effectiveness and clinical impact of a robotic train-the-trainer curriculum.

[Scientific development of critical care : Position paper]

Demographic changes in Germany means that nursing and medical care is becoming increasingly complex. This is especially true for intensive care. Despite the closure of hospitals in Germany, the number of beds in intensive care units rose between 2002 from 23,113 to 26,162 in 2010. At the same time the number of patients treated in intensive care units increased by 148,989 to 2,049,888. The increasing complexity requires specific education for nurses in intensive care based on a model of advanced nursing practice (ANP). Nursing experts who fulfill an advanced practise nursing are competent to make decisions autonomously and accountably within complex care situations. This includes decisions such as artificial ventilation, weaning, nutrition management and the management of delirium, wounds and pain. Nursing experts are responsible for specific clearly defined areas of care and initiate nurse-led services and practice. Scientific and research based evidence are transferred directly into health care practice and can be implemented directly. The DGF demands a scientific and with it academic development of critical care as advanced nursing practice based on a master level qualification. This also includes the request for expansion of competencies and roles and the assignment of decision making authority within complex health care situations and an orientation on the Competencies for European Critical Care Nurses of the European Federation of Critical Care Nursing Associations (EfCCNa).

Cohort-level disease prediction by extrapolation of individual-level predictions in transition dairy cattle

Dairy cattle experience metabolic stress during the transition from late gestation to early lactation resulting in higher risk for several economically important diseases (e.g. mastitis, metritis, and ketosis). Metabolic stress is described as a physiological state composed of 3 processes: nutrient metabolism, oxidative stress, and inflammation. Current strategies for monitoring transition cow nutrient metabolism include assessment of plasma non-esterified fatty acids and beta-hydroxybutyrate concentrations around the time of calving. Although this method is effective at identifying cows with higher disease risk, there is often not enough time to implement intervention strategies to prevent health disorders from occurring around the time of calving. Previously, we published predictive models for early lactation diseases at the individual cow level at dry-off. However, it is unknown if predictive probabilities from individual-level models can be aggregated to the cohort level to predict cohort-level incidence. Therefore, our objective was to test different data aggregation methods using previously published models that represented the 3 components of metabolic stress (nutrient metabolism, oxidative stress, and inflammation). We included 277 cows from five Michigan dairy herds for this prospective cohort study. On each farm, two to four calving cohorts were formed, totaling 18 cohorts. We measured biomarker data at dry-off and followed the cows until 30 days post-parturition for cohort disease incidence, which was defined as the number of cows: 1) having one or more clinical transition disease outcome, and/or 2) having an adverse health event (abortion or death of calf or cow) within each cohort. We tested three different aggregation methods that we refer to as the p-central, p-dispersion, and p-count methods. For the p-central method, we calculated the averaged predicted probability within each cohort. For the p-dispersion method, we calculated the standard deviation of the predicted probabilities within a cohort. For the p-count method, we counted the number of cows above a specified threshold of predicted probability within each cohort. We built four sets of models: one for each aggregation method and one that included all three aggregation methods (p-combined method). We found that the p-dispersion method was the only method that produced viable predictive models. However, these models tended to overestimate incidence in cohorts with low observed counts and underestimate risk in cohorts with high observed counts.