Built and natural environment correlates of physical activity of adults living in rural areas: a systematic review

BACKGROUND

According to social-ecological models, the built and natural environment has the potential to facilitate or hinder physical activity (PA). While this potential is well researched in urban areas, a current systematic review of how the built and natural environment is related to PA in rural areas is lacking.

METHODS

We searched five databases and included studies for adults (18-65 years) living in rural areas. We included quantitative studies investigating the association between any self-reported or objectively measured characteristic of the built or natural environment and any type of self-reported or objectively measured PA, and qualitative studies that reported on features of the built or natural environment perceived as barriers to or facilitators of PA by the participants. Screening for eligibility and quality assessment (using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields) were done in duplicate. We used a narrative approach to synthesize the results.

RESULTS

Of 2432 non-duplicate records, 51 quantitative and 19 qualitative studies were included. Convincing positive relationships were found between the availability and accessibility of places for exercise and recreation and leisure-time PA as well as between the overall environment and leisure-time PA. Possible positive associations were found between the overall environment and total and transport-related PA, between greenness/natural environment and total PA, between cycling infrastructure and aesthetics and MVPA, and between pedestrian infrastructure and total walking. A possible negative relationship was found between safety and security and total walking. Qualitative studies complemented several environmental facilitators (facilities for exercise and recreation, sidewalks or streets with low traffic, attractive natural environment) and barriers (lack of facilities and destinations, lack of sidewalks, speeding traffic and high traffic volumes, lack of street lighting).

CONCLUSIONS

Research investigating the relationship between the built and natural environment and PA behaviors of adults living in rural areas is still limited and there is a need for more high-quality and longitudinal studies. However, our most positive findings indicate that investing in places for exercise and recreation, a safe infrastructure for active transport, and nature-based activities are possible strategies that should be considered to address low levels of PA in rural adults.

TRIAL REGISTRATION

PROSPERO: CRD42021283508.

Terbium-149 production: a focus on yield and quality improvement towards preclinical application

Terbium-149 (T1/2 = 4.1 h, Eα = 3.98 MeV (16.7%), 28 µm range in tissue) is a radionuclide with potential for targeted alpha therapy. Due to the negligible emission of α-emitting daughter nuclides, toxicity to healthy tissue may be reduced in comparison with other α-particle emitters. In this study, terbium-149 was produced via 1.4 GeV proton irradiation of a tantalum target at the CERN-ISOLDE facility. The spallation products were mass separated and implanted on zinc-coated foils and, later, radiochemically processed. Terbium-149 was separated from the co-produced isobaric radioisotopes and the zinc coating from the implantation foil, using cation-exchange and extraction chromatographic techniques, respectively. At the end of separation, up to 260 MBq terbium-149 were obtained with > 99% radionuclidic purity. Radiolabeling experiments were performed with DOTATATE, achieving 50 MBq/nmol apparent molar activity with radiochemical purity > 99%. The chemical purity was determined by inductively coupled plasma-mass spectrometry measurements, which showed lead, copper, iron and zinc only at ppb level. The radiolabeling of the somatostatin analogue DOTATATE with [149Tb]TbCl3 and the subsequent in vivo PET/CT scans conducted in xenografted mice, showing good tumor uptake, further demonstrated product quality and its ability to be used in a preclinical setting.

How short-range adhesion slows down crack closure and contact formation

While viscoelastic, adhesive contact rupture of simple indenters is well studied, contact formation has received much less attention. Here, we present simulations of the formation of contact between various power law indenters and an adhesive, viscoelastic foundation. For all investigated indenters, we find that the macroscopic relaxation time τ scales approximately with 1/ρ1.8, where ρ is the range of adhesion. The prolongation of contact formation with Tabor parameter is rationalized by the increased dissipation that short-range adhesion causes on a moving crack.

Chemodiversity in flowers of Tanacetum vulgare has consequences on a florivorous beetle

The chemical composition of plant individuals can vary, leading to high intraspecific chemodiversity. Diversity of floral chemistry may impact the responses of flower-feeding insects. Tanacetum vulgare plants vary significantly in their leaf terpenoid composition, forming distinct chemotypes. We investigated the composition of terpenoids and nutrients of flower heads and pollen in plants belonging to three chemotypes - dominated either by β-thujone (BThu), artemisia ketone (Keto) or a mixture of (Z)-myroxide, santolina triene, and artemisyl acetate (Myrox) - using different analytical platforms. We tested the effects of these differences on preferences, weight gain and performance of adults of the shining flower beetle, Olibrus aeneus. The terpenoid composition and diversity of flower heads and pollen significantly differed among individuals belonging to the above chemotypes, while total concentrations of pollen terpenoids, sugars, amino acids, and lipids did not differ. Beetles preferred BThu over the Myrox chemotype in both olfactory and contact choice assays, while the Keto chemotype was marginally repellent according to olfactory assays. The beetles gained the least weight within 48 h and their initial mortality was highest when feeding exclusively on floral tissues of the Myrox chemotype. Short-term weight gain and long-term performance were highest when feeding on the BThu chemotype. In conclusion, the beetles showed chemotype-specific responses towards different T. vulgare chemotypes, which may be attributed to the terpenoid composition in flower heads and pollen rather than to differences in nutrient profiles. Both richness and overall diversity are important factors when determining chemodiversity of individual plants and their consequences on interacting insects.

Personal determinants of change agents' decision-making behavior in community health promotion: a qualitative study

BACKGROUND

Implementing environmental changes to promote healthier communities requires initial positive decisions by change agents from local politics and government. However, there is little research on what influences the change agents' decisions. This explorative, qualitative study aims to identify the personal determinants of the decision-making behavior of local change agents.

METHODS

We conducted semi-structured interviews to assess the personal determinants of decision-making behavior among 22 change agents from local politics and government. Relevant determinants were identified through a structured content analysis of the interview transcripts using the software MAXQDA 2020.

RESULTS

We found the following seven essential clusters of personal determinants of the decision-making behavior of change agents from local politics and government: Imprinting, socialization, and biography; experiences and involvement; attitudes and outcome expectations towards important issues and aspects; knowledge; emotions; personal benefits; and the perceived influences of others.

CONCLUSIONS

The identified personal determinants might serve as a source of understanding the decision-making behavior of change agents in community decision-making processes. Our findings can contribute to the effective planning and implementation of evidence-based multilevel interventions related to changing environmental conditions in communities and provide important information on which personal determinants should be considered when derive strategies for community health promotion within a systematic approach of developing an intervention program theory.

The effect of mycophenolate mofetil on podocytes in nephrotoxic serum nephritis

Mycophenolate mofetil (MMF) is applied in proteinuric kidney diseases, but the exact mechanism of its effect on podocytes is still unknown. Our previous in vitro experiments suggested that MMF can ameliorate podocyte damage via restoration of the Ca2+-actin cytoskeleton axis. The goal of this study was to characterize podocyte biology during MMF treatment in nephrotoxic serum (NTS) nephritis (NTN). NTN was induced in three-week old wild-type mice. On day 3, half of the mice were treated with MMF (100 mg/kgBW/d p.o.) for one week. On day 10, we performed proteomic analysis of glomeruli as well as super-resolution imaging of the slit diaphragm. For multiphoton imaging of Ca2+ concentration ([Ca2+]i), the experimental design was repeated in mice expressing podocyte-specific Ca2+ sensor. MMF ameliorated the proteinuria and crescent formation induced by NTS. We identified significant changes in the abundance of proteins involved in Ca2+ signaling and actin cytoskeleton regulation, which was further confirmed by direct [Ca2+]i imaging in podocytes showing decreased Ca2+ levels after MMF treatment. This was associated with a tendency to restoration of podocyte foot process structure. Here, we provide evidence that MPA has a substantial direct effect on podocytes. MMF contributes to improvement of [Ca2+]i and amelioration of the disorganized actin cytoskeleton in podocytes. These data extend the knowledge of direct effects of immunosuppressants on podocytes that may contribute to a more effective treatment of proteinuric glomerulopathies with the least possible side effects.

Development and reliability testing of an audit toolbox for the assessment of the physical activity friendliness of urban and rural environments in Germany

Background

According to socio-ecological theories, physical activity behaviors are linked to the physical and social neighborhood environment. Reliable and contextually adapted instruments are needed to assess environmental characteristics related to physical activity. This work aims to develop an audit toolbox adapted to the German context, to urban and rural settings, for different population groups, and different types of physical activity; and to evaluate its inter-rater reliability.

Methods

We conducted a systematic literature search to collect existing audit tools and to identify the latest evidence of environmental factors influencing physical activity in general, as well as in German populations. The results guided the construction of a category system for the toolbox. Items were assigned to the categories based on their relevance to physical activity and to the German context as well as their comprehensibility. We piloted the toolbox in different urban and rural areas (100 street segments, 15 parks, and 21 playgrounds) and calculated inter-rater reliability by Cohen's Kappa.

Results

The audit toolbox comprises a basic streetscape audit with seven categories (land use and destinations, traffic safety, pedestrian infrastructure, cycling infrastructure, attractiveness, social environment, and subjective assessment), as well as supplementary tools for children and adolescents, seniors and people with impaired mobility, parks and public open spaces, playgrounds, and rural areas. 76 % of all included items had moderate, substantial, or almost perfect inter-rater reliability (κ > 0.4).

Conclusions

The audit toolbox is an innovative and reliable instrument for the assessment of the physical activity friendliness of urban and rural environments in Germany.

Forschungsprojekt EUBeKo

Hintergrund

Bewegung ist über eine Reihe sozialökologischer Bedingungsfaktoren zu verstehen, an welchen eine erfolgreiche Bewegungsförderung ansetzen muss. Kommunen nehmen dabei eine bedeutende Rolle ein, da sie gesundheitsförderliche Verhältnisse ermöglichen können. Häufig wird die Konzipierung, Umsetzung und Evaluierung sozialökologischer Ansätze jedoch nicht systematisch und theoriegeleitet abgeleitet. Veränderungen in den Verhältnissen werden durch das Verhalten und die Entscheidungen sog. „change agents“ bzw. kommunaler Entscheidungstragender, wie z. B. Bürgermeister:innen, beeinflusst. Daher ist es wichtig, Einflussfaktoren auf Entscheidungsprozesse zu kennen, um Überzeugungsarbeit für Bewegungsförderung in der Kommune zu leisten. Zudem braucht es Multiplikator:innen (z. B. Mitarbeitende in Gesundheitsämtern), die Kompetenzen besitzen, verhältnisorientierte Interventionen in Kommunen systematisch umzusetzen.

Zielstellung und Projektverlauf

Das Forschungsprojekt „Entscheidungs- und Umsetzungsprozesse verhältnisorientierter Bewegungsförderung in der Kommune für mehr Chancengerechtigkeit systematisch planen und implementieren“ (EUBeKo) wurde im Rahmen des Förderschwerpunkts „Bewegung und Bewegungsförderung“ des Bundesministeriums für Gesundheit gefördert. In diesem Beitrag werden das Projekt EUBeKo mit seinen zwei Forschungsfragen zum einen nach der Rolle und den Kompetenzen von Multiplikator:innen und zum anderen nach den Einflussfaktoren auf kommunale Entscheidungsprozesse sowie die Planung und Umsetzung verhältnisorientierter Bewegungsförderung in zwei Modellkommunen als auch die Strategien der Dissemination (z. B. Projekt-Webseite) beschrieben.

Diskussion und Schlussfolgerungen

Zu den Stärken des Projekts zählt die systematische und theoriegeleitete Aufbereitung und Durchführung eines Prozesses verhältnisorientierter Bewegungsförderung in der Kommune mit besonderem Fokus auf Planungs- und Entscheidungsprozesse sowie auf die Zielgruppen der kommunalen Multiplikator:innen und Entscheidungstragenden. Herausforderungen finden sich im Theorie-Praxis-Transfer und in den Auswirkungen der COVID-19-Pandemie („coronavirus disease 2019“) auf die Projektumsetzung.

"suMus," a novel digital system for arm movement metrics and muscle energy expenditure

Objective: In the field of non-treatable muscular dystrophies, promising new gene and cell therapies are being developed and are entering clinical trials. Objective assessment of therapeutic effects on motor function is mandatory for economical and ethical reasons. Main shortcomings of existing measurements are discontinuous data collection in artificial settings as well as a major focus on walking, neglecting the importance of hand and arm movements for patients' independence. We aimed to create a digital tool to measure muscle function with an emphasis on upper limb motility. Methods: suMus provides a custom-made App running on smartwatches. Movement data are sent to the backend of a suMus web-based platform, from which they can be extracted as CSV data. Fifty patients with neuromuscular diseases assessed the pool of suMus activities in a first orientation phase. suMus performance was hence validated in four upper extremity exercises based on the feedback of the orientation phase. We monitored the arm metrics in a cohort of healthy volunteers using the suMus application, while completing each exercise at low frequency in a metabolic chamber. Collected movement data encompassed average acceleration, rotation rate as well as activity counts. Spearman rank tests correlated movement data with energy expenditure from the metabolic chamber. Results: Our novel application "suMus," sum of muscle activity, collects muscle movement data plus Patient-Related-Outcome-Measures, sends real-time feedback to patients and caregivers and provides, while ensuring data protection, a long-term follow-up of disease course. The application was well received from the patients during the orientation phase. In our pilot study, energy expenditure did not differ between overnight fasted and non-fasted participants. Acceleration ranged from 1.7 ± 0.7 to 3.2 ± 0.5 m/sec² with rotation rates between 0.9 ± 0.5 and 2.0 ± 3.4 rad/sec. Acceleration and rotation rate as well as derived activity counts correlated with energy expenditure values measured in the metabolic chamber for one exercise (r = 0.58, p < 0.03). Conclusion: In the analysis of slow frequency movements of upper extremities, the integration of the suMus application with smartwatch sensors characterized motion parameters, thus supporting a use in clinical trial outcome measures. Alternative methodologies need to complement indirect calorimetry in validating accelerometer-derived energy expenditure data.

Noncovalent Interactions in Halogenated Pyridinium Salts of the Weakly Coordinating Anion [Al(OTeF5 )4 ]. Chemistry 2023;29:e202202749. [PMID: 36268910 PMCID: PMC10107151 DOI: 10.1002/chem.202202749]

The synthesis and the first structural characterization of the halogenated pyridinium salts [C₅ F₅ NH]⁺ , [C₅ F₄ ClNH]⁺ , [(C₅ F₅ N)₂ H]⁺ , [(C₅ Cl₅ N)₂ H]⁺ of the weakly coordinating anion (WCA) [Al(OTeF₅ )₄ ]^- , showing noncovalent interactions in the solid state, are presented. The salts were characterized by the multinuclear NMR and IR spectroscopy as well as X-ray diffraction. Hirshfeld surface analysis and solid state structures reveal various intermolecular anion-π and σ-hole interactions between the corresponding halogenated pyridinium cations and the anion [Al(OTeF₅ )₄ ]^- .

Co-application of biochar and compost with decreased N fertilizer reduced annual ammonia emissions in wetland rice

Ammonia (NH3) emission from rice fields is a dominant nitrogen (N) loss pathway causing negative impacts on farm profitability and the environment. Reducing N fertilizer application to compensate for N inputs in organic amendments was evaluated for effects on N loss via volatilization, rice yields and post-harvest soil properties in an annual irrigated rice (Boro) – pre-monsoon rice (Aus) – monsoon (Aman) rice sequence. That experiment was conducted using the integrated plant nutrition system (IPNS; nutrient contents in organic amendments were subtracted from the full recommended fertilizer dose i.e., RD of chemical fertilizers) where six treatments with four replications were applied in each season: (T1) no fertilizer (control), (T2) RD, (T3) poultry manure biochar (3 t ha−1; pyrolyzed at 450°C) + decreased dose of recommended fertilizer (DRD), (T4) rice husk ash (3 t ha−1) + DRD, (T5) compost (3 t ha−1) + DRD, and (T6) compost (1.5 t ha−1)+ biochar (1.5 t ha−1) + DRD. The N loss via volatilization varied twofold among seasons being 16% in irrigated rice and 29% in the pre-monsoon rice crop. In irrigated rice, T6 had significantly lower NH3 emissions than all other treatments, except the control while in pre-monsoon and monsoon seasons, T6 and T3 were alike. Pooling the three seasons together, biochar (T3) or biochar plus compost (T6) reduced NH3 loss via volatilization by 36-37% while compost alone (T5) reduced NH3 loss by 23% relative to RD. Biochar (T3) and biochar plus compost mixture (T6) reduced yield-scaled NH3 emissions by 40 and 47% relative to the RD of chemical fertilizer (T2). The organic amendments with IPNS reduced the quantity of N fertilizer application by 65, 7, 24, and 45% in T3, T4, T5, and T6 treatments, respectively, while rice yields and soil chemical properties in all seasons were similar to the RD. This study suggests that incorporation of biochar alone or co-applied with compost and decrease of N fertilizer on an IPNS basis in rice-based cropping systems can reduce N application rates and NH3 emissions without harming yield or soil quality.

Usage of a graph database for the selection of sterile items in the OR

Purpose

In this work, we present a subsystem of a robotic circulating nurse, that produces recommendations for the next supplied sterile item based on incomplete requests from the sterile OR staff, the current situation, predefined knowledge and experience from previous surgeries. We describe a structure to store and query the underlying information in terms of entities and their relationships of varying strength.

Methods

For the implementation, the graph database Neo4j is used as a core component together with its querying language Cypher. We outline a specific structure of nodes and relationships, i.e., a graph. Primarily, it allows to represent entities like surgeons, surgery types and items, as well as their complex interconnectivity. In addition, it enables to match given situations and partial requests in the OR with corresponding subgraphs. The subgraphs provide suitable sterile items and allow to prioritize them according to their utilization frequency.

Results

The graph database was populated with existing data from 854 surgeries describing the intraoperative use of sterile items. A test scenario is evaluated in which a request for “Prolene” is made during a cholecystectomy. The software identifies a specific “Prolene” suture material as the most probable requested sterile item, because of its utilization frequency from over 95%. Other “Prolene” suture materials were used in less than 15% of the cholecystectomies.

Conclusion

We have proposed a graph database for the selection of sterile items in the operating room. The example shows how the partial information from different sources can be easily integrated in a query, leading to an unique result. Eventually, we propose possible enhancements to further improve the quality of the recommendations. In the next step, the recommendations of the software will be evaluated in real time during surgeries.

Determinants influencing municipal decision-makers in Germany regarding community health promotion

Background

Community health promotion should be based on theoretical behavioural and environmental approaches. Especially changes in the physical environment require administrative and political decisions. This study aims to identify determinants that influence decision-makers from local politics and administrations on decisions so that health promotion can be placed on the agenda of communities as a prerequisite of intervention implementation.

Methods

We used the methods of qualitative guided interviews and a quantitative survey. First, decision-makers from local politics and administrations in both urban and rural areas in Germany were interviewed in the period from July to November 2020. The interviews were analysed using qualitative content analysis according to Kuckartz and MAXQDA. Second, a nationwide online survey was conducted using Limesurvey. We used descriptive analyses. In both surveys, decision-makers reported the determinants for decision-making processes and their decision-making behaviour.

Results

22 interviews were conducted (women n = 7), and 415 participants (women n = 118) responded to the online survey. The decision-making behaviour of local decision-makers can be differentiated on different levels, following socio-ecological models: individual, socio-cultural, institutional, municipal and political. Each of these levels comprises a multitude of determinants that are essential for successful persuasion toward community health promotion. At the individual level, we identified determinants like attitudes, outcome expectations or emotions towards a topic.

Conclusions

The identification and understanding of determinants for local decision-making are essential for a tailored and theory-based intervention approach to place health promotion on the agenda of communities and to implement interventions. Further research is needed to replicate the importance of potential determinants and to develop effective intervention methods and techniques.

Key messages

S11-2 Cooperative planning with coaching elements in childcare centres: a qualitative investigation of childcare directors' perspectives

Background

Interventions to promote health-enhancing physical activity in early childhood education and care settings are most successful when tailored to the specific needs of each childcare centre and providing ongoing support to address context-specific barriers. Our research project therefore initiated organizational development processes in 12 childcare centres in Southern Germany supported by coaching and self-assessment tools. The staff of each centre was instructed to set three centre-specific SMART goals targeting physical activity and to use Goal Attainment Scaling in order to track the success at implementation. This qualitative study aims at exploring childcare centre directors' views on the guided planning process and identifying facilitators and barriers for its implementation.

Methods

We conducted guided semi-structured interviews with the directors of the centres after the 12- month organizational development process. 9 out of 12 directors were interviewed. The interviews were recorded, transcribed and analysed using qualitative content analysis with inductive category development.

Results

Childcare directors mainly considered themselves to be the person with the greatest responsibility for the success of the process. The coaching was regarded as helpful for structuring the process, involving the whole team and becoming clearer about goals. Several factors were identified as facilitators: a beneficial personnel situation, the intrinsic motivation of staff, good team cooperation, a high priority of physical activity, previous experience with similar projects, pressure for change, individual drivers, a good infrastructure, parents' support and support from the administrating organization. Reported barriers included team conflicts, lack of willingness to accept change and shortness of time.

Conclusions

Several contextual and interpersonal factors seem to influence the extent to which a cooperative planning process can be implemented by the staff of a childcare centre. The results help understand the process of change as a complex interventional system in which the intervention cannot be considered separately from the context.

S11 Improving knowledge co-creation and participation in physical activity promotion: The cooperative planning approach

A central problem of current efforts to promote health and physical activity (PA) is that many successful projects remain stuck in the demonstration phase and are not implemented successfully at scale. The use of participatory and/or co-creation approaches has been suggested to avoid this ?pilot project trap? and better adapt interventions to target group needs and setting specificities.

This symposium intends to introduce to an international audience a particular participatory concept that has become increasingly popular in PA promotion in Germany in recent years: The Cooperative Planning approach has been successfully used in sport facility planning, local and regional PA policy development, and various settings of PA promotion (incl. kindergartens, schools, vocational training, and communities). The workshop will shed light on the theoretical background and methodology of Cooperative Planning as well as its specific application in select settings.

The first presentation will introduce the concept of Cooperative Planning, outline potential areas of application, and compare it with other popular participatory and co-creation approaches in PA promotion. Following this, we will provide evidence from ongoing projects employing the approach to promote PA in kindergartens (Presentation 2) and in the community setting (Presentation 3). Presentation 4 will introduce an example from the retirement home setting and also highlight ways of combining Cooperative Planning with other approaches such as photovoice and participatory evaluation. The final presentation will provide an outlook on the future extension of the concept by introducing the idea of the Practice Dive, which may be used to further optimize knowledge co-creation between researchers and practitioners.

A closer look at the Cooperative Planning approach is both timely and relevant for an international audience for a number of reasons: Conceptually, Cooperative Planning is a theory-based framework that combines ideas of participation and co-creation for PA into an innovative whole-of-system approach. From a practical PA promotion perspective, it transcends many existing techniques by focusing both on engaging multipliers and members of the target group, and by involving all of them in the decisive intervention development process (e.g. rather than only via opinion polls or focus groups). This symposium will allow us to combine evidence from four different projects, highlighting both the specificities of working in different settings as well as different aspects and possible extensions of the Cooperative Planning approach.

O1-2 Identification of existing audit instruments for the assessment of urban and rural physical activity environments

Background

According to a socio-ecological perspective, the neighbourhood environment plays a critical role in promoting physical activity across all population groups. A comprehensive assessment of environmental characteristics is a prerequisite to the planning, implementation and evaluation of physical activity interventions. This work aims to identify existing audit tools for the assessment of physical activity related environmental features in order to evaluate a) their applicability in the European context and b) their relevance in the urban and rural context.

Methods

Within the research project EUBeKo[1] we searched relevant websites (e. g. Active Living Research) and scientific databases (e. g. PubMed) in order to identify existing audit instruments. We then developed a categorization system for the integration of the topics and items retrieved from the identified tools. To reveal context-relevant strengths and weaknesses, we critically inspected the instruments with the support of the current scientific evidence and literature regarding eligibility to the European context and rural/urban applicability.

Results

We identified 29 audit tools focusing on different topics and features influencing physical activity (e. g. infrastructure, barriers). Some also include aspects of the social environment (e. g. presence of people) or the subjective perception (e. g. walkability, aesthetics). We found that numerous tools contain aspects of the socio-ecological environment reflected on the item level that do not conform with European environmental characteristics (e. g. street signage, types of destinations). Furthermore, we identified an unequal distribution with few tools being developed explicitly for the rural context (n = 3).

Conclusions

It is challenging to rate the applicability and relevance of audit tools. We were able to develop a comprehensive categorization system that can assist researchers and practitioners in the selection of a suitable set of items for an optimized assessment of European physical activity environments. In addition, our work points out the need for an instrument reflecting urban and specifically rural peculiarities of the European context.

Progressive axonopathy when oligodendrocytes lack the myelin protein CMTM5

Oligodendrocytes facilitate rapid impulse propagation along the axons they myelinate and support their long-term integrity. However, the functional relevance of many myelin proteins has remained unknown. Here, we find that expression of the tetraspan-transmembrane protein CMTM5 (chemokine-like factor-like MARVEL-transmembrane domain containing protein 5) is highly enriched in oligodendrocytes and central nervous system (CNS) myelin. Genetic disruption of the Cmtm5 gene in oligodendrocytes of mice does not impair the development or ultrastructure of CNS myelin. However, oligodendroglial Cmtm5 deficiency causes an early-onset progressive axonopathy, which we also observe in global and tamoxifen-induced oligodendroglial Cmtm5 mutants. Presence of the Wld^S mutation ameliorates the axonopathy, implying a Wallerian degeneration-like pathomechanism. These results indicate that CMTM5 is involved in the function of oligodendrocytes to maintain axonal integrity rather than myelin biogenesis.

Herbivore-induced plant volatiles, not natural enemies, mediate a positive indirect interaction between insect herbivores

Many insect herbivores engage in apparent competition whereby two species interact through shared natural enemies. Upon insect attack, plants release volatile blends that attract natural enemies, but whether these volatiles mediate apparent competition between herbivores is not yet known. We investigate the role of volatiles that are emitted by bean plants upon infestation by Acyrthosiphon pisum aphids on the population dynamics and fitness of Sitobion avenae aphids, and on wheat phloem sap metabolites. In a field experiment, the dynamics of S. avenae aphids on wheat were studied by crossing two treatments: exposure of aphid colonies to A. pisum-induced bean volatiles and exclusion of natural enemies. Glasshouse experiments and analyses of primary metabolites in wheat phloem exudates were performed to better understand the results from the field experiment. In the field, bean volatiles did not affect S. avenae dynamics or survival when aphids were exposed to natural enemies. When protected from them, however, volatiles led to larger aphid colonies. In agreement with this observation, in glasshouse experiments, aphid-induced bean volatiles increased the survival of S. avenae aphids on wheat plants, but not on an artificial diet. This suggests that volatiles may benefit S. avenae colonies via metabolic changes in wheat plants, although we did not find any effect on wheat phloem exudate composition. We report a potential case of associational susceptibility whereby plant volatiles weaken the defences of receiving plants, thus leading to increased herbivore performance.

A neuronal mechanism for motivational control of behavior

Acting to achieve goals depends on the ability to motivate specific behaviors based on their predicted consequences given an individual’s internal state. However, the underlying neuronal mechanisms that encode and maintain such specific motivational control of behavior are poorly understood. Here, we used Ca²⁺ imaging and optogenetic manipulations in the basolateral amygdala of freely moving mice performing noncued, self-paced instrumental goal-directed actions to receive and consume rewards. We found that distinct neuronal activity patterns sequentially represent the entire action-consumption behavioral sequence. Whereas action-associated patterns integrated the identity, value, and expectancy of pursued goals, consumption-associated patterns reflected the identity and value of experienced outcomes. Thus, the interplay between these patterns allows the maintenance of specific motivational states necessary to adaptively direct behavior toward prospective rewards.

Cooperative planning in childcare centers to improve physical activity: a qualitative investigation of directors' perspectives

Interventions to promote physical activity (PA) in childcare centers have been shown to increase children’s PA levels; moreover, a growing number of evidence-based best practice guidelines exist for this setting. However, there is a lack of knowledge on the facilitators of and barriers to the successful implementation of PA guidelines and interventions. We used Cooperative Planning to improve capabilities for PA in childcare centers. This qualitative study aimed to explore childcare center directors’ views on the Cooperative Planning process and identify the facilitators of and barriers to its implementation. We conducted guided semi-structured interviews with the directors of nine childcare centers after completion of the 12-month Cooperative Planning process. The interviews were recorded, transcribed and analyzed using qualitative content analysis with inductive category development. Facilitators and barriers were systematized according to the Consolidated Framework for Implementation Research (CFIR). Cooperative Planning was regarded as being helpful for structuring the process and involving all team members. Several facilitators within the CFIR domains inner setting (structural characteristics, networks and communications, implementation climate), outer setting (support from parents and provider), characteristics of individuals (intrinsic motivation of the staff) and process (individual drivers) were identified. The reported barriers included structural characteristics (e.g. lack of time), networks and communications (e.g. team conflicts) and characteristics of individuals (e.g. lack of willingness to accept change). Several contextual and interpersonal factors seem to influence the extent to which a Cooperative Planning process can be implemented by a childcare center’s team. Future research is needed to evaluate the strategies needed to overcome the identified barriers.

Cyclotron production and radiochemical purification of terbium-155 for SPECT imaging

Background

Terbium-155 [T_1/2 = 5.32 d, Eγ = 87 keV (32%) 105 keV (25%)] is an interesting radionuclide suitable for single photon emission computed tomography (SPECT) imaging with potential application in the diagnosis of oncological disease. It shows similar decay characteristics to the clinically established indium-111 and would be a useful substitute for the diagnosis and prospective dosimetry with biomolecules that are afterwards labeled with therapeutic radiolanthanides and pseudo-radiolanthanides, such as lutetium-177 and yttrium-90. Moreover, terbium-155 could form part of the perfect “matched pair” with the therapeutic radionuclide terbium-161, making the concept of true radiotheragnostics a reality. The aim of this study was the investigation of the production of terbium-155 via the ¹⁵⁵Gd(p,n)¹⁵⁵Tb and ¹⁵⁶Gd(p,2n)¹⁵⁵Tb nuclear reactions and its subsequent purification, in order to obtain a final product in quantity and quality sufficient for preclinical application. The ¹⁵⁶Gd(p,2n)¹⁵⁵Tb nuclear reaction was performed with 72 MeV protons (degraded to ~ 23 MeV), while the ¹⁵⁵Gd(p,n)¹⁵⁵Tb reaction was degraded further to ~ 10 MeV, as well as performed at an 18 MeV medical cyclotron, to demonstrate its feasibility of production.

Result

The ¹⁵⁶Gd(p,2n)¹⁵⁵Tb nuclear reaction demonstrated higher production yields of up to 1.7 GBq, however, lower radionuclidic purity when compared to the final product (~ 200 MBq) of the ¹⁵⁵Gd(p,n)¹⁵⁵Tb nuclear reaction. In particular, other radioisotopes of terbium were produced as side products. The radiochemical purification of terbium-155 from the target material was developed to provide up to 1.0 GBq product in a small volume (~ 1 mL 0.05 M HCl), suitable for radiolabeling purposes. The high chemical purity of terbium-155 was proven by radiolabeling experiments at molar activities up to 100 MBq/nmol. SPECT/CT experiments were performed in tumor-bearing mice using [¹⁵⁵Tb]Tb-DOTATOC.

Conclusion

This study demonstrated two possible production routes for high activities of terbium-155 using a cyclotron, indicating that the radionuclide is more accessible than the exclusive mass-separated method previously demonstrated. The developed radiochemical purification of terbium-155 from the target material yielded [¹⁵⁵Tb]TbCl₃ in high chemical purity. As a result, initial cell uptake investigations, as well as SPECT/CT in vivo studies with [¹⁵⁵Tb]Tb-DOTATOC, were successfully performed, indicating that the chemical separation produced a product with suitable quality for preclinical studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41181-021-00153-w.

[Patient transport and networks for use of extracorporeal life support]

Neue Technologien und die kontinuierliche Weiterentwicklung extrakorporaler Unterstützungssysteme haben das Anwendungsspektrum des Extracorporeal Life Support (ECLS) in den letzten Jahren erweitert. Neben dem Einsatz im kardiogenen Schock oder unter Reanimation nehmen die Anfragen zur Übernahme instabiler Patienten aus peripheren Krankenhäusern zu. Durch organisatorische Herausforderungen wie die Etablierung von Netzwerken und ein strukturiertes Teamtraining aller Beteiligten ergibt sich eine rasche Verfügbarkeit des ECLS-Teams, um schnell beim zu versorgenden Patienten einzutreffen.

Extracellular Vesicles in neural cell interaction and CNS homeostasis

Central nervous system (CNS) homeostasis critically depends on the interaction between neurons and glia cells. Extracellular vesicles (EVs) recently emerged as versatile messengers in CNS cell communication. EVs are released by neurons and glia in activity-dependent manner and address multiple target cells within and outside the nervous system. Here, we summarize the recent advances in understanding the physiological roles of EVs in the nervous system and their ability to deliver signals across the CNS barriers. In addition to the disposal of cellular components via EVs and clearance by phagocytic cells, EVs are involved in plasticity-associated processes, mediate trophic support and neuroprotection, promote axonal maintenance, and modulate neuroinflammation. While individual functional components of the EV cargo are becoming progressively identified, the role of neural EVs as compound multimodal signaling entities remains to be elucidated. Novel transgenic models and imaging technologies allow EV tracking in vivo and provide further insight into EV targeting and their mode of action. Overall, EVs represent key players in the maintenance of CNS homeostasis essential for the lifelong performance of neural networks and thus provide a wide spectrum of biomedical applications.

Primary tumor side is associated with prognosis of colorectal cancer patients with brain metastases

Background

Brain metastases (BM) are a rare complication in colorectal cancer (CRC) patients and associated with an unfavorable survival prognosis. Primary tumor side (PTS) was shown to act as a prognostic and predictive biomarker in several trials including metastatic CRC (mCRC) patients. Here, we aim to investigate whether PTS is also associated with the outcome of CRC patients with BM.

Methods

Patients treated for CRC BM between 1988 and 2017 at an academic care center were included. Right-sided CRC was defined as located in the appendix, cecum and ascending colon and left-sided CRC was defined as located in the descending colon, sigma and rectum.

Results

Two hundred and eighty-one CRC BM patients were available for this analysis with 239/281 patients (85.1%) presenting with a left-sided and 42/281 patients (14.9%) with a right-sided primary CRC. BM-free survival (BMFS) was significantly longer in left-sided compared with right-sided CRC patients (33 versus 20 months, P = 0.009). Overall survival from CRC diagnosis as well as from diagnosis of BM was significantly longer in patients with a left-sided primary (42 versus 25 months, P = 0.002 and 5 versus 4 months, P = 0.005, respectively). In a multivariate analysis including graded prognostic assessment, PTS remained significantly associated with prognosis after BM (hazard ratio 0.65; 95% confidence interval: 0.46-0.92 months, P = 0.0016).

Conclusions

PTS was associated with survival times after the rare event of BM development in CRC patients. Therefore, its prognostic value remains significant even thereafter.

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Primary tumor side is a relevant and independent prognostic factor in mCRC.

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Left-sided CRC was associated with a significantly longer BMFS compared with right-sided CRC.

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OS from initial diagnosis of CRC as well as from BM was significantly longer in patients with left-sided primaries.

[Active hearing implants in chronic otitis media]

In patients with inadequate hearing improvement after tympanoplasty and failure of conventional hearing aid fitting, active hearing implants provide an alternative treatment option. Active middle ear implants function as a vibromechanical bypass of the stiffness and damping effect of a poorly oscillating tympanic membrane and the (reconstructed) ossicular chain. The selection of the hearing system depends on the maximum output levels of the hearing system and the anatomical conditions in mostly multiply operated ears. The development of variable coupling elements for active middle ear implants led to an extension of the indications to include not only purely sensorineural hearing loss but also mixed and conductive hearing loss in patients, as the transducer can now be coupled to the (mobile) stapes or the round window membrane. The article provides an overview of current clinical study results and recommendations on the indications for active hearing implants in patients with chronic otitis media.

Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction

Purpose

To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction.

Methods

Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar–agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton’s 4-step training approach. The students’ theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation.

Results

The MCQ results showed a significant increase of the student’s theoretical knowledge (50.2–75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good).

Conclusion

Undergraduate student’s medical education can be enhanced by teaching breast US skills.

Ultrahigh vacuum packaging and surface cleaning for quantum devices

We describe design, implementation, and performance of an ultra-high vacuum (UHV) package for superconducting qubit chips or other surface sensitive quantum devices. The UHV loading procedure allows for annealing, ultra-violet light irradiation, ion milling, and surface passivation of quantum devices before sealing them into a measurement package. The package retains vacuum during the transfer to cryogenic temperatures by active pumping with a titanium getter layer. We characterize the treatment capabilities of the system and present measurements of flux tunable qubits with an average T₁ = 84 µs and T₂ ^echo=134μs after vacuum-loading these samples into a bottom loading dilution refrigerator in the UHV-package.

Ammonia fluxes and emission factors under an intensively managed wetland rice ecosystem

Nitrogen (N) loss from rice production systems in the form of ammonia (NH₃) can be a significant N loss pathway causing significant economic and environmental costs. Yet, data on NH₃ fluxes in wetland rice ecosystems are still very scarce which limits the accuracy of national and global NH₃ budgets. We measured the NH₃ fluxes in situ in a wetland rice field and estimated emission factors (EF) under two soil management systems (i.e. conventional tillage, CT and strip tillage, ST); two residue retention levels (i.e. 15%, LR and 40% crop residue by height, HR); and three N fertilization rates (i.e. 108, 144 and 180 kg N ha^-1) in two consecutive years (2019 and 2020). The highest NH₃ peaks were observed within the first 3 days after urea application. The mean and cumulative NH₃ fluxes significantly increased with the increases in N fertilization rates and were 18.5% and 18.6% higher in ST than in CT in 2020 but not in 2019. Overall, the highest mean NH₃ fluxes were in 180 kg N ha^-1 coupled with either HR or LR and ST or CT. In 2019, the NH₃ EF was unchanged by any treatments. In 2020, the lower EF was in CT coupled with LR (15%) than all other treatment combinations, where ST with HR showed the highest EF (20%). Likewise, the lowest N rate (108 kg N ha^-1) in ST had the highest NH₃ EF (20%) that was similar to higher N rates (144 and 180 kg N ha^-1) in the same tillage treatment and to 180 kg N ha^-1 in CT. Our results highlight that NH₃ fluxes in rice field particularly the effects of ST correlated with higher soil pH and NH₄⁺ content and lower redox potential. Our results highlight that NH₃ fluxes are a potentially large N loss pathway in wetland rice under conventional and decreased soil disturbance regimes.

Allogeneic expanded adipose-derived stem cells in the treatment of rectovaginal fistulas in Crohn's disease

AIM

Crohn's disease (CD)-related rectovaginal fistulas (RVFs) are rare, challenging to treat and associated with a high morbidity. Due to a significant lack of data, we aimed to analyse the safety and feasibility of allogeneic adipose-derived stem cells (ASCs) in the treatment of CD-related RVF.

METHOD

Four consecutive patients with CD-related RVF underwent treatment with expanded allogeneic ASCs extracted from a healthy donor in a tertiary referral centre in 2019. None of the patients had an intestinal diversion at the time of the treatment. Follow-up was performed 6 months postoperatively.

RESULTS

The median operation time was 45 min with a median hospital stay of 3 days. No intra-operative complications occurred. Three patients (75%) developed recurrent RVF after a median follow-up of 19 days. Two patients required surgical treatment including loose seton drainage due to discharge and pain. One patient developed recurrence of symptoms after 10 days, but refused further surgical therapy. Only one patient (25%) showed healing of the RVF, with re-epithelialization of both the vaginal and rectal opening and absence of clinical symptoms.

CONCLUSION

Expanded allogeneic ASC therapy represents a novel safe treatment option for CD-associated RVF. Although efficacy appears limited, further controlled studies are required to draw robust conclusions.

Oligodendrocytes support axonal transport and maintenance via exosome secretion

Neurons extend long axons that require maintenance and are susceptible to degeneration. Long-term integrity of axons depends on intrinsic mechanisms including axonal transport and extrinsic support from adjacent glial cells. The mechanisms of support provided by myelinating oligodendrocytes to underlying axons are only partly understood. Oligodendrocytes release extracellular vesicles (EVs) with properties of exosomes, which upon delivery to neurons improve neuronal viability in vitro. Here, we show that oligodendroglial exosome secretion is impaired in 2 mouse mutants exhibiting secondary axonal degeneration due to oligodendrocyte-specific gene defects. Wild-type oligodendroglial exosomes support neurons by improving the metabolic state and promoting axonal transport in nutrient-deprived neurons. Mutant oligodendrocytes release fewer exosomes, which share a common signature of underrepresented proteins. Notably, mutant exosomes lack the ability to support nutrient-deprived neurons and to promote axonal transport. Together, these findings indicate that glia-to-neuron exosome transfer promotes neuronal long-term maintenance by facilitating axonal transport, providing a novel mechanistic link between myelin diseases and secondary loss of axonal integrity.

The long-term integrity of neuronal axons depends on intrinsic mechanisms such as axonal transport and on extrinsic support from adjacent glial cells. This study shows that genetic defects in glia that affect axonal integrity impair the secretion of oligodendrocyte exosomes and their ability to support nutrient-deprived neurons and promote axonal transport.

Application of 15N tracing for estimating nitrogen cycle processes in soils of a constructed wetland

Integrated Constructed Wetlands (ICW) area technology for the attenuation of contaminants such as organic carbon (C), nitrogen (N), phosphorous (P) and sulphur (S) in water coming from point or diffuse sources. Currently there is a lack of knowledge on the rates of gross N transformations in soils of the ICW bed leading to losses of reactive N to the environment. In addition, the kinetics of these processes need to be studied thoroughly for the sustainable use of ICW for removal of excessive N in the treatment of waste waters. Gross N transformation processes were quantified at two soil depths (0-15 and 30-45 cm) in the bed of a surface flow ICW using a ¹⁵N tracing approach. The ICW, located in Dunhill village at Waterford in Southeastern Ireland, receives 500 person equivalent waste waters containing large quantities of organic pollutants (ca. mean annual C, N, P and S contents of 240, 60, 5 and 73 mg L^-1). Soil was removed from these depths in December 2014 and incubated anaerobically in the laboratory, with either ¹⁵N labeled ammonium (NH₄⁺) or nitrate (NO₃^-), differentially labeled with ¹⁴NH₄¹⁵NO₃ and ¹⁵NH₄¹⁴NO₃ in parallel setups, enriched to 50 atm% ¹⁵N. Results showed that at both soil depths, NO₃^- production rates were small, which may have resulted in lower NO₃^- reduction by either denitrification or dissimilatory NO₃^- reduction to ammonium (DNRA). However, despite being low, the DNRA rates were greater than denitrification rates. Direct transformation of organic N to NO₃^-, without mineralization to NH₄⁺, was a prevalent pathway of NO₃^- production accounting for 28-33% of the total NO₃^- production. Relative contribution of this process to the total N mineralization was negligible at depth 1 (0.01%) but dominant at depth 2 (99.7%). Total NO₃^-production to total immobilization of NH₄⁺ and NO₃^- was very small (<0.50%) suggesting that ICW soils are not a source of NO₃^-. Despite a large potential of N immobilization existed at both the layers, relative N immobilization to the total N conversion was higher at depth 2 (ca. 2.2) than at depth 1 (ca. 1.5). The NH₄⁺ desorption rate at 30-45 cm was high. However, immobilization in the recalcitrant and labile organic N pools was higher. Mineralization and immobilization of NH₄⁺ processes showed that recalcitrant organic N was the predominant source in ICW soils whereas the labile organic N was comparatively small. Source apportionment of N₂O production showed that the majority of the N₂O produced through denitrification (ca. 92.5%) followed by heterotrophic nitrification (ca. 5.5%), co-denitrification (ca. 1.90%) and nitrification (0.20%). These results revealed that application of a detailed ¹⁵N tracing method can provide insights on the underlying processes of ecosystem based abundances of reactive N. A key finding of this study was that both investigated ICW layers were characterised by large N immobilization which restricts production of NO₃^- and further gaseous N losses.