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Institute
Background
A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix® Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan® Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort.
Methods
An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage.
Results
Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; PChi < .001). Operators rated the handling of VS as superior (rating of “good” or “very good: 86.1% VS vs. 20.8% IS, PChi < .001). Reinsertion of the needle into the catheter after partial withdrawal—prior or during the catheterization attempt—was associated with an increased risk of cannulation failure (7.909, CI 5.989–10.443, P < .001 and 23.023, CI 10.372–51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347–2.967, P = .001).
Conclusions
First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure.
During gestation, the most drastic change in oxygen supply occurs with the onset of ventilation after birth. As the too early exposure of premature infants to high arterial oxygen pressure leads to characteristic diseases, we studied the adaptation of the oxygen sensing system and its targets, the hypoxia-inducible factor- (HIF-) regulated genes (HRGs) in the developing lung. We draw a detailed picture of the oxygen sensing system by integrating information from qPCR, immunoblotting, in situ hybridization, and single-cell RNA sequencing data in ex vivo and in vivo models. HIF1α protein was completely destabilized with the onset of pulmonary ventilation, but did not coincide with expression changes in bona fide HRGs. We observed a modified composition of the HIF-PHD system from intrauterine to neonatal phases: Phd3 was significantly decreased, while Hif2a showed a strong increase and the Hif3a isoform Ipas exclusively peaked at P0. Colocalization studies point to the Hif1a-Phd1 axis as the main regulator of the HIF-PHD system in mouse lung development, complemented by the Hif3a-Phd3 axis during gestation. Hif3a isoform expression showed a stepwise adaptation during the periods of saccular and alveolar differentiation. With a strong hypoxic stimulus, lung ex vivo organ cultures displayed a functioning HIF system at every developmental stage. Approaches with systemic hypoxia or roxadustat treatment revealed only a limited in vivo response of HRGs. Understanding the interplay of the oxygen sensing system components during the transition from saccular to alveolar phases of lung development might help to counteract prematurity-associated diseases like bronchopulmonary dysplasia.
In der digitalisierten Arbeitswelt ermöglichen neue und flexible Informations- und Kommunikationstechnologien (IKT) eine raum- und zeitunabhängige Erreichbarkeit (Albers, 2018). Während die „ständige“ Erreichbarkeit öffentlich kontrovers diskutiert wird, zeigt sich im Bereich des Kommunikationsmanagements, insbesondere hinsichtlich der Untersuchung von Agenturen, eine Forschungslücke (Röttger & Zielmann, 2009). Dieser Beitrag knüpft daran an und liefert empirische sowie praxisnahe Erkenntnisse zur arbeitsbezogenen erweiterten Erreichbarkeit. Mit dem Fokus auf Mitarbeitende in Kommunikationsagenturen wurde untersucht, wie ihre Erreichbarkeit ausfällt und welche Gestaltungsansätze sich im Arbeitskontext daraus ableiten. Zu ihrer Beantwortung wurden qualitative, leitfadengestützte Interviews mit Vollzeitbeschäftigten (n= 10) aus mittelgroßen Agenturen (Größe: 20 bis 50 Beschäftigte, n= 5) durchgeführt und ausgewertet. Die Interviewstudie analysiert Ausmaß, Ursachen, individuelle und betriebliche Umgangsweisen sowie darauf aufbauende Handlungsansätze. Die Ergebnisse verdeutlichen zwei Aspekte der erweiterten Erreichbarkeit in Agenturen: Individualität und Vielfalt. Innerhalb der Untersuchung kann verdeutlicht werden, dass die Erreichbarkeit auf einer Kombination vielfältiger Ursachen beruht. Für die Gestaltung der Erreichbarkeit leiten sich daraus relevante Implikationen ab: Statt verbindlicher Vorschriften sollte ein selbstbestimmtes, flexibles Arbeiten im Vordergrund stehen.
Applications of pulsed electric fields for processing potatoes: Examples and equipment design
(2022)
In the last two decades, pulsed electric fields (PEF) have successfully been introduced into the food industry, as one of the most promising and "game changing" technologies. This review is devoted to the recent applications of pulsed electric fields used in processing potatoes. The potato processing market size was estimated to be ca. USD 24.83 billion (2018) and with an annual growth rate of 5.2%. The physicochemical characteristics of potatoes and the specificity of potato processing lines makes a pulsed electric field very versatile and flexible allowing one to achieve different technological aims by its implementation into technological lines. In this paper, a short analysis of the potato structure and its nutritional properties, applications of moderate electric fields, ohmic heating, and pulsed electric fields are presented. Moreover, the basic electroporation effects, metabolic responses, texture modification and different PEF assisted processes applied to the potato are discussed. Finally, some examples of commercial applications and a brief description of the available equipment for the PEF processing of potatoes are presented.
One challenge of the EU energy transition is the integration of renewable electricity generation in the distribution system. EU energy law proposes a possible solution by introducing “citizen energy communities” (Directive 2019/944/EU) which may be open for “cross-border participation”. This article proposes an innovative way of implementing such cross-border communities by linking distribution systems via a “switchable element”, a generation, storage, or consumption asset with a connection to each country. An optimization model has been developed to calculate the system cost savings of such a connection. Linking regions with complementary characteristics regarding electricity generation and demand via a switchable element leads to more efficient system utilization. Findings are relevant for the transposition of “citizen energy communities” in national laws.
Braune Brühe, was tun?
(2022)
Background: New ischaemic brain lesions on magnetic resonance imaging (MRI) are reported in up to 86% of patients after transcatheter edge-to-edge repair of the mitral valve (TEER-MV). Knowledge of the exact procedural step(s) that carry the highest risk for cerebral embolisation may help to further improve the procedure.
Aims: The aim of this study was to identify the procedural step(s) that are associated with an increased risk of cerebral embolisation during TEER-MV with the MitraClip system. Furthermore, the risk of overt stroke and silent brain ischaemia after TEER-MV was assessed.
Methods: In this prospective, pre-specified observational study, all patients underwent continuous transcranial Doppler examination during TEER-MV to detect microembolic signals (MES). MES were assigned to specific procedural steps: (1) transseptal puncture and placement of the guide, (2) advancing and adjustment of the clip in the left atrium, (3) device interaction with the MV, and (4) removal of the clip delivery system and the guide. Neurological examination using the National Institutes of Health Stroke Scale (NIHSS) and cerebral MRI were performed before and after TEER-MV.
Results: Fifty-four patients were included. The number of MES differed significantly between the procedural steps with the highest numbers observed during device interaction with the MV. Mild neurological deterioration (NIHSS ≤3) occurred in 9/54 patients. New ischaemic lesions were detected in 21/24 patients who underwent MRI. Larger infarct volume was significantly associated with neurological deterioration.
Conclusions: Cerebral embolisation is immanent to TEER-MV and predominantly occurs during device interaction with the MV. Improvements to the procedure may focus on this procedural step.