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Cancer is characterized by a remarkable intertumoral, intratumoral, and cellular heterogeneity that might be explained by the cancer stem cell (CSC) and/or the clonal evolution models. CSCs have the ability to generate all different cells of a tumor and to reinitiate the disease after remission. In the clonal evolution model, a consecutive accumulation of mutations starting in a single cell results in competitive growth of subclones with divergent fitness in either a linear or a branching succession. Acute lymphoblastic leukemia (ALL) is a highly malignant cancer of the lymphoid system in the bone marrow with a dismal prognosis after relapse. However, stabile phenotypes and functional data of CSCs in ALL, the so-called leukemia-initiating cells (LICs), are highly controversial and the question remains whether there is evidence for their existence. This review discusses the concepts of CSCs and clonal evolution in respect to LICs mainly in B-ALL and sheds light onto the technical controversies in LIC isolation and evaluation. These aspects are important for the development of strategies to eradicate cells with LIC capacity. Common properties of LICs within different subclones need to be defined for future ALL diagnostics, treatment, and disease monitoring to improve the patients’ outcome in ALL.
We investigate the properties of the QCD matter across the deconfinement phase transition in the scope of the parton-hadron string dynamics (PHSD) transport approach. We present here in particular the results on the electromagnetic radiation, i.e. photon and dilepton production, in relativistic heavy-ion collisions. By comparing our calculations for the heavy-ion collisions to the available data, we determine the relative importance of the various production sources and address the possible origin of the observed strong elliptic flow v2 of direct photons. We argue that the different centrality dependence of the hadronic and partonic sources for direct photon production in nucleusnucleus collisions can be employed to shed some more light on the origin of the photon v2 “puzzle”. While the dilepton spectra at low invariant mass show in-medium effects like an enhancement from multiple baryonic resonance formation or a collisional broadening of the vector meson spectral functions, the dilepton yield at high invariant masses (above 1.1 GeV) is dominated by QGP contributions for central heavy-ion collisions at ultra-relativistic energies. This allows to have an independent view on the parton dynamics via their electromagnetic massive radiation.
The high collision energies reached at the LHC lead to significant production yields of light (anti-)nuclei and (hyper-)nuclei in proton–proton, proton–lead and, in particular, lead–lead collisions. The excellent particle identification capabilities of the ALICE apparatus, based on the specific energy loss in the Time Projection Chamber and the velocity information in the Time-Of-Flight detector, allow for the detection of these rarely produced particles. Further, the Inner Tracking System gives the possibility to separate primary nuclei from those coming from weak decay of heavier systems. One example of such a weak decay is the measurement of the (anti-)hypertriton decay to 3He + π− (3H̅e̅ + π+). The aforementioned capabilities of the ALICE apparatus offer the unique opportunity to search for exotica, like the bound state of a Λ and a neutron which would decay into a deuteron and a pion, or the bound state of two Λ’s. Results on the production of stable nuclei in Pb–Pb collisions at √sNN = 2.76 TeV are presented, and compared with thermal model predictions. We further present the current status of the searches, by their upper limits on the production yields, and compare the results to thermal and coalescence model expectations.
The pA system is typically regarded in heavy ion collisions as a “cold” nuclear matter environment and thought to isolate and identify initial state effects due to the presence of multiple nucleons in the incoming nucleus. Moreover, pA collisions bridge the gap between peripheral AA collisions and the pp baseline to create a more complete understanding of underlying production mechanisms and how they evolve with multiplicity. Recent measurements at both RHIC and the LHC provide an indication, however, that the “cold” nuclear matter picture may be somewhat naïve.
Recent LHC results from the 2013 p–Pb run at √sNN = 5.02 TeV will be discussed.
Das Feld der interdisziplinäre Diskursforschung hat in den letzten Jahren zunehmend an Bedeutung gewonnen und sich zu einer etablierten Forschungsperspektive am Schnittpunkt von Sprache und Gesellschaft, von Wissen und Macht entwickelt. Die theoretische und methodische Vielgestaltigkeit dieser Forschungsperspektive führt allerdings insbesondere bei der Konzeption und Durchführung von Forschungsarbeiten solchen Zuschnitts immer wieder zu Unsicherheiten und Schwierigkeiten. Drei Werke, die – in unterschiedlicher Weise – auf das sich aus der Vielgestaltigkeit dieses Feldes ergebende Bedürfnis nach Systematisierung und Orientierung antworten, werden im Folgenden vorgestellt. Dabei gilt es deutlich herauszustellen, dass die vorgestellten Werke nicht als Methodenbücher oder Anleitungen zur "korrekten" Durchführung von diskursorientierten Forschungsarbeiten misszuverstehen, sondern vielmehr als Anregung und Verständigung über Fragen, Probleme und Richtungen der Diskursforschung auch über nationale und disziplinäre Grenzen hinweg zu lesen sind.
In this review, I argue that this textbook edited by BENNETT and CHECKEL is exceptionally valuable in at least four aspects. First, with regards to form, the editors provide a paragon of how an edited volume should look: well-connected articles "speak to" and build on each other. The contributors refer to and grapple with the theoretical framework of the editors who, in turn, give heed to the conclusions of the contributors. Second, the book is packed with examples from research practice. These are not only named but thoroughly discussed and evaluated for their methodological potential in all chapters. Third, the book aims at improving and popularizing process tracing, but does not shy away from systematically considering the potential weaknesses of the approach. Fourth, the book combines and bridges various approaches to (mostly) qualitative methods and still manages to provide abstract and easily accessible standards for making "good" process tracing. As such, it is a must-read for scholars working with qualitative methods. However, BENNETT and CHECKEL struggle with fulfilling their promise of bridging positivist and interpretive approaches, for while they do indeed take the latter into account, their general research framework remains largely unchanged by these considerations. On these grounds, I argue that, especially for scholars in the positivist camp, the book can function as a "how-to" guide for designing and implementing research. Although this may not apply equally to interpretive researchers, the book is still a treasure chest for them, providing countless conceptual clarifications and potential pitfalls of process tracing practice.
Die Entwicklungen in der Medizinischen Ausbildung der letzten Jahre konfrontieren Lehrende zunehmend mit neuen didaktischen Herausforderungen. An zahlreichen Standorten im deutschsprachigen Raum werden bereits Qualifizierungsangebote für Lehrende angeboten, jedoch fehlt bisher ein Orientierungsrahmen für medizindidaktische Kompetenzen, der ein Qualifikationsprofil für Lehrende darstellt.
Vor dem Hintergrund der Diskussion um die Kompetenzorientierung des Medizinstudiums und auf Grundlage aktueller internationaler Literatur wurde durch den GMA Ausschuss für Personal- und Organisationsentwicklung in der Lehre ein Kernkompetenzmodell für Lehrende in der Medizin entwickelt. Das Modell soll nicht nur den Lehrenden Orientierung zu ihrem Qualifikationsprofil geben, sondern auch die inhaltliche Ausrichtung hochschuldidaktischer (Aus-) Weiter- und Fortbildungen sowie die Evaluation von Fakultätsentwicklungsprozessen erleichtern und nicht zuletzt einheitliche Kriterien für die Beurteilung der Lehrqualifikation in deutschsprachigen Raum definieren.
Das Modell besteht aus sechs Kompetenzfeldern, für die jeweils Teilkompetenzen definiert und Lernziele beschrieben wurden. Anwendungsbeispiele sollen die jeweiligen Kompetenzen verdeutlichen.
Das Modell ist für die praktische Anwendung konzipiert und soll in einem nächsten Schritt durch spezifische Kompetenzen für Lehrende mit besonderen Aufgaben ergänzt werden.
Recent developments in medical education have created increasing challenges for medical teachers which is why the majority of German medical schools already offer educational and instructional skills trainings for their teaching staff. However, to date no framework for educational core competencies for medical teachers exists that might serve as guidance for the qualification of the teaching faculty. Against the background of the discussion about competency based medical education and based upon the international literature, the GMA Committee for Faculty and Organizational Development in Teaching developed a model of core teaching competencies for medical teachers. This framework is designed not only to provide guidance with regard to individual qualification profiles but also to support further advancement of the content, training formats and evaluation of faculty development initiatives and thus, to establish uniform quality criteria for such initiatives in German-speaking medical schools. The model comprises a framework of six competency fields, subdivided into competency components and learning objectives. Additional examples of their use in medical teaching scenarios illustrate and clarify each specific teaching competency. The model has been designed for routine application in medical schools and is thought to be complemented consecutively by additional competencies for teachers with special duties and responsibilities in a future step.
Membrane proteins are biological macromolecules that are located in a cell’s membrane and are responsible for essential functions within an organism, which makes them to prominent drug targets. The extraction of membrane proteins from the hydrophobic membrane bilayer to determine high-resolution crystal structures is a difficult task and only 2% of all solved proteins structures are membrane proteins. Computational methods may help to gain deeper insights into membrane protein structures and their functions. This study will give an overview of such computational methods on a representative set of membrane proteins and will provide ideas for future computational and experimental research on membrane proteins.
In a first step (chapter 2), I updated an earlier, manually-curated data set of homologous membrane proteins (HOMEP) to more recent versions in 2010 (HOMEP2) and 2013 (HOMEP3) using an automated clustering approach. High-resolution structures of membrane proteins listed in the PDB_TM database were structurally aligned and subsequently clustered using structural similarity scores. Both data sets were used as a standard gold reference set for subsequent work.
Subsequently, I have updated and applied the sequence alignment program AlignMe to determine protein descriptors that are suitable for detecting evolutionary relationship between homologous a-helical membrane proteins. Single input descriptors were tested alone and in combination with each other in different modes of AlignMe by optimizing gap penalties on the HOMEP2 data set. Most accurate alignments and homology models on the HOMEP2 data set were observed when using position-specific substitution information (P), secondary structure propensities (S) and transmembrane propensities (T) in the AlignMe PST mode. An evaluation on an independent reference set of membrane protein sequence alignments from the BAliBASE collection showed that different modes of AlignMe are suitable for different sequence similarity levels. The AlignMe PST mode improved the alignment accuracy significantly for distantly related proteins, whereas for closely-related proteins from the BAliBASE set the AlignMe PS mode was more suitable. This work was published in March 2013 in PLOS ONE. In order to allow also an easier usage of the AlignMe program, I have implemented a web server of AlignMe (chapter 4) that provides the optimized settings and gap penalties for the AlignMe P, PS and PST modes. A comparison to other recent alignment web server shows that the alignments of AlignMe are similar or even more accurate than those of other methods, especially for very distantly related proteins for which the inclusion of membrane protein information has been shown to be suitable. This work was published in the NAR web server issue in July 2014.
Although membrane-specific information has been shown to be suitable for aligning distantly related membrane proteins on a sequence level, such information was not incorporated into structural alignment programs making it unclear which method is the most suitable for aligning membrane proteins. Thus, I compared 13 widely-used pairwise structural alignment methods on an updated reference set of homologous membrane protein structures (HOMEP3) and evaluated their accuracy by building models based on the underlying sequence alignments and used scoring functions (e.g., AL4 or CAD-score) to rate the model accuracy (chapter 5). The analysis showed that fragment-based approaches such as FR-TM-align are the most useful for aligning structures of membrane proteins that have undergone large conformational changes whereas rigid approaches were more suitable for proteins that were solved in the same or a similar state. However, no method showed a significant higher accuracy than any other. Additionally, all methods lack a measure to rate the reliability of the accuracy for a specific position within a structure alignment. In order to solve these problems, I propose a consensus-type approach that combines alignments from four different methods, namely FR-TM-align, DaliLite, MATT and FATCAT and assigns a confidence value to each position of the alignment that describes the agreement between the methods. This work has been published 2015 in the journal “PROTEINS: structure, function and bioinformatics”.
Consensus alignments were then generated for each pair of proteins of the HOMEP3 data set and subsequently analyzed for single evolutionary events within membrane spanning segments and for irregular structures (e.g., 310- and p-helices) (chapter 6). Interestingly, single insertions and deletions could be observed with the help of consensus alignments in the conserved membrane-spanning segments of membrane proteins in four protein families. The detection of such single InDels might help to identify crucial residues for a proteins function.
Introduction: In 2008, the German Council of Science had advised universities to establish a quality management system (QMS) that conforms to international standards. The system was to be implemented within 5 years, i.e., until 2014 at the latest. The aim of the present study was to determine whether a QMS suitable for electronic learning (eLearning) domain of medical education to be used across Germany has meanwhile been identified.
Methods: We approached all medical universities in Germany (n=35), using an anonymous questionnaire (8 domains, 50 items).
Results: Our results (response rate 46.3%) indicated very reluctant application of QMS in eLearning and a major information deficit at the various institutions.
Conclusions: Authors conclude that under the limitations of this study there seems to be a considerable need to improve the current knowledge on QMS for eLearning, and that clear guidelines and standards for their implementation should be further defined.
Einleitung: Der Wissenschaftsrat empfahl 2008 den Universitäten innerhalb der nächsten 5 Jahre, d. h. bis spätestens 2014, ein Qualitätsmanagementsystem (QMS), das internationalen Maßstäben entspricht, zu etablieren. Ziel der vorliegenden Studie war es, zu evaluieren, ob es derzeit ein geeignetes QMS für das elektronische Lernen (eLearning) gibt, das speziell im Fach Humanmedizin deutschlandweit eingesetzt werden kann.
Methoden: Im Rahmen einer Umfrage wurden mittels eines anonymisierten Fragebogens (8 Domänen, 50 Items) alle Universitäten (n=35) des Fachbereichs Medizin in Deutschland evaluiert.
Ergebnisse: Die Ergebnisse (46,3% Rücklaufquote) zeigen einen nur zögerlichen Einsatz von QMS für eLearning und dass vor Ort ein großes Informationsdefizit herrscht.
Schlussfolgerung: Unter Berücksichtigung der Limitationen dieser Studie kann zusammenfassend festgehalten werden, dass erheblicher Bedarf zu bestehen scheint, das existierende Informationsdefizit für QMS eLearning zu mindern, sowie zukünftig genaue Richtlinien und Standards zur Umsetzung zu definieren.
Background: The West African country of Burkina Faso (BFA) is an example for the enduring importance of traditional plant use today. A large proportion of its 17 million inhabitants lives in rural communities and strongly depends on local plant products for their livelihood. However, literature on traditional plant use is still scarce and a comprehensive analysis for the country is still missing.
Methods: In this study we combine the information of a recently published plant checklist with information from ethnobotanical literature for a comprehensive, national scale analysis of plant use in Burkina Faso. We quantify the application of plant species in 10 different use categories, evaluate plant use on a plant family level and use the relative importance index to rank all species in the country according to their usefulness. We focus on traditional medicine and quantify the use of plants as remedy against 22 classes of health disorders, evaluate plant use in traditional medicine on the level of plant families and rank all species used in traditional medicine according to their respective usefulness.
Results: A total of 1033 species (50%) in Burkina Faso had a documented use. Traditional medicine, human nutrition and animal fodder were the most important use categories. The 12 most common plant families in BFA differed considerably in their usefulness and application. Fabaceae, Poaceae and Malvaceae were the plant families with the most used species. In this study Khaya senegalensis, Adansonia digitata and Diospyros mespiliformis were ranked the top useful plants in BFA. Infections/Infestations, digestive system disorders and genitourinary disorders are the health problems most commonly addressed with medicinal plants. Fabaceae, Poaceae, Asteraceae, Apocynaceae, Malvaceae and Rubiaceae were the most important plant families in traditional medicine. Tamarindus indica, Vitellaria paradoxa and Adansonia digitata were ranked the most important medicinal plants.
Conclusions: The national-scale analysis revealed systematic patterns of traditional plant use throughout BFA. These results are of interest for applied research, as a detailed knowledge of traditional plant use can a) help to communicate conservation needs and b) facilitate future research on drug screening.
Proteins of the secretin family form large macromolecular complexes, which assemble in the outer membrane of Gram-negative bacteria. Secretins are major components of type II and III secretion systems and are linked to extrusion of type IV pili (T4P) and to DNA uptake. By electron cryo-tomography of whole Thermus thermophilus cells, we determined the in situ structure of a T4P molecular machine in the open and the closed state. Comparison reveals a major conformational change whereby the N-terminal domains of the central secretin PilQ shift by ∼30 Å, and two periplasmic gates open to make way for pilus extrusion. Furthermore, we determine the structure of the assembled pilus.
Background: Second hand smoke (ETS)-associated particulate matter (PM) contributes considerably to indoor air contamination and constitutes a health risk for passive smokers. Easy to measure, PM is a useful parameter to estimate the dosage of ETS that passive smokers are exposed to. Apart from its suitability as a surrogate parameter for ETS-exposure, PM itself affects human morbidity and mortality in a dose-dependent manner. We think that ETS-associated PM should be considered an independent hazard factor, separately from the many other known harmful compounds of ETS. We believe that brand-specific and tobacco-product-specific differences in the release of PM matter and that these differences are of public interest. Methods: To generate ETS of cigarettes and cigarillos as standardized and reproducible as possible, an automatic second hand smoke emitter (AETSE) was developed and placed in a glass chamber. L&M cigarettes ("without additives", "red label", "blue label"), L&M filtered cigarillos ("red") and 3R4F standard research cigarettes (as reference) were smoked automatically according to a self-developed, standardized protocol until the tobacco product was smoked down to 8 mm distance from the tipping paper of the filter. Results: Mean concentration (Cmean) and area under the curve (AUC) in a plot of PM2.5 against time were measured, and compared. CmeanPM2.5 were found to be 518 μg/m3 for 3R4F cigarettes, 576 μg/m3 for L&M "without additives" ("red"), 448 μg/m3 for L&M "blue label", 547 μg/m3 for L&M "red label", and 755 μg/m3 for L&M filtered cigarillos ("red"). AUCPM2.5-values were 208,214 μg/m3·s for 3R4F reference cigarettes, 204,629 μg/m3·s for L&M "without additives" ("red"), 152,718 μg/m3·s for L&M "blue label", 238,098 μg/m3·s for L&M "red label" and 796,909 μg/m3·s for L&M filtered cigarillos ("red"). Conclusion: Considering the large and significant differences in particulate matter emissions between cigarettes and cigarillos, we think that a favorable taxation of cigarillos is not justifiable.
Background: Measurement of prostate-specific antigen (PSA) advanced the diagnostic and prognostic potential for prostate cancer (PCa). However, due to PSA’s lack of specificity, novel biomarkers are needed to improve risk assessment and ensure optimal personalized therapy. A set of protein molecules as potential biomarkers was therefore evaluated in serum of PCa patients.
Methods: Serum samples from patients undergoing radical prostatectomy (RPE) for biopsy-proven PCa without neoadjuvant treatment were compared to serum samples from healthy subjects. Preliminary screening of 119 proteins in 10 PCa patients and 10 controls was carried out by the Proteome Profiler Antibody Array. Those markers showing distinct differences between patients and controls were then further evaluated by ELISA in the serum of 165 PCa patients and 19 controls. Uni- and multivariate as well as correlation analysis were performed to test the capability of these molecules to detect disease and predict pathological outcome.
Results: Screening showed that soluble (s)E-cadherin, E-selectin, MMP2, MMP9, TIMP1, TIMP2, Galectin and Clusterin warranted further evaluation. sE-Cadherin, TIMP1, Galectin and Clusterin were significantly over- and MMP9 under-expressed in PCa compared to controls. The concentration of sE-cadherin, MMP2 and Clusterin correlated negatively and that of MMP9 and TIMP1 positively with the Gleason Sum at prostatectomy. Only sE-cadherin significantly correlated with the highest Gleason pattern. Compared to serum PSA, sE-cadherin provided an independent and better matching predictive ability for discriminating PCas with an upgrade at RPE and aggressive tumors with a Gleason Sum ≥7.
Conclusions: sE-cadherin performed most favorably from a large panel of serum proteins in terms of diagnostic and predictive potential in curatively treatable PCa. sE-cadherin merits further investigation as a biomarker for PCa.
Hintergrund: Die Interaktion zwischen β-HCG und TSH in der Schwangerschaft stellt ein differentialdiagnostisches Problem dar, weil die Wertung von supprimierten TSH-Spiegeln erschwert wird. Dies kann im schlimmsten Fall zu Fehlinterpretationen führen. Ziel der vorliegenden Arbeit war, diese Interaktion an einem großen Kollektiv in einen zeitlichen Kontext mit dem Verlauf der Schwangerschaft zu bringen, da der Zeitpunkt des Screenings entscheidenden Einfluss auf die Höhe des TSH-Spiegels hat. Zusätzlich wurden anhand der vorliegenden Daten Referenzbereiche für Schwangere berechnet und der Einfluss einer Jodmedikation untersucht.
Patienten und Methoden: Aus einem unselektionierten Pool von Patientinnen eines nuklearmedizinischen Praxisverbundes wurden die Daten von 1283 schilddrüsengesunden Schwangeren zwischen 16 und 48 Jahren ausgewertet. Neben der TSH-Bestimmung lag ein Schwerpunkt auf dem zeitlichen Verlauf, so dass die Schwangeren in Untergruppen von je 2 Wochen analysiert wurden. Untersucht wurde der Einfluss der Jodmedikation auf die TSH-Werte. Am Ende erfolgte mit Hilfe der logarithmischen Transformation unter Verwendung der 2-Sigma-Grenzen die Bestimmung neuer TSH-Referenzbereiche für Schwangere.
Ergebnisse: Es zeigt sich zu Beginn der Schwangerschaft ein Anstieg der mittleren TSH-Werte von 1,22 mU/l in der 2. SSW bis auf 1,7 mU/l um die 7. SSW mit einem konsekutiven Abfall der TSH-Werte bis auf 0,9 mU/l bis zur 16. SSW (entsprechend 52,9%). Der größte Abfall findet sich in der 12. bis 14. SSW, also zum Zeitpunkt des ersten Screenings. Die Jodmedikation hat keinen maßgeblichen Einfluss auf den TSH-Wert. Die Berechnung schwangerschaftskorrigierter Referenzbereiche zeigt im ersten Drittel TSH-Werte von 0,08 – 3,67 mU/l, im 2. Drittel 0,04 – 2,88 mU/l und im 3. Trimenon 0,17 – 3,19 mU/l.
Schlussfolgerungen: Die Arbeit zeigt, dass die niedrigsten TSH-Werte zum Zeitpunkt des ersten Screenings zu erwarten sind und deswegen möglicherweise zu Fehlentscheidungen führen können. Ein relevanter Zusammenhang der Jodmedikation mit dem TSH-Wert lässt sich nicht nachweisen. Neue Referenzbereiche für Schwangere könnten hilfreich sein, dieses diagnostische Dilemma zu vermeiden.
Diffusion tensor imaging (DTI) is amongst the simplest mathematical models available for diffusion magnetic resonance imaging, yet still by far the most used one. Despite the success of DTI as an imaging tool for white matter fibers, its anatomical underpinnings on a microstructural basis remain unclear. In this study, we used 65 myelin-stained sections of human premotor cortex to validate modeled fiber orientations and oft used microstructure-sensitive scalar measures of DTI on the level of individual voxels. We performed this validation on high spatial resolution diffusion MRI acquisitions investigating both white and gray matter. We found a very good agreement between DTI and myelin orientations with the majority of voxels showing angular differences less than 10°. The agreement was strongest in white matter, particularly in unidirectional fiber pathways. In gray matter, the agreement was good in the deeper layers highlighting radial fiber directions even at lower fractional anisotropy (FA) compared to white matter. This result has potentially important implications for tractography algorithms applied to high resolution diffusion MRI data if the aim is to move across the gray/white matter boundary. We found strong relationships between myelin microstructure and DTI-based microstructure-sensitive measures. High FA values were linked to high myelin density and a sharply tuned histological orientation profile. Conversely, high values of mean diffusivity (MD) were linked to bimodal or diffuse orientation distributions and low myelin density. At high spatial resolution, DTI-based measures can be highly sensitive to white and gray matter microstructure despite being relatively unspecific to concrete microarchitectural aspects.
Aim: We investigated the long-term impact of adjunctive systemic antibiotics on periodontal disease progression. Periodontal therapy is frequently supplemented by systemic antibiotics, although its impact on the course of disease is still unclear.
Material & Methods: This prospective, randomized, double-blind, placebo-controlled multi-centre trial comprising patients suffering from moderate to severe periodontitis evaluated the impact of rational adjunctive use of systemic amoxicillin 500 mg plus metronidazole 400 mg (3x/day, 7 days) on attachment loss. The primary outcome was the percentage of sites showing further attachment loss (PSAL) ≥1.3 mm after the 27.5 months observation period. Standardized therapy comprised mechanical debridement in conjunction with antibiotics or placebo administration, and maintenance therapy at 3 months intervals.
Results: From 506 participating patients, 406 were included in the intention to treat analysis. Median PSAL observed in placebo group was 7.8% compared to 5.3% in antibiotics group (Q25 4.7%/Q75 14.1%; Q25 3.1%/Q75 9.9%; p < 0.001 respectively).
Conclusions: Both treatments were effective in preventing disease progression. Compared to placebo, the prescription of empiric adjunctive systemic antibiotics showed a small absolute, although statistically significant, additional reduction in further attachment loss. Therapists should consider the patient's overall risk for periodontal disease when deciding for or against adjunctive antibiotics prescription.
Background: Detailed injury data are not available for international tournaments in field hockey. We investigated the epidemiology of field hockey injuries during major International Hockey Federation (Fédération Internationale de Hockey, FIH) tournaments in 2013.
Materials: and methods FIH injury reports were used for data collection. All major FIH tournaments for women (n=5) and men (n=11) in 2013 were included. The main focus of this study was to assess the pattern, time, site on the pitch, body site and mechanism of each of the injuries. We calculated the average number of injuries per match and the number of injuries per 1000 player match hours.
Results: The average number of injuries was 0.7 (95% CI 0.5 to 1.0) per match in women's tournaments and 1.2 (95% CI 0.8 to 1.7) per match in men's tournaments. The number of injuries per 1000 player match hours ranged from 23.4 to 44.2 (average 29.1; 95% CI 18.6 to 39.7) in women and 20.8 to 90.9 (average 48.3; 95% CI 30.9 to 65.8) in men. Most injuries occurred in the circle (n=25, 50%, in women, n=95, 51%, in men). The rate of injuries increased after the first quarter. Injuries to the head and face (n=20, 40%) were most common in women. The head/face (n=51, 27%) and the thigh/knee (n=52, 28%) were equally affected in men. The ball caused the most injuries, followed by the stick, collisions and tripping/falling. There were no deaths or injuries that required hospital treatment in the entire cohort.
Summary: Field hockey has a low incidence of acute injuries during competition.
Quantification of spatially and temporally resolved water flows and water storage variations for all land areas of the globe is required to assess water resources, water scarcity and flood hazards, and to understand the Earth system. This quantification is done with the help of global hydrological models (GHMs). What are the challenges and prospects in the development and application of GHMs? Seven important challenges are presented. (1) Data scarcity makes quantification of human water use difficult even though significant progress has been achieved in the last decade. (2) Uncertainty of meteorological input data strongly affects model outputs. (3) The reaction of vegetation to changing climate and CO2 concentrations is uncertain and not taken into account in most GHMs that serve to estimate climate change impacts. (4) Reasons for discrepant responses of GHMs to changing climate have yet to be identified. (5) More accurate estimates of monthly time series of water availability and use are needed to provide good indicators of water scarcity. (6) Integration of gradient-based groundwater modelling into GHMs is necessary for a better simulation of groundwater–surface water interactions and capillary rise. (7) Detection and attribution of human interference with freshwater systems by using GHMs are constrained by data of insufficient quality but also GHM uncertainty itself. Regarding prospects for progress, we propose to decrease the uncertainty of GHM output by making better use of in situ and remotely sensed observations of output variables such as river discharge or total water storage variations by multi-criteria validation, calibration or data assimilation. Finally, we present an initiative that works towards the vision of hyperresolution global hydrological modelling where GHM outputs would be provided at a 1-km resolution with reasonable accuracy.