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Die Nukleinsäure-Amplifikations Testung (NAT) von Blutprodukten wurde Mitte der 90er Jahre von europäischen Plasma verarbeitenden Firmen und großen deutschen Blutspendediensten entwickelt. Primäres Ziel war eine verbesserte Sicherheit von Blutprodukten, indem das so genannte diagnostische Fenster nach einer Virusinfektion bis zum ersten Nachweis von Antikörpern so weit wie möglich geschlossen werden sollte. Bei einer qualitätsgerechten PCR kommen bereits der Probenentnahme, dem Probentransport sowie der Probenlagerung große Bedeutung zu, da vermieden werden muß, daß es durch ungeeignete Antikoagulanzien oder Entnahmetechniken zu einem Sensitivitätsverlust kommt oder daß Kontaminationen falsch positive Ergebnisse hervorrufen. Wird ein Pooling von Proben durchgeführt, ergibt sich ein Verdünnungsfaktor, weshalb darauf zu achten ist, dass gegebenenfalls nachfolgende Anreicherungsschritte für Viren, wie z.B. eine Zentrifugation, implementiert werden. Der Gesamtprozeß von Pooling und Virusanreicherung ist ebenso wie die Probenvorbereitung durch geeignete Maßnahmen zu validieren und durch Qualitätssicherungsmaßnahmen zu flankieren. Die in der Extraktion der viralen Nukleinsäuren verwendeten Reagenzien sollten im Laboralltag möglichst einfach zu handhaben sein, keine Gefährdung des Laborpersonals darstellen und die Virus-Nukleinsäure gleichzeitig mit höchster Effizienz freisetzen und in sehr hoher Reinheit für die anschließende Amplifikation bereitstellen. Qualitätssicherungmaßnahmen sollen hier sowohl die geforderte Effizienz des Prozesses sichern als auch verhindern, daß es in dieser kritischen Phase zu Kontaminationen kommt. Zur Amplifikation stehen verschiedene Methoden zur Verfügung, wobei die PCR, insbesondere bei inhouse-Systemen, die weiteste Verbreitung gefunden hat. Der Prozeß der Amplifikation sollte möglichst im geschlossenen System erfolgen, wie dies z.B. in Real-time PCR-Systemen die Regel ist, ohne daß das Reaktionsgefäß während oder nach dem Amplifikationsprozeß geöffnet werden muß. Dies gewährleistet eine hohe Sicherheit vor Kontaminationen durch freigesetzte Amplifikate. Im Blutspendewesen ist es von höchster Bedeutung, daß negative Ergebnisse tatsächlich negative Blutspenden anzeigen. Interne Kontrollen, die eine korrekte Funktionsweise jeder individuellen PCR signalisieren, sollten deshalb in jeder Reaktion mitgeführt werden. Neben internen Kontrollen sind externe Negativ- und Positiv-Kontrollen mitzuführen, um falsch positive Reaktionen nachzuweisen bzw. auch die vor der PCR liegenden Prozesse wie Virusanreicherung und Extraktion zu überwachen. Alle Prozesse sind nach den von den Behörden festgelegten Kriterien durchgängig zu validieren, und es ist routinemäßig an externen Qualitätskontrollmaßnahmen (Ringversuchen) teilzunehmen.
Background
For rheumatoid arthritis (RA), the treat-to-target concept suggests attaining remission or at least low disease activity (LDA) after 12 weeks.
Objectives
This German, prospective, multicenter, non-interventional study aimed to determine the proportion of patients with RA who achieved their treat-to-target aim after 12 and 24 weeks of etanercept (ETN) treatment in a real-life setting, as opposed to patients achieving their therapeutic target at a later timepoint (week 36 or 52).
Methods
A total of 824 adults with a confirmed diagnosis of RA without prior ETN treatment were included. Remission and LDA were defined as DAS28 < 2.6 and DAS28 ≤ 3.2, respectively.
Results
The proportion of patients achieving remission was 24% at week 12 and 31% at week 24. The proportion of patients achieving LDA was 39% at week 12 and 45% at week 24. The proportion of patients achieving remission or LDA further increased beyond week 24 up to week 52. Improvement in pain and reduction in concomitant glucocorticoid treatment were observed. Improvements in patient-reported outcomes were also seen in patients who did not reach remission or LDA. No new safety signals were detected.
Conclusions
A considerable proportion of patients with RA attained the target of remission or LDA after 12 weeks of ETN treatment. Even beyond that timepoint, the proportion of patients achieving treatment targets continued to increase up to week 52.
Trial Registration
ClinicalTrials.gov Identifier: NCT02486302.
Plain Language Summary
Physicians measure response to treatment of rheumatoid arthritis using a disease activity score (DAS28). People with a DAS28 of less than 2.6 have very few to no symptoms (also called remission). People with a DAS28 of 3.2 or less, called low disease activity, may experience mild symptoms. When people do not respond to treatment after 12 weeks, it is usually recommended to prescribe a different treatment. Researchers do not know how many people who do not respond after 12 weeks would respond if treatment were continued. A total of 824 German people with rheumatoid arthritis who received a drug called etanercept for up to 52 weeks took part in this study. Researchers wanted to know how many people had remission or low disease activity after 12 weeks and 24 weeks of treatment.
After 12 weeks, 24 in 100 people had remission; this increased to 31 in 100 people after 24 weeks. Thirty-nine in 100 people had low disease activity after 12 weeks; this increased to 45 in 100 people after 24 weeks. The number of people with remission or low disease activity increased with longer treatment (up to 52 weeks). People needed less additional treatment with a type of drug called glucocorticoids. The people in this study experienced side effects that were similar to those reported by people who took etanercept in previous studies.
The researchers concluded that a considerable proportion of people responded to treatment with etanercept after 12 weeks. This proportion increased when treatment was continued for longer than 12 weeks.
Porous tantalum trabecular metal biomaterial has a similar structure to trabecular bone, and was recently added to titanium dental implants as a surface enhancement. The purpose of this prospective pilot study was to describe 5-year survival results and crestal bone level changes around immediately-provisionalized Trabecular Metal Dental Implants. Eligible patients were adults in need of ≥1 implants in the posterior jaw. A non-occluding single acrylic provisional crown was in place for up to 14 days before final restoration. Clinical evaluations with radiographs were conducted at each follow-up visit (1 month, 3 months, 6 months, and 1 to 5 years). The primary endpoint was implant survival, characterized using the Kaplan-Meier method. The secondary endpoint was changes in crestal bone level, evaluated using a paired t-test to compare mean crestal bone levels between the baseline, 6-month, and annual follow-up values. In total, 30 patients (37 implants) were treated. Mean patient age was 45.5 years, and 63% were female. There was one implant failure; cumulative survival at 5 years was 97.2%. After the initial bone loss of 0.40 mm in the first 6 months, there were no statistically significant changes in crestal bone level over time up to 5 years of follow-up.
Objective
Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients.
Design
This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation.
Results
After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM.
Conclusion
The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.
Rationale: Studies have suggested mental health improvements following the use of the psychotropic plant concoction ayahuasca in non-clinical and clinical samples.
Objectives: The present observational study assessed depressive symptomatology in 20 clinically depressed patients (symptom score > 13 on the Beck’s Depression Inventory) before attendance of an ayahuasca ceremony and 1 month and 1 year after. Secondary measures included ratings of altered states of consciousness and ego dissolution during the ayahuasca ceremony as well as global measures of mindfulness, satisfaction with life, depression, anxiety, and stress.
Results: Twenty participants completed baseline and 1-day follow-up, 19 completed measures at 1-month follow-up, and 17 completed measures at 1-year follow-up. BDI scores reduced from baseline (M = 22.7) to all post-ceremony measures (Ms 11.45, 12.89, and 8.88, for 1-day, 1-month, and 1-year follow-up, respectively). After 1 day, 12/20 participants were in remission (BDI < 13). Remission rates after 1 month and 1 year were 13/19 and 12/17, respectively. Three participants remained mildly depressed (BDI 14–19) at the 1-month and 1-year follow-up. Two participants did not respond and remained at a moderate/severe level of depression at 1-year follow-up. Reductions on the secondary mental health measures and increases in mindfulness and satisfaction with life were found up to 1 year post-ceremony. Improvements in clinical depression and mental health correlated with levels of experienced ego dissolution and oceanic boundlessness during the ceremony up to 1 month after the ceremony. Engagement in additional mental health treatments or use of another psychedelic during study participation may have contributed to improved mental health ratings at 1-year follow-up.
Conclusion: Ayahuasca produces long-term mental health improvements in clinically depressed patients, which highlights its therapeutic potential.
Rapidity-odd directed flow measurements at midrapidity are presented for Λ, Λ¯, K±, K0s and ϕ at sNN−−−−√= 7.7, 11.5, 14.5, 19.6, 27, 39, 62.4 and 200 GeV in Au+Au collisions recorded by the STAR detector at the Relativistic Heavy Ion Collider. These measurements greatly expand the scope of data available to constrain models with differing prescriptions for the equation of state of quantum chromodynamics. Results show good sensitivity for testing a picture where flow is assumed to be imposed before hadron formation and the observed particles are assumed to form via coalescence of constituent quarks. The pattern of departure from a coalescence-inspired sum-rule can be a valuable new tool for probing the collision dynamics.
Surface temperature is a fundamental parameter of Earth’s climate. Its evolution through time is commonly reconstructed using the oxygen isotope and the clumped isotope compositions of carbonate archives. However, reaction kinetics involved in the precipitation of carbonates can introduce inaccuracies in the derived temperatures. Here, we show that dual clumped isotope analyses, i.e., simultaneous ∆47 and ∆48 measurements on the single carbonate phase, can identify the origin and quantify the extent of these kinetic biases. Our results verify theoretical predictions and evidence that the isotopic disequilibrium commonly observed in speleothems and scleractinian coral skeletons is inherited from the dissolved inorganic carbon pool of their parent solutions. Further, we show that dual clumped isotope thermometry can achieve reliable palaeotemperature reconstructions, devoid of kinetic bias. Analysis of a belemnite rostrum implies that it precipitated near isotopic equilibrium and confirms the warmer-than-present temperatures during the Early Cretaceous at southern high latitudes.
We study the beam-energy and system-size dependence of \phi meson production (using the hadronic decay mode \phi -- K+K-) by comparing the new results from Cu+Cu collisions and previously reported Au+Au collisions at \sqrt{s_NN} = 62.4 and 200 GeV measured in the STAR experiment at RHIC. Data presented are from mid-rapidity (|y|<0.5) for 0.4 < pT < 5 GeV/c. At a given beam energy, the transverse momentum distributions for \phi mesons are observed to be similar in yield and shape for Cu+Cu and Au+Au colliding systems with similar average numbers of participating nucleons. The \phi meson yields in nucleus-nucleus collisions, normalised by the average number of participating nucleons, are found to be enhanced relative to those from p+p collisions with a different trend compared to strange baryons. The enhancement for \phi mesons is observed to be higher at \sqrt{s_NN} = 200 GeV compared to 62.4 GeV. These observations for the produced \phi(s\bar{s}) mesons clearly suggest that, at these collision energies, the source of enhancement of strange hadrons is related to the formation of a dense partonic medium in high energy nucleus-nucleus collisions and cannot be alone due to canonical suppression of their production in smaller systems.
We report measurements of the longitudinal double-spin asymmetry, ALL, for inclusive jet and dijet production in polarized proton-proton collisions at midrapidity and center-of-mass energy s√ = 510 GeV, using the high luminosity data sample collected by the STAR experiment in 2013. These measurements complement and improve the precision of previous STAR measurements at the same center-of-mass energy that probe the polarized gluon distribution function at partonic momentum fraction 0.015 ≲x≲ 0.25. The dijet asymmetries are separated into four jet-pair topologies, which provide further constraints on the x dependence of the polarized gluon distribution function. These measurements are in agreement with previous STAR measurements and with predictions from current next-to-leading order global analyses. They provide more precise data at low dijet invariant mass that will better constraint the shape of the polarized gluon distribution function of the proton.
Einleitung : Eine sinnvolle Einbindung von Pflegefachpersonen mit Hochschulabschluss in die Versorgungsabläufe wird international häufig mit besseren Behandlungsergebnissen bei den Patient*innen assoziiert. In Deutschland fehlt es derzeit noch an verlässlichen Zahlen über Absolvent*innen und deren Aufgabenfeldern. Ziel dieser Erhebung war daher, durch Wiederholung einer früheren Erhebung erneut den Anteil von Pflegefachpersonen mit Bachelor- oder Masterabschlüssen in der direkten Patient*innenversorgung zu ermitteln.
Methode: In einer Querschnittserhebung wurden die Pflegedirektor*innen der Universitätskliniken und Medizinischen Hochschulen (UK) Deutschlands mittels einer standardisierten Befragung nach der Anzahl der Pflegefachpersonen mit Hochschulabschlüssen (Bachelor, Master und Doktor) gefragt. Weitere Fragen betrafen deren Aufgabengebiete und Integrationsmaßnahmen. Die Daten wurden mittels deskriptiver Statistik ausgewertet.
Ergebnisse: Insgesamt konnten n = 29 gültige Fragebögen aus 35 UK in die Analyse eingeschlossen werden, daraus ergibt sich eine Rücklaufquote von 82,85%. Für insgesamt 18 UK konnte eine Steigerung der hochschulisch qualifizierten Pflegefachpersonen um n = 786, von 2015 (n = 593) auf 2018 (n = 1379) erreicht werden. Der Anteil an Pflegefachpersonen mit Hochschulabschluss in den teilnehmenden UK liegt bei 3,16% (SD = 1,66; Min - Max = 1,09 - 6,69; Q1 - Q3 = 1,49 - 4,04; 95% KI = 2,30 – 3,95). In der direkten Versorgung beträgt der Anteil 2,11% (SD = 1,40; Min – Max = 0,47 - 5,42; Q1 – Q3 = 0,87 – 3,16; 95% KI 1,36 - 2,76). Die Aufgabenschwerpunkte liegen im Bereich der Regelversorgung und Patient*innenedukation (Bachelorabsolvent*innen), der evidenzbasierten Pflegepraxisentwicklung (Masterabsolvent*innen) und Forschung (promovierte Absolvent*innen).
Diskussion: Im Vergleich zu 2015 ist der Anteil hochschulisch qualifizierter Pflegefachpersonen zwar angestiegen, doch er liegt immer noch auf einem sehr niedrigen Niveau. Die Hochschulabsolvent*innen nehmen versorgungs- und entwicklungsrelevante Aufgaben wahr, doch besteht hinsichtlich ihrer Aufgabengebiete Bedarf an kompetenzorientierter Differenzierung.
Transverse spin transfer to Λ and ¯Λ hyperons in polarized proton-proton collisions at √𝑠=200 GeV
(2018)
The transverse spin transfer from polarized protons to Λ and Λ¯ hyperons is expected to provide sensitivity to the transversity distribution of the nucleon and to the transversely polarized fragmentation functions. We report the first measurement of the transverse spin transfer to Λ and Λ¯ along the polarization direction of the fragmenting quark, DTT, in transversely polarized proton-proton collisions at s√=200GeV with the STAR detector at RHIC. The data correspond to an integrated luminosity of 18pb−1 and cover the pseudorapidity range |η|<1.2 and transverse momenta pT up to 8GeV/c. The dependence on pT and η are presented. The DTT results are found to be comparable with a model prediction, and are also consistent with zero within uncertainties.
We present the first inclusive measurements of the invariant and SoftDrop jet mass in proton-proton collisions at s√=200 GeV at STAR. The measurements are fully corrected for detector effects, and reported differentially in both the jet transverse momentum and jet radius parameter. We compare the measurements to established leading-order Monte Carlo event generators and find that STAR-tuned PYTHIA-6 reproduces the data, while LHC tunes of PYTHIA-8 and HERWIG-7 do not agree with the data, providing further constraints on parameter tuning. Finally, we observe that SoftDrop grooming, for which the contribution of wide-angle non-perturbative radiation is suppressed, shifts the jet mass distributions into closer agreement with the partonic jet mass as determined by both PYTHIA-8 and a next-to-leading-logarithmic accuracy perturbative QCD calculation. These measurements complement recent LHC measurements in a different kinematic region, as well as establish a baseline for future jet mass measurements in heavy-ion collisions at RHIC.
Aim
How species respond to climate change is influenced by their sensitivity to climatic conditions (i.e. their climatic niche) and aspects of their adaptive capacity (e.g. their dispersal ability and ecological niche). To date, it is largely unknown whether and how species’ sensitivity to climate change and their adaptive capacity covary. However, understanding this relationship is important to predict the potential consequences of a changing climate for species assemblages. Here, we test how species’ sensitivity to climate change and trait-based measures of their ecological adaptive capacity (i) vary along a broad elevational gradient and (ii) covary across a large number of bird species.
Location
A Neotropical elevational gradient (300–3600 m.a.s.l.) in the Manú Biosphere Reserve, south-east Peru.
Methods
We focus on 215 frugivorous bird species along a Neotropical elevational gradient. We approximate species’ sensitivity to climate change by their climatic niche breadth, based on species occurrences across South America and bioclimatic variables. In addition, we use a trait-based approach to estimate the dispersal ability of species (approximated by their wing pointedness), their dietary niche breadth (approximated by bill width) and their habitat niche breadth (the number of used habitat classes).
Results
We found that (i) species’ climatic niche breadth increased with elevation, while their trait-based dispersal ability and dietary niche breadth decreased with elevation, and (ii) sensitivity to climate change and trait-based adaptive capacity were not related across species.
Main conclusions
These results suggest different mechanisms of how species in lowland and highland assemblages might respond to climate change. The independent variation of species’ sensitivity to climate change and their trait-based adaptive capacity suggests that accounting for both dimensions will improve assessments of species’ susceptibility to climate change and potential impacts of climate change on diverse species assemblages.
Glecaprevir/pibrentasvir, a pangenotypic, direct-acting antiviral combination approved for chronic hepatitis C virus treatment, has limited real-world evidence supporting 8-week therapy in compensated cirrhosis. We investigated effectiveness and safety of 187 hepatitis C virus-infected, treatment-naïve, patients with compensated cirrhosis receiving 8-week glecaprevir/pibrentasvir therapy in the German Hepatitis C-Registry between 2 August 2017 and 1 January 2020. Sustained virologic response was 98.4% (127/129) in the per-protocol analysis (excluding patients lost to follow-up or who discontinued treatment due to compliance) and was 85.8% (127/148) in patients with data available in an intention-to-treat analysis. Nineteen patients were lost to follow-up; nine genotype 3 patients, nine nongenotype 3 patients and one mixed genotype patient. One patient relapsed, and one died, unrelated to treatment. Adverse events (>5%) were fatigue and headache. Two serious adverse events occurred; no adverse events resulted in drug discontinuation. An 8-week glecaprevir/pibrentasvir therapy was effective and well-tolerated in this real-world analysis.
A linearly polarized photon can be quantized from the Lorentz-boosted electromagnetic field of a nucleus traveling at ultrarelativistic speed. When two relativistic heavy nuclei pass one another at a distance of a few nuclear radii, the photon from one nucleus may interact through a virtual quark-antiquark pair with gluons from the other nucleus, forming a short-lived vector meson (e.g., ρ0). In this experiment, the polarization was used in diffractive photoproduction to observe a unique spin interference pattern in the angular distribution of ρ0 → π+π− decays. The observed interference is a result of an overlap of two wave functions at a distance an order of magnitude larger than the ρ0 travel distance within its lifetime. The strong-interaction nuclear radii were extracted from these diffractive interactions and found to be 6.53 ± 0.06 fm (197Au) and 7.29 ± 0.08 fm (238U), larger than the nuclear charge radii. The observable is demonstrated to be sensitive to the nuclear geometry and quantum interference of nonidentical particles. Polarized photon-gluon fusion reveals quantum wave interference of non-identical particles and shape of high-energy nuclei.
Measurements of mass and Λ binding energy of 4ΛH and 4ΛHe in Au+Au collisions at sNN−−−√=3 GeV are presented, with an aim to address the charge symmetry breaking (CSB) problem in hypernuclei systems with atomic number A = 4. The Λ binding energies are measured to be 2.22±0.06(stat.)±0.14(syst.) MeV and 2.38±0.13(stat.)±0.12(syst.) MeV for 4ΛH and 4ΛHe, respectively. The measured Λ binding-energy difference is 0.16±0.14(stat.)±0.10(syst.) MeV for ground states. Combined with the γ-ray transition energies, the binding-energy difference for excited states is −0.16±0.14(stat.)±0.10(syst.) MeV, which is negative and comparable to the value of the ground states within uncertainties. These new measurements on the Λ binding-energy difference in A = 4 hypernuclei systems are consistent with the theoretical calculations that result in ΔB4Λ(1+exc)≈−ΔB4Λ(0+g.s.)<0 and present a new method for the study of CSB effect using relativistic heavy-ion collisions.
Exploration of macrofungi in the Jammu and Kashmir regions, India, led to the discovery of two novel species, described herein as Lactarius indohirtipes sp. nov. and L. sharmai sp. nov. This paper presents detailed morphological descriptions and illustrations, as well as a phylogenetic analysis based on nrITS sequences. A comparative analysis with related species is also included.
Particulate matter (PM) largely consists of secondary organic aerosol (SOA) that is formed via oxidation of biogenic and anthropogenic volatile organic compounds (VOCs). Unambiguous identification of SOA molecules and their assignment to their precursor vapors is a challenge that has so far only succeeded for a few SOA marker compounds, which are now well characterized and (partly) available as authentic standards. In this work, we resolve the complex composition of SOA by a top-down approach based on a newly created aerosolomics database, which is fed by non-target analysis results of filter samples from oxidation flow reactor experiments. We investigated the oxidation products from the five biogenic VOCs α-pinene, β-pinene, limonene, 3-carene, and trans-caryophyllene and from the four anthropogenic VOCs toluene, o-xylene, 1,2,4-trimethylbenzene, and naphthalene. Using ultra-high performance liquid chromatography coupled to a high-resolution (Orbitrap) mass spectrometer, we determine the molecular formula of 596 chromatographically separated compounds based on exact mass and isotopic pattern. We utilize retention time and fragmentation mass spectra as a basis for unambiguous attribution of the oxidation products to their parent VOCs. Based on the molecular-resolved application of the database, we are able to assign roughly half of the total signal of oxygenated hydrocarbons in ambient suburban PM2.5 to one of the nine studied VOCs. The application of the database enabled us to interpret the appearance of diurnal compound clusters that are formed by different oxidation processes. Furthermore, the application of a hierarchical cluster analysis (HCA) on the same set of filter samples enabled us to identify compound clusters that depend on sulfur dioxide mixing ratio and temperature. This study demonstrates how aerosolomics tools (database and HCA) applied on PM filter samples can improve our understanding of SOA sources, their formation pathways, and temperature-driven partitioning of SOA compounds.