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New particle formation in the upper free troposphere is a major global source of cloud condensation nuclei (CCN)1,2,3,4. However, the precursor vapours that drive the process are not well understood. With experiments performed under upper tropospheric conditions in the CERN CLOUD chamber, we show that nitric acid, sulfuric acid and ammonia form particles synergistically, at rates that are orders of magnitude faster than those from any two of the three components. The importance of this mechanism depends on the availability of ammonia, which was previously thought to be efficiently scavenged by cloud droplets during convection. However, surprisingly high concentrations of ammonia and ammonium nitrate have recently been observed in the upper troposphere over the Asian monsoon region5,6. Once particles have formed, co-condensation of ammonia and abundant nitric acid alone is sufficient to drive rapid growth to CCN sizes with only trace sulfate. Moreover, our measurements show that these CCN are also highly efficient ice nucleating particles—comparable to desert dust. Our model simulations confirm that ammonia is efficiently convected aloft during the Asian monsoon, driving rapid, multi-acid HNO3–H2SO4–NH3 nucleation in the upper troposphere and producing ice nucleating particles that spread across the mid-latitude Northern Hemisphere.
During the last decades mammalian intracranial structures like the ethmoidal region have rarely been a focus of morphological studies, as they required invasive techniques. Contrary, the ontogeny of the fetal nasal capsule could easily be investigated based on histological material. Since the early 21st century modern imaging techniques like high-resolution computed tomography (μCT) reveal non-destructive insights into the mammalian skull. Furthermore, visualization software enables the virtual reconstruction of the tissues and additionally their morphometric analyses. However, the use of morphometric approaches on the nasal cavity is still scarce. Moreover, the turbinal skeleton is generally regarded as a unit, or the rostral respiratory part is compared to the caudal olfactory part; but the distinct olfactory turbinals have been considered only in a few studies.
The present study focuses on the highly diverse facial shape of the dog (Canis lupus familiaris) that evolved during domestication. Due to human-controlled breeding and care the natural selective pressure in prehistoric dogs has been replaced continually by artificial selection. As a consequence, harmful mutations on gene loci which e.g., control facial length growth got fixed within an extremely short time. According to veterinarian studies the turbinals of short snouted breeds continue their growth after the elongation of the facial bones has stopped prematurely. However, such investigations are based on low-resolution CT or MRT data and the morphological descriptions are vague. Referring to the elongation of the face in dolichocephalic breeds no former study has dealt with the detailed morphology of their turbinal skeleton so far.
The current study is based on comparative anatomical, morphometric, morphofunctional, and ontogenetic patterns of the dog’s turbinal skeleton. The 32 macerated skulls and four histological serial sections represent eleven breeds which cover different snout lengths (brachycephalic, mesaticephalic, dolichocephalic; according to two length indices), functional groups (scent hound, sighthound, companion/toy), and breeding histories (ancient pure-breeding associated with an unchanged appearance, modern time fashion breeding). The nasal cavity of the selected skulls was μCT-scanned and virtual 3D models of the turbinal skeleton were reconstructed. The breeds have been compared with each other in their number of olfactory turbinals, in the morphology of all turbinals and the lamina semicircularis as well as in their morphometrics and ontogeny. Based on morphological and ontogenetic patterns a new terminology of the interturbinals was established. The morphometric data covers the measurement of the relative turbinal surface area (IAT) and the calculation of the surface density (SDEN) and the turbinal complexity (TC). For the latter parameter a new morphometric approach was developed. For the ontogenetic comparison histological serial sections of perinatal dog stages have been consulted. As the dog’s ancestor macerated skulls of three adult Eurasian wolves (Canis lupus lupus) function for outgroup comparison and represent the grundplan with which the breeds are compared.
The results support former studies concerning a species-specific number of the fronto- and ethmoturbinals: in the Eurasian wolf and all postnatal dogs under study three ethmoturbinals and three frontoturbinals are observed. Additionally, two types of interturbinals are distinguished, namely four prominent interturbinals which are present in nearly all individuals and show a homologous pattern, and a variable number of additional interturbinals which differ in their shape among the dogs. Generally, longer snouted breeds have more additional interturbinals, so the total number of olfactory turbinals is increased to a maximum of 16 in the borzoi, whereas several short snouted breeds have only nine olfactory turbinals due to the loss of additional interturbinals and one prominent interturbinal. Regarding ontogeny the growth of the respiratory and the olfactory turbinals and the lamina semicircularis is highly associated with the growth of the facial bones after birth. As the viscerocranium of brachycephalic breeds is subjected to a postnatal growth inhibition the ethmoidal region stops growing prematurely, too. The turbinals of both functional parts develop less accessory lamellae that results in the reduction of the three morphometric parameters IAT, SDEN, and TC. The increase of all these three parameters with increasing snout length proves a correlation between both variables in the maxilloturbinal, all olfactory turbinals, and the lamina semicircularis in the dog. With the help of the perinatal dog stages plesiomorphic patterns which are present in all adult specimens (e.g., separation of ethmoturbinal I into two laminae, the presence of the uncinate process) were distinguished from less established morphological traits which get preferably reduced in association with brachycephaly (e.g., the anterior process of the posterior lamina of ethmoturbinal I, the caudal processes of frontoturbinal 1 and 2 within the frontal sinus due to the latter’s reduction). Obviously, the driving mechanism behind these and further variations are mutations on gene loci which control ontogenetic processes: the in other studies already described postnatal growth inhibition in the dermal bones of the midface of brachycephalic breeds seems to have a similar effect on the ethmoidal region. The results of the present study serve as basis for the evaluation how far the bony turbinals’ morphology, morphometrics, and ontogeny might be associated with physiological, genetic, neurological, and phylogenetic patterns. Additionally, the growth patterns of the hard tissues need to be compared to those of the soft tissues (i.e. the nasal epithelium).
Treatment‐related complications contribute substantially to morbidity and mortality in acute myeloid leukemia (AML) patients undergoing induction chemotherapy. Although AML patients are susceptible to fluid overload (FO) (e.g., in the context of chemotherapy protocols, during sepsis treatment or to prevent tumor lysis syndrome), little attention has been paid to its role in AML patients undergoing induction chemotherapy. AML patients receiving induction chemotherapy between 2014 and 2019 were included in this study. FO was defined as ≥5% weight gain on day 7 of induction chemotherapy compared to baseline weight determined on the day of admission. We found FO in 23 (12%) of 187 AML patients undergoing induction chemotherapy. Application of >100 ml crystalloid fluids/kg body weight until day 7 of induction chemotherapy was identified as an independent risk factor for FO. AML patients with FO suffered from a significantly increased 90-day mortality rate and FO was demonstrated as an independent risk factor for 90-day mortality. Our data suggests an individualized, weight-adjusted calculation of crystalloid fluids in order to prevent FO-related morbidity and mortality in AML patients during induction chemotherapy. Prospective trials are required to determine the adequate fluid management in this patient population.
Background: Rare diseases are, by definition, very serious and chronic diseases with a high negative impact on quality of life. Approximately 350 million people worldwide live with rare diseases. The resulting high disease burden triggers health information search, but helpful, high-quality, and up-to-date information is often hard to find. Therefore, the improvement of health information provision has been integrated in many national plans for rare diseases, discussing the telephone as one access option. In this context, this study examines the need for a telephone service offering information for people affected by rare diseases, their relatives, and physicians.
Methods: In total, 107 individuals participated in a qualitative interview study conducted in Germany. Sixty-eight individuals suffering from a rare disease or related to somebody with rare diseases and 39 health care professionals took part. Individual interviews were conducted using a standardized semi-structured questionnaire. Interviews were analysed using the qualitative content analysis, triangulating patients, relatives, and health care professionals. The fulfilment of qualitative data processing standards has been controlled for.
Results: Out of 68 patients and relatives and 39 physicians, 52 and 18, respectively, advocated for the establishment of a rare diseases telephone service. Interviewees expected a helpline to include expert staffing, personal contact, good availability, low technical barriers, medical and psychosocial topics of counselling, guidance in reducing information chaos, and referrals. Health care professionals highlighted the importance of medical topics of counselling—in particular, differential diagnostics—and referrals.
Conclusions: Therefore, the need for a national rare diseases helpline was confirmed in this study. Due to limited financial resources, existing offers should be adapted in a stepwise procedure in accordance with the identified attributes.
Background: Recently, public and political interest has focused on people living with rare diseases and their health concerns. Due to the large number of different types of rare diseases and the sizable number of patients, taking action to improve the life of those affected is gaining importance. In 2013, the federal government of Germany adopted a national action plan for rare diseases, including the call to establish a central information portal on rare diseases (Zentrales Informationsportal über seltene Erkrankungen, ZIPSE).
Objective: The objective of this study, therefore, was to conduct scientific research on how such a portal must be designed to meet the needs of patients, their families, and medical professionals, and to provide high-quality information for information seekers.
Methods: We chose a 3-step procedure to develop a needs-based prototype of a central information portal. In the first step, we determined the information needs of patients with rare diseases, their relatives, and health care professionals by means of qualitative interviews and their content-analytical evaluation. On the basis of this, we developed the basic structure of the portal. In the second step, we identified quality criteria for websites on rare diseases to ensure that the information linked with ZIPSE meets the quality demands. Therefore, we gathered existing criteria catalogs and discussed them in an expert workshop. In the third step, we implemented and tested the developed prototypical information portal.
Results: A portal page was configured and made accessible on the Web. The structure of ZIPSE was based on the findings from 108 qualitative interviews with patients, their relatives, and health care professionals, through which numerous information needs were identified. We placed particularly important areas of information, such as symptoms, therapy, research, and advisory services, on the start page. Moreover, we defined 13 quality criteria, referring to factors such as author information, creation date, and privacy, enabling links with high-quality information. Moreover, 19 users tested all the developed routines based on usability and comprehensibility. Subsequently, we improved the visual presentation of search results and other important search functions.
Conclusions: The implemented information portal, ZIPSE, provides high-quality information on rare diseases from a central point of access. By integrating the targeted groups as well as different experts on medical information during the construction, the website can assure an improved search for information for users. ZIPSE can also serve as a model for other Web-based information systems in the field of rare diseases.
Registered Report Identifier: RR1-10.2196/7425.
The consequences of the current COVID-19 pandemic for mental health remain unclear, especially regarding the effects on suicidal behaviors. To assess changes in the pattern of suicide attempt (SA) admissions and completed suicides (CS) in association with the COVID-19 pandemic. As part of a longitudinal study, SA admissions and CS are systematically documented and analyzed in all psychiatric hospitals in Frankfurt/Main (765.000 inhabitants). Number, sociodemographic factors, diagnoses and methods of SA and CS were compared between the periods of March–December 2019 and March–December 2020. The number of CS did not change, while the number of SA significantly decreased. Age, sex, occupational status, and psychiatric diagnoses did not change in SA, whereas the percentage of patients living alone while attempting suicide increased. The rate and number of intoxications as a SA method increased and more people attempted suicide in their own home, which was not observed in CS. Such a shift from public places to home is supported by the weekday of SA, as the rate of SA on weekends was significantly lower during the pandemic, likely because of lockdown measures. Only admissions to psychiatric hospitals were recorded, but not to other institutions. As it seems unlikely that the number of SA decreased while the number of CS remained unchanged, it is conceivable that the number of unreported SA cases increased during the pandemic. Our data suggest that a higher number of SA remained unnoticed during the pandemic because of their location and the use of methods associated with lower lethality.