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Derzeit breiten sich gebietsfremde Stechmücken (Diptera: Culicidae) aufgrund von Globalisierung und Klimawandel auf der ganzen Welt aus und bilden neue, stabile Populationen. Wegen ihrer hämatophagen Ernährungsweise sind sie Überträger von Pathogenen, die teilweise schwere bis tödliche Krankheiten beim Menschen, seinen Haustieren oder auch Wildtieren auslösen können. Mit den Stechmücken treten daher auch Infektionskrankheiten vermehrt in Gebieten auf, in denen sie vorher nicht vorkamen oder als bereits ausgerottet galten. Da die meisten im Menschen wirksamen Pathogene nicht durch Impfungen kontrolliert werden können, bleibt als eine der wenigen Möglichkeit der Krankheitsprävention die Dezimierung der Stechmückenpopulation. Daher sind Stechmücken momentan im Fokus von biologischer und epidemiologischer Forschung. Diese hat zum Ziel epidemische Krankheitsausbrüche vektorübertragener Krankheiten in der menschlichen Population zu verhindern. Eine Verringerung der lokalen Stechmückenpopulation bis hin zum Aussterben kann durch die Verwendung von Insektiziden, die Vernichtung von Bruthabitaten oder anderen Kontrollmaßnahmen erreicht werden. Jedoch sind diese Maßnahmen unterschiedlich effektiv, haben zum Teil unerwünsch-te ökologische und gesundheitsschädigende Folgen und sind unterschiedlich aufwendig und kostenintensiv in der Anwendung. Für die Entwicklung eines integrierten, effektiven, zielgerichteten und kostengünstigen Vektormanagements fehlen bislang jedoch die populationsbiologischen Grundlagen.
Ziel dieser Arbeit ist daher die Schaffung der Datengrundlage eines Integrierten Stechmückenmanagements für die Asiatische Buschmücke (Aedes japonicus japonicus THEOBALD 1901), die am weitesten verbreitete exotische Stechmücke in Deutschland. Schwerpunkte dafür wurden auf das zeitliche und räumliche Vorkommen, die Temperaturabhängigkeit des Lebenszyklus, sowie die Wirksamkeit von Kontrollmethoden gelegt.
Die Kenntnis der räumlichen Verbreitung und saisonalen Häufigkeit der Stechmücken ist notwendig, um befallene Standorte und Zeitpunkte des größten Populationszuwachses definieren zu können. Die Verbreitung und die Häufigkeit der endothermen Stechmücken sind stark von der Umgebungstemperatur abhängig, die beispielsweise deren Entwicklungsdauer und Sterblichkeit beeinflusst. Dabei entwickeln sich die verschiedenen Stadien (Ei, Larven, Puppe, Imago), die eine Stechmücke während ihres Lebens durchläuft, in Abhängigkeit von der Umgebungstemperatur unterschiedlich und haben jeweils andere Temperaturpräferenzen. Lebenszyklustabellen geben die Entwicklungsdauer und Mortalität pro Stadium in Abhängigkeit von der Temperatur an. Mit ihrer Hilfe können somit die räumlichen und zeitlichen Vorkommen und Häufigkeiten einer Stechmückenart berechnet werden. Dies ist insbesondere für Stechmücken in Gebieten mit jahreszeitlichen Temperaturveränderungen wichtig. Um Daten für eine solche Lebenszyklustabelle aufnehmen zu können, ist es notwendig Laborexperimente bei festgelegten Temperaturen durchzuführen. Die Voraussetzung dafür ist, dass die Stechmückenart im Labor optimale Bedingungen erhält, um ihren Lebenszyklus abschließen zu können. In dieser Arbeit wurde daher ein Laborprotokoll entwickelt, mithilfe dessen der Lebenszyklus der Asiatischen Buschmücke im Labor untersucht werden kann. Dazu wurden systematisch die Fütterung, die innerartliche Konkurrenz und das Wasservolumen des Brutge-fäßes für die aquatischen Stadien erprobt. Auf Basis dieses Protokolls wurden anschließend die Temperatureinflüsse auf die Entwicklung aller Stadien aufgenommen. Diese Daten dienten der Parametrisierung eines populationsdynamischen Modells. Dieses wurde verwendet, um Standorte mehrjähriger Populationen zu definieren, saisonale Häufigkeiten für Deutschland zu berechnen, durch Temperaturveränderungen hervorgerufene zukünftige Verbreitungsgebiete vorherzusagen, sowie Effekte von Kontrollmaßnahmen auf die Häufigkeit der Asiatischen Buschmücke zu modellieren.
Um eine dauerhafte Kontrolle der Stechmückenvektoren zu gewährleisten, ist weiterhin die permanente Neuentwicklung von wirksamen Kontrollmethoden notwendig. Dazu gehört die präventive Vermeidung von Bruthabitaten der aquatischen Stadien von Stechmücken. Die exotischen Stechmücken, die in Deutschland etabliert sind, gehören mehrheitlich der Gattung Aedes an und sind sogenannte Gefäßbrüter. Ihre bevorzugten Bruthabitate sind kleine Was-seransammlungen wie sie in Baumhöhlen, Gesteinsauswaschungen, Gießkannen, Regentonnen und Blumenuntersetzern vorkommen. In dieser Arbeit wurde untersucht, welche Farben und Volumina von Plastikbechern die Asiatische Buschmücke zur Eiablage bevorzugt, um präferierte Bruthabitate gezielt zu identifizieren und verringern zu können. Auch die Bereitstellung von Insektiziden wird durch in Stechmücken auftretende Insektizidresistenzen erschwert. Insektizide sollen dabei umweltfreundlich, spezifisch für den Zielorganismus und nicht gesundheitsschädlich für den Menschen sein. Weiterhin sind eine gute Anwendbarkeit, geringe Kosten und eine hohe Effizienz wünschenswert. Eine Quelle für potentielle Insektizide sind pflanzliche Stoffe, zum Beispiel ätherische Öle. Diese sind leicht erhältlich, natürlichen Ursprungs und wirksame Vergrämungsmittel gegen stechbereite Stechmückenweibchen. In dieser Arbeit wurde nach einer Literaturrecherche Nelkenöl ausgewählt und als Insektizid gegen Larven der Asiatischen Buschmücke getestet. Dafür wurden die akute toxische Wirkung von Nelkenöl bei drei Temperaturen untersucht und zusätzlich die Wirkung von Nelkenöl auf die Eiablage im Freiland. Nelkenöl zeigte dabei sowohl eine larvizide als auch eine eiablagehemmende Wirkung. Weiterhin wurde Kupfer in Form von kupferhaltigen Euromünzen als Larvizid untersucht. Kupfer ist ein wirksamer Stoff gegen die aquatischen Stadien von Stechmücken. Allerdings wurde der Stoff noch nicht in Form der einfach zu handhabenden, leicht erhältlichen Kupfermünzen getestet. Dazu wurden Vorexperimente durchgeführt, um herauszufinden, wieviel Kupferionen sich aus den Münzen lösen lassen. Anschließend wurde der akut toxische Effekt auf Larven der Asiatischen Buschmücke untersucht.
Ein Integriertes Stechmückenmanagement hat zum Ziel, die lokale Stechmückenpopulation zu kontrollieren, um so Stichen und daraus resultierender Krankheitsübertragung vorzubeugen. Dies erfolgt über die Aufklärung von Betroffenen, der Überwachung der Stechmückenpopulation, dem Testen auf Pathogenbefall und der direkten Kontrolle von Stechmücken. Diese Arbeit leistet einen Beitrag zu den Kenntnissen über die Laborhaltung einer exotischen Stechmückenart, zur Identifizierung von Bruthabitaten, zur zeitlichen und räumlichen Festlegung von Kontrollmaßnahmen und zur Anwendung von Larviziden und eines Vergrämungsmittels. Mit dieser Arbeit wurde die Grundlage eines faktenbasierten Integrativen Stechmückenmanagements für die Asiatische Buschmücke entwickelt, das eventuell auch auf weitere Aedes-Arten übertragbar ist, und als Handlungsempfehlung für politische Entscheidungstragende dienen kann.
The widely varying therapeutic response of patients with inflammatory bowel disease (IBD) continues to raise questions regarding the unclarified heterogeneity of pathological mechanisms promoting disease progression. While biomarkers for the differentiation of Crohn’s disease (CD) versus ulcerative colitis (UC) have been suggested, specific markers for a CD subclassification in ileal CD versus colonic CD are still rare. Since an altered signature of the tryptophan metabolism is associated with chronic inflammatory disease, we sought to characterize potential biomarkers by focusing on the downstream enzymes and metabolites of kynurenine metabolism. Using immunohistochemical stainings, we analyzed and compared the mucosal tryptophan immune metabolism in bioptic samples from patients with active inflammation due to UC or CD versus healthy controls. Localization-specific quantification of immune cell infiltration, tryptophan-metabolizing enzyme expression and mucosal tryptophan downstream metabolite levels was performed. We found generally increased immune cell infiltrates in the tissue of all patients with IBD. However, in patients with CD, significant differences were found between regulatory T cell and neutrophil granulocyte infiltration in the ileum compared with the colon. Furthermore, we observed decreased kynurenine levels as well as strong kynureninase (KYNU) expression specifically in patients with ileal CD. Correspondingly, significantly elevated levels of the kynurenine metabolite 3-hydroxyanthranilic acid were detected in the ileal CD samples. Highlighting the heterogeneity of the different phenotypes of CD, we identified KYNU as a potential mucosal biomarker allowing the localization-specific differentiation of ileal CD versus colonic CD.
Current evidence indicates that acute aerobic exercise might increase domain-specific cognitive performance. However, only a small number of studies deduced the impact on lower and higher cognitive functions systematically or analyzed dose–response relationships and the underlying mechanisms. This study aimed to expose the dose–response relationships by investigating the influence of exercise duration on subjective and objective arousal, cognitive attention and visual recognition memory tasks. Nineteen participants (eight female; 25.69 ± 3.11 years) were included in a randomized, three-armed intervention study in a cross-over design. The participants completed three different interventions consisting of either 15, 30 or 45 min of cycling at 60–70% VO2max. Arousal and cognitive measurements were taken before and immediately after (<2 min) exercise. All three interventions led to significant but comparable effects on self-perceived arousal, heart rate (HR) and rating of perceived exertion (RPE) (p < 0.05). Analysis of variance (ANOVA) indicated significant effects of exercise duration on visual recognition memory accuracy. Reaction times for higher and lower cognitive tasks did not change after exercise. Fifteen minutes of aerobic exercise was feasible to induce beneficial changes in self-perceived arousal. Processing speed of visual recognition memory and attention remained unaltered. Exercise exceeding fifteen minutes seemed to negatively impact visual recognition memory accuracy.
Macrophages facilitate essential homeostatic functions e.g., endocytosis, phagocytosis, and signaling during inflammation, and express a variety of scavenger receptors including CD163 and CD206, which are upregulated in response to inflammation. In healthy individuals, soluble forms of CD163 and CD206 are constitutively shed from macrophages, however, during inflammation pathogen- and damage-associated stimuli induce this shedding. Activation of resident liver macrophages viz. Kupffer cells is part of the inflammatory cascade occurring in acute and chronic liver diseases. We here review the existing literature on sCD163 and sCD206 function and shedding, and potential as biomarkers in acute and chronic liver diseases with a particular focus on Acute-on-Chronic Liver Failure (ACLF). In multiple studies sCD163 and sCD206 are elevated in relation to liver disease severity and established as reliable predictors of morbidity and mortality. However, differences in expression- and shedding-stimuli for CD163 and CD206 may explain dissimilarities in prognostic utility in patients with acute decompensation of cirrhosis and ACLF.
Background and purpose: The aim of the study was to determine the effects of post-traumatically released High Mobility Group Box-1 protein (HMGB1) and extracellular histones on cardiomyocytes (CM). We also evaluated a therapeutic option to capture circulating histones after trauma, using a hemadsorption filter to treat CM dysfunction. Experimental Approach: We evaluated cell viability, calcium handling and mitochondrial respiration of human cardiomyocytes in the presence of HMGB-1 and extracellular histones. In a translational approach, a hemadsorption filter was applied to either directly eliminate extracellular histones or to remove them from blood samples obtained from multiple injured patients. Key results: Incubation of human CM with HMGB-1 or histones is associated with changes in calcium handling, a reduction of cell viability and a substantial reduction of the mitochondrial respiratory capacity. Filtrating plasma from injured patients with a hemadsorption filter reduces histone concentration ex vivo and in vitro, depending on dosage. Conclusion and implications: Danger associated molecular patterns such as HMGB-1 and extracellular histones impair human CM in vitro. A hemadsorption filter could be a therapeutic option to reduce high concentrations of histones.
The UN's sustainable development goals (SDGs), which aim to solve important economic, social, and environmental problems of humanity, are to be supported by education for sustainable development (ESD). Empirical studies on the success of the implementation of the SDGs in the field of education are still pending. For this reason, using the loss of global biodiversity as an example, this study examined the extent to which high school students, teacher trainees in biology, and biology bachelor students can identify the causes of the global biodiversity loss. A new questioning tool was developed and tested on 889 participants. In addition, the relationship between connection to nature and the personal assessment about biodiversity threats was examined. The factor analysis of the scale used showed that 11 out of 16 items were assigned to the intended factor. The comparison between high school students, teacher trainees in biology, and biology bachelor students showed no significant difference in overall assessment of the reasons for global biodiversity loss. When comparing the three risk levels in which the risk factors for biodiversity could be divided, across the three student groups, only minor differences were found. Therefore, a specific education of prospective teachers is necessary, as they have to pass on the competence as multipliers to their students. No significant difference could be found when examining the relationship between connection to nature and the overall scores of the assessment scale for the reasons of biodiversity loss. However, it was found that people who felt more connected to nature were more capable of assessing the main causes of risk for global biodiversity, while people who felt less connected to nature achieved better scores for the medium factors
The occupation of dental assistants (DAs) involves many health risks of the musculoskeletal system due to static and prolonged work, which can lead to musculoskeletal disorders (MSDs). The aim of the study was to investigate the prevalence of MSDs in DAs in Germany. Methods: For this purpose, an online questionnaire analyzed 406 (401 female participants and 5 male participants, 401w/5m) DAs. It was based on the Nordic Questionnaire (lifetime, 12-month, and seven-day MSDs’ prevalence separated into neck, shoulder, elbow, wrist, upper back, lower back, hip, knee, and ankle), and occupational and sociodemographic questions as well as questions about specific medical conditions. Results: 98.5% of the participants reported complaints of at least one body region in their lives, 97.5% reported at least one complaint in the last 12 months and 86.9% affirmed at least one complaint in the last seven days. For lifetime, 12-month and seven-day prevalence, the neck was the region that was most affected followed by the shoulder, the upper back and the lower back. Conclusion: The prevalence of MSDs among German (female) DAs was very high. The most affected area is the neck, followed by the shoulder, the lower back, and the upper back. It, therefore, seems necessary to devote more attention to ergonomics at the working practice of DAs as well in education and in dental work.
This study proposes a novel multi-network architecture consisting of a multi-scale convolution neural network (MSCNN) with fully connected graph convolution network (GCN), named MSCNN-GCN, for the detection of musculoskeletal abnormalities via musculoskeletal radiographs. To obtain both detailed and contextual information for a better description of the characteristics of the radiographs, the designed MSCNN contains three subnetwork sequences (three different scales). It maintains high resolution in each sub-network, while fusing features with different resolutions. A GCN structure was employed to demonstrate global structure information of the images. Furthermore, both the outputs of MSCNN and GCN were fused through the concat of the two feature vectors from them, thus making the novel framework more discriminative. The effectiveness of this model was verified by comparing the performance of radiologists and three popular CNN models (DenseNet169, CapsNet, and MSCNN) with three evaluation metrics (Accuracy, F1 score, and Kappa score) using the MURA dataset (a large dataset of bone X-rays). Experimental results showed that the proposed framework not only reached the highest accuracy, but also demonstrated top scores on both F1 metric and kappa metric. This indicates that the proposed model achieves high accuracy and strong robustness in musculoskeletal radiographs, which presents strong potential for a feasible scheme with intelligent medical cases.
Long non-coding RNAs (lncRNAs) contribute to cardiac (patho)physiology. Aging is the major risk factor for cardiovascular disease with cardiomyocyte apoptosis as one underlying cause. Here, we report the identification of the aging-regulated lncRNA Sarrah (ENSMUST00000140003) that is anti-apoptotic in cardiomyocytes. Importantly, loss of SARRAH (OXCT1-AS1) in human engineered heart tissue results in impaired contractile force development. SARRAH directly binds to the promoters of genes downregulated after SARRAH silencing via RNA-DNA triple helix formation and cardiomyocytes lacking the triple helix forming domain of Sarrah show an increase in apoptosis. One of the direct SARRAH targets is NRF2, and restoration of NRF2 levels after SARRAH silencing partially rescues the reduction in cell viability. Overexpression of Sarrah in mice shows better recovery of cardiac contractile function after AMI compared to control mice. In summary, we identified the anti-apoptotic evolutionary conserved lncRNA Sarrah, which is downregulated by aging, as a regulator of cardiomyocyte survival.
Proper speech production requires auditory speech feedback control. Models of speech production associate this function with the right cerebral hemisphere while the left hemisphere is proposed to host speech motor programs. However, previous studies have investigated only spectral perturbations of the auditory speech feedback. Since auditory perception is known to be lateralized, with right-lateralized analysis of spectral features and left-lateralized processing of temporal features, it is unclear whether the observed right-lateralization of auditory speech feedback processing reflects a preference for speech feedback control or for spectral processing in general. Here we use a behavioral speech adaptation experiment with dichotically presented altered auditory feedback and an analogous fMRI experiment with binaurally presented altered feedback to confirm a right hemisphere preference for spectral feedback control and to reveal a left hemisphere preference for temporal feedback control during speaking. These results indicate that auditory feedback control involves both hemispheres with differential contributions along the spectro-temporal axis.
Let me start with a reminiscence: a few weeks ago, I was sitting in one of my preferred cafés in Paris, le Café Odéon- Théâtre de l’Europe, a vivid place near the Jardin de Luxembourg in the heart of the university quarter. I realised that the waiter was wearing a shirt with the letters "Defend Paris", which he explained to be a statement against the forces that make Paris an uneasy place to live, a defiance against the powerful and social injustice. With a mixture of rebellion and idealism, he added that he understands himself as part of a "Reclaim Your City" Movement, thus representing what is central for urban citizenship today: a republican defence against forces that make a metropolitan city a trademark to be sold to people who can afford it, but increasingly less a home for ordinary people who want to live in the city. Walking through the streets, passing a small jewelry shop, a place of distinguished understatement showing a picture of Meghan Markle wearing "rose"-earrings displayed in the window, the term "zombie urbanism" came to my mind – a term used by Jonny Aspen, professor at the Institute of Urbanism and Landscape in Oslo (See Bjerkeset and Aspen (forthcoming 2020) and here), to describe a cliché-like way of dealing with urban environment by developers and designers – a "staged urbanism", in which urban features are used as a means for selling, marketing and branding. This kind of city-marketing can prove quite successful: whereas the burning of Notre Dame mobilised hundreds of millions of donations within a short period of time, the burning of the National Museum in Rio de Janeiro soon after, extinguishing 200 years of documentation of cultural memory, mobilised only 225.000 Euros (state 1.4.2019). ...
Mit einem um die Behandlungskapazität des Gesundheitssystems erweiterten epidemiologischen SIRD-Modell werden Mechanismen und Dynamik einer Virusepidemie wie Corona anhand von stilisierten politischen Reaktionsmustern (Ignore, Shutdown, Ignore-Shutdown-Relax) simuliert. Ferner werden aus dem Modell Lehren für die statistische Analyse von Corona gezogen, wie die Aussagekraft publizierter Verdopplungszeiten und Reproduktionszahlen. Die Dunkelziffer unbestätigter Fälle und die im Epidemieverlauf variable Genauigkeit von medizinischen Infektionstests werden diskutiert. Zur Messung der medizinischen Kosten von Corona sowie für regionale und internationale Vergleiche wird ein Schadensindex der verlorenen Lebenszeit vorgeschlagen. Zuletzt geht die Arbeit kurz auf die ökonomischen Kosten von Corona in Deutschland ein.
We are students, scholars, and academics at European universities who unequivocally condemn the violent attacks on student and faculty members of Jawaharlal Nehru University (JNU), New Delhi that took place on 5th January 2020. We see the attacks as part of the larger pattern of systematic violence that is being consistently inflicted on students across Indian universities for the past month by the Indian police in collusion with far-right organisations. We are shocked by the proclivity of the Indian State to turn upon its own students, and by the failure of universities and other academic institutions to protect their members; the cases are too many to be all listed here, but along with JNU, this inhumane orchestration of violence has extended to Aligarh Muslim University, Banaras Hindu University in Uttar Pradesh, and Jamia Millia Islamia in New Delhi. ...
Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.
The teaching of professional roles in medical education is an interdisciplinary concern. However, surgeons require specific standards of professionalism for certain context-based situations. In addition to communication, studies require collaboration, leadership, error-/conflict-management, patient-safety and decision-making as essential competencies for surgeons. Standards for corresponding competencies are defined in special chapters of the German National Competency-based Learning Objectives for Undergraduate Medical Education (NKLM; chapter 8, 10). The current study asks whether these chapters are adequately taught in surgical curricula. Eight German faculties contributed to analysing mapping data considering surgical courses of undergraduate programs. All faculties used the MERlin mapping platform and agreed on procedures for data collection and processing. Sub-competency and objective coverage, as well as the achievement of the competency level were mapped. Overall counts of explicit citations were used for analysis. Collaboration within the medical team is a strongly represented topic. In contrast, interprofessional cooperation, particularly in healthcare sector issues is less represented. Patient safety and dealing with errors and complications is most emphasized for the Manager/Leader, while time management, career planning and leadership are not addressed. Overall, the involvement of surgery in teaching the competencies of the Collaborator and Manager/Leader is currently low. However, there are indications of a curricular development towards explicit teaching of these roles in surgery. Moreover, implicitly taught roles are numerous, which indicates a beginning awareness of professional roles.
Introduction: Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) occurs approximately 1 in 3.500 live births representing the most common malformation of the upper digestive tract. Only half a century ago, EA/TEF was fatal among affected newborns suggesting that the steady birth prevalence might in parts be due to mutational de novo events in genes involved in foregut development.
Methods: To identify mutational de novo events in EA/TEF patients, we surveyed the exome of 30 case-parent trios. Identified and confirmed de novo variants were prioritized using in silico prediction tools. To investigate the embryonic role of genes harboring prioritized de novo variants we performed targeted analysis of mouse transcriptome data of esophageal tissue obtained at the embryonic day (E) E8.5, E12.5, and postnatal.
Results: In total we prioritized 14 novel de novo variants in 14 different genes (APOL2, EEF1D, CHD7, FANCB, GGT6, KIAA0556, NFX1, NPR2, PIGC, SLC5A2, TANC2, TRPS1, UBA3, and ZFHX3) and eight rare de novo variants in eight additional genes (CELSR1, CLP1, GPR133, HPS3, MTA3, PLEC, STAB1, and PPIP5K2). Through personal communication during the project, we identified an additional EA/TEF case-parent trio with a rare de novo variant in ZFHX3. In silico prediction analysis of the identified variants and comparative analysis of mouse transcriptome data of esophageal tissue obtained at E8.5, E12.5, and postnatal prioritized CHD7, TRPS1, and ZFHX3 as EA/TEF candidate genes. Re-sequencing of ZFHX3 in additional 192 EA/TEF patients did not identify further putative EA/TEF-associated variants.
Conclusion: Our study suggests that rare mutational de novo events in genes involved in foregut development contribute to the development of EA/TEF.
Background: A web-based malaria reporting information system (MRIS) has the potential to improve malaria reporting and management. The aim of this study was to evaluate the existing manual paper-based MRIS and to provide a way to overcome the obstacles by developing a web-based MRIS in Indonesia.
Methods: An exploratory study was conducted in 2012 in Lahat District, South Sumatra Province of Indonesia. We evaluated the current reporting system and identified the potential benefits of using a web-based MRIS by in-depth interviews on selected key informants. Feasibility study was then conducted to develop a prototype system. A web-based MRIS was developed, integrated and synchronized, with suitability ranging from Primary Healthcare Centres (PHCs) to the Lahat District Health Office.
Results: The paper-based reporting system was sub-optimal due to a lack of transportation, communication, and human capacity. We developed a web-based MRIS to replace the current one. Although the web-based system has the potential to improve the malaria reporting information system, there were some barriers to its implementation, including lack of skilled operators, computer availability and lack of internet access. Recommended ways to overcome the obstacles are by training operators, making the application in an offline mode and able to be operated by mobile phone text messaging for malaria reporting.
Conclusion: The web-based MRIS has the potential to be implemented as an enhanced malaria reporting information system and investment in the system to support timely management responses is essential for malaria elimination. The developed application can be cloned to other areas that have similar characteristics and MRIS with a built-in web base to aid its application in the 5G future.
This Policy White Paper assesses several main elements of ECB’s upcoming review of its monetary policy strategy, announced in January 2020. Four aspects of the review are discussed in detail: i) ECB’s definition of price stability and the arguments for and against inflation targeting; ii) the scope of ECB’s objectives, considering financial stability, employment and the sustainability of the environment; iii) an update of ECB’s economic and monetary analyses to assess the risks to price stability; iv) the ECB’s communication practice. Furthermore, an overview of the ECB’s monetary policy strategy and its last evaluation in 2003 is given.