[Sport climbing, bouldering and associated injuries in childhood and adolescence]. / Sportklettern, Bouldern und assoziierte Verletzungen im Kindes- und Jugendalter.

BACKGROUND: Sport climbing and bouldering has developed from a rarely performed to a very popular sport in the last 30 years. Sport physicians are increasingly faced with its specific and otherwise uncommon injury pattern. Overall, the sport is relatively safe, particularly if performed in indoor facilities. INJURIES: The injuries frequently occur on the upper extremity, with the fingers being the most affected. Acute traumatic lesions such as sprains, fractures or ligament lesions are much rarer than overload and overuse caused by repetitive and highly stressing climbing movements. The most common injury is not the pulley rupture, as in adults, but the epiphyseal stress fracture of the base of the middle phalanx, which occurs practically only in climbing sport. The injury is treated conservatively, has a long recovery time of about 8 months and may lead to joint destruction and arthrosis if missed.

Variations of sex development: The first German interdisciplinary consensus paper.

INTRODUCTION: The term variations of sex development subsumes a large number of congenital conditions including chromosomal mosaics and variations of chromosomal, gonadal, and phenotypic sex. A situation of this nature may cause severe distress to both, parents and affected persons. One of the reasons for this is the binary form of gender classification in the society. In the past, because of a fear of possible stigmatization and an inability to cope with complex situations, it has been medical policy and practice for newborns to undergo early, mostly 'feminizing' elective surgery with the aim of achieving an outer genital appearance that is unambiguously male or female. Protests by advocacy groups for the most part as well as the results of outcome studies have shown that the development of affected persons may be very different to what has been expected and often does not result in the intended clear female or male gender identity as had been intended. It, therefore, seemed a matter of urgency to implement this new awareness as well as the ethical and personal human rights perspectives in the recommendations for the medical and psychosocial management of diverse sex development (DSD) in the future. STUDY DESIGN: In 2012, an interdisciplinary group of German academics engaged in the field of DSD decided to work on a consensus paper for this topic. It involved the participation of all faculties and non-scientific groups dealing with DSD, in particular advocacy and service-user groups. In a structured consensus, process recommendations were developed based on scientific literature as well as personal experiences of clinicians and affected individuals. RESULTS: Finally, 37 recommendations were agreed on. The strength of consensus is reflected in the degree of agreement as expressed in percentages. CONCLUSION: The introduction of the consensus paper reflects on the emerging paradigm shift and the necessity for a more open view of gender within society. The paper is intended to aid the performance of appropriate diagnostics in DSD-affected newborns and especially to help parents and affected persons cope with the biological and social consequences of DSD. With regard to medical or surgical therapy, it gives information about the most recent treatment trends.

["Jump in at the deep end" : simulator-based learning in acute care]. / "Sprung ins kalte Wasser" : Simulatorbasiertes Lernen in akutmedizinischen Bereichen.

BACKGROUND: With high-fidelity simulators in a modern blended learning setting, students are able to acquire knowledge and practical skills in acute medicine in realistic scenarios. However, it has not yet been clarified if the sequence of linking between knowledge and simulator-based training of practical skills plays an important role for increasing knowledge, for the self-concept and learning emotions of trainees. AIM: In a pilot study the influence of the type of knowledge acquisition under two independent conditions was investigated in which the order of presenting the learning material (firstly theory and then simulation vs. simulation elements before the theory) was reversed. In addition the influence of individual attributes of personality on the construction of situated knowledge was correlated with these conditions in two groups. MATERIAL AND METHODS: To investigate the outcome of simulator-based learning 20 students were randomly allocated to one of the two conditions and undertook two scenarios (anaphylactic shock and myocardial infarction), whereby the theoretical lessons were given either before or after the scenarios. Using standardized questionnaires and problem-centered semi-standardized interviews, the following variables of the participants were assessed: personality traits, current positive and negative feelings, professional self-concept, general self-efficacy and coping strategies for stress. Theoretical knowledge and practical skills were assessed using a knowledge test and standardized assessment questionnaires which also focused on performance and patient safety. RESULTS: All together the results showed a slight advantage for the condition of theory before simulation which was not determined by the acquisition of knowledge but by a better performance of trainees as assessed by the trainers. Regarding knowledge acquisition, no statistically significant differences could be shown. Significant differences (p < 0.05) were found for negative feelings (very intense negative emotional state) and for the professional self-concept (perception of own professional skills) in favor of the theory then simulation condition. More extrovert participants showed poorer results which could not be attributed to one of the conditions. However, the participants always assessed the allocated learning condition as the best premise for effective learning outcome. Reaction to stress has been described as "jumping in at the deep end" as well as the lasting effect on learning from errors. CONCLUSION: In the context of simulation-based teaching, the learning outcome not only depends on knowledge, practical skills and motivational variables but also on the presence of negative feelings, ability self-concepts and various personality traits. There was a trend which showed that simulation in the field of anesthesiology and emergency medicine should be set up with the theoretical basis first in order to avoid negative feelings.

Coherent neutron scattering and collective dynamics on mesoscale.

By combining, and modestly extending, a variety of theoretical concepts for the dynamics of liquids in the supercooled regime, we formulate a simple analytic model for the temperature and wavevector dependent collective density fluctuation relaxation time that is measurable using coherent dynamic neutron scattering. Comparison with experiments on the ionic glass-forming liquid Ca-K-NO3 in the lightly supercooled regime suggests the model captures the key physics in both the local cage and mesoscopic regimes, including the unusual wavevector dependence of the collective structural relaxation time. The model is consistent with the idea that the decoupling between diffusion and viscosity is reflected in a different temperature dependence of the collective relaxation time at intermediate wavevectors and near the main (cage) peak of the static structure factor. More generally, our analysis provides support for the ideas that decoupling information and growing dynamic length scales can be at least qualitatively deduced by analyzing the collective relaxation time as a function of temperature and wavevector, and that there is a strong link between dynamic heterogeneity phenomena at the single and many particle level. Though very simple, the model can be applied to other systems, such as molecular liquids.

[Sexual orientations]. / Sexuelle Orientierungen.

In this paper we study the concept of sexual orientation and its components by comparing the common orientations of hetero-, homo-, and bisexuality with alternative concepts suitable for describing persons with psychosexual and somatosexual divergencies (e.g., transgender or intersex developments). An assessment of these divergencies as well as their prevalence and societal influences are presented. Empirical findings on the relationship between sexual orientation and mental health are examined against the background of the sexual minority stress model, looking especially at the risks and the opportunities associated with belonging to a sexual minority. The paper also focuses on the normative power of a monosexual model. Finally, sexual orientation is conceptualized as an umbrella term encompassing both conscious and unconscious elements, including the aspects of sexual behavior, sexual identity, fantasies, and attraction.

Glass formation and shear elasticity in dense suspensions of repulsive anisotropic particles.

Kinetic vitrification, shear elasticity, and the approach to jamming are investigated for repulsive nonspherical colloids and contrasted with their spherical analog. Particle anisotropy dramatically increases the volume fraction for kinetic arrest. The shear modulus of all systems increases roughly exponentially with volume fraction, and a universal collapse is achieved based on either the dynamic crossover or random close packing volume fraction as the key nondimensionalizing quantity. Quantitative comparisons with recent microscopic theories are performed and good agreement demonstrated.

Collective diffusion in colloid-polymer suspensions: relative role of thermodynamics and hydrodynamics.

Theories such as the mode coupling theory (MCT) have seen recent success in predicting the kinetic arrest boundaries and resultant flow properties of colloidal suspensions. A key assumption of such theories is that interparticle forces and equilibrium structure control slow dynamics and gelation, not long-time many-body hydrodynamics. Here we report measurements of short-time collective diffusivities of colloid-polymer suspensions aimed at elucidating the relative contributions of hydrodynamics and thermodynamics as a phase transition or gelation boundary is approached. The experimental system is a hard sphere octadecyl silica suspension to which nonadsorbing polystyrene is added. Two different polymer molecular weights are chosen such that they give rise to a liquid-liquid or a gel transition as the colloid volume fraction or polymer concentration is increased. The short-time diffusivities are measured for each polymer molecular weight as a function of polymer concentration and colloid volume fraction. At a fixed polymer molecular weight and concentration, the colloid volume fraction is varied from dilute to concentrated and near the phase separation boundary. It is found for all measured colloid volume fractions that the diffusivities decrease linearly with increasing strength of the polymer-mediated depletion attraction at a fixed polymer molecular weight. Comparisons are made with theoretical predictions in the dilute limit. When the effects of thermodynamics are normalized out by multiplying the measured diffusivities with the suspension structure factor, it is found that the hydrodynamic effects are essentially those of hard spheres independent of the range and strength of depletion attraction.

Segmental dynamics in polymers: from cold melts to ageing and stressed glasses.

Recent progress in developing statistical mechanical theories of supercooled polymer melts and glasses is reviewed. The focus is on those approaches that are either explicitly formulated for polymers, or are applications of more generic theories to interpret polymeric phenomena. These include two configurational entropy theories, a percolated free volume distribution model, and the activated barrier hopping nonlinear Langevin theory. Both chemically-specific and universal aspects are discussed. After a brief summary of classic phenomenological approaches, a discussion of the relevant length scales and key experimental phenomena in both the supercooled liquid and glassy solid state is presented including ageing and nonlinear mechanical response. The central concepts that underlie the theories in the molten state are then summarized and key predictions discussed, including the glass transition in oriented polymer liquids and deformed rubber networks. Physical ageing occurs in the nonequilibrium glass, and theories for its consequences on the alpha relaxation are discussed. Very recent progress in developing a segment scale theory for the dramatic effects of external stress on polymer glasses, including acceleration of relaxation, yielding, plastic flow and strain hardening, is summarized. The article concludes with a discussion of outstanding theoretical challenges.

Barrier hopping, viscous flow, and kinetic gelation in particle-polymer suspensions.

The naive mode coupling-polymer reference interaction site model (MCT-PRISM) theory of gelation and elasticity of suspensions of hard sphere colloids or nanoparticles mixed with nonadsorbing polymers has been extended to treat the emergence of barriers, activated transport, and viscous flow. The barrier makes the dominant contribution to the single particle relaxation time and shear viscosity, and is a rich function of the depletion attraction strength via the polymer concentration, polymer-particle size asymmetry ratio, and particle volume fraction. The dependences of the barrier on these three system parameters can be accurately collapsed onto a single scaling variable, and the resultant master curve is well described by a power law. Nearly universal master curves are also constructed for the hopping or alpha relaxation time for system conditions not too close to the ideal MCT transition. Based on the calculated barrier hopping time, a theory for kinetic gel boundaries is proposed. The form and dependence on system parameters of the kinetic gel lines are qualitatively the same as obtained from prior ideal MCT-PRISM studies. The possible relevance of our results to the phenomenon of gravity-driven gel collapse is studied. The general approach can be extended to treat nonlinear viscoelasticity and rheology of polymer-colloid suspensions and gels.

Elasticity and clustering in concentrated depletion gels.

X-ray scattering and rheology are employed to study the volume fraction dependence of the collective structure and elastic moduli of concentrated nanoparticle-polymer depletion gels. The nonequilibrium gel structure consists of locally densified nonfractal clusters and narrow random interfaces. The elastic moduli display a power law dependence on volume fraction with effective exponents that decrease with increasing depletion attraction strength. A microscopic theory that combines local structural information with a dynamic treatment of gelation is in good agreement with the observations.

Structure, surface excess and effective interactions in polymer nanocomposite melts and concentrated solutions.

The Polymer Reference Interaction Site Model (PRISM) theory is employed to investigate structure, effective forces, and thermodynamics in dense polymer-particle mixtures in the one and two particle limit. The influence of particle size, degree of polymerization, and polymer reduced density is established. In the athermal limit, the surface excess is negative implying an entropic dewetting interface. Polymer induced depletion interactions are quantified via the particle-particle pair correlation function and potential of mean force. A transition from (nearly) monotonic decaying, attractive depletion interactions to much stronger repulsive-attractive oscillatory depletion forces occurs at roughly the semidilute-concentrated solution boundary. Under melt conditions, the depletion force is extremely large and attractive at contact, but is proceeded by a high repulsive barrier. For particle diameters larger than roughly five monomer diameters, division of the force by the particle radius results in a nearly universal collapse of the depletion force for all interparticle separations. Molecular dynamics simulations have been employed to determine the depletion force for nanoparticles of a diameter five times the monomer size over a wide range of polymer densities spanning the semidilute, concentrated, and melt regimes. PRISM calculations based on the spatially nonlocal hypernetted chain closure for particle-particle direct correlations capture all the rich features found in the simulations, with quantitative errors for the amplitude of the depletion forces at the level of a factor of 2 or less. The consequences of monomer-particle attractions are briefly explored. Modification of the polymer-particle pair correlations is relatively small, but much larger effects are found for the surface excess including an energetic driven transition to a wetting polymer-particle interface. The particle-particle potential of mean force exhibits multiple qualitatively different behaviors (contact aggregation, steric stabilization, local bridging attraction) depending on the strength and spatial range of the polymer-particle attraction.

Analyses of phagocytosis, evoked oxidative burst, and killing of black yeasts by human neutrophils: a tool for estimating their pathogenicity?

The pathogenicity of several dematiaceous yeasts that have, to date, rarely been isolated in humans remains unclear. Because professional phagocytes are prominent in lesions caused by dematiaceous fungi, we address this issue by comparing phagocytosis, evoked oxidative burst and killing by human neutrophils of different black yeasts in vitro. Whereas phagocytosis of all black yeasts tested and evoked oxidative burst yielded comparable results, in contrast, the degree of killing differed significantly after 5 h. Thereby, two groups could be identified; one in which strains are killed at high rates, for example, Hortaea werneckii (81 +/- 11.6%), Exophiala castellanii (96 +/- 8.6%), Phaeoannellomyces elegans (93 +/- 9.7%), Phaeococcomyces exophialae (87 +/- 8.7%), and the other in which strains are killed to a lesser degree, for example, Exophiala dermatitidis (ATCC 34100) (61 +/- 9.5%), E. dermatitidis (CBS 207.35) (66 +/- 7.5%), E. jeanselmei (50 +/- 10.5%), E. mesophila (63 +/- 11.6%), E. bergeri (63 +/- 9.1%), and E. spinifera (57 +/- 9.6%). Non-pigmented yeasts were killed at levels comparable with those at which the white mutant strain of E. dermatitidis (ATCC 44504) was killed (95 +/- 7.5%); the yeast strains tested were Candida albicans (DSM 11943) (95 +/- 4.0% killing) and Saccharomyces cerevisiae (DSM 1333) (95 +/- 10.3%). Comparison of killing rates with the observed pathogenicity of the melanized species suggests that low killing rates might indicate or even predict a high degree of invasiveness. Although previous experiments revealed that melanization conferred killing resistance on E. dermatitidis, the differences in killing rates of other dematious fungi suggest that melanization of the cell wall is in itself insufficient to confer virulence.

Encephalitis related to primary varicella-zoster virus infection in immunocompetent children.

INTRODUCTION: Encephalitis is a rare complication of primary varicella-zoster virus (VZV) infection in immunocompetent children. METHODS: The clinical and laboratory findings of two girls with VZV-related encephalitis are reported. RESULTS: Both children presented with focal epileptic seizures, corresponding to cortical/subcortical as well as white matter lesions. The first showed a typical vesicular skin rash. She was easily diagnosed and made a rapid recovery during acyclovir and steroid treatment. In the second girl, a preceding measles-mumps-rubella virus vaccination and the absence of skin vesicles were misleading with respect to the diagnosis, which was finally proven by IgG seroconversion and intrathecal synthesis of IgG antibodies to VZV. She developed left parieto-occipital tissue necrosis and recovered only transiently during initial acyclovir/steroid treatment. Eight weeks after onset, progressive white matter demyelination and the occurrence of erythema nodosum in the lower limbs necessitated a second 4-month course of oral steroids. The VZV PCR from cerebrospinal fluid was negative in both children. CONCLUSIONS: Primary VZV infection may cause severe encephalitis that may occur without skin vesicles and lead to a chronic course with systemic vasculitis. The coincidence of vaccination and neurologic diseases offers no proof per se of a causal relationship.

Peripheral decrease and pulmonary homing of CD4+CD45RO+ helper memory T cells in cystic fibrosis.

Interstitial lung disease, although of prognostic impact for patients with cystic fibrosis (CF), remains difficult to assess without histopathologic investigations. As changes of peripheral blood lymphocyte subsets (LS) may accompany severe systemic lymphocyte immune responses, we compared peripheral LS of 44 patients with CF, 23 non-CF patients with recurrent pulmonary infections and 83 healthy controls (flow cytometry; CD3, CD19, CD16, CD56, CD4, CD8, CD11b, CD45RA, CD45RO, HLA-DR and CD25 antigens). Additional immunohistochemistry was performed on lung tissue of four CF patients aged 0.5, 12, 17 and 20 years, respectively. Patients with CF showed low absolute counts of CD4+CD45RO+ memory helperT cells, CD16+CD56+ NK cells, CD8+ and interleukin-2 receptor-positive T cells in peripheral blood (P < 0.001). Similar changes were registered in the non-CF patients with pulmonary infections, indicating that those were not specific for CF. Immunohistochemistry showed activation of bronchus-associated lymphoid tissue with interstitial accumulation of CD4+CD45 RO+ T cells in the three older patients. Patients with CF show marked changes of peripheral blood LS which are presumably not CF-specific and may mirror homing to lung tissue in the course of interstitial lung disease. Further research should evaluate its usefulness in monitoring progression of lung disease in CF.

Effects of gallium and mercury ions on transport systems.

Mercury was previously shown to exert toxic effects by influencing ion channels and transporters in the kidney and brain. Gallium alloys were suggested as less toxic restorative materials. To compare the toxicity of gallium ions with those of mercury ions, we applied gallium nitrate Ga(NO3)3 (0.1-100 microM and mercuric chloride (HgCl2) (0.001-10 microM) to Xenopus oocytes expressing mammalian ion channels and transport proteins. Mercury (10 microM) inhibited the K+-channels ROMK and HERG, the phosphate transporter NaPi-3, the amino acid transporter rBAT, the cation transporter OCT-2, and the osmolyte transporter BGT. It activated the I(Ks)-channel but did not affect the Na+-channel ENaC, the anion channel NaPi-1, and the glucose transporter SGLT-1. Gallium was without significant effect on the channels and on SGLT1, NaPi-3, and rBAT, but inhibited BGT and OCT-2. In conclusion, both Hg2+ and Ga3+ may exert toxic effects on transport systems, which may partially explain their cytotoxic effects.

Macromolecular theory of solvation and structure in mixtures of colloids and polymers.

The structural and thermodynamic properties of mixtures of colloidal spheres and nonadsorbing polymer chains are studied within a general two-component macromolecular liquid state approach applicable for all size asymmetry ratios. The dilute limits, when one of the components is at infinite dilution but the other concentrated, are presented and compared to field theory and to models that replace polymer coils with spheres. Whereas the derived analytical results compare well, qualitatively and quantitatively, with mean-field scaling laws where available, important differences from "effective sphere" approaches are found for large polymer sizes or semidilute concentrations.

The contributions of memory and attention processes to cognitive abilities.

In two experiments, the contributions of memory and attention processes to the cognitive abilities of reasoning and perceptual speed were investigated. Two measures of speed of information retrieval from long-term and short-term memory (Posner paradigm, Sternberg paradigm) and two attention measures (continuous attention test, attention switching test) were included in the first experiment (N = 220). The memory tests led to correlations with the measures of cognitive abilities, whereas the attention test did not. The same tests as well as one additional memory test and one attention test (working memory test, test of covert orientation) were administered in the second experiment (N = 116). Again, the memory tests led to the larger correlations with the measures of cognitive abilities. Two components were obtained in components analysis, of which the first was characterized by high loadings of the memory tests and the second by high loadings of the attention tests. Only the memory component contributed to the prediction of cognitive abilities.

[Capacity limitation and intellectual ability]. / Kapazitätslimitierung und intellektuelle Leistungsfähigkeit.

In a study examining the influence of cognitive capacity limitation on intellectual ability, 124 university students were subjected to 7 computer-based tests in which cognitive demands were manipulated by varying the number of required ordering, arithmetic, and memory operations, respectively. Intelligence data were obtained by forming a composite score from Raven's Advanced Progressive Matrices and the Berlin Intelligence Structure Test. Increases in cognitive demands led to increases in reaction times and number of errors as well as to increases in common variance and in correlations between intelligence and number of errors in 5 and 2 (of 5) comparisons, respectively, while correlations between intelligence and reaction time were found to decrease with increasing task demands in 3 comparisons. All correlations were reduced considerably when storage capacity and coordination efficiency were partialled out. These findings suggest a relationship between capacity limitation and intellectual ability.

Experiences and expectations in evaluating preparation for an examination.

The predictability of the evaluation of preparing for an oral examination by means of self-concept and self-esteem as well as optimism and self-efficacy was investigated in a sample of 49 university students. Self-concept was measured by Frankfurter Selbstkonzeptskalen, self-esteem by the 16PF-O scale, personal optimism, social optimism, and self-efficacy by Fragebogen für Personalen Optimismus und Sozialen Optimismus--Erweitert, and the evaluation of the preparation by a self-report sheet. Data were collected 5 wk. before the examination. The self-report sheet was given again one week before the examination. Significant correlations of self-report scores with self-concept scores as well as 16PF-O scores representing past experiences were found for the first assessment. The correlations with personal optimism scores and self-efficacy scores representing expectations were also significant for the second assessment.