Direct radiation exposure of the eye lenses in cranial computed tomography and exposure reduction through radiographer training.

INTRODUCTION: Ionizing radiation can cause increased opacity of the lens and later lead to radiation-induced cataract. Therefore, the eye lens should be positioned outside of the direct radiation beam in cranial computed tomography (CCT). If this is not possible, protective measures must be taken, which includes the use of external lens protectors. In this study we assess whether direct radiation exposure of the eyes in CCT can be reduced by trained radiographers and whether the use of eye lens protectors improves after training. METHODS: First, we evaluated 763 non-enhanced CCT regarding direct radiation exposure of eyeballs and eye lenses and usage of lens shielding. Afterwards, we trained radiographers to avoid radiation exposure of the eyes by head adjustment and protectors and assessed the improvements in a subsequent study of 678 CCT. We tried to identify factors that influenced radiation exposure of the eye lens. RESULTS: After training, frequency of radiation exposure of lenses was significantly reduced by 5.9% (220/763 patients in pre- vs. 155/678 patients in post-training group, p = 0.01). The use of external lens protectors significantly increased after training by 9.8% (37/763 patients in pre- vs. 99/678 patients in post-training group, p < 0.001). The absence of tiltable headrest was a risk factor for increased eye lens radiation exposure in the pre-training group. The presence of cervical spine immobilizer was associated with more frequent radiation exposure of the lenses in the pre- and post-training group. CONCLUSIONS: Radiographer training and the use of tiltable headrest lead to reduction of radiation exposure to the eye lens. IMPLICATIONS FOR PRACTICE: Radiographer training is an effective method to reduce eye lens exposure in CCT. The usage of tiltable headrest minimizes the radiation exposure of the lenses.

Analysis of vaccine messages on social media (Twitter) in Scandinavia.

Vaccine hesitancy is listed as one of the top 10 global health threats by the WHO. Existing studies investigating the relationship between vaccine hesitancy and social media have found that misinformation and vaccine concerns on social media can cause significant declines in vaccine coverage rates. The objective of this study was to provide insight into the dynamics of vaccine messages on Twitter in Scandinavia (Denmark, Norway, Sweden), by analyzing tweets in local languages during 2019. A validated measure, the 5C scale, was used to map relevant predictors of vaccination behavior, capturing the factors confidence (in vaccines and the system that delivers them), complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching) and collective responsibility (willingness to protect others). A total of 1794 tweets met the inclusion criteria (DK: 48%, NO: 15%, SE: 37%), predominantly tweeted by private users (86%). The HPV vaccine was mentioned in 81% of tweets. Tweets were classified as expressing confidence (61%), complacency (18%), constraints (15%), calculation (15%), and collective responsibility (4%). Confidence in vaccines and the system that delivers them was expressed in 57%. A lack of confidence was expressed in 4% of all tweets, in combination with calculation in 39%. Analyzing public sentiment toward vaccination on Twitter is a useful tool to leverage for better understanding of the dynamics behind vaccine hesitancy. This analysis could provide actionable information for healthcare professionals and public health authorities to mitigate online misinformation and public vaccine concerns.

[Psychosocial effects of the pandemic on staff and residents of nursing homes as well as their relatives-A systematic review]. / Psychosoziale Auswirkungen der Pandemie auf Pflegekräfte und Bewohner von Pflegeheimen sowie deren Angehörige ­ Ein systematisches Review.

BACKGROUND: Following the COVID-19 pandemic residents of nursing homes, their visitors and families as well as employees are faced with new challenges. Protective measures have a strong impact on the well-being of all these groups of persons. MATERIAL AND METHODS: A systematic search was carried out for studies investigating the psychosocial consequences of the COVID-19 pandemic for residents, their visitors and families as well as nursing home staff. Results were analyzed by narrative synthesis. RESULTS: A total of 756 studies were screened and 15 studies were included. These studies were conducted between February and June 2020 with participants from 14 countries. Participants reported loneliness, grief and depressive symptoms among residents. Some gave an account of fear as a reaction of residents to social distancing. Residents with cognitive impairment suffered more although there are conflicting reports. The well-being of visitors and friends was compromised and their feeling of loneliness increased. Nursing home personnel reported fear of getting infected and of infecting residents or their own families. Infected workers in the USA expressed anger about a lack of protection. Furthermore, an increase in workload was reported. CONCLUSION: Studies conducted during the first months of the pandemic reported negative consequences for the psychosocial well-being of residents, their visitors and nursing home staff. Individual needs for future support of these groups are distinct and need further evaluation during the on-going pandemic.

SPMSQ for risk stratification of older patients in the emergency department : An exploratory prospective cohort study.

BACKGROUND: Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. OBJECTIVE: To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). METHOD: This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. RESULTS: The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46-0.63) but at 3 months (AUC 0.61, 95% CI 0.54-0.68), 6 months (AUC 0.63, 95% CI 0.56-0.70) and 12 months (AUC 0.63, 95% CI 0.56-0.70) after initial contact. CONCLUSION: For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

Reduced diffusion in normal appearing white matter of glioma patients following radio(chemo)therapy.

BACKGROUND AND PURPOSE: Standard treatment of high grade gliomas includes gross tumour resection followed by radio(chemo)therapy. Radiotherapy inevitably leads to irradiation of normal brain tissue. The goal of this prospective, longitudinal study was to use MRI to quantify normal appearing white and grey matter changes following radiation treatment as a function of dose and time after radiotherapy. MATERIALS AND METHODS: Pre-radiotherapy (proton or photon therapy) MRI and follow-up MRIs collected in 3 monthly intervals thereafter were analysed for 22 glioma patients and included diffusion tensor imaging, quantitative T1, T2* and proton density mapping. Abnormal tissue was excluded from analysis. MR signal changes were quantified within different dose bin regions for grey and white matter and subsequently for whole brain white matter. RESULTS: We found significant reductions in mean diffusivity, radial diffusivity, axial diffusivity and T2* in normal appearing white matter regions receiving a radiation dose as low as 10-20 Gy within the observational period of up to 18 months. The magnitude of these changes increased with the received radiation dose and progressed with time after radiotherapy. Whole brain white matter also showed a significant reduction in radial diffusivity as a function of radiation dose and time after radiotherapy. No significant changes were observed in grey matter. CONCLUSION: Diffusion tensor imaging and T2* imaging revealed normal appearing white matter changes following radiation treatment. The changes were dose dependant and progressed over time. Further work is needed to understand the underlying tissue changes and to correlate the observed diffusion changes with late brain malfunctions.

Incident depression and mortality among people with different types of dementia: results from a longitudinal cohort study.

PURPOSE: The aim of this study was to investigate the independent and combined association of incident depression and dementia with mortality and to explore whether the magnitude of the association varies according to different types of dementia, including Alzheimer's disease and vascular dementia. METHODS AND DESIGN: The study was based on a population-based longitudinal cohort consisting of 9940 participants at baseline and followed for over 14 years. The sample used for the analyses included 6114 participants with available information on diagnosis of incident dementia and depression. For survival analyses, Cox regression models with incident dementia (n = 293; 5%) and incident depression (n = 746; 12%) as time-dependent variables were used. RESULTS: Cox models adjusted for relevant confounders indicated that comorbidity of incident vascular dementia and incident depression was associated with a much higher mortality risk (HR 6.99; 95% CI 3.84-12.75) than vascular dementia in the absence of depression (HR 2.80; 95% CI 1.92-4.08). In contrast, estimates for comorbidity of Alzheimer's disease and depression were slightly lower than those for Alzheimer in absence of depression (HR 3.56; 95% CI 1.83-6.92 and HR 4.19; 95% CI 2.97-5.90, respectively). Incident depression in the absence of incident dementia was only weakly associated with mortality. CONCLUSIONS: These findings indicate that depression and vascular dementia might have synergistic effects on mortality. The results have relevant public health implications for prevention, routine screening for and early treatment of depression among older people, especially those at risk of vascular dementia.

[Perspectives of psychological aging research]. / Perspektiven der psychologischen Alternsforschung.

Psychological aging research (PAF) focuses on age-related changes and behavioral stability (e.g. structure of social relations), performance and competences (e.g. cognitive functioning) as well as experiences (e.g. well-being) in advanced age. Knowledge is based in particular on currently available longitudinal studies, which historically for the first time allow very long observational periods (nearly across the complete life span). Additionally, innovative statistical analytical methods co-developed in the PAF nowadays allow a better understanding of the dynamics of change than ever before. This results in a new picture of psychological aging that confirms the multifaceted strengths of human aging but also reveals new risks of the current "prolonged aging".

[Structural lag and room for possibilities in old age exemplified by central transitions. Initial results of a novel discipline trialogue between diaconal studies, psychology and theology]. / "Structural Lag" und Möglichkeitsräume des Alterns am Beispiel zentraler Transitionen. Erste Befunde eines neuartigen Disziplinentrialogs zwischen Diakoniewissenschaft, Psychologie und Theologie.

BACKGROUND: Although the need for interdisciplinary research is generally accepted in gerontology, such interdisciplinary communication is often limited to various combinations of psychological, sociological and biomedical scientific approaches. We argue that gerontology requires a continuous examination of novel disciplinary constellations to obtain a better understanding of aging in its complexity and to further develop this scientific field in its entirety. OBJECTIVE: The present study introduced and tested for the first time an innovative disciplinary trialogue, i.e. the combination of psychology, theology and diaconal studies. In particular, it is assumed that this combination can contribute to a more profound interpretation of the prominent concept of structural lag which is underresearched in gerontology. MATERIAL AND METHODS: The analysis of structural lag with another overarching concept, "room for possibilities", can provide a synergy-rich interpretation category for a range of challenges connected with old age. In this respect, three major transitions were selected to shed light on these concepts and examined by means of three focus group interviews: transition to retirement, need for long-term care in the private home context and transition to nursing home life. The data were evaluated using qualitative content analysis. RESULTS: The interdisciplinary-oriented evaluation of the interviews and the qualitative data analysis revealed the relevance of different perceptions of time in all three transitions. In addition, different dynamics in terms of the interplay of gains and losses as well as participation were found to be important for a better understanding of the three transitions. In particular, the subjective interpretation of the time remaining for living and the predetermined or self-selected time structuring of the daily routine were important factors for the perception of one's own potential. The results also underline a range of unused room for possibilities and the existence of structural lag for each transition. CONCLUSION: By the cooperation of the participating disciplines aspects of aging and their interdependence became visible. At the same time this pilot-like disciplinary trialogue revealed the challenges in combining interdisciplinary perspectives by the combination of empirical and hermeneutical methods.

Reference range for thyrotropin. Post hoc assessment.

UNLABELLED: Setting the reference range for thyrotropin (TSH) remains a matter of ongoing controversy. PATIENTS, METHODS: We used an indirect method to determine the TSH reference range post hoc in a large sample. A total of 399 well characterised subjects showing no evidence of thyroid dysfunction were selected for definition of the TSH reference limits according to the method of Katayev et al.. To this end, the cumulative frequency was plotted against the individual logarithmic TSH values. Reference limits were calculated by extrapolating the middle linear part of the regression line to obtain the cut-offs for the 95% confidence interval. We also examined biological variation in a sample of 65 subjects with repeat measurements to establish reference change values (RCVs). RESULTS: Based on these, the reference interval obtained by the novel technique was in close agreement with the conventionally established limits, but differed significantly from earlier recommendations. DISCUSSION: Following unverified recommendations could result in a portion of patients with subclinical thyroid dysfunctions being missed, an important consideration in a setting with a high prevalence of thyroid autonomy. CONCLUSION: Indirect post hoc verification of reference intervals from a large retrospective sample is a modern approach that gives plausible results. The method seems particularly useful to assess the adequacy and performance of reference limits reported or established by others in a particular setting. The present data should encourage re-evaluation of reference systems on a broader scale.

Usage of international standards for integrating extramural monitoring and personal health device data into medical information infrastructure.

Integrating extramural measured devices data into medical information systems is becoming more and more attractive for integrated medical care. A lot of devices already have the ability to transfer measured data to mobile devices or computers and a few systems offer submitting data to a centralized information database or information system. Unfortunately, all of these devices use proprietary protocols and processes which makes integration into other systems a major problem. To address this problem the Healthy Interoperability project has been created with the objective of creating a framework for transferring health data based on international standards. The paper outlines how the framework architecture takes full advantage from the definitions of the international standards ISO 11073, HL7, IHE and CEN 13606. Even the definition of the user profiles and the security framework is based on standards from ETSI, ISO and CEN. By using these standards the framework can also perfectly be used for intramural communication.

[Evaluation of new technologies by residents and staff in an institutional setting. Findings of the BETAGT project]. / Bewertung neuerer Technologien durch Bewohner und Pflegemitarbeiter im institutionellen Kontext : Befunde des Projekts BETAGT.

BACKGROUND: The aim of the substudy that was conducted as part of the project "Bewertung neuer Technologien durch Bewohner und Personal im Altenzentrum Grafenau der Paul Wilhelm von Keppler-Stiftung und Prüfung des Transfers ins häusliche Wohnen" (BETAGT) was to have residents and staff members in nursing homes with limited technological equipment complete a questionnaire about their life-long technological experiences and their general technological attitude. Furthermore, specific technological devices and systems were evaluated in terms of their potential with respect to safety, privacy, or help in decreasing burden. Data were collected using a newly developed brief questionnaire. SAMPLE AND METHODS: A total of 84 residents and 109 staff members sampled from 11 different institutions were asked about their life-long technology experiences, general attitudes towards technology as well as attitudes towards specific technological devices. Residents' opinions were assessed via brief structured interviews; a structured questionnaire was given to the staff members to complete. The technological devices to be evaluated were introduced via pictured descriptions. RESULTS: Residents and staff members showed a positive attitude towards technology. With regard to the potential of new technologies, residents and staff members expect different effects on several dimensions of quality of life. Both groups rated the potential of the dimension of safety to be highest. CONCLUSION: Contrary to widely held opinion, older adults living in institutions do not, in general, seem to be too critical about new technology. From the staff members' point of view, modern technology can be integrated into daily care routines of a nursing home, but the potentials of new technologies are considered in a very differential manner.

Development and calibration of a Thomson parabola with microchannel plate for the detection of laser-accelerated MeV ions.

This article reports on the development and application of a Thomson parabola (TP) equipped with a (90x70) mm(2) microchannel-plate (MCP) for the analysis of laser-accelerated ions, produced by a high-energy, high-intensity laser system. The MCP allows an online measurement of the produced ions in every single laser shot. An electromagnet instead of permanent magnets is used that allows the tuning of the magnetic field to adapt the field strength to the analyzed ion species and energy. We describe recent experiments at the 100 TW laser facility at the Laboratoire d'Utilization des Lasers Intenses (LULI) in Palaiseau, France, where we have observed multiple ion species and charge states with ions accelerated up to 5 MeV/u (O(+6)), emitted from the rear surface of a laser-irradiated 50 microm Au foil. Within the experiment the TP was calibrated for protons and for the first time conversion efficiencies of MeV protons (2-13 MeV) to primary electrons (electrons immediately generated by an ion impact onto a surface) in the MCP are presented.

[Quality of life by limited vision in old age: the example of age-related macula degeneration]. / Lebensqualität bei Seheinschränkung im Alter: Das Beispiel altersabhängige Makuladegeneration.

Age-related macula degeneration (AMD) is accompanied by considerable consequences regarding the psychosocial quality of life. A considerable body of research literature now indicates, for instance, an increased rate of depression and substantial loss of everyday capabilities in AMD patients. However, inter-individual differences are large and part of the explanation lies in differences in the ability to cope with and detach oneself from aims in life. The negative impact of AMD on the qualify of life is associated with a need for psychosocial support, but this need is barely met at present. A series of studies nevertheless supports the view that successful intervention is possible even with very old patients. In this respect the problems at present have less to do with recognition than with application and implementation.