Incentives for plasma donation.

BACKGROUND AND OBJECTIVES: This work provides an overview of the incentives used for plasma donation in Europe and beyond. The overview can provide new ideas to blood establishments. MATERIALS AND METHODS: We conducted a systematic online search of incentives used and asked national experts to validate the data across all European Union countries as well as other European and non-European countries. We categorized the data into level of incentive (using the Nuffield Council on Bioethics' rungs [2011]) and country. RESULTS: We analysed more than 490 organizations across 26 countries. Our findings reveal different incentives used in these countries. Snacks and pre-donation health checks are commonly provided. In addition, loyalty programmes, small gifts, vouchers, lotteries, travel compensations and time off from work extend the strategic incentive portfolio. Only seven countries offer financial compensation ranging from the equivalent of 10-35€ for European countries. In countries with a decentralized model, where more than one organization collects plasma, we observe that more diversified incentive strategies are generally used, including monetary and non-monetary incentives. In countries with a centralized model, where only one organization is allowed to collect plasma, financial compensation is usually not offered. Centralized plasma collection without financial compensation relies on a wider range of non-monetary incentives than with financial compensation. CONCLUSION: The country group analysis offers valuable insights into the relationship between incentive strategies and the prevailing centralized versus decentralized plasma collection model. This overview provides a broader understanding of incentives used by blood establishments and offers avenues for future practice.

Clocked dynamics in artificial spin ice.

Artificial spin ice (ASI) are nanomagnetic metamaterials with a wide range of emergent properties. Through local interactions, the magnetization of the nanomagnets self-organize into extended magnetic domains. However, controlling when, where and how domains change has proven difficult, yet is crucial for technological applications. Here, we introduce astroid clocking, which offers significant control of ASI dynamics in both time and space. Astroid clocking unlocks a discrete, step-wise and gradual dynamical process within the metamaterial. Notably, our method employs global fields to selectively manipulate local features within the ASI. Sequences of these clock fields drive domain dynamics. We demonstrate, experimentally and in simulations, how astroid clocking of pinwheel ASI enables ferromagnetic domains to be gradually grown or reversed at will. Richer dynamics arise when the clock protocol allows both growth and reversal to occur simultaneously. With astroid clocking, complex spatio-temporal behaviors of magnetic metamaterials become easily controllable with high fidelity.

[Detection, investigation, and management of delirium in hospitalized elderly].

Delirium is common in hospitalized older adults. The condition is frequently not recognized, or managed appropriately, and has a poor prognosis. This review finds that a proactive multicomponent interdisciplinary non-farmacological approach can reduce incidence. Delirium is managed by identification of the condition, accurate diagnosis and treatment of the causes, and all other correctable contributing factors, using nonpharmacologic approaches. In some cases, and if required for patient safety, low doses of high-potency antipsychotic agents can be used, in lowest possible dose and for the shortest possible time.

Short-term changes in soil pore size distribution: Impact of land use.

Changes in land use affect the pore size distribution (PSD) of the soil, and hence important soil functions such as gas exchange, water availability and plant growth. The objective of this study was to investigate potentially damaging and restorative soil management practices on soil pore structure. We quantified the rate of change in PSD six years after changes in land use taking advantage of the Highfield land-use change experiment at Rothamsted Research. This experiment includes short-term soil degradation and restoration scenarios established simultaneously within long-term contrasting treatments that had reached steady-state equilibrium. The land-use change scenarios comprised conversion to grassland of previously arable or bare fallow soil, and conversion of grassland to arable and bare fallow soils. In the laboratory, we exposed intact soil cores (100 cm3) to matric potentials ranging from -10 hPa to -1.5 MPa. Based on equivalent soil mass, the plant available water capacity decreased after conversion from grassland, whereas no change was observed after conversion to grassland. Structural void ratio decreased after termination of grassland and introduction of grassland in bare fallow soil, while no change was seen when changing arable to grassland. Consequently, it was faster to degrade than to restore a complex soil structure. The study illustrates that introducing grassland in degraded soil may result in short-term increase in soil density.

Soil degradation and recovery - Changes in organic matter fractions and structural stability.

The combination of concurrent soil degradation and restoration scenarios in a long-term experiment with contrasting treatments under steady-state conditions, similar soil texture and climate make the Highfield land-use change experiment at Rothamsted Research unique. We used soil from this experiment to quantify rates of change in organic matter (OM) fractions and soil structural stability (SSS) six years after the management changed. Soil degradation included the conversion of grassland to arable and bare fallow management, while soil restoration comprised introduction of grassland in arable and bare fallow soil. Soils were tested for clay dispersibility measured on two macro-aggregate sizes (DispClay 1-2 mm and DispClay 8-16 mm) and clay-SOM disintegration (DI, the ratio between clay particles retrieved without and with SOM removal). The SSS tests were related to soil organic carbon (SOC), permanganate oxidizable C (POXC) and hot water-extractable C (HWC). The decrease in SOC after termination of grassland was greater than the increase in SOC when introducing grassland. In contrast, it was faster to restore degraded soil than to degrade grassland soil with respect to SSS at macro-aggregate scale. The effect of management changes was more pronounced for 8-16 mm than 1-2 mm aggregates indicating a larger sensitivity towards tillage-induced breakdown of binding agents in larger aggregates. At microscale, SSS depended on SOC content regardless of management. Soil management affected macroscale structural stability beyond what is revealed from measuring changes in OM fractions, underlining the need to include both bonding and binding mechanisms in the interpretation of changes in SSS induced by management.

Association between T-wave discordance and the development of heart failure in left bundle branch block patients: Results from the Copenhagen ECG study.

BACKGROUND: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. METHODS: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. RESULTS: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. CONCLUSION: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.

Soil organic matter widens the range of water contents for tillage.

The effects of soil organic matter on the water contents for tillage were investigated by sampling soils with a uniform texture, but a range of soil organic carbon (SOC) from two long-term field experiments at Highfield in Rothamsted Research, UK and Askov Experimental Station, Denmark. The treatments studied in Highfield were Bare fallow (BF), Continuous arable rotation (A), Ley-arable (LA) and Grass (G); and in Askov: unfertilized (UNF), ½ mineral fertilizer (½ NPK), 1 mineral fertilizer (1NPK), and 1½ animal manure (1½AM). Minimally disturbed soil cores (100 cm3) were sampled per plot in both locations from 6 to 10 cm depth to generate water retention data. Soil blocks were also sampled at 6-15 cm depth to determine basic soil properties and to measure soil aggregate strength parameters. The range of soil water contents appropriate for tillage were determined using the water retention and the consistency approaches. SOC content in Highfield was in the order: G > LA = A > BF, and in Askov: 1½ AM > 1NPK = ½NPK > UNF. Results showed that different long-term management of the silt loam Highfield soil, and fertilization of the sandy loam Askov soil affected the mechanical properties of the soils- for Highfield soil, aggregates from the G treatment were stronger in terms of rupture energy when wet (-100 hPa matric potential) than the BF treatment. As the soil dried (-300 and -1000 hPa matric potentials), soil aggregates from the G treatment were relatively weaker and more elastic than the BF soil. Our study showed, for both Highfield and Askov soils, a strong positive linear increase in the range of water contents for tillage with increasing contents of SOC. This suggests that management practices leading to increased SOC can improve soil workability by increasing the range of water contents for tillage. We recommended using the consistency approach over the water retention approach for determining the range of water contents for tillage because it seems to give realistic estimates of the water contents for tillage.

Soil texture analysis revisited: Removal of organic matter matters more than ever.

Exact estimates of soil clay (<2 µm) and silt (2-20 µm) contents are crucial as these size fractions impact key soil functions, and as pedotransfer concepts based on clay and silt contents are becoming increasingly abundant. We examined the effect of removing soil organic matter (SOM) by H2O2 before soil dispersion and determination of clay and silt. Soil samples with gradients in SOM were retrieved from three long-term field experiments each with uniform soil mineralogy and texture. For soils with less than 2 g C 100 g-1 minerals, clay estimates were little affected by SOM. Above this threshold, underestimation of clay increased dramatically with increasing SOM content. Silt contents were systematically overestimated when SOM was not removed; no lower SOM threshold was found for silt, but the overestimation was more pronounced for finer textured soils. When exact estimates of soil particles <20 µm are needed, SOM should always be removed before soil dispersion.

20 years of experience in static intensity-modulated total-body irradiation and lung toxicity. Results in 257 consecutive patients.

PURPOSE: To analyze lung complications after allogeneic or autologous transplantation following total-body irradiation (TBI) with compensators, so-called sIMRT (static intensity-modulated radiotherapy). PATIENTS AND METHODS: Between 1983 and 1998, 257 patients with different hematologic malignancies underwent TBI in six fractions to a total dose of 12 Gy within 3 consecutive days (212 with 11 Gy lung dose) prior to allogeneic (n=174) or autologous (n=83) transplantation. 40 patients were <16 years of age. Minimum follow-up time was 5 years. Median follow-up period was 110 months (13-231 months). RESULTS: 5-year survival rate was 47.9%, 5-year tumor-related mortality 23%, 5-year treatment-related mortality 29.2% (12 Gy lung dose: 53.3%+/-14.6%, 11 Gy: 24.1%+/-5.7%). Interstitial pneumonitis (IP) developed in 28 of 257 patients (10.9% +/- 3.8%). IP incidences in the allogeneic and autologous groups were 14.4% (+/-5.6%) and 3.6% (0-7.6%), respectively. IP incidences with 12/11 Gy lung dose were 22% (+/-12%)/8.5% (+/-3.7%). IP mortality was 9.3% (+/-3.6%). 13 of 28 patients with IP had a cytomegalovirus infection, five an acute graft-versus-host disease grade IV of the lungs. IP incidences with 12/11 Gy lung dose were 25% (9-50%)/4.2% (0.2-19.1%) in patients <16 years, and 20.7% (9.4-37.4%) and 13.3% (+/-6.5%) in older patients after allogeneic transplantation. CONCLUSION: Compensator-generated static intensity-modulated TBI with a total dose of 12 Gy and a lung dose of 11 Gy is a modern and comfortable treatment with moderate lung toxicity, small dose inhomogeneities and little setup failure before transplantation. Especially patients <16 years of age benefit from lung dose reduction.

[Output-factors for squared, rectangular, and elongated photon fields of medical linear accelerators]. / Output-Faktoren für quadratische, rechteckige und elongierte Photonenfelder von medizinischen Linearbeschleunigern.

For reduction of data scattering in output-factor calculation, a new correction for Stirling's formula is introduced that takes into account the position of the upper and lower collimator jaw settings of linear accelerators. This correction factor requires two simple geometrical data of the treatment head, to describe the collimator exchange effect for open- as well as wedged fields. This model also implies a reduction of output measurements to only three field sizes, the minimum, the maximum, and a reference field size, without significant loss of accuracy in output factors.