Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III).

STUDY DESIGN: Cross-sectional validation study. OBJECTIVES: To develop and validate a self-report version of the Spinal Cord Independence Measure (SCIM III). SETTING: Two SCI rehabilitation facilities in Switzerland. METHODS: SCIM III comprises 19 questions on daily tasks with a total score between 0 and 100 and subscales for 'self-care', 'respiration & sphincter management' and 'mobility'. A self-report version (SCIM-SR) was developed by expert discussions and pretests in individuals with spinal cord injury (SCI) using a German translation. A convenience sample of 99 inpatients with SCI was recruited. SCIM-SR data were analyzed together with SCIM III data obtained from attending health professionals. RESULTS: High correlations between SCIM III and SCIM-SR were observed. Pearson's r for the total score was 0.87 (95% confidence interval (CI) 0.82-0.91), for the subscales self-care 0.87 (0.81-0.91); respiration & sphincter management 0.81 (0.73-0.87); and mobility 0.87 (0.82-0.91). Intraclass correlations were: total score 0.90 (95% CI 0.85-0.93); self-care 0.86 (0.79-0.90); respiration & sphincter management 0.80 (0.71-0.86); and mobility 0.83 (0.76-0.89). Bland-Altman plots showed that patients rated their functioning higher than professionals, in particular for mobility. The mean difference between SCIM-SR and SCIM III for the total score was 5.14 (point estimate 95% CI 2.95-7.34), self-care 0.89 (0.19-1.59), respiration & sphincter management 1.05 (0.18-2.28 ) and mobility 3.49 (2.44-4.54). Particularly patients readmitted because of pressure sores rated their independence higher than attending professionals. CONCLUSION: Our results support the criterion validity of SCIM-SR. The self-report version may facilitate long-term evaluations of independence in persons with SCI in their home situation.

The individual experience of functioning and disability in Switzerland--patient perspective and person-centeredness in spinal cord injury.

STUDY DESIGN: Qualitative, multi-center study. OBJECTIVES: The objective of this study is to explore the aspects of functioning and disability that are relevant to individuals with spinal cord injury (SCI), using a comprehensive approach based on the International Classification of Functioning, Disability and Health (ICF). METHODS: Forty-nine people with SCI from early post-acute and long-term rehabilitation settings participated in nine focus groups. Five open-ended questions based on the ICF were used to initiate discussion about relevant Body Functions and Structures, Activities and Participation, Environmental and Personal Factors. The focus groups were audiotaped and the recording was transcribed verbatim. Qualitative analyses included the identification, extraction and coding of meaningful concepts from the transcribed dialogue. Concepts were coded according to established rules using ICF categories and were summarized semi-quantitatively. RESULTS: In the analysis, 1582 different concepts were identified. For coding one concept, an average of 1.4 ICF categories was used. This resulted in 2235 concept-ICF category links, 1068 in the early post-acute and 1167 in the long-term context, respectively. For the coding, 274 out of the 1454 categories contained in the ICF were used. CONCLUSION: The ICF coding showed the broad range of relevant aspects in the functioning experience of persons with SCI. Besides body limitations (especially paralysis and pain), the most relevant concepts covered mainly barriers in physical environment, assistive devices and social support, as well as the impact on everyday life regarding leisure and work. The resulting list of ICF categories can be helpful in facilitating person-centered clinical care and research.

Long-term follow-up of patients with spinal cord injury with a new ICF-based tool.

STUDY DESIGN: To develop a computer program that supports the overview of a follow-up care process in people with spinal cord injury (SCI) in daily clinical practice. OBJECTIVES: To create a new electronic tool based on the International Classification of Functioning, Disability and Health (ICF) that enables information to be registered and visualized, including the use of a net-diagram ('spider') to show a patient's long-term development. This diagram helps the clinician to recognize predispositions over time, as well as making information accessible to the patient, so as to involve him as a participant in defining current and future treatment options. Furthermore, guidelines for the prevention of common diseases, based on the recommendations of internal medicine, rehabilitation medicine and findings in the SCI literature, were implemented to provide enhanced health coaching in the area of preventative care. METHODS: In an outpatient setting, four perspectives were assessed: patient, physician, occupational therapist and physiotherapist for a comprehensive bio-psycho-social consideration. All categories were assessed and graphically visualized with the electronic tool, on the basis of the ICF domains: body function, activities/participation and environmental factors. RESULTS: The assessed data were summarized and graphically represented using three spider charts. CONCLUSION: The tool facilitates the patient counselling and the interdisciplinary work in daily clinical practice. Such a visual report helps to recognize predispositions over time. Furthermore, it helps to explain the clinical and patient-related findings accessible to the patients, to involve them as participants in defining the goals and the treatment plan.

Functioning and disability in spinal cord injury from the consumer perspective: an international qualitative study using focus groups and the ICF.

STUDY DESIGN: Qualitative, multi-center study. OBJECTIVES: To examine the lived experiences of persons with spinal cord injury (SCI) in both the early post-acute and the long-term context using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. SETTING: International study sites representing the six World Health Organization world regions. METHODS: A qualitative study using focus groups methodology was conducted. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. The resulting meaningful concepts were linked to ICF categories according to established linking rules. RESULTS: Forty-nine focus groups with 230 participants were performed. Saturation was reached in four out of the six world regions. A total of 3122 and 4423 relevant concepts were identified in the focus groups for the early post-acute and the long-term context, respectively, and linked to a total of 171 and 188 second-level categories. All chapters of the ICF components Body functions, Activities and participation and Environmental factors were represented by the linked ICF categories. In all, 36 and 113 concepts, respectively, are not classified by the ICF and 306 and 444, respectively, could be assigned to the ICF component Personal Factors, which is not yet classified. CONCLUSION: A broad range of the individual experiences of persons with SCI is covered by the ICF. A large number of experiences were related to Personal Factors.

Topology and enhanced toxicity of bound microcystins in Microcystis PCC 7806.

The cyanobacterium Microcystis is a potent producer of microcystins and cyanopeptolins and causes most of the toxicity outbreaks in freshwaters worldwide. Microcystins are mainly stored in the cells and little is found in the water. The intracellular concentration of microcystins in Microcystis PCC 7806 was at least 0.9 mM, although the solubility of microcystins in water was only about 10 microM. This low solubility does not allow the solubilisation of such high amounts of microcystins in the cytosol of Microcystis. Differential fractionation of cell constituents showed that microcystins and cyanopeptolins were bound to a protein fraction primarily composed of phycobilins. The percentage of microcystins and cyanopeptolins found in the thylakoid membranes was very low. Phycobilins may be the major proteins that have binding sites for these oligopeptides. A molar ratio near to 6 was observed for microcystins to the phycobilin (alphabeta) monomer. The binding of the microcystins to the protein was rather weak and allowed rapid dissociation of microcystins from the protein-matrix. Toxicity assays with Thamnocephalus platyurus showed that native microcystin when still bound to cyanobacterial protein was more toxic than an equivalent amount that has been desorbed from the protein by treatment with methanol. It is suggested that phycobilins serve in the gut of grazers as carrier molecules for the rapid transport of microcystin from lysed cells of Microcystis to the epithelium where the uptake of microcystins occurs. Because protein-bound microcystin does not bind to C18 cartridges, this behaviour can be the cause of many analytical discrepancies observed. The blue-coloured water observed upon the collapse of Microcystis blooms may be extremely toxic because the released phycobilins may carry the major fraction of microcystins.

The photohydration of N-alkylpyridinium salts: theory and experiment.

Bicyclic aziridines formed by the irradiation of pyridinium salts in basic solution have recently been recognized to have great synthetic potential. We have undertaken a joint computational and experimental investigation of the mechanism of this photoreaction. We have computationally determined the structures and relative energies of the relevant stationary points on the lowest potential energy surface (PES) of the pyridinium and methylpyridinium ions. Two important intermediates are shown to be bound minima on the ground-state PES: azoniabenzvalene and a 6-aza[3.1.0]bicyclic ion with an exo-oriented substituent (analogous to prefulvene). We advance a mechanism which involves initial formation of this exo-bicyclic ion, followed by nitrogen migration around the ring via the azoniabenzvalene intermediate. Thus, the barrier separating the two intermediates is the factor that determines the degree of scrambling observed in the photoproducts when the carbon atoms are labeled with deuterium or substituted with additional methyl groups. For N-methylpyridinium, the exo-methyl bicyclic ion was computed to be approximately 1 kcalmol(-1) lower in energy than N-methyl-azoniabenzvalene. The transition state was computed to lie several kcal mol(-1) above the exo-methyl bicyclic ion (+8.4kcalmol(-1), 6-31G* RHF; +3.7kcalmol(-1), 6-31G* B3LYP), but still well below the energy available from the 254 nm excitation of the N-methylpyridinium ion. The computed relative energies correspond splendidly with several experimental findings which include the preference for exo products, the results of deuterium labeling, and the impact of additional substituent methyl groups on the product distribution.

N,N-dialkylaniline-substituted tetraethynylethenes: a new class of chromophores possessing an emitting charge-transfer state. Experimental and computational studies.

The photophysical properties of N,N-dimethylaniline- (DMA) substituted tetraethynylethene (TEE; 3,4-diethynylhex-3-ene-1,5-diyne) and related derivatives were investigated in a joint experimental and computational study. Measurements of the electronic emission spectra showed that these novel chromophores display a dual fluorescence which strongly depends on solvent polarity. Computational studies suggest that the twisted intramolecular charge-transfer state (TICT) model offers a possible explanation for the experimentally observed dual fluorescence. Time-dependent density functional calculations revealed that the initial excited state reached upon photoirradiation relaxes to a lower-energy TICT state in which either the dimethylamino group is twisted into an orthogonal position with respect to the remaining planar arylated TEE moiety or the entire DMA donor group takes an orthogonal orientation with respect to the rigid, planar TEE acceptor moiety. For the compounds investigated, the charge-transfer state responsible for the strongly solvent-dependent luminescence is directly connected with the initial excited state, namely, no crossing of states is involved.

Correlating the molecular electrostatic potentials of some organic peroxides with their antimalarial activities.

The molecular electrostatic potentials (MEPs) of artemisinin (also known as qinghaosu), yingzhaosu A, and some synthetic analogues have been calculated and studied as a means of distinguishing between high and low antimalarial activity. To facilitate comparison, the dimensionality of the MEP was reduced by Kohonen Neural Network transforms. The reduction revealed that peroxides exhibiting high antimalarial activity are characterized by a continuous strip of negative electric potential surrounding the molecule, whereas peroxides of lesser activity show a broken strip.

[The Procera Allceram all-ceramic system. The clinical and technical laboratory aspects in the use of a new all-ceramic system]. / Das Vollkeramiksystem Procera AllCeram. Klinische und labortechnische Aspekte bei der Anwendung eines neuen vollkeramischen Systems.

The aim of this article was to present the CAD/CAM-assisted Procera system as a new all-ceramic full-coverage crown system. New technologies need to be evaluated technically and clinically to be able to fulfill the requests for aesthetics, physical strength and biocompatibility when restoring the anterior and posterior region. The Procera AllCeram system offers the opportunity to fabricate densely sintered, high-purity, tooth-colored copings. Mechanical properties of the Procera alumina coping, indications and contraindications and additional applications are discussed. The clinical and technical procedures and any specific limitations and peculiarities are summarized and documented with clinical cases in a step-by-step illustration.

Brain uptake of tryptophan in urease-injected hyperammonemic rats after treatment with benzoate or hippurate.

The tryptophan uptake into forebrain and brainstem was measured in urease-injected rats and in controls after prior application of sodium benzoate or hippurate. Benzoate led to an increased brain uptake index of tryptophan. This effect was additive to the increase in tryptophan uptake effected by the provoked hyperammonemia. In contrast, hippurate did not alter tryptophan uptake across the blood-brain barrier. We conclude that benzoate should be monitored especially when applied intravenously to patients with hyperammonemic coma.

[Is there a seasonal fluctuation in the appearance of deep venous thrombosis?]. / Gibt es jahreszeitliche Schwankungen beim Auftreten von tiefen Venenthrombosen?

We have evaluated data from 481 patients. In all of them the incidence of postoperative dvt was registered by the 125I-labelled fibrinogen test. We have analysed our data in order to compare them with the results of Lawrence from Sydney. This author found a much higher incidence in dvt in the cold half of the year than in the hot months. However, in Basel there is no statistically significant difference in the incidence of dvt from month to month nor between the 4 seasons, and all this is independent from the type of drug prevention used. The conclusion we draw is that it is reasonable to use prevention of thromboembolic complications all the year round when living in Central Europe.