The regulatory network of the White Collar complex during early mushroom development in Schizophyllum commune.

Blue light is an important signal for fungal development. In the mushroom-forming basidiomycete Schizophyllum commune, blue light is detected by the White Collar complex, which consists of WC-1 and WC-2. Most of our knowledge on this complex is derived from the ascomycete Neurospora crassa, where both WC-1 and WC-2 contain GATA zinc-finger transcription factor domains. In basidiomycetes, WC-1 is truncated and does not contain a transcription factor domain, but both WC-1 and WC-2 are still important for development. We show that dimerization of WC-1 and WC-2 happens independent of light in S. commune, but that induction by light is required for promoter binding by the White Collar complex. Furthermore, the White Collar complex is a promoter of transcription, but binding of the complex alone is not always sufficient to initiate transcription. For its function, the White Collar complex associates directly with the promoters of structural genes involved in mushroom development, like hydrophobins, but also promotes the expression of other transcription factors that play a role in mushroom development.

Sensing of Continuum Robots: A Review.

The field of continuum robotics is rapidly developing. The development of new kinematic structures, locomotion principles and control strategies is driving the development of new types of sensors and sensing methodologies. The sensing in continuum robots can be divided into shape perception and environment perception. The environment perception is focusing on sensing the interactions between the robot and environment. These sensors are often embedded on an outer layer of the robots, so the interactions can be detected. The shape perception is sensing the robot's shape using various principles. There are three main groups of sensors that use the properties of electricity, magnetism and optics to measure the shape of the continuum robots. The sensors based on measuring the properties of electricity are often based on measuring the electrical resistance or capacitance of the flexible sensor. Sensors based on magnetism use properties of permanent magnets or coils that are attached to the robot. Their magnetic field, flux or other properties are then tracked, and shape reconstruction can be performed. The last group of sensors is mostly based on leveraging the properties of traveling light through optical fibers. There are multiple objectives of this work. Objective number one is to clearly categorize the sensors and make a clear distinction between them. Objective number two is to determine the trend and progress of the sensors used in continuum robotics. And finally, the third objective is to define the challenges that the researchers are currently facing. The challenges of sensing the shape or the interaction with the environment of continuum robots are currently in the miniaturization of existing sensors and the development of novel sensing methods.

Tibial fractures treated with mono-lateral fixation: Principles of design and application.

This paper presents the outcome of a data review of patients treated with the IOS external fixation system at the Royal Stoke University Hospital: a fixation designed to meet four requirements for external fixation proposed in this paper. Demographic data and outcome were collected and assessed. From 69 initial patients, 64 patients (55 males and 9 females) had an average age of 35.9 years. The mean time to union was 127 days. There were no incidences of malunion, or refracture post fixation removal attributable to the treatment method. In addition, in this cohort, there was no incidence of pin tract infection resulting in osteomyelitis. Of all the factors assessed the only factor to have any significant effect on healing was smoking: an average delay of 31 days. An examination of RUST (radiographic union score tibia) and modified RUST scores illustrated a potential false negative of up to 80%. Hence, this study cannot support the use of either scoring system to diagnose fracture healing. IOS external fixation was shown to be an effective method for the treatment of unstable tibial fractures. The reduction at fixation removal was shown to be very good. There was no incidence of osteomyelitis. It is, therefore, suggested that appropriately used external fixation is a viable alternative to intramedullary nailing if designed and surgically applied using four design principles outlined in this paper. Furthermore, it is proposed that external fixation be designed and applied to meet these four principles.

Perceived cognitive fatigue has only marginal effects on static balance control in healthy young adults.

We examined the influence of perceived cognitive fatigue on static balance control in healthy young adults to gain greater clarity about this issue than provided in previous research. Based on the prevailing assumption in pertinent literature, we hypothesized that the influence of cognitive fatigue on balance control depends on the attentional effort required by the balance tasks being performed. To test this hypothesis, 44 young adults (24 women and 20 men) were alternately assigned to either the experimental group that was cognitively fatigued (using the 16-min TloadDback-task with individualized settings) or the control group (who watched a documentary). Before and after the intervention, the participants performed six balance tasks that differed in (attentional) control requirements, while recording the center of pressure (COP). From these time series, sway variability, mean speed, and sample entropy were calculated and analyzed statistically. Additionally, perceived cognitive fatigue was assessed using VAS scales. Statistical analyses confirmed that the balance tasks differed in control characteristics and that cognitive fatigue was elevated in the experimental group, but not in the control group. Nevertheless, no significant main effects of cognitive fatigue were found on any of the COP measures of interest, except for some non-robust interaction effects related primarily to sample entropy. These results suggest that, in young adults, postural control in static balance tasks is largely automatic and unaffected by task-induced state fatigue.

Exploring running styles in the field through cadence and duty factor modulation.

According to the dual-axis model, running styles can be defined by cadence and duty factor, variables that have been associated with running performance, economy and injury risk. To guide runners in exploring different running styles, effective instructions to modulate cadence and duty factor are needed. Such instructions have been established for treadmill running, but not for overground running, during which speed can be varied. In this study, five participants completed eight field training sessions over a 4-week training period with acoustic instructions to modulate cadence, duty factor, and, in combination, running style. Instructions were provided via audio files. Running data were collected with sports watches. Participants' experiences with guided-exploration training were evaluated with the user experience questionnaire. Data analysis revealed acoustic pacing and verbal instructions to be effective in respectively modulating cadence and duty factor, albeit with co-varying effects on speed and the non-targeted variable (i.e. duty factor or cadence). Combining acoustic pacing and verbal instructions mitigated these co-varying effects considerably, allowing for running-style modulations in intended directions (particularly towards the styles with increased cadence and increased duty factor). User experience of this form of guided-exploration training was overall positive, but could be improved in terms of autonomy (dependability). In conclusion, combining acoustic pacing and verbal instructions for running-style modulation is effective in overground running.

[Selected legal aspects of end-of-life care : Euthanasia, palliative sedation and emergency medicine]. / Ausgewählte juristische Aspekte der Medizin am Lebensende : Sterbehilfe, palliative Sedierung und Notfälle.

The law distinguishes between several forms of intentional participation in life-shortening or life-ending acts ("euthanasia"). Therapy limitation is permitted or even required if the prerequisites for a medical intervention are no longer present. In contrast, active-direct killing (upon request) is categorically prohibited (§ 216 "Strafgesetzbuch" [StGB]). Considering the "fundamental right to self-determined dying", however, there is now a clear tendency to narrow the scope of punishable offences. This liberal "spirit of time" has already prevailed for assisted suicide, provided that it is carried out in a "freely responsible" manner. For pain therapy to reduce suffering, risks may be taken in light of the protection of life; however, here too, legitimization is required through the principle of actual or at least presumed consent. There are challenges in assessing and executing the patient's will in (suicidal) emergency situations, especially the adherence to autonomously made decisions on death.

Influence of MRI Follow-Up on Treatment Decisions during Standard Concomitant and Adjuvant Chemotherapy in Patients with Glioblastoma: Is Less More?

MRI is the gold standard for treatment response assessments for glioblastoma. However, there is no consensus regarding the optimal interval for MRI follow-up during standard treatment. Moreover, a reliable assessment of treatment response is hindered by the occurrence of pseudoprogression. It is unknown if a radiological follow-up strategy at 2-3 month intervals actually benefits patients and how it influences clinical decision making about the continuation or discontinuation of treatment. This study assessed the consequences of scheduled follow-up scans post-chemoradiotherapy (post-CCRT), after three cycles of adjuvant chemotherapy [TMZ3/6], and after the completion of treatment [TMZ6/6]), and of unscheduled scans on treatment decisions during standard concomitant and adjuvant treatment in glioblastoma patients. Additionally, we evaluated how often follow-up scans resulted in diagnostic uncertainty (tumor progression versus pseudoprogression), and whether perfusion MRI improved clinical decision making. Scheduled follow-up scans during standard treatment in glioblastoma patients rarely resulted in an early termination of treatment (2.3% post-CCRT, 3.2% TMZ3/6, and 7.8% TMZ6/6), but introduced diagnostic uncertainty in 27.7% of cases. Unscheduled scans resulted in more major treatment consequences (30%; p < 0.001). Perfusion MRI caused less diagnostic uncertainty (p = 0.021) but did not influence treatment consequences (p = 0.871). This study does not support the current pragmatic follow-up strategy and suggests a more tailored follow-up approach.

The Correlation of In Vivo MR Spectroscopy and Ex Vivo 2-Hydroxyglutarate Concentration for the Prediction of Isocitrate Dehydrogenase Mutation Status in Diffuse Glioma.

Isocitrate dehydrogenase (IDH) mutation status is an important biomarker in the glioma-defining subtype and corresponding prognosis. This study proposes a straightforward method for 2-hydroxyglutarate (2-HG) quantification by MR spectroscopy for IDH mutation status detection and directly compares in vivo 2-HG MR spectroscopy with ex vivo 2-HG concentration measured in resected tumor tissue. Eleven patients with suspected lower-grade glioma (ten IDH1; one IDHwt) were prospectively included. Preoperatively, 3T point-resolved spectroscopy (PRESS) was acquired; 2-HG was measured as the percentage elevation of Glx3 (the sum of 2-HG and Glx) compared to Glx4. IDH mutation status was assessed by immunochemistry or direct sequencing. The ex vivo 2-HG concentration was determined in surgically obtained tissue specimens using gas chromatography-mass spectrometry. Pearson correlation was used for assessing the correlation between in vivo MR spectroscopy and ex vivo 2-HG concentration. MR spectroscopy was positive for 2-HG in eight patients, all of whom had IDH1 tumors. A strong correlation (r = 0.80, p = 0.003) between 2-HG MR spectroscopy and the ex vivo 2-HG concentration was found. This study shows in vivo 2-HG MR spectroscopy can non-invasively determine IDH status in glioma and demonstrates a strong correlation with ex vivo 2-HG concentration in patients with lower-grade glioma.

[Selected legal aspects regarding limiting treatment at the end of life : Patient advance directive, proxy and indications]. / Ausgewählte juristische Aspekte der Therapiebegrenzung : Patientenverfügung, Stellvertretung und Indikation.

Respect for the patient's right to self-determination and the professional medical assessment of the (continued) existence of a therapeutic prospect of success of the respective curative intervention ("indication") are the two central reference parameters of every medical therapeutic decision. This is particularly true in cases of a progressive, irreversible, fatal course of the disease. However, the assessment of the presumed will of the patient or the meaningfulness of curative (intensive care) prolongation of life frequently causes difficulties. The law cannot eliminate these doubts in each individual case; it does, however, provide a framework so that factually and ethically justified therapy decisions can be made in each case. In this function, this legal framework-no matter how much it must first be concretized in the respective decision case-demands strict observance. This also includes the most recent change in the law that went into effect on 1 January 2023, through the introduction of a statutory right of (emergency) representation for spouses.

Role of respiratory characteristics in treatment adherence with noninvasive home mechanical ventilation in myotonic dystrophy type 1, a retrospective study.

Chronic respiratory insufficiency is common in patients with myotonic dystrophy type 1 (DM1) and can be treated with noninvasive home mechanical ventilation (HMV). HMV is not always tolerated well resulting in low treatment adherence. We aimed to analyze if baseline respiratory characteristics such as pulmonary function, level of pCO2 and presence of sleep apnea are associated with HMV treatment adherence in DM1 patients. Pulmonary function testing, polysomnography and blood gas measurement data of DM1 patients were retrospectively collected. Initiation of HMV and treatment adherence after one year was documented. Patients with low treatment adherence (average daily use of HMV <5 h) were grouped with patients that discontinued HMV and compared with patients with high treatment adherence (average daily use of HMV >5 h). HMV was initiated in 101 patients. After one year, 58 patients had low treatment adherence. There were no differences between the low and high treatment adherence group regarding the respiratory characteristics. None of the included predictors (gender, age, body mass index, cytosine-thymine-guanine repeat length, FVC, daytime pCO2, bicarbonate, nighttime pCO2, nighttime base excess, apnea-hypopnea index and mean saturation during sleep) was able to significantly predict high treatment adherence. In conclusion, the respiratory characteristics are not associated with treatment adherence with HMV in DM1 patients and cannot be used to identify patients at risk for low HMV treatment adherence.

Effect of anastomotic configuration on Crohn's disease recurrence after primary ileocolic resection: a comparative monocentric study of end-to-end versus side-to-side anastomosis.

There is ongoing debate whether the type of anastomosis following intestinal resection for Crohn's disease (CD) can impact on complications and postoperative recurrence. The aim of the present study is to describe the outcomes of side-to-side (S-S) vs end-to-end (E-E) anastomosis after ileocecal resection for CD. A retrospective comparative study was conducted in consecutive CD patients who underwent primary ileocecal resection between 2005 and 2013. All patients underwent colonoscopy 6 months postoperatively to assess endoscopic recurrence, defined as Rutgeerts' score (RS) ≥ i2. Surgical recurrence implied reoperation due to CD activity at the anastomotic site. Modified surgical recurrence was defined as the need for reoperation or balloon-dilation. Perioperative factors related to recurrence were evaluated. Of the 127 patients included, 51 (40.2%) received an E-E anastomosis. Median follow-up was longer in the E-E group (8.62 vs 13.68 years). Apart from the microscopic resection margins, patient, disease and surgical characteristics were similar between both groups. Anastomotic complications were comparable (S-S 5.3% vs E-E 5.8%, p = 1.00)0. Postoperatively, biologicals were used in 55.3% and 62.7% (p = 0.47) in S-S and E-E patients, respectively. Endoscopic recurrence did not differ between S-S and E-E patients (78.9 vs 72.9%, p = 0.37), with no significant difference in RS values between both groups (p = 0.87). Throughout follow-up, a higher surgical (p = 0.04) and modified surgical recurrence (p = 0.002) rate was observed in the E-E anastomosis group. Type of anastomosis was an independent risk factor for modified surgical recurrence. The type of anastomosis did not influence endoscopic recurrence and immediate postoperative disease complications. However, the wide diameter and the morphologic characteristic of the stapled S-S anastomosis resulted in a significant reduced risk for surgical and endoscopic reintervention on the long term.

Explaining refugee flows. Understanding the 2015 European refugee crisis through a real options lens.

In 2015 the unprecedented arrival of refugees in Europe posed serious challenges for the EU and its member countries on how to deal with such an influx. A key element in better managing refugee flows is to understand what drives these flows in a certain direction. A refugee who comes to Europe has to make trade-offs in terms of cost and benefits, duration, uncertainty and the multi-staged character of the journey. Real options models are a suitable tool for modelling these kind of decision dynamics. On the basis of a case-study, that compares three routes from Syria to Europe, we demonstrate how well the real options analysis is in line with the development of the refugee flows.

Association of online screen media exposure and burnout among adolescent senior high school students enrolled in different online curricula in Metro Manila: An analytic cross-sectional study / The Health Sciences Journal

Introduction@#Due to COVID-19 pandemic, it became imperative for the education sector to shift to online curriculum and eventually hybrid education. However, this policy posed challenges to educators and students, such as increased workload, prolonged screen time, and burnout. This study determined the association of online screen media exposure and burnout among adolescent senior high school students enrolled in different online curricula in Metro Manila.@*Methods@#This analytic cross-sectional study identified adolescent senior high school students in Metro Manila who were recruited via non-probability convenience sampling. Online screen media exposure was assessed based on the cut off value of four (4) or more hours of device usage related to online schooling, and participants answered the Copenhagen Burnout Inventory (CBI) to ascertain presence or absence of said condition. Data analysis included cross-tabulation for prevalence rate ratio (PRR), and Chi-square test for statistical significance.@*Results@#Of the 117 respondents, most had significant online screen media exposure (75.21%). For the CBI, 51 study subjects garnered a score of 50 and above, suggesting that 43.59% of the adolescents might be suffering from burnout. In addition, PRR was calculated to be 3.9 (p-value of .002).@*Conclusion@#Among adolescent senior high school students with significant online screen media exposure of four hours or more, there was 3.9 higher risk of exhibiting burnout symptoms, and this was statistically significant.

A Tempered Particle Filter to Enhance the Assimilation of SAR-Derived Flood Extent Maps Into Flood Forecasting Models.

Data assimilation (DA) is a powerful tool to optimally combine uncertain model simulations and observations. Among DA techniques, the particle filter (PF) has gained attention for its capacity to deal with nonlinear systems and for its relaxation of the Gaussian assumption. However, the PF may suffer from degeneracy and sample impoverishment. In this study, we propose an innovative approach, based on a tempered particle filter (TPF), aiming at mitigating PFs issues, thus extending over time the assimilation benefits. Probabilistic flood maps derived from synthetic aperture radar data are assimilated into a flood forecasting model through an iterative process including a particle mutation in order to keep diversity within the ensemble. Results show an improvement of the model forecasts accuracy, with respect to the Open Loop: on average the root mean square error (RMSE) of water levels decrease by 80% at the assimilation time and by 60% 2 days after the assimilation. A comparison with the Sequential Importance Sampling (SIS) is carried out showing that although SIS performances are generally comparable to the TPF ones at the assimilation time, they tend to decrease more quickly. For instance, on average TPF-based RMSE are 20% lower compared to the SIS-based ones 2 days after the assimilation. The application of the TPF determines higher critical success index values compared to the SIS. On average the increase in performances lasts for almost 3 days after the assimilation. Our study provides evidence that the application of the variant of the TPF enables more persistent benefits compared to the SIS.

Dynamics and Predictability of Tropical Cyclone Rapid Intensification in Ensemble Simulations of Hurricane Patricia (2015).

Hurricane Patricia (2015) over the eastern Pacific was a record-breaking tropical cyclone (TC) under a very favorable environment during its rapid intensification (RI) period, which makes it an optimal real case for studying RI dynamics and predictability. In this study, we performed ensemble Kalman filter analyses at Patricia's early development stage using both traditional observations and the Office of Naval Research Tropical Cyclone Intensity (TCI) field campaign data. It is shown that assimilating the inner-core TCI observations produces a stronger initial vortex and significantly improves the prediction of RI. Analysis of observation sensitivity experiments shows that the deep-layer dropsonde observations have high impact on both the primary and secondary circulations for the entire troposphere while the radar observations have the most impact on the primary circulations near aircraft flight level. A wide range of intensification scenarios are obtained through two sets of ensemble forecasts initialized with and without assimilating the TCI data prior to the RI onset. Verification of the ensemble forecasts against the TCI observations during the RI period shows that forecast errors toward later stages can originate from two different error sources at early stages of the vortex structure: One is a timing error from a delayed vortex development such that the TC evolution is the same but shifted in time; the other is due to a totally different storm such that there is no moment in time the simulated storm can obtain a correct TC structure.

Rain-Induced Stratification of the Equatorial Indian Ocean and Its Potential Feedback to the Atmosphere.

Surface freshening through precipitation can act to stably stratify the upper ocean, forming a rain layer (RL). RLs inhibit subsurface vertical mixing, isolating deeper ocean layers from the atmosphere. This process has been studied using observations and idealized simulations. The present ocean modeling study builds upon this body of work by incorporating spatially resolved and realistic atmospheric forcing. Fine-scale observations of the upper ocean collected during the Dynamics of the Madden-Julian Oscillation field campaign are used to verify the General Ocean Turbulence Model (GOTM). Spatiotemporal characteristics of equatorial Indian Ocean RLs are then investigated by forcing a 2D array of GOTM columns with realistic and well-resolved output from an existing regional atmospheric simulation. RL influence on the ocean-atmosphere system is evaluated through analysis of RL-induced modification to surface fluxes and sea surface temperature (SST). This analysis demonstrates that RLs cool the ocean surface on time scales longer than the associated precipitation event. A second simulation with identical atmospheric forcing to that in the first, but with rainfall set to zero, is performed to investigate the role of rain temperature and salinity stratification in maintaining cold SST anomalies within RLs. Approximately one third, or 0.1°C, of the SST reduction within RLs can be attributed to rain effects, while the remainder is attributed to changes in atmospheric temperature and humidity. The prolonged RL-induced SST anomalies enhance SST gradients that have been shown to favor the initiation of atmospheric convection. These findings encourage continued research of RL feedbacks to the atmosphere.

The Transcription Factor Roc1 Is a Key Regulator of Cellulose Degradation in the Wood-Decaying Mushroom Schizophyllum commune.

Wood-decaying fungi of the class Agaricomycetes (phylum Basidiomycota) are saprotrophs that break down lignocellulose and play an important role in nutrient recycling. They secrete a wide range of extracellular plant cell wall degrading enzymes that break down cellulose, hemicellulose, and lignin, the main building blocks of plant biomass. Although the production of these enzymes is regulated mainly at the transcriptional level, no activating regulators have been identified in any wood-decaying fungus in the class Agaricomycetes. We studied the regulation of cellulase expression in the wood-decaying fungus Schizophyllum commune. Comparative genomics and transcriptomics on two wild isolates revealed a Zn2Cys6-type transcription factor gene (roc1) that was highly upregulated during growth on cellulose, compared to glucose. It is only conserved in the class Agaricomycetes. A roc1 knockout strain showed an inability to grow on medium with cellulose as sole carbon source, and growth on cellobiose and xylan (other components of wood) was inhibited. Growth on non-wood-related carbon sources was not inhibited. Cellulase gene expression and enzyme activity were reduced in the Δroc1 strain. ChIP-Seq identified 1474 binding sites of the Roc1 transcription factor. Promoters of genes involved in lignocellulose degradation were enriched with these binding sites, especially those of LPMO (lytic polysaccharide monooxygenase) CAZymes, indicating that Roc1 directly regulates these genes. A conserved motif was identified as the binding site of Roc1, which was confirmed by a functional promoter analysis. Together, Roc1 is a key regulator of cellulose degradation and the first identified in wood-decaying fungi in the phylum Basidiomycota. IMPORTANCE Wood-degrading fungi in the phylum Basidiomycota play a crucial role in nutrient recycling by breaking down all components of wood. Fungi have evolved transcriptional networks that regulate expression of wood-degrading enzymes, allowing them to prioritize one nutrient source over another. However, to date all these transcription factors have been identified in the phylum Ascomycota, which is only distantly related to the phylum Basidiomycota. Here, we identified the transcription factor Roc1 as a key regulator of cellulose degradation in the mushroom-forming and wood-degrading fungus Schizophyllum commune. Roc1 is highly conserved in the phylum Basidiomycota. Using comparative genomics, transcriptomics, ChIP-Seq and promoter analysis we have identified direct targets of Roc1, as well as other aspects of the transcriptional response to cellulose.

Ventricle contact may be associated with higher 11C methionine PET uptake in glioblastoma.

PURPOSE: Ventricle contact is associated with a worse prognosis and more aggressive tumor characteristics in glioblastoma (GBM). This is hypothesized to be a result of neural stem cells located around the lateral ventricles, in the subventricular zone. 11C Methionine positron emission tomography (metPET) is an indicator for increased proliferation, as it shows uptake of methionine, an amino acid needed for protein synthesis. This study is the first to study metPET characteristics of GBM in relation to ventricle contact. METHODS: A total of 12 patients with IDH wild-type GBM were included. Using MRI, the following regions were determined: primary tumor (defined as contrast enhancing lesion on T1) and peritumoral edema (defined as edema visible on FLAIR excluding the enhancement). PET parameters in these areas were extracted using PET fused with MRI imaging. Parameters extracted from the PET included maximum and mean tumor-to-normal ratio (TNRmax and TNRmean) and metabolic tumor volume (MTV). RESULTS: TNRmean of the primary tumor showed significantly higher values for the ventricle-contacting group compared to that for the non-contacting group (4.44 vs 2.67, p = 0.030). Other metPET parameters suggested higher values for the ventricle-contacting group, but these differences did not reach statistical significance. CONCLUSION: GBM with ventricle contact demonstrated a higher methionine uptake and might thus have increased proliferation compared with GBM without ventricle contact. This might explain survival differences and should be considered in treatment decisions.

Nutritional status of patients referred for hyperbaric oxygen treatment; a retrospective and descriptive cross-sectional study.

INTRODUCTION: Due to the global rise of obesity, the role of nutrition has gathered more attention. Paradoxically, even overweight persons may be malnourished. This may delay wound healing or recovery of late radiation tissue injury (LRTI). Hyperbaric oxygen treatment (HBOT) is used to improve wound healing or LRTI complaints. The aim of this study was to assess the dietary intake levels of nutrients important for recovery in patients referred for HBOT. METHODS: This was a retrospective, cross-sectional study of patients referred for HBOT to a single centre between 2014 and 2019. Patients were offered a consultation with a dietitian as standard care. Information on nutrients was calculated from questionnaires, and compared to recommended daily allowances. RESULTS: One hundred and forty-six patients were included (80 female). Eighteen patients were treated for diabetic ulcers, 25 for non-diabetic ulcers and 103 for LRTI. Most were overweight or obese (64.4%), but did not consume the recommended quantities of calories, protein, or micronutrients. Vitamin C consumption was higher than recommended. Male patients had a higher intake of calories and protein than female patients but not other nutrients. No differences in intake existed between age or body mass index categories. CONCLUSIONS: The nutritional status of patients referred for HBOT may be inadequate for healing wounds or LRTI, despite anthropomorphic data indicating a positive energy balance. Daily attendance for HBOT provides a unique opportunity to monitor and correct these deficiencies. Routine screening for malnutrition and supplement deficiencies is recommended for patients referred for HBOT.

The lower limit for FEV1/FVC in dive medical assessments: a retrospective study.

INTRODUCTION: Interpreting pulmonary function test (PFT) results requires a valid reference set and a cut-off differentiating pathological from physiological pulmonary function; the lower limit of normal (LLN). However, in diving medicine it is unclear whether an LLN of 2.5% (LLN-2.5) or 5% (LLN-5) in healthy subjects constitutes an appropriate cut-off. METHODS: All PFTs performed at the Royal Netherlands Navy Diving Medical Centre between 1 January 2015 and 1 January 2021 resulting in a forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and/or FEV1/FVC with a Z-score between -1.64 (LLN-5) and -1.96 (LLN-2.5) were included. Records were screened for additional tests, referral to a pulmonary specialist, results of radiological imaging, and fitness to dive. RESULTS: Analysis of 2,108 assessments in 814 subjects showed that 83 subjects, 74 men and nine women, mean age 32.4 (SD 8.2) years and height 182 (7.0) cm, had an FVC, FEV1 and/or FEV1/FVC with Z-scores between -1.64 and -1.96. Of these 83 subjects, 35 (42%) underwent additional tests, 77 (93%) were referred to a pulmonary specialist and 31 (37%) underwent high-resolution CT-imaging. Ten subjects (12%) were declared 'unfit to dive' for various reasons. Information from their medical history could have identified these individuals. CONCLUSIONS: Use of LLN-2.5 rather than LLN-5 for FEV1/FVC in asymptomatic individuals reduces additional investigations and referrals to a pulmonary specialist without missing important diagnoses, provided a thorough medical history is taken. Adoption of LLN-2.5 could save resources spent on diving medical assessments and protect subjects from harmful side effects associated with additional investigations, while maintaining an equal level of safety.