Interprofessional education: a necessity in Alzheimer's dementia care-a pilot study.

Introduction: Interprofessional collaboration is seen as an indispensable prerequisite for high-quality health services and patient care, especially for complex diseases such as dementia. Thus, the current project aimed to extend interprofessional and competency-based education in the field of dementia care to the previously understudied therapy professions of nutrition, speech-language pathology, and physiotherapy. Methods: A three-day workshop was designed to provide specific learning objectives related to patient-centered dementia care, as well as competences for interprofessional collaboration. Teaching and learning approaches included case-based learning in simulated interprofessional case-conferences and peer-teaching. A total of 42 students (n = 20 nutrition therapy and counseling, n = 8 speech-language pathology, n = 14 physiotherapy), ranging from first to seventh semester, finished the whole workshop and were considered in data analysis. Changes in self-perceived attitudes toward interprofessional collaboration and education were measured by the German version of the UWE-IP. An in-house questionnaire was developed to evaluate knowledge and skills in the field of dementia, dementia management and interprofessional collaboration. Results: Participation in the workshop led to significant improvements in the total scores of the UWE-IP-D and the in-house questionnaire, as well as their respective subscales. Moderate to large effect sizes were achieved. All professions improved significantly in both questionnaires with large effect sizes. Significant differences between professions were found in the UWE-IP-D total score between students of speech-language pathology and physiotherapy in the posttest. Students of nutrition therapy and counseling revealed a significant lower level of self-perceived knowledge and skills in the in-house questionnaire pre- and post-testing. Discussion: The pilot-study confirms the effectiveness of interprofessional education to promote generic and interprofessional dementia care competencies and to develop positive attitudes toward interprofessional learning and collaboration in the therapy professions, thus increasing professional diversity in interprofessional education research. Differences between professions were confounded by heterogenous semester numbers and participation conditions. To achieve a curricular implementation, interprofessional education should be expanded to include a larger group of participants belonging to different professions, start early in the study program, and be evaluated over the long term.

[Relationship Between Social Integration, Global Self-Esteem, and Physical and Mental Health in a Representative German Sample]. / Zusammenhang von sozialer Teilhabe, globalem Selbstwert sowie physischer und psychischer Gesundheit in einer repräsentativen deutschen Stichprobe.

INTRODUCTION: Beyond participation as a civil right, social participation has already been considered from legal, ethical, socio-psychological and political perspectives as an important component of the self- and external evaluation of a person as a valuable member of a society. Thus, social psychological studies frequently showed the importance of the sense of belonging as a central psychological component of social participation for both personal and social self-esteem. From a medical-psychological perspective, the association of global self-esteem and self-efficacy with health is well established. However, it is an open question whether social participation is directly related to psychological and physical well-being or whether this relationship is mediated via global self-esteem. MATERIAL AND METHODS: Based on a nationwide representative survey in Germany (N=2.531; age 14-93, M=48.58; 55.4% women), the variables social participation (KsT-5), global self-esteem (SISE), and physical and mental health (EQ5D) were measured using standardized questionnaires to examine a potential mediation. RESULTS: As expected, significant positive correlations between social participation, global self-esteem and physical and mental health were found with medium ranged effect sizes. However, global self-esteem only partially mediated the association between social participation and health, i. e. a direct significant association between social participation and health could be proven. DISCUSSION: The results underline the direct relevance of social participation for physical and mental health. This opens a hitherto hardly used perspective for health promotion in interaction with socio-political challenges in the topics of integration, inclusion and the sense of belonging.

Spinal Neuromodulation for Peripheral Arterial Disease of Lower Extremities: A Ten-Year Retrospective Analysis.

OBJECTIVE: This long-term retrospective study evaluated the survival and amputation outcome of subjects who received neuromodulation therapy for the management of peripheral arterial disease (PAD). MATERIALS AND METHODS: The study reviews the health data of a single cohort of 51 patients who received spinal neuromodulation (spinal cord stimulation [SCS] or dorsal root ganglion stimulation [DRG-S]) for PAD from 2007 to 2022 in a single German center. Survival rate and major amputation rate were determined. Pain, quality of life, walking distance, and opioid usage were assessed before implantation (baseline), one, six, and 12 months (M) after implantation, and then annually (during a follow-up visit). Implant-related complications also were documented. RESULTS: In total, 51 patients (37 men [mean age 68.9 ± 10.2 years], 14 women [mean age (68.7 ± 14.6 years]) underwent SCS (n = 49) or DRG-S (n = 2) implantation owing to persistent ischemic pain. The follow-up mean years ± SD is 4.04 ± 2.73. At baseline, patients were classified as Rutherford's category 3 (n = 23), category 4 (n = 15) or category 5 (n = 9). At 24 M, 42 of 47 patients did not require a major amputation after the implant. All the patients reported nearly complete pain relief from pain at rest. A total of 75% of patients were able to walk >200 m, and 87% of patients who used opioids at baseline were off this medication at 24 M. Overall, 93% of patients reported an improvement in their overall health assessment. These improved outcomes were sustained through years three to 10 for patients who have reported outcomes. CONCLUSIONS: Our single-center data support the efficacy of spinal neuromodulation for improvements in limb salvage, pain relief, mobility, and quality of life. The data also show that neuromodulative therapy has a long-term therapeutic effect in patients with chronic limb pain with Rutherford category 3, 4, and 5 PAD.

Entomological identification of the post-mortem colonization of wolf cadavers in different decomposition stages.

Human-driven biodiversity loss is progressively becoming a problem with dramatic consequences for the conservation of vital ecosystems. The increasing number of illegal killings of the grey wolf (Canis lupus, Linnaeus, 1758), a threatened species, displays the need for investigation and prosecution of such offences. Forensic entomology makes use of the knowledge about necrophagous insects to estimate a minimum time-since-death interval of the deceased person or animal, which can give important information on a possible perpetrator. The cadaver fauna along five decomposition stages of wolves in Germany was investigated in the period 2014-2021. The insects from 70 wolf cadavers, originating from all over Germany, were provided by the Leibniz Institute for Zoo and Wildlife Research Berlin. The accumulated degree day (ADD) model was applied for the post-mortem interval estimation on wolf cadavers for the first time. A total of 20 coleopteran species and 14 different dipteran species were discovered and identified. Almost 99 % of all insect specimens were from the order of Diptera, and beetles (Coleoptera) accounted for only 1 % of the cadaver fauna. The blowflies (Calliphoridae) are of particular importance for forensic issues, accounting for about 66 % of all families. Carrion beetles (Silphidae) were found as the second most abundant family (about 21 %). In addition, combining all cases, a steadily increasing insect species richness S was detected from early decay to advanced decay (fresh S = 8; bloated S = 12; active decay S = 21; advanced decay S = 34). In the following remains stage, the species number decreased again (S = 24). However, no significant difference in the number of species was found between the stages of decay when the cases were considered individually. The temporal pattern of insect appearance was found to be congruent with those of previous studies. Furthermore, a time of death was determined for each case and compared to the pathologist's estimates. This study provides insights into the arthropod fauna of wolf remains for the first time, applies the ADD-Model for post-mortem interval estimation, and discusses the suitability of forensic entomology for wildlife death investigations.

Three-Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities.

OBJECTIVES: Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology. MATERIALS AND METHODS: Twenty-seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36-month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3-, 6-, 12-, 18-, 24-, and 36 months post-permanent implant. Implant-related complications were also documented. RESULTS: Compared to baseline, we observed a significant pain relief (p < 0.001) at 3 (58%), 12 (66%), 18 (69%), 24 (71%), and 36 months (73%) in 21 patients (52.5 ± 14.2 years; 12 female), respectively. Mental and physical function showed immediate and sustained improvements. Participants reported improvements in quality of life. Opioid dosage reduced significantly (p < 0.001) at 3 (30%), 12 (93%), 18 (98%), 24 (99%), and 36 months (99%), and 20 of 21 patients were completely opioid-free after 36 months. There were five lead migrations and two electrode fractures (corrected by surgical intervention) and one wound infection (conservatively managed). CONCLUSIONS: DRG neuromodulation appears to be a safe, effective, and durable option for treating neuropathic pain caused by PNI. The treatment allows cessation of often ineffective pharmacotherapy (including opioid misuse) and significantly improves quality of life.

The Meaningfulness of Effect Sizes in Psychological Research: Differences Between Sub-Disciplines and the Impact of Potential Biases.

Effect sizes are the currency of psychological research. They quantify the results of a study to answer the research question and are used to calculate statistical power. The interpretation of effect sizes-when is an effect small, medium, or large?-has been guided by the recommendations Jacob Cohen gave in his pioneering writings starting in 1962: Either compare an effect with the effects found in past research or use certain conventional benchmarks. The present analysis shows that neither of these recommendations is currently applicable. From past publications without pre-registration, 900 effects were randomly drawn and compared with 93 effects from publications with pre-registration, revealing a large difference: Effects from the former (median r = 0.36) were much larger than effects from the latter (median r = 0.16). That is, certain biases, such as publication bias or questionable research practices, have caused a dramatic inflation in published effects, making it difficult to compare an actual effect with the real population effects (as these are unknown). In addition, there were very large differences in the mean effects between psychological sub-disciplines and between different study designs, making it impossible to apply any global benchmarks. Many more pre-registered studies are needed in the future to derive a reliable picture of real population effects.

Entomological and Cardiologic Evidence of Time Since Death in Short Postmortem Intervals.

Estimating the time since death of the deceased is a main goal in forensic investigations, but this can be challenging due to contradictory results derived from different investigations at the scene of death. We present a case of a 78-year-old woman, found dead in a small forest with broad-leaved trees, whose husband had a history of domestic violence. Routinely performed investigations, such as postmortem rectal temperature and lividity, yielded inconsistent time since death results between only a few and longer than 20 h. This difficulty was most likely caused by high ambient temperatures of up to 38.0°C, which negatively influenced the informative value of the applied nomogram method. Additionally, performed entomological investigation of fly maggots (Lucilia illustris) recovered from the corpse and the assessment of heart pacemaker data revealed consistent and incontrovertible results. The presented case highlights the benefits of information provided by entomological investigations and data evaluation of cardiac implantable electronic devices and the combined use of the two techniques.

Can gender priming eliminate the effects of stereotype threat? The case of simple dynamic systems.

Mathematics and mental rotation are classic fields where it has been shown that priming women with their gender identity impedes performance. Whereas past research focused mainly on stereotype threat effects in women in a narrowly defined context, this study broadened the research focus: We primed 264 women and men equally with a male, a neutral, or a female prime before they had to solve a simple dynamic system task. As expected, female-primed women subsequently performed worst of all six groups. Solution rates were almost 14% higher for the women in the male-primed condition. Men performed better than women in all three priming conditions. However, this difference was reduced in the male-primed condition as women's performance had increased as anticipated. Unexpected was a decline in the male performance in the same condition. The study showed that gender priming had a significant effect on women in tasks involving simple dynamic systems. However, mathematical knowledge and area of occupation clearly were stronger predictors for both men and women. Priming alone cannot eliminate the effects of stereotype threat.

Meta-analyses and other methodological issues in meditation research: Reply to Orme-Johnson and Dillbeck (2014).

We are grateful to Orme-Johnson and Dillbeck (2014) for raising several potential methodological concerns they have with our meta-analysis of the psychological effects of meditation and for thereby providing us with the opportunity to clarify these points. Orme-Johnson and Dillbeck raised 4 points that they believed might have led to unfair treatment of studies that reported the effects of transcendental meditation (TM). First, they were concerned with the way we aggregated effects over different categories of variables. Second, they disagreed with our contention that there might have been some upward bias in the effects reported for TM studies. Third, they argued that the results from TM studies do not differ depending on whether studies were done by researchers affiliated with TM institutions, and 4th, they questioned the completeness of our selection of TM studies. We still believe that our methodology for reporting study results was justified on theoretical grounds and argue that the results for all variable categories are readily available in our analysis. We also still find some indication of upward bias for TM studies, even using the method they propose. We cannot say much regarding author affiliation because we did not raise that point, and, last, we have to concede that we indeed missed some TM studies. Yet this omission did not have any substantial practical consequences concerning our conclusions. We end with a short discussion about how meditation research should be conducted in the future.

The heart beat does not make us tick: the impacts of heart rate and arousal on time perception.

According to popular models of human time perception, variations in prospective timing are caused by two factors: the pulse rate of an internal pacemaker and the amount of attention directed to the passage of time. The results concerning the effect of attention on subjective timing have been conclusive, but the mechanisms that drive the pacemaker are still far from being understood. In two experiments, we examined the impact of two factors that in the existing literature on human time perception have been argued to affect such a pacemaker: arousal and heart rate. Experienced arousal and heart rate were varied independently by means of specific physical exercises: (a) A muscle exercise increased arousal and heart rate; (b) a breath-holding exercise increased arousal but decreased heart rate; and (c) in the control condition, arousal and heart rate were held constant. The results indicate that increased subjective arousal leads to higher time estimates, whereas heart rate itself has no relevant impact on time perception. The results are discussed with respect to the underlying mechanisms of prospective time perception.

The psychological effects of meditation: a meta-analysis.

In this meta-analysis, we give a comprehensive overview of the effects of meditation on psychological variables that can be extracted from empirical studies, concentrating on the effects of meditation on nonclinical groups of adult meditators. Mostly because of methodological problems, almost ¾ of an initially identified 595 studies had to be excluded. Most studies appear to have been conducted without sufficient theoretical background. To put the results into perspective, we briefly summarize the major theoretical approaches from both East and West. The 163 studies that allowed the calculation of effect sizes exhibited medium average effects (r = .28 for all studies and r = .27 for the n = 125 studies from reviewed journals), which cannot be explained by mere relaxation or cognitive restructuring effects. In general, results were strongest (medium to large) for changes in emotionality and relationship issues, less strong (about medium) for measures of attention, and weakest (small to medium) for more cognitive measures. However, specific findings varied across different approaches to meditation (transcendental meditation, mindfulness meditation, and other meditation techniques). Surprisingly, meditation experience only partially covaried with long-term impact on the variables examined. In general, the dependent variables used cover only some of the content areas about which predictions can be made from already existing theories about meditation; still, such predictions lack precision at present. We conclude that to arrive at a comprehensive understanding of why and how meditation works, emphasis should be placed on the development of more precise theories and measurement devices.

Interface phenomena in (super)hard nitride nanocomposites: from coatings to bulk materials.

Mechanical properties of nanocomposites usually surpass the mechanical properties of their micro-structured and single-crystalline counterparts. This is mainly due to an extremely high density of internal interfaces in nanocomposites like grain, crystallite and phase boundaries. When compared to diamond, carbides and borides, nitrides are of interest because of their high temperature oxidation resistance and compatibility with iron containing alloys. This tutorial review classifies the contributions of various internal interfaces to the hardness of the nanocomposites, and appreciates the outstanding role of partially coherent phase boundaries in the hardness enhancement. With selected examples of transition metal nitrides containing aluminium and silicon as well as of boron nitrides, it is explained how the nanocomposites with partially coherent phase boundaries and thus with enhanced hardness can be synthesised. As the possible ways of the formation of coherent phase boundaries, the local epitaxial growth of phases with limited mutual solubility, the production of supersaturated solid solutions followed by the segregation of elements during the spinodal decomposition and the incomplete phase transformation are discussed. The most important techniques, used for synthesis of nitride nanocomposites, like CVD, PVD, precursor-based methods, mechanical alloying and high-pressure-high-temperature synthesis are briefly reviewed. Besides, a short overview on hardness definitions and hardness measurements is included.

The tautomeric forms of cyameluric acid derivatives.

The tautomerism of cyameluric acid C6N7O3H3 (1 a), cyamelurates and other heptazine derivatives has recently been studied by several theoretical investigations. In this experimental study we prepared stannyl and silyl derivatives of cyameluric acid (1 a): C6N7O3[Sn(C4H9)3]3 (3 a), C6N7O3[Sn(C2H5)3]3 (3 b), and C6N7O3[Si(CH3)3]3 (4). In order to investigate the structure of 1 a the mono- and dipotassium cyamelurate hydrates K(C6N7O3H2)2 H2O (5) and K2(C6N7O3H)1 H2O (6) were synthesized by UV/Vis-controlled titration of a potassium cyamelurate solution with aqueous hydrochloric acid. Compounds 3-6 were characterized by FTIR and solid-state NMR spectroscopy as well as simultaneous thermal analysis (TGA, DTA). The single crystal X-ray structures of the salts 5 and 6 show that the hydrogen atoms in both anions are localized on the peripheral nitrogen atoms. This indicates-in combination with the solid-state NMR studies-that the most stable tautomer of solid 1 a is the triketo form with C3h symmetry. However, derivatives of both the hydroxyl and the amido tautomers may be formed depending on the substituent atoms: The spectroscopic data and single crystal structures of compounds C6N7O3[Si(CH3)3]3 (4) and the solvate C6N7O3[Sn(C2H5)3]3C2H4Cl2 (3 b') show that the former is derived from the symmetric trihydroxy form of 1 a, while 3 b' crystallizes as a chain-like polymer, which contains the tin atoms as multifunctional building blocks, that is, bridging pentacoordinated Et3SnO2 and Et3SnON units as well as non-bridging four-coordinated Et3SnN units. The cyameluric nucleus is part of the polymeric chains of C6N7O3[Sn(C2H5)3]3C2H4Cl2 (3 b'), by the action of both tautomeric forms of cyameluric acid, the amide and the ester form.

s-Triazine and tri-s-triazine based organic-inorganic hybrid gels prepared from chlorosilanes by exchange reactions.

Hybrid polymers [(DeltaO3)4Si3]n and [(DeltaO3)SiMe]n (where Delta = C6N7 or C3N3) have been prepared by a novel sol-gel process based on exchange reactions of MeSiCl3 or SiCl4 with C6N7(OSiMe3)3 and C3N3(OSiMe3)3.