The Notion of Continuing Education in Local Education Reports in Germany—An Analysis of Regional Disparities in Topics, Data, and Governance Recommendations

In Germany: continuing education (CE) is, to a large extent, controlled by municipalities (“Kommunen”). Municipalities have published an increasing number of education reports in recent years. These are intended as steering instruments for local education policy. Given that municipalities and the districts they represent differ in their structures, different challenges and opportunities associated with CE emerge. So far, it remains unclear which aspects of CE are considered by different types of municipalities in their reports and which steering potentials are seen. Based on a content analysis, we present findings on reported topics of CE, the extent of data usage, and derived recommendations for local governance. We separated four district types, showing different degrees of the dimension urban–rural. Although cities published education reports more frequently, rural districts were more likely to address CE issues. However, they had less data available, resulting in a lower range of topics and narrow overall opportunities for addressing CE. Therefore, improvement of data and accessibility of data are important to enhance the monitoring and governance of CE in municipalities. Regarding the reviewed recommendations, clear differences between district types emerged. For instance, expanding offers of CE for immigrants was mainly an issue of large cities, whereas rural districts emphasized the spatial and digital accessibility of offerings.

Distribution and correlation of Sabellidites cambriensis (Annelida?) in the basal Cambrian on Baltica

Sabellidites cambriensis is a tubular non-mineralized metazoan that appears as compressed ribbon-shaped imprints with transverse wrinkling, thick walls and an even tube diameter of up to 3 mm. The distribution of Sabellidites is investigated in three Ediacaran–Cambrian sections on the Digermulen Peninsula in Arctic Norway, spanning the Manndrapselva Member of the Stáhpogieddi Formation and the lower member of the Breidvika Formation. Here, the Ediacaran–Cambrian boundary is located in the lower part of the upper parasequence (third cycle) of the Manndrapselva Member. Specimens of Sabellidites are rare but consistently present close to the lowest level of Treptichnus pedum and upsection, whereas the taxon is common and abundant in the lower part of the lower member of the Breidvika Formation, with an upper record at c. 55 m above the base. The range is comparable with that of the GSSP section in Newfoundland, Canada, establishing Sabellidites as an index fossil for the lowermost Cambrian. In the Manndrapselva Member, Sabellidites co-occurs with the acritarch Granomarginata, indicative of the lowermost Cambrian Granomarginata Zone, whereas in the Breidvika Formation it co-occurs with Asteridium. Sabellidites is widely distributed in Baltica, through the Rovnian and Lontovan regional stages but confined to the Fortunian global stage. In its lower range, Sabellidites is associated with a Treptichnus pedum trace fossil association and a depauperate leiosphaerid acritarch assemblage, followed by a Granomarginata assemblage. In its upper range, Sabellidites co-occurs with acritarchs of the Asteridium–Comasphaeridium Zone and the tubular foraminiferan Platysolenites. In Baltica, Sabellidites is a useful index fossil.

The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles

Introduction The activation of the hypothalamic–pituitary–gonadal axis that occurs in male minipuberty during the first 5 months of life is important for early germ cell development. Orchidopexy during minipuberty may improve fertility potential as the germinative epithelium may benefit from the naturally occurring gonadotropin stimulation. We hypothesize that most boys with congenital nonsyndromic cryptorchidism display normal reproductive hormonal profiles and histological findings during minipuberty. Methods We included boys with congenital nonsyndromic cryptorchidism who underwent orchidopexy at less than 160 days of age, having no potential for spontaneous resolution clinically. At surgery, testicular biopsies and reproductive hormones were collected and compared with normal reference values. We measured the germ cells (G/T) and type A dark spermatogonia number per tubule. Results Thirty-five boys aged 37 to 159 (median age: 124) days at orchidopexy were included, five were bilateral. G/T was below the normal lower range in 26% (9/35) of the cases. In six of these cases, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were above 97.5 percentile, whereas one case had FSH below 2.5 percentile. Totally, 97% (33/34, one FSH was missing) exhibited a normal LH/FSH ratio. LH was more often above 97.5 percentile than FSH: 34% (12/35) versus 3% (1/34, p < 0.001). Inhibin B was below 2.5 percentile in 17% (6/35) of cases who all proved FSH above normal mean and four had LH above normal mean. Conclusion Generally, reproductive hormonal profiles of the cryptorchid boys exhibited normal minipubertal pattern. Thus, 26% of the boys had reduced germ cell number, and transient hypogonadotropic hypogonadism could be suspected in few cases.

Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial

Background Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion. Methods We used data from MR CLEAN, a multicenter trial including patients with acute ischemic stroke due to anterior circulation large vessel occlusion randomized to endovascular treatment plus medical care (intervention) versus medical care alone (control). We segmented total brain volume (TBV) and intracranial volume (ICV) on baseline non-contrast computed tomography (n = 410). Next, we determined the degree of atrophy as the proportion of brain volume in relation to head size (1 − TBV/ICV) × 100%, analyzed as continuous variable and in tertiles. The primary outcome was a shift towards better functional outcome on the modified Rankin Scale expressed as adjusted common odds ratio. Treatment effect modification was tested using an interaction term between brain atrophy (as continuous variable) and treatment allocation. Results We found that brain atrophy significantly modified the effect of endovascular treatment on functional outcome (P for interaction = 0.04). Endovascular treatment led to larger shifts towards better functional outcome in the higher compared to the lower range of atrophy (adjusted common odds ratio, 1.86 [95% CI: 0.97–3.56] in the lowest tertile vs. 1.97 [95% CI: 1.03–3.74] in the middle tertile vs. 3.15 [95% CI: 1.59–6.24] in the highest tertile). Conclusion Benefit of endovascular treatment is larger in the higher compared to the lower range of atrophy, demonstrating that advanced atrophy should not be used as an argument to withhold endovascular treatment.

Starting Pitch Selection is Precise in Exploratory Study of Collegiate Nonmusic Majors

Starting pitch selection—whether intentional or habitual or otherwise— has been theorized to vary according to multiple variables. The purpose of this study was to explore starting pitch selection in undergraduate nonmusic major singers by using four well known songs and nonsinging tasks. Participants were actively singing in a college choir and majoring in fields outside of music. Performances indicated very small deviations in the median starting pitch for each criterion song (100–200 cents). Data indicated discrimination in starting pitch selection between songs. Active singers may place songs in the middle portion of the vocal range compared with the tendency toward lower range in nonsingers in previous research. A history of voice lessons was significantly associated with a positive response to a follow-up questionnaire item “I chose an intentional range for my voice.”

Production of Cyclotron-Based Gallium-68 With Low Energy Protons: Preliminary Target Design and Cyclotron Shielding Considerations

Nuclear reactors, cyclotrons and generators are being used to produce nuclear medicine radionuclides. Radiopharmaceuticals based on Gallium-68 are widely used both experimentally and clinically in Positron Emission Tomography (PET). Currently Ga-68 is mainly produced via 68Ge/68Ga generators, which are expensive. An alternative method is by cyclotron using high enriched Zinc-68 via the 68Zn(p,n)68Ga reaction. Investigations have been conducted for producing Ga-68 using a solid target impacted with a proton beam in energies between (13–14) MeV or higher. The main interest of this work is to produce Ga-68 using energies within a lower range, therefore Ga-68 can be accessed to locations with cyclotrons of lower energy. In this article, an approach to a novel target design to get Ga-68 with low energy protons is conducted. Adequate shielding to avoid extra doses outer the cyclotron is also considered. Monte Carlo code FLUKA is used to simulate the processes of interaction of radiation with matter and the radioactive isotope production. For a beam energy of 11 MeV and current on target of 40 μA the simulated produced activity is about 69.1 GBq. The results show the feasibility of producing Ga-68 with low energy protons and self-shielding system guarantees the regulation-based dose exposition outer the cyclotron.

Combining EQ-5D-5L items into a level summary score: demonstrating feasibility using non-parametric item response theory using an international dataset

Background The EQ-5D-5L is a well-established health questionnaire that estimates health utilities by applying preference-based weights. Limited work has been done to examine alternative scoring approaches when utility weights are unavailable or inapplicable. We examined whether the Mokken scaling approach can elucidate 1) if the level summary score is appropriate for the EQ-5D-5L and 2) an interpretation of such a score. Methods The R package “mokken” was used to assess monotonicity (scaling coefficients H, automated item selection procedure) and manifest invariant item ordering (MIIO: paired item response functions [IRF], HT). We used a rich dataset (the Multiple Instrument Comparison, MIC) which includes EQ-5D-5L data from six Western countries. Results While all EQ-5D-5L items demonstrated monotonicity, the anxiety/depression (AD) item had weak scalability (Hi = 0.377). Without AD, scalability improved from Hs = 0.559 to Hs = 0.714. MIIO revealed that the 5 items can be ordered, and the ordering is moderately accurate in the MIC data (HT = 0.463). Excluding AD, HT improves to 0.743. Results were largely consistent across disease and country subgroups. Discussion The 5 items of the EQ-5D-5L form a moderate to strong Mokken scale, enabling persons to be ordered using the level summary score. Item ordering suggests that the lower range of the score represents mainly problems with pain and anxiety/depression, the mid-range indicates additional problems with mobility and usual activities, and middle to higher range of scores reveals additional limitations with self-care. Scalability and item ordering are even stronger when the anxiety/depression item is not included in the scale.

The use of Li2O fortified growing compost to enhance lithiation in white Agaricus bisporus mushrooms: Li uptake and co-accumulation of other trace elements

In an attempt to enrich the fruiting bodies with Lithium (Li), this study cultivated mushrooms using growing sets that were fortified with Li2O at 1.0, 5.0, 10, 50, 100 and 500 mg·kg−1 dw. Compost fortification up to 100 mg·kg−1 dw induced a dose-dependent increase in Li accumulation with resulting median mushroom concentrations of 2.0, 8.6, 16, 29 and 38 mg·kg−1 dw, respectively, relative to the unfortified control at 0.087 mg·kg−1 dw. The dose dependency appears to level off as Li2O addition approaches 100 mg·kg−1, suggesting that there is a limit to the ability of the species to accumulate/tolerate Li. Mushrooms did not grow at the 500 mg·kg−1 dw fortification level. At the highest viable level of fortification (100 mg·kg−1 dw), the fruiting bodies were around 440-fold richer in Li content than the control mushrooms. Additionally, the fortification at all levels up to 100 mg·kg−1 dw showed very low, if any, effect on the co-accumulation of the other, studied trace mineral constituents, with concentrations occurring at the lower range of those reported for commercial A. bisporus mushrooms.

819 A RARE CASE OF RESPIRATORY SENSE LEAD DYSFUNCTION IN A PATIENT WITH A HYPOGLOSSAL NERVE STIMULATOR

Introduction In patients with moderate to severe obstructive sleep apnea (OSA) who are intolerant to PAP therapy, hypoglossal nerve stimulation (HGNS) is being increasingly considered as alternative treatment. Implantation involves placing cuff electrodes on inclusion branches of the hypoglossal nerve and a respiratory effort-sensing lead which is placed between the right intercostal muscle layers. These are connected to the implantable pulse generator which usually sits in a right infraclavicular pocket. Report of case(s) A 49-year-old male with severe OSA (AHI 30.8/hour) was implanted with a HGNS two years ago with successful activation a month later. He successfully up titrated his amplitude to the maximum stimulation level within his set range (0.9v – 1.7v). He underwent HGNS titration with AHI reduction to 13.9/hour at 2.1 volts and given a new higher range of 1.5 to 2.5 volts. This was accompanied by reduction in snoring, witnessed apneas and associated arousals with more consolidated sleep and improvement in his Epworth sleepiness score to 3 from 12 as noted prior to HGNS. The patient continued to up titrate over the next six months within his new range to 2.4 volts, when he reported increased sensitivity and intolerance at every stimulation level with recurrence of snoring and daytime sleepiness. He underwent interrogation of his device with subsequent awake endoscopy and change to his electrode configuration with a new lower range of 1.0 to 2.0 volts. However, he continued to have the same complaints. A second interrogation revealed increased impedance within the circuit of the respiratory sensing lead which was reproducible. The patient underwent sensing lead replacement in the operating room. He has since been able to increase stimulation levels without complaints and improvement in his OSA symptoms and is scheduled to have a follow-up hone sleep test (HST). Conclusion This case illustrates the importance of a structured approach in the evaluation of a reduced tolerance to HGNS. This includes assessing adherence, interrogation of the device’s circuitry, evaluating electrode configurations, stimulation thresholds with consideration for awake endoscopy. Repeating this process may be necessary to detect rare or delayed mechanical problems that may occur over time with HGNS. Support (if any):