This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page AtriCure has received an expanded indication for the AtriClip left atrial appendage (LAA) exclusion system in CE-marked countries in Europe The product is now indicated for use in patients at high risk of thromboembolism for whom LAA exclusion is warranted The AtriClip family of devices are designed to exclude electrically isolate and eventually eliminate the LAA—a major source of blood clots in patients with atrial fibrillation (AF)—during cardiac surgery “This new indication is tremendous validation of our AtriClip device,” said Michael Carrel president and chief executive officer of AtriCure “With over 550,000 patients successfully treated worldwide we have seen the impact that our devices have on patient care The expanded indication from the European Commission confirms our own clinical evidence that strokes can be reduced in patients who are at high risk of developing thromboembolism and we continue to see strong opportunity to grow adoption of mechanical appendage closure.” “I’ve been using AtriClip devices for over a decade and have seen firsthand the benefits of its safety and efficacy,” said Nicolas Doll (Schuechtermann Clinic and they provide patients with the benefit of long-term prevention of stroke which makes adoption of the AtriClip an easy decision.” and website in this browser for the next time I comment Δdocument.getElementById( "ak_js_1" ).setAttribute( "value" Metrics details agoraphobia is associated with a significant risk for relapse after the end of treatment Personalized and adaptive approaches appear promising to improve maintenance treatment and aftercare as they acknowledge patients’ varying individual needs with respect to intensity of care over time there is a deficit of knowledge about the detailed symptom course after discharge from acute treatment which is a prerequisite for the empirical development of rules to decide if and when aftercare should be intensified this study aimed firstly at the investigation of the naturalistic symptom course of agoraphobia after discharge from initial treatment and secondly at the development and evaluation of a data-driven algorithm for a digital adaptive aftercare intervention A total of 56 agoraphobia patients were recruited in 3 hospitals participants completed a weekly online monitoring assessment for three months While symptom severity remained stable at the group level individual courses were highly heterogeneous Approximately two-thirds of the patients (70%) reported considerable symptoms at some time indicating a need for medium or high-intense therapeutic support Simulating the application of the algorithm to the data set resulted in an early (86% before week six) and relatively even allocation of patients to three groups (need for no findings confirm the need for adaptive aftercare strategies in agoraphobia adaptive approaches may provide immediate support to patients who experience symptom deterioration and thus promise to contribute to an optimized allocation of therapeutic resources and overall improvement of care Patients’ needs after treatment termination differ interventions are needed that adjust the intensity of support to the patients’ current needs Several components play a role in an adaptive approach: Modifications to the treatment (e.g changes in treatment intensity) are guided by a-priori decision rules at specific stages (i.e predefined time points) and consider tailoring variables (e.g a decision rule could suggest maintaining a low-intense treatment (no modification) if there is a decrease in avoidance behavior (tailoring variable) within the first three weeks of treatment (decision stage) in case of an increase in avoidance behavior the frequency of psychotherapy sessions could be increased One way to operationalize decision rules is to introduce cutoff-scores a score that determines the level of symptom severity that must be exceeded to start with a more intense treatment alternative Appropriate cutoffs must be set to keep the balance between a too low (i.e treat all patients with the most intensive level) and a too high score (i.e no patient receives the most intensive level of care) available resources and potential risks of modifications (e.g side effects) should be considered when defining decision rules It is expected that IMIs will be more accessible and far less costly compared to traditional (face to face) aftercare interventions and thus may find their way into routine care Although combining the strengths of IMIs and adaptive approaches seems promising these approaches must first be developed and empirically tested and then implemented to routine care Studies on post-treatment symptom trajectories and relapse are limited Especially for routine care conditions there are hardly any data Our knowledge on the natural course of symptoms after treatment termination is insufficient to establish meaningful decision rules for adaptive aftercare The first aim was to explore the natural symptom courses in patients with agoraphobia during the initial three months following treatment termination The primary objective was to describe the natural symptom courses after discharge and assess the necessity for additional support The second aim of the study was to develop algorithms (decision rules) for a potential adaptive aftercare intervention and to apply these decision rules to the collected data in order to test their plausibility and simulate the patients’ group allocations over time Three participants did not complete an assessment and one had withdrawn consent to the study four cases were excluded from the data analysis The number of completed assessments ranged from 4 to 13 (M = 12.04; SD = 2.22) N = 49 provided data for baseline (t1) and N = 51 completed the final assessment (t2) they completed 92.58% (674 of 728) of the scheduled assessments The mean age of participants was 45.36 years (SD = 10.35 years) ranging from 20 to 62 years Average duration of inpatient treatment was 45.18 days (SD = 10.02; min = 31 Out of the 56 patients 54 (96.00%) met ICD-10 diagnosis for agoraphobia with panic disorder two patients met ICD-10 diagnosis for agoraphobia only 39 patients (69.6%) were diagnosed with at least one additional disorder 34 patients were diagnosed with an affective disorder (depressive episode (F32): n = 7; recurrent depressive disorder (F33): n = 27 n = 23 patients (46.9%) stated that they currently took medication for their anxiety disorder n = 14 stated that they were treated with selective serotonin reuptake inhibitors (SSRIs) Nine patients mentioned other antidepressants it ranged between M = 8.94 in week 6 (SD = 4.07) and week 10 (SD = 4.52) and M = 10.70 (SD = 4.30) at baseline For the avoidance item of the OASIS (item 3) patients reported least avoidance in week 10 (M = 1.62; SD = 1.01) and highest avoidance directly after discharge (M = 2.08; SD = 1.03) Only two patients reported not having a single panic attack during the observation period patients experienced between M = 1.29 (SD = 2.10; week 12) and M = 0.91 (SD = 1.08; week 2) panic attacks per week The total score on the PHQ-4 ranged between M = 4.42 (SD = 2.88; week 10) and M = 5.67 (SD = 2.89; week 3) patients were asked about perceived difficulties related to the transition from inpatient treatment to their everyday lives and also about the utilization of professional support during the observation period In response to the question “Have you sought professional help for your agoraphobia since your discharge from the hospital?” 25 of the 51 patients (49%) stated that they had sought some sort of professional help after discharge 22 patients initiated outpatient psychotherapy The average gap between the start date of help (actual and planned) was approximately 40 days (M = 39.5; SD = 29.9; min = 1; max = 106; n = 28) When asked "Did you find the transition from hospital to everyday life difficult?" 5.9% answered "not at all" This strategy is intended to prevent more intensive and costly treatment from being carried out unnecessarily and allocate resources to those patients who need it most Individual symptom trajectories measured with the sum score of the OASIS The three groups indicated by colors correspond to the PAS level at the end of the study: red = severe Adaptive group allocation over the course of 12 weeks after hospital discharge This longitudinal multicenter study explores naturalistic symptom progression in patients with agoraphobia with and without panic disorder Two thirds of patients still show considerable symptoms at the end of inpatient treatment 76.5% rated the transition period after discharge rather or very difficult clearly highlighting the need for additional support after discharge from inpatient treatment Although around half initiated outpatient treatment they face a gap of around 40 days without help The results confirm that consecutive aftercare offers are meaningful Adaptive interventions seem especially promising as they can take into account the heterogeneous needs and symptom courses in this critical transition period The resources saved by the internet-based and adaptive components could lead to higher acceptance and lower cost per person increasing the likelihood of implementation in routine care decision rules for a possible adaptive aftercare intervention are derived While the group-level analyses are not very informative (no significant variation at the group level) individual symptom courses show very diverse patterns over time Descriptive and visual analyses of individual symptom courses confirm high heterogeneity of symptom courses after discharge Symptom courses are very heterogeneous within individuals suggesting that some patients go through a difficult transition period after discharge from hospital while others manage to stabilize their treatment gains an adaptive aftercare intervention is sketched out Final decision rules incorporate two different cutoff scores on central monitoring measures that performed well in identifying patients in need quickly Cutoff 1 is based on mean symptom severity over two consecutive weeks especially patients indicating high symptom severity (after all 43% of patients) could benefit from the resources that are freed up with about 86% of adjustments take place in the first weeks after discharge from hospital patients could profit from the higher intensity of support significantly combined with adaptive internet-based interventions enables for rapid response to deterioration and immediate provision of additional help the adaptive allocation algorithm proves plausible and promises to facilitate resource allocation the majority of patients (70%) experience a crisis Predicting who will experience a crisis and when is challenging continuous symptom monitoring is crucial to individualize adaptive aftercare interventions no information on the effectiveness of the initial inpatient treatment was available Patients with agoraphobia require support after end of acute treatment patients experience heterogeneous symptom courses and consequently require individualized treatment strategies adaptive treatment strategies can adjust the level of support dynamically over time to better fit the individual needs to the intensity of support Internet-based adaptive aftercare approaches are feasible and have great potential to improve the healthcare situation by allocating resources to the patients who need it most when they need it most grounded on cognitive behavioral therapy (CBT) principles and exposure exercises (guided and self-managed) CBT is offered in both individual and group settings patients were encouraged by therapists to consider outpatient care upon their discharge from the hospital Given the division between inpatient and outpatient services in Germany it becomes the responsibility of the patient to actively seek additional care The diagnostic criteria of the ICD-10 are as follows: (a) a marked and persistent fear of several situations; (b) exposure to the phobic situation almost invariably provokes an immediate anxiety response; (c) significant emotional distress due to avoidance or symptoms; (d) symptoms are restricted to the feared situations or thoughts about them; (e) the anxiety or phobic avoidance is not better accounted for by another mental disorder A panic disorder can be indicated with the fifth digit (F40.00 Agoraphobia without panic disorder; F40.01 Agoraphobia with panic disorder) Exclusion criteria included acute suicidality there were no restrictions on the use of other psychological or pharmacological treatment for the duration of the study Patients provided written informed consent The study was performed in accordance with the declaration of Helsinki it was approved by the ethics committee of the University Hospital Heidelberg If the assessment was not completed after 3 days participants received an automated e-mail reminder If participants failed to complete the assessment twice in a row they were contacted by phone to resolve technical issues Participants who completed the final assessment received an online gift voucher (€30) The combination of the three questionnaires is widely used and allows the examination of central anxiety constructs The ACQ comprises 14 items on a 5-point Likert scale ranging from never (1) to always (5) to measure the frequency with which anxiety-related cognitions occur when the person is nervous or anxious The internal consistency of the ACQ is acceptable The BSQ consists of 17 items and measures the extent of anxiety about physical symptoms (e.g weak knees) on a 5-point Likert scale ranging from not at all (1) to extremely (5) The total score is calculated from the mean of all items answered The internal consistency of the BSQ is good The MI uses 27 items to assess the extent of avoidance behavior in various situations (e.g The data are collected both alone and in company on a five-point Likert scale from never 1 to always 5 the total score is composed of the mean scores of the avoidance alone and avoidance accompanied scales The internal consistency of both scales of the MI is excellent ranging from not at all (0) to almost every day (3) The total score is an overall measure of symptom burden the internal consistency is good with Cronbach's α = 0.85 This sample size allows the frequency of agoraphobic avoidance behavior and other outcome measures to be assessed with sufficient accuracy which is appropriate for the study objective The data that support the findings of this study are 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Statistical Computing (R Foundation for Statistical Computing Download references Supported by German Center for Mental Health (DZPG) We thank all patients who participated in the study We are grateful to all therapists on site for recruiting and carefully instructing the patients We thank Lutfi Arikan for his support in the technical implementation of the online monitoring Open Access funding enabled and organized by Projekt DEAL Median Zentrum für Verhaltensmedizin Bad Pyrmont wrote the main manuscript text and performed statistical analyses gave clinical advice for developing the symptom monitoring recruited participants and did on-site study management in the clinics All authors reviewed and approved the manuscript The authors declare no competing interests Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Download citation DOI: https://doi.org/10.1038/s41598-024-52803-z Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article Sign up for the Nature Briefing newsletter — what matters in science Oncostatin M regulates the reversion of heart muscle cells into precursor cells and is vitally important for the self-healing powers of the heart Cellular reversion processes arise in diseases of the heart muscle for example myocardial infarction and cardiomyopathy which limit the fatal consequences for the organ Scientists from the Max Planck Institute for Heart and Lung Research in Bad Nauheim and the Schüchtermann Klinik in Bad Rothenfelde have identified a protein which fulfils a central task in this reversion process by stimulating the regression of individual heart muscle cells into their precursor cells It is now planned to improve the self-healing powers of the heart with the help of this protein Cellular regression in diseased heart tissue with the help of oncostatin M: the image shows heart muscles under the fluorescence microscope In order to regenerate damaged heart muscle as caused by a heart attack the damaged muscle cells must be replaced by new ones The number of cells to be replaced may be considerable depending on the extent of the damage caused Simpler vertebrates like the salamander adopt a strategy whereby surviving healthy heart muscle cells regress into an embryonic state produces cells which contain a series of stem cell markers and re-attain their cell division activity The cardiac function is then restored through the remodelling of the muscle tissue An optimised repair mechanism of this kind does not exist in humans Although heart stem cells were discovered some time ago exactly how and to what extent they play a role in cardiac repair is a matter of dispute It has only been known for a few years that processes comparable to those found in the salamander even exist in mammals Thomas Braun’s research group at the Max Planck Institute for Heart and Lung Research in Bad Nauheim has now discovered the molecule responsible for controlling this dedifferentiation of heart muscle cells in mammals The scientists initially noticed the high concentration of oncostatin M in tissue samples from the hearts of patients suffering from myocardial infarction It was already known that this protein is responsible for the dedifferentiation of different cell types The researchers therefore treated cultivated heart muscle cells with oncostatin M in the laboratory and were then able to trace the regression of the cells live under the microscope: “Based on certain changes in the cells we were able to see that almost all heart muscle cells had been dedifferentiated within six days of treatment with oncostatin M,” explains Braun “We were also able to demonstrate the presence of various stem cell markers in the cells This should be understood as an indicator that these cells had been switched to a repair mode.” the Max Planck researchers succeeded in demonstrating that oncostatin M actually does stimulate the repair of damaged heart muscle tissue as presumed One of the two test groups had been modified genetically in advance to ensure that the oncostatin M could not have any effect in these animals “The difference between the two groups was astonishing Whereas in the group in which oncostatin M could take effect almost all animals were still alive after four weeks 40 percent of the genetically modified mice had died from the effects of the infarction,” says Braun The reason for this was that oncostatin M ensured clearly quantifiable better cardiac function in the unmodified animals The scientists in Bad Nauheim would now like to find a way of using oncostatin M in treatment The aim is to strengthen the self-healing powers of the damaged heart muscle and to enable the restoration of cardiac function for the first time is that oncostatin M was also observed to be counterproductive and exacerbated the damage in an experiment on a chronically diseased heart “We believe that oncostatin M has considerable potential for efficiently healing damaged heart muscle tissue What we now need is to be able to pinpoint the precise window of application to prevent any possible negative effects,” says Braun His themes of oppression and social injustice highlight the plight of those desperate to flee poverty 17 minutes long and over 140 feet wide, the black and white film literally envelops the viewer Overlaid is an entire brass band playing a dirge-like composition uncompleted gestures and uncertain endings,’ Kentridge has said Played across eight screens, More Sweetly Play the Dance (pictured) was commissioned by the EYE Filmmuseum in  Amsterdam and the Lichtsicht-Projection Biennale VIEW GOOGLE MAPS escapism and design stories from around the world direct to your inbox Industry news and insights from Europe and around the World Keep up-to-date with the latest new products and technology GERMANY: Mystery still surrounds an explosion and fire at a refrigeration plant in Dissen in Osnabrück in which two men suffered severe burns and six others were injured The explosion took place on Saturday morning (July 22) while engineers were carrying out work on the refrigeration system at a MUK/Transthermos refrigerated warehouse The routine maintenance work on the refrigeration plant is said to have involved the “exchange of individual components for technical reasons” The local fire brigade reported that it arrived at the scene to find an “extensive” fire in the area of ​​the refrigeration systems on the back of the building The “violent explosion” had also blown large lumps of debris on to the adjacent A33 autobahn suffered severe burn injuries and were flown by helicopters to specialist clinics Four others were injured and two firefighters had to be treated in the course of the incident The incident is currently under investigation but the police blamed “improper procedures” during the maintenance work It has been widely reported that the system was using highly flammable propane refrigerant Transthermos refused to confirm this “since the investigations are still ongoing” but the Osnabrück police maintained that the refrigerant was propane An earlier confusing statement by the police on the maintenance work being carried out said that the “propane gas had to be drained Cooling Post is the leading online resource covering latest news and developments in the cooling industry air conditioning news and the latest heat pump developments Privacy & Cookie Policy © Copyright 2025, Cooling Post Ltd - All Rights Reserved | Website by Capital Web