ObjectivesInvestigate the use of call-out (CO) and closed-loop communication (CLC) during a simulated emergency situation, and its relation to profession, age, gender, ethnicity, years in profession, educational experience, work experience and leadership style.DesignExploratory study.SettingIn situ simulator-based interdisciplinary team training using trauma cases at an emergency department.ParticipantsThe result was based on 16 trauma teams with a total of 96 participants. Each team consisted of two physicians, two registered nurses and two enrolled nurses, identical to a standard trauma team.ResultsThe results in this study showed that the use of CO and CLC in trauma teams was limited, with an average of 20 CO and 2.8 CLC/team. Previous participation in trauma team training did not increase the frequency of use of CLC while ≥2 structured trauma courses correlated with increased use of CLC (risk ratio (RR) 3.17, CI 1.22 to 8.24). All professions in the trauma team were observed to initiate and terminate CLC (except for the enrolled nurse from the operation theatre). The frequency of team members’ use of CLC increased significantly with an egalitarian leadership style (RR 1.14, CI 1.04 to 1.26).ConclusionsThis study showed that despite focus on the importance of communication in terms of CO and CLC, the difficulty in achieving safe and reliable verbal communication within the interdisciplinary team remained. This finding indicates the need for validated training models combined with further implementation studies.

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Lipoprotein lipase (LPL), a key enzyme in the metabolism of triglyceride-rich plasma lipoproteins, is a homodimer. Dissociation to monomers leads to loss of activity. Evidence that LPL dimers rapidly exchange subunits was demonstrated by fluorescence resonance energy transfer between lipase subunits labeled with Oregon Green and tetrametylrhodamine, respectively, and also by formation of heterodimers composed of radiolabeled and biotinylated lipase subunits captured on streptavidine-agarose. Compartmental modeling of the inactivation kinetics confirmed that rapid subunit exchange must occur. Studies of activity loss indicated the existence of a monomer that can form catalytically active dimers, but this intermediate state has not been possible to isolate and remains hypothetical. Differences in solution properties and conformation between the stable but catalytically inactive monomeric form of LPL and the active dimers were studied by static light scattering, intrinsic fluorescence, and probing with 4,4-dianilino-1,1-binaphtyl-5,5-disulfonic acid and acrylamide. The catalytically inactive monomer appeared to have a more flexible and exposed structure than the dimers and to be more prone to aggregation. By limited proteolysis the conformational changes accompanying dissociation of the dimers to inactive monomers were localized mainly to the central part of the subunit, probably corresponding to the region for subunit interaction. Lipoprotein lipase (LPL)1 plays a fundamental role in the metabolism of blood lipoproteins (1-3). Lowered LPL activity results in dyslipidemia (4). The catalytically active form of LPL is a noncovalent homodimer of 55 kDa subunits (5, 6). The functional site of LPL is at the luminal surface of the vascular endothelium, where the enzyme is bound to heparan sulfate proteoglycans (1-4). Inactive monomers are less tightly bound to heparan sulfate (7) and are therefore the dominant form of LPL in the circulating blood (8).In vitro studies show that the dimeric state of LPL is unstable (9). Under physiological conditions (pH, temperature, and concentration of salt), the dimers spontaneously dissociate into monomers within a few minutes. The formed monomers may reassociate but into inactive aggregates (9). It is believed that this process is irreversible. The inactivation is strongly prevented by heparan sulfate and heparin (7). The dimeric form of LPL is also relatively stable in the presence of high concentrations of salt (at low temperature) (9, 10). In the early 1970s this discovery allowed purification of the active enzyme from bovine milk by using adsorption to heparin-Sepharose followed by elution with a salt gradient (5, 11). Osborne et al. (6) showed that the inactivation rate is dependent on the concentration of LPL. On this basis, they proposed that inactivation of LPL includes a step of reversible dissociation of the dimer followed by a step of irreversible unfolding of the dissociated monomers (6).LPL, pancreatic lipase, hepatic lipase, and endothelial lipase share sequence homolo...

Diagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry-based population study.

The incidence of PONV in bariatric surgery patients was high despite a PONV prophylaxis regime following current guidelines. These results cast doubt as to the effectiveness of the usual PONV prophylaxis in this patient group and point to the need for further investigation of PONV prophylaxis and treatment in bariatric surgery patients.