bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of radiative and advective populations in Canadian temperature time series using the Linear Pattern Discrimination algorithm
Authors: Žaknić‐Ćatović Ana , Gough William A.
Published: March 2021

Long‐term high‐frequency air temperature time series, typically considered the most authoritative observed records for the detection of climate changes, appear physically heterogeneous by nature. We examine multiple Canadian air temperature records for the presence of physical heterogeneities, using the analysis of their diurnal temperature patterns as the main criterion for the separation of temperature series into ‘homogeneous’ populations. Based on the key differences observed in their diurnal air temperature patterns, two distinct populations of the air temperature sample are identified and assumed to be the result of different heat exchange mechanisms. The Linear Pattern Discrimination (LPD) algorithm, implemented in the R‐code, is introduced in this work and applied to 66‐year long hourly temperature records of 25 Canadian stations for the separation of the radiative temperature population from the advective temperature population and examination of incidences of specific, advective cases in air temperature data. The LPD analysis reveals a predominance of a remarkably warmer, radiatively driven air temperature regime. In contrast, the significantly colder and geographically controlled advective temperature regime plays a counterbalancing role on the overall magnitude of the midlatitude air temperature signal. Our findings suggest that a substantial temperature increase in annual averages of advective minima amplifies the effect of a positively shifted radiative temperature range, intensifying the overall heating observed in the Canadian North and northwestern regions.
Root dynamics along a restoration chronosequence of revegetated grasslands in degraded alpine meadows of the Qinghai‐Tibetan Plateau, China
Authors: Hu Lei , Zi Hongbiao , Luo Xueping , Lerdau Manuel , Wang Changting
Published: March 2021

Revegetation using perennial grass, such as Elymus nutans is an effective approach in abating grassland degradation on the Qinghai‐Tibetan Plateau. However, knowledge of root dynamics along restoration chronosequences of revegetated grasslands are limited. To gain better insight into root dynamics, we used minirhizotrons to examine changes in root traits, including root standing crop, production, mortality, and turnover along a restoration chronosequence of three revegetated grasslands (cultivated in 2002, 2006, and 2010 corresponding to late, middle, and early recovery stage) in four consecutive growing seasons (2014, 2015, 2016, and 2017). We found that the aboveground plant biomass was higher in the middle recovery stage than that in the early and late recovery stages, while plant species richness showed an increasing trend from the early to late recovery stage. Similar with the plant biomass response, the belowground root standing crop and production were significantly higher in the middle recovery stage than in the early and late recovery stages. Root mortality was decreased and root turnover tend to be stable from the early to late recovery stage. Root turnover was positively correlated with soil NO3−‐N content and negatively correlated with aboveground plant biomass. Moreover, root standing crop and mortality increased from May to September across all growing seasons; however, root production decreased within this period. Our study highlighted significant links between aboveground and belowground plant parts that may help effectively manage revegetated grassland on the Qinghai‐Tibetan Plateau.
A regression‐based approach to compute the pixels sensitivity map of linear accelerator portal imaging devices
Authors: Ahmad Mahmoud , Nourzadeh Hamidreza , Siebers Jeffrey
Published: March 2021

Purpose

To determine the pixel sensitivity map (PSM) for amorphous silicon electronic portal imaging devices (EPIDs) using a single flood field signal.

Method and materials

A raw EPID signal results from the incident particle energy fluence, the inherent pixels response, and the background signal. In large open fields, particle energy fluence is a slow‐varying signal that is locally considered spatially constant. Pixels response is a fast and abrupt varying behavior. The background signal is due to the EPID panel electronics, which is determined during radiation absence. To determine the PSM, after correcting for the background signal, we apply a model that captures the underlying smooth particle energy fluence‐induced signal. This fluence signal‐fitted model is then used to determine the PSM. Here, we use a polynomial‐based regression surface model in both x and y dimensions. To validate the generated PSM, we measure beams and compute PSMs for multiple beam energies with and without flattening filters and for multiple source‐to‐imager distances. Since the PSM is a detector characteristic, it should be independent of those variables. We also intercompare measurements of fixed slit fields with the EPID being shifted between measurements.

Results

The fluence signal of the flattening filter‐free (FFF) beams was optimally modeled as a 12th degree polynomial surfaces, which had 0.1% residuals near the central axis. The 6 and 10 MV FFF PSMs were within ˜0.1%, and independent of the EPID SID, suggesting that the PSM is energy independent. The 6, 10, and 15 MV flattened‐beam PSMs were well modeled as 12th degree polynomial surfaces, which were equivalent within ˜0.24% but differed from the FFF PSM by up to 0.5% near the beam central axis. Applying the FFF PSMs to the flattened‐beam measurements reduced the central‐axis deviation between the raw and corrected signal to 0.1%, confirming the PSM energy independence hypothesis. When the FFF PSM is utilized, output verification with shifted slit deliveries agreed within ˜0.5% for all beam energies, which is within the radiation delivery uncertainty of ˜0.57%.

Conclusion

PSM for MV EPIDs can be determined by separating out the slowly varying, well‐behaved fluence signal from the pixel‐to‐pixel sensitivity variations. The quality of the PSM is found to be dependent on the quality of the surface fit, which is best for the 6 MV FFF beam measured at SID equal to 180 cm. Within fitting errors, the PSM is independent of beam energy for 6, 10, and 15 MV beams with and without flattening filters. The PSM generation does not require shifting the EPID panel nor multiple EPID panel irradiations and should be usable for linacs with fixed geometry EPIDs.
Effect of diagnostic ultrasound and microbubble‐enhanced chemotherapy on metastasis of rabbit VX2 tumor
Authors: Zhang Yi , Tang Najiao , Huang Leidan , Qiao Wei , Zhu Qiong , Liu Zheng
Published: March 2021

Purpose

Ultrasound‐targeted microbubble destruction (UTMD) has been widely applied to enhance chemotherapy of tumors, yet few studies have focused on the metastatic potential induced by UTMD. This study aimed to explore the metastasis of VX2 tumors after treatment with UTMD and chemotherapy.

Methods

Forty‐four New Zealand rabbits bearing subcutaneous VX2 tumors were enrolled for the treatment of UTMD with chemotherapy. For UTMD, the tumors were insonated using two pulsing protocols of diagnostic ultrasound (DUS, VINNO and ECARE) with a mechanical index (MI) of 0.29–0.33, tone burst of 8.0 cycles, and frequencies of 3–4 MHz. A total dose of 2 ml SonoVue® was injected intermittently during 10‐min UTMD exposure. The combination therapy was treated using doxorubicin (DOX, 2 mg/kg) and DUS, while the tumors treated using DOX only served as the control. Tumor size was measured using the tumor volume formula. Survival time was observed until animal death or the end of the study (120 days). Specific organs (lung, liver, kidney, and brain) were removed for metastatic evaluation.

Results

There were no statistical differences in overall metastasis classification and individual organ metastases among all groups (P > 0.05). The tumor growth rate only showed inhibition on the 5th day (P < 0.01). The survival time did not demonstrate any significant difference between UTMD and chemotherapy only (P > 0.05).

Conclusions

UTMD using long‐pulse DUS with commercial microbubbles did not pose a risk of metastasis enhancement in DOX chemotherapy.
The metabolic representation of ischemia in rat brain slices: A hyperpolarized 13C magnetic resonance study
Authors: Shaul David , Grieb Benjamin , Sapir Gal , Uppala Sivaranjan , Sosna Jacob , Gomori J. Moshe , Katz‐Brull Rachel
Published: March 2021

The ischemic penumbra in stroke is not clearly defined by today's available imaging tools. This study aimed to develop a model system and noninvasive biomarkers of ischemic brain tissue for an examination that might potentially be performed in humans, very quickly, in the course of stroke triage. Perfused rat brain slices were used as a model system and 31P spectroscopy verified that the slices were able to recover from an ischemic insult of about 3.5 min of perfusion arrest. This was indicated as a return to physiological pH and adenosine triphosphate levels. Instantaneous changes in lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) activities were monitored and quantified by the metabolic conversions of hyperpolarized [1‐13C]pyruvate to [1‐13C]lactate and [13C]bicarbonate, respectively, using 13C spectroscopy. In a control group (n = 8), hyperpolarized [1‐13C]pyruvate was administered during continuous perfusion of the slices. In the ischemia group (n = 5), the perfusion was arrested 30 s prior to administration of hyperpolarized [1‐13C]pyruvate and perfusion was not resumed throughout the measurement time (approximately 3.5 min). Following about 110 s of the ischemic insult, LDH activity increased by 80.4 ± 13.5% and PDH activity decreased by 47.8 ± 25.3%. In the control group, the mean LDH/PDH ratio was 16.6 ± 3.3, and in the ischemia group, the LDH/PDH ratio reached an average value of 38.7 ± 16.9. The results suggest that monitoring the activity of LDH and PDH, and their relative activities, using hyperpolarized [1‐13C]pyruvate, could serve as an imaging biomarker to characterize the changes in the ischemic penumbra.
Researcher practitioner engagement in health research: The development of a new concept
Authors: Daniels Nicola , Gillen Patricia , Casson Karen
Published: March 2021

The engagement of frontline practitioners in the production of research‐derived knowledge is often advocated. Doing so can address perceived gaps between what is known from research and what happens in clinical practice. Engagement practices span a continuum, from co‐production approaches underpinned by principles of equality and power sharing to those which can minimalize practitioners' contributions to the knowledge production process. We observed a conceptual gap in published healthcare literature that labels or defines practitioners' meaningful contribution to the research process. We, therefore, aimed to develop the concept of “Researcher Practitioner Engagement” in the context of academically initiated healthcare research in the professions of nursing, midwifery, occupational therapy, physiotherapy, and speech and language therapy. Guided by Schwartz‐Barcott et al.'s hybrid model of concept development, published examples were analyzed to establish the attributes, antecedents, and consequences of this type of engagement. Academic researchers (n = 17) and frontline practitioners (n = 8) with relevant experience took part in online focus groups to confirm, eliminate, or elaborate on these proposed concept components. Combined analysis of theoretical and focus group data showed that the essence of this form of engagement is that practitioners' clinical knowledge is valued from a study's formative stages. The practitioner's clinical perspectives inform problem‐solving and decision‐making in study activities and enhance the professional and practice relevance of a study. The conceptual model produced from the study findings forms a basis to guide engagement practices, future concept testing, and empirical evaluation of engagement practices.
Protecting individuals living with overweight and obesity: Attitudes and concerns toward COVID‐19 vaccination in Canada
Authors: Vallis Michael , Glazer Stephen
Published: March 2021

Objective

The aim of this study was to assess attitudes toward coronavirus disease 2019 (COVID‐19) vaccination and the degree of fear of COVID‐19 among those living with obesity.

Methods

Two samples were recruited for an online survey: one sample was a representative sample of Canadians living with overweight and obesity (n = 1,089), and the second was a convenience sample of individuals recruited from obesity clinical services or patient organizations (n = 980). Respondents completed ratings of their comfort receiving a COVID‐19 vaccination along with the Vaccine Hesitancy Scale and the Fear of COVID‐19 Scale.

Results

Approximately one‐third of respondents, regardless of sample or weight category, were not comfortable receiving a vaccination, and one‐half expressed moderate or greater perceived risks of vaccination. Confidence in vaccinations was extremely low, especially for those in the clinical sample. Fear of COVID‐19 was substantial and predicted attitudes toward vaccination. Females were less comfortable receiving the vaccine and perceived more risks than males.

Conclusions

These results suggest those living with obesity are highly ambivalent about COVID‐19 vaccination. Despite their being at high risk, their confidence in vaccines is very low. Results suggest the need for patient‐centered counseling, with a focus on shared decision‐making to strengthen confidence and reduce perceived risk.
A Novel Combinatorial Approach to the Ferroelectric Properties in HfxZr1−xO2 Deposited by Atomic Layer Deposition
Authors: Jung Yong Chan , Mohan Jaidah , Hwang Su Min , Kim Jin-Hyun , Le Dan N. , Sahota Akshay , Kim Namhoon , Hernandez-Arriaga Heber , Veyan Jean-Francois , Kim Harrison Sejoon , Kim Si Joon , Choi Rino , Kim Jiyoung
Published: April 2021

Since HfO2‐based ferroelectric films were reported in 2011, several doping/alloying elements have been introduced to secure interesting ferroelectric/antiferroelectric properties of Hf‐based fluorite‐structured thin films. Using a conventional approach by atomic layer deposition (ALD), an enormous number of experiments would be required to reveal the compositional effects of doping/alloying components in ternary and quaternary systems. Therefore, for a comprehensive study of the ferroelectric properties of HfxZr1−xO2, a novel combinatorial ALD technique that enables the fabrication of multicomponent films with a different composition ratio and thickness via saturated/non‐saturated ALD without changing the supercycle of each material is reported. The gradient of the amount of HfO2 over a 100 mm substrate is achieved using a lower Hf‐precursor temperature that results in an insufficient Hf‐precursor dose for saturated deposition. Systematic study on the HfxZr1−xO2 combinatorial library is carried out by spectroscopic ellipsometry, X‐ray photoelectron spectroscopy, and X‐ray diffraction. Furthermore, TiN/HfxZr1−xO2/TiN capacitors are fabricated to measure the remnant polarization. The obtained results clearly show the ferroelectric–antiferroelectric transition according to continuous composition change instead of discrete research. Therefore, a highly productive method for studying ferroelectricity changes in terms of a doping and a composition of HfO2‐based ferroelectric thin films through a novel ALD combinatorial approach is proposed.
Form‐based security in mobile health data collection systems
Authors: Katarahweire Marriette , Bainomugisha Engineer , Mughal Khalid A. , Ngubiri John
Published: March 2021

Mobile Health Data Collection Systems (MHDCS) use electronic forms for data collection in place of paper surveys. Data is entered into the electronic forms by community health workers with smartphones. These systems are used in clinical trials and continuous monitoring of participants. Data collected in MHDCS is diverse with varying sensitivity levels. This therefore calls for the application of different security mechanisms to protect the data. In this paper, a data sensitivity classification model is proposed. It determines the sensitivity levels of form attributes depending on the context and sensitive parameters. The electronic form is the starting point of the data collection process. We augment the form with sensitivity levels and a mapping of security mechanisms to the sensitivity levels is made. Through threat modeling, we identify potential threats and possible mitigations. We demonstrate the feasibility of our approach by prototyping the proposed model into the Open Data Kit tool suite. Tests show that the security mitigations specified during form design are executed once the secure form is loaded on the mobile device during data collection. Our ultimate aim is to facilitate the addition of security requirements into the data collection processes right from the start of the design process.
Physicochemical Properties of Cassava Starch‐Konjac Glucomannan Composites
Authors: Liu Yawei , Xu Bing , An Fei , Liu Jie
Published: March 2021

Cross‐linked cassava starch‐konjac glucomannan composite (CCS‐KGM), native cassava starch‐sodium trimetaphosphate‐konjac glucomannan composite (NCS‐STMP‐KGM), and cross‐linked cassava starch‐sodium trimetaphosphate‐konjac glucomannan composite (CCS‐STMP‐KGM) are prepared to study the effect of STMP and KGM on the native cassava starch and cross‐linked cassava starch. A small amount of KGM adheres to the surface of cassava starch granules in the three composites. The results of Fourier transform infrared spectroscopy indicate that cross‐links form in the cross‐linked cassava starch and three composites. The X‐ray diffraction analysis reveals that the crystallization type of native cassava starch modified by STMP and KGM remains unchanged (A‐type). The mean particle size of cross‐linked cassava starch and the three composites are larger than that of native cassava starch. STMP and KGM decrease the swelling power and water loss rate of native cassava starch. Dynamic rheological results suggest that STMP and KGM increase storage modulus and loss modulus of native cassava starch gel. It provides the possibility for both STMP and KGM to improve the gel properties of native cassava starch rather than cross‐linked reaction, and also expands the application field of KGM with low cost.
Microencapsulation of Lactobacillus casei and Bifidobacterium animalis Enriched with Resistant Starch from Vigna Unguiculata
Authors: Rengadu Danielle , Gerrano Abe S. , Mellem John J.
Published: March 2021

In this study, the viability and stability of probiotics (Lactobacillus casei and Bifidobacterium animalis) encapsulated in a resistant starch medium through freeze‐drying is evaluated. Particle size, SEM, and color analysis are done on the microcapsules. The encapsulation yield after freeze‐drying is between 81.55% and 88.78%, with viability of the microcapsules analyzed in simulated gastric juice (SGJ) and simulated intestinal juice (SIJ) as well as in apple juice store at 4 °C over 28 days. The microencapsulated probiotics in this study has a substantial final count for SGJ and SIJ between 7.30–7.98 Log colony‐forming unit (CFU) mL‐1 and 7.26–7.89 Log CFU mL‐1, respectively. The Log CFU mL‐1 for free cells are significantly lower than the microcapsules. The final viability for microcapsules in the juice at the end of 28 days for resistant starch + L. casei (RSL), resistant starch + B. animalis (RSB), and resistant starch + L. casei + B. animalis(RSLB) are 7.53, 6.98, and 7.46 Log CFU mL‐1. This confirms that microencapsulation enhance the survival of L. casei and B. animalis in fruit juice under cold storage. Results from this study show that resistant starch has potential as an encapsulating material as it protected the probiotic cells in conditions such as freeze‐drying, simulated gastrointestinal digestion and low pH environments during beverage application.
“Man Looks at the Outward Appearance, God Looks at the Heart:” Inclusion and Identity in a High Boundary Religion
Authors: Walker Jonathan , Fitzgerald Scott T.
Published: April 2021

In this case study, we bring together literatures on identity and culture to examine the boundary work taking place within the United Pentecostal Church International (UPCI), a historically conservative denomination with a fundamentalist orientation toward Christian belief and practice. Our findings demonstrate that boundaries are subject to deviation—and even intentional alteration—at the local level. We introduce the concept of “self‐effacing boundary work” to describe a strategy that deemphasizes exclusionary group practices and beliefs while simultaneously seeking to retain a unique group identity. Organizational leaders and idioculture play key roles in this process.
Orchestration and Situation Awareness in an Assistance System for Assembly Tasks
Authors: Behrendt Wernher , Strohmeier Felix
Published: April 2021

We report on the design, specification and implementation of a situation awareness module used for assistive systems in manufacturing, in the context of Industry 4.0. A recent survey of research done in Germany and Europe, concerning assistive technology in industry shows a very high potential for “intelligent assistance” by combining smart sensors, networking and AI. While the state of the art concerning actual technology in industrial use points more towards user-friendly, speech-based interaction with personal assistants for information retrieval (typically of in-house documentation), the research presented here addresses an enterprise-level assistance system that is supported by a number of specialized Assistance Units that can be customized to the end users’ specifications and that range from tutoring systems to tele-robotics. Key to the approach is situation awareness, which is achieved through a combination of a-priori, task knowledge modelling and dynamic situation assessment on the basis of observation streams coming from sensors, cameras and microphones. The paper describes a working fragment of the industrial task description language and its extensions to cover also the triggering of assistive interventions when the observation modules have sent data that warrants such interventions.
Palliativversorgung
Authors: Ateş Gülay , Jaspers Birgit , Peuten Sarah , Schneider Werner , Radbruch Lukas
Published: March 2021

In Krankenhäusern hält das deutsche Gesundheitswesen für Patientinnen und Patienten in komplexen, nicht heilbaren Krankheitssituationen unterschiedliche palliative Versorgungsangebote vor. Hierzu zählen Palliativstationen sowie krankenhausinterne Palliativdienste. Deren Aufgaben umfassen die Linderung von Symptomen, Unterstützung bei psychosozialen oder spirituellen Problemen, Beratung bei ethischen Fragestellungen, Aufbau oder Ausbau des ambulanten Versorgungsnetzes sowie Koordination und Kommunikation zwischen den Versorgungsanbietenden. Der multiprofessionelle und interdisziplinäre Ansatz der Palliativversorgung zielt nicht nur auf Patienten mit lebenslimitierenden Erkrankungen in der letzten Phase des Lebens, sondern kann bereits zu einem früheren Zeitpunkt eingesetzt werden, teilweise auch parallel zu kurativen Therapieansätzen. Der ganzheitliche Ansatz der Palliativversorgung berücksichtigt dabei die individuellen Bedürfnisse und Prioritäten der Patienten sowie die Bedarfe von Zugehörigen und deren Rolle im Versorgungssystem inklusive Angebote der Trauerbegleitung. Den Erhalt individueller Lebensqualität und eine ressourcenorientierte Stärkung zur Bewältigung des Alltags stehen im Fokus der Palliativversorgung.Nach einem kurzen Einblick in die Angebotsvielfalt des stationären und ambulanten Hospiz- und Palliativbereich wird anhand von eigenen Studien der Zugang zur Palliativversorgung im Krankenhaus und bei Krankenhausentlassung aufgezeigt. Anschließend werden Herausforderungen bei der Einbindung der Palliativversorgung und potenzielle Probleme bei der Krankenhausentlassung dargestellt. Eine rechtzeitige und möglichst frühe Einbindung der hospizlichen und palliativen Versorgungsangebote kann nachhaltig entlastend für das gesamte Versorgungssystem (sowohl Betroffene als auch Behandelnde) sein sowie potenzielle Schnittstellenproblematiken reduzieren.
Versorgungsplanung am Beispiel der Spitallisten der beiden Basel
Authors: Steiner Michael
Published: March 2021

Mit der bedarfsorientierten Spitalplanung anhand der Nomenklatur der Spitalplanungsleistungsgruppen (SPLG) steigen die Kantone Basel-Landschaft und Basel-Stadt in eine umfassende Versorgungsplanung in der Region Basel ein. Der gesamte Planungsprozess von der Bedarfsanalyse über die Mengenprognose pro SPLG bis hin zur technischen Umsetzung des Planungsmodells anhand einer linearen Optimierung ist Gegenstand dieses Beitrags. Dabei werden die Umsetzungschancen aufgezeigt, die eine medizinisch-planungsorientierte Nomenklatur für die Weiterentwicklung der Krankenhausplanung in Deutschland bieten kann.
Multisektorale Schnittstelle: Hospitalisierungen von Pflegeheimbewohnenden mit Schwerpunkt Sturz
Authors: Behrendt Susann , Schwinger Antje , Tsiasioti Chrysanthi , Stammann Carina , Willms Gerald , Hasseler Martina , Studinski Elisa , Özdes Tanyel , Krebs Stephanie , Klauber Jürgen
Published: March 2021

Knapp eine dreiviertel Million Pflegebedürftige leben in deutschen Pflegeheimen und sind in der Regel hochbetagt, multimorbid und vulnerabel. Jeder fünfte von ihnen ist jährlich im Durchschnitt der Quartale mindestens einmal im Krankenhaus. Hospitalisierungen sind damit einer der zentralen Bestandteile ihrer gesundheitlichen Versorgung. Gleichzeitig sind sie gerade für diese Personengruppe nachweislich mit erhöhten Risiken für die Verschlechterung des Gesundheitszustands verbunden, die Frage der Vermeidbarkeit von Hospitalisierungen gewinnt hier gegenwärtig an Auftrieb. Primär basierend auf Analysen von Routinedaten der AOK-Kranken- und Pflegekassen identifiziert der Beitrag die häufigsten Anlässe für den Transfer von Pflegeheimbewohnenden ins Krankenhaus: kardiovaskuläre und Atemwegserkrankungen sowie Infarkte. Darüber hinaus zeigen sich bei Pflegeheimbewohnenden Indikationen, die als potentielle Hinweise für Versorgungsdefizite im Setting Pflegeheim gelten. Die empirische Detailanalyse eines der häufigsten Anlässe, dem Sturz, unterstreicht die Bedeutung einer berufsgruppenübergreifenden Prävention: drei Viertel der Pflegeheimbewohnenden erhalten sturzrisikoerhöhende Medikation, 16% von ihnen werden spätestens im Folgequartal der Verordnung sturzassoziiert hospitalisiert. Sturzprophylaxe ist in diesem Sinne auch immer Hospitalisierungsprävention.
Personalfluktuation in deutschen Krankenhäusern: Jeder sechste Mitarbeiter wechselt den Job
Authors: Pilny Adam , Rösel Felix
Published: March 2021

Pflegepersonal wird in Krankenhäusern zunehmend knapp. Für das verbleibende Personal bedeutet dies eine steigende Arbeitsbelastung, mehr Unzufriedenheit und häufigere Jobwechsel, die die Situation oft weiter verschärfen. In diesem Beitrag analysieren wir auf Basis einer Sonderauswertung der Bundesagentur für Arbeit die Personalfluktuation in den deutschen Krankenhäusern für die Jahre 2004 bis 2016 und vergleichen sie mit anderen Wirtschaftszweigen. Etwa jede/r sechste Krankenhausbeschäftigte wechselt innerhalb eines Jahres den Job; in der Gesamtwirtschaft ist es jede/r dritte Arbeitnehmer/in. Über fast alle Bundesländer zeigt sich eine überdurchschnittliche Zunahme der Jobwechsel in den vergangenen Jahren. Dies liegt fast ausschließlich an der höheren Fluktuation beim Pflegepersonal. Die Rotationsrate bei Ärztinnen und Ärzten ist sogar rückläufig. Eine Verbesserung der Jobsituation für Pflegerinnen und Pfleger ist und bleibt daher eine der Top-Prioritäten auf der gesundheitspolitischen Agenda.
Auswirkungen der Covid-19-Pandemie auf die Krankenhausleistungen im Jahr 2020
Authors: Mostert Carina , Hentschker Corinna , Scheller-Kreinsen David , Günster Christian , Malzahn Jürgen , Klauber Jürgen
Published: March 2021

Die Covid-19-Pandemie hat das stationäre Versorgungsgeschehen stark verändert. Der Beitrag beschreibt wesentliche durch die Pandemie bedingte Leistungsveränderungen. Des Weiteren werden die Charakteristika und Versorgungsstrukturen von Covid-19-Patienten dargestellt. Es zeigt sich ein deutlicher Rückgang der Krankenhausaufnahmen im Jahr 2020 im Vergleich zum Vorjahr, der in der ersten Pandemiewelle (März bis Mai) stärker ausfiel als in der zweiten Pandemiewelle (Oktober bis Dezember). Dies ging mit einer Verschiebung des Leistungsspektrums hin zu Fällen mit einer höheren Fallschwere einher. Bei den operativen Leistungen ist ein geringerer Rückgang zu verzeichnen als bei den übrigen Leistungen. Auch bei ausgewählten dringlichen Behandlungsanlässen kam es zu Fallzahlrückgängen. Noch stärkere Rückgänge wiesen die überwiegend verschiebbaren Behandlungsanlässe auf, bei denen sich auch während der Sommermonate keine Nachholeffekte abzeichneten. Dass es sich bei Covid-19 um eine sehr schwere Erkrankung handelt, verdeutlichen die hohen Sterblichkeitsraten der stationären Patienten sowie deren lange Verweil- und Beatmungsdauer.
Fallpauschalenbezogene Krankenhausstatistik: Diagnosen und Prozeduren der Krankenhauspatienten auf Basis der Daten nach § 21 Krankenhausentgeltgesetz
Authors: Spindler Jutta
Published: March 2021

Mit den DRG-Daten nach § 21 Krankenhausentgeltgesetz (KHEntgG) steht den Nutzerinnen und Nutzern im Rahmen des Angebots des Statistischen Bundesamtes seit dem Jahr 2005 neben den Grunddaten und den Diagnosedaten der Krankenhäuser eine weitere wichtige Datenquelle zur Verfügung. Gegenstand dieses Beitrags sind zentrale Ergebnisse zur stationären Versorgung des Jahres 2019, die das Informationsspektrum der herkömmlichen amtlichen Krankenhausstatistik ergänzen und erweitern. Im Vordergrund stehen die Art und Häufigkeit durchgeführter Operationen und medizinischer Prozeduren sowie die Darstellung wichtiger Hauptdiagnosen, ergänzt um ihre jeweiligen Nebendiagnosen auch unter fachabteilungsspezifischen Gesichtspunkten der vollstationär behandelten Krankenhauspatientinnen und -patienten. Ausgewählte Ergebnisse zum erbrachten Leistungsspektrum der Krankenhäuser, insbesondere zur Art und zum Umfang der abgerechneten Fallpauschalen (DRGs), den Hauptdiagnosegruppen (MDCs) sowie zum Casemix (CM) und Casemix-Index (CMI) werden in diesem Beitrag ebenfalls dargestellt.
Krankenhaus-Directory 2019 – DRG-Krankenhäuser im Vergleich
Authors: Mostert Carina , Pritzkau Andreas
Published: March 2021

Das Directory deutscher Krankenhäuser bietet eine jährlich aktualisierte Übersicht stationärer Leistungserbringer. Die Darstellung umfasst unter anderem Informationen zur Struktur des vereinbarten Leistungsangebots, zum Grad der Spezialisierung, zur regionalen Marktpositionierung und Wettbewerbssituation sowie Informationen zur Ergebnisqualität nach dem Verfahren Qualitätssicherung mit Routinedaten (QSR). Insgesamt finden mehr als 1.300 Krankenhäuser Eingang, zu denen eine Budgetvereinbarung für das Jahr 2019 oder QSR-Behandlungsergebnisse vorliegen.
Patientenorientierte Notfallsteuerung
Authors: Messerle Robert , Schreyögg Jonas , Gerlach Ferdinand M.
Published: March 2021

Der Referentenentwurf zur Notfallversorgung wurde kurz vor einer der größten Krisen der Bundesrepublik veröffentlicht. Strukturelle Probleme des deutschen Gesundheitswesens wurden in der Krise besonders sichtbar und mussten quasi über Nacht zumindest provisorisch gelöst werden. Schon zuvor legten steigende Fallzahlen und eine weitgehend fehlende Steuerung die Probleme der Notfallversorgung offen. Eine grundlegende Strukturreform zur längerfristigen Behebung der verschiedenen Defizite erscheint einmal mehr notwendig, wurde aber vom Gesetzgeber zunächst vertagt.

Der Sachverständigenrat stellte dazu bereits 2018 umfassende Empfehlungen vor, welche hier vorgestellt und punktuell ergänzt werden. Das Leitbild sind sektorenübergreifend koordinierte, klar abgestufte Versorgungspfade. In Integrierten Leitstellen (ILS) beurteilen erfahrene Fachkräfte rund um die Uhr die Behandlungsdringlichkeit der Anrufer und lenken die Versorgung in bedarfsgerechte und effiziente Strukturen. Ebenfalls rund um die Uhr erreichbare Integrierte Notfallzentren (INZ) stellen an qualitativ besonders geeigneten Kliniken den ersten Anlaufpunkt dar. Die weitere Behandlung erfolgt aus einer Hand, ambulant oder stationär.
Entlassmanagement – Status quo und Lösungsansätze zur Verbesserung
Authors: Lingnau Ruth , Blum Karl , Willms Gerald , Pollmann Thorsten , Gohmann Philipp , Broge Björn
Published: March 2021

Durch das Gesetz zur Stärkung der Versorgung in der gesetzlichen Krankenversicherung (GKV-VSG) und den Rahmenvertrag Entlassmanagement soll eine bedarfsgerechte, kontinuierliche Weiterversorgung der Patienten im Anschluss an die Krankenhausbehandlung gewährleistet werden. Die bisherigen Erfahrungen mit der Umsetzung des Rahmenvertrages bestätigen allerdings, dass es nach wie vor Schnittstellenprobleme zwischen den am Patientenübergang beteiligten Akteuren gibt. In diesem Beitrag werden aktuelle Problemlagen im Entlassmanagement beschrieben und Möglichkeiten vorgestellt, wie sich Routinedaten für den Prozess des Entlassmanagements erfolgversprechend nutzen lassen. Dies wird am Beispiel eines aktuellen Projekts beschrieben, das den Informationsaustausch zwischen den Sektoren fördert und so die Entlassplanung verbessern soll. Dabei unterstützt ein auf Routinedaten basierendes Modell das initiale Assessment zur frühzeitigen Identifikation von Patienten mit erhöhtem poststationärem Versorgungsbedarf und ermöglicht zusammen mit einem beschleunigten, IT-basierten Genehmigungsprozess für Nachsorgeleistungen eine effektivere Entlassplanung und Patientenüberleitung.
Sektorübergreifende Versorgung bei Herzinsuffizienz
Authors: Störk Stefan , Peters-Klimm Frank , Bleek Julian , Ninic Rajko , Klöss Andreas
Published: March 2021

Die Versorgung von Patienten mit Herzinsuffizienz ist gekennzeichnet durch hohe Behandlungsintensität und häufige Wechsel zwischen den Leistungssektoren. Dies macht ein hohes Maß an Abstimmung und Kommunikation zwischen den Leistungserbringern der beteiligten Versorgungsebenen erforderlich. Dieser Beitrag geht der Frage nach, inwieweit das deutsche Gesundheitssystem Strukturen bereithält, die eine nahtlose Versorgung von Herzinsuffizienzpatienten unterstützen.Als Ausgangspunkt der Betrachtungen diente eine Routinedatenanalyse auf der Grundlage bundesweiter Abrechnungsdaten von über 26 Mio. AOK-Versicherten aus den Jahren 2018–2019. Der Fokus lag auf zentralen Charakteristika der Herzinsuffizienz-Population und der Versorgungsprozesse sowie wichtigen Schnittstellen der Versorgung. Erwartungsgemäß fanden sich unter den Herzinsuffizienz-Patienten viele ältere und pflegebedürftige Menschen. Die Komorbiditätslast und Polypharmaziequote waren hoch. Dies spiegelte sich in einem hohen Betreuungsbedarf mit vielen Arztkontakten und Krankenhausaufenthalten wider.Studiendaten weisen auf Versorgungsdefizite hinsichtlich einer frühen und validen Diagnosestellung sowie der Langzeitbehandlung hin. Ungenügend implementierte Regelungen der Kooperation, fehlende Kommunikationsformate sowie Vergütungsstrukturen, die wenig Anreize für kooperative Versorgungsformen bieten, tragen dazu bei, dass das Zusammenspiel von Hausarzt und Kardiologe noch nicht optimal funktioniert. Ein optimaler Übergang vom Krankenhaus in die ambulante Weiterversorgung ist personal- und ressourcenintensiv und trotz sinnvoller gesetzgeberischer Vorgaben häufig nicht umgesetzt. Brüche bestehen zudem in Bezug auf die Anbindung des Patienten an das professionelle System.Die hier vorgestellten Case-Management-Strategien enthalten verschiedene Komponenten, die geeignet sind, Schwachstellen in der bestehenden Versorgung zu kompensieren. Neben der Erfassung von Körperwarnsignalen scheinen insbesondere verbindliche Regelungen zur Kooperation, die Einbindung nichtärztlicher Fachkräfte sowie die Etablierung sektorübergreifender Kommunikationsformen essentiell, um eine nahtlose Versorgung von Herzinsuffizienz-Patienten zu gewährleisten. Eine wichtige Rolle spielt zudem das Vergütungssystem, das mit seiner sektoralen Trennung und dem Bezug auf einzelne Leistungserbringer nicht ausreichend Anreize für eine kooperative Versorgung setzt.
Versorgungskette von Patienten mit Polytrauma
Authors: Hoffmann Reinhard , Schweigkofler Uwe , Reimertz Christoph , Bouillon Bertil
Published: March 2021

Der Beitrag stellt die aktuelle Organisation und Struktur der Polytraumaversorgung in Deutschland dar. Die Überlebenswahrscheinlichkeit nach Klinikeinlieferung ist hoch. Traumazentren, Traumanetzwerke und Qualitätssicherungsmaßnahmen spielen hierbei eine zentrale Rolle. Schnittstellen werden beschrieben und „Schwachstellen“ aufgezeigt. Insbesondere im Bereich der gezielten Allokation knapper werdender Ressourcen, in der Personalrekrutierung und im Bereich der Rehabilitation und Wiedereingliederung müssen künftig verstärkte Schwerpunkte gesetzt werden.
Cancer therapy in mice using a pure population of CD8+ T cell specific to the AH1 tumor rejection antigen
Authors: Stringhini Marco , Spadafora Ilaria , Catalano Marco , Mock Jacqueline , Probst Philipp , Spörri Roman , Neri Dario
Published: April 2021

There is a growing interest in the use of patient-derived T cells for the treatment of various types of malignancies. The expansion of a polyclonal and polyspecific population of tumor-reactive T cells, with a subsequent infusion into the same donor patient, has been implemented, sometimes with positive results. It is not known, however, whether a set of T cells with a single antigen specificity may be sufficient for an effective therapy. To gain more insights in this matter, we used naturally occurring T cells recognizing a retroviral peptide (AH1), which is endogenous in many tumor cell lines of BALB/c origin and which serves as potent tumor rejection antigen. We were able to isolate and expand this rare population of T cells to numbers suitable for therapy experiments in mice (i.e., up to 30 × 106 cells/mouse). After the expansion process, T cells efficiently killed antigen-positive tumor cells in vitro and demonstrated tumor growth inhibition in two syngeneic murine models of cancer. However, AH1-specific T cells failed to induce complete regressions of established tumors. The incomplete activity was associated with a failure of injected T cells to survive in vivo, as only a very limited amount of T cells was found in tumor or secondary lymphoid organs 72 h after injection. These data suggest that future therapeutic strategies based on autologous T cells may require the potentiation of tumor-homing and survival properties of cancer-specific T cells.
Single-cell profiling of myasthenia gravis identifies a pathogenic T cell signature
Authors: Ingelfinger Florian , Krishnarajah Sinduya , Kramer Michael , Utz Sebastian G. , Galli Edoardo , Lutz Mirjam , Zwicky Pascale , Akarca Ayse U. , Jurado Nicole Puertas , Ulutekin Can , Bamert David , Widmer Corinne C. , Piccoli Luca , Sallusto Federica , Núñez Nicolás G. , Marafioti Teresa , Schneiter Didier , Opitz Isabelle , Lanzavecchia Antonio , Jung Hans H. , De Feo Donatella , Mundt Sarah , Schreiner Bettina , Becher Burkhard
Published: March 2021

Myasthenia gravis (MG) is an autoimmune disease characterized by impaired neuromuscular signaling due to autoantibodies targeting the acetylcholine receptor. Although its auto-antigens and effector mechanisms are well defined, the cellular and molecular drivers underpinning MG remain elusive. Here, we employed high-dimensional single-cell mass and spectral cytometry of blood and thymus samples from MG patients in combination with supervised and unsupervised machine-learning tools to gain insight into the immune dysregulation underlying MG. By creating a comprehensive immune map, we identified two dysregulated subsets of inflammatory circulating memory T helper (Th) cells. These signature ThCD103 and ThGM cells populated the diseased thymus, were reduced in the blood of MG patients, and were inversely correlated with disease severity. Both signature Th subsets rebounded in the blood of MG patients after surgical thymus removal, indicative of their role as cellular markers of disease activity. Together, this in-depth analysis of the immune landscape of MG provides valuable insight into disease pathogenesis, suggests novel biomarkers and identifies new potential therapeutic targets for treatment.
Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study
Authors: Bartnik Krzysztof , Podgórska Joanna , Rosiak Grzegorz , Korzeniowski Krzysztof , Giziński Jakub , Sajdek Michał , Wróblewski Tadeusz , Zieniewicz Krzysztof , Nyckowski Paweł , Rowiński Olgierd
Published: March 2021

Purpose

Treatment response following transarterial chemoembolization (TACE) is frequently evaluated with Liver Imaging Reporting and Data System Treatment Response (LR-TR) algorithm, but its association with patients’ outcomes is not supported in the literature. The purpose of this study was to provide such data.

Methods

A retrospective analysis of 99 TACE patients with stage A/B hepatocellular carcinoma according to Barcelona-Clinic Liver Cancer staging system was performed. Two radiologists assessed LR-TR, while a third radiologist re-assessed divergent results. Overall survival (OS) and time to disease progression (TTP) were the primary endpoints of the study, while the Cox proportional hazard model was used for outcome analyses.

Results

Interobserver agreement was substantial between the two readers with κ = 0.69 (95% CI 0.58–0.81). The median OS in viable, equivocal, and non-viable groups were 27, 27, and 73 months, respectively (p < 0.001). However, after adjustment for confounding factors, there was no significant association between initial viable response and OS (HR 0.98 [95% CI 0.37–2.63], p = 0.97), while equivocal response remained statistically significant (HR 3.52. [95% CI 1.27–9.71], p = 0.015). No significant association was noted when viable and equivocal groups were analyzed in aggregate (HR 1.03 [95% CI 0.4–2.4], p = 0.96). The median TTP did not differ between non-viable and viable groups (23 vs 18 months, respectively; p = 0.98). None of the analyzed predictors was associated with TTP.

Conclusion

Initial LR-TR response was not an independent predictor for OS nor TTP. The preliminary results suggest the necessity for more aggressive management of equivocal patients.
Fluid mechanics of the left atrial ligation chick embryonic model of hypoplastic left heart syndrome
Authors: Ho Sheldon , Chan Wei Xuan , Yap Choon Hwai
Published: March 2021

Left atrial ligation (LAL) of the chick embryonic heart at HH21 is a model of the hypoplastic left heart syndrome (HLHS) disease, demonstrating morphological and hemodynamic features similar to human HLHS cases. Since it relies on mechanical intervention without genetic or pharmacological manipulations, it is a good model for understanding the biomechanics origins of such HLHS malformations. To date, however, the fluid mechanical environment of this model is poorly understood. In the current study, we performed 4D ultrasound imaging of LAL and normal chick embryonic hearts and 4D cardiac flow simulations to help shed light on the mechanical environment that may lead to the HLHS morphology. Results showed that the HH25 LAL atrial function was compromised, and velocities in the ventricle were reduced. The HH25 LAL ventricles developed a more triangular shape with a sharper apex, and in some cases, the atrioventricular junction shifted medially. These changes led to more sluggish flow near the ventricular free wall and apex, where more fluid particles moved in an oscillatory manner with the motion of the ventricular wall, while slowly being washed out, resulting in lower wall shear stresses and higher oscillatory indices. Consequent to these flow conditions, at HH28, even before septation is complete, the left ventricle was found to be hypoplastic while the right ventricle was found to be larger in compensation. Our results suggest that the low and oscillatory flow near the left side of the heart may play a role in causing the HLHS morphology in the LAL model.
Lower temperature influences Cauliflower mosaic virus systemic infection
Authors: Alers-Velazquez Roberto , Khandekar Sushant , Muller Clare , Boldt Jennifer , Leisner Scott
Published: March 2021

Lower temperatures delayed development of systemic symptoms by Cauliflower mosaic virus (CaMV) in two different plant hosts. However, lower temperature exposure increased CaMV nucleic acid levels in leaves of systemically-infected turnips. Furthermore, lower temperature altered the formation of aggregates formed by the CaMV major inclusion body (IB) protein, P6. Finally, lower temperature altered the architecture of the actin cytoskeleton. These data may suggest that lower temperatures alter the actin cytoskeleton, facilitating the formation of larger IBs that hold on to their internal virions more strongly than small ones, impairing virus particle release and causing a delay in systemic infection.
Associations between social burden, perceived stress, and diurnal cortisol profiles in older adults: implications for cognitive aging
Authors: Pretscher Anna , Kauzner Saskia , Rohleder Nicolas , Becker Linda
Published: March 2021

Stress can be a risk factor for mental and physical health. We investigated the role of social burden as a potential stressor in older age and its associations with cognitive aging (i.e., within the domains inhibition and cognitive flexibility of executive functioning). Eighty-three older adults (N = 38 male, mean age = 74.0 ± 5.7 years, body-mass index = 25.5 ± 4.1 kg/m2) aged 64 years or older participated. Cognitive flexibility and inhibition were assessed by means of a Trail-Making Test (TMT) and a Stroop task. Perceived levels of social burden and perceived stress in general were assessed via standardized questionnaires. Furthermore, diurnal cortisol profiles were assessed. Overall, older participants showed lower cognitive performance than the younger (both inhibition and cognitive flexibility; p < .044). However, this association did not remain significant when adjusting for multiple comparisons. Social burden was highly correlated with perceived stress, highlighting its importance as a stressor (p < .001). Furthermore, participants who reported higher levels of perceived stress showed lower performance in the TMT as a measure for cognitive flexibility (p < .001). Moreover, social burden was associated with cognitive flexibility, which was assessed by means of the TMT (p = .031). However, this association did not remain significant when using the adjusted α-level. Furthermore, we found that total diurnal cortisol output was a mediator for the relationship between age and inhibition, which was assessed by means of a Stroop task. At last, we found that the mediating role of cortisol interacts with social burden in the way that especially in younger age, high levels of social burden are associated with higher cortisol levels and, therefore, with lower cognitive performance. We conclude that it is important to consider social burden as an additional stressor in older age which is associated with cognitive aging.