bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of 1064‐nm and Dual‐Wavelength (532/1064‐nm) Picosecond‐Domain Nd:YAG Lasers in the Treatment of Facial Photoaging: A Randomized Controlled Split‐Face Study
Authors: Zhang Mengli , Huang Yuqing , Wu Qiuju , Lin Tong , Gong Xiangdong , Chen Hao , Wang Yan
Published: March 2021

Background and Objectives

To compare the efficacy and safety of 1064‐nm and dual‐wavelength (532/1064 nm) picosecond Nd:YAG lasers with a holographic optic in the treatment of facial photoaging.

Study Design/Materials and Methods

In this prospective, randomized split‐face study, each half of each participant′s face was randomly treated with a 1064‐nm or 532/1064‐nm picosecond laser. All participants underwent five treatment sessions and follow‐up visits 1 and 3 months after the final treatment. The primary outcomes were measured as the global photoaging scores, determined by two physicians who were blinded to the treatments. The secondary outcomes were the participant‐assessed Global Aesthetic Improvement Scale (GAIS) and satisfaction scores. Histopathological examinations were performed.

Results

Global photoaging scores decreased significantly after treatment with either laser. The global photoaging scores, GAIS scores, and satisfaction scores did not differ significantly between the 1064‐nm and 532/1064‐nm picosecond laser treatments. Histological changes were similar between the two groups. Intraepidermal vacuoles and dermal hemorrhaging were observed immediately and 24 h after treatment. After five treatments, neocollagenesis was observed in the upper dermis of both groups, and elastic fibers were more elongated and orderly.

Conclusions

Treatments with 1064‐nm and 532/1064‐nm picosecond Nd:YAG lasers were comparably effective at improving photodamaged facial skin by remodeling the collagen and elastin network through laser‐induced optical degradation and vascular damage.
Revisions to the IASP definition of pain—What does this mean for children?
Authors: Stevens Bonnie
Published: March 2021

The complexity of the phenomenon of pain defies a simple and straightforward definition. Acute, chronic, nociplastic and neuropathic pain account for multiple pathologic mechanisms and forms of expression. Pain varies widely in intensity, duration and nature, often complicating description for those who are experiencing the pain and/ or those who are observing it. Assessment of pain in children can be challenging, especially in those who may be incapable of self‐report report due to development immaturity or disability. In these children the responsibility of assessing pain often falls to the professional or lay care provider, whose knowledge, expertise and beliefs influence their judgements. The experience of pain includes not only the physiologic and behavioural indicators most frequently included in pain assessment measures but also encompasses the social and cognitive components that often go unrecognized. The 1979 IASP definition of pain has been praised for its brevity, simplicity and attention to the multidimensional nature of the phenomenon. It has also been criticized for ignoring mind‐body interactions, disempowering and neglecting vulnerable populations, paying little attention to ethical dimensions, and excluding cognitive and social factors that are integral to the experience of pain. After four decades, the 1979 definition of pain and the accompanying notes were evaluated and revised by a 14‐member IASP presidential task force with representation from basic and clinical research, geographical location and populations served (Pain, 2020, 161, 1976). These revisions resulted in decreasing the emphasis of pain associated with tissue damage in the definition, and, by removing the word ‘described’, allowing those who were nonverbal to be assessed using other validated pain indicators. Important revisions were also made to the Notes. The revisions that are most relevant for pain in children are discussed.
Characterization of the Detonation Pressure of a PETN Based PBX with the Optical Active Method
Authors: Quaresma Joana , Deimling Lukas , Campos Jose , Mendes Ricardo
Published: March 2021

Detonation metrology is essential for the development of energetic materials, to characterize existing explosives, and to characterize materials behavior under high pressures. The optical active method (OAM), based on PMMA optical fibers (250 μm diameter) and their radiation transmission loss when shocked, was used to characterize the detonation wave (DW) and shock wave (SW) in inert barriers and applied to measure the detonation pressure in condensed explosives. The detonation velocity and detonation pressure of a PBX based on PETN (86 % PETN, 14 % Sylgard), known as Seismoplast were measured. The OAM with protected optical probes (POP) was used to determine the mean detonation velocity (7337 m s−1), whereas the OAM with bare optical probes (BOP) was used to measure the induced shock velocities generated by Seismoplast on different thicknesses of PMMA (1–9 mm), aluminum and copper (1–7 mm). Based on the shock velocities at the interfaces between the explosive and the inert barriers, the CJ pressure of Seismoplast was determined as 21.2 GPa.
Influences of Bu‐NENA and BDNPA/F Plasticizers on the Properties of Binder for High‐Energy NEPE Propellants
Authors: Wang Yalun , Rong Hui , Zhang Xiuhui , Chen Yu , Luo Wen , Liu Yunfei , Yao Weishang , Tian Ye
Published: March 2021

Desensitized energetic plasticizer (DEP) plays a crucial role in the properties of the binder, and thus can further influence the performances of desensitive Nitrate Ester Plasticized Polyether (NEPE) propellants, which represents the development direction of the next generation solid propellant composites. However, at present, a study on influencing mechanisms for curing properties of propellant binders at the atomic and molecular level was rarely reported. In the current study, based on the curing kinetics and mechanical properties of PET/N‐100 binder, the influencing mechanism of the DEPs, BDNPA/F, and Bu‐NENA, on the binder was determined by the Gaussian quantum chemical calculation and MD simulation at the chemical bond and polymer chain levels, as well as the characterizations of the curing network structure, glass transition temperature, and microphase separation of the binder system. The consistent results at both micro and macro levels offer important theoretical guidance for studying the structure‐mechanism‐performance relationship of propellant binder, as well as for exploring the strategies that can reveal the curing mechanism of the binder system in depth.
Insights into the mechanisms of light‐oxygen‐voltage domain color tuning from a set of high‐resolution X‐ray structures
Authors: Remeeva Alina , Nazarenko Vera V. , Kovalev Kirill , Goncharov Ivan M. , Yudenko Anna , Astashkin Roman , Gordeliy Valentin , Gushchin Ivan
Published: March 2021

Light‐oxygen‐voltage (LOV) domains are widespread photosensory modules that can be used in fluorescence microscopy, optogenetics and controlled production of reactive oxygen species. All of the currently known LOV domains have absorption maxima in the range of ~440 to ~450 nm, and it is not clear whether they can be shifted significantly using mutations. Here, we have generated a panel of LOV domain variants by mutating the key chromophore‐proximal glutamine aminoacid of a thermostable flavin based fluorescent protein CagFbFP (Gln148) to asparagine, aspartate, glutamate, histidine, lysine and arginine. Absorption spectra of all of the mutants are blue‐shifted, with the maximal shift of 8 nm observed for the Q148H variant. While CagFbFP and its Q148N/D/E variants are not sensitive to pH, Q148H/K/R reveal a moderate red shift induced byacidic pH. To gain further insight, we determined high resolution crystal structures of all of the mutants studied at the resolutions from 1.07 Å for Q148D to 1.63 Å for Q148R. Whereas in some of the variants, the aminoacid 148 remains in the vicinity of the flavin, in Q148K, Q148R and partially Q148D, the C‐terminus of the protein unlatches and the side chain of the residue 148 is reoriented away from the chromophore. Our results explain the absence of color shifts from replacing Gln148 with charged aminoacids and pave the way for rational design of color‐shifted flavin based fluorescent proteins.
Interlayer Excitonic Spectra of Vertically Stacked MoSe2/WSe2 Heterobilayers
Authors: Gillen Roland
Published: March 2021

The optical spectra of vertically stacked / heterostructures contain additional “interlayer” excitonic peaks that are absent in the individual monolayer materials and exhibit a significant spatial charge separation in out‐of‐plane direction. A many‐body perturbation theory approach is used to simulate the excitonic spectra of / heterobilayers with three stacking orders, considering both momentum‐direct and momentum‐indirect excitons. The small oscillator strengths and the optical responses of the interlayer excitons are significantly stacking‐dependent and give rise to high radiative lifetimes in the range of 5–200 ns at low temperature for the “bright” interlayer excitons. Solving the finite‐momentum Bethe–Salpeter Equation (BSE), the lowest energy excitation is predicted to be an exciton over the fundamental indirect band gap, with a binding energy of 220 meV. However, in agreement with recent magneto‐optics experiments and previous theoretical studies, the simulations of the effective excitonic g‐factors suggest that the low energy momentum‐indirect excitons are not experimentally observed. The existence of “interlayer” C excitons with significant exciton binding energies and optical oscillator strengths is further revealed, which are analogous to the prominent band nesting excitons in mono‐ and few‐layer transition‐metal dichalcogenides.
Research on interference avoidance effect of OneWeb satellite constellation's progressive pitch strategy
Authors: Li Ting , Jin Jin , Li Wei , Ren Zixuan , Kuang Linling
Published: March 2021

Due to the scarcity of spectrum resources, the non‐geostationary orbit (NGSO) satellite constellations, which have achieved rapid development in recent years, have to deal with the challenge of spectral coexistence with geostationary orbit (GSO) satellite systems. OneWeb has put forward the “progressive pitch” strategy for GSO networks protection; however, the technical details are not exposed. Herein, we propose a method to obtain the exact progressive pitch parameters suitable for OneWeb system in terms of the technical route of this strategy. Constrained by GSO satellite system's interference protection criterion, an optimization problem is formulated by mathematical modeling of the spectral coexistence scenario between OneWeb system and a GSO satellite system. This optimization problem is resolved by a set of transformations, and the progressive pitch parameters with less loss of the system service capability are obtained. In addition, numerical simulation results verify the effectiveness of the progressive pitch strategy with our obtained parameters for interference avoidance in most parts of the world, but service blind areas of OneWeb system may appear in some time. Finally, we briefly analyze the causes and elimination ways of the blind areas.
Receiving Care Through Digital Health Technologies: Drivers and Implications of Old-Age Digital Health Exclusion
Authors: Poli Arianna , Kostakis Ioannis , Barbabella Francesco
Published: March 2021

The transition from traditional to progressively digitised health systems is leading to new forms of care including, for instance, telehealth and mobile health (mHealth) solutions. On the one hand, such solutions hold the potential for allowing easier, quicker and remote access to health care. On the other hand, digital health technologies can set new challenges for older people, especially for those who are not familiar with such technologies, in terms of receiving the care they need through good access and level of use of services. Furthermore, these services do not necessarily reflect everyone’s preferences and needs. This chapter aims to conceptualise and systematically discuss old-age digital health exclusion. First, we highlight key structural, environmental, individual and socio-technical drivers of the non-use and low-use of digital technologies, considering also the aspect of agency and personal preferences. Second, we point out the main individual and societal implications of old-age digital health exclusion. Third, we provide a conceptual framework for old-age digital health exclusion which includes older people, drivers and implications. Finally, we offer some reflections about digital health technologies in health care, highlighting related issues, risks and challenges for ageing societies.
Introduction: Framing Civic Exclusion
Authors: Torres Sandra
Published: March 2021

The topic of old-age social exclusion has received increased attention as studies that measure the prevalence of this multidimensional phenomenon have shown its spread across countries; see Ogg (2005) who focuses on Europe, Hrast et al. (2013) who considers Central and Eastern Europe, and Macleod et al. (2019) who measure exclusion in the UK. The three chapters that belong to this section pay specific attention to two of the domains which Walsh et al. (2017) refer to as civic participation and socio-cultural aspects in their framework on exclusion in later life. In this book, we refer to them as civic exclusion [see Walsh et al. this volume]. It is worth noting that this domain has received the least scholarly attention so far within the literature (van Regenmortel et al. 2016; Walsh et al. 2017), even though there is clear evidence that civic engagement and socio-cultural aspects of exclusion can have an impact on self-rated health (Poortinga 2006). Thus, the purpose of the chapter is to offer an abridged introduction to the topic of civic exclusion in later life in order to offer context to the three chapters in this section.
Unemployment at 50+: Economic and Psychosocial Consequences
Authors: Murdock Elke , Filbig Marceline , Borges Neves Rita
Published: March 2021

Throughout the lifespan, unemployment has severe consequences in terms of economic exclusion, and overall social exclusion, but is compounded in older age. Within the EU, a growing number of older adults (50+) are affected by joblessness. Job loss at a later stage in a professional career may determine an early and permanent exit from the labour market with significant psychosocial consequences. Herein lies the age-specific risk for older unemployed adults: once becoming unemployed they are at greater risk at staying unemployed. As a result, older unemployed people may face income cuts, deprivation of a central adulthood role and their mental and physical health may suffer. In this chapter, we draw attention to the latent functions of work, and the psychosocial consequences of job loss in later life. Applying a life-course perspective, the aim of this chapter is to explore how job loss can be framed as a form of acute economic exclusion, and how this exclusion can have significant implications for poor mental health. In a context of rising retirement ages, and the lack of preparedness of the labour market to deal with an ageing workforce, it is essential to understand these dynamics to guide policy development.
Coping Mechanisms of Divorced and Widowed Older Women to Mitigate Economic Exclusion: A Qualitative Study in Turkey and Serbia
Authors: Barlin Hande , Vojvodic Katarina , Mercan Murat Anil , Milicevic-Kalasic Aleksandra
Published: March 2021

Many old adults are faced with the risk of social exclusion, which inhibits them from enjoying a satisfactory quality of life. Accordingly, understanding this multidimensional and multifaceted complex phenomena is crucial for building an inclusive society. Hence, studies concentrating on vulnerable groups with higher probability of economic forms of exclusion, such as widowed or divorced materially deprived women, are valuable as exclusion necessitates different actions for different segments of the older population. Against this background, this chapter investigates resilience and coping mechanisms of materially deprived widowed and separated/divorced older women. Data is taken from a qualitative study in Turkey and Serbia, two EU candidate countries with different enabling environments and social protections for older people, but with a similar level of connectedness within extended families. Semi-structured in-depth interviews with materially deprived divorced and widowed women, aged 65 years and older were conducted. The data was analysed based on the framework method. The analysis identifies the economic exclusion experienced by these women, along with the resilience and the different coping mechanisms that they demonstrate. Furthermore, it makes a cross-country comparison between Turkey and Serbia laying out similarities and differences between the two nations on this topic.
Analytical Instruments for Studying TSEI
Authors: Huntjens Patrick
Published: March 2021

The findings from literature in the previous chapters have been brought together in a conceptual framework (see Sect.3.9) and an analytical framework for Transformative Social-Ecological Innovation (Sect. 5.1). It’s main purpose is to study the dynamic interplay between actors and institutional structures influencing and inducing institutional change. This chapter furthermore provides a further operationalization of the TSEI analytical framework for analysing shifts in power dynamics (Sect. 5.2), by investigating a series or cluster of closely related action situations and mapping how power dynamics change. An example of TSEI-framework application is provided in Sect. 6.6. Finally, Sect. 5.3 provides a framework for analysing different levels of collective learning, which is considered as one of the key variables for studying the outputs of TSEI. Finally, this chapter highlights some important insights on collaborative action research and related methods (Sect. 5.4).
Introduction
Authors: Lemke Claudia
Published: March 2021

The Atlantic hurricane season terminated for this term with category-5 hurricanes such as Dorian (National Weather Service, 2019). Because of climate change, intense and damaging hurricanes are three times more frequent nowadays than 100 years ago (Grinsted, Ditlevsen & Hesselbjerg, 2019; McGrath, 2019). Likewise, scientific evidence suggests that climate change made Europe's major heatwave in 2018 more than twice as likely to occur (Schiermeier, 2018; World Weather Attribution, 2018).
Empirical findings
Authors: Lemke Claudia
Published: March 2021

In this chapter, the previously developed methodology of the MLSDI (see Chapter 4) is computed for a sample region, and the empirical findings are presented and discussed. Thereby, the knowledge (see Section 2.3.3; e.g. Weitz et al., 2018) and the sustainability gap (see Section 2.3.4; e.g. Hall et al., 2017) are tackled.
Discussion and conclusion
Authors: Lemke Claudia
Published: March 2021

This chapter discusses and reflects on the accomplished theoretical (see Chapter 2 and Chapter 3), methodological (see Chapter 4), and the empirical research (see Chapter 5). The present work is part of Phase C of the transdisciplinary research agenda in sustainability science (see Section 2.3.4; e.g. Lang et al., 2012). It draws on previous studies and problem framings from research and practice (Phase A), makes use of prior disclosures from the scientific and the practitioner community (Phase B), and finally provides new results that are relevant for both research and practice (Phase C).
Versorgungsprozesse und das Zusammenspiel der Sektoren im internationalen Vergleich
Authors: Struckmann Verena , Winkelmann Juliane , Busse Reinhard
Published: March 2021

Eine sektorenübergreifende Sichtweise ist insbesondere vor dem Hintergrund der zahlreichen technischen Fortschritte, steigender Kosten und einer alternden Gesellschaft mit zunehmend chronischen, aber häufig ambulant behandelbaren Erkrankungen wichtig. Mehrere europäische Länder begegnen diesen Entwicklungen, indem sie die Leistungserbringung über die Sektorengrenzen hinweg neu gestalten und Versorgungsprozesse systematisch durch eine Re-Organisation der Gesundheitsversorgung im ambulanten und stationären Sektor steuern. Anhand der Beschreibung aktueller Reformen, Verschiebungen von Zuständigkeiten, dem Aufbau der Leistungserbringung anhand von Patientenpfaden mit besonderem Fokus auf Schnittstellen, Organisation und Kommunikation wird deutlich, dass diese Herausforderungen in anderen europäischen Ländern (Dänemark, Finnland, Niederlande, Norwegen und Österreich) bereits konkreter als in Deutschland angegangen wurden. Auch wenn sich Gesundheitssysteme unterscheiden, was das Lernen von anderen verkompliziert, gibt es durchaus Ansätze und dafür notwendige Voraussetzungen, die auch für den deutschen Kontext Anregungen bieten können.
Sektorenübergreifende Versorgungssteuerung
Authors: Messerle Robert , Schreyögg Jonas
Published: March 2021

Seit Jahrzehnten versucht die Gesundheitspolitik, die Auswirkungen der sektoralen Trennung im Gesundheitswesen abzumildern. Im Ergebnis stehen heterogene Versorgungsoptionen anstelle eines übergreifenden ordnungspolitischen Konzepts. Der von verschiedenen Seiten festgestellte Reformbedarf im Rahmen der Corona-Pandemie sollte nun zum Anlass genommen werden, größere Schritte zu gehen. Ausgehend vom Status quo der Versorgung erscheinen insbesondere drei Handlungsbereiche wichtig: eine sektorenübergreifende, morbiditäts- und leistungsorientierte Versorgungsplanung, ein einheitliches sektorengleiches Vergütungssystem und mehr Freiräume für ein aktives Versorgungsmanagement, um an den lokalen Kontext angepasste Versorgungsmodelle zu ermöglichen.
Stand und Perspektiven einer sektorenübergreifenden Qualitätssicherung
Authors: Döbler Klaus , Follert Peter
Published: March 2021

Sektorenübergreifende Qualitätssicherungsverfahren sind als effektive und praktikable Weiterentwicklung und Ergänzung sektorspezifischer Qualitätssicherungsverfahren anzusehen. Sie können insbesondere durch „Schnittstellenindikatoren“ zur Optimierung der Versorgung an Sektorengrenzen beitragen, durch Follow-up-Indikatoren eine teilweise validere Erfassung der Ergebnisqualität ermöglichen und eine stärkere Integration der aktuellen Sektoren unterstützen.Qualitätssicherung muss handlungsrelevant sein. Für sektorübergreifende Verfahren muss daher die Verantwortlichkeit für die Ergebnisqualität von Follow-up-Indikatoren indikatorenspezifisch geklärt werden. Darüber hinaus spielen über die einzelne Einrichtung hinausgehende Auswertungsebenen eine gewichtige Rolle, wie beispielsweise Versorgungsketten, regionale Strukturen oder Versorgungsverträge. Es besteht noch erheblicher Forschungs- und Entwicklungsbedarf, solche Auswertungsebenen konkret zu bestimmen und zu operationalisieren.Eine wirkungsvolle Modellierung handlungsrelevanter Qualitätssicherungsverfahren setzt voraus, dass die qualitätsrelevanten Leistungen und Ereignisse zuverlässig identifiziert werden können. Die aktuell unterschiedlichen Kodier- und Abrechnungsregeln zwischen und innerhalb der verschiedenen Sektoren stellen eine schwerwiegende Implementationsbarriere dar. Diese Problematik ist allein innerhalb des SGB V von großer Bedeutung; „sozialgesetzbuchübergreifend“ in noch größerem Ausmaß.Eine „sozialgesetzbuchübergreifende Qualitätssicherung“ erfordert neue gesetzliche Vorgaben. Sie würde die Komplexität der Messung und Bewertung von Qualitätsergebnissen, aber auch die Differenziertheit von Qualitätsbewertungen erheblich erweitern.
Krankenhauspolitische Chronik
Authors: Bürger Dirk , Purwins Martina
Published: March 2021

Der Bundestag, dessen Abgeordnete im Ausschuss für Gesundheit, das Bundesgesundheitsministerium, die Landesgesundheitsminister und der Bundesrat setzen jährlich neben den gesundheits- auch die krankenhauspolitischen Rahmenbedingungen. Benannte Expertenbeiräte der Bundesregierung, die Gesundheitsexperten der Parteien, diverse Verbände, die (Sozial-)Gerichtsbarkeit und Bundesbehörden sowie politiknahe und wissenschaftliche Institute prägen dabei die öffentliche Diskussion um diese Regelungen. Die Selbstverwaltungspartner auf Bundesebene nutzen die ihnen übertragenen Aufgaben zur vertraglichen Gestaltung, um die medizinische und pflegerische Versorgung in den Krankenhäusern anhand der aktuellen Anforderungen weiterzuentwickeln. Die „Krankenhauspolitischen Chronik“ liefert eine Übersicht über alle wesentlichen Entscheidungen der Akteure der deutschen Gesundheits- und Krankenhauspolitik und informiert über die Aktivitäten in den vergangenen 12 Monaten.
Die Krankenhausbudgets 2018 und 2019 im Vergleich
Authors: Leclerque Gregor , Mostert Carina
Published: March 2021

Der Beitrag untersucht die Veränderungen in den jährlich zu vereinbarenden Budgets der Jahre 2018 und 2019 auf Basis von 1.181 somatischen Krankenhäusern. Deren Budgets (ohne Berücksichtigung von Ausgleichen) sind um 4,5 % gestiegen, was einem Mittelzuwachs von etwa 2,9 Mrd. Euro entspricht. Der Budgetanstieg liegt damit rund 1,4 Prozentpunkte höher als im Vorjahr. Budgeterhöhend hat sich dabei erneut vor allem die Preisentwicklung ausgewirkt. Hier ist neben der Entwicklung der LBFW auch das erhöhte Budgetvolumen der Zu- und Abschläge – und dabei insbesondere das Pflegestellenförderprogramm – von Bedeutung. Die Mengenentwicklung hingegen trägt nur geringfügig zum Budgetanstieg bei, wobei die Fallzahlen stagnieren und der moderate Anstieg vollständig auf strukturelle Entwicklungen zurückgeführt werden kann. Wenngleich die Gesamtentwicklung der Budgets durch den DRG-Bereich dominiert wird, so zeigt sich bei den Zusatzentgelten eine höhere Dynamik. Fortgesetzt hat sich die Tendenz zu deutlich späteren Verhandlungen und Genehmigungen der AEBs. Gemessen am Gesamtcasemixvolumen wurde 2019 nur knapp 38 % unterjährig umgesetzt.
Statistische Krankenhausdaten: Grunddaten der Krankenhäuser 2018
Authors: Bölt Ute
Published: March 2021

Dieser Beitrag fasst die Ergebnisse der Krankenhausstatistik zu den Grunddaten der Krankenhäuser für das Berichtsjahr 2018 zusammen. Er gibt einen Überblick über die sachlichen und personellen Ressourcen (z. B. Betten, Fachabteilungen, Personal) sowie die Inanspruchnahme von Krankenhausleistungen (Patientenbewegungen). Die Krankenhausstatistik ist eine seit 1991 bundeseinheitlich durchgeführte jährliche Vollerhebung. Auskunftspflichtig sind die Träger der Krankenhäuser. Die Diagnosedaten der Krankenhauspatienten werden wie die fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) jeweils in einem gesonderten Beitrag behandelt (siehe 20 und 21).
Zuweisung und Patientennavigation ins Krankenhaus
Authors: Geraedts Max , de Cruppé Werner
Published: March 2021

Rechtlich gesehen dürfen nur Patientinnen und Patienten stationär im Krankenhaus behandelt werden, die ambulant nicht behandelt werden können. Empirisch sieht es jedoch so aus, dass viele elektive Patienten in Krankenhäuser stationär eingewiesen und dort behandelt werden, obwohl deren Erkrankungen oder zumindest Teile der notwendigen Prozeduren auch ambulant hätten behandelt bzw. durchgeführt werden können. Ob dieser Zuweisung der Patienten eine informierte Krankenhauswahl zugrunde lag, muss zumindest bezweifelt werden – weder Patientinnen und Patienten noch zuweisende Ärztinnen und Ärzte nutzen bisher in größerem Umfang die zur Verfügung stehenden objektiven Informationen. Stattdessen dominieren bei der Krankenhauswahl und -zuweisung weiterhin die eigenen oder die Erfahrungen von Angehörigen und Bekannten. Dabei hat sich das Informationsangebot über Krankenhäuser vor allem durch vergleichende Internetportale, die die Daten der Qualitätsberichte der Krankenhäuser nutzen, in den letzten Jahren stetig erhöht. Jedoch sind die grundlegenden Fragen der Krankenhauswahl für den Großteil der Patienten kaum mit Hilfe dieser Portale zu beantworten – verfügt das Krankenhaus über die zur Behandlung notwendige technische und personelle Ausstattung, behandelt das Krankenhaus nach den aktuell effektivsten und sichersten Methoden, welche Ergebnisse können Patienten erwarten, welche Erfahrungen haben vergleichbare Patienten gemacht? Entweder fehlen diese Informationen, sie sind schwer zu finden oder sie sind nicht laienverständlich. Darüber hinaus wird die Krankenhauswahl und Zuweisung von Patienten durch interessengebundene Informationen und Aktivitäten professioneller Informationsvermittler, aber auch Krankenhäuser beeinflusst, sodass vermutlich zuweilen auch in nicht geeignete Krankenhäuser zugewiesen wird. Von einer sorgfältig abgewogenen Krankenhauswahl bzw. -zuweisung, bei der Patienten und einweisende Ärzte auch digital verfügbare Informationen berücksichtigen, um das geeignetste Krankenhaus zu finden, sind wir noch weit entfernt.
Statistische Krankenhausdaten: Diagnosedaten der Krankenhauspatienten 2018
Authors: Schelhase Torsten
Published: March 2021

Die Diagnosen der Krankenhauspatienten bilden das gesamte vollstationäre Geschehen in den deutschen Krankenhäusern ab. Dieser Beitrag beschreibt die Ergebnisse der Diagnosedaten der Krankenhauspatienten für das Jahr 2018. Diese amtliche Statistik wird seit 1993 jährlich als Vollerhebung durchgeführt, alle Krankenhäuser in Deutschland sind auskunftspflichtig. Erfasst werden alle Patienten, die im Berichtsjahr aus der vollstationären Behandlung eines Krankenhauses entlassen werden. Im Jahr 2018 waren dies knapp 20 Millionen Patienten; damit ist die Fallzahl im Vorjahresvergleich weiter gesunken. Die Ergebnisse der Diagnosen werden nach wichtigen Indikatoren wie Hauptdiagnosen, Alter, Geschlecht und Verweildauer dargestellt. Aufgrund geschlechts- und altersspezifischer Morbiditätshäufigkeiten werden die Ergebnisse teilweise standardisiert und so um den demographischen Effekt bereinigt. Dadurch sind bevölkerungsunabhängige Aussagen möglich.
Patientenorientierte Versorgungssteuerung im Krankenhaus
Authors: Ronellenfitsch Ulrich , Schwarzbach Matthias
Published: March 2021

In der Patientenversorgung tätige Mitarbeiter erleben häufig einen Konflikt zwischen dem systemimmanent vorgegebenen Ziel einer möglichst wirtschaftlichen Behandlung und der berufsethisch geprägten Bestrebung, ein aus Sicht des Patienten möglichst gutes Behandlungsergebnis zu erreichen. Dieser Konflikt kann durch den Einsatz von Instrumenten zur patientenorientierten Versorgungssteuerungabgemildert werden. Klinische Pfade stellen ein solches Instrument dar. Sie sind interdisziplinäre evidenzbasierte Behandlungspläne für definierte Erkrankungen, Beschwerdebilder oder Prozeduren und geben die idealerweise während der Behandlung durchzuführenden diagnostischen und therapeutischen Maßnahmen vor. Für ihre Erstellung, die Implementierung in den klinischen Alltag und ihren fortwährenden Einsatz ist ein interdisziplinärer und partizipativer Ansatz unabdingbar. Ihr Inhalt ist kontextabhängig anzupassen. Daten zum Nutzen Klinischer Pfade weisen ein eingeschränktes Evidenzlevel auf, da randomisierte Studien methodisch nur schwierig durchführbar sind. Es wäre wünschenswert, wenn Elemente der Intersektoralität in Klinischen Pfaden bislang noch stärker berücksichtigt würden.
Schnittstelle Krankenhaus – Rehabilitation
Authors: Wasem Jürgen , Frankenhauser-Mannuß Julia , Hüer Theresa , Walendzik Anke
Published: March 2021

Die Schnittstelle zwischen Krankenhaus und Rehabilitation ist mit einem Wechsel des Behandlungsfokus und zugleich der Einrichtung verbunden. Bei Einführung des DRG-Systems geäußerte Befürchtungen, die Krankenhäuser würden zulasten der Rehabilitation ökonomisch optimieren, haben sich zumindest nicht flächendeckend realisiert. Auch der Übergang von der Akutversorgung im Krankenhaus zur Rehabilitation bei Erwerbstätigen gilt hinsichtlich des Finanzierungswechsels von der Kranken- zur Rentenversicherung überwiegend als sinnvoll gestaltet, auch aufgrund regulativer Vorgaben. Demgegenüber wird davon ausgegangen, dass beim Übergang von Krankenhaus in die langzeitpflegerische Versorgung Potenziale zur Rehabilitation nicht ausgeschöpft werden. Dies liegt an einer Reihe von Ursachen, unter anderem auch an finanziellen Anreizen für die untereinander im Beitragssatz-Wettbewerb stehenden Krankenkassen.
Versorgungsnetze für Menschen mit psychischen Störungen
Authors: Greve Nils , Bomke Paul , Kurzewitsch Elisabeth , Becker Thomas
Published: March 2021

Der Beitrag geht von den Erfordernissen einer leitliniengerechten Versorgung für Menschen mit schweren psychischen Erkrankungen aus. Aus der Gegenüberstellung dieser idealtypischen, auf regionalen Netzwerken gründenden Versorgung mit den derzeitigen Versorgungsstrukturen und bereits bestehenden Ansätzen leitet er nächste Schritte zur Transformation der gegenwärtigen Strukturen ab.
Contribution of cell death signaling to blood vessel formation
Authors: Tisch Nathalie , Ruiz de Almodóvar Carmen
Published: March 2021

The formation of new blood vessels is driven by proliferation of endothelial cells (ECs), elongation of maturing vessel sprouts and ultimately vessel remodeling to create a hierarchically structured vascular system. Vessel regression is an essential process to remove redundant vessel branches in order to adapt the final vessel density to the demands of the surrounding tissue. How exactly vessel regression occurs and whether and to which extent cell death contributes to this process has been in the focus of several studies within the last decade. On top, recent findings challenge our simplistic view of the cell death signaling machinery as a sole executer of cellular demise, as emerging evidences suggest that some of the classic cell death regulators even promote blood vessel formation. This review summarizes our current knowledge on the role of the cell death signaling machinery with a focus on the apoptosis and necroptosis signaling pathways during blood vessel formation in development and pathology.
The nilpotent cone in the Mukai system of rank two and genus two
Authors: Hellmann Isabell
Published: March 2021

We study the nilpotent cone in the Mukai system of rank two and genus two. We compute the degrees and multiplicities of its irreducible components and describe their cohomology classes.
Equivariant embeddings of strongly pseudoconvex Cauchy–Riemann manifolds
Authors: Fritsch Kevin , Heinzner Peter
Published: March 2021

Let X be a CR manifold with transversal, proper CR action of a Lie group G. We show that the quotient X/G is a complex space such that the quotient map is a CR map. Moreover the quotient is universal, i.e. every invariant CR map into a complex manifold factorizes uniquely over a holomorphic map on X/G. We then use this result and complex geometry to prove an embedding theorem for (non-compact) strongly pseudoconvex CR manifolds with transversal $$G \rtimes S^1$$

G
⋊

S
1

-action. The methods of the proof are applied to obtain a projective embedding theorem for compact CR manifolds.
Partition regularity of polynomial systems near zero
Authors: Luperi Baglini Lorenzo
Published: March 2021

Recently, S. Kanti Patra and Md. Moid Shaikh proved the existence of monochromatic solutions to systems of polynomial equations near zero for particular dense subsemigroups $$(S,+)$$

(
S
,
+
)

of $$(\mathbb {R}^{+},+)$$

(

R

+

,
+
)

. We extend their results to a much larger class of systems whilst weakening the requests on S, using solely basic results about ultrafilters.
High-pressure and high-temperature single-crystal X-ray diffraction of complex garnet solid solutions up to 16 GPa and 823 K
Authors: Beyer Christopher , Kurnosov Alexander V. , Ballaran Tiziana Boffa , Frost Daniel J.
Published: March 2021

P–V–Tequations of state (EoS) of synthetic garnet solid solutions with ternary grossular–almandine–pyrope compositions relevant to the Earth’s upper mantle have been determined in order to examine whether garnet properties can be accurately interpolated from those of the end-members. Volumes have been measured as a function of pressure using single-crystal X-ray diffraction measurements performed inside a diamond anvil cell. Isothermal bulk moduli and first pressure derivatives were obtained by fitting theP–Vdata using a third-order Birch–Murnaghan equation of state. Two nominally eclogitic garnets (Prp47Alm19Grs31And3and Prp53Alm19Grs18And3Sps7) were found to have isothermal bulk moduli (KT0) and pressure derivatives (K′T0) of 170(3) GPa, 4.1 (4) and 173 (2) GPa, 3.8 (5), respectively.KT0andK′T0for an almandine-rich garnet (Prp26Alm63Grs6And5) were found to be 175 (3) GPa and 3.7 (7), respectively. High-temperature compression experiments at 703 K and 823 K were carried out on sample Prp47Alm19Grs31And3, resulting in the high-temperature EoS term (∂KT/∂T)P = − 0.025 (6) and a thermal expansion (α0) of 2.86 (4) × 10−5 K−1. The results imply that the bulk moduli of aluminous garnet solid solutions stable at upper mantle conditions can be deduced from the properties of the end-members with minimal uncertainty. We show that the difference in the bulk sound velocity determined for a multicomponent eclogitic garnet composition and obtained for the same composition from the end-member properties is better than 0.5% for pressures and temperatures corresponding to Earth’s upper mantle.
Intra-specific variation in lichen secondary compounds across environmental gradients on Signy Island, maritime Antarctic
Authors: Bokhorst Stef , Asplund Johan , Convey Peter
Published: March 2021

Lichens produce various carbon-based secondary compounds (CBSCs) in response to abiotic conditions and herbivory. Although lichen CBSCs have received considerable attention with regard to responses to UV-B exposure, very little is known about intra-specific variation across environmental gradients and their role in protection against herbivory in the Antarctic. Here we report on the variation in CBSCs of two widely distributed and common Antarctic lichens, Usnea antarctica and Umbilicaria antarctica, between sites with different solar exposure (NW–SE) and along natural nitrogen (N) gradients which are associated with changing lichen-invertebrate associations on Signy Island (South Orkney Islands, maritime Antarctic). Fumarprotocetraric and usnic acid concentrations in Usnea showed no relationships with solar exposure, lichen-N or associated invertebrate abundance. However, fumarprotocetraric acid concentration was 13 times higher at inland sites compared to coastal sites along the N-gradients. Gyrophoric acid concentration in Umbilicaria was 33% lower in sun-facing (northerly exposed) habitats compared to more shaded (south-facing) rocks and declined with elevation. Gyrophoric acid concentration was positively correlated with the abundance and species richness of associated microarthropods, similar to the patterns found with lichen N. This initial investigation indicates that there can be large intraspecific variation in lichen CBSC concentrations across relative short distances (< 500 m) on Signy Island and raises further questions regarding current understanding of the role of CBSCs in Antarctic lichens in relation to biotic and abiotic pressures.
A review on the role of gut microbiota in immune checkpoint blockade therapy for cancer
Authors: Kim Esther , Ahn Hyeok , Park Hansoo
Published: March 2021

Gut microbiota has been studied in relation to human health and disease prediction for decades. Also, immune checkpoints (ICPs) are enthusiastically investigated for anti-tumor immunotherapy. Recent studies show potential of gut microbiome and gut cytokines as biomarkers for carcinogenesis and response prediction of immune checkpoint inhibitor (ICI) response. Evidence has revealed that intestinal microorganisms play a major role in the effectiveness of programmed cell death 1 (PD-1) and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) blockade. In this review, we have focused on how microbiome and microbiome-generated cytokines affect immune checkpoints. We have also described the molecular mechanisms behind this interplay and the bacterial strains that have a potential role in immunotherapy.
The association of three DNA repair genes polymorphisms on the frequency of chromosomal alterations detected by fluorescence in situ hybridization
Authors: Santiago Fábio , Silvestre Rafaele Tavares , Otero Ubirani Barros , Tabalipa Marianne Medeiros , de Moura Ribeiro-Carvalho Marilza , Scherrer Luciano Rios , Al-Rikabi Ahmed , Liehr Thomas , Alves Gilda , Ornellas Maria Helena
Published: March 2021

Purpose

Gas station workers (GSWs) are exposed to carcinogenic agents. The aim was to study the association of high somatic chromosome alterations (CAs) rates in the blood of GSWs and the polymorphisms of three genes playing a role in DNA double-strand break repair.

Methods

This is a cross-sectional study with 114 GSWs and 115 age-matched controls. Cytogenetic analyses, blood exams, medical interviews and genotypes for RAD51/G135C (rs1801320), ATM/P1054R (rs1800057) and CHEK2/T470C (rs17879961) genes were performed.

Results

The CA rate in GSWs was 9.8 CAs/1000 metaphases, and 19.1% of the workers had > 10 CAs per 1000 metaphases (group two). GSWs had decreased levels of monocytes (P = 0.024) in their blood exams. The number of variant alleles of the RAD51/G135C polymorphism was higher in GSWs (P = 0.011) compared to the controls, and were associated with enhanced number of CAs per worker (P = 0.008). No allele variant was found for CHEK2/T470C in this study.

Conclusion

The RAD51/G135C polymorphism appears to be related to genome instability in gas station workers. Increasing the knowledge of DNA repair gene variations involved in maintaining genomic stability in GSWs may be crucial for future cancer prevention.
Steroid treatment for the first episode of childhood nephrotic syndrome: comparison of the 8 and 12 weeks regimen using an individual patient data meta-analysis
Authors: Schijvens Anne M. , Teeninga Nynke , Dorresteijn Eiske M. , Teerenstra Steven , Webb Nicholas J. , Schreuder Michiel F.
Published: March 2021

Steroids are the cornerstone of the treatment of childhood nephrotic syndrome. The optimal duration for the first episode remains a matter of debate. The aim of this study is to determine whether the 8 weeks International Study of Kidney Disease in Children (ISKDC) regimen is equally effective as the 12 weeks steroid regimen from the German society of pediatric nephrology (Arbeitsgemeinschaft für Pädiatrische Nephrologie [APN]). An individual patient data (IPD) meta-analysis of randomized controlled trials reporting on prednisolone treatment for a first episode of childhood nephrotic syndrome was conducted. European trials aimed at investigating the ISKDC and/or APN steroid regimen were selected. The lead investigators of the selected trials were requested to provide the IPD of the specific treatment groups. Four trials included European cohorts using dosing schedules according to the regimens studied. IPD of two trials were available. A significant difference was found in time to first relapse after cessation of steroid treatment between the 8 and 12 weeks treatment group with a median time to relapse of 29 and 63 days, respectively. Moreover, relapse rate ratios during total follow-up were 51% higher for the 8 weeks regimen. Finally, younger children have a significantly lower time to first relapse and frequently relapsing nephrotic syndrome.

Conclusions: The results of this IPD meta-analysis suggest that the 8 weeks steroid regimen for a first episode of steroid-sensitive nephrotic syndrome may not be equally effective as the 12 weeks steroid regimen. Moreover, this study highlights the importance of using uniform definitions to enable accurate comparison and interpretation of trial results.

Trial registration: Registration number: CRD42020199244, date of registration 16-08-2020

What is Known:• Steroids are the cornerstone of the treatment of childhood nephrotic syndrome, however the optimal duration for the first episode remains a matter of debate.• Currently, the 8 weeks ISKDC protocol and 12 weeks APN protocol are among the most frequently used protocols in Europe.

What is New:• The 8 weeks steroid regimen for a first episode of steroid-sensitive nephrotic syndrome may not be equally effective as the 12 weeks steroid regimen for the treatment of a first episode of nephrotic syndrome.• Younger children have a significantly shorter time to first relapse and time to frequent relapsing nephrotic syndrome.
Metabolic activity of hydro-carbon-oxo-borate on a multispecies subgingival periodontal biofilm: a short communication
Authors: Shibli Jamil Awad , Rocha Thayane Furtado , Coelho Fernanda , de Oliveira Capote Ticiana Sidorenko , Saska Sybele , Melo Marcelo A. , Pingueiro João Marcos Spessoto , de Faveri Marcelo , Bueno-Silva Bruno
Published: March 2021

Objective

This study evaluated the metabolic activity of hydro-carbon-oxo-borate complex (HCOBc) on a multispecies subgingival biofilm as well as its effects on cytotoxicity.

Materials and methods

The subgingival biofilm with 32 species related to periodontitis was formed in the Calgary Biofilm Device (CBD) for 7 days. Two different therapeutic schemes were adopted: (1) treatment with HCOBc, 0.12% chlorhexidine (CHX), and negative control group (without treatment) from day 3 until day 6, two times a day for 1 min each time, totaling 8 treatments and (2) a 24-h treatment on a biofilm grown for 6 days. After 7 days of formation, biofilm metabolic activity was determined by colorimetry assay, and bacterial counts and proportions of complexes were determined by DNA-DNA hybridization. Both substances’ cytotoxicity was evaluated by cell viability (XTT assay) and clonogenic survival assay on ovary epithelial CHO-K1 cells and an osteoblast precursor from calvaria MC3T3-E1 cells.

Results

The first treatment scheme resulted in a significant reduction in biofilm’s metabolic activity by means of 77% by HCOBc and CHX treatments versus negative control. The total count of 11 and 25 species were decreased by treatment with hydro-carbon-oxo-borate complex and CHX, respectively, compared with the group without treatment (p < 0.05), highlighting a reduction in the levels of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, and Fusobacterium periodontium. CHX significantly reduced the count of 10 microorganisms compared to the group treated with HCOBc (p < 0.05). HCOBc and CHX significantly decreased the pathogenic red-complex proportion compared with control-treated biofilm, and HCOBc had even a more significant effect on the red complex than CHX had (p ≤ 0.05). For the second treatment scheme, HCOBc complex and CHX significantly decreased 61 and 72% of control biofilms’ metabolic activity and the counts of 27 and 26 species, respectively. HCOBc complex did not significantly affect the proportions of formed biofilms, while CHX significantly reduced red, orange, and yellow complexes. Both substances exhibited similar cytotoxicity results.

Conclusions

This short communication suggested that the HCOBc complex reduced a smaller number of bacterial species when compared to chlorhexidine during subgingival biofilm formation, but it was better than chlorhexidine in reducing red-complex bacterial proportions. Although HCOBc reduced the mature 6-day-old subgingival multispecies biofilms, it did not modify bacterial complexes’ ratios as chlorhexidine did on the biofilms mentioned above. Future in vivo studies are needed to validate these results.

Clinical relevance

HCOBc complex could be used to reduce red-complex periodontal bacterial proportions.