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Objectives This study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.
Participants 3296 emergency medical stations in Germany.
Setting Rural areas in Germany.
Primary and secondary outcome measures Three UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.
Results Current EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).
Conclusion These results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.
As a postmodern detective novel, "City of Glass" circles around its genre, deconstructing topical notions such as the 'case' and citing the commonplace language of hardboiled detectives as well as Poe's archetypical Dupin. Furthermore, the novel also refers to completely different texts and genres: Milton's Christian epic "Paradise Lost", for example, is allotted an important position in the 6th chapter with its speculations about a regaining of the Adamic language. The allusions to the puritan poet Milton exemplifies how Auster synthesizes a postmodern inquiry into genre and language with references to "premodern moral questions", highlighting interesting analogies between post- and premodern practices of reading and writing. An even more astonishing example are the subtle references to Defoe's "Robinson Crusoe", the best-selling puritan "spiritual autobiography" about the survival of a castaway on a remote Caribbean island, which have not yet been accorded scholarly attention. Although they don't seem to be of much significance at first sight, they, too, build on the relationship between puritan and postmodern reading and writing. In this paper, Joachim Harst unfolds the many parallels between Auster's and Defoe's first novels and shows how Auster reads "Robinson Crusoe" as an exemplary figure for existential solitude and artistic creativity. Auster's postmodern view on Defoe's novel also helps to highlight fissures in Robinson's seemingly complete "selfcomposure" via autobiography, while the colonial aspects of Defoe's novel resonate with Auster's postcolonial critique of America's puritan origins. Harst concludes with a glance at Auster's references to "Robinson Crusoe" in his other early works, especially his autofictional text "Invention of Solitude", in which he depicts the artist as "shipwreck[ed] in the heart of the city" and uses "Robinson Crusoe" to construct a biographical mythology aiming at creative authorship.
Due to globally rising numbers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, resources for real-time reverse-transcription polymerase chain reaction (rRT-PCR)-based testing have been exhausted. In order to meet the demands of testing and reduce transmission, SARS-CoV-2 antigen-detecting rapid diagnostic tests (Ag-RDTs) are being considered. These tests are fast, inexpensive, and simple to use, but whether they detect potentially infectious cases has not been well studied. We evaluated three lateral flow assays (RIDA®QUICK SARS-CoV-2 Antigen (R-Biopharm), SARS-CoV-2 Rapid Antigen Test (Roche)), and NADAL® COVID-19 Ag Test (Nal von Minden GmbH, Regensburg, Germany) and one microfluidic immunofluorescence assay (SARS-CoV-2 Ag Test (LumiraDx GmbH, Cologne, Germany)) using 100 clinical samples. Diagnostic rRT-PCR and cell culture testing as a marker for infectivity were performed in parallel. The overall Ag-RDT sensitivity for rRT-PCR-positive samples ranged from 24.3% to 50%. However, for samples with a viral load of more than 6 log10 RNA copies/mL (22/100), typically seen in infectious individuals, Ag-RDT positivity was between 81.8% and 100%. Only 51.6% (33/64) of the rRT-PCR-positive samples were infectious in cell culture. In contrast, three Ag-RDTs demonstrated a more significant correlation with cell culture infectivity (61.8–82.4%). Our findings suggest that large-scale SARS-CoV-2 Ag-RDT-based testing can be considered for detecting potentially infective individuals and reducing the virus spread.
KCNQ1 encodes the voltage-gated potassium (Kv) channel KCNQ1, also known as KvLQT1 or Kv7.1. Together with its ß-subunit KCNE1, also denoted as minK, this channel generates the slowly activating cardiac delayed rectifier current IKs, which is a key regulator of the heart rate dependent adaptation of the cardiac action potential duration (APD). Loss-of-function mutations in KCNQ1 cause congenital long QT1 (LQT1) syndrome, characterized by a delayed cardiac repolarization and a prolonged QT interval in the surface electrocardiogram. Autosomal dominant loss-of-function mutations in KCNQ1 result in long QT syndrome, called Romano–Ward Syndrome (RWS), while autosomal recessive mutations lead to Jervell and Lange-Nielsen syndrome (JLNS), associated with deafness. Here, we identified a homozygous KCNQ1 mutation, c.1892_1893insC (p.P631fs*20), in a patient with an isolated LQT syndrome (LQTS) without hearing loss. Nevertheless, the inheritance trait is autosomal recessive, with heterozygous family members being asymptomatic. The results of the electrophysiological characterization of the mutant, using voltage-clamp recordings in Xenopus laevis oocytes, are in agreement with an autosomal recessive disorder, since the IKs reduction was only observed in homomeric mutants, but not in heteromeric IKs channel complexes containing wild-type channel subunits. We found that KCNE1 rescues the KCNQ1 loss-of-function in mutant IKs channel complexes when they contain wild-type KCNQ1 subunits, as found in the heterozygous state. Action potential modellings confirmed that the recessive c.1892_1893insC LQT1 mutation only affects the APD of homozygous mutation carriers. Thus, our study provides the molecular mechanism for an atypical autosomal recessive LQT trait that lacks hearing impairment.
The retinoid X receptor (RXR) is a ligand-sensing transcription factor acting mainly as a universal heterodimer partner for other nuclear receptors. Despite presenting as a potential therapeutic target for cancer and neurodegeneration, adverse effects typically observed for RXR agonists, likely due to the lack of isoform selectivity, limit chemotherapeutic application of currently available RXR ligands. The three human RXR isoforms exhibit different expression patterns; however, they share high sequence similarity, presenting a major obstacle toward the development of subtype-selective ligands. Here, we report the discovery of the saturated fatty acid, palmitic acid, as an RXR ligand and disclose a uniform set of crystal structures of all three RXR isoforms in an active conformation induced by palmitic acid. A structural comparison revealed subtle differences among the RXR subtypes. We also observed an ability of palmitic acid as well as myristic acid and stearic acid to induce recruitment of steroid receptor co-activator 1 to the RXR ligand-binding domain with low micromolar potencies. With the high, millimolar endogenous concentrations of these highly abundant lipids, our results suggest their potential involvement in RXR signaling.
Elderly people still play a minor role in research on information needs and usage patterns of Internet users. Online research and advocacy groups look optimistically at the (economic and social) potential of the active and technology–skilled elderly; other approaches dealing with the social appropriation of technology see obstacles and stress the dangers of an increasing digital divide between generations. Our objective is to refer to taken for granted normative assumptions of the digital divide discourse, highlighting different requirements for the appropriation of the Internet. Using the concept of technological generations we look at formal and informal learning of young and elderly people in the German context. We use survey material and field impressions we gained in various technology related studies. The results show that the "two worlds apart" assumption (young vs. elderly people) is too simplistic. Factors like gender, education and socio–economic status still play an important role for acceptance and diffusion of a technology. The diffusion rate among the elderly is increasing, but will continue to lag behind the figures of the young users. Cultural preparations and easy access modes are essential for the elderly, who could make use of latecomer advantages. Informal learning and peer group support will be crucial for the diffusion of the Internet among the elderly. In our conclusions we look at the specific social status of the elderly cohort, which makes a comparison with other social groups very difficult.
Since ethnic stereotyping gained new political virulence in the current ethnopopulist climate, the three-day conference, organized by five researchers from the Department of Comparative Literature at the University of Vienna, aimed to promote academic discussion on new perspectives on imagology. In twenty-six presentations, international scholars shared their findings on strategies of Othering within a transdisciplinary framework of different theoretical approaches from postcolonial theory to gender studies, from intermediality to musicology, in order to fathom the boundaries of imagological research today. An additional poster session gave students the opportunity to present their research on hetero- and auto-stereotypes within literature.
The object of this paper is to further understand how reading literature increases capacity for empathy, and how narratives positively influence human beings. This will be done via a close reading of China Miéville's "Perdido Street Station" with particular focus on the character Yagharek whose tragic situation and journey provides a starting point for a discussion about empathy. The question is whether speculative fiction can be more capable of triggering empathy than other genres. In his analysis Dennis Friedrichsen demonstrates the ways in which fantasy literature creates an effective distance to the real world in order to negotiate complicated issues of morality, ethics and empathy.
Die in diesem Essay erarbeitete Fragestellung fusst auf einem musikontologischen Problem: Welche Art von Gegenstand ist ein Musikwerk? Eine wichtige Aufgabe der Ontologie der Musik ist es, die Konsequenzen der Einführung der Notation in eine musikalische Praxis zu bewerten. Zur Klärung muss unter anderem die Rolle verstanden werden, die der Partitur zugeschrieben wird. Mit diesem Essay möchte ich auf das, was ich als ernsthaftes Missverständnis der Rolle der Partitur betrachte, insbesondere in Bezug auf die klassische Musik, hinweisen. Das Verständnis der Partitur als Spielanleitung, wie es in den letzten Jahrzehnten sowohl in der musikwissenschaftlichen als auch in der musikontologischen Literatur zu finden war, gilt es zu hinterfragen. In diesem Beitrag werde ich nach einem einleitenden Abschnitt zunächst sechs Argumente gegen die Vorstellung der Partitur als Spielanweisung formulieren; es folgen Kommentare zu einigen Passagen von Robert Schumann, Hermann Hesse und Peter Shaffer, um im weiteren Verlauf einen aktuellen Diskussionsbeitrag über die Rolle der Partitur in der klassischen Musik zu liefern.
Les études critiques sur Gabriela Zapolska (1857-1921), féministe polonaise aux brillants et multiples talents littéraires, ont systématiquement relevé dans ses oeuvres son goût passionné pour les couleurs (impressionnisme) et les formes (beauté et laideur du corps féminin). Dans cet article, nous montrerons que Zapolska n'accordait pas moins d'importance à la musicalité du monde qu'à sa beauté plastique: le son dans toutes ses variations et gradations accompagne le parcours de ses protagonistes féminines dans leur quête d'identité. Murmures ou rires révèlent déjà leur féminité, mais ne suffisent encore pas pour lui permettre de s'épanouir. Le travail de libération ne s'accomplit que grâce à la musique. La réciprocité entre la féminité et la musique est posée comme allant de soi: l'expression par la voix ou l'instrument devient l'expression d'une essence cachée et matrilinéaire de l'existence. Pour Zapolska, la musicalité du monde est genrée et elle est marquée d'une signature féminine.