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Since 2010, an intensified ambulatory cardiology care programme has been implemented in southern Germany. To improve patient management, the structure of cardiac disease management was improved, guideline-recommended care was supported, new ambulatory medical services and a morbidity-adapted reimbursement system were set up. Our aim was to determine the effects of this programme on the mortality and hospitalisation of enrolled patients with cardiac disorders. We conducted a comparative observational study in 2015 and 2016, based on insurance claims data. Overall, 13,404 enrolled patients with chronic heart failure (CHF) and 19,537 with coronary artery disease (CAD) were compared, respectively, to 8,776 and 16,696 patients that were receiving usual ambulatory cardiology care. Compared to the control group, patients enrolled in the programme had lower mortality (Hazard Ratio: 0.84; 95% CI: 0.77–0.91) and fewer all-cause hospitalisations (Rate Ratio: 0.94; 95% CI: 0.90–0.97). CHF-related hospitalisations in patients with CHF were also reduced (Rate Ratio: 0.76; 95% CI: 0.69–0.84). CAD patients showed a similar reduction in mortality rates (Hazard Ratio: 0.81; 95% CI: 0.76–0.88) and all-cause hospitalisation (Rate Ratio: 0.94; 95% CI: 0.91–0.97), but there was no effect on CAD-related hospitalisation. We conclude that intensified ambulatory care reduced mortality and hospitalisation in cardiology patients.
Das Staatsangehörigkeitsrecht verankert rechtlich Vorstellungen über Zugehörigkeit und bestimmt wer vollumfängliche Rechte in einer Gesellschaft hat und wer nicht. Jahrzehntelang wurde Migration in Deutschland als etwas temporäres betrachtet. Im Staatsangehörigkeitsrecht galt bis zur Reform 1999/2000 weitgehend das „ius sanguinis“, das Abstammungsrecht, das auf einem rassistischen und völkischen Staatsverständnis beruht. Diese Reform bedeutete somit mehr als eine reine Gesetzesänderung. Sie war eine Anerkennung Deutschlands als Einwanderungsland und die Veränderung der Vorstellung deutscher Identität. Als Reaktion entbrannte infolge der Reformpläne eine hitzige, rassistische Debatte in der Öffentlichkeit über ebendiese Fragen, die unter dem polarisierten Schlagwort „Doppelpass“ verhandelt wurde. Es war die lauteste migrationspolitische Debatte dieser Zeit.
Kurze Zeit vor Beginn dieser Debatte war die rechtsterroristische Gruppe „Nationalsozialistischer Untergrund“ (NSU) abgetaucht, um einem Haftbefehl zu entgehen. Der NSU war ein deutsches, neonazistisches Netzwerk, in dessen Mittelpunkt drei Terrorist*innen standen. Sie verübten über einen Zeitraum von zwölf Jahren eine rassistische Mordserie an neun Personen türkischer, kurdischer und griechischer Herkunft sowie drei Sprengstoffanschläge auf migrantische Orte und ermordeten eine Polizistin. Den ersten ihrer Sprengstoffanschläge begingen sie nur einen Monat nach der Unterzeichnung der Reform. Wenige Monate nach dem Inkrafttreten des Gesetzes begannen sie mit dem Anschlag auf Enver Şimşek ihre rassistische Mordserie.
Diese Arbeit untersucht anhand der Struktur der Historisch-Materialistischen Politikanalyse das Migrationsregime um die Staatsangehörigkeitsreform von 1999/2000 und wie der NSU darin verortet werden kann.
Die Kontextanalyse stellt auf der Grundlage einer Literaturrecherche die relevanten historischen und strukturellen Faktoren der Debatte sowie des NSU dar. Im nächsten Schritt werden mithilfe einer Analyse von Zeitungsartikel aus dieser Zeit die relevanten Akteur*innen identifiziert und in die vier Hegemonieprojekte neoliberal, sozial, linksliberal-alternativ und konservativ gruppiert. Darauffolgend wird der Ablauf der Debatte in vier Phasen darstellt und als Aushandlung der vier Hegemonieprojekte rekonstruiert. Dabei zeigt sich, dass kein Projekt sich vollumfänglich durchsetzen und Hegemonie erreichen konnte, sie jedoch unterschiedlich stark in den Medien repräsentiert wurden.
Im letzten Schritt betrachtet diese Arbeit Verbindungen dieser Migrationsregime-Analyse zum NSU. Sie kommt zu dem Ergebnis, dass der NSU kein Akteur im Migrationsregime um die Staatsangehörigkeitsdebatte von 1998/99 war. Aufgrund der geringen Erkenntnisse über spezifische Meinungen des NSU zum Staatsangehörigkeitsrecht, können keine kausalen Beziehungen hergestellt werden. Dennoch zeigt diese Arbeit Gemeinsamkeiten in den Weltbildern, Annahmen und migrationspolitischen Zielen des NSU, des konservativen Hegemonieprojektes sowie Teilen der Bevölkerung auf. Dadurch wird ein Beitrag dazu geleistet den NSU als Produkt und Teil der deutschen Gesellschaft zu begreifen.
Our knowledge of early evolution of snakes is improving, but all that we can infer about the evolution of modern clades of snakes such as boas (Booidea) is still based on isolated bones. Here, we resolve the phylogenetic relationships of Eoconstrictor fischeri comb. nov. and other booids from the early-middle Eocene of Messel (Germany), the best-known fossil snake assemblage yet discovered. Our combined analyses demonstrate an affinity of Eoconstrictor with Neotropical boas, thus entailing a South America-to-Europe dispersal event. Other booid species from Messel are related to different New World clades, reinforcing the cosmopolitan nature of the Messel booid fauna. Our analyses indicate that Eoconstrictor was a terrestrial, medium- to large-bodied snake that bore labial pit organs in the upper jaw, the earliest evidence that the visual system in snakes incorporated the infrared spectrum. Evaluation of the known palaeobiology of Eoconstrictor provides no evidence that pit organs played a role in the predator–prey relations of this stem boid. At the same time, the morphological diversity of Messel booids reflects the occupation of several terrestrial macrohabitats, and even in the earliest booid community the relation between pit organs and body size is similar to that seen in booids today.
Background: Patients with rare diseases (RDs) are often diagnosed too late or not at all. Clinical decision support systems (CDSSs) could support the diagnosis in RDs. The MIRACUM (Medical Informatics in Research and Medicine) consortium, which is one of four funded consortia in the German Medical Informatics Initiative, will develop a CDSS for RDs based on distributed clinical data from ten university hospitals. This qualitative study aims to investigate (1) the relevant organizational conditions for the operation of a CDSS for RDs when diagnose patients (e.g. the diagnosis workflow), (2) which data is necessary for decision support, and (3) the appropriate user group for such a CDSS.
Methods: Interviews were carried out with RDs experts. Participants were recruited from staff physicians at the Rare Disease Centers (RDCs) at the MIRACUM locations, which offer diagnosis and treatment of RDs.
An interview guide was developed with a category-guided deductive approach. The interviews were recorded on an audio device and then transcribed into written form. We continued data collection until all interviews were completed. Afterwards, data analysis was performed using Mayring’s qualitative content analysis approach.
Results: A total of seven experts were included in the study. The results show that medical center guides and physicians from RDC B-centers (with a focus on different RDs) are involved in the diagnostic process. Furthermore, interdisciplinary case discussions between physicians are conducted.
The experts explained that RDs exist which cannot be fully differentiated, but rather described only by their overall symptoms or findings: diagnosis is dependent on the disease or disease group. At the end of the diagnostic process, most centers prepare a summary of the patient case. Furthermore, the experts considered both physicians and experts from the B-centers to be potential users of a CDSS. The experts also have different experiences with CDSS for RDs.
Conclusions: This qualitative study is a first step towards establishing the requirements for the development of a CDSS for RDs. Further research is necessary to create solutions by also including the experts on RDs.
Background: Rare Diseases (RDs), which are defined as diseases affecting no more than 5 out of 10,000 people, are often severe, chronic and life-threatening. A main problem is the delay in diagnosing RDs. Clinical decision support systems (CDSSs) for RDs are software systems to support clinicians in the diagnosis of patients with RDs. Due to their clinical importance, we conducted a scoping review to determine which CDSSs are available to support the diagnosis of RDs patients, whether the CDSSs are available to be used by clinicians and which functionalities and data are used to provide decision support.
Methods: We searched PubMed for CDSSs in RDs published between December 16, 2008 and December 16, 2018. Only English articles, original peer reviewed journals and conference papers describing a clinical prototype or a routine use of CDSSs were included. For data charting, we used the data items “Objective and background of the publication/project”, “System or project name”, “Functionality”, “Type of clinical data”, “Rare Diseases covered”, “Development status”, “System availability”, “Data entry and integration”, “Last software update” and “Clinical usage”.
Results: The search identified 636 articles. After title and abstracting screening, as well as assessing the eligibility criteria for full-text screening, 22 articles describing 19 different CDSSs were identified. Three types of CDSSs were classified: “Analysis or comparison of genetic and phenotypic data,” “machine learning” and “information retrieval”. Twelve of nineteen CDSSs use phenotypic and genetic data, followed by clinical data, literature databases and patient questionnaires. Fourteen of nineteen CDSSs are fully developed systems and therefore publicly available. Data can be entered or uploaded manually in six CDSSs, whereas for four CDSSs no information for data integration was available. Only seven CDSSs allow further ways of data integration. thirteen CDSS do not provide information about clinical usage.
Conclusions: Different CDSS for various purposes are available, yet clinicians have to determine which is best for their patient. To allow a more precise usage, future research has to focus on CDSSs RDs data integration, clinical usage and updating clinical knowledge. It remains interesting which of the CDSSs will be used and maintained in the future.
According to the free radical theory of aging, reactive oxygen species (ROS) have been proposed to be a major cause of aging for a long time. Meanwhile, it became clear that ROS have diverse functions in a healthy organism. They act as second messengers, and as transient inhibitors of phosphatases and others. In fact, their detrimental role is highly dependent on the context of their production. NADPH oxidases (Nox) have been discovered as a controllable source of ROS. NoxO1 enables constitutive ROS formation by Nox1 by acting as a constitutively active cytosolic subunit of the complex. We previously found that both Nox1 and NoxO1 were highly expressed in the colon, and that NoxO1-/- deficiency reduces colon health. We hypothesized that a healthy colon potentially contributes to longevity and NoxO1 deficiency would reduce lifetime, at least in mouse. In contrast, here we provide evidence that the knockout of NoxO1 results in an elongated life expectancy of mice. No better endothelial function, nor an improved expression of genes related to longevity, such as Sirt1, were found, and therefore may not serve as an explanation for a longer life in NoxO1 deficiency. Rather minor systemic differences, such as lower body weight occur. As a potential reason for longer life, we suggest better DNA repair capacity in NoxO1 deficient mice. Although final fatal DNA damage appears similar between wildtype and NoxO1 knockout animals, we identified less intermediate DNA damage in colon cells of NoxO1-/- mice, while the number of cells with intact DNA is elevated in NoxO1-/- colons. We conclude that NoxO1 deficiency prolongs lifetime of mice, which correlates with less intermediate and potentially fixable DNA damage at least in colon cells.
Diese Dissertation soll die Frage beantworten, ob die Forderung der Krankenkassen, die Nabelhernie und die epigastrische Hernie als ambulante Operation zu realisieren, gerechtfertigt bzw. sinnvoll ist. Sie soll ferner Steuergrößen und Maßnahmen identifizieren, die die Überführung des Eingriffs in den ambulanten Rahmen begünstigen können.
Seit den achtziger Jahren des letzten Jahrhunderts wird versucht, durch die kurzstationäre und ambulante Operation verschiedener Krankheitsbilder der Forderung nach Kostenersparnis im Gesundheitswesen nachzukommen. Von den Krankenkassen wird gefordert, den Verschluss einer Hernia umbilicalis: Ohne Plastik: Mit Exstirpation einer Nabelzyste, den Verschluss einer Hernie epigastrica: Ohne Plastik sowie den Verschluss einer Hernia umbilicalis: Mit Plastik im Rahmen einer ambulanten Operation zu korrigieren. Entsprechend wurden diese Eingriffe 2005 in die Liste der ambulant zu erbringenden und stationsersetzenden Maßnahmen aufgenommen. Dennoch liegt die durchschnittliche stationäre Verweildauer nach diesem Eingriff weiterhin bei 3,5 Tagen.
Phylogenetisch ist die Entstehung von Nabelhernien durch anatomisch präformierte Schwachstellen der Bauchwand bedingt, an denen Muskulatur fehlt und nur Aponeurosen und Faszien vorhanden sind. Die Entstehung wird aber auch durch Begleiterkrankungen und Risikofaktoren begünstigt.
In die vorliegende Untersuchung wurden nach Anwendung verschiedener Ausschlusskriterien 95 Patienten aufgenommen, die im Zeitraum zwischen dem 24. August 2009 und dem 24. Juni 2012 mit der Hauptdiagnose einer Nabelhernie bzw. epigastrischen Hernie - Diagnose nach ICD10 - K42.0, K42.1, K42.9, K43.0, K43.1 und K43.9 in der Klinik für Allgemein- und Viszeralchirurgie der Hochtaunuskliniken Bad Homburg operiert wurden. Die selektierten Patienten, welche betrachtet wurden, teilten sich in 61 primäre Nabelhernien, fünf Rezidivnabelhernien, elf epigastrische Hernien, drei Rezidive epigastrischer Hernien und 15 Kombinationseingriffe mit simultaner Operation einer Nabelhernie und einer Leistenhernie auf.
Als Operationsverfahren kam entweder eine Naht Stoß-auf-Stoß (NSAS), die Technik nach Mayo mit einer Fasziendoppelung oder die Implantation von alloplastischem Fremdmaterial entweder mittels eines Ventralex™ Patch oder Proceed™ Patch in Sublay-Technik oder bei ausgedehnten Befunden eine retromuskuläre Mesh Plastik (RMMP) zum Einsatz. Als laparoskopisches Verfahren wurde das Intraperitoneale Onlay Mesh (IPOM) verwendet.
Die Auswertung für die deskriptive Statistik erfolgte mit Microsoft® Excel® 2013. Anschließend wurde die Auswertung der explorativen wie auch der mathematisch/induktiven Statistik mit Hilfe von BiAS. für Windows™ Version 11/2015 durchgeführt.
Nach Analyse des Patientengutes konnte anhand von Korrelationsanalysen herausgearbeitet werden, dass das Alter, die Anzahl der Begleiterkrankungen, die Anzahl der Risikofaktoren und die ASA-Klassifikation (American Society of Anesthesiologists), die Größe der Bruchlücke in Zentimetern und die Schmerzen am zweiten postoperativen Tag einen schwachen Zusammenhang rho (ρ) zwischen 0,23 und 0,39 mit der Liegedauer bei jedoch signifikanten p-Wert p ≤ 0,05 aufwiesen. Einen stärkeren Zusammenhang mit einem Korrelationskoeffizienten ρ von 0,42 und 0,40 im Hinblick auf die Liegedauer zeigten hierbei die Operationsdauer und die Schmerzen am ersten postoperativen Tag. Den stärksten signifikanten Zusammenhang mit einem ρ von 0,64 zeigten die Schmerzen am dritten postoperativen Tag.
Die Verweildauer wurde auch durch die Wahl des Operationsverfahrens beeinflusst. Hier ergab sich eine signifikante Verlängerung der Verweildauer durch unterschiedliche Operationsverfahren sowohl in der Begutachtung des Gesamtkollektivs als auch in der Subgruppe NSAS, Mayo und Patch.
Im Anschluss konnte anhand multivariater Analysen festgestellt werden, dass die Operationsdauer, das Operationsverfahren und die ASA-Klassifikation mit p-Werten ≤ 0,05 mit der Liegedauer signifikant korrelierten. Auch konnte mit Hilfe der multivariaten Analyse aufgezeigt werden, dass die Größe der Bruchlücke in Zentimetern und die Schmerzen am ersten und zweiten postoperativen Tag mit Signifikanzwerten ≤ 0,05 mit der Liegedauer korrelierten.
Nach der durchgeführten Analyse, wie auch nach Betrachtung der Literatur, ist die Grundlage zur Durchführbarkeit einer ambulanten Operation die Erfüllung der medizinischen Voraussetzungen, die Erfüllung der Kriterien für ambulante Operationen und die Erfüllung der Entlassungskriterien. Zudem sollten Patienten mit kardiovaskulären Erkrankungen, insbesondere bei Vorliegen einer Herzinsuffizienz, aber auch bei COPD, Asthma und Schlafapnoesyndrom und einem BMI größer 30 nicht für eine ambulante Operation in Betracht gezogen werden. Auch gelten ein ASA Status größer als 2, Nebenwirkungen der (Allgemein-)Narkose wie PONV, Schwindel, Schläfrigkeit und ein erhöhtes postoperatives Schmerzniveau sowie eine große Defektgröße als hinderlich für die ambulante Durchführung der Operationen.
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Die vorliegende Studie versucht einen Beitrag zur Erforschung von Implementationsmöglichkeiten des bilingualen Sprachvermögens von Schüler*innen mit Migrationshintergrund für den Regelschulkontext zu leisten, indem ein bilinguales Interaktionsangebot beim Peer-Learning für türkisch-deutschsprachig aufwachsende Schüler*innen der dritten und vierten Klasse in einem quasi-experimentellen Setting unter Verwendung von Mixed Methods untersucht wird.
Methoden
(2020)
Rezension zu: Akremi, Leila, Nina Baur, Hubert Knoblauch und Boris Traue (Hrsg.): Handbuch Interpretativ forschen. Weinheim, Basel: Beltz Juventa 2018. 961 Seiten. ISBN: 978-3-7799-3126-3. Preis: C 49,95.
This paper defends The Transformation of Values into Prices on the Basis of Random Systems, published in EIER, by answering to the Comments made in the same journal by Professors Mori, Morioka and Yamazaki. The clarifications mainly concern the justification of the randomness assumptions, the conditions needed to obtain the equality of total profit with total surplus value in the simplified one-industry system and the invariance of the results to changes in the units of measurement.
Background: Alterations in the SCN5A gene encoding the cardiac sodium channel Nav1.5 have been linked to a number of arrhythmia syndromes and diseases including long-QT syndrome (LQTS), Brugada syndrome (BrS) and dilative cardiomyopathy (DCM), which may predispose to fatal arrhythmias and sudden death. We identified the heterozygous variant c.316A > G, p.(Ser106Gly) in a 35-year-old patient with survived cardiac arrest. In the present study, we aimed to investigate the functional impact of the variant to clarify the medical relevance.
Methods: Mutant as well as wild type GFP tagged Nav1.5 channels were expressed in HEK293 cells. We performed functional characterization experiments using patch-clamp technique.
Results: Electrophysiological measurements indicated, that the detected missense variant alters Nav1.5 channel functionality leading to a gain-of-function effect. Cells expressing S106G channels show an increase in Nav1.5 current over the entire voltage window.
Conclusion: The results support the assumption that the detected sequence aberration alters Nav1.5 channel function and may predispose to cardiac arrhythmias and sudden cardiac death.
Monoterpenes and their monoterpenoid derivatives form a subclass of terpene(oid)s. They are widely used in medicines/pharmaceuticals, as flavor and fragrance compounds, or in agriculture and are also considered as future biofuels. However, for many of these substances, the extraction from natural sources poses challenges such as occurring at low concentrations in their raw material or because the natural sources are diminishing. Furthermore, many of the structurally more complex terpenoids cannot be chemically synthesized in an economic way. Therefore, microbial production provides an attractive alternative, taking advantage of the often distinct regio- and stereoselectivity of enzymatic reactions. However, monoterpenes and monoterpenoids are challenging products for industrial biotechnology processes due to their pronounced cytotoxicity, which complicates the production in microorganisms compared to longer-chain terpenes (sesquiterpenes, diterpenes, etc.).
The aim of this thesis was to generate a biotechnological complement to fossil-resources-based chemical processes for industrial monoterpenoid production. Therefore, a starting point for the further development of a microbial cell factory based on the microbe Pseudomonas putida KT2440 was aimed to be created. This production organism should be able to conduct a whole- cell biocatalysis to selectively oxyfunctionalize monoterpene hydrocarbons using renewable industrial by-products and waste streams as raw material for monoterpenoid production (Figure 1). As a model substance, the production of (-)-menthol should be addressed due to its industrial significance. (-)-Menthol is one of the world’s most widely-used flavor and fragrance compounds by volume as well as a medical component, having an annual production volume of over 30,000 tons. An approach for (-)-menthol production from renewable resources could be a biotechnological(-chemical) two-step conversion (Figure 1), starting from (+)-limonene, a by-product of the citrus fruit processing industry.
The thesis project was divided into three parts. In the first part, enzymes (limonene-3- hydroxylases) were to be identified that can convert (+)-limonene into the precursor of (-)-menthol, (+)-trans-isopiperitenol. To counteract product toxicity, in the second part, the tolerance of the intended production organism P. putida KT2440 towards monoterpenes and their monoterpenoid derivatives should be increased. Finally, in the third part, the identified hydroxylase enzymes would be expressed in the improved P. putida KT2440 strain to create a whole-cell biocatalyst for the first reaction step of a two-step (-)-menthol production, starting from (+)-limonene.
To achieve these objectives, different genetic/molecular biology and analytical methods were applied. In this way, two cytochrome P450 monooxygenase enzymes from the fungi Aureobasidium pullulans and Hormonema carpetanum could be identified and functionally expressed in Pichia pastoris, which can catalyze the intended hydroxylation reaction on (+) limonene with high stereo- and regioselectivity. A further characterization of the enzyme from A. pullulans showed that apart from (+) limonene the protein can also hydroxylate ( ) limonene, - and -pinene, as well as 3-carene.
Furthermore, within this thesis, mechanisms of microbial monoterpenoid resistance of P. putida could be identified. It was shown that the different monoterpenes and monoterpenoids tested have very different toxicity levels and that mainly the Ttg efflux pumps of P. putida GS1 are responsible for the tolerance to many of these compounds. Based on these results, a P. putida KT2440 strain with increased resistance to various monoterpenoids, including isopiperitenol, could then be generated, which can be used as a host organism for the further development of monoterpenoid-producing cell factories.
While within the scope of this work the heterologous expression of the fungal gene in prokaryotic cells in a functional form could not be realized despite different approaches, the identified enzymes, the monoterpenoid-tolerant P. putida strain and a plasmid developed for heterologous gene expression in P. putida provide a starting point for the further design of a microbial cell factory for biotechnological monoterpenoid production.
Degeneration of neurons, such as the inner ear spiral ganglion neurons (SGN), may be decelerated or even stopped by neurotrophic factor treatment, such as brain-derived neurotrophic factor (BDNF), as well as electrical stimulation (ES). In a clinical setting, drug treatment of the SGN could start directly during implantation of a cochlear implant, whereas electrical stimulation begins days to weeks later. The present study was conducted to determine the effects of consecutive BDNF and ES treatments on SGN density and electrical responsiveness. An electrode drug delivery device was implanted in guinea pigs 3 weeks after deafening and five experimental groups were established: two groups received intracochlear infusion of artificial perilymph (AP) or BDNF; two groups were treated with AP respectively BDNF in addition to ES (AP + ES, BDNF + ES); and one group received BDNF from the day of implantation until day 34 followed by ES (BDNF ⇨ ES). Electrically evoked auditory brainstem responses were recorded. After one month of treatment, the tissue was harvested and the SGN density was assessed. The results show that consecutive treatment with BDNF and ES was as successful as the simultaneous combined treatment in terms of enhanced SGN density compared to the untreated contralateral side but not in regard to the numbers of protected cells.
Das Vorkommen von Kunststoffmaterialien <5 mm, sogenanntem Mikroplastik
(MP), in marinen Ökosystemen wurde bereits eingehend untersucht. Im Gegensatz dazu existieren erhebliche Wissenslücken hinsichtlich der Abundanz und der Auswirkung von MP in limnischen Ökosystemen. Vor diesem Hintergrund steht das Umweltvorkommen, mögliche Eintragspfade und die Auswirkungen von MP auf aquatische Invertebraten im Fokus dieser Arbeit. Zur Bestimmung der MP-Abundanz in Fließgewässern sind Sedimente der Elbe untersucht worden. Hierfür wurde zunächst eine Methode zur Extraktion und Identifizierung von MP aus Umweltproben entwickelt, optimiert und validiert. In der anschließenden Analyse konnten in elf Probenahmestellen 55–17400 MP kg-1 in den Sedimenten nachgewiesen werden. Der Einfluss der Gezeitenströmung wurde anhand der abnehmenden MP-Abundanz in der Tideelbe deutlich. Insgesamt weisen die Ergebnisse darauf hin, dass Sedimente von Fließgewässern eine Senke für MP darstellen. Für die Evaluation von Eintragspfaden von MP in Oberflächengewässer wurden die
Einleiter von fünf Kläranlagen beprobt und 240–897 MP m-3 in den Einleitern detektiert. Die Detailuntersuchung einer Kläranlage zeigte, dass >99% der MP-Fracht im Verlauf der Abwasseraufbereitung entfernt wird. Hierbei erfolgte die Hauptentfernung
bereits in der Vorklärung. Somit stellen Kläranlagen effektive Barrieren für den Eintrag von MP dar.
Insgesamt wird ersichtlich, dass die getesteten Arten C. riparius und G. pulex relativ insensitiv gegenüber einer MP-Exposition sind. So konnten bei G. pulex keine und bei C. riparius erst bei sehr hohen MP-Konzentrationen adverse Effekte detektiert werden. Hierbei ist die Autökologie der Spezies eine mögliche Erklärung für die Toleranz gegenüber partikulären Stressoren. Auf Basis dieser Daten sowie der ermittelten MPAbundanz kann das Umweltrisiko von MP in limnischen Ökosystemen vorläufig als
gering eingeschätzt werden. Hierbei gilt es jedoch zu beachten, dass eine abschließende
Bewertung aufgrund der nach wie vor existierenden Unsicherheiten nicht möglich ist. Diese Unsicherheiten betreffen die Umweltkonzentration von MP <80 μm, das Verhaltensowie das Wirkpotential dieser heterogenen und dynamischen Stressorenklasse
in umweltrelevanten Szenarien.
Aquatic ecosystems are globally contaminated with microplastics (MP). However, comparative data on MP levels in freshwater systems is still scarce. Therefore, the aim of this study is to quantify MP abundance in water and sediment of the German river Elbe using visual, spectroscopic (Fourier-transform infrared spectroscopy) and thermo analytical (pyrolysis gas chromatography mass spectrometry) methods. Samples from eleven German sites along the German part of the Elbe were collected, both in the water and sediment phase, in order to better understand MP sinks and transport mechanisms. MP concentrations differed between the water and sediment phase. Sediment concentrations (mean: 3,350,000 particles m−3, 125–5000 μm MP) were in average 600,000-fold higher than water concentrations (mean: 5.57 particles m−3, 150–5000 μm MP). The abundance varied between the sampling sites: In sediments, the abundance decreased in the course of the river while in water samples no such clear trend was observed. This may be explained by a barrage retaining sediments and limiting tidal influence in the upstream parts of the river. Particle shape differed site-specifically with one site having exceptionally high quantities of spheres, most probably due to industrial emissions of PS-DVB resin beads. Suspended MP consisted predominantly of polyethylene and polypropylene whereas sediments contained a higher diversity of polymer types. Determined MP concentrations correspond well to previous results from other European rivers. In a global context, MP levels in the Elbe relate to the lower (water) to middle section (sediment) of the global range of MP concentrations determined for rivers worldwide. This highlights that elevated MP levels are not only found in single countries or continents, but that MP pollution is an issue of global concern.
Anhand der Konstruktion von Joan of Arc in Saint Joan untersucht dieser Artikel, wie George Bernard Shaw die Position einer Außenseiterin nutzt, um seine geschlechtspolitischen und ästhetischen Ziele zu verdeutlichen. Im Vergleich mit älteren Darstellungen der französischen Nationalheldin wird Shaws spezifische Rezeption des Jeanne-d’Arc-Mythos skizziert und dargestellt, wie Shaw Joans geschlechtliche Differenz als Fortsetzung seiner Kritik an Geschlechternormen entwickelt. Aufbauend darauf präsentiert Shaw Joan zudem als mentale Ausnahmefigur, über deren Visionen ein anderer Begriff des Realismus stark gemacht wird, mit dem Shaw sein eigenes schriftstellerisches Wirken identifiziert.
The macrophage-inducible C-type lectin (mincle) is part of the innate immune system and acts as a pattern recognition receptor for pathogen-associated molecular patterns (PAMPS) and damage-associated molecular patterns (DAMPs). Ligand binding induces mincle activation which consequently interacts with the signaling adapter Fc receptor, SYK, and NF-kappa-B. There is also evidence that mincle expressed on macrophages promotes intestinal barrier integrity. However, little is known about the role of mincle in hepatic fibrosis, especially in more advanced disease stages. Mincle expression was measured in human liver samples from cirrhotic patients and donors collected at liver transplantation and in patients undergoing bariatric surgery. Human results were confirmed in rodent models of cirrhosis and acute-on-chronic liver failure (ACLF). In these models, the role of mincle was investigated in liver samples as well as in peripheral blood monocytes (PBMC), tissues from the kidney, spleen, small intestine, and heart. Additionally, mincle activation was stimulated in experimental non-alcoholic steatohepatitis (NASH) by treatment with mincle agonist trehalose-6,6-dibehenate (TDB). In human NASH, mincle is upregulated with increased collagen production. In ApoE deficient mice fed high-fat western diet (NASH model), mincle activation significantly increases hepatic collagen production. In human cirrhosis, mincle expression is also significantly upregulated. Furthermore, mincle expression is associated with the stage of chronic liver disease. This could be confirmed in rat models of cirrhosis and ACLF. ACLF was induced by LPS injection in cirrhotic rats. While mincle expression and downstream signaling via FC receptor gamma, SYK, and NF-kappa-B are upregulated in the liver, they are downregulated in PBMCs of these rats. Although mincle expressed on macrophages might be beneficial for intestinal barrier integrity, it seems to contribute to inflammation and fibrosis once the intestinal barrier becomes leaky in advanced stages of chronic liver disease.
Objectives: The aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache.
Design: This was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes.
Setting: The study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School.
Participants and interventions: Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months.
Main outcome measures: Pain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication.
Clinical results: The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = −38%, standard deviation = 25%, p = 0.012). Comparable reductions were observed for maximal pain intensity (−25%, standard deviation = 20%, 0.014) and for minimal pain intensity (−35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care.
Conclusions: In contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care.
Hintergrund: Die Erstversorgung von Wunden und kleinere chirurgische Eingriffe gehören neben der hochspezialisierten Medizin zu den allgemein notwendigen Grundleistungen der Notfallversorgung in den Kliniken. Die Vergütung der ambulanten Notfallleistungen für gesetzlich Versicherte erfolgt derzeit nach dem Einheitlichen Bewertungsmaßstab (EBM), welchem die betriebswirtschaftliche Aufwandserfassung des niedergelassenen Sektors als Kalkulationsgrundlage dient. Krankenhäuser haben im Vergleich zu Arztpraxen wesentlich höhere Vorhaltungskosten.
Ziel der Arbeit: In dieser Arbeit wird das entstehende Kosten-Erlös-Verhältnis der ambulanten Wundversorgung in einer Notaufnahme durch die Vergütung nach EBM analysiert.
Material und Methoden: Die Daten wurden in der Notaufnahme des Universitätsklinikums Frankfurt am Main über 12 Monate erhoben. Eingeschlossen wurden alle Patienten, die in diesem Zeitraum eine Wundversorgung mittels Naht erhielten. Die Kosten wurden der Abrechnung nach EBM 01210 (bzw. 01212) mit der Zusatzpauschale für kleinchirurgische Eingriffe EBM 02301 gegenübergestellt.
Ergebnisse: Im Beobachtungszeitraum wurden 1548 Patienten versorgt; das entspricht 19,52 % aller unfallchirurgischen Fälle. Den Kosten einer Standardwundversorgung in Höhe von 45,40 € steht eine Vergütung von 31,83 € gegenüber. Die Berechnung des Gesamterlöses weist einen Defizitbetrag von 13,57 € pro ambulantem Fall auf; dies entspricht einem Jahresdefizit von 21.006,36 €.
Diskussion: Es konnte gezeigt werden, dass ohne Betrachtung der relevanten Vorhaltekosten in keinem Fall eine Kostendeckung erreicht werden kann.
Die bisherige Vergütung der ambulanten Wundversorgung nach EBM erscheint unzureichend. Eine Anpassung bzw. Zusatzvergütung scheint notwendig, um eine ausreichende Versorgungsqualität in Zukunft sicherstellen zu können.
The inflammatory response plays an important role in the pathophysiology of multiple injuries. This study examines the effects of severe trauma and inflammatory response on markers of neuronal damage. A retrospective analysis of prospectively collected data in 445 trauma patients (Injury Severity Score (ISS) ≥ 16) is provided. Levels of neuronal biomarkers (calcium-binding Protein B (S100b), Enolase2 (NSE), glial fibrillary acidic protein (GFAP)) and Interleukins (IL-6, IL-10) in severely injured patients (with polytrauma (PT)) without traumatic brain injury (TBI) or with severe TBI (PT+TBI) and patients with isolated TBI (isTBI) were measured upon arrival until day 5. S100b, NSE, GFAP levels showed a time-dependent decrease in all cohorts. Their expression was higher after multiple injuries (p = 0.038) comparing isTBI. Positive correlation of marker level after concomitant TBI and isTBI (p = 0.001) was noted, while marker expression after PT appears to be independent. Highest levels of IL-6 and -10 were associated to PT und lowest to isTBI (p < 0.001). In all groups pro-inflammatory response (IL-6/-10 ratio) peaked on day 2 and at a lower level on day 4. Severe TBI modulates kinetic profile of inflammatory response by reducing interleukin expression following trauma. Potential markers for neuronal damage have a limited diagnostic value after severe trauma because undifferentiated increase.
Background: The treatment of severely injured patients, especially in older age, is complex, and based on strict guidelines. Methods: We conducted a retrospective study by analyzing our internal registry for mortality risk factors in deceased trauma patients. All patients that were admitted to the trauma bay of our level-1-trauma center from 2014 to 2018, and that died during the in-hospital treatment, were included. The aim of this study was to carry out a quality assurance concerning the initial care of severely injured patients. Results: In the 5-year period, 135 trauma patients died. The median (IQR) age was 69 (38–83) years, 71% were male, and the median (IQR) Injury Severity Score (ISS) was 25 (17–34) points. Overall, 41% of the patients suffered from severe traumatic brain injuries (TBI) (AIShead ≥ 4 points). For 12.7%, therapy was finally limited owing to an existing patient’s decree; in 64.9% with an uncertain prognosis, a ‘therapia minima’ was established in consensus with the relatives. Conclusion: Although the mortality rate was primarily related to the severity of the injury, a significant number of deaths were not exclusively due to medical reasons, but also to a self-determined limitation of therapy for severely injured geriatric patients. The conscientious documentation concerning the will of the patient is increasingly important in supporting medical decisions.
miR-142-3p expression is predictive for severe traumatic brain injury (TBI) in trauma patients
(2020)
Background: Predictive biomarkers in biofluids are the most commonly used diagnostic method, but established markers in trauma diagnostics lack accuracy. This study investigates promisingmicroRNAs(miRNA)releasedfromaffectedtissueafterseveretraumathathavepredictive values for the effects of the injury.
Methods: A retrospective analysis of prospectively collected data and blood samples of n = 33 trauma patients (ISS≥16) is provided. Levels of miR-9-5p, -124-3p, -142-3p, -219a-5p, -338-3pand-423-3p inseverelyinjuredpatients (PT)withouttraumatic braininjury (TBI) or with severe TBI (PT + TBI) and patients with isolated TBI (isTBI) were measured within 6 h after trauma.
Results: The highest miR-423-3p expression was detected in patients with severe isTBI, followed by patients with PT + TBI, and lowest levels were found in PT patients without TBI (2−∆∆Ct,p = 0.009). ApositivecorrelationbetweenmiR-423-3plevelandincreasingAIShead (p = 0.001) and risk of mortality (RISC II, p = 0.062) in trauma patients (n = 33) was found. ROC analysis of miR-423-3p levels revealed them as statistically significant to predict the severity of brain injury in trauma patients (p = 0.006). miR-124-3p was only found in patients with severe TBI, miR-338-3p was shown in all trauma groups. miR-9-5p, miR-142-3p and miR-219a-5p could not be detected in any of the four groups. Conclusion: miR-423-3p expression is significantly elevated after isolated traumatic braininjuryandpredictableforsevereTBIinthefirsthoursaftertrauma. miR-423-3pcouldrepresent a promising new biomarker to identify severe isolated TBI.
Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment tool in decompensated liver cirrhosis that has been shown to prolong transplant-free survival. Hepatic encephalopathy (HE) is a frequent complication of decompensated cirrhosis, eventually induced and/or aggravated by TIPS, that remains a clinical challenge especially in these patients. Therefore, patient selection for TIPS requires careful assessment of risk factors for HE. TIPS procedural parameters regarding stent size and invasive portosystemic pressure gradient measurements thereby have an important role. Endovascular shunt modification, in combination with a conservative medical approach, often results in a significant reduction of symptoms. This review summarizes HE molecular mechanisms and pathophysiology as well as diagnostic and therapeutic approaches targeting shunt-induced HE.
Die angespannte Lage am Wohnungsmarkt hat in vielen Städten eine neue Welle von Verdrängungsprozessen induziert und insbesondere die Situation einkommensschwacher Haushalte häufig prekär werden lassen. Angesichts dieser Entwicklungen haben sich vielerorts mietenpolitische Bewegungen konstituiert, die sich für eine Abkehr von einer neoliberalisierten und zunehmend finanzialisierten Wohnungsversorgung einsetzen. Lisa Vollmer nimmt in ihrer Forschungsarbeit zwei solcher Bewegungen in den Blick und fragt danach, wie sich politische Kollektivität in den alltäglichen Praktiken von Mieter*innen in Berlin bzw. New York formiert.
Background: WATSU (portmanteau word: water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water (35°C = 95°F = 308.15 K). It combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is reported to be used to address physical and mental issues. The objective of this systematic review (PROSPERO Registration No. CRD42016029347) and the meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies.
Methods: A search for "WATSU OR watershiatsu OR (water AND shiatsu)" was conducted without any restrictions in 32 databases. Peer reviewed original articles addressing WATSU as a stand-alone hydrotherapy were assessed for risk of bias. Quantitative data of effects on pain, physical function, and mental issues were processed in random model meta-analyses with subgroup analyses by study design. Effect sizes were expressed as Hedges's g (± 95% confidence intervals).
Results: Of 1,906 unique citations, 27 articles regardless of study design were assessed for risk of bias. WATSU has been applied to individuals of all ages. Indications covered acute (e.g. pregnancy related low back pain) and chronic conditions (e.g. cerebral palsy) with beneficial effects of WATSU regarding e.g. relaxation or sleep quality. Meta-analyses suggest beneficial effect sizes of WATSU on pain (overall Hedges’s g = -0.71, 95% CI = -0.91 to -0.51), physical function (overall Hedges’s g = -0.76, 95% CI = -1.08 to -0.44), and mental issues (overall Hedges’s g = -0.68, 95% CI = -1.02 to -0.35).
Conclusion: Various applications, indications and beneficial effects of WATSU were identified. The grade of this evidence is estimated to be low to moderate at the best. To strengthen the findings of this study, high-quality RCTs are needed.
Circulating monocytes contribute to inflammatory processes. We here validate abnormal expression of inflammation-related genes in monocytes of a large and well-characterised group of MDD patients, and relate the outcomes to pertinent clinical characteristics. Thirty-two genes of a previously established inflammation-related gene signature were assessed in 197 patients with MDD, and 151 controls collected during the EU-MOODINFLAME project. Monocyte gene- expression data were related to age, sex, BMI, depression severity, childhood adversity (CA) and suicide risk (SR). Three distinct gene profiles were identified within the MDD group (downregulated, mixed upregulated and strongly upregulated genes). Patients in the merged upregulated groups had a significantly higher prevalence of CA and high SR. Using hierarchical clustering of the genes, we found a cluster of mainly cytokine (production)-related genes; patients with SR had a significantly higher expression of this cluster than patients without SR (particularly for IL-6, IL1A and IL1B). Such difference did not emerge for patients with and without CA. A downregulated gene profile was found for patients not exposed to CA and without SR (particularly for glucocorticoid-signalling genes NR3C1a and HSPA1/B). No inflammatory changes were observed for healthy controls exposed to CA. Our data show that inflammatory activation in MDD is not uniform, and that immunologically discernible phenotypes of depression can be linked to CA and high SR. The absence of monocyte inflammatory activation in healthy controls exposed to CA suggests an inflammatory involvement in MDD-prone individuals exposed to early stressors, but not healthy controls.
In the fish embryo toxicity (FET) test with zebrafish (Danio rerio) embryos, 3,4-dichloroaniline (3,4-DCA) is often employed as a positive control substance. Previous studies have characterized bioconcentration and transformation of 3,4-DCA in this test under flow-through conditions. However, the dynamic changes of chemical concentrations in exposure media and embryos were not studied systematically under the commonly used semi-static exposure conditions in multiwell plates. To overcome these limitations, we conducted semi-static exposures experiments where embryolarval zebrafish were exposed to 0.5, 2.0, and 4.0 mg L−1 of 3,4-DCA for up to 120 hpf, with 24-h renewal intervals. During each renewal interval, concentrations of 3,4-DCA were quantified in water samples at 0, 6, 18, and 24 h using high-performance liquid chromatography with diode array detection. Levels of 3,4-DCA in larvae were measured after 120 h exposure. Concentrations of 3,4-DCA in the test vessels decreased rapidly during exposure. Taking these dynamics into account, bioconcentration factors in the present study ranged from 12.9 to 29.8 L kg−1, depending on exposure concentration. In summary, this study contributed to our knowledge of chemical dynamics in the FET test with embryolarval zebrafish, which will aid in defining suitable exposure conditions for future studies.
Predictability and the cross-section of expected returns: a challenge for asset pricing models
(2020)
Many modern macro finance models imply that excess returns on arbitrary assets are predictable via the price-dividend ratio and the variance risk premium of the aggregate stock market. We propose a simple empirical test for the ability of such a model to explain the cross-section of expected returns by sorting stocks based on the sensitivity of expected returns to these quantities. Models with only one uncertainty-related state variable, like the habit model or the long-run risks model, cannot pass this test. However, even extensions with more state variables mostly fail. We derive criteria models have to satisfy to produce expected return patterns in line with the data and discuss various examples.
We introduce Implied Volatility Duration (IVD) as a new measure for the timing of uncertainty resolution, with a high IVD corresponding to late resolution. Portfolio sorts on a large cross-section of stocks indicate that investors demand on average about seven percent return per year as a compensation for a late resolution of uncertainty. In a general equilibrium model, we show that `late' stocks can only have higher expected returns than `early' stocks if the investor exhibits a preference for early resolution of uncertainty. Our empirical analysis thus provides a purely market-based assessment of the timing preferences of the marginal investor.
5‐Lipoxygenase (5‐LO) is the initial enzyme in the biosynthesis of leukotrienes, which are mediators involved in pathophysiological conditions such as asthma and certain cancer types. Knowledge of proteins involved in 5‐LO pathway regulation, including gene regulatory proteins, is needed to evaluate all options for therapeutic intervention in these diseases. Here, we present a mass spectrometric screening of ALOX5 promoter‐interacting proteins, obtained by DNA pulldown and label‐free quantitative mass spectrometry. Protein preparations from myeloid and B‐lymphocytic cell lines were screened for promoter DNA interactors. Through statistical analysis, 66 proteins were identified as specific ALOX5 promotor binding proteins. Among those, the 15 most likely candidates for a prominent role in ALOX5 gene regulation are the known ALOX5 interactors Sp1 and Sp3, the related factor Sp2, two Krüppel‐like factors (KLF13 and KLF16) and six other zinc finger proteins (MAZ, PRDM10, VEZF1, ZBTB7A, ZNF281 and ZNF579). Intriguingly, we also identified two helicases (BLM and DHX36) and the proteins hnRNPD and hnRNPK, which are, together with the protein MAZ, known to interact with DNA G‐quadruplex structures. As G‐quadruplexes are implicated in gene regulation, spectroscopic and antibody‐based methods were used to confirm their presence within the GC‐rich sequence of the ALOX5 promoter. In summary, we have systematically characterized the interactome of the ALOX5 promoter, identifying several zinc finger proteins as novel potential ALOX5 gene regulators. Further, we have shown that the ALOX5 promoter can form DNA G‐quadruplex structures, which may play a functional role in ALOX5 gene regulation.
Complete reosseointegration after treatment of periimplantitis was never published yet. This short scientific communication reports about results of a randomized controlled preclinical study. An electrolytic approach was compared to a classical modality (ablative, cotton pellets soaked with sodium chloride solution and H2O2. For electrolytic cleaning a complete reosseointegration was achieved in several cases serving as a proof of concept.
Purpose: Neonatal surgery for abdominal wall defects is not performed in a centralized manner in Germany. The aim of this study was to investigate whether treatment for abdominal wall defects in Germany is equally effective compared to international results despite the decentralized care.
Methods: All newborn patients who were clients of the major statutory health insurance company in Germany between 2009 and 2013 and who had a diagnosis of gastroschisis or omphalocele were included. Mortality during the first year of life was analysed.
Results: The 316 patients with gastroschisis were classified as simple (82%) or complex (18%) cases. The main associated anomalies in the 197 patients with omphalocele were trisomy 18/21 (8%), cardiac anomalies (32%) and anomalies of the urinary tract (10%). Overall mortality was 4% for gastroschisis and 16% for omphalocele. Significant factors for non-survival were birth weight below 1500 g for both groups, complex gastroschisis, volvulus and anomalies of the blood supply to the intestine in gastroschisis, and female gender, trisomy 18/21 and lung hypoplasia in omphalocele.
Conclusions: Despite the fact that paediatric surgical care is organized in a decentralized manner in Germany, the mortality rates for gastroschisis and omphalocele are equal to those reported in international data.
In diesem Paper geht es um die quantitative Messung des objektiven Well-being in Hessen.
Es wird auf die objektive Lebensqualität in regionaler Perspektive fokussiert. Damit einhergehend wird – hier in diesem Paper bezogen auf Hessen – danach gefragt, welche intraregionalen Unterschiede diesbezüglich bestehen. Die Ausgangsthese lautet, dass sich das objektive Well-being intraregional stärker voneinander unterscheidet als das interregionale Well-being, d. h. dass kleinräumig die Unterschiede in der Lebensqualität größer sind als in größeren Räumen.
Die Berechnungen umfassen den Zeitraum von 2005 bis 2019 und wurden in räumlicher Perspektive für Hessen, Rheinland-Pfalz und die Metropolregion FrankfurtRheinMain durchgeführt. In diesem Paper wird auf die Ergebnisse für Hessen eingegangen.
Der regionale Well-being-Ansatz von GEWAK/IWAK umfasste in seiner ursprünglichen Fassung (bei grundsätzlicher Orientierung an den Empfehlungen der Enquête-Kommission des Deutschen Bundestags „Wachstum, Wohlstand, Lebensqualität“) zehn Indikatoren aus den folgenden vier Bereichen (siehe untenstehende Tab. 1 in Abschnitt 2.2): 1. Wirtschaft: Verfügbares Einkommen pro Kopf, Anteil der SGB-II-Empfänger/innen an den Erwerbsfähigen, Schuldenstand der Kreise/Städte pro Kopf; 2. Gesellschaft: Beschäftigungsquote, Sekundarabschluss-Quote, Lebenserwartung; 3. Umwelt: Energieverbrauch im Produzierenden Gewerbe, Anteil der Erholungs-, Wald- und Wasserfläche, Feinstaubbelastungen (als Jahresmittelwerte) sowie 4. Region: Bevölkerungsdichte. Die genannten zehn Indikatoren wurden mit ihren jeweiligen regionalen Ausprägungen gewichtet zum jeweiligen Gesamtindikatorwert für das regionale Well-being zusammengeführt.
Über diese früheren Berechnungen hinausgehend, wurden neben dem sogenannten Basiskonzept (mit Indikatoren, die in den bisherigen Untersuchungen genutzt wurden, mit folgender Ausnahme: „Stickstoffüberschuss“ anstelle von „Energieverbrauch im Produzierenden Gewerbe“) auch noch Well-being-Werte mittels eines erweiterten Konzepts (mit neuen Indikatoren wie der Miet-Einkommens-Relation oder der Kriminalitätsrate) berechnet. Damit wird untersucht, welche Bedeutung die Anzahl und die Art der ausgewählten Indikatoren auf das Wellbeing in Hessen auf regionaler Ebene haben.
Auf diese Weise entstand ein breites Bild über das regionale objektive Well-being in Hessen und seine jeweiligen Bestimmungsfaktoren in den beiden Varianten. Nach der Darstellung des methodischen Konzepts in Kapitel 2 werden danach in Kapitel 3 die Schätzergebnisse bezüglich der Gewichtungsfaktoren für die einzelnen Well-being-Subindikatoren präsentiert, ehe die hierauf aufbauenden regionalen Well-being-Befunde in Kapitel 4 behandelt werden. Eine Schlussbetrachtung (Kapitel 5) rundet das vorliegende Paper ab.
Diurnal valley winds frequently form over complex topography, particularly under fair weather conditions, and have a significant impact on the local weather and climate. Since diurnal valley winds result from complex and multi-scale interactions, their representation in numerical weather prediction models is challenging. Better understanding of these local winds based on observations is crucial to improve the accuracy of the forecasts. This study investigates the diurnal evolution of the three-dimensional mean wind structure in a deep Alpine valley, the Rhone valley at Sion, using data from a radar wind profiler and a surface weather station operated continuously from 1 September 2016 to 17 July 2017. In particular, the wind profiler data was analyzed for a subset of days on which fair weather conditions allowed for the full development of thermally driven winds. A pronounced diurnal cycle of the wind speed, as well as a reversal of the wind direction twice per day is documented for altitudes up to about 2 km above ground level (AGL) in the warm season and less than 1 km AGL in winter. The diurnal pattern undergoes significant changes during the course of the year. Particularly during the warm-weather months of May through to September, a low-level wind maximum occurs, where mean maximum up-valley velocities of 8–10 m s−1 are found between 15–16 UTC at altitudes around 200 m AGL. In addition, during nighttime, a down-valley jet with maximum wind speeds of 4–8 m s−1 around 1 km AGL is found. A case study of a three-day period in September 2016 illustrates the occurrence of an elevated layer of cross-valley flow around 1–1.5 km AGL.
Background: Patients with locally advanced bladder cancer (cT3/4 cN0/N+ cM0) have a poor prognosis despite radical surgical therapy and perioperative chemotherapy. Preliminary data suggest that the combination of radiation and immunotherapy does not lead to excess toxicity and may have synergistic (abscopal) anti-tumor effects. We hypothesize that the combined preoperative application of the PD-1 checkpoint-inhibitor Nivolumab with concomitant radiation therapy of the bladder and pelvic region followed by radical cystectomy with standardized lymphadenectomy is safe and feasible and might improve outcome for patients with locally advanced bladder cancer.
Methods: Study design: “RACE IT” (AUO AB 65/18) is an investigator initiated, prospective, multicenter, open, single arm phase II trial sponsored by Technical University Munich. Study drug and funding are provided by the company Bristol-Myers Squibb.
Study treatment: Patients will receive Nivolumab 240 mg i.v. every 2 weeks for 4 cycles preoperatively with concomitant radiation therapy of bladder and pelvic region (max. 50.4 Gy). Radical cystectomy with standardized bilateral pelvic lymphadenectomy will be performed between week 11–15.
Primary endpoint: Rate of patients with completed treatment consisting of radio-immunotherapy and radical cystectomy at the end of week 15.
Secondary endpoints: Acute and late toxicity, therapy response and survival (1 year follow up).
Main inclusion criteria: Patients with histologically confirmed, locally advanced bladder cancer (cT3/4, cN0/N+), who are ineligible for neoadjuvant, cisplatin-based chemotherapy or who refuse neoadjuvant chemotherapy.
Main exclusion criteria: Patients with metastatic disease (lymph node metastasis outside pelvis or distant metastasis) or previous chemo-, immune- or radiation therapy.
Planned sample size: 33 patients, interim analysis after 11 patients.