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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.
The Nok Culture of Central Nigeria is known for its sophisticated terracotta figurines initially described in the 1950s by the British archaeologist Bernard Fagg. Since 2009, the Nok Culture has been the subject of research at the Goethe University Frankfurt within the scope of a long-term project funded by the German Research Foundation (DFG). This book is the outcome of a PhD thesis that involved pXRF analysis of features associated with the Nok Culture, namely stone-pot-arrangements and pit features.
Stone-pot-arrangements are considered to be burials, indicated by arranged and modified stones associated with complete pots and, in a few cases, a necklace made of stone beads. However, the absence of bones and other skeletal remains meant that their interpretation as burials was unresolved. The interpretation of pits or pit-like structures, of various shapes and sizes, also remained inconclusive.
Employing pXRF analysis succeeded in revealing traces of a decomposed body, supporting the hypothesis of stone-pot-arrangements being interments. Together with the analysis of pits, new ideas about the formation and use of Nok sites were advanced. These culminated in a 'patchwork model' that assumes a repetitive cycle of utilising land for farming, settlements and burials, followed by abandonment and subsequent re-visiting and re-use of the formerly abandoned land.
Background: Enhancers play a fundamental role in orchestrating cell state and development. Although several methods have been developed to identify enhancers, linking them to their target genes is still an open problem. Several theories have been proposed on the functional mechanisms of enhancers, which triggered the development of various methods to infer promoter–enhancer interactions (PEIs). The advancement of high-throughput techniques describing the three-dimensional organization of the chromatin, paved the way to pinpoint long-range PEIs. Here we investigated whether including PEIs in computational models for the prediction of gene expression improves performance and interpretability.
Results: We have extended our TEPIC framework to include DNA contacts deduced from chromatin conformation capture experiments and compared various methods to determine PEIs using predictive modelling of gene expression from chromatin accessibility data and predicted transcription factor (TF) motif data. We designed a novel machine learning approach that allows the prioritization of TFs binding to distal loop and promoter regions with respect to their importance for gene expression regulation. Our analysis revealed a set of core TFs that are part of enhancer–promoter loops involving YY1 in different cell lines.
Conclusion: We present a novel approach that can be used to prioritize TFs involved in distal and promoter-proximal regulatory events by integrating chromatin accessibility, conformation, and gene expression data. We show that the integration of chromatin conformation data can improve gene expression prediction and aids model interpretability.
Background: Cytokines are mediators of inflammation that contribute to a low-grade inflammation in different disorders like major depression and obesity. It still remains unclear which psychological and medical factors interact with cytokine regulation. In the current investigation, the association between levels of pro-and anti-inflammatory cytokines and anthropometrics, mood state (depressiveness), physical activity and sleep were investigated in a sample of community-dwelled adults.
Methods: Forty-nine subjects met the inclusion criteria for analyses and were assessed at two time-points (baseline (T1) and follow-up (T2), average T1-T2-interval = 215 days). Serum cytokine measures included the pro-inflammatory cytokines interleukin (IL)-2, IL-12, IFN-γ and TNF-α, the anti-inflammatory cytokines IL-4, IL-5, IL-10 and IL-13 and the granulocyte-macrophage colony-stimulating factor (GM-CSF); anthropometrics were assessed via physical examination, depressiveness was assessed via Beck Depression Inventory (BDI)2, parameters of physical activity (steps, METs) and sleep (night/total sleep duration) were measured via a 1-week actigraphy.
Results: Correlation analyses showed low-to moderate significant relationships between the majority of cytokines and the BDI2 at T1, positive correlation with weight and BMI at T1 and T2, and negative correlations with the number of steps and METs at T2 and T2. Regression analyses for T1 revealed that the BDI2 score was the best positive predictor for the concentrations of all nine cytokines, followed by the number of steps and the nightsleep duration as negative predictors. At T2, the amount of steps was found to be negatively associated with IL-4, IL5, IL-10, GM-CSF, IFN-γ, and TNF-α, whereas the BMI could significantly predict IL-12 and IL-13. The BDI2-score was not significantly associated with any of the cytokines. No associations could be found between dynamics in cytokines from T1 and T2 and changes in any of the variables.
Discussion: The present results indicate an influence of physical activity, subjective well-being and body composition on inflammatory mediators. Since there was no standardized intervention targeting the independent variables between T1 and T2, no assumptions on causality can be drawn from the association results.
Background In the pandemic, testing for SARS-CoV-2 by RT-PCR in one of the pillars on which countermeasures are based. Factors limiting the output of laboratories interfere with the effectiveness of public health measures. Conserving reagents by pooling samples in low-probability settings is proposed, but may cause dilution and loss of sensitivity.
Methods We tested an alternate approach (FACT) by simultaneously incubating multiple respiratory swabs in a single tube. This protocol was evaluated by serial incubation of a respiratory swab in up to 10 tubes. The analytics validity of this concept was demonstrated in a five-sample mini pool set-up. It was consequently applied in the testing of 50 symptomatic patients (five-sample pools) as well as 100 asymptomatic residents of a nursing home (ten-sample pools).
Results Serial incubation of a respiratory swab in up to 10 tubes did not lead to a significant decline in viral concentration. The novel FACT-protocol did not cause a false negative result in a five-sample mini-pool setup, with non-significantly differing Ct values between single sample and mini-pool NAT. In two routine applications, all mini pools containing positive patient samples were correctly identified.
Conclusions Our proposed FACT-protocol did not cause a significant loss in analytic or diagnostic sensitivity compared to single sample testing in multiple setups. It reduced the amount of reagents needed by up to 40%, and also reduced hands-on time. This method could enhance testing efficiency, especially in groups with a low pretest-probability, such as systemically relevant professional groups.
Background: In the pandemic, testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time polymerase chain reaction is one of the pillars on which countermeasures are based. Factors limiting the output of laboratories interfere with the effectiveness of public health measures. Conserving reagents by pooling samples in low-probability settings is proposed but may cause dilution and loss of sensitivity. Blood transfusion services had experience in performance of high throughput nucleic acid testing (NAT) analysis and can support the national health system by screening of the inhabitants for SARS-COV-2.
Methods: We evaluated a new approach of a multiple-swab method by simultaneously incubating multiple respiratory swabs in a single tube. Analytical sensitivity was constant up to a total number of 50 swabs. It was consequently applied in the testing of 50 symptomatic patients (5-sample pools) as well as 100 asymptomatic residents of a nursing home (10-sample pools).
Results: The novel method did not cause false-negative results with nonsignificantly differing cycle threshold values between single-swab and multiple-swab NAT. In two routine applications, all minipools containing positive patient samples were correctly identified.
Conclusions: The new method enables countries to increase the total number of testing significantly. The multiple-swab method is able to screen system relevant groups of employees frequently. The example in Germany shows that blood transfusion services can support general health systems with their experience in NAT and their high-throughput instruments. Screening of a huge number of inhabitants is currently the only option to prevent a second infection wave and enable exit strategies in many countries.
Während den ersten Mikrosekunden nach dem Urknall glaubt man, dass unser Universum aus einer heißen, dichten und stark wechselwirkenden Materie bestanden haben soll, welche man das Quark-Gluonen-Plasma (QGP) nennt.
In diesem Medium sind die elementaren Bausteine der Materie, die Quarks und die Gluonen, nicht mehr in Hadronen gebunden, sondern können sich stattdessen wie quasi-freie Teilchen verhalten.
Für die ALICE Kollaboration an CERN's Large Hadron Collider (LHC) ist die Untersuchung dieses Mediums eines der Hauptziele. Um dieses Medium im Labor zu erzeugen, werden Protonen und Nukleonen auf nahezu Lichtgeschwindigkeit beschleunigt und anschließend zur Kollision gebracht. Dabei werden Schwerpunktsenergien von bis zu 13 TeV bei Proton-Proton (pp) Kollisionen und bis zu 5.02 TeV bei Blei-Blei (Pb--Pb) Kollisionen erreicht.
Bei solchen hochenergetischen Kollisionen werden die kritischen Werte der Energiedichte und Temperatur von jeweils ungefähr 1 GeV/c und undgefähr 155 MeV überschritten, welche mithilfe von "lattice QCD" bestimmt wurden. Sie bieten daher die perfekten Voraussetzungen für einen Phasenübergang von normaler Materie zu einem QGP.
Die Entwicklung eines solchen Mediums, beginnend bei der eigentlichen Kollision, gefolgt von der Ausbildung des Plasmas und der letztendlichen Hadronisierung, kann jedoch nicht direkt untersucht werden, da das Plasma eine extrem kurze Lebensdauer hat.
Die Studien die das QGP untersuchen möchten, müssen sich deshalb auf Teilchenmessungen und deren Veränderung aufgrund von Einflüssen durch das Medium beschränken.
Es ist noch nicht definitiv geklärt, ob sich ein QGP nur in Kollisionen schwerer Ionen bildet, oder ob dies auch in kleineren Kollisionssystemen wie Proton-Proton oder Proton-Blei der Fall ist.
Damit in dieser Thesis Einschränkungen bezüglich einer möglichen Erzeugung eines mini-GQP in kleinen Kollisionssystemen gemacht werden kann, wird der Fokus auf Messungen von neutralen Pionen und Eta Mesonen mit dem ALICE Detektor am CERN LHC gesetzt. Hierfür wird in einem Referenzsystem von Proton-Proton Kollisionen bei sqrt(s)=8 TeV und in einem Proton-Blei (p--Pb) System bei sqrt(sNN)=8.16 TeV, welches eine nukleare Modifikation erfährt, gemessen und die Ergebnisse verglichen.
Da in Proton-Proton Kollisionen die Bildung eines QGP, aufgrund zu geringer Energiedichte, nicht erwartet wird, dient eine Messung in diesem System als Messbasis, um Effekte der Kollision selbst von Effekten nach der Kollision zu separieren, welche die Teilchenproduktion beeinflussen.
Teilchen können zusätzlich zu dem QGP auch mit kalter Kernmaterie interagieren, was sich in asymmetrischen Proton-Blei Kollisionen testen lässt. In diesem Kollisionssystem wird größtenfalls ein vergleichsweise kleines QGP gebildet, wohingegen das Blei Ion selbst als kalte Kernmaterie agieren kann.
Zusätzlich zu den Mesonenmessungen wird in dieser Thesis auch die Erzeugung von direkten Photonen bei niedrigen Transversalimpulsen (pT) in multiplizitätsabhängigen p--Pb Kollisionen bei einer Schwerpunktsenergie von sNN=5.02 TeV gemessen, welche als direkte Probe, sowie als charakteristisches Signal des QGP gilt.
Die neutralen Pionen, welche in dieser Thesis gemessen werden, kann man als einen Überlagerungszustand der zwei leichtesten Quarksorten, dem "up" (u) und dem "down" (d) Quark, sowie deren entsprechenden Anti-Teilchen verstehen.
Das eta meson hingegen hat einen zusätzlichen Anteil des "strange" Quarks und eine resultierende höhere Masse.
Quarks sind Teil des Standardmodells der Teilchenphysik, welches die Elementarteilchen und die zwischen ihnen wirkenden Elementarkräfte, ausgeübt durch Bosonen, beschreibt.
Das Modell umfasst insgesamt sechs Quarks, welche sich durch ihre Masse und Ladung unterscheiden und als Grundbestandteil von gebundenen Zuständen, sogenannten Hadronen, fungieren.
Die "up" und "down" Quarks gelten hierbei als die leichtesten Quarks und kommen daher am häufigsten in der Natur vor. Das bekannteste Beipiel stellen hier die allgemein bekannten Protonen (uud) und Neutronen (udd) dar, welche die Grundkomponenten von Nukleonen sind.
Die restlichen Quarks tragen eine deutlich höhere Masse und haben daher eine große Tendenz, sich in leichtere Quarks umzuwandeln, wodurch ihre Lebensdauer sehr gering ist. Die "top" und "bottom" Quarks, welche die Schwersten sind, können daher nicht in gewöhnlicher Materie gefunden werden.
Sie können jedoch experimentell durch hoch energetische Teilchenkollisionen erzeugt werden und indirekt über ihre Zerfallsprodukte nachgewiesen werden.
Quarks tragen eine elektrische Ladung von entweder 1/3 oder 2/3, sowie eine Farbladung, wobei Letztere verantwortlich für ihre Bindung in Hadronen ist.
Hadronen bestehen entweder aus drei Quarks, dann werden sie Baryonen genannt, oder aus einem Quark-Antiquark Paar, welches Meson genannt wird.
Diese gebundenen Zustände erfüllen eine insgesamt neutrale Farbladung, sowie eine vollzählige elektrische Ladung.
Des Weiteren gibt es auch exotische Penta-Quark Zustände, welche aus vier Quarks und einem Antiquark bestehen und bereits experimentell nachgewiesen wurden.
Aufgrund der starken Wechselwirkung, welche durch Gluonen vermittelt wird, können Quarks nicht einzeln beobachtet werden.
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To successfully learn using open Internet resources, students must be able to critically search, evaluate and select online information, and verify sources. Defined as critical online reasoning (COR), this construct is operationalized on two levels in our study: (1) the student level using the newly developed Critical Online Reasoning Assessment (CORA), and (2) the online information processing level using event log data, including gaze durations and fixations. The written responses of 32 students for one CORA task were scored by three independent raters. The resulting score was operationalized as “task performance,” whereas the gaze fixations and durations were defined as indicators of “process performance.” Following a person-oriented approach, we conducted a process mining (PM) analysis, as well as a latent class analysis (LCA) to test whether—following the dual-process theory—the undergraduates could be distinguished into two groups based on both their process and task performance. Using PM, the process performance of all 32 students was visualized and compared, indicating two distinct response process patterns. One group of students (11), defined as “strategic information processers,” processed online information more comprehensively, as well as more efficiently, which was also reflected in their higher task scores. In contrast, the distributions of the process performance variables for the other group (21), defined as “avoidance information processers,” indicated a poorer process performance, which was also reflected in their lower task scores. In the LCA, where two student groups were empirically distinguished by combining the process performance indicators and the task score as a joint discriminant criterion, we confirmed these two COR profiles, which were reflected in high vs. low process and task performances. The estimated parameters indicated that high-performing students were significantly more efficient at conducting strategic information processing, as reflected in their higher process performance. These findings are so far based on quantitative analyses using event log data. To enable a more differentiated analysis of students’ visual attention dynamics, more in-depth qualitative research of the identified student profiles in terms of COR will be required.
Correctness of program transformations and translations in concurrent programming is the focus of our research. In this case study the relation of the synchronous pi-calculus and a core language of Concurrent Haskell (CH) with asynchronous communication is investigated. We show that CH embraces the synchronous pi-calculus. The formal foundations are contextual semantics in both languages, where may- as well as should-convergence are observed. We succeed in defining and proving smart properties of a particular translation mapping the synchronous pi-calculus into CH. This implies that pi-processes are error-free if and only if their translation is an error-free CH-program Our result shows that the chosen semantics is not only powerful, but can also be applied in concrete and technically complex situations. The developed translation uses private names. We also automatically check potentially correct translations that use global names instead of private names. As a complexity parameter we use the number of MVars introduced by the transformation, where MVars are synchronized 1-place buffers. The automated refutation of incorrect translations leads to a classification of potentially correct translations, and to the conjecture that one global MVar is insufficient.
Correctness of program transformations and translations in concurrent programming is the focus of our research. In this case study the relation of the synchronous pi-calculus and a core language of Concurrent Haskell (CH) with asynchronous communication is investigated. We show that CH embraces the synchronous pi-calculus. The formal foundations are contextual semantics in both languages, where may- as well as should-convergence are observed. We succeed in defining and proving smart properties of a particular translation mapping the synchronous pi-calculus into CH. This implies that pi-processes are error-free if and only if their translation is an error-free CH-program Our result shows that the chosen semantics is not only powerful, but can also be applied in concrete and technically complex situations. The developed translation uses private names. We also automatically check potentially correct translations that use global names instead of private names. As a complexity parameter we use the number of MVars introduced by the transformation, where MVars are synchronized 1-place buffers. The automated refutation of incorrect translations leads to a classification of potentially correct translations, and to the conjecture that one global MVar is insufficient.
Correctness of program transformations and translations in concurrent programming is the focus of our research. In this case study the relation of the synchronous pi-calculus and a core language of Concurrent Haskell (CH) with asynchronous communication is investigated. We show that CH embraces the synchronous pi-calculus. The formal foundations are contextual semantics in both languages, where may- as well as should-convergence are observed. We succeed in defining and proving smart properties of a particular translation mapping the synchronous pi-calculus into CH. This implies that pi-processes are error-free if and only if their translation is an error-free CH-program Our result shows that the chosen semantics is not only powerful, but can also be applied in concrete and technically complex situations. The developed translation uses private names. We also automatically check potentially correct translations that use global names instead of private names. As a complexity parameter we use the number of MVars introduced by the transformation, where MVars are synchronized 1-place buffers. The automated refutation of incorrect translations leads to a classification of potentially correct translations, and to the conjecture that one global MVar is insufficient.
Tropical cyclones (TC) represent a substantial threat to life and property for Caribbean and adjacent populations. The prospective increase of TC magnitudes, expressed in the 15th chapter of the IPCC AR5 report, entails a rising probability of ecological and social disasters, which were tragically exemplified by several severe Caribbean TC strikes during the past 20 years. Modern IPCC-grade climate models, however, still lack the required spatial and temporal resolution to accurately consider the underlying boundary conditions that modulate long-time TC patterns beyond the Instrumental Era. It is thus necessary to provide a synoptic mechanistic understanding regarding the origin of such long-time patterns, in order to predict reliable changes of TC magnitude and frequency under future climate scenarios. Caribbean TC records are still rare and often lack the necessary continuity and resolution to overcome these limitations. Here, we report on an annually-resolved sedimentary archive from the bottom of the Great Blue Hole (Lighthouse Reef, Belize). The TC record encompasses 1885 years and extends all existing site-specific TC archives both in terms of resolution and duration. We identified a likely connection between long-term TC patterns and climate phenomena responses to Common Era climate variations and offer a conceptual and comparative view considering several involved tropospheric and oceanographic control mechanisms such as the El-Niño-Southern-Oscillation, the North Atlantic Oscillation and the Atlantic Multidecadal Oscillation. These basin-scaled climate modes exercise internal control on TC activity by modulating the thermodynamic environment (sea-surface temperature and vertical wind shear stress dynamics) for enhanced/suppressed TC formation both on millennial (primary) and multi-decadal (secondary) time scales. We interpret the beginning of the Medieval Warm Period (MWP) as an important time interval of the Common Era record and suspect that the southward migration of the intertropical convergence zone (ITCZ) caused, in combination with extensive hydro-climate changes, a shift in the tropical Atlantic TC regime. The TC activity in the south-western Caribbean changed in general from a stable and less active stage (100–900 CE) to a more active and variable state (1,100 CE-modern).
Zielsetzung: Die Daten für das Jahr 2018 des Registers „Abdominelles Aortenaneurysma“ (AAA) des Deutschen Instituts für Gefäßmedizinische Gesundheitsforschung (DIGG) der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin werden vorgestellt.
Methodik: Im Jahr 2018 beteiligten sich an dem Register insgesamt 135 Kliniken. Für die offene Versorgung (OR) des intakten AAA (iAAA) gaben 118 (87,4 %) Kliniken, für die endovaskuläre Versorgung (EVAR) des iAAA 133 (98,5 %) Kliniken Daten ein. Für das rupturierte AAA (rAAA) wurden von 80 Kliniken (59,3 %) (EVAR) bzw. 65 (48,1 %) Kliniken (OR) Patienten gemeldet. Ausgewertet wurden die Daten von 4051 stationär behandelten Patienten.
Ergebnisse: 2800 iAAA (75,8 %) wurden endovaskulär und 895 (24,2 %) offen versorgt. Bei den endovaskulär versorgten Patienten mit iAAA verlief der Eingriff in 86,4 % der Fälle komplikationslos. Es verstarben insgesamt 32 Patienten (1,1 %) bis zur Entlassung. Bei den offen versorgten Patienten wiesen 73,4 % der Patienten keine Komplikationen auf. Verstorben sind insgesamt 42 Patienten (4,7 %). Von den 356 Patienten mit rAAA wurden 192 (53,9 %) endovaskulär und 164 (46,1 %) offen versorgt. Nur 11,0 % der mit OR versorgten Patienten, aber 23,4 % bei EVAR wiesen freies Blut in der Bauchhöhle auf. Bei EVAR sind 30,7 % der Patienten während des stationären Aufenthalts verstorben, bei OR 20,1 %.
Schlussfolgerung: Die Ergebnisse des Jahres 2018 zu Klinikletalität und Morbidität bei endovaskulärer und offener Versorgung des iAAA bestätigen weitestgehend die publizierten Ergebnisse für die Jahre 2013 bis 2017. Beim rAAA wurde 2018 erstmals über mehr endovaskuläre als offene Versorgungen berichtet – mit Ergebnissen, die denen der Vorjahre diametral entgegengesetzt waren. Patienten mit EVAR wiesen die höhere Komorbidität als Patienten mit OR auf und die Klinikletalität war höher. Es bleiben die Ergebnisse der Folgejahre abzuwarten, um diesen Trend genauer bewerten zu können.
Zielsetzung: Die Daten für das Jahr 2019 des Registers „Abdominelles Aortenaneurysma“ (AAA) des Deutschen Instituts für Gefäßmedizinische Gesundheitsforschung (DIGG) der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin werden vorgestellt.
Methodik: Im Jahr 2019 beteiligten sich an dem Register insgesamt 109 Kliniken. Für die offene Versorgung (OR) des intakten AAA (iAAA) gaben 78 (71,6 %) Kliniken, für die endovaskuläre Versorgung (EVAR) des iAAA 102 (93,6 %) Kliniken Daten ein. Für das rupturierte AAA (rAAA) wurden von 36 Kliniken (33,0 %) (EVAR) bzw. 50 (45,9 %) Kliniken (OR) Patienten gemeldet. Ausgewertet wurden die Daten von 1967 stationär behandelten Patienten. Von den insgesamt 1793 iAAA waren 1501 infrarenal (83,7 %) und 292 (16,3 %) juxtarenal gelegen.
Ergebnisse: 1429 iAAA (79,7 %) wurden endovaskulär und 364 (20,3 %) offen versorgt. Bei den endovaskulär versorgten Patienten mit iAAA verlief der Eingriff in 86,3 % der Fälle komplikationslos. Es verstarben insgesamt 15 Patienten (1,0 %) bis zur Entlassung. Bei den offen versorgten Patienten wiesen 67,0 % der Patienten keine Komplikationen auf. Verstorben sind insgesamt 20 Patienten (5,5 %). Bei EVAR war die Klinikletalität bei Versorgung juxtarenaler AAA mit 3,7 % signifikant höher als bei Versorgung infrarenaler AAA mit 0,6 % (p = 0,002), bei OR konnten hingegen keine signifikanten Unterschiede hinsichtlich der Klinikletalität aufgezeigt werden (juxtarenal 4,8 %, infrarenal 5,8 %; p = 0,470). Von den 174 Patienten mit rAAA wurden 80 (46,0 %) endovaskulär und 94 (54,0 %) offen versorgt. Bei EVAR sind 20,0 % der Patienten während des stationären Aufenthalts verstorben, bei OR 36,2 %.
Schlussfolgerung: Die Ergebnisse des Jahres 2019 zu Klinikletalität und Morbidität bei endovaskulärer und offener Versorgung des iAAA bestätigen weitgehend die publizierten Ergebnisse für die Jahre 2013 bis 2018. Beim rAAA sind die Ergebnisse der einzelnen Jahresberichte hingegen widersprüchlich, die kleinen berichteten jährlichen Fallzahlen erlauben nur Aussagen über größere Zeiträume.
Hintergrund: In Industrieländern sind bis zu 3 % aller Kinder von einer Erdnussallergie betroffen. Allergy to Peanuts imPacting Emotions And Life (APPEAL) ist die erste große Studie, die die Auswirkungen und Belastungen durch eine Erdnussallergie auf Betroffene und Angehörige untersucht.
Material und Methoden : Betroffene mit Erdnussallergie und deren Eltern/Betreuer nahmen entweder an einer Online-Umfrage teil (APPEAL‑1, n = 273) oder gaben detaillierte Interviews (APPEAL‑2, n = 32).
Ergebnisse : Von den Befragten der APPEAL-1-Studie (56 erwachsene Patienten mit Erdnussallergie und 217 Eltern/Betreuer von Personen mit Erdnussallergie) gaben 85 % an, dass die Erdnussallergie ihre täglichen Aktivitäten beeinflusst, 65 % fühlten sich deshalb isoliert. 91 % sorgten sich besonders bei gesellschaftlichen Anlässen vor einer potenziellen Erdnussexposition; 85 % verspürten Hindernisse beim Pflegen sozialer Kontakte. Die häufigsten psychologischen Auswirkungen der Erdnussallergie waren Frustration (89 %), Unsicherheit (86 %) und Stress (88 %). Ein Großteil der Befragten (84 %) beschrieb ein Gefühl der Andersartigkeit. Durch die Erdnussallergie kommt es häufig zu Beeinträchtigungen bei sozialen Aktivitäten, im schulischen Umfeld, im Beruf (bei Eltern und erwachsenen Betroffenen) sowie in Bezug auf emotionales Befinden und Beziehungen. Als wichtigste Bewältigungsstrategien nannten die Teilnehmer eine gute Überwachung von Nahrung und Hygiene, den Austausch mit anderen und eine akribische Planung von Aktivitäten.
Schlussfolgerungen : Dies ist die erste alltagsbezogene Umfrage in Deutschland, die die Auswirkungen und Belastungen einer Erdnussallergie bei betroffenen Kindern, Jugendlichen und deren Eltern/Betreuern sowie bei selbst betroffenen Erwachsenen aufzeigt.
Competition over land is at the core of many sustainable development challenges in Myanmar: villagers, companies, governments, ethnic minority groups, civil society organisations and non-governmental organisations from local to the international level claim access to and decision-making power over the use of land. Therefore, this article investigates the actor interactions influencing land-use changes and their impacts on the supply of ecosystem services and human well-being. We utilise a transdisciplinary mixed-methods approach and the analytical lens of the social-ecological systems framework. Results reveal that the links between land-use changes, ecosystem services and human well-being are multifaceted; For example ecosystem services can decline, while human well-being increases. We explain this finding through three different pathways to impact (changes in the resource systems, the governance systems or the broader social, economic and political context). We conclude with implications of these results for future sustainable land governance.