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A growing number of artificial intelligence (AI)-based clinical decision support systems are showing promising performance in preclinical, in silico evaluation, but few have yet demonstrated real benefit to patient care. Early-stage clinical evaluation is important to assess an AI system’s actual clinical performance at small scale, ensure its safety, evaluate the human factors surrounding its use and pave the way to further large-scale trials. However, the reporting of these early studies remains inadequate. The present statement provides a multi-stakeholder, consensus-based reporting guideline for the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by Artificial Intelligence (DECIDE-AI). We conducted a two-round, modified Delphi process to collect and analyze expert opinion on the reporting of early clinical evaluation of AI systems. Experts were recruited from 20 pre-defined stakeholder categories. The final composition and wording of the guideline was determined at a virtual consensus meeting. The checklist and the Explanation & Elaboration (E&E) sections were refined based on feedback from a qualitative evaluation process. In total, 123 experts participated in the first round of Delphi, 138 in the second round, 16 in the consensus meeting and 16 in the qualitative evaluation. The DECIDE-AI reporting guideline comprises 17 AI-specific reporting items (made of 28 subitems) and ten generic reporting items, with an E&E paragraph provided for each. Through consultation and consensus with a range of stakeholders, we developed a guideline comprising key items that should be reported in early-stage clinical studies of AI-based decision support systems in healthcare. By providing an actionable checklist of minimal reporting items, the DECIDE-AI guideline will facilitate the appraisal of these studies and replicability of their findings.

Background. Reverse-transcribed gene copies (retrocopies) have emerged as major sources of evolutionary novelty. MicroRNAs (miRNAs) are small and highly conserved RNA molecules that serve as key post-transcriptional regulators of gene expression. The origin and subsequent evolution of miRNAs have been addressed but not fully elucidated. Results.In this study, we performed a comprehensive investigation of miRNA origination through retroduplicated mRNA sequences (retro-miRs). We identified 17 retro-miRs that emerged from the mRNA retrocopies. Four of these retro-miRs had de novo origins within retrocopied sequences, while 13 retro-miRNAs were located within exon regions and duplicated along with their host mRNAs. We found that retro-miRs were primate-specific, including five retro-miRs conserved among all primates and two human-specific retro-miRs. All retro-miRs were expressed, with predicted and experimentally validated target genes except miR-10527. Notably, the target genes of retro-miRs are involved in key biological processes such as metabolic processes, cell signaling, and regulation of neurotransmitters in the central nervous system. Additionally, we found that these retro-miRs play a potential oncogenic role in cancer by targeting key cancer genes and are overexpressed in several cancer types, including liver hepatocellular carcinoma and stomach adenocarcinoma. Conclusions. Our findings demonstrated that mRNA retrotransposition is a key mechanism for the generation of novel miRNAs (retro-miRs) in primates. These retro-miRs are expressed, conserved, have target genes with important cellular functions, and play important roles in cancer.

BackgroundReverse transcribed gene copies, or retrocopies, have emerged as a major source of evolutionary novelties. MicroRNAs (miRNAs) are small, highly conserved RNAs molecules among species that serve as key post-transcriptional regulators of gene expression. The birth and subsequent evolution of miRNAs have been addressed, but not fully.ResultsIn this study, we carried out a comprehensive investigation of miRNAs origination through retroduplicated mRNA sequences (retrocopies). We identified 17 retroduplicated miRNAs (retro-miRs) that emerged from mRNAs retrocopies. Four of these retro-miRs hadde novoorigination within retrocopied sequences, while 13 retro-miRNAs were located within exon regions and were duplicated along with their host mRNAs. We found that retro-miRs are primates specific, including 5 retro-miRs conserved among all primates and two human-specific retro-miRs. All of the retro-miRs were expressed and had predicted and experimentally validated target genes, with the exception of miR-10527. Notably, the target genes of retro-miRs are involved in key biological processes, such as metabolic processes, cell signaling and regulation of neurotransmitters in the central nervous system. Additionally, we found that these retro-miRs have a potential oncogenic role in cancer, targeting key cancer genes and being overexpressed in several cancer types, including Liver Hepatocellular Carcinoma and Stomach Adenocarcinoma.ConclusionOur findings demonstrate that mRNAs retrotransposition is a key mechanism for the generation of novel miRNAs (retro-miRs) in primates. These retro-miRs are expressed, conserved, have target genes with important cellular functions, and play roles in cancer.

Rationale: Steroid profiles combined with the corticotropin stimulation test can be used to obtain a more complete picture of adrenocortical function in critically ill patients. Objectives: Our objective was to investigate whether steroid profiles before and after corticotropin stimulation predict shock development and mortality in human sepsis. Methods: An exploratory data analysis of a double-blind, randomized trial in sepsis (HYPRESS [Hydrocortisone for the PRevention of Septic Shock]) was performed. The trial included adult patients with sepsis who were not in shock and were randomly assigned to placebo or hydrocortisone treatment (200 mg for 5 days). Corticotropin tests were performed in 206 patients before randomization and in 20 healthy subjects. Samples were analyzed using the multi-analyte stable isotope dilution method (LC-MS/MS) for steroid profiling. Steroid profiles of healthy subjects undergoing corticotropin tests served as controls to determine reference ranges. Measurements and Main Results: Corticotropin test samples from 180 patients and 20 volunteers were included. Compared to healthy subjects, patients with sepsis had elevated levels of 11-desoxycorticosterone and 11-desoxycortisol, consistent with activation of both glucocorticoid and mineralocorticoid pathways before stimulation. After stimulation with corticotropin, the cortisol response was subnormal in 12% and the corticosterone response in 50% of sepsis patients. A predominance of glucocorticoids over mineralocorticoids after corticotropin stimulation (cortisol-corticosterone ratio > 32.2) predicted the development of shock within 14 days and death within 90 days in the placebo group. Conclusions: In this exploratory data analysis, corticotropin stimulated cortisol-to-corticosterone ratio served as a criterion to predict shock development and mortality in sepsis. Clinical trial registered with www.clinicaltrials.gov Identifier: NCT00670254. Registered 1 May 2008.

Rationale Steroid profiles in combination with a corticotropin stimulation test provide information about steroidogenesis and its functional reserves in critically ill patients. Objectives We investigated whether steroid profiles before and after corticotropin stimulation can predict the risk of in-hospital death in sepsis. Methods An exploratory data analysis of a double blind, randomized trial in sepsis (HYPRESS [HYdrocortisone for PRevention of Septic Shock]) was performed. The trial included adult patients with sepsis who were not in shock and were randomly assigned to placebo or hydrocortisone treatment. Corticotropin tests were performed in patients prior to randomization and in healthy subjects. Cortisol and precursors of glucocorticoids (17-OH-progesterone, 11-desoxycortisol) and mineralocorticoids (11-desoxycorticosterone, corticosterone) were analyzed using the multi-analyte stable isotope dilution method (LC–MS/MS). Measurement results from healthy subjects were used to determine reference ranges, and those from placebo patients to predict in-hospital mortality. Measurements and main results Corticotropin tests from 180 patients and 20 volunteers were included. Compared to healthy subjects, patients with sepsis had elevated levels of 11-desoxycorticosterone and 11-desoxycortisol, consistent with activation of both glucocorticoid and mineralocorticoid pathways. After stimulation with corticotropin, the cortisol response was subnormal in 12% and the corticosterone response in 50% of sepsis patients. In placebo patients (n = 90), a corticotropin-stimulated cortisol-to-corticosterone ratio > 32.2 predicted in-hospital mortality (AUC 0.8 CI 0.70–0.88; sensitivity 83%; and specificity 78%). This ratio also predicted risk of shock development and 90-day mortality. Conclusions In this exploratory analysis, we found that in sepsis mineralocorticoid steroidogenesis was more frequently impaired than glucocorticoid steroidogenesis. The corticotropin-stimulated cortisol-to-corticosterone ratio predicts the risk of in-hospital death. Trial registration Clinical trial registered with www.clinicaltrials.gov Identifier: NCT00670254. Registered 1 May 2008, https://clinicaltrials.gov/ct2/show/NCT00670254.

Background There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.

Transplantable cell encapsulation systems present a promising approach to deliver a therapeutic solution from hormone-producing cells for the treatment of endocrine diseases like type 1 diabetes. However, the development of a broadly effective and safe transplantation system has been challenging. While some current micro-sized capsules have been optimized for adequate nutrient and metabolic transport, they lack the robustness and retrievability for the clinical safety translation that macro-devices may offer. An existing challenge to be addressed in the current macro-devices is their configuration which may lead to unsatisfactory mass transfer. Here, we design and characterize a millimeter-size particle system of poly-ethylene glycol (PEG) featuring internal toroidal spiral channels, called toroidal spiral particles (TSPs). The characteristic internal structure of the TSPs allows for large encapsulation capacity and large surface area available to all the encapsulated cell mass for effective molecular diffusion. The polymeric matrix renders the particle flexible yet robust for safe transplantation and retrieval. We demonstrate the feasibility of fabricating these particles with various polymer compositions, while optimizing their mechanical properties as well as glucose and insulin permeability. Encapsulation of islets of Langerhans is achieved with high loading capacity (∼160 IEQ per TSP) and excellent cell viability. TSP-encapsulated islets showed similar glucose-stimulated insulin secretion to the naked islets. Preliminary biocompatibility of the TSPs on naïve C57BL/6 mice shows minimal inflammatory response after 4-week transplantation into the intraperitoneal (IP) space. Long-term therapeutic efficacy of encapsulated islets needs to be confirmed in diabetic rodent models in the future, while determining minimal mass required to reverse diabetes. However, we believe from the in vitro favorable results and the TSPs' unique design that TSPs may provide a safe, effective method to transplant and retrieve therapeutic cells for type 1 diabetes treatment and may also be applicable for other cell therapies.

ObjectiveTo evaluate the feasibility of continuous paO2 prediction in an intraoperative setting among neurosurgical patients with modern machine learning methods.Materials and MethodsData were extracted from routine clinical care of lung-healthy, neurosurgical patients. We used recursive feature elimination to identify relevant features for the prediction of paO2. Five machine learning algorithms (gradient boosting regressor, k-nearest neighbors regressor, random forest regressor, support vector regression, multi-layer perceptron regressor) and a multivariate linear regression were then tuned and fitted to the selected features. A performance matrix consisting of Spearman’s ρ, mean absolute percentage error (MAPE) and root mean squared error (RMSE) was finally computed based on the test set and used to compare and rank each algorithm.ResultsWe analyzed 4,180 patients with 12,497 observations. A total of 20 features were selected from analysis of the training dataset comprising 836 patients with 9,992 observations. The best algorithm, random forest, was able to predict paO2 values with ρ=0.90, MAPE=10.4%, and RMSE=30.9mmHg, closely followed by gradient boosting and multi-layer perceptron. Support vector regression, k-nearest neighbors regressor and the linear regression did not achieve the performance metrics.DiscussionWe successfully applied and compared several machine learning algorithms to estimate continuous paO2 values in neurosurgical patients. The random forest regressor performed best over all three categories of the performance matrix.ConclusionPaO2 can be predicted by perioperative routine data in neurosurgical patients.

Juhász, L. (2021). Towards understanding the temporal accuracy of OpenStreetMap: A quantitative experiment In: Minghini, M., Ludwig, C., Anderson, J., Mooney, P., Grinberger, A.Y. (Eds.). Proceedings of the Academic Track at the State of the Map 2021 Online Conference, July 09-11 2021, 19-22. Available at https://zenodo.org/communities/sotm-2021

Owusu, M., Herfort, B. & Lautenbach, S. (2021). Towards a framework for measuring local data contribution in OpenStreetMap In: Minghini, M., Ludwing, C., Anderson, J., Mooney, P., Grinberger, A.Y. (Eds.). Proceedings of the Academic Track at the State of the Map 2021 Online Conference, July 09-11 2021, 16-18. Available at https://zenodo.org/communities/sotm-2021&nbsp

Mooney, P. & Galván, E. (2021). What has machine learning ever done for us? In: Minghini, M., Ludwig, C., Anderson, J., Mooney, P., Grinberger, A.Y. (Eds.). Proceedings of the Academic Track at the State of the Map 2021 Online Conference, July 09-11 2021, 9-12. Available at https://zenodo.org/communities/sotm-2021

Veselovsky, V., Sarkar, D., Anderson, J. & Soden, R. (2021). An automated approach to identifying corporate editing activity in OSM In: Minghini, M., Ludwig, C., Anderson, J., Mooney, P., Grinberger, A.Y. (Eds.). Proceedings of the Academic Track at the State of the Map 2021 Online Conference, July 09-11 2021, 31-33. Available at https://zenodo.org/communities/sotm-2021

Li, Y. & Anderson, J. (2021). Introducing OpenStreetMap user embeddings: Promising steps toward automated vandalism and community detection In: Minghini, M., Ludwig, C., Anderson, J., Mooney, P., Grinberger, A.Y. (Eds.). Proceedings of the Academic Track at the State of the Map 2021 Online Conference, July 09-11 2021, 23-26. Available at https://zenodo.org/communities/sotm-2021

Graux, D. & Michel, T. (2021). Involvement of OpenStreetMap in European H2020 projects In: Minghini, M., Ludwing, C., Anderson, J., Mooney, P., Grinberger, A.Y. (Eds.). Proceedings of the Academic Track at the State of the Map 2021 Online Conference, July 09-11 2021, 34-36. Available at https://zenodo.org/communities/sotm-2021

ZusammenfassungDie interventionelle Emphysemtherapie bietet ein breites Spektrum an chirurgischen und endoskopischen Optionen zur Behandlung von Patienten mit fortgeschrittenem Lungenemphysem. Zur Sicherstellung der Behandlungsqualität ist eine interdisziplinäre Zusammenarbeit von Pneumologie, Thoraxchirurgie und bildgebenden Disziplinen in der Auswahl, Therapie und Nachsorge von Emphysem-Patienten erforderlich. Das vorliegende Positionspapier beschreibt erforderliche Struktur- und Qualitätsvoraussetzungen von Behandlungszentren.

Einleitung: Der Lernort SkillsLab/Lernklinik in der ��rztlichen Weiterbildung erscheint aufgrund der hier vorhandenen Ausstattung, R��umlichkeiten und der Kompetenzen des Personals sinnvoll. Eine regelm����ige Nutzung f��r Kurse ist jedoch selten. Material undMethoden: Der [zum vollst��ndigen Text gelangen Sie ��ber die oben angegebene URL]

Hintergrund: Die ��rztliche Gespr��chsf��hrung und die Kommunikation mit PatientInnen haben unabh��ngig vom medizinischen Fachgebiet einen bedeutsamen Stellenwert in der Arbeit von ��rztInnen. Kommunikationstrainings sind mittlerweile an vielen medizinischen Fakult��ten in die [zum vollst��ndigen Text gelangen Sie ��ber die oben angegebene URL]

Einleitung: Die Digitalisierung in der Medizin wird den ��rztlichen Berufsalltag in den kommenden Jahren umfassend ver��ndern [ref:1]. ��rztinnen und ��rzte m��ssen Kompetenzen entwickeln, um mit den digitalen Technologien umzugehen, die Anwendbarkeit im Einzelfall einzuordnen [zum vollst��ndigen Text gelangen Sie ��ber die oben angegebene URL]

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n=122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n=146; 85.9%), only 42.4% (n=72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n=9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients.

Sarkar, D. & Anderson, J. (2021). Community interactions in OSM editing In: Minghini, M., Ludwing, C., Anderson, J., Mooney, P., Grinberger, A.Y. (Eds.). Proceedings of the Academic Track at the State of the Map 2021 Online Conference, July 09-11 2021, 6-8. Available at https://zenodo.org/communities/sotm-2021&nbsp

Early post-operative delirium is a common perioperative complication in the post anesthesia care unit. To date it is unknown if a specific anesthetic regime can affect the incidence of delirium after surgery. Our objective was to examine the effect of volatile anesthetics on post-operative delirium.Single Center Observational Study.Post Anesthesia Care Units at a German tertiary medical center.30,075 patients receiving general anesthesia for surgery.Delirium was assessed with the Nursing Delirium Screening Scale at the end of the recovery period. Subgroup-specific effects of volatile anesthetics on post-operative delirium were estimated using generalized-linear-model trees with inverse probability of treatment weighting. We further assessed the age-specific effect of volatiles using logistic regression models.Out of 30,075 records, 956 patients (3.2%) developed delirium in the post anesthesia care unit. On average, patients who developed delirium were older than patients without delirium. We found volatile anesthetics to increase the risk (Odds exp. (B) for delirium in the elderly 1.8-fold compared to total intravenous anesthesia. Odds increases with unplanned surgery 3.0-fold. In the very old (87 years or older), the increase in delirium is 6.2-fold. This result was confirmed with internal validation and in a logistic regression model.Our exploratory study indicates that early postoperative delirium is associated with the use of volatile anesthetics especially in the sub-cohort of patients aged 75 years and above. Further studies should include both volatile and intravenous anesthetics to find the ideal anesthetic in elderly patients.

In patients with major annulus calcifications (MAC) requiring en-bloque decalcification anterolateral minithoracotomy is not suitable for safe and reproducible mitral valve surgery (MVS) procedures. In these cases, full sternotomy (FS) is still the preferred approach. Alternatively, less invasive MVS via partial upper sternotomy (PS) and transseptal access can be used in experienced centers. After reviewing the records of 1741 patients, who were treated with either isolated MVS or combined procedures, we identified 32 patients who had undergone en-bloque decalcification for MAC. The 2 techniques (PS-group n = 17, FS-cohort n = 15) were presented in terms of 1-year mortality as well as intra- and perioperative outcome. In the PS group, the age was 60.06 ± 7.56 patients, 64.7% were female and had a STS Predicted Risk of Mortality (PROM) score of 1.01 ± 1.06. In the FS group the patients (53.3% female) mean age was 58.47 ± 14.45 and had a STS PROM score 2.35 ± 2.73%. Rates of mitral repair were in the PS and FS cohort 64.7% and 46.7%, respectively. One-year mortality for PS-MVS was 5.9% (n = 1) and 20% (n = 3) for FS-MVS. The cardiopulmonary bypass (FS: 181.60 ± 49.99 minutes, PS: 192.83 ± 77.32 minutes and the cross-clamp times (FS: 119.67 ± 46.06, PS: 136.94 ± 54.37 minutes). The observed ventilation times in the PS and FS group were 5 hours (IQR 3.5–9) and 10 hours (IQR 5–15), respectively. A permanent pacemaker implantation was not necessary in any patient. In patients with MAC and en-bloque decalcification PS seems to be a safe access and might be a valid less invasive alternative to minithoracotomy.

OBJECTIVES The aim of this study was to identify predictors of periprocedural success and safety in minimally invasive mitral valve surgery and to determine the impact of pathology localization and repair technique on reoperation-free survival. METHODS We isolated 686 patients (mean age 60.5, standard deviation 12.3 years, 69.4% male) who underwent surgery for mitral valve prolapse between 2002 and 2020 in a single institution. Patients with concomitant disease, redo or mitral pathology other than degenerative mitral disease were excluded from the analysis. Periprocedural safety was defined as: freedom from perioperative death, myocardial infarction, stroke, use of extracorporeal membrane oxygenation or reoperation for bleeding. Operative success was defined as: successful primary mitral repair without conversion to replacement or to larger thoracic incisions, without residual mitral regurgitation > mild at discharge or reoperation within 30 days. Predictors for perioperative success and safety were identified using univariable and multivariable analyses. The impact of prolapse localization and repair technique on reoperation-free survival was assessed by Cox regression. RESULTS The mitral repair rate and the need for concomitant tricuspid repair were 94.6% and 16.5%, respectively. Perioperative mortality occurred in 5 patients (0.7%). The criteria for perioperative safety and success were met in 646/686 (94.2%) and 648/686 (94.5%) patients, respectively. The absence of tricuspid disease requiring repair was the only independent predictor of safety in this cohort [hazard ratio (HR) 0.460 (0.225–0.941), P = 0.033]. The only independent predictor of operative success was the use of chordal replacement [0.27 (0.09–0.83), P = 0.022]. Reoperation-free survival was 98.5%, 94.5% and 86.9% at 1, 5 and 10 years, respectively. Posterior leaflet pathology demonstrated a higher reoperation-free survival as compared to other localizations (log-rank P = 0.002). The localization of leaflet pathology but not the repair method was an independent predictor for reoperation-free survival (HR 1.455, 95% confidence interval 1.098–1.930; P = 0.009). CONCLUSIONS In minimally invasive mitral surgery for degenerative disease, chordal replacement yields higher rates of periprocedural success than leaflet resection. Posterior leaflet pathology is an independent predictor of reoperation-free survival.

Introduction: In the wake of the COVID-19 pandemic, alternatives to established and proven formats had to be found in university teaching within a very short time. In the case of the SkillsLab at the Dorothea Erxleben Lernzentrum Halle (Saale) at the Martin Luther University Halle (Saale)-Wittenberg, this meant in relation to the communication courses that a considerable proportion of the simulation participants of advanced age or with pre-existing conditions were suddenly no longer available for conversation simulations in teaching.Project description: In the course of the seminar "Conversation with relatives - dealing with relatives" in the 8th semester, the conversation simulation was therefore adapted at short notice and converted into a telephone conversation. Thus, the simulation subjects were able to participate remotely and the students had the opportunity to test their doctor-patient conversation skills with regard to telephone calls in a safe environment. Results: The focus on nonverbal techniques and the departure from the usual face-to-face setting was perceived by students and simulation subjects alike as a positive stimulus and particularly challenging. The lack of visual impressions had made empathic conversation more difficult. Discussion and Conclusions: The positive experiences from this project should be used to expand the communication curriculum in the future to include telephone-based conversations with simulation subjects. Ideally, it would then be possible for the simulation persons to be present in the future after the conversation for feedback mediation and group discussion. Einleitung: Im Zuge der COVID-19 Pandemie mussten in der universitären Lehre in kürzester Zeit Alternativen zu etablierten und bewährten Formaten gefunden werden. Im Falle des SkillsLabs im Dorothea Erxleben Lernzentrum Halle (Saale) an der Martin-Luther-Universität Halle (Saale)-Wittenberg bedeutete dies bezogen auf die Kommunikationskurse, dass ein beachtlicher Teil der Simulationspersonen im höheren Alter oder mit Vorerkrankungen plötzlich nicht mehr für Gesprächssimulationen in der Lehre zur Verfügung stand.Projektbeschreibung: Im Zuge des Seminares "Angehörigengespräch - Umgang mit Angehörigen" im 8. Fachsemester wurde die Gesprächssimulation deshalb kurzfristig angepasst und in ein Telefonat umgewandelt. Somit wurde es den Simulationspersonen ermöglicht aus der Ferne mitzuarbeiten und die Studierenden hatten die Möglichkeit in sicherer Umgebung ihre Arzt-Patienten-Gesprächsführung in Bezug auf Telefonate zu erproben. Ergebnisse: Der Fokus auf nonverbalen Techniken und das Verlassen des üblichen Face-to-Face Settings wurde gleichermaßen durch die Studierenden und die Simulationspersonen als ein positiver Impuls und besondere Herausforderung wahrgenommen. Das Fehlen der optischen Eindrücke habe eine empathische Gesprächsführung schwieriger gemacht. Diskussion und Schlussfolgerungen: Die positiven Erfahrungen aus diesem Projekt sollen genutzt werden um das Kommunikationscurriculum zukünftig um telefongestützte Gespräche mit Simulationspersonen zu erweitern. Im Idealfall ist es dann möglich, dass die Simulationspersonen zukünftig nach dem Gespräch zur Feedbackvermittlung und zur Gruppendiskussion anwesend sein können.

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts. © 2021, The Author(s).

Objective: The contact restrictions caused by the Covid-19 pandemic fundamentally limit patient-centered teaching. To realize a patient-oriented education in the block training "Internal Medicine" at the University Hospital Halle (Saale) despite the challenges, the already established teaching module "Interprofessional Teleconsultation" was adapted. The short article outlines the interprofessional teaching module including first evaluation results and describes the adapted block training.Method: In the "Internal Medicine" block training, students in a lecture hall navigated a telepresence system, which was accompanied by a physician across the ward and conducted an anamnesis via video and audio transmission without actual patient contact. Results: Students, physicians, and patients were open-minded about this form of communication during the Covid-19 pandemic and quickly got accustomed to the use of the telepresence system. To be able to react to technical challenges (e.g. unstable connection between the communication partners), a careful preparation of the lecturers is necessary. Conclusion: In using a telepresence system, patient-oriented teaching of students in the block training "Internal Medicine" can be ensured with low-threshold technical effort during the Covid-19 pandemic. The telepresence system allows for the involvement of patients into teaching while adhering to the necessary hygiene measures. Despite technical challenges, the teaching format based on telepresence is suitable as an alternative to face-to-face teaching if actual patient contact is not possible. Zielsetzung: Die Kontakteinschränkungen durch die Covid-19-Pandemie beeinträchtigen die patientennahe Lehre grundlegend. Um trotz der besonderen Herausforderungen eine patientennahe Ausbildung im Blockpraktikum "Innere Medizin" am Universitätsklinikum Halle (Saale) zu realisieren, wurde das bereits etablierte Lehrmodul "Interprofessionelles Telekonsil" adaptiert. Der Kurzbeitrag skizziert das interprofessionelle Lehrmodul mit ersten Evaluationsergebnissen und beschreibt das adaptierte Blockpraktikum.Methodik: Im Blockpraktikum "Innere Medizin" navigieren die Studierenden von einem Hörsaal aus ein von einem*r Ärzt*in begleitetes Telepräsenzsystem über die Station und führen so via Video- und Audio-Übertragung ein Anamnesegespräch ohne unmittelbaren Patientenkontakt. Ergebnisse: Sowohl die Studierenden und Ärzt*innen als auch die Patient*innen standen dieser Form der Kommunikation während der Covid-19-Pandemie aufgeschlossen gegenüber und gewöhnten sich schnell an den Umgang mit dem Telepräsenzsystem. Um gegebenenfalls auf technische Herausforderungen (z.B. instabile Verbindung zwischen den Kommunikationspartner*innen) reagieren zu können, ist eine sorgfältige Vorbereitung der Dozent*innen notwendig. Schlussfolgerung: Durch den Einsatz des Telepräsenzsystems kann die patientennahe Ausbildung der Studierenden im Blockpraktikum "Innere Medizin" während der Covid-19-Pandemie mit niederschwelligem technischen Aufwand gewährleistet werden. Das Telepräsenzsystem ermöglicht dabei die Einbindung von Patient*innen in die studentische Lehre bei gleichzeitiger Einhaltung der erforderlichen Hygienemaßnahmen. Trotz technischer Herausforderungen ist das Lehrformat mit Telepräsenz als Alternative zur Präsenzlehre geeignet, wenn ein unmittelbarer Patientenkontakt nicht möglich ist.

This paper evaluates the use of a phase change composite (PCC) material consisting of paraffin wax (n-Tetradecane) and expanded graphite as a potential storage medium for cold thermal energy storage (TES) systems to support air conditioning applications. The PCC-TES system is proposed to be integrated with the vapor compression refrigeration cycle of an air conditioning (AC) system. The use of this PCC material is novel because of its unique material and thermal characteristics as compared to ice or chilled water that are predominantly used in commercial TES systems for air cooling applications. The work of this paper proposed and tested a hypothesis, which suggests that integrating a conventional AC with a PCC-TES would result in significant benefits concerning compressor size, compressor efficiency, electricity consumed and CO2 emissions. The proposed integration would also contribute to reduce electricity demand during peak hours and reduce necessity to build more expensive power plants and distribution lines. To test the hypothesis, a simulation model in Aspen Plus® software was prepared. However, Aspen Plus® does not have a built-in library to predict PCC’s melting and solidification behaviors. Therefore, an analytical heat transfer model was written as a system of equations in Fortran code into Aspen Plus® calculation block to simulate the phase change behavior and associated characteristics. The overall simulation model, which was designed specifically for this research work, consists of two main parts that communicate with each other. The first part simulates the AC’s refrigeration loop using the built-in Aspen Plus® components and the second part implements the PCC heat transfer model written within the calculation block of Aspen Plus®. The simulation model was validated by crosschecking the calculated results with actual experimental data from an actual 4 kWh PCC-TES benchtop thermal storage system. Very good agreement was observed between the simulations and laboratory data. Simulated performance of the proposed integration between the AC and the PCC-TES indicated the potential to (1) downsize the compressor by 50%, (2) lower electrical consumption by the compressor by 30%, (3) lower CO2 emissions by 30%, and (4) double the compressor efficiency during off and mid peak hours. The present work is a conceptual design and optimization study and does not account for integration inefficiencies, energy losses, real-world operation complexity, and added capital cost of TES integration with AC systems.

Motivated by the internal flow geometry of spiral-wound membrane modules with ladder-type spacers, we consider the Stokes flow singularity at a corner that joins porous and solid walls at arbitrary wedge angle $$\varTheta $$ . Seepage flux through the porous wall is coupled to the pressure field by Darcy’s law; slip is described by a variant of the Beavers–Joseph boundary condition. On a macroscopic, outer length scale, the singularity appears like a jump discontinuity in the normal velocity, characterized by a non-integrable 1 / r divergence of the pressure. For arbitrary $$\varTheta $$ , we develop an algebraic criterion to determine the admissible radial exponent(s) in a leading, inner similarity solution—which represents a weaker, integrable singularity in the pressure. A complete map of exponent versus $$\varTheta $$ is provided for $$0< \varTheta < 2 \pi $$ : this has an intricate structure with infinitely many solution branches clustering around $$\varTheta = \pi $$ and $$\varTheta = 2 \pi $$ . By generalizing the similarity form with a ( $$\ln r$$ ) term and iterating on the slip and seepage conditions, we can carry the outer and inner power series to arbitrarily high order. Nevertheless, a numerical splice is required in between. For this purpose, we apply an iterative, numerical-asymptotic patching scheme described by Nitsche and Parthasarathi (J Fluid Mech 713:183–215, 2012). Detailed velocity and pressure profiles are calculated for three wedge angles ( $$\varTheta = 3\pi /4, \pi /2, \pi /4$$ ) and two dimensionless slip lengths ( $$\sigma = 20, 40$$ ). The general trends for decreasing wedge angle are (i) weakening of the pressure singularity, (ii) increasing magnitude of the radial component of velocity, and (iii) movement of the inner–outer transition farther from the corner. Wedges with $$\varTheta < \pi $$ are seen to differ fundamentally from the flat wedge ( $$\varTheta = \pi $$ ) previously considered by Nitsche and Parthasarathi (2012).

Am jeweils ersten Tertialtag wird für PJ'lerInnen des Universitätsklinikums Halle Saale die Veranstaltung „Praxissimulation mit SchauspielpatientInnen“ durchgeführt. Es finden 4 Simulationsfälle in Teamarbeit à zwei Studierenden in den Räumlichkeiten [zum vollständigen Text gelangen Sie über die oben angegebene URL], Gemeinsame Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA), des Arbeitskreises zur Weiterentwicklung der Lehre in der Zahnmedizin (AKWLZ) und der Chirurgischen Arbeitsgemeinschaft Lehre (CAL)

Background: Skeletal muscle is central to whole body metabolic homeostasis, with age and disease impairing its ability to function appropriately to maintain health. Inadequate NAD+ availability is proposed to contribute to pathophysiology by impairing metabolic energy pathway use. Despite the importance of NAD+ as a vital redox cofactor in energy production pathways being well-established, the wider impact of disrupted NAD+ homeostasis on these pathways is unknown.\ud \ud Methods: We utilised skeletal muscle myotube models to induce NAD+ depletion, repletion and excess and conducted metabolic tracing to provide comprehensive and detailed analysis of the consequences of altered NAD+ metabolism on central carbon metabolic pathways. We used stable isotope tracers, [1,2-13C] D-glucose and [U-13C] glutamine, and conducted combined 2D-1H,13C-heteronuclear single quantum coherence (HSQC) NMR spectroscopy and GC-MS analysis.\ud \ud Results: NAD+ excess driven by nicotinamide riboside (NR) supplementation within skeletal muscle cells resulted in enhanced nicotinamide clearance, but had no effect on energy homeostasis or central carbon metabolism. Nicotinamide phosphoribosyltransferase (NAMPT) inhibition induced NAD+ depletion and resulted in equilibration of metabolites upstream of glyceraldehyde phosphate dehydrogenase (GAPDH). Aspartate production through glycolysis and TCA cycle activity was increased in response to low NAD+, which was rapidly reversed with repletion of the NAD+ pool using NR. NAD+ depletion reversibly inhibits cytosolic GAPDH activity, but retains mitochondrial oxidative metabolism, suggesting differential effects of this treatment on sub-cellular pyridine pools. When supplemented, NR efficiently reversed these metabolic consequences. However, the functional relevance of increased aspartate levels after NAD+ depletion remains unclear, and requires further investigation.\ud \ud Conclusions: These data highlight the need to consider carbon metabolism and clearance pathways when investigating NAD+ precursor usage in models of skeletal muscle physiology.

Dynamic Nuclear Polarization (DNP) can substantially enhance the sensitivity of NMR experiments. Among the implementations of DNP, ex-situ dissolution DNP (dDNP) achieves high signal enhancement levels owing to a combination of a large temperature factor between 1.4 and 300 K with the actual DNP effect in the solid state at 1.4 K. For sufficiently long T1 relaxation times much of the polarization can be preserved during dissolution with hot solvent, thus enabling fast experiments during the life time of the polarization. Unfortunately, for many metabolites found in biological samples such as blood, relaxation times are too short to achieve a significant enhancement. We have therefore introduced 13C-carbonyl labeled acetyl groups as probes into amino acid metabolites using a simple reaction protocol. The advantage of such tags is a sufficiently long T1 relaxation time, the possibility to enhance signal intensity by introducing 13C, and the possibility to identify tagged metabolites in NMR spectra. We demonstrate feasibility for mixtures of amino acids and for blood serum. In two-dimensional dDNP-enhanced HMQC experiments of these samples acquired in 8 s we can identify acetylated amino acids and other metabolites based on small differences in chemical shifts. © 2019

We report on the precise manipulation of the fine structures of toroidal-spiral particles (TSPs) generated by a self-assembly process of droplet sedimentation at low Reynolds numbers in a miscible bulk solution followed by solidification. The biocompatible polymeric TSP can serve as a device for drug delivery and in vivo therapeutic cell expansion, activation, and delivery, for which highly tunable and reproducible structures are essential to design dosages and release kinetics. TSP formation can be divided into two stages: initial infusion of the drop vs its subsequent sedimentation, deformation, and entrainment of the surrounding bulk solution. The infusion rate affects the drop shape and tail length. These two features represent crucial initial conditions for subsequent shape evolution, which determines the overall morphology of the TSP and fine structure of the internal channel. Our computer simulations of drop dynamics add a new capability to the swarm-of-Stokeslets technique: unequal viscosities of the drop and bulk phases (i.e., non-unit viscosity ratio). During sedimentation, the density difference between the droplet and the bulk solution played a more pronounced role than the viscosity ratio, which was revealed both by experimental observations and numerical simulations. Understanding the fundamental hydrodynamics and developing a flow map will ultimately aid in the design of TSPs with tunable empty channels toward drug delivery and cell encapsulation.

The coastal lagoon system Bahia Magdalena / Almejas (BM/A) at the Pacific coast of Baja California Sur, Mexico, is a large water body extremely important for ecological, economic and social reasons. Because of its natural environment BM/A was declared as one of the areas deserving marine conservation priority. The exact number of fishermen and their families living around the Bay is not known, and neither is the currently registered small boats in service, nor the fishing efforts, expenses and yields. Recently, several civil organizations started working in the BM/A with the mission to solve some of the identified environmental and social problems. However, because of the lack of reliable data, wide spread corruption, and undirected and uncoordinated research make it very difficult to suggest ways to improve the livelihood of the small-scale shrimp fishermen without endangering the environment. Some promising options are small-scale aquaculture projects, mainly for off-shore mollusks production, and to offer eco-tourist activities as well as eco-friendly sport fishing. Both bring local employment opportunities while maintaining a quality environment. En busca de sustentabilidad de la pesqueria de camaron a baja escala en el sistema lagunar Magdalena-Almejas Baja California Sur, Mexico: una revision El sistema lagunar Bahia Magdalena / Almejas (BM/A) ubicado en la costa oeste de Baja California Sur, Mexico, es un cuerpo de agua de extrema importancia bajo las perspectivas ecologica, economica y social. Dado su ambiente natural, BM/A es considerada un area prioritaria en terminos de conservacion marina. Se desconoce cuantas familias de pescadores viven entorno a la bahia, asi como el numero registrado de embarcaciones pequenas en activo, el esfuerzo pesquero, sus gastos, o su rendimiento. Recientemente, varias organizaciones civiles comenzaron labores en BM/A bajo la consigna de resolver algunos de los problemas ambientales y sociales identificados. Sin embargo, debido a la falta de datos confiables y a la corrupcion, aunados a investigacion mal dirigida y sin coordinacion, dificultan la posibilidad de sugerir maneras de mejorar la sustentabilidad de la pesca menor de camaron sin poner en riesgo el ambiente. Algunas alternativas prometedoras son los proyectos acuaculturales a pequena escala, principalmente para produccion de moluscos lejos de la costa, asi como las actividades ecoturisticas y la pesca deportiva ecologicamente amigable, dado que ambas abren oportunidades de empleo locales conservando la calidad del ambiente.

This paper presents a detailed numerical analysis to describe the transient heat transfer in a phase change composite-thermal energy storage (PCC-TES) system exchanging heat with a heat transfer fluid. The “PCC-TES” is precisely composed of 78% low temperature paraffin, namely n-Tetradecane (C14H30) and 22% expanded graphite) and a heat transfer fluid (namely, ethylene glycol). Such detailed numerical approach to precisely describe the heat exchange between this specifically proposed phase change composite thermal energy storage (PCC-TES) and the heat transfer fluid has not been yet addressed in literature. The mathematical modeling of the PCC-TES involves formulating two PDEs that represent conduction within the PCC (phase 1) and advection within the heat transfer fluid (phase 2). The two coupled PDEs were solved with a finite difference method. Numerics were implemented using Fortran. Results were validated using experimental data and demonstrated acceptable agreement and an accurate representation of this specific transient heat transfer problem. The variations between experimental time traces of temperature and numerically calculated data are estimated at approximately (4–9%) and attributed to the heat loss in the actual experiment. Accordingly, the slabs in the actual experiment needed a longer time to reach the temperature of the Ethylene Glycol entering the PCC-TES structure from the inlet at the top. The paper also demonstrated that a lumped-parameter ODE model can perform an incredibly good job of predicting the enthalpy uptake of the PCC precisely matching the PDE results for the enthalpy uptake of the PCC due to the high thermal conductivity of the graphite. The proposed PCC-TES system will be integrated with air conditioning systems to efficiently meet cooling demand and reduce emissions. Previous work by our research group has demonstrated that the [AC + PCC-TES] hybrid design can reduce compressor size by 50%, double the compressor efficiency (COP) during mid/off-peak hours, reduce electricity consumption by 30%, and cut CO2 emissions by 30% – all without compromising overall system performance or building comfort level.

Problemstellung/Ziele: Interprofessionelle Lernerfahrungen wirken positiv auf die Gesundheitsversorgung [ref:1]. Eine interprofessionelle Lerneinheit zur Palliativberatung für Medizin und Pflege wurde entwickelt und bezüglich Wissenserwerb, Kompetenzzuwachs, Transferperspektive[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Problemstellung/Ziele: Interprofessionell zusammenzuarbeiten und dabei unterschiedliche Fachkompetenzen und Sichtweisen effektiv für die Patientenversorgung zu nutzen, soll durch interprofessionelles Lernen verbessert werden. Projektbeschreibung: Mit Unterstützung der Robert Bosch[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Background Minithoracotomy (MT) has gained broad acceptance for mitral valve surgery (MVS) in the last decade. In the presence of defined limitations of MT, however, full sternotomy (FS) is still widely preferred. We assume that the less investigated partial upper sternotomy (PS) will permit the gap between MT and FS in MVS to be closed. The purpose of this study is to investigate a valid less invasive alternative to MT for isolated MVS or multivalve surgery. Methods This retrospective analysis includes data on 1,639 patients, who underwent either isolated or combined primary MVS at our department from May 2011 to August 2017. Out of these, 663 patients were operated via MT access. One-hundred three patients had been judged as not suitable for MT but feasible for PS approach in which 53.4% (n = 55) had isolated MVS and 46.6% patients (n = 48) underwent multivalve surgery. Concomitant myocardial revascularization was performed in 2.9% of the study patients (n = 3). Results Operative, 90-day, and 1-year mortality in the PS-cohort was 0, 1.0% (n = 1), and 3.3% (n = 3), respectively. During a median follow-up time of 1,115 days (interquartile range 398–1806), all-cause mortality was 5.8% (n = 6). Operative times for cardiopulmonary-bypass and cross-clamping were 167 minutes (140–198) and 107 minutes (93–132), respectively. Median length of stay at the intensive care unit and hospital was 1 (1–2) and 7 days (7–10), respectively. Conclusion The presented results demonstrate that there is a cohort of patients, who are not candidates for MT in MVS but may be operated successfully by an alternative less invasive approach.

During sedimentation in a miscible, viscous liquid, polymeric drops self-assemble into a toroidal-spiral structure, which can be solidified by photoinitiated cross-linking. With a suitable arrangement three drops can be encapsulated, possibly enabling controlled release of a therapeutic drug cocktail.

Infections are major causes of morbidity and mortality in the early postoperative period after liver transplant. We observed a high rate of enterococcal infections at our center. Therefore, we added an intraoperative single shot of vancomycin to the standard regimen of meropenem given over 5 days. The aim of this study was to determine the prevalence of both Enterococcus faecium and Enterococcus faecalis infections during the first 28 days after surgery depending on the type of antibiotic prophylaxis and their implications on mortality and morbidity.Our retrospective cohort analysis included 179 patients: 93 patients received meropenem only and 86 patients were treated with meropenem plus vancomycin.During the first 28 days after transplant, microbiological tests showed that 51 patients (28.5%) were positive for Enterococcus faecium and 25 patients (14.0%) were positive for Enterococcus faecalis. Enterococcus faecium infections appeared significantly more often in patients without vancomycin (P = .013). In the second week after transplant, there was a significant reduction in Enterococcus faecium infections in the meropenem plus vancomycin group (P = .015). Enterococcus faecalis infections occurred more often in the patients receiving meropenem alone, but results were not statistically significant (P = .194). There was a trend toward more frequent renal replacement therapy in the meropenem plus vancomycin group. We found no differences between the groups regarding survival after 1 and 2 years, length of hospital stay, or duration in the intensive care unit. Overall 1-year survival was 78.8% (141/179 patients).Although postoperative Enterococcus species infections can be reduced after liver transplant by adding vancomycin to the intraoperative antibiotic regimen, it does not improve the long-term outcomes.

Vor dem Hintergrund der zunehmenden bakteriellen Resistenzen ist es hochste Zeit, dass Reinigungsdienste, interne wie externe, sich einer zeitgemasen, effizienten infektionsprophylaktischen Arbeitsweise zuwenden. In Ihrer Funktion als Hygienefachkraft sollten Sie den Reinigungsdienst beraten, schulen und begleiten. Ein gut geschulter Reinigungsdienst leistet einen grosen Beitrag, dass Krankheitserreger innerhalb eines Krankenhauses nicht weitergetragen werden. Reinigungsdienste haben also eine wichtige Funktion zu erfullen und sollten von den Auftraggebern ernst genommen, aber auch an ihren Leistungen gemessen werden. Es bleibt auserdem zu hoffen, dass die Kommissionen und Ausschusse, die sich mit hygienerelevanten Arbeitsweisen in medizinischen Einrichtungen befassen, die Tatigkeit der Reinigungsdienste noch genauer spezifizieren.

Die unterschiedlichen Berufsgruppen in medizinischen Einrichtungen kommen mit biologischem Material wie Blut, Sekreten, Urin u. a. in Beruhrung. Um die Gesundheitsgefahrdung der Beschaftigten zu verringern oder zu vermeiden, sind Empfehlungen, Gesetze und verbindliche Regeln einzuhalten. In diesen Vorgaben sind in erster Linie Berufe erwahnt, die direkt mit dem Patienten und/oder dessen biologischem Material in Kontakt kommen. Hierzu gehoren Arzte und Pflegepersonal. Nicht minder intensiv hat auch der Reinigungsdienst Kontakt zu biologischen Arbeitsstoffen. Der Reinigungsdienst wurde hier bisher kaum erwahnt und wenn, dann als »Personal fur Instandhaltungsarbeiten« oder anonym mit »Fremdfirmen« bezeichnet. Es fehlte eine klare Benennung und Zuordnung der Reinigungsdienste. In den neuen TRBA 250 ist ein Anfang gemacht. Der Hygieneplan einer jeden medizinischen Einrichtung ist eine Dienstanweisung, d. h. fur alle Berufsgruppen, auch fur den Reinigungsdienst bindend.