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In a field experiment with 341 participants, we study whether social comparisons, either in isolation or in combination with a climate-related moral appeal, can change the use of public and car-related transportation. We do so in the context of a mobility budget offered to employees of a large German company as an alternative to a company car. The budget can be used to pay for both leisure and commuting trips, and for various modes of transport. Behavioral interventions in this setting are of particular interest, since companies are constrained to significantly alter financial benefits to employees yet strive to lower carbon emissions via a shift to low-emission transport modes. We find strong evidence for a reduction in car-related mobility in response to the combined treatment, driven by reduced expenditures for taxi and UBER rides. This is accompanied by substitution towards micromobility, but not towards public transport. Furthermore, we do not find any effects of the social comparison alone. Our results demonstrate that norm-based nudges are able to change transportation behavior, at least temporarily.

This project investigates the social perception of different occupational groups in Germany in terms of the Stereotype Content Model dimensions warmth and competence.

Beschreibung: Laut Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen kann ein Decision Coaching, insbesondere in komplexen Behandlungssituationen, eine sinnvolle Ergänzung zu Entscheidungshilfen im Shared-Decision-Making-Prozess sein. Die aktuelle Forschung zeigt, dass [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Next-generation sequencing has greatly advanced the molecular diagnostics of malignant hematological diseases and provides useful information for clinical decision making. Studies have shown that certain mutations are associated with prognosis and have a direct impact on treatment of affected patients. Therefore, reliable detection of pathogenic variants is critically important. Here, we compared four sequencing panels with different characteristics, from number of genes covered to technical aspects of library preparation and data analysis workflows, to find the panel with the best clinical utility for myeloid neoplasms with a special focus on acute myeloid leukemia. Using the Acrometrix Oncology Hotspot Control DNA and DNA from acute myeloid leukemia patients, panel performance was evaluated in terms of coverage, precision, recall, and reproducibility and different bioinformatics tools that can be used for the evaluation of any next-generation sequencing panel were tested. Taken together, our results support the reliability of the Acrometrix Oncology Hotspot Control to validate and compare sequencing panels for hematological diseases and show which panel-software combination (platform) has the best performance.

Contact between members of different groups can help to reduce prejudice between groups, discrimination and violence. For this purpose, members of different groups have to meet on the basis of equal status pursuing cooperatively a common goal. In addition to direct physical contact, factors such as imagined contact, the knowledge about vicarious contact of another ingroup member, and contact by using electronic media have shown to be effective. Contact works because it reduces mutual anxieties, increases empathy for the other group, delivers information about the outgroup and reduces ethnocentric views on the ingroup and its norms as well as its behaviour routines. In order to ensure that contact experiences with single members of an outgroup generalize to prejudice about the whole outgroup, group memberships of the interaction partners have to be salient - if needed after a first phase of person-focused interaction. People, especially those with high prejudice, sometimes try to avoid contact. Negative contact increases prejudice, however, it happens less frequently compared to positive contact. Contact reduces prejudice in low-status groups to a lesser extent than in dominant groups. In addition, contact with members of a dominant group can undermine readiness for political mobilization against injustice in the low-status group. Contact can be promising if used as intervention strategy to reduce prejudice and escalation in conflict between groups: The paper presents examples of applications of contact interventions in schools and in housing policy, as a means to improve mutual understandings of the police and of minority groups, as well as after violent conflicts, such as war and civil war. Contact can help; however, it cannot be seen as a substitute for policies focussing on the reduction of injustice., Kontakt zwischen Mitgliedern unterschiedlicher Gruppen kann helfen, Vorurteile zwischen den Gruppen, Diskriminierung und Gewalt zu reduzieren. Dazu muss der Kontakt auf Augenhöhe stattfinden und die Mitglieder aus den unterschiedlichen Gruppen müssen kooperativ ein gemeinsames Ziel verfolgen. Neben direkten, physischen Begegnungen haben sich vorgestellte Kontakte, das Wissen um die Wahrnehmung von Kontakten durch andere Mitglieder der eigenen Gruppe und Kontakte unter Verwendung elektronischer Medien als effektiv erwiesen. Kontakt wirkt, weil er gegenseitige Ängste reduziert, die Empathie für die andere Gruppe steigert, Informationen über die andere Gruppe vermittelt und ethnozentrische Perspektiven auf die eigene Gruppe und ihre Normen und Verhaltensgewohnheiten relativiert. Damit Kontakte mit einzelnen Mitgliedern der fremden Gruppe auf die Vorurteile über die gesamte Gruppe generalisieren, muss die Gruppenzugehörigkeit der konkreten Interaktionspartner*innen bewusst sein - wenn nötig, nach einer ersten Phase personenbezogener Interaktionen. Menschen versuchen manchmal, Kontakte mit Fremden zu vermeiden. Das gilt vor allem für Menschen mit starken Vorurteilen. Kontakt ist nicht immer positiv. Negative Kontakte verstärken Vorurteile, sie sind allerdings eher seltener als positive Kontakte. Kontakt wirkt auf Mitglieder unterlegener Gruppen weniger stark vorurteilsreduzierend als auf Mitglieder dominanter Gruppen. Auch kann positiver Kontakt mit Mitgliedern dominanter Gruppen bei Mitgliedern unterlegener Gruppen dazu beitragen, deren politische Mobilisierung gegen Ungerechtigkeit zu unterminieren. Kontakt kann erfolgversprechend als Interventionsmechanismus eingesetzt werden, um Vorurteile und die negative Eskalation von Konflikten zwischen Gruppen abzumildern: Geschildert werden Beispiele für Einsatzmöglichkeiten von Kontaktprogrammen in der Schule und in der Ansiedlungspolitik, im Zuge der Förderung gegenseitigen Verständnisses von Polizei und Minderheiten und nach heftigen gewalttätigen Auseinandersetzungen, wie nach Kriegen oder Bürgerkriegen. Kontakt kann helfen, ersetzt aber nicht eine Politik des Ausgleichs von Ungerechtigkeiten.

Alterations of cognitive functions have been described in COPD. Our study aimed to disentangle the relationship between the degree of cognitive function and COPD characteristics including quality of life (QoL).Data from 1969 COPD patients of the COSYCONET cohort (GOLD grades 1–4; 1216 male/ 753 female; mean (SD) age 64.9 ± 8.4 years) were analysed using regression and path analysis. The DemTect screening tool was used to measure cognitive function, and the St. George‘s respiratory questionnaire (SGRQ) to assess disease-specific QoL.DemTect scores were =60 years of age. For statistical reasons, we used the average of both algorithms independent of age in all subsequent analyses. The DemTect scores were associated with oxygen content, 6-min-walking distance (6-MWD), C-reactive protein (CRP), modified Medical Research Council dyspnoea scale (mMRC) and the SGRQ impact score. Conversely, the SGRQ impact score was independently associated with 6-MWD, FVC, mMRC and DemTect. These results were combined into a path analysis model to account for direct and indirect effects. The DemTect score had a small, but independent impact on QoL, irrespective of the inclusion of COPD-specific influencing factors or a diagnosis of cognitive impairment.We conclude that in patients with stable COPD lower oxygen content of blood as a measure of peripheral oxygen supply, lower exercise capacity in terms of 6-MWD, and higher CRP levels were associated with reduced cognitive capacity. Furthermore, a reduction in cognitive capacity was associated with reduced disease-specific quality of life. As a potential clinical implication of this work, we suggest to screen especially patients with low oxygen content and low 6-MWD for cognitive impairment.

Aggregation of the RNA-binding protein TDP-43 is the main common neuropathological feature of TDP-43 proteinopathies. In physiological conditions, TDP-43 is predominantly nuclear and contained in biomolecular condensates formed via liquid-liquid phase separation (LLPS). However, in disease, TDP-43 is depleted from these compartments and forms cytoplasmic or, sometimes, intranuclear inclusions. How TDP-43 transitions from physiological to pathological states remains poorly understood. Here, we show that self-oligomerization and RNA binding cooperatively govern TDP-43 stability, functionality, LLPS and cellular localization. Importantly, our data reveal that TDP-43 oligomerization is connected to, and conformationally modulated by, RNA binding. Mimicking the impaired proteasomal activity observed in patients, we found that TDP-43 forms nuclear aggregates via LLPS and cytoplasmic aggregates via aggresome formation. The favored aggregation pathway depended on the TDP-43 state –monomeric/oligomeric, RNA-bound/-unbound– and the subcellular environment –nucleus/cytoplasm. Our work unravels the origins of heterogeneous pathological species occurring in TDP-43 proteinopathies.

ASIEN: The German Journal on Contemporary Asia, Nr. 105 (2007): ASIEN (Oktober)

Background Screening programmes for tuberculosis (TB) among immigrants rarely consider the heterogeneity of risk related to migrants’ country of origin. We assess the performance of a large screening programme in asylum seekers by analysing (i) the difference in yield and numbers needed to screen (NNS) by country and WHO-reported TB burden, (ii) the possible impact of screening thresholds on sensitivity, and (iii) the value of WHO-estimated TB burden to improve the prediction accuracy of screening yield. Methods We combined individual data of 119,037 asylum seekers screened for TB in Germany (2002–2015) with TB estimates of the World Health Organization (WHO) (1990–2014) for their 81 countries of origin. Adjusted rate ratios (aRR) and 95% credible intervals (CrI) of the observed yield of screening were calculated in Bayesian Poisson regression models by categories of WHO-estimated TB incidence. We assessed changes in sensitivity depending on screening thresholds, used WHO TB estimates as prior information to predict TB in asylum seekers, and modelled country-specific probabilities of numbers needed to screen (NNS) conditional on different screening thresholds. Results The overall yield was 82 per 100,000 and the annual yield ranged from 44.1 to 279.7 per 100,000. Country-specific yields ranged from 10 (95%- CrI: 1–47) to 683 (95%-CrI: 306–1336) per 100,000 in Iraqi and Somali asylum seekers, respectively. The observed yield was higher in asylum seekers from countries with a WHO-estimated TB incidence > 50 relative to those from countries ≤50 per 100,000 (aRR: 4.17, 95%-CrI: 2.86–6.59). Introducing a threshold in the range of a WHO-estimated TB incidence of 50 and 100 per 100,000 resulted in the lowest “loss” in sensitivity. WHO’s TB prevalence estimates improved prediction accuracy for eight of the 11 countries, and allowed modelling country-specific probabilities of NNS. Conclusions WHO’s TB data can inform the estimation of screening yield and thus be used to improve screening efficiency in asylum seekers. This may help to develop more targeted screening strategies by reducing uncertainty in estimates of expected country-specific yield, and identify thresholds with lowest loss in sensitivity. Further modelling studies are needed which combine clinical, diagnostic and country-specific parameters. Electronic supplementary material The online version of this article (10.1186/s12879-019-3902-x) contains supplementary material, which is available to authorized users.

Jedes Jahr werden in der Schweiz mehr als 40000 neue Krebserkrankungen diagnostiziert und Krebs ist die zweithäufigste Todesursache. Dieser dritte schweizerische Krebsbericht zeigt die aktuelle Situation von Krebs in der Schweiz und die Entwicklung der letzten 30 Jahre sowie regionale und internationale Vergleiche auf. Der Bericht präsentiert gesamtschweizerische Schätzungen zu Neuerkrankungen, Todesfällen, Überlebensraten und zur Anzahl von an Krebs erkrankten Personen. Die Zahlen werden ergänzt durch die Erläuterung von Risikofaktoren, die in der wissenschaftlichen Literatur als gesichert gelten. Nach einem allgemeinen Überblick über Krebs folgen Kapitel mit detaillierten Informationen über die wichtigsten Krebsarten bei Erwachsenen sowie bei Kindern und Jugendlichen. Die zur Erarbeitung dieses Berichts verwendeten Methoden sind in einem separaten Methodenbericht detailliert dargestellt.

Successful decarbonization of the electricity sector hinges on the support of the public, which is at risk when electricity generation emits local externalities. This paper estimates the impact of wind turbine deployment on granular measures of revealed preferences for renewable electricity in product and political markets. We address endogenous siting of turbines with a novel IV approach that exploits quasi-experimental variation in profitability. We find that nearby wind turbines significantly reduce citizens' support, but this effect quickly fades with distance from the site. Our results shed light on how distance requirements and financial participation could enhance support for renewables.

The possibilities to involve small-scale prosumers for ancillary services in the distribution grid through aggregators and local flexibility markets question whether it is profitable for prosumers to oversize proactively. In this analysis, a Python model is developed to identify the cost-optimal operation plan of the PV-battery system and to evaluate the device flexibility. An economic assessment is carried out to derive the cost-benefit of sizing based on the mean electricity price. A sensitivity analysis is performed with the above results to study the profitable sizing of PV-battery systems with flexibility services. The results show a promising advantage of oversizing although limitations prevail with the extent of flexibility services offered., Comment: The research is available as a GitHub repository under https://github.com/BabuKumaranNalini/sizingflexibility

We investigate productivity and cost pass-through of German manufacturing firms using administrative data from 2001 to 2014. Our framework allows for the estimation of quantity-based production functions for multi-product firms while controlling for unobserved productivity shocks and unobserved input quality. Using our parameter estimates, we can compute total factor productivity, markups and marginal costs. We find no effect of the EU ETS on firm productivity or profits for the whole sector, and a positive effect for some industries. Firms pass on shocks to materials costs completely, or even more than completely, whereas pass-through of energy costs is around 35-60%. Although pass-through of energy costs is incomplete, it nevertheless allowed firms to recover more than their total carbon costs due to generous free allocation of allowances. Our results add to the recent literature concerning the causal effects of climate policy on firms and are relevant for policy makers when defining the level of free allowance allocation to industry.

Supplemental Digital Content is available in the text, Sepsis is associated with impaired clinical outcomes. It requires timely diagnosis and urgent therapeutic management. Because staffing during after-hours is limited, we explored whether after-hour admissions are associated with worse clinical outcomes in patients with sepsis. In this retrospective cohort study, we analyzed nationwide acute care admissions for a main diagnosis of sepsis in Switzerland between 2006 and 2016 using prospective administrative data. The primary outcome was in-hospital mortality using multivariable logistic regression models. Secondary outcomes were intensive care unit (ICU) admission, intubation, and 30-day readmission. We included 86,597 hospitalizations for sepsis, 60.1% admitted during routine-hours, 16.8% on weekends and 23.1% during night shift. Compared to routine-hours, we found a higher odds ratio (OR) for in-hospital mortality in patients admitted on weekends (Adjusted OR 1.05, 95% confidence interval [95% CI] 1.01, 1.10, P = .041). Also, the OR for ICU admission (OR 1.14, 95% CI 1.10, 1.19, P

Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity. Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: ≤50%, 2: >50% BE-involvement for each lobe). 1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians' diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby ≤50% BE occurred in 18.6% in ≤2 lobes, in 10.0% in 3-4 lobes, in 15.9% in 5-6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores ≥4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.

The COPD Assessment Test (CAT) is in widespread use for the evaluation of patients with chronic obstructive pulmonary disease (COPD). We assessed whether the CAT items carry additional information beyond the sum score regarding COPD characteristics including emphysema. Patients of GOLD grades 1 to 4 from the COPD cohort COSYCONET (German COPD and Systemic Consequences - Comorbidities Network) with complete CAT data were included (n = 2270), of whom 493 had chest CT evaluated for the presence of emphysema. Comorbidities and lung function were assessed following standardised procedures. Cross-sectional data analysis was based on multiple regression analysis of the single CAT items against a panel of comorbidities, lung function, or CT characteristics (qualitative score, 15th percentile of mean lung density), with age, BMI and gender as covariates. This was supported by exploratory factor analysis. Regarding the relationship to comorbidities and emphysema, there were marked differences between CAT items, especially items 1 and 2 versus 3 to 8. This grouping was basically confirmed by factor analysis. Items 4 and 5, and to a lower degree 1, 2 and 6, appeared to be informative regarding the presence of emphysema, whereas the total score was not or less informative. Regarding comorbidities, similar findings as for the total CAT score were obtained for the modified Medical Research Council scale (mMRC) which was also informative regarding emphysema. Our findings suggest that the usefulness of the CAT can be increased if evaluated on the basis of single items which may be indicating the presence of comorbidities and emphysema.

Tumor-specific genomic aberrations are routinely determined by high throughput genomic measurements. However, it is unclear how complex genome alterations affect molecular networks through changing protein levels, and consequently biochemical states of tumor tissues. Here, we investigated how tumor heterogeneity evolves during prostate cancer progression. In this study, we performed proteogenomic analyses of 105 prostate samples, consisting of both benign prostatic hyperplasia regions and malignant tumors, from 39 prostate cancer (PCa) patients. Exome sequencing, copy number analysis, RNA sequencing and quantitative proteomic data were integrated using a network-based approach and related to clinical and histopathological features. In general, the number and magnitude of alterations (DNA, RNA and protein) correlated with histopathological tumor grades. Although common sets of proteins were affected in high-grade tumors, the extent to which these proteins changed their concentrations varied considerably across tumors. Our multi-layer network integration identified a sub-network consisting of nine genes whose activity positively correlated with increasingly aggressive tumor phenotypes. Importantly, although the effects on individual gene members were barely detectable, together the perturbation of this sub-network was predictive for recurrence-free survival time. The multi-omics profiling of multiple tumor sites from the same patients revealed cases of likely shared clonal origins as well as the occasional co-existence of multiple clonally independent tumors in the same prostate. Overall, this study revealed molecular networks with remarkably convergent alterations across tumor sites and patients, but it also exposed a diversity of network effects: we could not identify a single sub-network that was perturbed in all high-grade tumor regions.

Additional file 8: Review history.

Additional file 1. Supplementary text and supplementary figures.

Objectives: Interference fit fixation of soft-tissue grafts is in clinical focus to allow anatomic graft fixation, which increases stability and graft isometry. Although many screws are commercially available, enhanced biodegradability, handling and stability in early healing phases remain under demand.[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

Journal of synchrotron radiation 25(1), 1 - 8 (2018). doi:10.1107/S1600577517015272, Wavefront errors of rotationally parabolic refractive X-ray lenses made of beryllium (Be CRLs) have been recovered for various lens sets and X-ray beam configurations. Due to manufacturing via an embossing process, aberrations of individual lenses within the investigated ensemble are very similar. By deriving a mean single-lens deformation for the ensemble, aberrations of any arbitrary lens stack can be predicted from the ensemble with \bar{\sigma} = 0.034λ. Using these findings the expected focusing performance of current Be CRLs are modeled for relevant X-ray energies and bandwidths and it is shown that a correction of aberrations can be realised without prior lens characterization but simply based on the derived lens deformation. The performance of aberration-corrected Be CRLs is discussed and the applicability of aberration-correction demonstrated over wide X-ray energy ranges., Published by IUCr, Chester

Rationale Alterations of acid-base metabolism are an important outcome predictor in acute exacerbations of COPD, whereas sufficient metabolic compensation and adequate renal function are associated with decreased mortality. In stable COPD there is, however, only limited information on the combined role of acid-base balance, blood gases, renal and respiratory function on exacerbation risk grading. Methods We used baseline data of the COPD cohort COSYCONET, applying linear and logistic regression analyses, the results of which were implemented into a comprehensive structural equation model. As most informative parameters it comprised the estimated glomerular filtration rate (eGFR), lung function defined via forced expiratory volume in 1 s (FEV1), intrathoracic gas volume (ITGV) and (diffusing capacity for carbon monoxide (DLCO), moreover arterial oxygen content (CaO2), partial pressure of oxygen (PaCO2), base exess (BE) and exacerbation risk according to GOLD criteria. All measures were adjusted for age, gender, body-mass index, the current smoking status and pack years. Results 1506 patients with stable COPD (GOLD grade 1–4; mean age 64.5 ± 8.1 y; mean FEV1 54 ± 18 %predicted, mean eGFR 82.3 ± 16.9 mL/min/1.73 m2) were included. BE was linked to eGFR, lung function and PaCO2 and played a role as indirect predictor of exacerbation risk via these measures; moreover, eGFR was directly linked to exacerbation risk. These associations remained significant after taking into account medication (diuretics, oral and inhaled corticosteroids), whereby corticosteroids had effects on exacerbation risk and lung function, diuretics on eGFR, BE and lung function. Conclusion Even in stable COPD acid-base metabolism plays a key integrative role in COPD risk assessment despite rather small deviations from normality. It partially mediates the effects of impairments in kidney function, which are also directly linked to exacerbation risk.

Key Points Question Is the implementation of the Swiss diagnosis-related group reimbursement system associated with a reduction in length of hospital stay without negatively affecting in-hospital mortality and readmission rates in adult patients? Findings In this cohort study of data from 2 426 722 adult patients, the gradual decrease in length of hospital stay observed from 2009 to 2015 was not substantially greater after the implementation of the Swiss diagnosis-related group system in 2012. An increase in 30-day readmission rates and a decrease in in-hospital mortality were observed after the introduction of the Swiss diagnosis-related group system. Meaning Swiss diagnosis-related group implementation appeared to be associated with higher readmission rates and lower in-hospital mortality but not with a substantial decrease in length of hospital stays., Importance In 2012, hospital reimbursement in Switzerland changed from a fee-for-service per diem system to a diagnosis-related group (SwissDRG) system. Whether this change in reimbursement is associated with harmful implications for quality of care and patient outcomes remains unclear. Objective To examine the association of the SwissDRG implementation with length of hospital stay (LOS), in-hospital mortality, and 30-day readmission rates in the overall adult inpatient population and stratified by 5 individual diagnoses. Design, Setting, and Participants This cohort study used administrative data from the Swiss Federal Statistical Office to investigate medical hospitalizations in Switzerland from January 1, 2009, through December 31, 2015. All hospitalizations for adult medical inpatients were included in the main analysis. Patients who presented with 1 of the 5 common medical diagnoses were included in the subanalyses: community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, acute myocardial infarction, acute heart failure, and pulmonary embolism. An interrupted time series model was used to determine changes in time trends for risk-adjusted LOS, in-hospital mortality, and 30-day readmission after the implementation of SwissDRG in 2012. Analyses were performed from March 1, 2018, to June 30, 2018, and from November 1, 2018, to December 18, 2018. Main Outcomes and Measures Monthly patient-level data for LOS, in-hospital mortality, and 30-day readmission rates. Results The sample included a total of 2 426 722 hospitalized adult patients. Of this total, 1 018 404 patients (41.9%; 531 226 [52.2%] male, median [interquartile range (IQR)] age of 69 [55-80] years) composed the before-SwissDRG period; 1 408 318 patients (58.0%; 730 228 [51.9%] male, median [IQR] age of 70 [56-81] years) composed the after-SwissDRG period. The overall LOS gradually decreased from unadjusted mean (SD) 8.0 (12.7) days in 2009 to 7.2 (17.3) days in 2015. This reduction in LOS, however, was not substantially greater with the implementation of SwissDRG in 2012 (risk-adjusted slope, –0.0166 days; 95% CI, –0.0223 to –0.0110 days), with an adjusted difference in slopes of 0.0000 days (95% CI, –0.0072 to 0.0072 days). Risk-adjusted all-cause in-hospital mortality declined from 4.9% in 2009 to 4.6% in 2015, with a substantially greater decline after implementation of SwissDRG (difference between monthly slopes before and after implementation, –0.0115%; 95% CI, –0.0190% to –0.0039%). In the same period, risk-adjusted 30-day readmission rates increased from 14.4% in 2009 to 15.0% in 2015, with a greater increase after SwissDRG implementation (change in monthly slope, 0.0339%; 95% CI, 0.0254%-0.0423%). Patients with acute myocardial infarction were found to have a substantially greater increase after SwissDRG implementation in 30-day readmission rates (adjusted difference in slopes, 0.1144%; 95% CI, 0.0617%-0.1671%). Conclusions and Relevance Among medical hospitalizations in Switzerland, SwissDRG implementation appeared to be associated with an increase in readmission rates and a decrease in in-hospital mortality but not with the gradual decrease in LOS observed in the historical control period., This cohort study examines hospitalization and patient outcomes data of hospitalized adult patients before and after the implementation of the diagnosis-related group reimbursement system in Switzerland.

EuroQol Group 5-Dimension Self-Report Questionnaire. (PDF 149â kb)

After the successful start of the hard X-ray FEL at SwissFEL in 2016, the soft X-ray FEL ATHOS at SwissFEL is expected to deliver the first beam by end of 2019. This contribution describes the beamlines attached to the FEL and reports on the status and plans for this soft X-ray facility. The ATHOS facility will operate three end stations. Two stations are already defined and are currently in the design and construction phase whereas the third station will be defined in the future. The first station (AMO) is dedicated to Atomic and Molecular physics as well as nonlinear spectroscopy. It is expected to get light in mid 2020. The second station (Furka) is for condensed matter physics. The beamline consists of a grating monochromator and distributes the beam downstream of the grating chamber by means of horizontal deflecting mirrors. Pink and monochromatic beam operation is foreseen at all branches. The monochromator uses variable line-spacing gratings on spherical substrates with a variable included angle and operates without an entrance slit. Its mechanics is based on the SX-700 design, but with the grating facing up and the mirror facing down. The installation of the beamline will start in August 2019., Proceedings of the 39th Free Electron Laser Conference, FEL2019, Hamburg, Germany

Yield of screening and number needed to screen. Yield of screening for active TB per 1000 screened individuals and number needed to screen to detect 1 case of TB with 95% credible intervals, stratified by age group, sex, year of screening, and asylum seekersâ country of origin. (PDF 77 kb)

Structured questionnaire to perform phone interviews with all included patients 30â days after hospital admission to assess their outcome data and satisfaction. (PDF 265â kb)

The SwissFEL Aramis beamline provides hard X-ray FEL radiation down to 1 Angström with 5.8 GeV and short period, 15 mm, in-vacuum undulators (U15). To reach the maximum designed K-value of 1.8 the U15s have to be operated with vacuum gaps down to 3.0 mm. The thirteen-undulator modules are 4 m long and each of them is equipped with a pair of permanent magnet quadrupoles at the two ends, aligned magnetically to the undulator axis. Optical systems and dedicated photon diagnostics are used to check the alignment and improve the K-value calibration. In this talk the main steps of the undulator commissioning will be recalled and a systematic comparison between the magnetic results and the electron and photon based measurements will be reported to highlight achievements and open issues., Proceedings of the 39th Free Electron Laser Conference, FEL2019, Hamburg, Germany

Die Wirkungskanäle von Lobbyismus sind vielfältig und – zumindest in der Theorie – weitgehend bekannt. Jedoch gibt es nur wenig empirische Evidenz hinsichtlich der Wahrnehmung von Lobbyismus in der Bevölkerung. Vor diesem Hintergrund hat das ZEW – Leibniz-Zentrum für Europäische Wirtschaftsforschung gemeinsam mit der Universität Mannheim eine repräsentative Umfrage in Deutschland durchgeführt. Das Haupter-gebnis: Die große Mehrheit der Bevölkerung sieht nicht nur einen enormen Einfluss von Lobbygruppen auf die nationale und die in Brüssel gemachte Politik (EU-Politik), sondern steht diesem Einfluss auch sehr ablehnend gegenüber.

The Athos line will cover the photon energy range from 250 to 1900 eV and will operate in parallel to the hard X-ray line Aramis of SwissFEL. The paper will describe the current layout of the Athos FEL line starting from the fast kicker magnet followed by the dogleg transfer line, the small linac and the 16 APPLE undulators. From there the photon beam passes through the photonics front end and the beamline optics before reaching the experimental stations AMO and FURKA. The focus of this contribution will be on the two bunch operation commissioning (two bunches in the same RF macropulse), which started in 2018, and the characterization of the major components like the APPLE X undulator UE38, the CHIC chicane and the dechirper. The Athos installation inside the tunnel is alternating with Aramis FEL user operation and the first lasing is planned for winter 2019 / 2020., Proceedings of the 39th Free Electron Laser Conference, FEL2019, Hamburg, Germany

The number of supermarkets offering grocery delivery has increased in recent years. Many studies conclude that CO2 emission savings result from this concept. Since the delivery of groceries also consumes energy and produces emissions, break-even points can be calculated, where the delivery is environmentally beneficial compared to customer pickup. In this paper, influences of differing vehicle use on break-even points for savings of energy and CO2 emissions are analyzed for the case of Haidhausen S&uuml, d, a district in Munich, Germany. Internal combustion engine and electric vehicles are investigated to depict current as well as future trends. After an introduction to the methodology used, the potential to save energy and CO2 emissions related to the delivery of groceries in the chosen district of Munich are evaluated. Subsequently, influences on the break-even points are presented and discussed. As the results show, a delivery of groceries leads to energy and carbon dioxide savings in a wide range of private vehicle use for grocery shopping trips. Nevertheless, if the complete customer vehicle fleet is electrified, the use of delivery vehicles with an internal combustion engine could cause an additional environmental impact at the current modal split for shopping trips in Germany.

Die Wirkungskanäle von Lobbyismus sind vielfältig und – zumindest in der Theorie – weitgehend bekannt. Jedoch gibt es nur wenig empirische Evidenz hinsichtlich der Wahrnehmung von Lobbyismus in der Bevölkerung. Vor diesem Hintergrund hat das ZEW – Leibniz-Zentrum für Europäische Wirtschaftsforschung gemeinsam mit der Universität Mannheim eine repräsentative Umfrage in Deutschland durchgeführt. Das Haupter-gebnis: Die große Mehrheit der Bevölkerung sieht nicht nur einen enormen Einfluss von Lobbygruppen auf die nationale und die in Brüssel gemachte Politik (EU-Politik), sondern steht diesem Einfluss auch sehr ablehnend gegenüber.

Technical appendix. Technical appendix containing additional details related to methods, data sources, and analysis. (PDF 542 kb)

Eine Facette des klinischen Erscheinungsbildes der „chronic obstructive pulmonary disease“ (COPD) ist die chronische Bronchitis mit einem überwiegend inflammatorischen Korrelat. Der Pathogenese der chronischen Bronchitis liegen komplexe pathophysiologische Vorgänge zugrunde, welche bislang nur unvollstädig bekannt und im Einzelnen nicht vollständig geklärt sind. Die Definition der „global initiative on obstructive lung disease“ (GOLD) erwähnt eine abnormale inflammatorische Reaktion der Lunge auf schädliche Partikel und Gase und rückt somit die Entzündung ins Zentrum der Pathogenese. Zigarettenrauch und wichtige Umweltnoxen wie Stickstoffdioxid (NO2) führen über die hervorgerufene Entzündung bei Menschen und anderen Spezies zu Veränderungen des Atemwegsepithels und zur Stimulation der Produktion von proinflammatorischen Zytokinen wie dem Granulozyten-Makrophagen-Kolonie-stimulierenden Faktor (GM-CSF). Die strukturellen Veränderungen schließen auch die Muzin-produzierenden epithelialen Komponenten ein. Ein relevantes klinisches Symptom der chronischen Bronchitis stellt die Hypersekretion dar. Die Regulation der Muzinsynthese und -sekretion unterliegt komplexen neuralen, neuroendokrinen und parakrinen Mechanismen. Mit dem Ziel, zugrunde liegende Regulationsmechanismen der Mukussekretion bei der chronisch inflammatorischen Erkrankung COPD näher zu charakterisieren, liegt der Schwerpunkt dieser Arbeit in der Bedeutung des proinflammatorischen Zytokins GM-CSF. Folgenden Fragen, welchen eine Bedeutung bei der Regulation der Mukussekretion zukommt, wird in der vorliegenden Arbeit nachgegangen: Welchen Einfluss hat die Lang- und Kurzzeitexposition von NO2 auf die tracheobronchiale Muzinsekretion? Welchen Einfluss zeigt die peptiderge Substanz Substanz P (SP) auf die Muzinsekretion exponierter Tiere auch im Speziesvergleich? Wirkt das proinflammatorische Zytokin GM-CSF sekretagog? Gibt es interaktive Prozesse zwischen dem Zytokin GM-CSF und dem Tachykinin SP im Hinblick auf die Sekretomodulation? Zur experimentellen Klärung dieser Fragestellungen wurde ein etabliertes Tiermodell gewählt. Für das Studium der Reaktionsweise entzündlich alterierter Atemwege erfolgte die inhalative Exposition gegenüber NO2 im Rattenmodell. Die Muzinsekretion wurde an Trachealexplantaten von Fischerratten (F344-Ratten) und Sprague-Dawley-Ratten (SD-Ratten) durch die Anwendung der etablierten Ussing-Kammer-Methode untersucht. Zur Quantifizierung der Sekretion trachealer submuköser Drüsen erfolgte die radioaktive Markierung der Muzine mit 35S. Zum Studium der trachealen Muzinsekretion erfolgte die inhalative Exposition mit Induktion einer Schädigung und Herbeiführung einer akuten und subakuten bis chronischen Tracheobronchitis. Mit standardisierter Methodik wurden bei männlichen Ratten der jeweiligen Spezies Expositionszeiten von 1, 3 und 20 Tagen sowie darüber hinaus teilweise von 2 und 28 Tagen gegenüber NO2 bei einer Konzentration von 10 ppm gewählt. Kontrolltiere wurden einer Atmosphäre ohne NO2 ausgesetzt. Neben der Basalsekretion wurde zunächst an den Trachealexplantaten die maximal stimulierte Sekretion durch Acetylcholin (ACh) in Stadien der artifiziellen Entzündung und im Nativzustand erfasst. Mit diesen Grundlagen kann ein sekretomodulatorischer Effekt des Peptides SP und eine Dosis-Wirkungs-Beziehung des proinflammatorischen Zytokins GM-CSF im zeitlichen Verlauf unter NO2-Exposition untersucht werden. Zudem wurde hinsichtlich des Sekretionsergebnisses die Frage nach einem additiven Effekt von GM-CSF und SP an langzeit-exponierten Tracheen untersucht. Die Sekretionsanalyse ergab, dass eine NO2-Exposition von 10 ppm die Muzinsekretion der Rattentrachea beider Spezies zeitabhängig nicht signifikant beeinflusst. Es zeigten sich allerdings gleichgerichtete Tendenzen ohne Signifikanz im Sekretionsverlauf. Im Speziesvergleich zeigten dabei SD-Ratten eine größere sekretorische Potenz im Vergleich zu F344-Ratten im Sinne eines nahezu parallel verschobenen Sekretionsniveaus auf. Darüber hinaus wurde die Sekretionsrate nativ und bis zu einer Expositionsdauer von 20 Tagen bei beiden Spezies durch Acetylcholin im Vergleich zur Basalsekretion signifikant gesteigert. Hierbei fanden sich im direkten Vergleich zu den nativen Fischerratten wiederum signifikante Differenzen nach 3 sowie 20 Tagen. Signifikante sekretagoge Effekte von Substanz P ließen sich bei Fischerratten und SD-Ratten sowohl bei den Kontrolltieren als auch bei nahezu allen untersuchten Expositionsgruppen aufzeigen. GM-CSF zeigte in unserem Rattenmodell der COPD dosis- und expositionszeitabhängig eine Stimulation der trachealen Muzinsekretion. Eine signifikante Sekretionsantwort in der 3-Tages-Expositionsgruppe konnte für 0,1 ng/ml GM-CSF und für 0,4 ng/ml GM-CSF demonstriert werden. Zudem fand sich eine Signifikanz in der 20-Tages-Expositionsgruppe für 0,1 und 0,15 sowie 0,2 ng/ml GM-CSF. Für die Dosis von 0,2 ng/ml GM-CSF ergab sich ein hochsignifikantes Ergebnis. Die gleichzeitige Gabe von GM-CSF und SP zeigte in der Langzeitexposition keinen messbaren additiven sekretagogen Effekt und ergab das Sekretionsniveau von SP. Dies wurde nach 20 Tagen Expositionsdauer untersucht, da für diese Gruppe für beide Einzelsubstanzen jeweils eine signifikante Sekretionsantwort gesehen wurde. Die mutmaßlich unterschiedlichen sekretagogen Mechanismen von SP und GM-CSF sind vereinbar mit der Beobachtung, dass SP auch unabhängig vom Vorhandensein einer Atemwegsinflammation wirksam ist. Diese Ergebnisse liefern einen Beitrag zum Verständnis der Komplexität der bei der Regulation der Muzinsekretion beteiligten Pathomechanismen des Tracheobronchialepithels in der chronischen Bronchitis. Der sekretagoge Effekt von GM-CSF in der chronischen Inflammation wurde demonstriert. Mit dem Ziel einer Beeinflussung der Hypersekretion bei der COPD ist hier ein zielgerichteter therapeutischer Ansatz denkbar. Der Einsatz von neutralisierenden Antikörpern gegen GM-CSF oder dessen Rezeptor ist als spezifisches Therapiekonzept vorstellbar. Dieses ist in Ergänzung zu den etablierten antiinflammatorischen therapeutischen Möglichkeiten bei der COPD zu sehen und ermöglicht im Gegensatz dazu ein zielgerichtetes Eingreifen in die inflammatorische Kaskade. Es bedarf weiterer Untersuchungen, um die Rolle einer solchen Herangehensweise zu konkretisieren., One facet of the clinical manifestation of chronic obstructive pulmonary disease (COPD) is chronic bronchitis, with inflammation being the predominant correlating factor. The pathogenesis of chronic bronchitis is based on complex pathophysiological processes, which are currently not fully known and have not yet been fully clarified, in detail. The definition from the "global initiative on obstructive lung disease" (GOLD) mentions an abnormal inflammatory reaction of the lung to harmful particles and gases, thus putting inflammation at the centre of the pathogenesis. Cigarette smoke and important environmental noxae such as nitrogen dioxide (NO2) cause changes in the respiratory epithelium of humans and other species through eliciting inflammation and stimulate the production of pro-inflammatory cytokines, such as granulocyte-macrophage colony stimulating factor (GM-CSF). These structural changes also involve the mucin-producing epithelial components. One relevant clinical symptom of chronic bronchitis is hypersecretion. The regulation of mucin synthesis and secretion is subject to complex neural, neuro-endocrine and paracrine mechanisms. With the aim of characterising the underlying regulatory mechanisms of mucus secretion in the chronic inflammatory disease COPD, the focus of this work is on the significance of the pro-inflammatory cytokine GM-CSF. The following questions that are of importance for the regulation of mucus secretion will be investigated in this paper: What influence do long- and short-term exposure of NO2 have on tracheobronchial mucin secretion? What influence does the peptidergic substance substance P (SP) have on the mucin secretion of exposed animals, and how does this compare by species? Does the pro-inflammatory cytokine GM-CSF act as a secretagogue? Are there interactive processes between the cytokine GM-CSF and the tachykinin SP with regard to secretion modulation? An established animal model was chosen for the experimental clarification of these questions. To study the mode of response of respiratory tracts altered through inflammation, inhalative exposure to NO2 was implemented in rats. Mucin secretion was investigated in tracheal explants of Fischer rats (F344 rats) and Sprague-Dawley rats (SD rats) using the established Ussing chamber method. In order to quantify the secretion of tracheal submucosal glands, the mucin underwent radioactive labelling with 35S. In order to study tracheal mucin secretion, inhalative exposure was implemented, with damage induced and acute and subacute to chronic tracheobronchitis brought about. Using standardised methods, exposure times of 1, 3 and 20 days were selected for male rats of the species in question, as well as of 2 and 28 days, in some cases, to NO2 at a concentration of 10 ppm. Control animals were subject to an atmosphere without NO2. In addition to basal secretion, initially, the maximum stimulated secretion due to acetylcholine (ACh) was recorded on the tracheal implants in stages of artificial inflammation and in the natural state. With an understanding of these foundations, the secreto-modulatory effect of the peptide SP and the dose–response relationship of the pro-inflammatory cytokine GM-CSF can then be investigated over time under exposure to NO2. In addition, the question of any additive effect of GM-CSF and SP in terms of secretion result was investigated in tracheas exposed long-term. The secretion analysis showed that NO2 exposure of 10 ppm does not significantly influence tracheal mucin secretion in rats of either species in a time-dependent manner. However, similar trends were demonstrated that were of no significance over the course of secretion. In the species comparison, SD rats exhibited a greater secretory potential compared to F344 rats, in line with an almost parallel shift in secretion level. What is more, in both species, the natural secretion rate and that up until an exposure duration of 20 days was significantly increased by acetylcholine compared to basal secretion. Here, again, in a direct comparison with the native Fischer rats, significant differences were noted after 3 and 20 days. Significant secretagogic effects were able to be demonstrated for substance P in Fischer rats and SD rats, both in the control animals and in almost all the exposure groups investigated. GM-CSF was shown to stimulate tracheal mucin secretion in our COPD rat model in a manner that was both dose- and exposure-time-dependent. A significant secretory response was able to be demonstrated in the 3-day exposure group for 0.1 ng/ml GM-CSF and for 0.4 ng/ml GM-CSF. In addition, significance was noted in the 20-day exposure group for 0.1 and 0.15 as well as 0.2 ng/ml GM-CSF. A highly significant result was obtained for the dose of 0.2 ng/ml GM-CSF. Simultaneous administration of GM-CSF and SP did not indicate any measurable additive secretagogic effect over long-term exposure and resulted in the secretion level of SP. This was investigated after 20 days of exposure, since for this group, a significant secretory response was seen for both individual substances. The supposedly different secretagogic mechanisms of SP and GM-CSF are compatible with the observation that SP is in any case effective regardless of the presence of any respiratory inflammation. These results contribute to the understanding of the complexity of the tracheobronchial epithelium pathomechanisms involved in the regulation of mucin secretion in chronic bronchitis. The secretagogic effect of GM-CSF in the presence of chronic inflammation was demonstrated. Here, a targeted therapeutic approach is conceivable, with the aim of influencing hypersecretion in cases of COPD. The use of neutralising antibodies against GM-CSF or its receptor is plausible as a specific therapy concept. This should be viewed in addition to the established anti-inflammatory therapeutic options for COPD and, by contrast, enables targeted intervention in the inflammatory cascade. Further research is needed to substantiate the role of such an approach.

Period averaged incidence of tuberculosis (per 100,000) and 95% confidence intervals reported by WHO, 1990–2014. Overview of period averaged incidence of tuberculosis (per 100,000) and 95% confidence intervals reported by WHO (1990–2014) based on own calculations for countries used in this study. (PDF 113 kb)

TThe number of supermarkets offering a grocery delivery has been increasing during the last years. Many studies deduce CO2 emission savings using this concept. Since the delivery of groceries also consumes energy and produces emissions, break-even points can be calculated, from where the delivery has environmental advantages compared to the customer pickup. In this paper, influences of differing vehicle use on break-even points for savings of energy and CO2 emissions are analyzed for the case of Haidhausen Süd, a city district of Munich in Germany. Internal combustion engine and electric vehicles are investigated to depict current as well as future trends. After an introduction to the used methodology, the potential to save energy and CO2 emissions related to the delivery of groceries in the chosen district of Munich is evaluated. Afterwards, influences on the break even points are presented and discussed. As the results show, a delivery of groceries leads to energy and carbon dioxide savings in a wide range of private vehicle use for grocery shopping trips. Nevertheless, if the complete customer vehicle fleet is electrified, the use of delivery vehicles with an internal combustion engine can cause an additional environmental impact at the current modal split for shopping trips in Germany.