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Large quantities dilute acetic acid are generated during the industrial acetylation of cellulose. In the light of sustainability and circularity, it is crucial to recover and recycle the acetic acid (closed loop) released during this production. In this work, a simulation strategy for the robust design of the recovery of acetic acid from cellulose acetate production wastewater was developed and experimentally validated. The corresponding models (NRTL & UNIFAC) were discussed and used for simulation trials. The practical values confirmed the assumption of the applicability of a NRTL activity coefficient of αij = 0.2. [ABSTRACT FROM AUTHOR]

Dealing with a difficult airway is familiar to emergency care providers in both the prehospital and clinical settings. In anesthesiology and emergency medical care different algorithms almost equal in their wording have been introduced, indicating that an emergency front of neck airway access (eFONA) has to be established in the case of a cannot ventilate-cannot oxygenate situation. In a survey (Surveymonkey®) data concerning the level of experience with eFONA, devices required, previous training and complications were allocated among acute and emergency care providers of different backgrounds (doctors and paramedics). Furthermore, we asked about individual attitudes to and frequency of previous situations, in which an eFONA was not established despite strong indications. Of the respondents 15% (n = 63) answered that they had experienced this type of situation. eFONA had been performed by 28% of the interviewed (n = 117), reflecting the high number of military and EMT (emergency medical team) physicians participating in the survey. The number of experiences are rarely representative for the civilian setting. Different adjuncts may be helpful to detect the cricothyroid ligament. To use ultrasound seems obvious but it doubles the time for the detection of the cricothyroid ligament. Laryngeal masks can be employed as a supraglottic airway device (SAD) during "plan B". Stabilizing the airway with a SAD almost doubles the success of identifying laryngeal landmarks in females. The crew resource management (CRM) guidelines are more than essential in threatening situations demanding measures like eFONA. Providers should anticipate emerging problems and whenever feasible call for help and finally speak up. Naming a failed airway should be avoided as it implies a failure of the provider or of the entire airway team. In fact, the term non-accessible airway should be introduced. This might help to avoid the implication of a major failure. So far, an ideal simulator to train eFONA has not been introduced but it is mandatory to train procedures and algorithms on different types of simulators and manikins to achieve mastery. [ABSTRACT FROM AUTHOR]

Investigations on freeze‐thaw stressing of TWIST components In the experimental building CUBE – a flagship project of carbon concrete construction –, two double‐curved components made of shotcrete are visible. There are increased demands on its appearance and especially on the quality of the exposed concrete of the building envelope. A special feature is the production technology of the shell structures made of shotcrete. Due to the special shape of the components, there are increased moisture stresses and the resulting damage potential due to frost. Computational studies show significantly higher frost loads on inclined exposed concrete surfaces compared to wall surfaces. The generally higher water content of inclined concrete surfaces means that the water contained in the pore spaces freezes at temperatures just below 0 °C. In the case of wall surfaces, the water contained is more frequently stored in very fine pores. The capillary pressure prevailing here means that ice only forms at temperatures below –20 °C. [ABSTRACT FROM AUTHOR]

Advanced Computational Design The SFB Advanced Computational Design addresses the research question of how to advance design tools and processes through multi‐ and interdisciplinary basic research. We will develop advanced computational design tools in order to improve design quality and efficiency of processes in architecture and construction. The proposed research is structured in three areas: design methodology (A1), visual and haptic design interaction (A2) and form finding (A3). A1 focuses on the conceptual basis for new digital methods of design based on machine learning. A1 also acts as a platform for integrating and evaluating the computational tools and methods developed in A2 and A3. A2 investigates real‐time global‐illumination and optimization algorithms for lighting design, as well as a new method for large‐scale haptic interactions in virtual reality. In A3, form finding will be explored regarding geometric, mechanical and material constraints, in particular: paneling of complex shapes by patches of certain surface classes while optimizing the number of molds; algorithms for finding new transformable quad‐surfaces; mechanical models for an efficient simulation of bio‐composite material systems. Furthermore, new ways of form finding will be explored through physical experiments, which will allow for reconsidering model assumptions and constraints, validating the developed algorithmic approaches, and finding new ones. [ABSTRACT FROM AUTHOR]

The observation that high school students often do not recognize the contributions of other subjects such as applied mathematics or informatics to chemistry may be countered by introducing appropriate mathematical modelling in chemistry class. It should be focused on topics which are typically part of the regular curricula. Here chemical kinetics is employed within the introduction of the nucleophilic substitution as an example allowing conjunctions to mathematics and informatics. In this context, kinetics is deepened by quantitative considerations as well as simulations. The time laws for the kinetics of first and second order are derived using mathematical methods that are typically included in present mathematics curricula. In addition, two quantitatively analyzable model experiments can be used to allow a playfully understanding of the differential equations and their solutions. Furthermore, these model experiments can be transformed into concise computer algorithms. In this way, students learn the different methods experiment, analytical derivation, and simulation for gaining chemical knowledge. [ABSTRACT FROM AUTHOR]

In this paper we present the serious moral game "uMed: Your Choice", which was specially developed for the ethics training of medical students at the University of Zurich. First, we outline the institutional and curricular framework of the course in which "uMed" is used. Then we present the learning goals to be achieved with the game and the game mechanisms used. Finally, we summarise first practical experiences with the game in ethics education and offer suggestions on what to consider when using the game. [ABSTRACT FROM AUTHOR]

Numerical simulation aims at the analysis and prediction of physical phenomena using computers, which in contrast to traditional experiments is not only cheaper, but also allows for a repeated processing with different setups or boundary conditions. Based on mathematical models (such as partial differential equations), the underlying problem will be solved using numerical algorithms often running on modern compute clusters or supercomputers. For better visual comprehension the results are typically presented in graphical manner (pictures or movies) to gain insight and also realise complex correlations. Within this article, the entire simulation pipeline from formulas to colourful pictures will be highlighted in order to compute flood events. [ABSTRACT FROM AUTHOR]

The Center for Data Analysis, Visualization, and Simulation (DAViS) at the University of Applied Science of the Grisons and the Swiss Center of Allergy and Asthma Research supports research on applications in topics like machine learning, big data, visualization, and simulation. The paper illustrates complex data analysis of life science data in a common research project. [ABSTRACT FROM AUTHOR]

Background: As in other areas, military surgery is being transformed by developments in artificial intelligence, robotics and digitalization. Although the prospect of operating with a robot-assisted surgery system in the country of deployment while the responsible surgeon is in Germany is still a long way off, the training of military surgeons and the treatment of injured soldiers on deployment would nowadays be unimaginable without the digitalization of surgery in the armed forces. The structure of the medical environment in German clinics places restrictions on training that is close to operational reality. In the daily routine it is not possible to carry out the necessary numbers of deployment-relevant emergency surgical procedures under the expected conditions. Such procedures thus require the use of appropriate simulators or simulated scenarios that are as close to reality as possible. Although military surgeons are qualified in at least two specialist areas, the availability of telemedicine on deployment is helping to noticeably improve the treatment of injured soldiers. Telemedical consultation with colleagues in Germany makes it possible, for example, to reach joint decisions across different branches and disciplines. Conclusion: Until now it has not been possible to substitute the attending surgeon in the country of deployment with robot-assisted surgery systems or even robots for carrying out life-saving and stabilizing procedures; however, in order to provide surgeons with the necessary tools to successfully operate in situations where there is a shortage of personnel and materials in an inhospitable environment, use is made of the means that are currently available in the German medical services and constant efforts are made to explore the future possibilities of digital simulation. This article shows the reader the current status of digitalization in surgical training and deployments in the German armed forces. [ABSTRACT FROM AUTHOR]

Virtual patients have long been established as part of medical training. With their help, students can develop their therapeutic and diagnostic skills under conditions that are as realistic as possible, without any risk for a patient. While model or dummy simulations represent a standard in dentistry for the training of manual skills, computer-based, interactive simulations of virtual patient cases in this field are rarely described. Some of these systems have been designed for a limited purpose and do not permit a flexible and reusable design of virtual patients, or only permit it with restrictions. The MedBiquitous standard offers solutions for this purpose. This has proven itself in the medical field as a basis for virtual patient simulations. It offers an expandable structure for the data of virtual patients and describes fundamental algorithms of associated simulation software. In this paper, virtual patient player simulation software for interactive emergency training in dentistry is developed on the basis of the MedBiquitous model. As an example, a first virtual patient was created. MedEmergency Player enables action-focussed simulation without rigidly predefined linear or branched treatment pathways, unlike existing systems and the previous use of the MedBiquitous standard. The user directly experiences and examines the reactions as with a real patient [ABSTRACT FROM AUTHOR]

Abstract: Conceptual basics and tools to assess the multi hazard vulnerability of existing buildings The European Macroseismic Scale 1998 – (EMS‐98) is an instrument for the natural hazard of earthquakes, which allows the explanation of the observed differences in the behavior of the prevailing building types by introducing and concrete implementation of the vulnerability classes. The EMS‐98 enables also the identification of purely empirically justified ranges of scatter. The basic methodology is also applicable to other natural hazards such as flood, tsunami and wind. This allows for the development of a unified methodology for the consideration of building vulnerability in the sense of a multi hazard approach. For the first time, a vulnerability‐oriented instrument is available to evaluate a building stock for different natural hazards according to criteria that have been standardized in terms of engineering. The multi hazard vulnerability with its possible spreads is examined and visualized on real building inventories. With the concept of “LEGOisation” the existing buildings, a novel approach is presented to allow the sub‐structuring of buildings in stories (including roof, basement and ceiling) to further development of the classification towards specific damage characteristics and local vulnerability. It provides an outlook on a “Conceptual Simulation Tool” to be developed, which uses the tools and methods developed to simulate damage and losses as a result of various natural hazards and their sequences. [ABSTRACT FROM AUTHOR]

Abstract: Stability assessment of steel members with mono‐ and double symmetric I‐cross sections subjected to bending, axial compression and torsion. The simplified assessment method with reduction factors is still used for the design of steel members. The interaction formulae of EN 1993‐1‐1 apply to members with double symmetric I‐ and H‐sections as well as hollow sections. The formulae are not valid for members with scheduled torsion. An extension of the scope of the assessment method to mono‐symmetric cross sections and scheduled torsion is currently being evaluated in the context of the revision and further development of Eurocode 3. This publication reports on numerical simulations of the structural stability behavior of members with mono and double symmetric I‐/H‐sections in bending, axial compression and torsion, as well as the establishment of a simplified assessment method with reduction factors and its backgrounds. Hence, it provides a useful contribution to the current discussion. [ABSTRACT FROM AUTHOR]

Abstract: Equivalent initial imperfections for applying the partial internal forces method for flexural buckling about the weak axis. This paper compares design approaches for equivalent initial imperfections of steel members with hot‐rolled double symmetric I‐/H‐profiles subjected to buckling about the weak axis. In addition to the normative rules applied in Germany and Europe, design approaches for imperfections are also taken into account, which are currently discussed as part of the further development of Eurocode 3. A proposal using the partial internal forces method allows a consistent design for steel members taking into account the cross‐sectional failure as well as the flexural buckling about the strong and weak axis. The proposal leads to design results that agree well with the results of numerical simulations. [ABSTRACT FROM AUTHOR]

An important challenge in learning ultrasound-assisted interventions, such as pericardiocentesis, is the navigation of the needle in a three-dimensional space on the basis of a two-dimensional image. In order to learn this in vitro realistic simulators are required. We manufactured a model which allows simulation of pericardiocentesis on the basis of ballistic gelatin (12.6%, 250 Bloom). Furthermore, the pericardiocentesis model was subjectively evaluated by 37 anesthetists in a pre-post design. The models used proved to be technically simple to manufacture, hard wearing and realistic. They are therefore regularly used in our hospitals to learn ultrasound-assisted interventions. [ABSTRACT FROM AUTHOR]

Health Technology Assessment is one of the standard instruments in support of the decision-making to define the public health services both internationally and in the German health care system. Besides system- atic reviews, benefit-harm-analyses, health economic evaluations, and, decision-analytic modelling, especially epidemiological and biometrical questions and methods play a key role. From this perspective discus- sions on increased European cooperation including calls for wider harmonization are attracting greater interests. The overall aim is, to present at the GMDS workshop relevant information on this emerging field of harmonization in Europe across similarities and differences in the HTA process. Current developments around the composition of the EU-HTA Network are provided. This network accepts the challenge to define and establish a "Joint Work" across Europe. Special emphasis was placed on the discussion on "Harmonization of HTA: is it a threat or does it mean support?". Furthermore, methodolo- gical discussions and questions are being addressed: "Are Real World Data and Surrogates possible parameters for decision-making or HTA?" [ABSTRACT FROM AUTHOR]

Patients with factitious disorders intentionally fabricate, exaggerate or feign physical and/or psychiatric symptoms for various open and covert psychological reasons. There are many issues regarding the diagnostic state and classification of factitious disorders. Both the categorical differentiation of and clinical continuum ranging from somatoform/dissociative disorders to malingering are being controversially debated. Epidemiological studies on the frequency of factitious disorder meet basic methodological difficulties. Reported rates of prevalence and incidence in the professional literature most probably have to be considered underestimations. Illness deception and self-harm as core features of the abnormal illness behaviour in factitious disorder may refer to various highly adverse and traumatic experiences during early development in a subgroup of patients. Chronic courses of illness prevail; however, there are also episodic variants. [ABSTRACT FROM AUTHOR]

Simulation programs like the Finite Element Method belong to the set of standard tools in product development. These systems are used to describe scientific problems using mathematical means and present the solutions for those problems in a graphical way. They also support the development process of a product significantly. Subject matter decisions however, are made by the calculation engineer. To do that, she needs sufficient theoretical, application specific knowledge and thus knowledge about potential sources of errors. As errors in the analysis cannot be ruled out even until the very end of the project, certain subject matter risks persist. Consistent process and quality management can help mitigating those risks or even avoid them completely. Liability risks are strongly related to subject matter risks. For those, we can distinguish between contractual and non-contractual liabilities. Product liability claims belong to the latter, too. Fundamentally, the risk to be accountable for a product defect is the greater, the more responsibility the calculation engineer has within the company. This paper is supposed to give an overview about the civil law liability risks of calculation engineers. This means, it especially targets companies and engineers that provide calculation services to third parties or execute those services for internal product development. [ABSTRACT FROM AUTHOR]

Simulation assumes a growing importance in the field of emergency medical education. Many rescue service schools work with simulators or even have their own simulation center. Classic resuscitation training in the classroom is increasingly being replaced by realistic case scenarios. But simulators themselves do not train! Using a simulator in emergency medical training does not necessarily mean achieving sustained learning success among the participants. Depending on the skills, abilities or competences being taught, there seems to be different requirements for simulation. However, there is no scientific evidence about how strong learners should be stressed in order to achieve the best learning effect. However, it can be stated that for training purely technical skills, simulators that represent the anatomical or physiological reality as accurately as possible should be used. If soft skills, practical knowledge and decision-making are the learning objectives, a scenario with extremly realistic conditions needs to be embedded. Mid-fidelity simulators seem to be able to cover the widest range of imparting skills for emergency medical training. No matter what simulator is used, the following applies: The selected scenario must be realistic and the simulation as well as technical capabilities of the simulator must be coordinated. A well-presented scenario with a well-trained teacher using a simple resuscitation doll appears to be better than a highly complex, however unrealistic, amateur simulation scenario for successful learning. [ABSTRACT FROM AUTHOR]

Hintergrund: Die Arzt-Patient-Kommunikation über die Arzneitherapie zeigt häufig Defizite, was u.a. eine unzureichende medikamentöse Adhärenz zur Folge haben kann. Vernachlässigt wurde in diesem Zusammenhang lange Zeit das Verordnungsgespräch. Zielsetzung: Im neu konzipierten Wahlpflichtblock setzen sich Studierende der Humanmedizin aktiv mit Arzt-Patient-Gesprächen im Rahmen derArzneiverordnungauseinander. Berücksichtigung finden wesentliche Aspekte einer sicheren und effektiven Arzneitherapie sowie das Modell der Partizipativen Entscheidungsfindung. Unter Anleitung entwickeln die Studierenden einen Gesprächsleitfaden, dessen Anwendung auch individuellen Bedürfnissen und Vorstellungen Rechnung tragen soll. Beschreibung/Methoden: In diesem einwöchigen Kurs erarbeiten sich die Studierenden wichtige Hintergrundinformationen anhand eines Fallbeispiels im Rahmen des Problem-basierten Lernens. Unterstützt werden sie durch ein Impulsreferat und auf einer elektronischen Lernplattform angebotene Literatur. Die gemeinsame Synthese der Aspekte zu Arzneitherapie und Patientenbeteiligung in Form eines Gesprächsleitfadens erfolgt in einem interaktiven Workshop. Am Ende der Woche können die Studierenden sich und den (Muster-) Leitfaden in einem mit einem Schauspielerpatienten simulierten Verordnungsgespräch ausprobieren, das anhand einer Checkliste beurteilt wird. Ergebnisse: Informelle Rückmeldungen und die standardisierte fakultätsweite elektronische Evaluation zeigen ein hohe Akzeptanz und große Zufriedenheit seitens der Studierenden. Die Checkliste erlaubt eine weitgehend reliable Beurteilung der Gespräche anhand überwiegend trennscharfer Items. Portfolioeinträge und Freitextevaluationen sprechen dafür, dass bei den Teilnehmern Einstellungen und Haltungen beein-flusst werden. [ABSTRACT FROM AUTHOR]

Background: Time is of critical importance in acute stroke management. The establishment of thrombectomy now adds to the complexity and interdisciplinarity of the initial phase. In non-medical high-fidelity situations, such as aviation, crew resource management (CRM) has proven to be highly efficient. It has therefore also been implemented in professional cardiovascular life support training. In a setting where every minute counts, CRM and regular training of the high-fidelity stroke team could offer ways to improve treatment of acute stroke patients. Objectives: We evaluated the effects of a CRM-based stroke team with regular simulation training on the quality of care (e.g. door to needle time and thrombolysis rate) as well as on staff satisfaction and perceived patient safety in the emergency department of a tertiary care neurocenter. Material and methods: We implemented a dedicated stroke team consisting of 7 persons who are notified by a collective call via speed dial and conceived a simulator-based team training for all new stroke team members which we conduct at monthly intervals. We recorded door to needle times of all consecutive patients, staff satisfaction in the emergency room and the acceptance of this new learning format. Results: This approach led to a relevant and sustained reduction of the mean door to needle time to less than 30 min. It improved perceived patient safety in residents with professional experience of less than 2 years. There was a very high acceptance within the stroke team training and staff and its usefulness was judged to be very high. Conclusion: Even though our data do not allow positive effects on patient outcomes to be inferred, the implementation of a CRM-based stroke team and simulator training has had multiple positive effects on the workflow and work satisfaction in the treatment of acute stroke patients. [ABSTRACT FROM AUTHOR]

Background: Unanticipated airway problems in infants can rapidly develop into severe hypoxemia. Team members can provide support and suggest steps of action if a shared mental model of the next steps exists. Briefing prior to induction of anaesthesia may create such a shared mental model among all team members.Objectives: The aim of the study was to assess whether a short briefing on the recommendations for an unexpected difficult airway, developed by the Working Group on Paediatric Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine, would influence the management of an unexpected difficult mask ventilation in an infant. The study also aims to assess whether a shared mental model would encourage the anaesthesia nurse to speak up and foster implicit coordination.Methods: Nineteen teams consisting of an anaesthesia resident and an anaesthesia nurse participated in a scenario of an urgent induction of anaesthesia in an infant. Teams were randomized to either conduct a briefing on the recommendations for an unexpected difficult airway prior to induction of anaesthesia or to have access to a Web-based cognitive aid with an emergency manual page containing the identical algorithm if needed. Induction of anaesthesia triggered upper airway obstruction and desaturation. The time course of desaturation followed published physiologic modelling. The time until the obstruction was relieved was recorded. Video recordings of the scenarios were analysed with respect to coordination patterns prior to induction as well as to coordination forms (implicit vs. explicit) during the emergency. At the end of the course, participants were asked to fill out a questionnaire.Results: Teams of both groups checked on the availability of airway equipment, but teams in the briefing group talked more often about treatment steps to relieve airway obstruction (p < 0.005). The time until the obstruction was relieved was significantly shorter in the briefing group (median: 80 s vs. 126 s; p < 0.005). In 45 % of the intervention scenarios the nurse suggested the solution to the airway problem whereas only 10 % of the nurses in the control group proposed a measure to relieve the obstruction (n.s.). Both groups showed no difference in the frequency of implicit vs. explicit coordination patterns. Nurses from the intervention group found the situation to be less an emergency and felt better prepared than nurses from the control group (p < 0.05).Conclusion: Briefings prior to anaesthesia induction in paediatric anaesthesia should include management of unanticipated problems. In a simulation setting, a briefing on treatment steps for an unexpected difficult airway improves management of an upper airway obstruction. Explicit communication of intended actions by the anaesthesiologist may foster speaking up by team members. [ABSTRACT FROM AUTHOR]

Einleitung: Medizinstudierende erlangen durch ihre Ausbildung ein umfassendes medizinisches Fachwissen. Allerdings erfordert der Arztberuf zusätzliche Fähigkeiten wie Ressourcenallokation, Wirtschaftlichkeit, Konzeption, Organisation und Prozessmanagement im Gesundheitssystem. Auf die Rolle des Arztes als Manager werden die Studierenden nicht ausreichend vorbereitet. Deshalb entwickelten wir den Kurs MeCuM-SiGma, welcher Medizinstudierenden die Grundlagen von Gesundheitspolitik und -management vermittelt. In diesem Projektbericht stellen wir das didaktische Konzept und erste Ergebnisse der Evaluation des Lehrprojekts vor. Projektbeschreibung: Der seit 2010 bestehende, einsemestrige Kurs vermittelt Medizinstudierenden neben den oben bereits erwähnten Kenntnissen grundlegende Managementkompetenzen. Das immer im Wintersemester stattfindende, freiwillige Lehrprojekt wird ehrenamtlich von Ärzten und Mitarbeitern des Mentoring-Büros (MeCuM-Mentor) der medizinischen Fakultätder LMU München koordiniert sowie organisiert und steht allen Medizinstudierenden der beiden medizinischen Fakultäten in München zur Teilnahme offen. In der ersten Phase dieses Zusatzangebots lernen die Studierenden in fallbasierten, problem-orientierten Tutorials unter Anleitung von geschulten Tutoren und in Expertenvorträgen u.a. die Grundlagen des politischen Systems und des Gesundheitssystems in Deutschland kennen. In der zweiten Phase nehmen die Teilnehmer die Rollen der Mitglieder des Vorstandes sowie des Aufsichtsrates des Klinikums der Universität München ein und bearbeiten in Teamarbeit im Rahmen einer Simulation ein bereits bestehendes Projekt des Klinikums. Begleitet wird diese Phase von Workshops zu den prozeduralen Lernzielen (u.a. zu Teamarbeit, Projektmanagement und Verhandlungsstrategien), die in Kooperation mit inner- und außeruniversitären Kooperationspartnern durchgeführt werden. In enger Zusammenarbeit mit dem Vorstand des Klinikums wird von den Kursverantwortlichen im Vorfeld eine geeignete reale Problemstellung ausgewählt, mit der sich der Klinikumsvorstand aktuell befasst. Dieses bearbeiten die Studierenden in der dritten und letzten Phase unseres Kurses unter Supervision von Tutoren und unter Mithilfe von Klinikumsmitarbeitern. Zum Abschluss stellen die Teilnehmer ihre Ergebnisse dem realen Vorstand und Aufsichtsrat in einer Abschlusspräsentation vor. Ergebnisse: Der Kurs wird mittels einer schriftlichen Evaluation der Teilnehmer, einer mündlichen Feedbackrunde, einer Evaluation der Abschlussprojekte und eines Feedbacks von Vorstand und Aufsichtsrat des Klinikums evaluiert. Alle bisherigen Teilnehmer maßen dem Kurs einen großen inhaltlichen Informationsgewinn zu, bekundeten einen Zuwachs an Wissen zum Gesundheitswesen und schätzten die Relevanz der Kursziele hoch ein. Die Mehrheit fand die Inhalte wichtig für ihre spätere ärztliche Tätigkeit. Insgesamt wurde der Kurs von den Teilnehmern sehr gut [Gesamtnote auf sechsstufiger Notenskala (1=sehr gut; 6=ungenügend): 1,28 (Mittelwert)±0,45 (Standardabweichung)] bewertet. Diskussion: Die Bedeutung der Rolle des Arztes als Manager sowohl in medizinischen Organisationeinheiten als auch als Weichensteller im Gesundheitssystem wird in der medizinischen Ausbildungvernachlässigt. Unser Kursangebot beginnt diese Lücke zu schließen und wird mit großem Interesse und hervorragender Evaluation von Teilnehmern, Kooperationspartnern, Vorstand und Aufsichtsrat unserer Universitätsklinik angenommen. [ABSTRACT FROM AUTHOR]

In Deutschland zeigen sich Infrastrukturbauwerke infolge Alterung und einer andauernden Steigerung des Schwerverkehrsaufkommens in zunehmend schlechterem Zustand. In diesem Zusammenhang kommt der Beurteilung der Resttragfähigkeit von Bauwerken besondere Bedeutung zu. Prognosen der (Rest-) Lebensdauer können dazu einen entscheidenden Beitrag leisten. Am Lehrstuhl für Massivbau der Ruhr-Universität Bochum wurde daher die Umsetzbarkeit einer Lebensdauerprognose an einem Bestandsbauwerk mithilfe von im Bauwesen verbreiteter Software untersucht. Die Lebensdauerprognose basiert dabei auf der wiederholten nichtlinearen Berechnung der als FE-Modell diskretisierten Struktur bis in den Grenzzustand der Tragfähigkeit. Nach Auswahl geeigneter Software wird das zu untersuchende Bauwerk in ein adäquates FE-Modell überführt. Anschließend werden maßgebende Belastungen im Hinblick auf die am Bauwerk relevanten Schädigungsmechanismen identifiziert und modelliert. Es folgt die Vorstellung eines Verfahrens zur Lebensdauersimulation, in dem zunächst wesentliche Schädigungsprozesse sowie Streuungen und Unschärfen untersucht werden. Nach der Entwicklung eines Berechnungsalgorithmus und dessen Verifikation am Kleinbeispiel wird das Simulationskonzept auf das untersuchte Bestandsbauwerk übertragen. Eine Auswertung der Simulationsergebnisse identifiziert schlussendlich die maßgebenden Wirkungsmechanismen und belegt die Funktionsfähigkeit des entwickelten Simulationskonzepts. Structural life-time assessment employing well-established engineering software Currently Germany's infrastructure shows a progressively downgraded state of preservation due to aging along with an always increasing number of heavy good transports on the roads. In this context also the remaining bearing capacities of bridges gain rising importance. For an assessment lifetime prognoses can be very helpful. Therefore, an implementation of structural lifetime-simulations employing commercial software has been developed at the institute of concrete structures of the Ruhr-Universität Bochum. The concept is now proven by application to an existing pre-stressed concrete bridge. Generally, structural lifetime prognoses are based on repeated nonlinear simulation of a discretized bridge structure by finite elements up to the ultimate limit state. Once, appropriate software is chosen with respect to the simulation demands previously defined, the reference bridge is idealized by finite elements. Relevant load scenarios in view of pivotal damage mechanisms are identified and consequently set up. Next, the concept of structural lifetime simulation accounting for relevant damage mechanisms and imprecise input data is introduced briefly. A suited computational algorithm is developed and verified in a test case. Subsequently the concept is transferred to the reference bridge. Post-processing of the simulation results identifies the relevant working principles and proves practical abilities of the simulation concept. [ABSTRACT FROM AUTHOR]

Obstetric analgesia and anesthesia have some specific aspects, which in particular are directly related to pathophysiological alterations during pregnancy and also to the circumstance that two or even more individuals are always affected by complications or therapeutic measures. This review article deals with some evergreens and hot topics of obstetric anesthesia and essential new knowledge on these aspects is described. The article summarizes the talks given at the 16th symposium on obstetric anesthesia organized by the Scientific Committee for Regional Anaesthesia and Obstetric Anaesthesia within the German Society of Anaesthesiology. The topics are in particular, special features and pitfalls of informed consent in the delivery room, challenges in education and training in obstetric anesthesia, expedient inclusion of simulation-assisted training and further education on risk minimization, knowledge and recommendations on fasting for the delivery room and cesarean sections, monitoring in obstetric anesthesia by neuraxial and alternative procedures, the possibilities and limitations of using ultrasound for lumbal epidural catheter positioning in the delivery room, recommended approaches in preparing peridural catheters for cesarean section, basic principles of cardiotocography, postoperative analgesia after cesarean section, the practice of early bonding in the delivery room during cesarean section births and the management of postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

In order to guarantee the validity of neuropsychological test profiles, it is essential to assess the plausibility of reported deficits. The present study aimed to examine the influence of malingering on the Alertness test of the Test of Attentional Performance (TAP). For that purpose we tested 17 healthy subjects under (i) optimal effort, (ii) simulation and (iii) coached simulation conditions. In result, coached simulants showed shorter and less variable reaction times than naïve simulants but still slower and more variable reactions than under optimal effort. Thus, even with detailed knowledge about plausible simulation strategies, participants were not able to fake consistent slower reactions. Consequently, even though this cannot hold true for the reverse, constant reaction times in an alertness test can indicate optimal behavioral effort. In comparison to patients, coached simulation can no longer be identified via single test parameters. However, under consideration of multiple test parameters it is still possible to assess the plausibility of test behavior even in the presence of detailed knowledge about plausible simulation strategies. [ABSTRACT FROM AUTHOR]

Dandachi-FitzGerald, Ponds and Merten (2013) conducted a survey on symptom validity practices and beliefs among neuropsychologists from six European countries. Members of the German Neuropsychological Society constituted the largest group of participants. The results obtained for this subsample (n = 211) were selected for a review. Although research participants acknowledged the importance of a thorough evaluation of symptom validity, unstandardized assessment approaches appeared to prevail. The most common symptom validity tests employed by German neuropsychologists were the Testbatterie zur Forensischen Neuropsychologie, the Word Memory Test, the Rey 15-Item Memory Test, the Amsterdam Short-Term Memory Test and the Aggravations- und Simulationstest. Substantial variation was observed both for prevalence estimates of negative response bias in neuropsychological evaluations and for professionals' familiarity with modern approaches of symptom validation. Moreover, the relevance of symptom validation differed considerably between clinical and forensic referral contexts. Official professional guidelines for symptom validity assessment are still lacking for the German speaking countries. [ABSTRACT FROM AUTHOR]

Introduction: Simulation often relies on a case-based learning approach and is used as a teaching tool for a variety of audiences. The knowledge transfer goes beyond the mere exchange of soft skills and practical abilities and also includes practical knowledge and decision-making behavior; however, verification of knowledge or practical skills seldom unfolds during simulations. Simulation-based learning seems to affect many learning domains and can, therefore, be considered to be multifactorial in nature. At present, studies examining the effects of learning environments with varying levels of reality on the cognitive long-term retention of students are lacking. Aim: The present study focused on the question whether case scenarios with varying levels of reality produce differences in the cognitive long-term retention of students, in particular with regard to the learning dimensions knowledge, understanding and transfer. Material and methods: The study was conducted on 153 students in the first clinical semester at the Justus-Liebig University of Giessen. Students were randomly selected and subsequently assigned, also in a random fashion, to two practice groups, i.e. realistic and unrealistic. In both groups the students were presented with standardized case scenariosconsisting of three case studies, which were accurately defined with a case report containing a detailed description of each scenario and all relevant values so as to ensure identical conditions for both groups. The unrealistic group sat in an unfurnished practice room as a learning environment. The realistic group sat in a furnished learning environment with various background pictures and ambient noise. Students received examination questions before, immediately following and 14 days after the practice. Examination questions were identical at each of the three time points, classified into three learning dimensions following Bloom's taxonomy and evaluated. Furthermore, examination questions were supplemented by a questionnaire concerning the individual perception of reality and own learning success, to be filled in by students immediately after the practice. Examination questions and questionnaires were anonymous but associated with each other. Results: Even with less experienced participants, realistic simulation design led to a significant increase of knowledge immediately after the end of the simulation. This effect, however, did not impact the cognitive long-term retention of students. While the realistic group showed a higher initial knowledge after the simulation, this 'knowledge delta' was forgotten within 14 days, putting them back on par with the unrealistic comparison group. It could be significantly demonstrated that 2 weeks after the practice, comprehension questions were answered better than those on pure knowledge. Therefore, it can be concluded that even vaguely realistic simulation scenarios affect the learning dimension of understanding. Conclusion: For simulation-based learning the outcome depends not only on knowledge, practical skills and motivational variables but also on the onset of negative emotions, perception of own ability and personality profile. Simulation training alone does not appear to guarantee learning success but it seems to be necessary to establish a simulation setting suitable for the education level, needs and personality characteristics of the students. [ABSTRACT FROM AUTHOR]

Background: Telephone-assisted instructions for cardiopulmonary resuscitation (T-CPR) are highly recommended by the current European Resuscitation Council (ERC) guidelines for resuscitation 2010. Aim: The aim of this study was to analyze the adherence of laypersons to T-CPR instructions given by dispatchers in a mock scenario. The dispatchers adapted international T-CPR instructions to local requirements. Material and methods: An emergency 'collapse in the office' with subsequent T-CPR was simulated for 10 volunteer, untrained administrative staff, as the only single emergency witness and 4 emergency medical service (EMS) dispatchers. Each volunteer was sent to a 'colleague' who simulated a sudden cardiovascular event and collapsed unconscious during the description of symptoms. The local lay responder made an emergency call by landline telephone and was connected to the dispatcher. In the course of the simulation the 'victim' was replaced by a CPR manikin. Results: Every participant, i.e. 10 out of 10, assessed the victim, recognized the situation and telephoned for help. On the orders of the dispatchers 9 out of the 10 activated the loudspeaker of the telephone but 4 still continued to use the handset. The instructions for positioning were followed by all 10. Correct positioning of the victim required a median of 33 s with an interquartile range (IQR) of 30-39 s. Breathing control including instructions lasted a median of 54 s (IQR 49-60 s). Breathing was assessed by 8 out of 10 but only 2 out of 8 achieved a duration of 10 s as recommended by the ERC guidelines for resuscitation 2010. After a median of 202 s (IQR 196-241 s) chest compressions were started by 9 out of 10 and were performed for a median of 63 s (IQR 60-69 s). A correct technique was used by 7 but with a low rate of 80 compressions/min (IQR 72-86/min). The instructions for ventilation were understood by 9 out of 10. Mouth-to-mouth resuscitation was performed by 7 participants and technically correct by 5 of them. The ventilation cycle of the 7 active participants lasted for a mean of 25 s (IQR 24-30 s). The mean total duration of the timeframe analyzed was 340 s (IQR 334-368 s). Conclusion: The results demonstrate that the local T-CPR concept for untrained laypersons is feasible in a mock scenario. No substantial errors were observed for the majority of the untrained responders but the simulation also showed that not every emergency witness implemented the instructions according to the dispatcher's expectations. The T-CPR procedure was also more time-consuming than expected; therefore, every standardized T-CPR concept should be tested for local practicability. In accordance with current studies, the results suggest that the focus should be on compression-only CPR instructions in urban settings. Dispatcher education in T-CPR should incorporate videotaped mock-up scenarios with untrained local laypersons. [ABSTRACT FROM AUTHOR]

The assessment of trauma-related disorders is becoming increasingly more important in forensic psychiatric expert opinions. The most important diagnosis in this context is posttraumatic stress disorder. The essential diagnostic criteria of this disorder are outlined. Differential diagnostic considerations are often necessary with respect to less specific symptom complexes, such as the complex posttraumatic stress disorder or diagnoses which as a rule cannot etiologically be causally associated with trauma alone, such as depression or anxiety disorders. Furthermore, the significance of symptom validity tests is critically discussed. Test results have to be considered carefully in the medicolegal context and require a thorough clinical assessment. [ABSTRACT FROM AUTHOR]

Growing attention has been drawn to patient safety during recent months due to media reports of clinical errors. To date only clinical incident reporting systems have been implemented in acute care hospitals as instruments of risk management. However, these systems only have a limited impact on human factors which account for the majority of all errors in medicine. Crew resource management (CRM) starts here. For the commissioning of a new hospital in Minden, training programs were installed in order to maintain patient safety in a new complex environment. The training was planned in three parts: All relevant processes were defined as standard operating procedures (SOP), visualized and then simulated in the new building. In addition, staff members (trainers) in leading positions were trained in CRM in order to train the complete staff. The training programs were analyzed by questionnaires. Selection of topics, relevance for practice and mode of presentation were rated as very good by 73% of the participants. The staff members ranked the topics communication in crisis situations, individual errors and compensating measures as most important followed by case studies and teamwork. Employees improved in compliance to the SOP, team competence and communication. In high technology environments with escalating workloads and interdisciplinary organization, staff members are confronted with increasing demands in knowledge and skills. To reduce errors under such working conditions relevant processes should be standardized and trained for the emergency situation. Human performance can be supported by well-trained interpersonal skills which are evolved in CRM training. In combination these training programs make a significant contribution to maintaining patient safety. [ABSTRACT FROM AUTHOR]

Out-of-hospital (OOH) pediatric emergencies have a relatively low prevalence. In Germany the vast majority of cases are attended by non-specialized emergency physicians (EPs) for whom these are not routine procedures. This may lead to insecurity and fear. However, it is unknown how EPs perceive and assess pediatric emergencies and how they could be better prepared for them. All active EPs (n=50) of the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University Medical Centre of Göttingen were presented with a structured questionnaire in order to evaluate their perception and assessment of OOH pediatric emergencies. The 43 participating EPs made highly detailed statements on the expected characteristics of OOH pediatric emergencies. Their confidence level grew with the children’s age (p<0.03) and with their own experience (p<0.01). The EPs felt particular deficits in the fields of cardiopulmonary resuscitation (n=18) and trauma management (n=8). The preferred educational strategies included simulator-based training (n=24) as well as more exposure to pediatric intensive care and pediatric anesthesia (n=12). Despite their own limited experience EPs can realistically assess the incidence and severity of pediatric emergencies. They felt the greatest deficits were in the care of infrequent but life-threatening emergencies. Three educational groups can be differentiated: knowledge and skills to be gained with children in hospital, clinical experience from adult care also applicable in children and rare diagnoses and interventions to be trained with manikins or simulators. [ABSTRACT FROM AUTHOR]

A system has been developed which allows respiration and apnea events to be simulated. With this system respiratory amplitude and respiratory frequency can be varied and it is also possible to simulate varying degrees of upper airway obstruction. In this study the simulator has been applied to eight positive pressure ventilation devices from different manufacturers for the treatment of obstructive sleep apnea. The results showed remarkable differences between the devices regarding the dynamics and the final pressure delivered during the periods with repetitive apnea. The application of simulators such as the one used here in order to test positive pressure devices for the treatment of obstructive sleep apnea has proved to be feasible and is recommended for future investigations of treatment devices. [ABSTRACT FROM AUTHOR]

Physicians have to demonstrate non-technical skills, such as communication and team leading skills, while coping with critical incidents. These skills are not taught during medical education. A crisis resource management (CRM) training was established for 4th to 6th year medical students using a full-scale simulator mannikin (Emergency Care Simulator, ECS®, METI). The learning objectives of the course were defined according to the key points of Gaba’s CRM concept. The training consisted of theoretical and practical parts (3 simulation scenarios with debriefing). Students’ self-assessment before and after the training provided the data for evaluation of the training outcome. A total of 65 students took part in the training. The course was well received in terms of overall course quality, debriefings and didactic presentation, the mean overall mark being 1.4 (1: best, 6: worst). After the course students felt significantly more confident when facing incidents in clinical practice. The main learning objectives were achieved. The effectiveness of applying the widely used ECS® full-scale simulator in interdisciplinary teaching has been demonstrated. The training exposes students to crisis resource management issues and motivates them to develop non-technical skills. [ABSTRACT FROM AUTHOR]

The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization. To analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes. The use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods. The introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patient’s portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway. [ABSTRACT FROM AUTHOR]

Computer simulations will be characterized in epistemic respect as a method between experiment and theory. It will be argued that simulations do not provide numerical solutions, rather they use generative mechanisms to imitate a dynamics. Climate science will be considered as a case both systematically and historically. Only simulation experiments allow to build models that imitate a dynamics without solving the relevant equations. [ABSTRACT FROM AUTHOR]

The problem faced in this paper is a periodic pricing of inventory with obsolescence and an unknown time horizon. Typical inventory items with these properties are music CDs. The periodic pricing of music CDs is used as a tool to manipulate the demand thereof as they become less popular. A CD will, however, not perish in the time it is kept as inventory, as is the case with perishable inventory. This property accounts for the obsolescence. Other kinds of items in inventory that also become obsolete are typical fashion goods, like clothes. Contrary to CDs the demand for these goods do have a known time horizon (usually at the end of a season). The paper starts out by giving an introduction to the problems faced in a CD shop. Background information is given on how CD shops operate. The method of pricing CDs is explained. The current policy at a CD shop of when, and how many orders are placed is explained. This introduction is followed by an overview of relevant literature on various types of inventory problems. The review is structured according to the three properties of the problem. The first property is the pricing of items in inventory. The second property is that items in inventory may be considered as inventory with a random lifetime. The third property is that the items in inventory become obsolete. The subject of the pricing of inventory has received substantial attention in the operations research literature over the years. The conclusion after consultation of the references on the periodic pricing of inventory is that all these articles have two characteristics in common: the time horizon of the items in inventory are considered to be fixed and it is known by how much the price will change. In the problem under consideration only the second characteristic may be assumed. The objective in most of the literature is to find the time when, and how many times the price should be changed. The second property deals with inventory with a stochastic lifetime. By... [ABSTRACT FROM AUTHOR]