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To optimize wood-fired heat (and power) plants, it is essential to rapidly determine the chemical composition of solid biofuels on-site shortly before combustion. However, the standard procedures for chemical analysis [inductively coupled plasma-optical emission spectrometry (ICP-OES), inductively coupled plasma-mass spectrometry] are time-consuming, expensive and require highly trained personnel. Thus, they are unsuitable for online fuel analysis. Newly developed, rapid, on-site analysis methods might enhance analysis at the plant. Thereby, X-ray fluorescence (XRF) analysis is one of the most promising methods. So far, XRF has been evaluated in various fields like geology, coal, ash analysis, as well as biomass in general, but this method is still insufficiently investigated for the sector of solid biofuels. The aim of this work is to evaluate and optimize an XRF analyzer for the rapid determination of chemical elements in wood fuels. The XRF analyzer was calibrated using several wood chip samples. Measurements before and after calibration were compared with the reference method (ICP-OES). Results show that XRF can be recommended for analyzing the elements Mg, P, K, Ca, Si, Al, Cr, Mn, Fe, Zn and Pb, while S, Cl, Ti and Ni can potentially be determined with element-specific calibrations. Cu, As, and Cd could not be measured satisfactorily, as many measurements were below the limit of detection. Still, XRF might be used for threshold value monitoring (e.g., in the scope of the German Waste Wood Ordinance).

Das Bundesministerium für Ernährung und Landwirtschaft (BMEL) plant ein Gesetz zum Schutz von Kindern vor Werbung für Lebensmittel mit hohem Zucker‑, Fett- oder Salzgehalt (Kinder-Lebensmittel-Werbegesetz – KLWG). Das BMEL möchte so Übergewicht und ernährungsmitbedingte Erkrankungen wie z. B. Adipositas bei Kindern und Jugendlichen reduzieren. Dem bisher bekannten Entwurf des Gesetzes zufolge würde jedoch nicht nur an Kinder, d. h. Personen unter 14 Jahren, gerichtete Werbung für Lebensmittel mit verhältnismäßig hohem Gehalt an Zucker, Salz oder Fett untersagt. Vielmehr würde das KLWG in der vorgeschlagenen Fassung ein nahezu generelles Werbeverbot für fast alle Lebensmittel jenseits von Frischfleisch, Frischfisch, Obst, Gemüse, Hülsenfrüchten, Milch und (ungesüßten) Säften implizieren. Ein Inkrafttreten des Gesetzes würde somit die Werbe- und Kommunikationsmöglichkeiten für (viele) Unternehmen in der Lebensmittelbranche massiv einschränken. Nicht nur auf dem Lebensmittelmarkt wären erhebliche Wettbewerbseffekte zu erwarten, sondern insbesondere auch in der Medienwirtschaft für privatwirtschaftliche Rundfunkunternehmen und Medienagenturen. Damit wirkt das geplante Werbeverbot als „Brandbeschleuniger“ für das schleichende „Mediensterben“ und gefährdet letztlich auch die Meinungs- und Medienvielfalt in Deutschland. In der Konsequenz droht vor allem im dualen Rundfunksystem eine fundamentale Verschiebung.

The discovery of new functional materials is one of the key challenges in materials science. Combinatorial high-throughput approaches using reactive sputtering are commonly employed to screen unexplored phase spaces. During reactive combinatorial deposition, the process conditions are rarely optimized, which can lead to poor crystallinity of thin films. In addition, sputtering at shallow deposition angles can lead to off-axis preferential orientation of the grains. This can make the results from a conventional structural phase screening ambiguous. Here, we perform a combinatorial screening of the Zn–Ta–N phase space with the aim to synthesize the novel semiconductor Zn2TaN3. While the results of the X-ray diffraction (XRD) phase screening are inconclusive, including Auger parameter analysis in our workflow allows us to see a very clear discontinuity in the evolution of the Ta binding environment. This is indicative of the formation of a new ternary phase. In additional experiments, we isolate the material and perform a detailed characterization confirming the formation of single-phase wurtzite Zn2TaN3. Besides the formation of the new ternary nitride, we map the functional properties of ZnxTa1–xN and report previously unreported clean chemical state analysis for Zn3N2, TaN, and Zn2TaN3. Overall, the results of this study showcase common challenges in high-throughput materials screening and highlight the merit of employing characterization techniques sensitive toward changes in the materials’ short-range order and chemical state.

Wood combustion is a major part of the current efforts to reduce CO2emissions. However, wood combustion leads to emissions of other pollutants like fine particulate matter. A new option to reduce particulate matter emissions is a metal mesh filter with counter current flushing. An automatic prototype was tested under realistic conditions including starts and stops of the boiler. For regeneration, the filter was flushed using water in opposite flow direction. The water was recycled multiple times to limit water consumption. The results are very promising. Regeneration was successful and no signs of decay could be observed over 419.5 h of operation and 234 regenerations. The filter can be operated during all phases of boiler operation, which is a major step forward compared to alternative secondary measures. Separation efficiency was high with 80–86%, even though the filter showed internal leakage, which reduced the separation efficiency. Additionally, waste products were examined. About 1000 l wastewater can be expected to be produced every month, which could be disposed using the communal waste water system, given the low heavy metal loading. A part of the fine particulate matter is unsoluble and has to be removed from the regeneration water before reuse. The unsoluble fraction contains the majority of heavy metals and has to be disposed as fly ash or used for urban mining. Generally spoken, the metal mesh filter is a new, promising option which can overcome limitations of current secondary measures without increasing costs given its simple and robust construction.

Particulate matter emissions are a key issue of modern biomass boilers. A novel gas cleaning method using a metal mesh filter combined with water-based cleaning was developed and tested. The filter was tested batch-wise. Flue gas of a commercial 50-kW boiler was filtered until a pressure drop of 2000 Pa was reached. Afterwards, the filter was regenerated. The initial prototype used ultrasound in order to remove the filter cake from the filter candles. Regeneration was complete and, even after boiler malfunctions producing tar, the filter cake could still be removed. Given the good results, a second cleaning mode, flushing the filter candles with water, was tested. The results were as good as with ultrasonic cleaning. Peak mass collection efficiency was very high with 98 ± 2% (burning wood pellets). However, directly after cleaning, the first layer of filter cake has to be developed. In this initial phase, collection efficiency is low. Service time until maximum pressure drop was reached depended on the gas velocity. Using pellets as fuel, at a gas velocity of 66.6 m/h, 12-h service time was reached and 4.1 g dust was collected per square meter filter surface, while at 33.3 m/h, service time increased to 55 h and collected dust to 13.9 g/m2. Using low-quality wood chips, the raw gas dust loading was much higher but also the maximum loading of the filter was higher with 13.3 to 28.9 g dust separated per square meter. Still, the service time decreased to 3.4 respective 38 h. Peak collection efficiency increased to 99.5 ± 0.8%. The overall collection efficiency including the buildup of the filter cake depends on the gas velocity and fuel. It ranges from 74 ± 4 to 91 ± 1%. The feasibility of the filter concept could be proven, and further development towards a commercial application is in progress. Metal mesh filters with countercurrent cleaning showed a high potential given their simple and robust design, as well as high collection efficiency.

Für die Therapie pädiatrischer Rezidiv- oder Hochrisikopatienten in frühen klinischen Studien der Phase I und II wurden unter dem Dach der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) seit 2016 fünf regionale Phase-I/II-Studiennetzwerke etabliert. Durch die Verbundstruktur werden die Kompetenzen und Ressourcen gebündelt, um so die rasche und effiziente Durchführung früher klinischer Studien mit pädiatrischen Patienten zu unterstützen. Mit der INFORM-Studie steht in der pädiatrischen Onkologie eine populationsbasierte molekulare Diagnostikstudie für Kinder- und Jugendliche mit rezidivierten Tumorerkrankungen in Deutschland und 12 anderen Ländern zur Verfügung. Erste Daten zeigen, dass Präzisionsmedizin in der pädiatrischen Onkologie im internationalen, multizentrischen Setting möglich ist, einen klinischen Nutzen erbringt und dazu beiträgt, hereditäre Krebsprädispositionssyndrome zu identifizieren, Diagnosen zu präzisieren und Patienten passenden Phase-I/II-Studien zuzuordnen. Das Angebot an innovativen molekularen Therapiestudien der Phase I/II für Kinder und Jugendliche in Deutschland ist aktuell limitiert. Die pädiatriespezifische Entwicklung zielgerichteter Therapiekonzepte und Kombinationstherapien, eine breite molekulargenetische Charakterisierung und eine darauf basierende, effiziente Zuordnung der Patienten zu Studien sind daher wichtige Aufgaben in den kommenden Jahren.

•Professional quality of life is crucial for oncology professionals.•Alexythymia and empathy affect the individual capacity to cope with stress.•Alexythimia has a negative impact on radiation therapists’ professional quality of life.•Higher empatic concern increases the quality of professional well-being.•This data may help targeting professionals at risk to implement preventive strategies.

The Image Biomarker Standardization Initiative validated consensus-based reference values for 169 radiomics features, thus enabling calibration and verification of radiomics software.

The established practice of wood ash disposal in landfills removes valuable elements, such as metals and plant nutrients, from the utilization cycle. In order to use the residual material wood ash as a secondary raw material and to conserve important natural resources (landfill space, mineral, and metallic raw materials), a treatment process must be developed. As a basis for such a process, fundamental knowledge of element solubility is required. Therefore, a sequential extraction process describing the mobility of the ash-forming elements was carried out for three ash fractions from a wood-fired heat and power plant. This work describes the extraction of 24 elements from ash by four sequentially applied extractants. As an aqueous solvent, bidest. water was used, acetic acid was used as the acidic solvent, hydroxylamine hydrochloride was used as the reducing solvent, and ammonium acetate with hydrogen peroxide was used as the oxidizing solvent. Element concentrations in the individual extractants were determined by ICP–OES. We found that the extraction is influenced by the ash fraction, the particle size, and the element-specific behavior during ash formation. Extractability is higher from filter and cyclone ash fractions compared to grate ash as well as from smaller particle size fractions within grate ash compared to coarse grate ash particles. The majority of the metals were acid-soluble. In parameter studies, we found that extractability can be increased by using stronger solvents, grinding the ash, and a longer extraction time. The results provide information on (I) the environmental mobility of the ash-forming elements and (II) suitable solvents and process parameters for the processing of ashes, with the aim of a consistent recycling of valuable substances and nutrients.

To design and optimize furnaces, modeling is a key tool. Modeling of solid fuel conversion requires the availability of valid kinetic data for the parametrization of combustion models. To provide kinetic data for low temperature devolatilization, 1 g of wood dust (oak and spruce) was devolatilized under isothermal conditions at 250–400 °C in ambient air. Between 250 and 300 °C, the reaction mechanism changes; thus only the data of 300–400 °C can be used for a kinetic analysis. For spruce, a pre-exponential factor of 237 s–1and an activation energy of 0.222 × 105J/mol were measured, and for oak 89.6 s–1and 0.181 × 105J/mol. As compared to literature data, the reaction is less temperature sensitive, indicating a diffusion limitation caused by the large sample size and experimental conditions. However, the results might be closer to reality as the conditions are similar to a furnace during start-up. Additionally, the release of the main elements, carbon, hydrogen, and oxygen, was measured. At low temperatures, carbon is enriched in the sample, as the sample is partially carbonized. With increasing temperature, more carbon is liberated as gases and less solid carbon remains.

The combustion of natural untreated wood in firewood stoves generates ashes with high contents of minor and trace elements. Those ashes can be disposed via garbage collection. Those ashes can also be used as a fertilizer. This study investigates the elemental composition of four natural untreated wood species (beech, oak, spruce, and fir) and their ashes produced in a firewood stove. In total, 30 minor and trace elements were analyzed using inductively coupled plasma-optical emission spectroscopy. With a complete set of fuel and ash data, possible effects of ashes from untreated wood on the environment are discussed. They contain nutrients in concentrations so that ashes are comparable to commercial fertilizers, but they also contain toxic trace elements in concentrations at or above limits given by relevant German legislation. However, the trace elements are not only potentially harmful but also valuable. Therefore, ashes are also valuable in terms of an urban mining prospectus because they do contain certain elements in comparable concentrations as commercially used ores. It is therefore necessary to separate the trace elements from the ash matrix before it is put on soil, and the separated trace elements need to be processed to crude materials for demanded rare earth elements.

In this work we prepare Langmuir–Blodgett monolayers with a trifunctional amphiphilic anthraphane monomer. Upon spreading at the air/water interface, the monomers self-assemble into 1 nm-thin monolayer islands, which are highly fluorescent and can be visualized by the naked eye upon excitation. In situfluorescence spectroscopy indicates that in the monolayers, all the anthracene units of the monomers are stacked face-to-face forming excimer pairs, whereas at the edges of the monolayers, free anthracenes are present acting as edge groups. Irradiation of the monolayer triggers [4 + 4]-cycloadditions among the excimer pairs, effectively resulting in a two-dimensional (2D) polymerization. The polymerization reaction also completely quenches the fluorescence, allowing to draw patterns on the monomer monolayers. More interestingly, after transferring the monomer monolayer on a solid substrate, by employing masks or the laser of a confocal scanning microscope, it is possible to arbitrarily select the parts of the monolayer that one wants to polymerize. The unpolymerized regions can then be washed away from the substrate, leaving 2D macromolecular monolayer objects of the desired shape. This photolithographic process employs 2D polymerizations and affords 1 nm-thin coatings.

We investigate the influence of non-executive outside directors on firms' innovative performance for a sample of 1,393 listed firms in the EU-15 member states plus Norway and Switzerland in the period 2005 to 2010. Our results show that the fraction of non-executive outside directors on the board is associated with a significant decrease in the number of patent applications if competition in the market is low. This may indicate that restrictive monitoring and lower advising competences of outside directors mitigate executives' incentives to innovate. In industries with effective competition, the negative influence of outsiders is offset by the pressure to focus on innovation strategies. Finally, the results are significant for continental European firms but not for the subsample of UK firms pointing to differences in the impact of specific governance systems with respect to innovation.

Hypoxia is associated with poor treatment outcome in several tumor entities. Positron emission tomography (PET) offers the possibility to visualize tumor hypoxia in a spatially resolved manner using dedicated hypoxia PET tracers. The aim of this article is to review different tracers, PET acquisition methods and data analysis strategies that have been used in previous studies. A literature research has been performed in the database PubMed using the keywords “FMISO”, “FAZA”, “HX4”, “EF3/5” or “Cu-ATSM” in combination with “hypoxia”, “PET”, and “radiotherapy” in order to review the current status of hypoxia PET acquisition and data analysis strategies. A total of 141 articles were identified during the literature search. However, after exclusion of preclinical or simulation studies, 51 remained. Hypoxia PET imaging using different PET tracers was shown to have prognostic power in order to stratify patients according to outcome after chemoradiotherapy. However, most studies present small patient groups and use a variety of different PET acquisition protocols and data analysis strategies. Hypoxia PET acquisition can be performed using either static or dynamic PET acquisition. Due to the slow diffusive transport of the tracer, image acquisition needs to be performed several (2–4) h post-injection. Motivated by the low intrinsic contrast of hypoxia PET imaging, most studies use tumor-to-muscle ratios (TMR) to define areas of tumor hypoxia from static PET images, whereas dynamic scans are quantitatively analyzed using kinetic modeling. Data acquisition and analysis for hypoxia PET imaging requires standardization and harmonization, in order to empower large multicenter trials in the future, which are needed to proof the clinical benefit of personalized treatments on the basis of hypoxia PET imaging.

Residents currently log robotic cases in the ACGME system as a “surgeon” if they performed any critical step of the procedure on the surgeon console. There is no standardization as to which steps or how much of the procedure should be performed by the resident. It was our objective to establish a tool for logging the true operative experience in robotic surgery to aid in assessing surgical competency as well as curriculum development.

In September of 2014, the American College of Radiology joined a number of other organizations in sponsoring the 2015 National Academy of Medicine report, Improving Diagnosis In Health Care. Our presentation to the Academy emphasized that although diagnostic errors in imaging are commonly considered to result only from failures in disease detection or misinterpretation of a perceived abnormality, most errors in diagnosis result from failures in information gathering, aggregation, dissemination and ultimately integration of that information into our patients’ clinical problems. Diagnostic errors can occur at any point on the continuum of imaging care from when imaging is first considered until results and recommendations are fully understood by our referring physicians and patients. We used the concept of the Imaging Value Chain and the ACR’s Imaging 3.0 initiative to illustrate how better information gathering and integration at each step in imaging care can mitigate many of the causes of diagnostic errors. Radiologists are in a unique position to be the aggregators, brokers and disseminators of information critical to making an informed diagnosis, and if radiologists were empowered to use our expertise and informatics tools to manage the entire imaging chain, diagnostic errors would be reduced and patient outcomes improved. Heath care teams should take advantage of radiologists’ ability to fully manage information related to medical imaging, and simultaneously, radiologists must be ready to meet these new challenges as health care evolves. The radiology community stands ready work with all stakeholders to design and implement solutions that minimize diagnostic errors.

Firewood combustion is the main renewable heating source for households in Europe and is responsible for a certain share of harmful emissions such as particle matter. Common wood combustion appliances in households are firewood stoves. Forced by stringent limits of European emission control legislations, the stove industry developed a wide variety of new pollution control technologies which can be integrated into firewood stoves. The aim of this study was to evaluate the performance of three emission control systems to be applied in firewood stoves which were a foam ceramic element, a catalytic active coated foam ceramic element, and a honeycomb catalyst. Combustion tests with these devices and dummies under real life operation conditions were conducted which included starting phases and stove operation in nominal and partial load. Particulate and gaseous emissions were measured, and emission conversion rates were calculated. Results showed no significant emission reduction rates for the foam ceramic element. The catalytic active coated foam ceramic element reduced the emissions considerably in nominal and partial load operation up to 32% for carbon monoxide, 61% for organic gaseous carbon, and up to 41% for particulate matter. However, emission reduction rates were rather low in the starting phase. The honeycomb catalyst showed the highest emission reduction potential of all systems in the study. The reduction rates were significant in all combustion phases and were up to 73% for carbon monoxide, 58% for organic gaseous carbon, and up to 33% for particulate matter.

Der vorliegende Beitrag ermittelt das aktuelle Ausmaß kommunaler Betätigung in der Abfallwirtschaft auf Basis von 9248 deutschen Gemeinden und Städten. Vor allem in Großstädten mit über 100.000 Einwohnern haben Kommunen fast vollständig die Restmüllsammlung übernommen. Zwar wird insgesamt über alle Kommunen betrachtet nur für knapp 34 % der Gebiete die Erfassung durch kommunale Unternehmen vorgenommen. Gewichtet man die jeweiligen Gebiete jedoch mit der Einwohneranzahl, entfällt insgesamt knapp 62 % der Restmüllerfassung auf kommunale Entsorgungsunternehmen. In Großstädten über 100.000 Einwohner haben sich kommunale Unternehmen sogar 94 % des Marktes gesichert. Private Entsorger dominieren hingegen vor allem im ländlichen Raum. Diese Befunde deuten auf eine Rosinenpickerei der Kommunen hin, die sich insbesondere die dicht besiedelten profitablen Gebiete herausgesucht haben. Im Vergleich zu bisher verfügbaren Statistiken über kommunale Aktivitäten in der Abfallwirtschaft (vgl. etwa Monopolkommission 2014) zeigt sich eine weitere Zunahme der Rekommunalisierung. Sollten die Wettbewerbsbedingungen nunmehr auch in anderen Bereichen der Abfallwirtschaft, wie etwa bei Wertstoffen, zugunsten der Kommunen verzerrt werden, ist hier mit ähnlichen Rekommunalisierungstendenzen und einer Verdrängung privater Wettbewerber zu rechnen. This paper provides an empirical analysis of local government engagement in garbage collection in 9248 German municipalities. Especially in large municipalities with more than 100,000 inhabitants local government-owned businesses have almost completely taken over garbage collection. Even though only 34% of all municipalities are organising garbage collection through local government-owned businesses, the fraction rises to 62% once we weigh municipalities by inhabitants. In large cities with more than 100,000 inhabitants local government-owned businesses have secured 94% of the market for themselves. In contrast, private firms dominate rural areas. These findings suggest that local governments engage in cherry picking and mainly serve the most profitable areas. Compared to existing statistics on local-government activities in garbage collection, as, for example, provided by the German Monopolies Commission, we find yet another increase in local government-owned business activities. If the institutional framework in other areas, such as the recycling industry, is also changed so as to tilt the level-playing field and favour local government-owned businesses similar developments and a further expulsion of private firms must be expected.

The crucial point in inorganic particle formation from biomass combustion is the temperature-dependent release of inorganic compounds, especially potassium (K). Currently, common wood fuels comprise of a comparatively low amount of K, but the increased usage of wood energy requires new feedstocks in the future. Potentially new feedstocks, such as short rotation coppice (SRC), fuels from agriculture (e.g., straw), or wood from broad-leafed trees of low rotation, contain usually high ash contents and/or high K concentrations. Apparently, these feedstocks will cause increased inorganic particle emissions from biomass combustion processes. The principle of a decreased firebed temperature as a primary measure aiming at a retention of K in the ashes of the firebed is a common approach for particle emission reduction and was investigated in several previous studies. The present study describes the usage of an ash-rich fuel from SRC pellets made from willow in a residential pellet boiler modified with an unique prototype of direct water-based firebed cooling. This test setup enables the study of the isolated impact of decreased firebed temperatures and its influence on the combustion process and emissions as well. A statistically significant effect of the firebed cooling on temperatures below the burner plate as on gaseous HCl and SO2was found. The high ash content of the used fuel limited the effectiveness of the applied direct firebed cooling in residential biomass combustion. The accumulation of a thick and thermal insulating ash layer above the burner plate decreased the heat transfer, limited the cooling efficiency, and revealed deviations from the expected particle formation process.

Seit der Fernbusliberalisierung im Januar 2013 hat eine starke Durchdringung des Marktes für Personenverkehr durch Fernbusse stattgefunden. Es zeigt sich deutlich, dass bereits zum jetzigen Zeitpunkt Wettbewerbseffekte auf den Schienenpersonenfernverkehr feststellbar sind. Dies lässt sich vor allem für das Randnetz beobachten. Auch scheint grundsätzlich die Nachfrage des ICE stärker betroffen zu sein als diejenige des IC. Dies könnte dadurch erklärt werden, dass die Relation zwischen dem Preis und der Fahrzeit beim Vergleich zwischen ICE und Fernbus eine größere Bedeutung hat als beim Vergleich zwischen IC und Fernbus. So könnten auf Strecken, die sowohl vom IC als auch ICE befahren werden, einige Kunden deshalb den ICE gewählt haben, weil ihnen die relativ hohe Zeitersparnis mehr wert war als die relativ geringe Preisersparnis. Dieses Verhältnis könnte zwischen dem ICE und dem Fernbus zugunsten des Fernbusses umgeschwungen sein, da hier die Preisersparnis erheblich ist. Aus den Ergebnissen leiten sich verschiedene wirtschaftspolitische Implikationen ab. Insbesondere stellt sich die Frage, ob analog zu der Autobahnmaut für Lastkraftwagen eine Maut auch für Fernbusse eingeführt werden sollte. Nicht nur würde damit eine Gleichstellung von Fernbussen und Lastkraftwagen hergestellt, sondern auch eine Anpassung zum Schienenverkehr, da Eisenbahnverkehrsunternehmen für die Nutzung der Bahninfrastruktur heute Nutzungsbeiträge entrichten müssen. The market for passenger transport has significantly changed since the German long-distance bus market has been deregulated in January 2013. Today we already find significant effects on long-distance rail transport services, especially in the periphery of the rail network. We find that the demand for high-speed trains in Germany, called Intercity Express (ICE), are more affected than demand for the somewhat slower Intercity (IC) trains. This finding may be explained if the relationship between price and travel time is more important for the comparison between ICE and buses than for the comparison of IC and buses. On relations which are serviced by both IC and ICE trains some customers may have previously chosen the ICE as it has been only a little bit more expensive than the IC. This trade-off may have changed, as bus travel is significantly less expensive and, therefore, price savings substantial. The results lead us to a number of policy conclusions: Especially the question arises whether a road toll for long-distance buses should be introduced, given that trucks already pay tolls. This would not only leads to an equal treatment of buses and trucks, but more importantly between buses and trains, as train operating companies already have to pay for the usage of rail infrastructures today.

In addition to the system’s complexity and uncertainty, healthcare managers face many challenges, including the increasing levels of demand and patient expectations at the time of more budget constraints enforced on healthcare service in Ireland. The delivery of a better patient care requires effective decision making especially in planning of healthcare resources. For an emergency department (ED) of a leading university hospital in the south of Dublin City, a decision support application for resource planning considering multiple performance indicators was developed. A comprehensive discrete event simulation model was used to identify the most significant variables and key factors that affect the ED performance. Combining this model with Taguchi orthogonal arrays and data envelopment analysis in an integrated manner helps to improve decision-making procedure in terms of systematic scenarios’ selection and evaluation. The developed system is used for resource planning and also to assess risks due to the shortage of medical staff of the emergency department. Results show the importance of balancing doctor numbers employed within ED in order to maintain reasonable patient throughput time.

State-of-the art radiotherapy (RT) techniques have become extremely flexible. As a consequence, highly conformal target doses in combination with optimal organ-at-risk sparing are possible. Due to this highly precise application of complex dose distributions, treatments with higher radiation doses in the tumor but without increased toxicity levels are now feasible. This offers the possibility to adapt dose distributions according to individual radiation sensitivities as measured with functional imaging modalities. Recently, combined PET/MRI has become available. This novel hybrid imaging modality offers the possibility to simultaneously image anatomical, functional and molecular characteristics of a tumor. Consequently, PET/MRI may be an optimal basis for RT individualization. This review discusses different potential applications of PET/MRI for RT treatment planning, as well as technical challenges for the integration of multi-parametric PET/MRI data into RT treatment planning.

Objective Presentation of a technique to determine objectively the degree of symmetry in the area of nose and lip in cleft patients based on analysis of photographs. To compare the objective measurements with the subjective impression.Design This was a retrospective study using a predefined photo documentation standard to capture images of the area of nose and lip.Setting Department of Oral and Maxillofacial Surgery, University of Jena, Germany.Patients Unilateral cleft patients following primary lip repair (group 1; n = 36) or secondary correction (group 2; n = 23).Main Outcome Measures Measurements were taken on standardized photographs of three dimensions in the area of the nose and two dimensions in the upper lip region. Sign tests were used to ascertain differences between the cleft and unaffected sides separately for each group. Subjective impressions regarding symmetry were gathered and quantified by means of a visual analog scale (VAS). The Mann-Whitney Utest was employed to compare the observers' impressions between the two groups.Results While significant side differences were found for all distances in group 1, only the side differences in the height of the nostril remained significant in group 2. Subjective evaluation of the nostril area improved significantly following corrective surgery. However, no such change in the area of the upper lip was recognized by the observers.Conclusions We were able to demonstrate that the measurable symmetry of the nostril area, as well as the upper lip, was significantly enhanced by corrective surgery. However, only the subjective impression of the nostril was improved.

Abstract: Purpose: This retrospective, case-control study aimed at evaluating the influence of patient-, tumor-, and management-related factors on the outcome of surgical therapy for facial basal-cell carcinoma (BCC) employing a multivariate analysis. Methods: One hundred one patients who underwent ablative surgery for BCC of the face at the Department of Oral and Maxillofacial Surgery/ Plastic Surgery, University Hospital Jena, between April 2005 and January 2009, were analyzed. Patients’ charts were screened for anamnestic features as well as management- and follow-up-related details. Standardized photographs were subjected to an esthetic evaluation. Logistic regression was used to identify factors associated with postsurgical wound healing disorders, recurrence, and esthetic impairment. Results: Following surgical BCC treatment, age and tumor location in the area of the eyes, nose, lips, and ears were independent predictors of wound healing disorders. Tumor location in the area of the eyes, nose, lips, and ears, subtype and class were independent predictors of recurrence. Female gender and location in the area of the eyes, nose, lips, and ears were independent predictors of esthetic impairment. Micrographic surgery and distant reconstruction technique were management-related predictors of wound healing disorders and esthetic outcome, respectively. Conclusions: The identified negative predictors of treatment outcome should be included in the informed consent to objectify the patient's preoperative expectations.

In their study, Zafar and colleagues demonstrate that our interpretations and recommendations do not exist in a vacuum; radiologists must embrace the opportunity and responsibility of working with our referring colleagues to optimize patient care when identifying and reporting on incidental findings.

Abstract: Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, malignant dermal mesenchymal neoplasm characterized by a slow, infiltrative growth. These neoplasms have a high tendency to recur locally after surgical excision. However, metastasizing cases are exceedingly rare. Cytogenetically, DFSP is characterized by a t(17;22)(22;q13) aberration with fusion of the COL1A1 gene on chromosome 17 with the PDGFB gene on chromosome 22. Here, we report on a successful treatment of a patient with a targeted therapy using the tyrosine kinase inhibitor Imatinib mesylate in neoadjuvant intention. Patients and methods: A patient with recurrent and initially unresectable but non-metastatic DFSP of the scalp received Imatinib over 3 months with increasing dosage from 400 mg/day to 800 mg/day orally. Due to the location of the DFSP in our patient, we intended to decrease tumor size preoperatively to allow complete surgical resection. Response to therapy was assessed by computed tomography. Results: Preoperative treatment with Imatinib resulted in decrease of tumor size by over 60% in the greatest dimension during 3 months of therapy, enabling the complete resection of the DFSP by radical surgery with achieving an acceptable cosmetic result. Surgery was followed by adjuvant Imatinib therapy over 6 months. Conclusions: Imatinib mesylate is effective in neoadjuvant treatment of primary unresectable dermatofibrosarcoma protuberans and can be considered as a useful option in the therapy regimen.

Abstract: Background: The advances of cranio-maxillofacilal surgery are considerably driven by the evolution of microsurgical techniques. At present, these methods continue to provide new therapeutic options to the field. Especially, free flap transfer has evolved to become an integral part of current treatment protocols for head and neck malignancies. It ensures uneventful wound healing even after previous radiotherapy and can often preserve form and function. For many patients, this may lead to a significant improvement in their quality of life. Objectives: This review summarizes aspects of tumor therapy, the impact of radiation, and discusses different techniques of microvascular tissue transfer. Discussion: Specific advantages in different anatomical sites of the head and neck region are highlighted in contrast to existing alternatives. Selected cases exemplify the use of popular transplants. Summary: While planning reconstructions, it is important to consider both the functional and aesthetic aspects. The best individual outcome is based on a thoughtful match of available methods to a given defect and the patient’s condition.

Applying Diamond Like Carbon (DLC) as medical coating has become well established since large scale plasma processes like Plasma Immersion Ion Implantation and Deposition (PIII&D) are available. Now the focus of research lies on systematic modification of certain biological relevant properties and the most recent field of interest turned to generating antimicrobial behaviour. This is desirable for medical tools as well as for different types of medical implants. Since silver and copper are known to provide a bactericidal effect, one tries to introduce clusters of these noble metals into the carbon matrix.The basic principle of the method presented is to convert a metal containing polymer film into DLC by ion bombardment. In this paper the hydrogenated DLC matrix is characterized and the evolution of the metal particles is studied. By means of film composition (RBS/ERD), bonding structure (Raman spectroscopy) and hardness (nanoindentation), the dependency of these material properties on ion species, energy and fluence is investigated. TEM imaging is used to visualize the film structure.Upon ion irradiation of the polymer films, increased density and considerable loss of hydrogen can be observed, which both are controlled by ion fluence and mass. The crosslinking of the carbon network, caused by hydrogen drive out as well as atomic displacements in collision cascades, results in the formation of a-C:H. The silver particles in the film some ion induced growth, but still remain as nanoclusters in the a-C:H matrix. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Ewing's sarcoma is the second most common primary bone malignancy in childhood and adolescence. We present a standardized interdisciplinary treatment protocol according to the EURO-E.W.I.N.G. 99 study, applied in the treatment of a 7-year-old patient with localized Ewing's sarcoma of the left mandible. After six blocks of VIDE (vincristine/ifosfamide/doxorubicin/etoposide) chemotherapy and stem cells rescue, intensity modulated external radiation with 48.6 Gy and subsequent high dose therapy with busulphan-melphalan were administered. Tumor resection and immediate bony reconstruction was performed using a microvascular fibula graft 10 weeks after radiation. Because of the effective neoadjuvant treatment, no extensive soft tissue resection was necessary. Healing of the osteosynthesis was uneventful. No local or systemic recurrence and no signs of significant facial deformity were found after 12 month follow-up. The presented case underlines the requirement for multidisciplinary protocols involving radiologists, pathologists, oncologists, radiation oncologists, and surgeons for accurate diagnosis and appropriate therapy. To preserve cosmetics and function within the craniofacial area after tumor resection in children, microvascular reconstructive procedures can be successfully performed with a vascularized fibular graft.

A method is presented to identify and quantify hypoxia in human head-and-neck tumours based on dynamic [¹⁸F]-Fmiso PET patient data, using a model for the tracer transport. A compartmental model was developed, inspired by recent immunohistochemical investigations with the tracer pimonidazole. In order to take the trapping of the tracer and the diffusion in interstitial space into account, the kinetic model consists of two compartments and a specific input function. This voxel-based data analysis allows us to decompose the time-activity curves (TACs) into their perfusion, diffusion and hypoxia-induced retention components. This characterization ranges from well perfused tumours over diffusion limited hypoxia to strong hypoxia and necrosis. The overall shape of the TAC and the model parameters may point at the structural architecture of the tissue sample. The model addresses the two main problems associated with hypoxia imaging with PET. Firstly, the hypoxic areas are spatially separated from well perfused vessels, causing long diffusion times of the tracer. Secondly, tracer uptake occurs only in viable hypoxic cells, which constitute only a small subpopulation in the presence of necrosis. The resulting parameters such as the concentration of hypoxic cells and the perfusion are displayed in parameter plots (‘hypoxia map’). Quantification of hypoxia performed with the presented kinetic model is more reliable than a criterion based on static standardized uptake values (SUV) at an early timepoint, because severely hypoxic/necrotic tissues show low uptake and are thus overlooked by SUV threshold identification. The derived independent measures for perfusion and hypoxia may provide a basis for individually adapted treatment planning.