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Commonly used to characterize mind wandering, task-unrelated thought has long been associated with negative affective outcomes. However, less is known about how other thought dimensions including intentionality and freedom of movement interact with task-unrelated thought to modulate momentary affect in everyday life. To address this, we used ecological momentary assessments to prompt participants to report their thought patterns and affective valence five times a day for seven consecutive days. Each assessment asked participants to report on their affective valence as well as several thought dimensions including their task-relatedness, intentionality and freedom of movement. We examined the latter two thought dimensions alone as well as how they interacted with the commonly examined dimension of task-relatedness with respect to their relationship to momentary affect. We replicated the well-established negative relationship between task-unrelated thought and momentary affect. Furthermore, unintentional task-unrelated thought was associated with more negative affect than intentional thought. This pattern was also observed more broadly in thoughts regardless of their task relevance. In contrast, freely moving thought was positively related to momentary affect in general. A significant interaction between task-relatedness and freedom of movement of thought revealed that the commonly reported negative relationship between task-unrelated thought and more negative affect is mitigated by freely moving thought. In summary, our findings indicate that these various thought dimensions have unique relationships with momentary affect, highlighting the importance of accounting for thought dimensions in establishing its affective and possibly other functional consequences.

The Compact SOLSTICE, a compact far and mid ultraviolet (FUV and MUV) spectrograph, flew on a sounding rocket on 18 June 2018 to validate and potentially calibrate the SOLar STellar Irradiance Comparison Experiment (SOLSTICE) onboard the Solar Radiation Climate Experiment (SORCE) spacecraft. This article reports the instrument design, the calibration of the FUV channel, and the FUV irradiance measurements. Irradiance measurements are compared to SOLSTICE showing agreement within the combined instrumental uncertainties at most wavelengths, including the H Lyman-$\alpha $ α emission at 121.6 nm. Some unexplained differences in line ratios between 130.5 nm and 147.5 nm are observed.

Accurate information on diet composition is central to understanding and conserving carnivore populations. Quantitative fatty acid signature analysis (QFASA) has emerged as a powerful tool for estimating the diets of predators, but ambiguities remain about the timeframe of QFASA estimates and the need to account for species-specific patterns of metabolism. We conducted a series of feeding experiments with four juvenile male brown bears (Ursus arctos) to (1) track the timing of changes in adipose tissue composition and QFASA diet estimates in response to a change in diet and (2) quantify the relationship between consumer and diet FA composition (i.e., determine "calibration coefficients"). Bears were fed three compositionally distinct diets for 90-120 days each. Two marine-based diets were intended to approximate the lipid content and composition of the wild diet of polar bears (U. maritimus). Bear adipose tissue composition changed quickly in the direction of the diet and showed evidence of stabilization after 60 days. During hibernation, FA profiles were initially stable but diet estimates after 10 weeks were sensitive to calibration coefficients. Calibration coefficients derived from the marine-based diets were broadly similar to each other and to published values from marine-fed mink (Mustela vison), which have been used as a model for free-ranging polar bears. For growing bears on a high-fat diet, the temporal window for QFASA estimates was 30-90 days. Although our results reinforce the importance of accurate calibration, the similarities across taxa and diets suggest it may be feasible to develop a generalized QFASA approach for mammalian carnivores.

Zusammenfassung Hintergrund Osteoidosteome zählen zu den benignen ossären Neoplasien und können am gesamten Skelett auftreten. Die verlängerte Diagnosestellung eines Osteoidosteoms der Großzehe veranlasste uns, einen Fallbericht mit Review der Literatur zu verfassen, um mögliche Fehlerquellen zu identifizieren und einen Beitrag zur zügigeren Diagnosefindung und Therapie zu leisten. Literatur In der deutschen Literatur sind aktuell nur zwei Fallberichte zu Osteoidosteomen der Zehen bekannt. International wurde allerdings eine Vielzahl an Fällen beschrieben, die in der Zusammenschau ein homogenes Bild ergeben. Eine sehr deutliche Häufung von Osteoidosteomen am Endglied der Großzehe lassen eine posttraumatische Ätiologie möglich erscheinen. Der typische NSAR-sensible Nachtschmerz ist klinisch eindeutig und sollte an jeder Lokalität des Körpers an ein Osteoidosteom denken lassen. Auffällig ist das an den Zehen einzigartige Symptom der Makrodaktylie, was ein dankbarer Hinweis zur Diagnosefindung sein kann. Die mittlere Zeit vom Symptombeginn bis zur korrekten Diagnosestellung betrug 12 Monate. Häufig wurden Fehldiagnosen und Fehltherapien unter einer anderen Verdachtsdiagnose beschrieben. Eine mögliche Ursache ist die häufig atypische und uneindeutige Bildgebung. Die operative Therapie stellt bei Osteoidosteomen der Zehen die Methode der Wahl dar und sollte stets durch eine histopathologische Untersuchung ergänzt werden.

BACKGROUND: Home telemonitoring has been used with discharged patients in an attempt to reduce 30-day readmissions with mixed results. OBJECTIVE: To assess whether home 30-day telemonitoring after discharge for patients at high risk of readmission would reduce readmissions or mortality. DESIGN: Prospective, randomized controlled trial. PATIENTS: We compared 30-day readmission rates and mortality for patients at high risk for readmission who received home telemonitoring versus standard care between November 1, 2014, and November 30, 2018, in 2 tertiary care hospitals. INTERVENTIONS: The intervention group received home-installed equipment to measure blood pressure, heart rate, pulse oximetry, weight if heart failure was present, and glucose if diabetes was present. Results were transmitted daily and reviewed by a nurse. Both groups received standard care. MAIN MEASURES: The primary outcome was a composite end point of hospital readmission or death within 30 days after discharge. The secondary outcome was an emergency department visit within 30 days after discharge. KEY RESULTS: A total of 1380 participants (mean [SD] age, 66 [14] years; 722 [52.3%] men and 658 [47.7%] women) participated in this study. Using a modified intention-to-treat analysis, the risk of readmission or death within 30 days among patients at high readmission risk was 23.7% (137/578) in the control group and 18.2% (87/477) in the telemonitoring group (absolute risk difference, − 5.5% [95% CI, − 10.4 to − 0.6%]; relative risk, 0.77 [95% CI, 0.61 to 0.98]; P = .03). Emergency department visits occurred within 30 days after discharge in 14.2% (81/570) of patients in the control group and 8.6% (40/464) of patients in the telemonitoring group (absolute risk difference, − 5.6% [95% CI, − 9.4 to − 1.8%]; relative risk, 0.61 [95% CI, 0.42 to 0.87]; P = .005). CONCLUSIONS: Thirty days of postdischarge telemonitoring may reduce readmissions of high-risk patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02136186. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-020-06589-1.

Zusammenfassung Hintergrund Die Notfallversorgung befindet sich im Umbruch. In Notaufnahmen werden Patienten ausgehend von Symptomen und Dringlichkeit versorgt; dies bildet sich jedoch in den etablierten Routinedaten der gesetzlichen Sozialversicherung nicht ab. Ziel des AKTIN-Projekts war der Aufbau einer datenschutzkonformen Registerinfrastruktur zur Nutzung von klinischen Routinedaten aus Notaufnahmen. Methoden Über eine standardisierte Schnittstelle werden aus den verschiedenen Dokumentationssystemen kontinuierlich Daten der Notaufnahmebehandlung in ein lokales Data Warehouse exportiert. Dort stehen sie sowohl für lokale Nutzungen, wie interne Berichte und Qualitätsmanagement, als auch gleichzeitig datenschutzkonform für multizentrische Auswertungen zur Verfügung. Anhand der Registerpopulation wird die Ersteinschätzung sowie die Erhebung von Vitalparametern in Abhängigkeit von Vorstellungsgründen für einen 12-Monats-Zeitraum analysiert. Ergebnisse Für den Zeitraum 04/2018 bis 03/2019 wurden 436.149 gültige Fälle aus 15 Notaufnahmen übermittelt. In 86,0 % der Fälle ist eine Ersteinschätzung dokumentiert. Diese fand in 70,5 % innerhalb von 10 min nach Ankunft des Patienten statt. In 10 Kliniken wird regelhaft (82,3 %) ein Vorstellungsgrund erfasst. Die Erfassung von Vitalparametern variiert plausibel zwischen den Vorstellungsgründen. Schlussfolgerung Das AKTIN-Notaufnahmeregister bietet einen zeitnahen Einblick in das Versorgungsgeschehen der Notaufnahmen ohne zusätzlichen Dokumentationsaufwand und unabhängig vom primären IT-System, Kostenträger, Fallart und Abrechnungsmodus. Die Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung werden weitgehend umgesetzt. Durch die Etablierung von standardisierten Vorstellungsgründen werden symptombasierte Analysen und Gesundheitssurveillance ermöglicht.

ZusammenfassungUnsere Zeit der sprunghaft anwachsenden Datenmengen in allen Bereichen erfordert die Ausbildung von Datenkompetenz als Schlüsselkompetenz für das 21. Jahrhundert. Kenntnisse zur Datensammlung, zum Datenmanagement, zur Datenevaluation und zur Datenanwendung bilden die Grundlage für einen kompetenten Umgang mit Daten in Wissenschaft, Wirtschaft und Gesellschaft. Umfangreiche Datenmengen sind heute in allen Lebensbereichen in Wertschöpfungsketten eingebunden, die es zu gestalten und zu bewerten gilt. Insbesondere im Bereich der Wissenschaftsdaten wird dies auch institutionell unterstützt, um aus Daten neues Wissen und neue Einsichten generieren zu können.

Zusammenfassung Hintergrund Vor dem Hintergrund der steigenden Inanspruchnahme und aktuellen Veränderungen in der Notfallversorgung ist eine standardisierte Erfassung relevanter Kennzahlen in Notaufnahmen zwingend erforderlich. Ziel der Arbeit Es werden die Konsentierung von Inhalten und technische Umsetzung eines automatisierten Reportings für Notaufnahmen des AKTIN-Notaufnahmeregisters beschrieben. Ziel war ein aussagefähiger Monatsbericht zur Prozesssteuerung und Qualitätssicherung. Material und Methoden Datengrundlage ist der Datensatz Notaufnahme V2015.1 der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin e. V. (DIVI). Die Konsentierung der Inhalte erfolgte auf Basis von externen Referenzen und fachlicher Expertise; die technische Entwicklung erfolgte anhand eines Testdatensatzes. Mit der Software R und Apache Formatting Objects Processor (FOP) wird der finale Bericht im PDF-Format automatisiert erstellt. Ergebnisse Der Bericht enthält unter anderem Angaben zu Fallzahlen, Demografie der Patienten, Vorstellungsgründen, Ersteinschätzung, Verbleib und ausgewählten Prozesszeiten in Form von Tabellen und Grafiken. Er wird monatsweise automatisch oder auf Anforderung aus den Routinedaten generiert. Fehlende Werte und Ausreißer werden zur Abschätzung der Datenqualität separat ausgewiesen. Diskussion Beim AKTIN-Monatsbericht handelt es sich um ein Instrument, welches das Versorgungsgeschehen aufbereitet und visualisiert. Die konsentierten Kennzahlen sind praxistauglich und bilden auch die Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung ab. Die Nutzung von Interoperabilitätsstandards erlaubt eine automatische Erfassung im Alltag, gewährleistet eine Unabhängigkeit von einzelnen IT-Systemen und kann als Grundlage für ein klinikübergreifendes Benchmarking dienen.

Polar bears (Ursus maritimus) rely on sea ice for hunting marine mammal prey. Declining sea ice conditions associated with climate warming have negatively affected polar bears, especially in the southern portion of their range. At higher latitudes, the transition from multi-year ice to thinner annual ice has been hypothesized to increase biological productivity and potentially improve polar bear foraging conditions. To investigate this possibility, we used quantitative fatty acid signature analysis to characterize the diet composition of 148 polar bears in two high-latitude subpopulations from 2012 to 2014: (1) Viscount Melville Sound, where little is known about marine mammal ecology, and (2) Northern Beaufort Sea, a subpopulation considered stable with comparatively more ecological data. We used adipose tissue lipid content as an index of body condition. To characterize long-term habitat conditions, we examined trends in sea ice metrics from 1979 to 2014 in both regions. Although the diets of bears in both subpopulations were dominated by ringed seal (Pusa hispida, mean biomass consumption = 45%), bears in Viscount Melville Sound showed higher proportional consumption of beluga whale (Delphinapterus leucas; mean biomass consumption = 37%) than any other polar bear subpopulation studied to date. Although the three-year duration of our study precludes long-term insights, relatively lighter sea ice conditions in Viscount Melville Sound were associated with reduced consumption of preferred prey (i.e., ringed seal), especially among female polar bears. Further, polar bears in Viscount Melville sound were in poorer body condition than those in the Northern Beaufort Sea. Our results do not indicate that declining sea ice has had any positive effect on polar bear foraging at high-latitudes.

We analyse the top tail of the wealth distribution in France, Germany, and Spain using the first and second waves of the Household Finance and Consumption Survey (HFCS). Since top wealth is likely to be under-represented in household surveys, we integrate big fortunes from rich lists, estimate a Pareto distribution, and impute the missing rich. In addition to theForbeslist, we rely on national rich lists since they represent a broader base of the big fortunes in those countries. As a result, the top 1% wealth share increases notably for the three selected countries after imputing the top wealth. We find that national rich lists can improve the estimation of the Pareto coefficient in particular when the list of national USD billionaires is short.

We formalize algebraic numbers in Isabelle/HOL. Our development serves as a verified implementation of algebraic operations on real and complex numbers. We moreover provide algorithms that can identify all the real or complex roots of rational polynomials, and two implementations to display algebraic numbers, an approximative version and an injective precise one. We obtain verified Haskell code for these operations via Isabelle's code generator. The development combines various existing formalizations such as matrices, Sturm's theorem, and polynomial factorization, and it includes new formalizations about bivariate polynomials, unique factorization domains, resultants and subresultants.

Background Symptoms of depression and anxiety experienced by undergraduate medical students have become a prominent concern. Evidence about students’ depression and anxiety including prevalence, trajectory during medical education, gender differences and comparisons with age-matched peers is conflicting. However few studies of medical students’ mental health specify the precise time of assessment. Proximity to examinations may be relevant. Precise identification of the time of data collection might help explain contradictory findings and facilitate provision of more timely support. Methods This study addressed whether: Proximity of final examinations affected students’ depression and anxiety symptomsMales and females differed in this respect. We analysed data provided by 446 final year students from 6 UK medical schools. These students were a subset of data provided by 14 UK medical schools which participated in an online survey comparing first and final year students and in which final year response rates exceeded 30%. We used the Hospital Anxiety and Depression Scale to assess symptoms of depression and anxiety and the norms to indicate potentially clinically relevant cases. We grouped students into those for whom final exams were imminent i.e. within 2 months of completing the survey (n = 164) and those for whom exams were more distant or had been taken (n = 282). We used parametric and non-parametric tests to compare both groups and gender differences in respect of depression and anxiety sum scores and cases rates. Results For both depression and anxiety male and female students facing imminent final exams recorded greater prevalence and significantly higher mean scores. The effect size of differences for anxiety were large. No substantial gender differences were found for depression. Regardless of the timing of final exams female students recorded both significantly higher mean scores and clinically relevant rates for anxiety. Conclusions Proximity to final exams negatively affected the mental health of both male and female final year students. The study suggests that there may be times in the undergraduate medical curriculum when additional or targeted support is needed. It also highlights the need for research to provide a greater specificity of context when investigating medical students’ mental health.