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We have produced a number of small format gallium arsenide (GaAs) arrays to address the material, electronic, and technological problems that need to be solved in order to develop mega pixel, Fano-limited spectroscopic x-ray imagers. Results will be presented of a series of x-ray measurements carried out on a prototype 5×5 array, fabricated from 40 μm thick epitaxial GaAs. The device has pixel sizes of 200×200 μm[sup 2] and pitch 250 μm. As a preliminary investigation of performance, two pixels have been instrumented. Measurements from 5.9 to 98 keV were carried out both in our laboratory and at the Hamburger Synchrotronstrahlungslabor research facility in Hamburg, Germany. Both pixels were found to be remarkably uniform, both in their spectral and spatial response to x-rays. The average nonlinearity in the spectral response is <1% across the energy range 5.9–98 keV. Using a 12 keV, 20×20 μm[sup 2] pencil beam, the spatial uniformity was found to be better than 98% over the entire pixel surfaces, consistent with the statistical precision of the measurement. The energy resolution at -40 °C is 400 eV full width at half maximum (FWHM) at 5.9 keV rising to 700 eV FWHM at 98 keV. No difference in energy resolution was found between full area and pencil beam illumination. An analysis of the resolution function has shown that the detector is dominated by electronic noise at low energies and Fano noise at energies above 30 keV. By best-fitting the expected resolution function to the entire data set, we derive a Fano factor of 0.140±0.05, together with a charge transport factor as low as 1.4×10[sup -3]. Further improvement in the resolution function has been achieved by replacing the conventional resistive feedback preamplifiers with a new resistorless design, which provides a lower component of electronic noise. In this case, a resolution of 266 eV FWHM at 5.9 keV has been achieved at room temperature (23 ... [ABSTRACT FROM AUTHOR]

Background: Many health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a "context-mechanisms-outcomes"-based model provides insights into when and why beneficial outcomes can be achieved.Methods: We conducted 15 semi-structured interviews with health professionals employed at the hospital. The data were qualitatively analysed using a "context-mechanisms-outcomes"-based model. Specifically, mechanisms were defined as the different components of the integrated care intervention and categorised according to Wagner's Chronic Care Model (CCM). Context was understood as the setting in which the mechanisms are brought into practice and described by the barriers and facilitators encountered in the implementation process. These were categorised according to the six levels of Grol and Wensing's Implementation Model (IM): innovation, individual professional, patient, social context, organisational context and economic and political context. Outcomes were defined as the effects triggered by mechanisms and context, and categorised according to the six dimensions of quality of care as defined by the World Health Organization, namely effectiveness, efficiency, accessibility, patient-centeredness, equity and safety.Results: The integrated care intervention consisted of three main components: a specific reimbursement system ("early complex geriatric rehabilitation"), multidisciplinary cooperation, and comprehensive geriatric assessments. The inflexibility of the reimbursement system regarding the obligatory number of treatment sessions contributed to over-, under- and misuse of services. Multidisciplinary cooperation was impeded by a high workload, which contributed to waste in workflows. The comprehensive geriatric assessments were complemented with information provided by family members, which contributed to decreased likelihood of adverse events.Conclusions: We recommend an increased focus on trying to understand how intervention components interact with context factors and, combined, lead to positive and/or negative outcomes. [ABSTRACT FROM AUTHOR]

Background: Probiotics can modulate the immune system in healthy individuals and may help reduce symptoms related to respiratory infections. Objective: The objective of the study was to investigate the effect of the probiotic strain Lactobacillus paracasei subsp. paracasei, L. casei 431 (Chr. Hansen A/S) (hereafter, L. casei 431) on immune response to influenza vaccination and respiratory symptoms in healthy adults. Design: A randomized double-blind, placebo-controlled trial was conducted in 1104 healthy subjects aged 18-60 y at 2 centers in Germany and Denmark. Subjects were randomly assigned to receive an acidified milk drink containing ≥109 colony-forming units of L. casei 431 (n = 553) or placebo (n = 551) for 42 d. After 21 d, subjects received the seasonal influenza vaccination. The primary outcome was seroprotection rate (anti-influenza antibody titers by hemagglutination inhibition) 21 d after vaccination. Other outcomes were seroconversion rate and mean titers, influenza A–specific antibodies and incidence, and duration and severity of upper respiratory symptoms. Antibiotic use and use of health care resources were recorded. Results: There was no effect of L. casei 431 on immune responses to influenza vaccination. Generalized linear mixed modeling showed a shorter duration of upper respiratory symptoms in the probiotic group than in the placebo group (mean ± SD: 6.4 ± 6.1 vs. 7.3 ± 9.7 d, P = 0.0059) in the last 3 wk of the intervention period. No statistically significant differences were found for incidence or severity. Conclusions: Daily consumption of L. casei 431 resulted in no observable effect on the components of the immune response to influenza vaccination but reduced the duration of upper respiratory symptoms. The trial was registered at www.isrctn.com as ISRCTN08280229. [ABSTRACT FROM AUTHOR]

Focuses on summer universities for women in Germany. Historical background on the venture of summer universities for women; Significance of universities for women; Function of summer universities.