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Background Insight into outcome variation between hospitals could help to improve quality of care. We aimed to assess the validity of early outcomes as quality indicators for acute ischemic stroke care for patients treated with endovascular therapy (EVT). Methods and Results We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. Random effect linear and proportional odds regression were used to analyze the effect of case mix on between‐hospital differences in 2 early outcomes: the National Institutes of Health Stroke Scale (NIHSS) score at 24 to 48 hours and the expanded thrombolysis in cerebral infarction score. Between‐hospital variation in outcomes was assessed using the variance of random hospital effects (tau 2 ). In addition, we estimated the correlation between hospitals' EVT‐patient volume and (case‐mix–adjusted) outcomes. Both early outcomes and case‐mix characteristics varied significantly across hospitals. Between‐hospital variation in the expanded thrombolysis in cerebral infarction score was not influenced by case‐mix adjustment (tau 2 =0.17 in both models). In contrast, for the NIHSS score at 24 to 48 hours, case‐mix adjustment led to a decrease in variation between hospitals (tau 2 decreases from 0.19 to 0.17). Hospitals' EVT‐patient volume was strongly correlated with higher expanded thrombolysis in cerebral infarction scores ( r =0.48) and weakly with lower NIHSS score at 24 to 48 hours ( r =0.15). Conclusions Between‐hospital variation in NIHSS score at 24 to 48 hours is significantly influenced by case‐mix but not by patient volume. In contrast, between‐hospital variation in expanded thrombolysis in cerebral infarction score is strongly influenced by EVT‐patient volume but not by case‐mix. Both outcomes may be suitable for comparing hospitals on quality of care, provided that adequate adjustment for case‐mix is applied for NIHSS score.

Icy grain mantles are the main reservoir of the volatile elements that link chemical processes in dark, interstellar clouds with the formation of planets and composition of their atmospheres. The initial ice composition is set in the cold, dense parts of molecular clouds, prior to the onset of star formation. With the exquisite sensitivity of JWST, this critical stage of ice evolution is now accessible for detailed study. Here we show the first results of the Early Release Science program "Ice Age" that reveal the rich composition of these dense cloud ices. Weak ices, including, $^{13}$CO$_2$, OCN$^-$, $^{13}$CO, OCS, and COMs functional groups are now detected along two pre-stellar lines of sight. The $^{12}$CO$_2$ ice profile indicates modest growth of the icy grains. Column densities of the major and minor ice species indicate that ices contribute between 2 and 19% of the bulk budgets of the key C, O, N, and S elements. Our results suggest that the formation of simple and complex molecules could begin early in a water-ice rich environment., Comment: To appear in Nature Astronomy on January 23rd, 2023. 33 pages, 16 figures, 3 tables; includes extended and supplemental data sections. Part of the JWST Ice Age Early Release Science program's science enabling products. Enhanced spectra downloadable on Zenodo at the following DOI: 10.5281/zenodo.7501239

Background Time to reperfusion in patients with ischemic stroke is strongly associated with functional outcome and may differ between hospitals and between patients within hospitals. Improvement in time to reperfusion can be guided by between‐hospital and within‐hospital comparisons and requires insight in specific targets for improvement. We aimed to quantify the variation in door‐to‐reperfusion time between and within Dutch intervention hospitals and to assess the contribution of different time intervals to this variation. Methods and Results We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. The door‐to‐reperfusion time was subdivided into time intervals, separately for direct patients (door‐to‐computed tomography, computed tomography‐to‐computed tomography angiography [CTA], CTA‐to‐groin, and groin‐to‐reperfusion times) and for transferred patients (door‐to‐groin and groin‐to‐reperfusion times). We used linear mixed models to distinguish the variation in door‐to‐reperfusion time between hospitals and between patients. The proportional change in variance was used to estimate the amount of variance explained by each time interval. We included 2855 patients of 17 hospitals providing endovascular treatment. Of these patients, 44% arrived directly at an endovascular treatment hospital. The between‐hospital variation in door‐to‐reperfusion time was 9%, and the within‐hospital variation was 91%. The contribution of case‐mix variables on the variation in door‐to‐reperfusion time was marginal (2%–7%). Of the between‐hospital variation, CTA‐to‐groin time explained 83%, whereas groin‐to‐reperfusion time explained 15%. Within‐hospital variation was mostly explained by CTA‐to‐groin time (33%) and groin‐to‐reperfusion time (42%). Similar results were found for transferred patients. Conclusions Door‐to‐reperfusion time varies between, but even more within, hospitals providing endovascular treatment for ischemic stroke. Quality of stroke care improvements should not only be guided by between‐hospital comparisons, but also aim to reduce variation between patients within a hospital, and should specifically focus on CTA‐to‐groin time and groin‐to‐reperfusion time.

The total disk gas mass and elemental C, N, O composition of protoplanetary disks are crucial ingredients for our understanding of planet formation. Measuring the gas mass is complicated, since H$_2$ cannot be detected in the cold bulk of the disk and the elemental abundances with respect to hydrogen are degenerate with gas mass in all disk models. We present new NOEMA observations of CO, $^{13}$CO, C$^{18}$O and optically thin C$^{17}$O $J$=2-1 lines, and use additional high angular resolution Atacama Large Millimeter Array millimeter continuum and CO data to construct a representative model of LkCa 15. The transitions that constrain the gas mass and carbon abundance most are C$^{17}$O 2-1, N${_2}$H$^+$ 3-2 and HD 1-0. Using these three molecules we find that the gas mass in the LkCa 15 disk is $M_\mathrm{g}=0.01 ^{+0.01}_{-0.004} M_{\odot}$, a factor of six lower than estimated before. The carbon abundance is C/H = ($3 \pm 1.5) \times10^{-5}$, implying a moderate depletion of elemental carbon by a factor of 3-9. All other analyzed transitions also agree with these numbers, within a modeling uncertainty of a factor of two. Using the resolved \ce{C2H} image we find a C/O ratio of $\sim$1, which is consistent with literature values of H$_2$O depletion in this disk. The lack of severe carbon depletion in the LkCa 15 disk is consistent with the young age of the disk, but contrasts with the higher depletions seen in older cold transition disks. Combining optically thin CO isotopologue lines with N$_2$H$^+$ is promising to break the degeneracy between gas mass and CO abundance. The moderate level of depletion for this source with a cold, but young disk, suggests that long carbon transformation timescales contribute to the evolutionary trend seen in the level of carbon depletion among disk populations, rather than evolving temperature effects and presence of dust traps alone., Comment: 16 pages, 8 figures. Accepted for publication in A&A

BackgroundRandomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice.MethodsThe Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0–2), and death.ResultsOf 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9–10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, pConclusionsWithout the use of CT perfusion selection criteria, EVT in the 6.5–24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window.

Context. Protoplanetary disks are known to host spiral features that are observed in scattered light, ALMA continuum and more recently in CO gas emission and gas dynamics. It is however unknown if spirals in gas and dust trace the same morphology. Aims. We study the morphology and amplitude of dusty spirals as function of Stokes number and the underlying mechanisms causing a difference from gas spirals. We then construct a model to relate the deviation from Keplerian rotation in the gas to a perturbation in surface density of gas and dust. Methods. We use FARGO-3D with dust implementation to numerically study the spirals, after which the results are interpreted using a semi-analytical model. This model is tested on observational data to predict the perturbation of the spiral in gas dynamics based on the continuum data. Results. We find that the pitch angle of a spiral does not differ significantly between gas and dust. The amplitude of the dust spiral decreases with Stokes number (St) and starts to fade out at a typical St > 0.1 as the dust becomes decoupled from the gas. The semianalytical model provides an accurate and fast representation of the spiral in surface density of the dust from the gas. We find a spiral in the TW Hya velocity residual map, never seen before, which is a feature in the vertical velocity and has a kink at the continuum gap, yielding strong evidence for a planet at 99 au. Conclusions. We built a model that gives an estimate of the underlying dynamics of dust in a spiral, which can serve as a proof of planetary origin of spirals and can be a probe for the Stokes number in the disk., 11 pages, 8 figures, appendices, accepted to A&A 14 September 2020

The composition of planets may be largely determined by the chemical processing and accretion of icy pebbles in protoplanetary disks. Recent observations of protoplanetary disks hint at wide-spread depletion of gaseous carbon. The missing volatile carbon is likely frozen in CO and/or CO$_2$ ice on grains and locked into the disk through pebble trapping in pressure bumps or planetesimals. We present the results of the first successful ACA (Atacama Compact Array) [C I] $J$ = 1-0 mini-survey of seven protoplanetary disks. Using tailored azimuthally symmetric DALI (Dust And LInes) thermo-chemical disk models, supported by the [C I] $J$ = 1-0 and resolved CO isotopologue data, we determine the system-averaged elemental volatile carbon abundance in the outer disk of three sources. Six out of seven sources are detected in [C I] $J$ = 1-0 with ACA, four of which show a distinct disk component. Based on the modeling we find severe cold gaseous carbon depletion in the outer disk of DL Tau and moderate depletion in the outer disks of DR Tau and DO Tau. Combining the outer and inner disk carbon abundances, we demonstrate definitive evidence for radial drift in the disk of DL Tau, where the existence of multiple dust rings points to either short lived or leaky dust traps. We find dust locking in the compact and smooth disks of DO Tau and DR Tau, hinting at unresolved dust substructure. Comparing our results with stars of different ages and luminosities, we identify an observational evolutionary trend in gaseous carbon depletion that is consistent with dynamical models of CO depletion processes. Transport efficiency of solids in protoplanetary disks can significantly differ from what we expect based on the current resolved substructure in the continuum observations. This has important implications for our understanding of the impact of radial drift and pebble accretion on planetary compositions., Comment: 23 pages, 19 figures, accepted to A&A

IEEE access 8, 165913-165926 (2020). doi:10.1109/ACCESS.2020.3022824, Published by IEEE, New York, NY

International Conference on the Technology of Plasticity, ICTP 2017 : 17-22 September 2017, Cambridge, United Kingdom / Edited by Julian Allwood International Conference on the Technology of Plasticity, ICTP 2017, Cambridge, UK, 17 Sep 2017 - 22 Sep 2017; Amsterdam [u.a.] : Elsevier, Procedia engineering, 207, 437-441 (2017). doi:10.1016/j.proeng.2017.10.801, Published by Elsevier, Amsterdam [u.a.]

Development and manufacturing of high quality cast parts with tight dimensional requirements depend to a large extent on the stability and application of the sand cores. The core-sand is based on a complex granular multi-material system, where curing of an organic or inorganic system bond the grains into a porous core. The chosen combination of sand and binder determines the thermo-mechanical properties of the core. The paper provides an overview of current modelling capabilities along the life cycle of sand cores. A detailed analysis of the production steps is presented as well as the resulting properties linked to the application in the casting process. Several questions and some answers are given to the understanding of core related defects and how simulation can bridge the gap between core production and application of cores in the casting process. Today, process simulation of sand core production is an accepted tool for core box design and prediction of robust production conditions. The first modelling step is core shooting where expanding air is the driving force for sand flow from a core shooting machine into the core box. Coupled two phase flow modelling of air and granular material is required to represent the process sufficiently. The final process step in core manufacturing is core curing and moisture transport where porous media gas flow modelling is applied. Phase transformations as well as the relevant transport phenomena and the complete heat balance in case of thermally controlled processes need to be considered. During casting the deformation of the bonded sand material is generally governed by thermal expansion, phase transformation and the location of core prints. For long thin walled cores, buoyancy forces due to density differences between the cast material and the bonded sand material can play an important role due to creep effects in the organic binder systems. For inorganic systems moisture content and moisture transport during casting are affecting the mechanical behaviour, such as bending strength. The paper presents a detailed overview of a recent implemented soil plasticity model which is calibrated for different binder systems and sand types. The data are based on comprehensive mechanical tests to provide temperature, moisture and time dependent input data for the shown examples. This includes new steps and future challenges in modelling the anisotropy of printed sand cores and digitalization of the foundry in general.

We studied a possibility of fabricating LaN/B grazing incidence multilayer mirrors for 6.

In magnetic resonance imaging (MRI), compressed sensing (CS) enables the reconstruction of undersampled sparse data sets. Thus, partial acquisition of the underlying k-space data is sufficient, which significantly reduces measurement time. WhileTwo resampling strategies in combination with CS reconstructions are presented. Numerical simulations are performed for low-SNR spatially sparse data obtained fromAn improvement in overall image quality compared to conventional CS reconstructions was observed for both strategies. Specifically spike artifacts in the background were suppressed, while the changes in signal pixels remained small.The proposed methods improve the quality of CS reconstructions. Furthermore, because resampling is applied during post-processing, no additional measurement time is required. This allows easy incorporation into existing protocols and application to already measured data.

At the beginning of this century the German Trauma Society (DGU) became extensively active with an initiative on quality promotion, development of quality assurance and transparency regarding treatment of the severely injured. A white book on "Medical care of the severely injured" was published, focusing on the requirements on structural quality and especially procedural quality. The impact of the white book was immense and a trauma network with approved trauma centers, structured and graded for their individual trauma care performance, was developed. In order to monitor and document the required quality of care, a registry was needed. Furthermore, for cooperation within the trauma networks innovative methods for digital transfer of radiological images and patient documents became necessary. Finally, the auditing criteria for trauma centers had and still have to be completed with advanced medical education and training programs. In order to realize the implementation of such a broad spectrum of economically relevant and increasingly complex activities the Academy of Trauma Surgery (AUC) was established as a subsidiary of the DGU in 2004. The AUC currently has four divisions: 1) networks and health care structures, 2) registries and research management, 3) telemedicine, 4) medical education and training, all of which serve the goal of the initiative. The AUC is a full service provider and management organization in compliance with the statutes of the DGU. According to these statutes the business operations of the AUC also cover projects for numerous groups of patients, projects for the joint society the German Society for Orthopedics and Trauma (DGOU) as well as other medical institutions. This article describes the success stories of the trauma network (TraumaNetzwerk DGU®), the TraumaRegister DGU®, the telecooperation platform TKmed®, the new and fast-growing orthogeriatric center initiative (AltersTraumaZentrum DGU®) and the division of medical education and training, e.g. advanced trauma life support (ATLS®) and other training programs including the innovative interpersonal competence (IC) course.

The geriatric trauma working party, a subgroup of the German Society of Trauma Surgery (Deutsche Gesellschaft fur Unfallchirurgie, DGU), focuses on the challenges of geriatric fractures, which are steadily increasing due to demographic changes. Inherent comorbidities implicate perioperative complications leading to loss of mobility and endangered independence followed by an increased burden on the social services. An interdisciplinary approach is required. The geriatric trauma working party defined criteria for interdisciplinary treatment and comprehensive care as well as early rehabilitation in interdisciplinary geriatric fracture centers. By passing an independent audit process these centers can achieve certification as a geriatric trauma center DGU (AltersTraumaZentrum DGU). Certified centers can participate in a recently established geriatric fracture registry which includes an internationally consented data set. Audit and registry enable centers to acquire an international benchmark, ensure permanent improvement in quality and allow participation in health services research.

Development of trauma systems is a demanding process. The United States and Germany both have sophisticated trauma systems. This manuscript is a summary of political, economic, and medical changes that have led to the development of both trauma systems and the current high-quality standards.We specifically asked three questions: (1) What tasks are involved in developing a modern trauma system? (2) What is the approach to achieve this task? (3) Do these systems work?We conducted a systematic review of relevant articles by searching electronic databases (PubMed, Embase, Cochrane library) using the following search terms: "trauma system", "polytrauma", "trauma networks", and "trauma registry". Of 2573 retrieved manuscripts, the authors made a personal selection of studies. A personal study selection from our experiences was added when their contribution to the topic was judged important.Worldwide, similar tasks concerning trauma care have to be addressed. In most societies, traffic accidents and firearm-related injuries contribute to a high number of trauma victims. The German approach has been to decrease the number of accidents through injury prevention and to provide better care by establishing an emergency medical system. For in-hospital treatment, clinical care has constantly improved and a close interaction with members from the American Association for the Surgery of Trauma and the Orthopaedic Trauma Association has helped a great deal to achieve these improvements. The German healthcare system was developed as a powerful healthcare tool covering patients from injury to rehabilitation. In addition, trauma and injury research has been strengthened to deal with various questions of trauma care.Organized injury prevention programs and systematized professional patient care can address the issues associated with the global burden of trauma. These trauma systems require constant monitoring and improvement.

The adsorption and dissociation of carbon dioxide on a Ru(0001) single crystal surface was investigated by reflection–absorption infrared spectroscopy (RAIRS) and temperature-programmed desorption (TPD) spectroscopy for CO2 adsorbed at 85 K. RAIRS spectroscopy shows that the adsorption of CO2 on a Ru(0001) single crystal is partially dissociative, resulting in CO2 and CO. The CO vibrational mode was also observed to split into two distinct modes, indicating two general populations of CO present at the surface. Furthermore, a time-dependent blue-shift is observed, which is characteristic of increasing CO surface coverage. TPD showed that coverages of up to 0.3 ML were obtained, and no evidence for chemisorption of oxygen on ruthenium was found.

Purpose We report on our experience in terms of eligibility, safety, response and survival for treatment of hepatocellular carcinoma (HCC) with 90Y microspheres. Secondly, we investigated the urinary excretion of 90Y following treatment.

Drei Jahre nach Grundung des TraumaNetzwerkD DGU ist zu Beginn des Jahres 2009 ein groser Teil aller in Deutschland an der Schwerverletztenversorgung beteiligten Kliniken registriert und in regionalen Traumanetzwerken (TNW) organisiert. Bundesweit existieren mittlerweile 41 konstituierte TNW mit uber 660 teilnehmenden Kliniken. Weitere 18 TNW sind ebenfalls registriert, befinden sich aber noch in der Planungsphase (nicht konstituiert). Durchschnittlich existieren bislang pro Bundesland 39 regionale und uberregionale Traumazentren bzw. Einrichtungen zur Basisversorgung schwerverletzter Patienten. Umgerechnet auf das Versorgungsgebiet liegt der durchschnittliche Einzugsbereich eines Traumanetzwerks bei 8708 km2. Die gunstigsten geographischen Versorgungsprofile finden sich in Nordrhein-Westfalen, die ungunstigsten geographischen Versorgungsstrukturen in Sachsen-Anhalt und Mecklenburg-Vorpommern.

At the beginning of this century the German Trauma Society (DGU) became extensively active with an initiative on quality promotion, development of quality assurance and transparency regarding treatment of the severely injured. A white book on "Medical care of the severely injured" was published, focusing on the requirements on structural quality and especially procedural quality. The impact of the white book was immense and a trauma network with approved trauma centers, structured and graded for their individual trauma care performance, was developed. In order to monitor and document the required quality of care, a registry was needed. Furthermore, for cooperation within the trauma networks innovative methods for digital transfer of radiological images and patient documents became necessary. Finally, the auditing criteria for trauma centers had and still have to be completed with advanced medical education and training programs. In order to realize the implementation of such a broad spectrum of economically relevant and increasingly complex activities the Academy of Trauma Surgery (AUC) was established as a subsidiary of the DGU in 2004. The AUC currently has four divisions: 1) networks and health care structures, 2) registries and research management, 3) telemedicine, 4) medical education and training, all of which serve the goal of the initiative. The AUC is a full service provider and management organization in compliance with the statutes of the DGU. According to these statutes the business operations of the AUC also cover projects for numerous groups of patients, projects for the joint society the German Society for Orthopedics and Trauma (DGOU) as well as other medical institutions. This article describes the success stories of the trauma network (TraumaNetzwerk DGU®), the TraumaRegister DGU®, the telecooperation platform TKmed®, the new and fast-growing orthogeriatric center initiative (AltersTraumaZentrum DGU®) and the division of medical education and training, e.g. advanced trauma life support (ATLS®) and other training programs including the innovative interpersonal competence (IC) course.

Die Qualitat der Polytraumaversorgung in Deutschland ist – bedingt durch geographische Unterschiede zwischen den Bundeslandern und durch die Abweichung der Behandlungskonzepte in einzelnen Krankenhausern sehr inhomogen. Um eine weitere Verbesserung der Polytraumaversorgung in Deutschland zu gewahrleisten erscheint es sinnvoll, strukturelle und personelle Voraussetzungen in der Versorgung schwerverletzter Patienten in den jeweiligen Versorgungsstufen weitestgehend zu standardisieren und die Kliniken in lokalen Traumanetzwerken zusammenzufassen. Die Voraussetzungen fur regionale Traumanetzwerke sowie fur die strukturelle, personelle Ausstattung und Organisation der zukunftig mit der Schwerverletztenversorgung betrauten Kliniken wurden in dem Weisbuch ,Schwerverletztenversorgung – Empfehlungen zur Struktur und Organisation von Einrichtungen zur Behandlung von Schwerverletzten in der Bundesrepublik‘ zusammengefasst. Das gemeinsame Ziel ist es, entgegen der derzeitigen Entwicklung im deutschen Gesundheitssystem eindeutige Anforderungen an Struktur, Organisation und Ausstattung fur eine kompetente und nachhaltige Schwerverletz tenversorgung auch auserhalb von Ballungszentren festzulegen, um damit eine einheitlich hohe Versorgungsqualitat zu gewahrleisten. Die einzelnen Schritte zur Umsetzung eines Netzwerks werden im Rahmen dieses Artikels aufgezeigt.

Das schwere Trauma ist in jedem Lebensalter und besonders bei alten multimorbiden Patienten eine relevante medizinische und okonomische Herausforderung. Die Schwerverletzten erfordern eine Behandlungsfuhrung unter Einbindung interdisziplinarer Kompetenz aus einer Hand durch einen Arzt, der in der Therapie der Verletzung/Grunderkrankung und in der Intensivmedizin gleichermasen spezialisiert ist. Hierfur besonders geeignet ist ein Chirurg/Unfallchirurg mit Weiterbildung in der speziellen chirurgischen Intensivmedizin. Selbstverstandlich muss eine chirurgische Intensivstation durch einen dort hauptamtlich und ausschlieslich tatigen Chirurgen geleitet werden. Die Superspezialisierung in der Kompetenz von Unfallchirurgen hat in anderen Landern (z. B. der USA) zu einer erheblichen Verbesserung des Outcomes gefuhrt. Im Rahmen der Superspezialisierung hat die hierin integrierte Intensivmedizin einen wichtigen Beitrag geleistet. Eine weitere Verbesserung der Traumaversorgung erfordert eine innovative und kompetente Forschung mit dem Fokus nicht nur auf allgemeine intensivmedizinische Masnahmen, z. B. Beatmungsverfahren, sondern auch auf Aspekte, die sich der kausalen Komplexitat der „Trauma-Krankheit“ widmen. Die zusammenhangende, kausale Betrachtung der Traumatisierung mit den pathobiochemischen, pathophysiologischen und immunpathologischen Folgen unter Einbeziehung der unterschiedlichen chirurgisch-therapeutischen Strategien ist der eigentliche zielfuhrende chirurgisch-intensivmedizinische Forschungsansatz. Die Organfunktionsstorungen mussen moglichst in ihrer Entstehung gemindert oder verhindert werden. Auf diesem Forschungsgebiet sind Unfallchirurgen und Chirurgen weltweit fuhrend tatig. Sinnvollerweise gehort die praktische Tatigkeit in der Intensivmedizin in dieses Forschungskonzept hinein.

Die jahrliche Zahl polytraumatisierter Patienten in Deutschland belauft sich nach Schatzungen auf uber 30.000 Verletzte, die Zahl der Universitatskliniken und Maximalversorger auf etwa 90–100 Institutionen. Wie viele Krankenhauser zur Versorgung schwerer und schwerster Polytraumen hierzulande allerdings insgesamt bereitstehen ist allgemein nicht bekannt. Ziel war es, eine Ubersicht uber diejenigen Krankenhauser zu gewinnen, welche aufgrund ihrer strukturellen und organisatorischen Voraussetzungen theoretisch in der Lage waren bzw. definitiv an der klinischen Polytraumaversorgung teilnehmen. Dabei wurden mogliche Auswirkungen der unterschiedlichen geographischen Verteilung sowie infrastrukturelle Gegebenheiten der einzelnen Bundeslander analysiert. Anhand von (Krankenhaus-)Daten der Statistischen Amter des Bundes und der Lander, einer eigens durchgefuhrten Internetrecherche, einer Umfrage an verschiedenen unfallchirurgischen Abteilungen sowie auf Datenbasis des Traumaregisters der Deutschen Gesellschaft fur Unfallchirurgie (DGU) erfolgte die Erfassung und Einteilung aller recherchierten Krankenhauser in verschiedene Versorgungsstufen. Mittels einer speziellen Software wurden anschliesend alle Krankenhauser in ein digitales Landkartensystem eingetragen und in das Internet ( www.dgu-online.de ) eingespeist, wo diese allgemein abrufbar sind. Ferner wurde die Vorhaltung notarztlicher Rettungsmittel in den einzelnen Bundeslandern erhoben sowie Daten des statistischen Bundesamtes bzgl. Populationsdichte, Unfallaufkommen, Strasennetz und Verkehrstoter in die Untersuchung eingeschlossen. Ingesamt konnten 108 Krankenhauser der Maximalversorgung, 209 Krankenhauser der Schwerpunktversorgung und 431 Krankenhauser der Grund- und Regelversorgung ermittelt werden. Es fanden sich deutliche Unterschiede in der Versorgungsdichte (Krankenhauser, Notarzt- und Rettungshubschrauberstandpunkte) und Infrastruktur (Strasennetz) in den einzelnen Bundeslandern. Dabei scheint es eine Korrelation zwischen der Anzahl todlicher Unfalle und den jeweiligen geographischen bzw. infrastrukturellen Gegebenheiten in den einzelnen Bundeslandern zu geben. Numerisch finden sich in der BRD ausreichend Krankenhauser zur Versorgung polytraumatisierter Patienten. Allerdings bestehen weiterhin regionale Unterschiede in der Vorhaltung ausreichend ausgestatteter Traumazentren und den infrastrukturellen Gegebenheiten. Um eine flachendeckende Verbesserung der Polytraumaversorgung in Deutschland gewahrleisten zu konnen, erscheint es sinnvoll, die Qualitat der Versorgung Schwerverletzter durch eine regionale Vernetzung einzelner Krankenhauser und Standardisierung struktureller und personeller Voraussetzungen zu optimieren.

In this paper a technological approach for the fabrication of deformable electronic surfaces is reviewed. The approach consists of the fabrication of thin film devices on a flat but deformable substrate such as a plastic or glass foil using conventional processing tools. After the fabrication, the foil can be deformed to other shapes by air pressure or stamping. A spherical cap shape is used as a model system. This deformation induces large stress in the substrate, which is plastically deformed. To avoid damage to the thin film devices, they are built on top of "hard" islands, which limit the strain in the devices to manageable levels. Amorphous silicon TFT's on silicon nitride islands show little qualitative change in characteristics after a plastic deformation of the substrate to strain levels over 5%. Interconnect lines between islands are subjected to a large strain if they are deposited and patterned before the substrate deformation, and require novel approaches.

Ziel der vorliegenden Arbeit war es, den aktuellen Wissensstand 1. zur Effektivitat der Luftrettung und 2. zum Einflus der Kategorie der primaren Zielklinik auf die Letalitat polytraumatisierter Patienten zu dokumentieren. Systematische Literaturanalyse (1970–2003) und Identifikation aller Arbeiten mit mindestens Evidenzniveau III (retrospektive Kohortenstudie) und Kontrollgruppe; eigene Ergebnisse. Ad 1: 17 Studien zu dieser Fragestellung wurden erfasst und ausgewertet. In keiner Arbeit sind Zeitvorteile durch den Einsatz der Luftrettung nachweisbar. 11/17 Studien weisen einen statistisch signifikanten Uberlebensvorteil (8,2% bis 52%) insbesondere bei mittlerer Verletzungsschwere durch den Einsatz der Luftrettung nach. Ad 2: Alle 6 Studien belegen eine deutliche Senkung der Letalitat (19% bis 42%) bei primarer klinischer Behandlung in einem Traumazentrum oder einer Klinik vergleichbarer Versorgungsqualitat. Die analysierten Studien lassen einen Trend zu besseren Ergebnissen durch den Einsatz der Luftrettung erkennen. Bei gleicher Zielklinik und eindeutigen Zeitnachteilen der Luftrettung kann dieser durch eine bessere klinische Diagnostik und Behandlung aufgrund von Ausbildungs- und Erfahrungsvorteilen des RTH-Teams erklart werden. Die Letalitat kann zudem durch eine primare Behandlung in einem Traumazentrum oder einer Klinik vergleichbarer Versorgungsqualitat signifikant gesenkt werden. Die freie Wahl der Zielklinik auch uber grosere Entfernung verbleibt daher als spezifischer, klinisch relevanter Vorteil des Einsatzes von Hubschraubern in der Unfallrettung.

Einleitung. Klinische Untersuchungen zeigen, dass ein standardisiertes Schockraummanagement die Behandlungsergebnisse von Schwerverletzten verbessert.

Background: Appendectomy is a very common procedure in abdominal surgery. In numerous clinical trials it was proven that laparoscopic appendectomy outmatches conventional treatment. Nevertheless, m