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Europa is a premier target for advancing both planetary science and astrobiology, as well as for opening a new window into the burgeoning field of comparative oceanography. The potentially habitable subsurface ocean of Europa may harbor life, and the globally young and comparatively thin ice shell of Europa may contain biosignatures that are readily accessible to a surface lander. Europa’s icy shell also offers the opportunity to study tectonics and geologic cycles across a range of mechanisms and compositions. Here we detail the goals and mission architecture of the Europa Lander mission concept, as developed from 2015 through 2020. The science was developed by the 2016 Europa Lander Science Definition Team (SDT), and the mission architecture was developed by the preproject engineering team, in close collaboration with the SDT. In 2017 and 2018, the mission concept passed its mission concept review and delta-mission concept review, respectively. Since that time, the preproject has been advancing the technologies, and developing the hardware and software, needed to retire risks associated with technology, science, cost, and schedule.

Hintergrund: Krankenhausern kommt bei der Tabakentwohnung (TE) eine Schlusselrolle zu. Dennoch werden nur selten Interventionen zur TE angeboten trotz nachgewiesener Effektivitat. Ziel der vorliegenden Untersuchung war es, Daten rauchender Patienten zu erheben, um eine zielgruppenspezifische Intervention im Krankenhaus zu entwickeln. Methodik und Patienten: Von Juli bis September 2009 wurde bei allen stationaren Aufnahmen der Rauchstatus erhoben und durch Messung des CO-Hb validiert. Raucher, die zum ersten Mal stationar auf periphere Stationen aufgenommen wurden, erhielten ein umfangreiches Fragebogeninstrument. Ausschlusskriterien waren zu kurze Liegedauer und kognitive bzw. sprachliche Einschrankungen. Von den teilnehmenden Rauchern (TN) wurden zusatzlich klinische Daten erhoben. Ergebnisse: Die Raucherquote lag bei 25 %. Die Teilnahmequote der einschliesbaren Patienten lag bei 89,4 %. Der Fragebogen fand bei Rauchern eine hohe Akzeptanz und lieferte eine Vielzahl von Informationen fur die anschliesende Beratung. Pro Tag kann in einer 80-Betten-Abteilung mit 3 – 4 Rauchern fur eine Intervention gerechnet werden. Mindestens ein Kontakt ist wahrend des Aufenthaltes moglich. Obwohl 75 % der TN bereits mindestens einen Aufhorversuch aufwiesen, hatten nur die Wenigsten Unterstutzungsmasnahmen in Anspruch genommen. Schlussfolgerungen: Spezifische Fragebogen sind zur Evaluation der Rauchanamnese in Akutkrankenhausern geeignet und konnen eine bettseitige Raucherberatung wesentlich erleichtern. Um ihrer Schlusselrolle bei der TE gerecht werden zu konnen, sollten mehr Krankenhauser entsprechende Interventionen implementieren.

Flexible bronchoscopy is a standard examination today and is conducted not only in nearly every hospital but also in privately owned practices. The vast majority of patients want sedation for this examination. Such a procedure is nearly always necessary in complex and interventional procedures, irrespective of the patient's wish. The recommendation at hand to use sedation measures for flexible bronchoscopy is based on the results of numerous clinical studies and also takes account of individual experiences in this area. The structural and procedural requirements and the requirements for staff training are defined and should describe the minimum standard when it comes to conducting a bronchoscopy under sedation. Furthermore the drugs recommended for sedation are discussed and their methods of application shown. Finally the recommendations also include suggestions for patient clarification, monitoring and discharge. They should provide the examiner with concrete operating options and therefore above all increase patient safety.

The purpose of this study was to investigate the potential correlation between the presence and size of the cisterna chyli (CC) on computed tomography (CT) and the presence of cardiovascular disease. Materials and methods Out of a 3000-patient cohort 2599 patients who received a CT examination of the chest and/or abdomen with measurable inferior vena cava and azygos vein were included in this retrospective study. To assess the presence of cardiovascular disease the following parameters were recorded from the PACS or clinical information system: diameter of vena cava and azygos vein, presence of ascitis, serum creatinine, history of congestive heart failure, coronary artery disease or arterial hypertension and medication (diuretics, beta-blocker). In addition the volume of the CC and the presence or absence of malignant disease were recorded. Mean values (vessel diameters, creatinine) or percentages were calculated and compared for the groups with (n = 416) and without (n = 2183) a cisterna. Multivariate logistic regression analysis was performed for all parameters to identify the potential association with the presence and size of a cisterna. In addition the simultaneous influence of the parameter malignancy, cardiovascular disease and age on presence and size of the CC was analyzed in a logistic regression model. Results The presence or absence of a CC was not associated with any of the measured parameter. Regarding the size of the CC, there was a positive correlation with the diameter of the azygos vein, the presence of ascitis and diuretic medication. The influences of malignancy, elevated central venous pressure and age on the development of a CC proved to be highly significant but could not be separated or quantified. Conclusion The volume of the cisterna chyli is influenced by pathologic states with an increased central venous pressure, while the presence or absence of the cisterna seems to be independent of those factors.

Tabakentwohnung findet in Klinik und Praxis leider noch zu selten statt. Als Grunde werden fehlendes Personal, fehlende Zeit, Mangel an Qualifikation und fehlende Kostenerstattung angegeben. Dabei konnen bereits kurze Interventionen einen Effekt erzielen. Der aktuelle Goldstandard zur Tabakentwohnung besteht in der Kombination einer verhaltenstherapeutischen Unterstutzung mit einer medikamentosen Begleittherapie.

Bronchoscopic training courses are an essential part of the education in bronchoscopy for all kinds of specialisations and professions performing such investigations. All aspects of the application should be mentioned during a course. These recommendations are necessary because the number of bronchoscopies performed in the last years has increased due to the increasing number of patients, improved equipment and better availability. Courses should provide the basic knowledge including main points of indications, preconditions for the procedure and decisions of consequence after bronchoscopy. Participants should be trained in the skills of correct handling and performing flexible bronchoscopies in training dummies. Necessary competence requirements on the course instructor are adequate professional qualifications, paedagogic skills and the availability of appropriate teaching material. Quality assurance of the course should be achieved by consequent evaluation. A widely spread field of bronchoscopic applications can improve patient care in many medical specialisations.

We report a 12-year-old boy who underwent stent implantation into the left main bronchus at the age of 9.5 years for palliation of severe bronchial stenosis. He had developed complete obstruction of the stent by granulation tissue resulting in respiratory deterioration and the requirement of mechanical ventilation. The stent obstruction was treated at the age of 11.5 years by cryorecanalization. In this technique, cooling of the tip of the cryoprobe is used to induce adherence of the obstructing tissue allowing the subsequent removal of tissue particles by retraction of the probe. Under general anesthesia, a miniaturized cryoprobe was advanced via the working channel of a flexible bronchoscope. Repeat maneuvers of freezing and retraction resulted in complete recanalization of the stent. Repeat bronchoscopies 4 and 12 weeks later revealed recurrent formation of some granulation tissue which was removed by repeat cryorecanalization. Seven months after the initial procedure there was a complete patency of the stent. According to our experience, cryorecanalization is a safe and effective alternative for the treatment of stent obstruction by granulation tissue. Due to the introduction of a miniaturized probe, this method is well applicable in children since it can be performed via the working channel of a flexible pediatric bronchoscope.

The electronic and atomic structure of the 4H-SiC surface was investigated. Photoemission data indicate that the surface contains about 2 Si layers on top of the bulk layers. Scanning tunneling mic ...

The atomic and electronic structure of 4H-SiC(1 1 02) surfaces were investigated using scanning tunneling microscopy (STM), low-energy electron diffraction (LEED) and photoemission (PES). Two well ordered phases existing on this surface, i.e. (2×1) and c(2×2) are discussed. The (2×1) phase consists of a Si adlayer which is topped by an array of ordered Si-nanowires with electronic states confined to one dimension. For the c(2×2) phase STM indicates the presence of adatoms and PES a surface composition close to bulk SiC stoichiometry. A detailed atomic model for this c(2×2) phase is proposed.

The (1 over(1, ¯) 0 2) orientated plane of hexagonal silicon carbide of the 4H polytype consists of a periodic arrangement of stripes with alternating bond configuration on a nanometer scale. The two stripe configurations of the bulk truncated surface have an atomic structure very close to the carbon-face SiC basal plane and the cubic SiC(1 0 0) surface, respectively. The structural and electronic properties of the c(2 × 2) reconstruction on the 4 H-SiC (1 over(1, ¯) 0 2) surface were investigated using photoemission spectroscopy (PES), scanning tunneling microscopy (STM) and low-energy electron diffraction (LEED). The core level photoemission spectra reveal two surface shifted Si2p components and one shifted C1s component in addition to the SiC bulk peaks. In accordance with the periodicity observed in LEED, atomically resolved STM micrographs show a c(2 × 2) arrangement of bright features which are accounted as Si adatoms. The electronic structure of this SiC (1 over(1, ¯) 0 2) -c (2 × 2) phase is experimentally determined by angle resolved PES studies of the valence band revealing four surface states. Based on the experimental observations and a comparison to similar phases on other SiC surfaces, a tentative surface model can be developed which consists of Si adatoms in so-called H3 sites on the basal-plane type stripes and carbon dimers in Si bridging configuration on the cubic stripes of the bulk truncated surface. © 2007 Elsevier B.V. All rights reserved.

Ordered reconstruction phases on the 4H-SiC(1102) surface have been investigated using low-energy electron diffraction (LEED), Auger electron spectroscopy (AES) and scanning tunneling microscopy (STM). After initial hydrogen etching, the samples were prepared by Si deposition and annealing in ultra-high vacuum (UHV). Two distinct reconstruction phases develop upon annealing, first with a (2×1), and at higher temperatures with a c(2×2) LEED pattern. After further annealing the fractional order LEED spots vanish and a (1x1) pattern develops. For the (2×1) phase, STM micrographs show that adatom chains develop on large flat terraces, which in view of AES consist of additional Si. These highly linear and equidistant chains represent a self-assembled well-ordered pattern of nanowires developing due to the intrinsic structure of the 4H-SiC(1102) surface. For the c(2×2) phase AES indicates a surface composition close to the bulk stoichiometry. For the (1×1) phase a further Si depletion is observed.