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In 2019, a novel coronavirus called the severe acute respiratory syndrome coronavirus 2 led to the outbreak of the coronavirus disease 2019, which was deemed a pandemic by the World Health Organization in March 2020. Owing to the accelerated rate of mortality and utilization of hospital resources, health care systems had to adapt to these major changes. This affected patient care across all disciplines and specifically within the perioperative services. In this review, we discuss the strategies and pitfalls of how perioperative services in a large academic medical center responded to the initial onset of a pandemic, adjustments made to airway management and anesthesia specialty services - including critical care medicine, obstetric anesthesiology, and cardiac anesthesiology - and strategies for reopening surgical caseload during the pandemic.

Social norms, also called social comparison nudges, have been shown to be particularly effective in promoting healthy food choices and environmentally friendly behaviors. However, there is limited evidence on the effectiveness of these nudges for promoting sustainable and climate-friendly food choices and their potential to reduce greenhouse gas emissions and support the related SDGs. The paper reports a field experiment that tests the effectiveness of two social norms in a real-life setting based on revealed preferences. The study distinguishes between the widely researched descriptive norms and guessed norms, the latter being tested in this context for the first time. While descriptive norms communicate typical patterns of behavior (e.g., 50% of canteen visitors choose vegetarian meals), guessed norms are determined by the individual’s best guess about the norm in a specific context. The results confirm a remarkable nudging effect of guessed norms: The higher the presumed proportion of vegetarian dishes sold, the lower the probability of choosing a vegetarian dish. Surprisingly, this effect is independent of the respective norm specification (meat or vegetarian norm). The paper provides advice for policy makers about when and how to use guessed norms.

Postoperative pulmonary complications contribute to perioperative morbidity and mortality in addition to being associated with increased health care costs. In this review article, we outline risk factors for the development postoperative pulmonary complications, describe their impact on perioperative outcomes, and focus on the role of intraoperative ventilation strategies in decreasing postoperative pulmonary complications.

Introduction: Diagnosing non-traumatic spinal cord injury (NTSCI) is often challenging. However, clear discrimination from non-spinal pathologies, e.g., “myelopathy-mimics” (MMs), is critical in preventing long-term disability and death. In this retrospective study we (1) investigated causes of NTSCI, (2) identified clinical markers associated with NTSCI and (3) discuss implications for NTSCI management.Methods: Our sample consisted of 5.913 consecutive neurological and neurosurgical patients who were treated in our emergency department during a one-year period. Patients with a new or worsened bilateral sensorimotor deficit were defined as possible NTSCI. We then compared clinical and imaging findings and allocated patients into NTSCIs and MMs.Results: Of ninety-three included cases, thirty-six (38.7%) were diagnosed with NTSCI. Fifty-two patients (55.9%) were classified as MMs. In five patients (5.4%) the underlying pathology remained unclear. Predominant causes of NTSCI were spinal metastases (33.3%), inflammatory disorders (22.2%) and degenerative pathologies (19.4%). 58.6% of NTSCI patients required emergency treatment. Presence of a sensory level (p =

Johann Friedrich Böhmer, Regesta Imperii, IV. Lothar III. und ältere Staufer, 4. Abteilung: Papstregesten 1124–1198, Teil 4: 1181–1198, Lieferung 3: 1185–1187 Urban III. und Gregor VIII., bearb. von Ulrich Schmidt unter Mitwirkung von Katrin Baaken, Wien/Köln/Weimar: Böhlau Verlag 2012. XVI und 976 S. ISBN 978-3-412-20856-1. € 150,–

Diabetes has been shown to be associated with postoperative infections; however, the association of haemoglobin A1c (HbA1c) with postoperative surgical site infections (SSI) is unclear. All HbA1c data from patients receiving general, vascular, or orthopaedic surgeries between 1 January 2014 and 1 December 2016 were identified from hospital records. The primary outcome was 30-day SSI. Multivariable logistic regression was performed to determine if HbA1c was associated with infection. The cohorts assessed were: (1) HbA1c

Zusammenfassung Mit dem vor kurzem veröffentlichten Urteil des BVerwG vom 9. 5. 2019, Az. 7 C 34.17, wurde zum ersten Mal höchstrichterlich die Frage behandelt, ob ein Informationsanspruch nach § 1 Abs. 1 Informationsfreiheitsgesetz (IFG) in Bezug auf Informationen des BKartA aus einem Fusionskontrollverfahren besteht. Konkret ging es um den Zugang eines nicht beigeladenen Dritten zum Votum des Berichterstatters. Das BVerwG hat das Bestehen eines Informationsanspruchs wegen des Ausschlussgrunds nach § 3 Nr. 3 lit. b IFG verneint. Dieser Beitrag greift das Urteil auf und geht – abstrahiert von dem der Entscheidung zugrunde liegenden konkreten Sachverhalt – der Frage nach, unter welchen Voraussetzungen ein Anspruch auf Zugang zu Informationen des Bundeskartellamts aus einem Fusionskontrollverfahren besteht.

Hospital length of stay (LOS) is an important quality metric for total hip arthroplasty. Accurately predicting LOS is important to expectantly manage bed utilization and other hospital resources. We aimed to develop a predictive model for determining patients who do not require prolonged LOS.This was a retrospective single-institution study analyzing patients undergoing elective unilateral primary total hip arthroplasty from 2014 to 2016. The primary outcome of interest was LOS less than or equal to the expected duration, defined as ≤3 days. Multivariable logistic regression was performed to generate a model for this outcome, and a point-based calculator was designed. The model was built on a training set, and performance was assessed on a validation set. The area under the receiver operating characteristic curve and the Hosmer-Lemeshow test were calculated to determine discriminatory ability and goodness-of-fit, respectively. Predictive models using other machine learning techniques (ridge regression, Lasso, and random forest) were created, and model performances were compared.The point-based score calculator included 9 variables: age, opioid use, metabolic equivalents score, sex, anemia, chronic obstructive pulmonary disease, hypertension, obesity, and primary anesthesia type. The area under the receiver operating characteristic curve of the calculator on the validation set was 0.735 (95% confidence interval, 0.675-0.787) and demonstrated adequate goodness-of-fit (Hosmer-Lemeshow test, P = .37). When using a score of 12 as a threshold for predicting outcome, the positive predictive value was 86.1%.A predictive model that can help identify patients at higher odds for not requiring a prolonged hospital LOS was developed and may aid hospital administrators in strategically planning bed availability to reduce both overcrowding and underutilization when coordinating with surgical volume.

It has been observed that, in a variety of tasks, losses have a larger impact on behavior than do gains of equal size. This phenomenon is referred to as loss aversion. It is thought that the negativity bias in behavior is reflected in and potentially causally related to a negativity bias in emotional arousal. We examine skin conductance responses—a psychophysiological marker for emotional arousal—during the anticipation of gains and losses. In contrast to most previous research, gains and losses were separated from each other and symmetric in magnitude. We found that skin conductance responses during the anticipation phase increased with the magnitude of both gains and losses. Contrary to the predictions of the loss aversion hypothesis, the anticipation of a loss did not elicit stronger reactions than the anticipation of a gain of equal size.

While reports state that consumers are increasingly willing to consume more sustainably, no study has considered how the activation of very basic human needs, such as the state of hunger, affects sustainable food consumption. The authors expect that hungry consumers display a lower preference for sustainable food items and that this hunger-induced imprint on food consumption patterns must be traced back to the fact that the activation of very fundamental human needs contaminates stereotypical perceptions of sustainable products. More importantly, hunger primarily operates spontaneously, as well as automatically, and affects perceptions, which are difficult to control (and which sometimes go unnoticed). A laboratory experiment studied this premise by sampling 166 participants with 18 h of actual food deprivation, half of them having breakfast before and the other half after completing the experimental tasks. The participants who had breakfast show a stronger tendency to choose sustainable products, which can be traced back to implicit gentleness-associations concerning sustainable products in the Implicit Association Test (IAT). Albeit explicitly held beliefs also influence choices, these judgments are not affected by food deprivation. A field study then replicates the findings in a real-life setting.

Safety-net hospitals disproportionately care for high-risk patients. Prior work has shown safety-net hospitals to have inferior postoperative outcomes with higher cost and worse patient ratings. We aim to examine the association of hospital safety-net burden with morbidity and mortality in patients with opioid overdose hospital admission.Retrospective cross-sectional analysis using the National Inpatient Sample registry from 2010 to 2014.Multi-institutional.We included 547, 399 patients admitted to a United States hospital with an International Classification of Disease, Ninth Revision, code of opioid overdose. To study the association of hospital safety-net burden on mortality and morbidity, we calculated hospital safety-net burden defined as the percent of Medicaid or uninsured among all admitted patients. Hospitals were categorized into one of three categories: low burden hospitals, medium burden hospitals, and high burden hospitals (i.e., safety-net hospitals). We performed a mixed effects multivariable logistic regression analysis to assess the association of hospital safety-net burden with short-term inpatient outcomes.None.The primary outcomes were inpatient mortality and morbidity.Compared to MBHs and LBHs, HBHs had a greater proportion of minority patients (i.e., Black, Hispanic, and Native American) and patients with median household income in the lowest quartile (p 0.001). Among prescription opioid overdose admissions, the odds of inpatient mortality and pulmonary and cardiac morbidity were also not significantly higher between HBHs versus LBHs (p 0.05).Safety-net hospital disproportionately care for vulnerable populations, however the odds of poor outcomes were no different in opioid overdose. Safety-net hospitals should have equal access to the funding and resources that allows them to deliver the same standard of care as their counterparts.

The impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care.This was a single center retrospective study in the United States of patients admitted to the surgical and neurosurgical ICUs during 2013 and 2015. The primary outcome was hospital LOS after transfer request. The secondary outcome was the timing of provider orders representing care decisions (milestones) that would advance the patient's care. Patient, surgery, and bed covariates were accounted for in a multivariate regression and propensity matching analysis.Out of the cohort of 4,926 patients, 1,717 met inclusion criteria. 670 (39%) experienced ≥12 hours of TD. For each day of TD, there was an average increase of 0.70 days in LOS (P 0.001). The last milestone occurred on average 0.35 days later (P 0.001). Propensity matching analyses were confirmatory (P 0.001, P 0.001).TD is associated with longer LOS and delays in milestone clinical decisions that progress care. Eliminating delays in milestones could mitigate TD's impact on LOS.

The novel method of Cosmic-ray neutron sensing (CRNS) allows non-invasive soil moisture measurements at a hectometer scaled footprint. Up to now, the conversion of soil moisture to a detectable neutron count rate relies mainly on the equation presented by Desilets et al. (2010). While in general a hyperbolic expression can be derived from theoretical considerations, their empiric parameterisation needs to be revised for two reasons. Firstly, a rigorous mathematical treatment reveals that the values of the four parameters are ambiguous because their values are not independent. We find a 3-parameter equation with unambiguous values of the parameters which is equivalent in any other respect to the 4-parameter equation. Secondly, high-resolution Monte-Carlo simulations revealed a systematic deviation of the count rate to soil moisture relation especially for extremely dry conditions as well as very humid conditions. That is a hint, that a smaller contribution to the intensity was forgotten or not adequately treated by the conventional approach. Investigating the above-ground neutron flux by a broadly based Monte-Carlo simulation campaign revealed a more detailed understanding of different contributions to this signal, especially targeting air humidity corrections. The packages MCNP and URANOS were used to derive a function able to describe the respective dependencies including the effect of different hydrogen pools and the detector-specific response function. The new relationship has been tested at three exemplary measurement sites and its remarkable performance allows for a promising prospect of more comprehensive data quality in the future.

Secondary cosmic-ray neutrons may be effectively used as a proxy for environmental hydrogen content at the hectare scale. These neutrons are generated mostly in the upper layers of the atmosphere within particle showers induced by galactic cosmic rays and other secondary particles. Below 15 km altitude their intensity declines as primary cosmic rays become less abundant and the generated neutrons are attenuated by the atmospheric air. At the earth surface, the intensity of secondary cosmic-ray neutrons heavily depends on their attenuation within the atmosphere, i.e. the amount of air the neutrons and their precursors pass through. Local atmospheric pressure measurements present an effective means to account for the varying neutron attenuation potential of the atmospheric air column above the neutron sensor. Pressure variations possess the second largest impact on the above-ground epithermal neutron intensity. Thus, using epithermal neutrons to infer environmental hydrogen content requires precise knowledge on how to correct for atmospheric pressure changes.We conducted several short-term field experiments in saturated environments and at different altitudes, i.e. different pressure states to observe the neutron intensity pressure relation over a wide range of pressure values. Moreover, we used long-term measurements above glaciers in order to monitor the local dependence of neutron intensities and pressure in a pressure range typically found in Cosmic-Ray Neutron Sensing. The results are presented along with a broad Monte Carlo simulation campaign using MCNP 6. In these simulations, primary cosmic rays are released above the earth atmosphere at different cut-off rigidities capturing the whole evolution of cosmic-ray neutrons from generation to attenuation and annihilation. The simulated and experimentally derived pressure relation of cosmic-ray neutrons is compared to those of similar studies and assessed in the light of an appropriate atmospheric pressure correction for Cosmic-Ray Neutron Sensing.

Management of patients with a tracheostomy tube includes many components of care provided by clinicians from various health care disciplines. In recent years, clinicians worldwide have demonstrated a renewed interest in the management of patients with tracheostomy due to the recognition that more effective and efficient management of this patient population is necessary to decrease morbidity and mortality and to optimize the value of the procedure. Commensurate with the goal of enhancing the care of patients with tracheostomy, we conducted a systematic review to facilitate the development of recommendations relevant to the care of adult patients with tracheostomy in the acute care setting. From our systematic review, clinical practice guidelines were developed to address questions regarding the impact of tracheostomy bundles, tracheostomy teams, and protocol-directed care on time to decannulation, length of stay, tracheostomy-related cost, tracheostomy-related adverse events, and other tracheostomy-related outcomes in tracheostomized adult patients in the acute care setting. Using a modification of the RAND/UCLA Appropriateness Method, 3 recommendations were developed to assist clinicians with tracheostomy management of adult patients in the acute care setting: (1) evidence supports the use of tracheostomy bundles that have been evaluated and approved by a team of individuals experienced in tracheostomy management to decrease time to decannulation, tracheostomy-related adverse events, and other tracheostomy-related outcomes, namely, improved tolerance of oral diet; (2) evidence supports the addition of a multidisciplinary tracheostomy team to improve time to decannulation, length of stay, tracheostomy-related adverse events, and other tracheostomy-related outcomes, namely, increased speaking valve use; (3) evidence supports the use of a weaning/decannulation protocol to guide weaning and removal of the tracheostomy tube to improve time to decannulation.

This study tests the prediction that perceived corruption reduces ethical behavior. Integrating a standard “cheating” experiment into a broad household survey in rural Thailand, we find tentative support for this prediction: respondents who perceive corruption in state affairs are more likely to cheat and, thus, to fortify the negative consequences of corruption. Interestingly, there is a small group of non-conformers. The main relation is robust to consideration of socio-demographic, attitudinal, and situational control variables. Attendance of others at the cheating experiment, stimulating the reputational concern to be seen as honest, reduces cheating, thus indicating transparency as a remedy.

Problem gamblers discount delayed rewards more rapidly than do non-gambling controls. Understanding this impulsivity is important for developing treatment options. In this article, we seek to make two contributions: First, we ask which of the currently debated economic models of intertemporal choice (exponential versus hyperbolic versus quasi-hyperbolic) provides the best description of gamblers’ discounting behavior. Second, we ask how problem gamblers differ from habitual gamblers and non-gambling controls within the most favored parametrization. Our analysis reveals that the quasi-hyperbolic discounting model is strongly favored over the other two parametrizations. Within the quasi-hyperbolic discounting model, problem gamblers have both a significantly stronger present bias and a smaller long-run discount factor, which suggests that gamblers’ impulsivity has two distinct sources.

Investigations of neutron transport through air and soil by Monte Carlo simulations led to major advancements toward a precise interpretation of measurements; they particularly improved the understanding of the cosmic-ray neutron footprint. Up to now, the conversion of soil moisture to a detectable neutron count rate has relied mainly on the equation presented by Desilets and Zreda in 2010. While in general a hyperbolic expression can be derived from theoretical considerations, their empiric parameterization needs to be revised for two reasons. Firstly, a rigorous mathematical treatment reveals that the values of the four parameters are ambiguous because their values are not independent. We found a three-parameter equation with unambiguous values of the parameters that is equivalent in any other respect to the four-parameter equation. Secondly, high-resolution Monte-Carlo simulations revealed a systematic deviation of the count rate to soil moisture relation especially for extremely dry conditions as well as very humid conditions. That is a hint that a smaller contribution to the intensity was forgotten or not adequately treated by the conventional approach. Investigating the above-ground neutron flux through a broadly based Monte-Carlo simulation campaign revealed a more detailed understanding of different contributions to this signal, especially targeting air humidity corrections. The packages MCNP and URANOS were used to derive a function able to describe the respective dependencies, including the effect of different hydrogen pools and the detector-specific response function. The new relationship has been tested at two exemplary measurement sites, and its remarkable performance allows for a promising prospect of more comprehensive data quality in the future.

This paper studies ethnic in-group bias in online trust games played by two large representative samples in the United States and Germany through the Trustlab platform, which was launched by the OECD and several research partners in 2017. The ethnic in-group bias, defined as the propensity to favour members of one’s own ethnic group in terms of monetary payoff, is significant in both countries. In the United States, members of the three largest ethnic groups trust people from their own ethnic group more than those from other groups. African Americans have a larger in-group bias than White Americans and Hispanics. Ethnic differentiation is not selective, as each group tends to have lower trust in the two other ethnic groups but at roughly the same rate. In contrast, ethnic differentiation is strongly selective in Germany: subjects of German parentage discriminate twice as much against Turkish descent participants as against Eastern European descent participants. Members of both ethnic minorities in Germany trust each other less than their own ethnic group, but do not discriminate against ones of German parentage. We also examine whether releasing information on the trustee being rich reduces ethnic differentiation, while conjecturing that this is a way to remove the stereotype that ethnic minorities are “undeserving poor”. We show that, in this case, discrimination by the ethnic majority is indeed reduced. People of Turkish descent who are rich tend to be more trusted than lower-income people of Turkish descent. However, releasing information on income can backfire, as it can increase mistrust within minorities. Finally, we show that group loyalty exists not only according to ethnicity but also according to income, as rich German parentage subjects trust other rich in-group members significantly more than do non-rich Germans.

Ein Blick in die Zukunft lässt erkennen, dass unser vermeintlich grenzenloser Konsum langsam aber sicher an seine natürlichen Grenzen stößt. Der fortschreitende Klimawandel und seine nicht ignorierbaren Auswirkungen auf die Umwelt, unser Umfeld und unsere Gesellschaft zwingen unser Wirtschaftssystem und seine Akteure dazu, wirtschaftliches Handeln nachhaltiger zu gestalten. Im Rahmen dieses Zukunftsberichtes sollen Einblicke in aktuelle Forschungsprojekte und Ergebnisse studentischer Forschungsarbeiten der Professur für Marketing der CAU Kiel gegeben werden, die sich mit dem Wandel hin zu nachhaltigerem Konsumentenverhalten beschäftigt. In qualitativen Analysen wird die Einstellung von Konsumierenden zu Themen wie dem Fleischkonsum, der Undurchsichdigkeit inflationärer CO2-Labels, dem Phänomen Flugscham und der Frage nach Nachhaltigkeits-Lehre in der Schule, beleuchtet. Darüber hinaus wird im Rahmen verschiedener Forschungsprojekte der Professur vermittelt, wie sich klimafreundliche Ernährung durch „Nudging“ fördern lässt, wie indirekte Rebound-Effekte auf Ebene privater Haushalte wirken, welche Verantwortung auf Konsumenten in Zeiten der Digitalisierung zukommt, wie sich Konsumentenverantwortung in Zeiten der Globalisierung interkulturell unterscheiden lässt und was es mit dem Phänomen der Konsumentenfeindlichkeit auf sich hat.

We report on a precise measurement of the electron-antineutrino angular correlation ($a$ coefficient) in free neutron beta-decay from the $a$SPECT experiment. The $a$ coefficient is inferred from the recoil energy spectrum of the protons which are detected in 4$\pi$ by the $a$SPECT spectrometer using magnetic adiabatic collimation with an electrostatic filter. Data are presented from a 100 days run at the Institut Laue Langevin in 2013. The sources of systematic errors are considered and included in the final result. We obtain $a = -0.10430(84)$ which is the most precise measurement of the neutron $a$ coefficient to date. From this, the ratio of axial-vector to vector coupling constants is derived giving $|\lambda| = 1.2677(28)$.

Most simulated micro-founded macro models use solely consumer-demand aggregates in order to estimate preference parameters of a representative consumer, for use in policy evaluation. Focusing on dynamic models with time-separable preferences, we show that aggregation holds if, and only if, momentary utility functions fall in the Identical-Shape Harmonic Absolute-Risk Aversion (ISHARA) utility class, identifying which parameters of ISHARA utility functions are allowed to vary over time. Given this theoretical result, it should be easy to empirically reject the aggregation properties that the macroeconomic representative-consumer identification approach requires: it suffices to show that permanent incomes guaranteeing the same living standard across households of different size violate an affine relationship. In order to test the validity of this affine equation, we develop a vignette survey that produces appropriate data without demand-estimation restrictions imposed by models. Surprisingly, in six countries, this equation is not rejected, lending support to using consumer-demand aggregates.

Monitoring soil moisture is still a challenge: it varies strongly in space and time and at various scales while well established sensors typically suffer from a small spatial support. With a sensor footprint up to several hectares, Cosmic-Ray Neutron Sensing (CRNS) is an emerging technology to address that challenge. So far, the CRNS method has typically been applied with single sensors or in sparse national scale networks. This study presents, for the first time, a dense network of 24 CRNS stations that covered, from May to July 2019, an area of just 1 km2: the pre-alpine Rott headwater catchment in Southern Germany which is characterized by strong soil moisture gradients in a heterogeneous landscape with forests and grasslands. With substantially overlapping sensor footprints, that network was designed to study root zone soil moisture dynamics at the catchment-scale. The observations of the dense CRNS network were complemented by extensive measurements that allow to study soil moisture variability at various spatial scales: roving (mobile) CRNS units, remotely sensed thermal images from Unmanned Areal Systems (UAS), permanent and temporary wireless sensor networks, profile probes as well as comprehensive manual soil sampling. Since neutron counts are also affected by hydrogen pools other than soil moisture, vegetation biomass was monitored in forest and grassland patches, as well as meteorological variables; discharge and groundwater tables were recorded to support hydrological modeling experiments. As a result, we provide a unique and comprehensive dataset to several research communities: to those who investigate the retrieval of soil moisture from cosmic-ray neutron sensing, to those who study the variability of soil moisture at different spatio-temporal scales, and to those who intend to better understand the role of root-zone soil moisture dynamics in the context of catchment and groundwater hydrology, as well as land – atmosphere exchange processes. The data set is available through EUDAT, splitted into the two subsets https://doi.org/10.23728/b2share.85fe0f9dac0f48df9215c17e65d1f1e1 (Fersch et al., 2020a) and https://doi.org/10.23728/b2share.93ed99e486904d48a8a6a68083066198 (Fersch et al., 2020b).

The novel method of Cosmic-ray neutron sensing (CRNS) allows non-invasive soil moisture measurements at a hectometer scaled footprint. Using this technique one can relate the flux density of albedo neutrons, generated in cosmic-ray induced air showers, to the amount of water within a radius of several hundred meters. In the recent years the understanding of neutron transport by Monte Carlo simulations led to major advancements in precision, which have successfully targeted a manifold of use cases. For example the improvements in the signal interpretation have meanwhile also been applied to the determination of snow water in Alpine regions. Up to now, the conversion of soil moisture to a detectable neutron count rate relies mainly on the equation presented by Desilets and Zreda. While in general a hyperbolic expression can be derived from theoretical considerations, their empiric parameterisation needs to be revised as many groups have found site-specific calibrations, which are simply based on different empirical data sets.Investigating the above-ground neutron intensity by a broadly based Monte Carlo simulation campaign revealed a more detailed understanding of different contributions to this signal, especially targeting air humidity corrections. The packages MCNP and URANOS were used to derive a function able to describe the respective dependencies including the effect of different hydrogen pools and the sensor response function. The resulting formula significantly improves the soil-moisture-to-intensity conversion and allows for a more comprehensive instrument data quality, which especially closes the gap between observations of very dry and wet conditions.

Cosmic-Ray neutron (CRN) sensors are widely used to determine soil moisture on the hectar scale. Precise measurements, especially in the case of mobile application, demand for neutron detectors with high counting rates and high signal-to-noise ratios. For a long time CRNS instruments have relied on helium-3 as an efficient neutron converter. Its ongoing scarcity demands for technological solutions using alternative converters, which are lithium-6 and boron-10. In order to scale up the method and to reduce costs we recently have developed large-scale neutron detectors including readout electronics and data acquisition systems based on Arduino microcontrollers. These boron-lined detectors shall offer an alternative platform to current Helium-3 based systems and allow for modular instrument designs. Individual shieldings of different segments within the detector introduces the capability of gaining spectral information. This opens the possibility for active signal correction during mobile measurements, where the influence of the constantly changing near-field to the overall signal should be corrected. Furthermore, the signal-to-noise ratio could be increased by combining pulse-height and pulse-length spectra to discriminate between neutrons and other environmental radiation. This novel detector therefore combines high-selective counting electronics with large-scale instrumentation technology. The successful implementation of our design allowed also to build the largest up to now existing CRNS detector.

Objective To compare pulmonary artery catheter (PAC) placement by transesophageal echocardiography combined with pressure waveform transduction versus the traditional technique of pressure waveform transduction alone. Design A prospective, randomized trial. Setting Single university hospital. Participants Forty-eight patients with chronic thromboembolic pulmonary hypertension (CTEPH) scheduled for pulmonary thromboendarterectomy. Interventions PACs were placed in 48 patients with CTEPH scheduled for pulmonary thromboendarterectomy by either a combined approach (eg, transesophageal echocardiography [TEE] and pressure waveform transduction) or by pressure waveform transduction alone. Measurements and Main Results Successful placement of the PAC via a combined technique or pressure waveform transduction alone was timed, number of attempts recorded, and final location noted. The final location of the pressure waveform-guided catheters was the proximal right pulmonary artery in 6 of 24 cases (25%), whereas the combined method resulted in successful placement in the proximal right pulmonary artery in 24 of 24 cases (100%). The pressure waveform technique resulted in a mean time to placement and mean number of attempts of 74 seconds and 1.70 attempts, respectively. The combined approach resulted in a mean time to placement and mean number of attempts of 89 seconds and 1.79 attempts, respectively. The combined method resulted in placement in the proximal right pulmonary artery significantly more often than the pressure-only method but did not reduce significantly the number of attempts or time required to place the catheter successfully. Additionally, among those cases that required more than 1 attempt or manipulation, there was no difference in the time to successful placement or the number of attempts required for successful placement. Conclusion TEE guidance during PAC insertion was hypothesized to result in a higher success rate, precise placement, and shorter times to placement. One hundred percent of the PACs inserted with TEE guidance were positioned successfully in the proximal right pulmonary artery, which is the institutional preference. Although the combined technique resulted in greater precision, the clinical significance of this is unknown. The time to placement benefit was not confirmed by this study.

This study examines structural differences in the subjective quality of health care in Germany using a newspaper survey. We find that there are significant differences between urban and rural areas as well as between public and private insurance. In rural areas, the provision of general practitioners, specialists and hospitals are considered as worse than in cities. In particular, public insured individuals asses the provision of specialized doctors and hospitals as lower than private insured and criticize long waiting times for appointments and lacking coverage of health care costs by the statutory health insurance.

Intra-hospital transport (IHT) of intensive care unit (ICU) patients is associated with a 30% to 60% incidence of adverse events (AEs). This prospective observational study collected data from 200 patient transports from a 24-bed cardiovascular intensive care unit (ICU) between July 2017 and December 2017. Phase 1 of the study focused on identifying and correcting deficiencies in nurses' knowledge regarding IHT. Phase 2 observed the occurrence and type of AEs during the IHT of ICU patients with and without physician accompaniment. The preeducation mean nursing knowledge score was 30.8 ± 10.2 (scale 0-100), and postcurriculum test mean score was 80 ± 20.2 (p < .001). In a series of 200 ICU transports, the incidence of AEs was 21.5% (n = 43). In patients who were unstable prior to transport, there was no difference in complications with or without a physician present (p = 0.40, χ = 0.696, odds ratio = 0.643, 95% confidence interval: 0.245-1.96). Patient needs during transport were met with preexisting orders or treatment orders received telephonically. Nurses' knowledge of transport standards improved significantly with education. Physician presence did not affect outcomes. The interventions needed to respond to complications did not require physician presence. In this cohort, there was no statistically significant benefit from physician attendance in transport.

Cosmic-Ray Neutron Sensing (CRNS) is a novel technique for determining environmental water content by measuring albedo neutrons in the epithermal to fast energy range with moderated neutron detectors. We have investigated the response function of stationary and mobile neutron detectors typically used for environmental research in order to improve the model accuracy for neutron transport studies. Monte Carlo simulations have been performed in order to analyze the detection probability in terms of energy-dependent response and angular sensitivity for different variants of CRNS detectors and converter gases. Our results reveal the sensor's response to neutron energies from 0.1 eV to 1 MeV and highest sensitivity to vertical fluxes. The detector efficiency shows good agreement with reference data from the structurally similar Bonner Spheres. The relative probability of neutrons contributing to the overall integrated signal is especially important in regions with non-uniform albedo fluxes, such as complex terrain or heterogeneous distribution of hydrogen pools., 18 pages, 7 figures