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ZusammenfassungEine Hämorrhagie ist in 30–40 % der Patienten, die im Rahmen eines Traumas versterben, todesursächlich und die häufigste vermeidbare Todesursache. Für nichtkomprimierbare Blutungen im Bereich des Abdomens oder des Beckens wird in den letzten Jahren zunehmend (wieder) die Anwendung der „resuscitative endovascular balloon occlusion of the aorta“ (REBOA) zur temporären Blutungskontrolle diskutiert. Seit August 2020 steht im Schockraum des Universitären Notfallzentrums des Universitätsspital Bern die REBOA als Therapieoption im Rahmen der Schwerverletztenversorgung zur Verfügung. Wir berichten in dieser Fallserie unsere Erfahrungen aus allen 7 Anwendungen im Laufe des ersten Jahres.

Background Many countries report a significant increase in emergency department (ED) visits. Patients with musculoskeletal disorders account for a large proportion of non-urgent cases. Objective Characterization and evaluation of a new service that provides immediate access to physiotherapy for patients in the ED. Method To characterize a new service at the Department of Emergency Medicine, Bern University Hospital, and to evaluate first experiences with it, a mixed methods approach was chosen. Data was collected from the electronic patient file and from a logbook kept by the physiotherapists. In addition, guideline-based interviews with involved health care staff were conducted. Results During the 63 days of the pilot study 79 patients were treated by physiotherapists. The most frequently reported patient complaint was back pain (47 %). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In 59 % of patients no medical imaging and in 58 % no additional physiotherapy was prescribed. Patients rated the physiotherapeutic service as very good or excellent (88 %). Physiotherapy was experienced as positive and appreciated by the other professions, and all interviewees emphasized the added value for patients. Conclusion The pilot study indicates that the physiotherapeutic consultation service has the potential to improve quality of care. The findings of this study are therefore valuable when considering the introduction of such a service in an ED.

ZusammenfassungEs wird der Einsatz von Handheld-Ultraschallgeräten unter technischen und datenschutzrechtlichen Gesichtspunkten, Geräteeigenschaften, Funktionalität, Dokumentation, Indikationen, Delegation der Leistung, Anwendungen durch Ärzte, Studierende und nichtärztliches Personal beleuchtet und diskutiert.

The use of handheld ultrasound devices from a technical and data protection point of view, device properties, functionality, documentation, indications, delegation of performance, applications by doctors, students and non-medical staff is examined and discussed.Es wird der Einsatz von Handheld-Ultraschallgeräten unter technischen und datenschutzrechtlichen Gesichtspunkten, Geräteeigenschaften, Funktionalität, Dokumentation, Indikationen, Delegation der Leistung, Anwendungen durch Ärzte, Studierende und nichtärztliches Personal beleuchtet und diskutiert.

Zusammenfassung. Die Schweiz ist von der COVID-19-Pandemie stark betroffen. Das klinische Spektrum dieser Erkrankung hinsichtlich klinischer Präsentation und Verlauf ist breit. Eine korrekte initiale Beurteilung in der Praxis oder auf der Notfallstation ist wichtig und umfasst neben Anamnese und klinischer Untersuchung auch bildgebende Verfahren und Laboruntersuchungen. Die meisten Personen mit COVID-19 können ambulant behandelt werden. Eine Hospitalisation kann notwendig werden bei Kranken mit ausgeprägter COVID-19-Pneumonie oder weiteren Komplikationen, die vor allem in der 2. und 3. Phase der Erkrankung auftreten. Auch muss die Dynamik der Erkrankung in die Überlegungen mit einbezogen werden. Bei ambulanten Patientinnen und Patienten erfolgt in der Regel eine symptomatische Therapie, Antibiotika oder Kortikosteroide sind nicht indiziert.

Hemorrhage is the cause of death in 30-40% of severely injured patients due to trauma and the most frequent avoidable cause of death. In civilian emergency medical services, the majority of life-threatening hemorrhages are found in incompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a lifesaving procedure for temporary bleeding control in multiple trauma patients. Since August 2020 REBOA is implented in the treatment of seriously injured patients in the emergency department of the University Hospital of Bern. In this case series we report on our experiences in all seven patients in whom we performed this procedure during the first year.Eine Hämorrhagie ist in 30–40 % der Patienten, die im Rahmen eines Traumas versterben, todesursächlich und die häufigste vermeidbare Todesursache. Für nichtkomprimierbare Blutungen im Bereich des Abdomens oder des Beckens wird in den letzten Jahren zunehmend (wieder) die Anwendung der „resuscitative endovascular balloon occlusion of the aorta“ (REBOA) zur temporären Blutungskontrolle diskutiert. Seit August 2020 steht im Schockraum des Universitären Notfallzentrums des Universitätsspital Bern die REBOA als Therapieoption im Rahmen der Schwerverletztenversorgung zur Verfügung. Wir berichten in dieser Fallserie unsere Erfahrungen aus allen 7 Anwendungen im Laufe des ersten Jahres.

COVID-19 in the Family Practice - Outpatient Treatment or Hospitalization?

We aimed to determine the incidence of all vestibular symptoms in a large interdisciplinary tertiary emergency department (ED) and to assess stroke prevalence, and frequency of other life-threatening aetiologies. In this 1-year retrospective study, we manually screened all medical records of 23,608 ED visits for descriptions of vestibular symptoms. Symptoms were classified according to the International Classification of Vestibular Disorders of the Barany Society. We evaluated all patients older than 16 years in whom vestibular symptoms were the main or accompanying complaint. We extracted clinical, radiological, and laboratory findings as well as aetiologies from medical records. We identified a total of 2596 visits by 2464 patients (11% of ED visits) who reported at least one vestibular symptom. In 1677/2596 visits (64.6%), vestibular symptoms were the main reason for the ED consultation. Vestibular symptoms were classified as dizziness (43.8%), vertigo (33.9%), postural symptoms (6.5%), or more than one symptom (15.8%). In 324/2596 visits (12.5%), cerebrovascular events were the aetiology of vestibular symptoms, and in 355/2596 visits (13.7%), no diagnosis could be established. In 23.8% of visits with vestibular symptoms as the main complaint, the underlying condition was life-threatening. Frequency and impact of vestibular symptoms in patients visiting the ED were higher than previously reported, and life-threatening aetiologies such as strokes are common. Therefore, awareness among physicians regarding the importance of vestibular symptoms has to be improved.

Arthrocentesis in the Emergency Department

The combination of an ageing population with improving survival in malignant and non-malignant disease processes results in a growing cohort of patients with advanced or end-stage chronic diseases who require acute medical care. Emergency care has historically been stereotyped as the identification and treatment of acute life-threatening problems. Although palliative care may be considered to be new to the formal curriculum of emergency medicine, in many domains the ultrasound skillset of a physician in acute medical care can be efficaciously deployed the benefit of patients with both malignant and non-malignant disease processes that require palliative care in the full breadth of acute healthcare settings. In diagnostic domains (abdominal pain, urinary tract obstruction, dyspnoea, venous thromboembolism and musculoskeletal pain) and for specific intervention guidance (thoracentesis, paracentesis, venous access, regional anaesthesia and musculoskeletal interventions) we suggest that POCUS has the potential to streamline improve patient satisfaction, streamline diagnostic strategies, optimise patient length of stay, expedite timely symptomatic relief and reduce complications in this important patient population. POCUS is a mandatory competence in the European curriculum of internal medicine, and specific training programs which cover applications in the domains of palliative care in acute care settings are available. Supervision, quality assurance and appropriate documentation are required. We expect that as the availability of mobile units suitable for point of care applications increases, these applications should become standard of care in the acute management of patients who require palliative care.

Background Guidelines recommend endotracheal intubation in trauma patients with a Glasgow coma scale (GCS) Methods We performed a retrospective analysis of all consultations to an urban ED in Switzerland that presented with an acute alcohol intoxication between 1st June 2012 and 31th Mai 2017. Patient and emergency consultations’ characteristics, related injuries, intubation and reason for intubations were extracted. As a subgroup analysis, we analysed the patients with a GCS Results Of 3003 consultations included from 01.06.2012 to 31.05.2017, 68 were intubated, leading to a proportional incidence of 2.3% intubations in alcohol-intoxication. Intubated patients had a lower blood alcohol concentration (1.3 g/kg [IQR 1.0–2.2] vs. 1.6 g/kg [IQR1.1–2.2], p = 0.034) and less often suffered from chronic alcohol abuse (1183 [39.4%] patients vs. 14 [20.6%], p = 0.001) than non-intubated patients. Patients with trauma were intubated more often (33 patients [48.5%] vs. 742 [25.3%], p p = 0.011). Conclusions Intubation in alcohol-intoxicated patients is rare and, among intoxicated patients with GCS

Background Extended focused assessment with sonography for trauma (eFAST) has been shown to have moderate sensitivity for detection of pneumothorax in trauma. Little is known about the location or size of missed pneumothoraces or clinical predictors of pneumothoraces in patients with false-negative eFAST. Methods This retrospective cross-sectional study includes all patients with multiple blunt trauma diagnosed with pneumothorax who underwent both eFAST and CT performed in the ED of a level 1 trauma centre in Switzerland between 1 June 2012 and 30 September 2014. Sensitivity of eFAST for pneumothorax was determined using CT as the gold standard. Demographic and clinical characteristics of those who had a pneumothorax detected by eFAST and those who did not were compared using the Mann-Whitney U or Pearson’s χ2 tests. Univariate binary logistic regression models were used to identify predictors for pneumothoraces in patients with negative eFAST examination. Results The study included 109 patients. Overall sensitivity for pneumothorax on eFAST was 0.59 and 0.81 for pneumothoraces requiring treatment. Compared with those detected by eFAST, missed pneumothoraces were less likely to be ventral (30 (47.6%) vs 4 (9.3%), p

Diving Accidents in Lakes - a Retrospective Study of a Level-1 Emergency Centre in Switzerland

BackgroundSystematic imaging reduces the rate of missed appendicitis and negative appendectomies in patients with suspected acute appendicitis (AA). Little is known about the utility of ultrasound as a first diagnostic measure in patients with suspected AA. The aim of this retrospective study is to determine whether ultrasound, performed by emergency physicians or radiologists, can be used as first diagnostic measure in suspected cases to rule out AA and to avoid unnecessary CT.MethodsWe performed a retrospective analysis at the ED of the University Hospital Bern, Switzerland, from 2012 to 2014. Our standard protocol is that all adult patients suspected of appendicitis receive an ultrasound as their first imaging test, either by an emergency physician or a radiologist. The test characteristics of conclusive and inconclusive ultrasound exams were compared with a pragmatic gold standard.ResultsThe study included 508 patients with suspected AA. 308 patients (60.4%) had a conclusive ultrasound. Among these, sensitivity for appendicitis was 89.6% (95% CI 82.1% to 94.3%), specificity 93.8% (89.1% to 96.6%), the positive predictive value was 87.98 (80.84 to 92.71) and the negative predictive value was 94.65 (91.18 to 96.80). The remaining 200 (39.4%) patients had an inconclusive ultrasound exam. 29% (59/200) of these patients ultimately had appendicitis. Less experienced emergency physician sonographers came to a definitive conclusion in 48.1% (95% CI 36.9% to 59.5%), experienced emergency physician sonographers in 76.0% (68.4% to 82.5%) and radiologists in 52.4% (44.5% to 60.2%).ConclusionA conclusive ultrasound of the appendix performed by either emergency physicians or radiologists is a sensitive and specific exam to diagnose or exclude AA in patients with suspected AA. Because of 6% false negative exams, clinical follow-up is mandatory for patients with negative ultrasound. An inconclusive ultrasound warrants further imaging or a follow-up visit, since 29% of patients with inconclusive ultrasound had an AA.

Aim. To investigate the characteristics of Emergency Department (ED) presentations due to acute paracetamol intoxication. Methods. Retrospective observational study of patients presenting to the ED of Bern University Hospital between May 1, 2012, and October 31, 2018, due to a paracetamol overdose (defined as intake of >4 g/24 h). Cases were identified using the full-text search of the electronic patient database and were grouped into intentional (suicidal/parasuicidal) and unintentional intoxications (e.g., patient unaware of maximal daily dose). Results. During the study period, 181 cases were included and 143 (79%) of those were intentional. Compared to the patients in the unintentional group, patients in the intentional group were more often female (85% vs 45%, p<0.001) and younger (median age 23.0 vs 43.5 years, p<0.001), more frequently suffered from psychiatric comorbidities (93%, (including 49% with borderline personality disorder) vs 24%, p<0.001), and paracetamol was more often taken as a single dose (80% vs 13%, p<0.001). Although the median daily ingested dose was lower in the unintentional than in the intentional group (8.2 g vs 12.9 g, p<0.001), patients in the unintentional group presented later (29% vs 84% within 24 h of ingestion, p<0.001), included more cases of acute liver failure (nine (24%) vs six (4%), p<0.001), and were more often hospitalised (24% vs 52% treated as outpatients, p=0.002). There were no significant differences between the groups regarding drug-induced liver injury (seven cases (5%) in the intentional and one (3%) in the unintentional group) or fatalities (one in each group). Conclusions. The majority of presentations due to paracetamol poisoning were intentional, most commonly in female patients with borderline personality disorder. Patients with unintentional paracetamol intoxication had worse outcomes with respect to acute liver failure and hospitalisation. Future preventive measures should raise awareness of paracetamol toxicity in the general population and encourage particular attention and frequent follow-ups when prescribing paracetamol for vulnerable groups.

The consequences of mushroom poisoning range from mild, mostly gastrointestinal, disturbances to organ failure or even death. This retrospective study describes presentations related to mushroom poisoning at an emergency department in Bern (Switzerland) from January 2001 to October 2017. Gastrointestinal disturbances were reported in 86% of the 51 cases. The National Poisons Information Centre and mycologists were involved in 69% and 61% of the cases, respectively. Identification of the mushroom type/family was possible in 43% of the cases. The most common mushroom family was Boletaceae (n = 21) and the most common mushrooms Xerocomus chrysenteron (n = 7, four being part of a cluster), Clitocybe nebularis, Lepista nuda and Lactarius semisanguifluus (n = 5 each, four being part of a cluster). Poisonous mushrooms included Amanita phalloides (n = 3, all analytically confirmed), Boletus satanas (n = 3), Amanita muscaria (n = 2) and Amanita pantherina (n = 2). There were no fatalities and 80% of the patients were discharged within 24 h. Mushroom poisoning does not appear to be a common reason for emergency consultation and most presentations were of minor severity and related to edible species (e.g., due to incorrect processing). Nevertheless, poisonous mushrooms and severe complications were also recorded. Collaboration with a poison centre and/or mycologists is of great importance, especially in high risk cases.

Infrared thermography is an affordable, fast and hence widespread method to detect temperature distributions on the external surfaces of buildings. The interpretation of obtained thermal images requires the knowledge of the status of a multitude of climatic parameters preceding the thermography investigation. The length of the adequate time interval back in the climatic history depends on the thermal properties of the investigated building facade. Based on thermography of an old building with insulated and non-insulated facades, equipped with temperature sensors and a nearby meteo station, a numerical study has been carried out to quantify the individual influence of parameters such as air and sky temperature, wind, solar irradiation, thermal transmittance (U-value) and emissivity on the evaluation of thermal images. Subsequently, an in-depth numerical study is carried out to determine the minimum climatic history needed to correctly interpret the thermal images of various constructions having different thermal performance characteristics.

Integrated Room Automation (IRA) for office buildings deals with the automated control of blinds, electric lighting, heating, cooling, and ventilation of a room or building zone. Model Predictive Control (MPC) presents a promising method to achieve energy savings thanks to improved control. This paper presents the development and validation of an intermediate complexity, integrated building and building equipment model suitable for application within MPC. A resistance-capacitance (RC) modeling approach was chosen. The result is a 12th order multiple-input-multiple-output bilinear model for the coupled simulation of the thermal, light and air quality dynamics of a single room. It includes the subsystems mechanical and natural ventilation, radiator and floor heating, cooling ceiling and thermally activated building system. For computational efficiency and compatibility with MPC, several approximations and a reduction of complexity were necessary. The resulting behaviors were validated against detailed building and system simulations. The model was found to deliver accurate and reliable results. It can be flexibly configured to represent typical building types and variants of technical systems. Furthermore, it is sufficiently efficient to support large-scale sensitivity studies. Finally, the model is ready for adaptation and integration into commercial algorithms for the control of real buildings.

Ein 53-jahriger Patient wurde uns aus einem Regionalspital zugewiesen mit heftigen linksseitigen Unterbauchschmerzen, Nausea ohne Erbrechen sowie Hypotonie und Kaltschweissigkeit, die perakut drei Stunden vor Hospitalisation aufgetreten waren.

BACKGROUND: Burns in Switzerland are frequent and lead to high economic and social costs. However, little is known about the aetiology of burns suffered by patients seeking treatment in hospital emergency departments. This knowledge could be used to develop preventive measures. METHODS: This retrospective analysis included all patients (≥16 years old) with acute thermal injuries of known cause admitted to the adult emergency department in Bern University Hospital (Switzerland, not a specialised burns unit) between 2000 and 2012. Clinical and sociodemographic data were extracted from medical records, i.e. the environment in which the burn occurred, as well as details of burn severity and aetiology. RESULTS: Seven hundred and one (701) patients with a mean age of 35.0±14.5 years (56% men) were included in the analysis. The winter season and the days around Christmas, turn of the year and Swiss National Day were identified as times with high risk of burns. Household (45%) and workplace (31%) were the most common locations/settings in which the burns occurred. Approximately every second burn was caused by scald, every fourth by flame and every seventh by hot objects. The analysis identified cooking, tar and electricity in workplace accidents, barbecues and the use of gasoline as aetiological factors in burns in leisure time, together with water in domestic thermal injuries. Burns occurred predominantly on non-protected skin on the hand and arms. The most severe burns were seen in electrical and flame burns. Men suffered more severe burns than women in all settings except psychopathology. CONCLUSIONS: The data suggest that the incidence and severity of burns in Switzerland could be reduced by preventive strategies and public campaigns, including education on fire protection systems, raising awareness about the times and locations where the risks of burns are greater, further improvement in workplace safety, particularly with cooking facilities and electrical equipment, and the development of innovative safety devices (i.e. machines, protective gloves). These findings have to be interpreted carefully, as this study includes only adult patients who presented in our ED and, in most cases, the burns covered less than 20% of the body surface.Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved. Language: en

Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen’s d was calculated as effect size for all statistically significant tests. Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (d z = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED.

This paper presents an investigation of how ModelPredictiveControl (MPC) and weatherpredictions can increase the energy efficiency in Integrated Room Automation (IRA) while respecting occupant comfort. IRA deals with the simultaneous control of heating, ventilation and air conditioning (HVAC) as well as blind positioning and electric lighting of a building zone such that the room temperature as well as CO2 and luminance levels stay within given comfort ranges. MPC is an advanced control technique which, when applied to buildings, employs a model of the building dynamics and solves an optimization problem to determine the optimal control inputs. In this paper it is reported on the development and analysis of a Stochastic ModelPredictiveControl (SMPC) strategy for buildingclimatecontrol that takes into account the uncertainty due to the use of weatherpredictions. As first step the potential of MPC was assessed by means of a large-scale factorial simulation study that considered different types of buildings and HVAC systems at four representative European sites. Then for selected representative cases the control performance of SMPC, the impact of the accuracy of weatherpredictions, as well as the tunability of SMPC were investigated. The findings suggest that SMPC outperforms current control practice.

Werden bei Warmebild-Interpretationen Angaben zum Warmedurchgang einzelner Bauteile gemacht, so sollte das nur mit standardisiert dargestellten Thermogrammen geschehen. Der hier vorgestellte Beitrag zeigt, wie die QualiThermo-Methode dafur die Skalierungs-Vorgaben liefert. Diese Methodik ist auf rein empirischer Basis entstanden und wurde im Rahmen eines durch das schweizerische Bundesamt fur Energie (BFE) geforderten Forschungsprojektes uberpruft und weiterentwickelt. Dazu wurde ein Testgebaude uber einen langeren Zeitraum warmetechnisch detailliert ausgemessen und gleichzeitig mit zwei IR-Kameras beobachtet. Danach konnte mittels Simulationsberechnungen und anschliesenden Sensitivitatsanalysen aufgezeigt werden, welche Meteo-Faktoren fur die Genauigkeit der Abschatzung von Warme verlusten von Bauteilen entscheidend sind. Mit dem QualiThermoVerfahren steht dem Praktiker somit ein Instrument zur Verfugung, welches in beschranktem Rahmen vergleichbare und nachvollziehbare IR-Bildauswertungen zulasst. Aus den gewonnenen Erkenntnissen und den gesammelten Erfahrungen wurden zudem Hinweise und Tipps fur die Praxis abgeleitet, welche dem Thermografen helfen, in einer kalten Winternacht hochwertige und zielgerichtete IR-Aufnahmen zu erstellen und auszuwerten. A proposal for standardized thermal images. Statements on the thermal transmittance of building details based on thermal images should be delivered by means of standardized “thermograms“. The presented “QualiThermo” method gives the guidelines for the temperature scaling. The empirically developed method has been validated during a project supported by the Swiss Federal Office of Energy (SFOE) and enhanced further. For this purpose a test house was instrumented with temperature sensors and measured for several weeks. For certain short periods the building was simultaneously monitored by two infrared cameras. By means of numerical simulations and consecutive sensitivity analysis the major parameters influencing the accuracy of heat losses of building details were identified. “QualiThermo” is a helpful method at the disposal of thermography practitioners which – within certain limits – allows comprehensible and reproducible analysis of thermograms. Out of the findings of this project practical procedures and tips can be deduced to support practitioners producing correct thermograms during a winter night and adequate interpretation. 1 Ausgangslage zur Gebaudethermografie von ausen 1.1 Nutzen der Bauthermografie

By integrating the building structure as thermal energy storage into the building services concept, thermally activated building systems (TABS) have proven to be economically viable for the heating and cooling of buildings. Having already developed an integrated design method and various control concepts in the past, in the present paper the impact of different aspects of TABS regarding the energetic performance of such systems is analyzed. Based on a simulation case study for a typical Central European office building, the following conclusions can be drawn. The energy efficiency of TABS is significantly influenced by the hydronic circuit topology used. With separate zone return pipes energy savings of approximately 15–25 kW h/m2 a, or 20–30% of heating as well as cooling demand, can be achieved, compared to common zone return pipes, where energy losses occur due to mixing of return water. A strong impact on energy efficiency can also be observed for the control strategy. Thus, by intermittent operation of the system using pulse width modulation control (PWM), the electricity demand for the water circulation pumps can be reduced by more than 50% compared to continuous operation. Concerning cold generation for TABS, it is shown that free cooling with a wet cooling tower is most efficient, if the cold source is the outside air. Variants with mechanical chillers exhibit 30–50% higher electricity demands for cold generation and distribution, even though their runtimes are much shorter compared to the cooling tower runtimes. In conclusion, the results show that significant energy savings can be achieved using adapted system topologies and applying appropriate control solutions for TABS.

The Eawag's new headquarters “Forum Chriesbach” is an exemplary illustration of a ‘sustainable’ construction design for office buildings. With a unique combination of architectural and technical elements the building reaches a very low 88 kWh/m 2 overall primary energy consumption, which is significantly lower than the Swiss Passive House standard, Minergie-P. A monitoring and evaluation project shows that the building is heated mainly by using the sun and internal heat gains from lighting, electrical appliances and occupants, resulting in an extremely low space heating demand. Cooling is provided by natural night time ventilation and the earth-coupled air intake, which pre-cools supply air and provides free cooling for computer servers. However, values for embodied energy and electricity consumption remain significant, even with partial on-site electricity production using photovoltaics. TRNSYS computer simulations show the contributions of individual building services to the overall energy balance and indicate that the building is resilient towards changes in parameters such as climate or occupancy density. Measurements confirm comfortable room temperatures below 26 °C, even during an extremely hot summer period, and 20–23 °C in the winter season. An economic analysis reveals additional costs of only 5% compared to a conventionally constructed building and a payback-time of 13 years.

BackgroundThis article addresses typical injury patterns related to the traditional Swiss folk wrestling, ‘Schwingen’. This is a fight between two competitors with its own rules, grips and throws. A variety of injuries have been occasionally reported. The aim of this study was to characterise all cases of Schwingen injuries treated in the University Hospital of Bern from January 2006 to July 2016.MethodsTo assess the frequency, type and outcome of Schwingen injuries, database search was performed of all inpatient and outpatient cases related to Schwingen that were admitted to Bern University Hospital from January 2006 to December 2016.ResultsA total of 32 such patients could be identified. Apart from a single woman, all patients were male. 31 of the 32 players were Swiss. One patient was admitted to the intermediate care unit, eight patients underwent surgery, two were hospitalised for further treatment and two were given a plaster. 17 other patients were given medications such as painkillers. One was dismissed without further treatment and another one left the hospital on his own. Typical injury patterns varied from simple lesions to distortions and fractures as well as head injuries and other neurological complications.ConclusionThe majority of injuries caused by Schwingen are not life threatening. Nevertheless, there is always the potential of head injuries and neurological deficits. Apart from the economic loss due to treatment costs and sick leave, these injuries can be disabling for life. It should therefore be obligatory for all players to evaluate preventive measures.

Thermoaktive Bauteilsysteme (TABS) haben eine zunehmende Bedeutung bei der energieeffizienten Kuhlung und Heizung von Gebauden, doch ihre Regelung/Steuerung fuhrt in der Praxis oft zu Problemen. Mit dem Ziel, diese Probleme in den Griff zu bekommen, wurde vor funf Jahren das Forschungsprojekt TABS-Control gestartet, das zu Beginnd des Jahres 2009 abgeschlossen wurde. Es wurden folgende wesentliche Resultate erarbeitet: Modelle und Simulationsprogramme fur TABS; Performance-Bound-Berechnungen fur die Zonenregelung; eine Auswahl von Regel-/ Steuer-Strategien fur die Zonenregelung, u. a. mit Losungen fur das automatische Umschalten zwischen Heizen und Kuhlen, fur den Taktbetrieb der Zonenpumpe und fur eine Raumtemperaturregelung; Implementierung von Standardlosungen in einem Gebaudeautomationssystem; Labortests; das neue UBB-Planungsverfahren (Unknown-But-Bounded) zur integrierten Planung von TABS und ihrer Regelung/Steuerung; ein Excel-Planungstool; Richtlinien zur Wahl der Topologie der hydraulischen Schaltung; eine Methode zur Betriebsoptimierung; eine theoretische Grundlage (UBB-Ansatz) fur das neue integrierte Planungsverfahren und die neuen Regel-/Steuer-Strategien; eine Patentanmeldung. Regulation and control of thermally activated building systems (TABS). Thermally activated building systems (TABS) are becoming increasingly important in terms of energy efficient cooling and heating of buildings. In practice, however, regulation and control of such systems often causes problems. Started five years ago with the aim of getting to grips with these problems, the TABS Control research project was completed in early 2009. The project yielded the following results: various models and simulation programs for TABS; performance-bound calculations for regulating zones; a range of zone regulation/control strategies for planners to choose from, including good solutions for automatic switching between heating and cooling, for pulsed operation of the zone pump and for room temperature control; the implementation of a subset of these strategies as standard solutions in a Siemens building automation system; laboratory tests on these strategies; a new procedure for the integrated planning of TABS and their regulation/control (referred to as UBB planning procedure – Unknown But Bounded); an Excel planning tool; guidelines on selecting the hydraulic switching topology; a method for operation optimization; the theoretical basis for the new integrated planning procedure and the new regulation/ control strategies; a patent application.

Thermally activated building systems (TABS) integrate the building structure as energy storage, and have proofed to be energy efficient and economic viable for the heating and cooling of buildings. Although TABS are increasingly used, in many cases control has remained an issue to be improved. In this paper, a method is outlined allowing for automated control of TABS in intermittent operation with pulse width modulation (PWM). This method represents one part of a TABS control solution with automatic switching between cooling and heating modes for variable comfort criteria which was published before. A first pulse width modulation control solution is derived based on a simple 1st order model of TABS. Then a second, even simpler solution is given that significantly reduces the tuning effort. Finally, the paper outlines a pulse width modulation control procedure and gives two application examples of the PWM control carried out in a laboratory test room.

SUMMARY A research project on the control and design of thermally activated building systems (TABS) has been started in May 2004. This paper presents one selected result after three years of work: A comprehensive TABS zone control strategy with a modular concept consisting of maximally four parts which allows creating four different control strategies. The (mandatory) first part of the comprehensive control strategy is an outside air temperature compensated supply water temperature control based on an unknown-but bounded approach to cope with uncertainties and variations in the heat gains during operation. The (optional) second part of the comprehensive control strategy is an algorithm for room temperature feedback control. With this part, room temperatures are controlled in an energyefficient way. The algorithm also corrects wrong parameter settings of the other control parts. The (optional) third part of the comprehensive control strategy is a pulse-width modulation (PWM) module for intermittent operation of the recirculation pump. The intermittent operation is used to save pump energy, but it is also applied to benefit from low-cost energy sources such as free-cooling during the night or electrical energy in low tariff phases. The (mandatory) fourth part of the comprehensive control strategy is a standard sequence controller to control the zone supply water temperature within the according setpoint range. In simulations, all four control strategies are applied to TABS and the simulation results are analyzed regarding comfort criteria and energy efficiency.

This paper presents application range and functionality of thermally activated building systems (tabs). Tabs are increasingly used for energy efficient and economical cooling and heating of commercial buildings. Thereby, the building structure is used as thermal storage allowing the use of renewable energy sources. Based on a simulation study for a typical office building the aspects of thermal comfort, maximum permissible heat gains in the room and the re-cooling of the building mass are analysed. It is shown that depending on the maximum permissible daily room temperature amplitude with tabs typical heat gain profiles with peak loads up to around 50 W/m2 floor area can be managed. However, the transitional (mid-season) periods with already high solar gains and still restricted comfort range, in most cases will be decisive for the dimensioning of tabs, thus limiting maximum loads to lower values. The results also show that processes on the room side are almost unaffected from the processes on the supply side. In the cooling case, this allows for the re-cooling period of the fabric being extended to 24 h a day with accordingly “high” supply temperatures and peak load reductions of up to 50%. The results given may serve as orientation guide whether a tabs may be applicable in a specific building, and provides relevant parameters for the dimensioning of tabs.

In an office building equipped with a thermally activated building component system (TABS) detailed in situ measurements have been performed. The measurements presented in this paper have been concentrated on the concrete core conditioning (CCC) system, which is used for heating and cooling the building. Plastic pipes with circulating water have been placed in the concrete slab. One coil of the thermally activated concrete slab has been measured in detail using 80 measurement points. The measurements include temperature measurements at different heights of the concrete slabs as well as in the suspended floor and in both adjacent rooms. Furthermore the supply and return water temperature, the volume flow for the coil as well as the heat flow at the surface of the concrete slab have been measured. The measurements have been analyzed in the frequency-domain with help of a Fourier-transform. The temperature measurements and the volume flow have been utilized to validate a FEM-program working in the frequency-domain and a simplified RC star network placed in the time-domain simulation environment TRNSYS. The simplified RC-network has been previously validated with help of the FEM-program working in frequency-domain. For the validation of the FEM-program the measured time series have been transformed into Fourier-series and then used as input to the FEM-program performing the calculation in frequency-domain.

This paper describes the development of a thermally activated ceiling panel for incorporation in lightweight and retrofitted buildings. The system allows use of renewable energy sources for the heating and cooling of office and industrial buildings. The design for the new ceiling panel exploits the properties of the phase change material (PCM) paraffin. Its high thermal storage capacity during phase change—up to 300 Wh/(m 2 day)—enables the overall panel thickness to be limited to a mere 5 cm. Active control of the thermal storage is achieved by means of an integrated water capillary tube system. The research project also included the development of a numerical model for computation of the thermal behavior of wall and ceiling systems incorporating PCMs. Simulation calculations were performed to determine the necessary thermal properties of the ceiling panels and specify requirements for the materials to be used. Laboratory tests were performed to verify the system’s performance and a pilot application is soon to be tried out in practice.

PRINCIPALS Accidents in agriculture are a problem of global importance. The hazards of working in agriculture are manifold (machines, animals, heights). We therefore assessed injury severity and mortality from accidents in farming. METHODS We retrospectively analysed all farming accidents treated over a 12-year period in the emergency department (ED) of our level I trauma centre. RESULTS Out of 815 patients 96.3% were male and 3.7% female (p

Modern low NOx domestic oil and gas burners use the effect of flue gas recirculation to lower combustion temperature and hence to reduce the amount of NO being formed. Because these burners do take flue gas from the combustion chamber and mix it with primary air, a strong interaction is possible between the burner and the boiler. This interaction has to be taken into account particularly for the jet pump type of flue gas recirculators, because it can lower the rate of recirculation and hence increase the NOx emissions drastically. Numerical simulations (CFD) of the oil combustion process within a commercially available domestic burner have been carried out. Extensive comparison with experimental data (LDV, PDPA, LIF, probe) shows the achievable accuracy of numerical simulations for such complex geometry's nowadays. The final discussion gives reasons for the differences between simulations and measurements and shows the necessariness of further developments concerning the oil model.

Injuries of the spleen in blunt abdominal trauma are common and can lead to fatal bleeding. The diagnostic of choice to determine severity and treatment is usually made in contrast-enhanced CT. In our case we used contrast-enhanced ultrasound to identify the origin of an intra-abdominal bleeding following a minor trauma in a patient with splenomegaly due to an Epstein-Barr virus infection.