Characteristics of the Diffuse Astrophysical Electron and Tau Neutrino Flux with Six Years of IceCube High Energy Cascade Data

We report on the first measurement of the astrophysical neutrino flux using particle showers (cascades) in IceCube data from 2010-2015. Assuming standard oscillations, the astrophysical neutrinos in this dedicated cascade sample are dominated (∼90%) by electron and tau flavors. The flux, observed in the sensitive energy range from 16 TeV to 2.6 PeV, is consistent with a single power-law model as expected from Fermi-type acceleration of high energy particles at astrophysical sources. We find the flux spectral index to be γ=2.53±0.07 and a flux normalization for each neutrino flavor of ϕ_{astro}=1.66_{-0.27}^{+0.25} at E_{0}=100  TeV, in agreement with IceCube's complementary muon neutrino results and with all-neutrino flavor fit results. In the measured energy range we reject spectral indices γ≤2.28 at ≥3σ significance level. Because of high neutrino energy resolution and low atmospheric neutrino backgrounds, this analysis provides the most detailed characterization of the neutrino flux at energies below ∼100  TeV compared to previous IceCube results. Results from fits assuming more complex neutrino flux models suggest a flux softening at high energies and a flux hardening at low energies (p value ≥0.06). The sizable and smooth flux measured below ∼100  TeV remains a puzzle. In order to not violate the isotropic diffuse gamma-ray background as measured by the Fermi Large Area Telescope, it suggests the existence of astrophysical neutrino sources characterized by dense environments which are opaque to gamma rays.

Assessing the impact of coordinated COVID-19 exit strategies across Europe

As rates of new coronavirus disease 2019 (COVID-19) cases decline across Europe owing to nonpharmaceutical interventions such as social distancing policies and lockdown measures, countries require guidance on how to ease restrictions while minimizing the risk of resurgent outbreaks. We use mobility and case data to quantify how coordinated exit strategies could delay continental resurgence and limit community transmission of COVID-19. We find that a resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. Further, we find that appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe means that half as many lockdown periods would be required to end continent-wide community transmission.

Dietary patterns are related to cognitive functioning in elderly enriched with individuals at increased risk for Alzheimer's disease

Purpose

To investigate cross-sectional associations between dietary patterns and cognitive functioning in elderly free of dementia.

Methods

Data of 389 participants from the German DELCODE study (52% female, 69 ± 6 years, mean Mini Mental State Score 29 ± 1) were included. The sample was enriched with elderly at increased risk for Alzheimer’s disease (AD) by including participants with subjective cognitive decline, mild cognitive impairment (MCI) and siblings of AD patients. Mediterranean and MIND diets were derived from 148 Food Frequency Questionnaire items, and data-driven patterns by principal component analysis (PCA) of 39 food groups. Associations between dietary patterns and five cognitive domain scores were analyzed with linear regression analyses adjusted for demographics (model 1), and additionally for energy intake, BMI, other lifestyle variables and APOe4-status (model 2). For PCA-derived dietary components, final model 3 included all other dietary components.

Results

In fully adjusted models, adherence to Mediterranean and MIND diet was associated with better memory. The ‘alcoholic beverages’ PCA component was positively associated with most cognitive domains. Exclusion of MCI subjects (n = 60) revealed that Mediterranean and MIND diet were also related to language functions; associations with the alcoholic beverages component were attenuated, but most remained significant.

Conclusion

In line with data from elderly population samples, Mediterranean and MIND diet and some data-derived dietary patterns were related to memory and language function. Longitudinal data are needed to draw conclusions on the putative effect of nutrition on the rate of cognitive decline, and on the potential of dietary interventions in groups at increased risk for AD.

Electronic supplementary material

The online version of this article (10.1007/s00394-020-02257-6) contains supplementary material, which is available to authorized users.

Combined ACL reconstruction and opening wedge high tibial osteotomy at 10-year follow-up: excellent laxity control but uncertain return to high level sport

PURPOSE

The purpose of this study was to report the long-term outcomes of a continuous series of patients who underwent simultaneous anterior cruciate ligament (ACL) reconstruction and opening wedge high tibial osteotomy (HTO) for varus-related early medial tibio-femoral osteoarthritis. It was hypothesized that this combined surgery sustainably allowed return to sport with efficient clinical and radiological results.

METHODS

From 1995 to 2015, all combined ACL reconstruction (bone-patellar tendon-bone graft) and opening wedge HTO for anterior laxity and early medial arthritis were included. Clinical evaluation at final follow-up used Tegner activity score, Lysholm score, subjective and objective IKDC scores. Radiologic evaluation consisted in full-length, standing, hip-to-ankle X-rays, monopodal weight-bearing X-rays and skyline views. AP laxity assessment used Telos™ at 150 N load. Student's t test was performed for matched parametric data, Wilcoxon for nonparametric variables and Friedman test was used to compare small cohorts, with p < 0.05.

RESULTS

35 Patients (36 knees) were reviewed with a mean follow-up of 10 ± 5.2 years. The mean age at surgery was 39 ± 9. At final follow-up 28 patients (80%) returned to sport (IKDC ≥ B): 11 patients (31%) returned to sport at the same level and 6 (17%) to competitive sports. Mean subjective IKDC and Lysholm scores were 71.8 ± 14.9 and 82 ± 14.1, respectively. The mean decrease of the Tegner activity level from preinjury state to follow-up was 0.8 (p < 0.01). Mean side-to-side difference in anterior tibial translation was 5.1 ± 3.8 mm. Three patients were considered as failures. The mean preoperative mechanical axis was 4.2° ± 2.6° varus and 0.8° ± 2.7° valgus at follow-up. Osteoarthritis progression for medial, lateral, and femoro-patellar compartments was recorded for 12 (33%, p < 0.05), 6 (17%, p < 0.001), and 8 (22%, p < 0.05) knees, respectively. No femoro-tibial osteoarthritis progression was observed in 22 knees (61%).

CONCLUSIONS

Combined ACL reconstruction and opening wedge HTO allowed sustainable stabilization of the knee at 10-year follow-up. However, return to sport at the same level was possible just for one-third of patients, with femoro-tibial osteoarthritis progression in 39% of cases.

LEVEL OF EVIDENCE

III.

[Time-allocation study of nurse and physician activities in the emergency department]

Hintergrund

Systematische und vergleichende Analysen der Tätigkeiten des ärztlichen und pflegerischen Personals in der Notaufnahme fehlen für den deutschsprachigen Bereich.

Ziel der Arbeit

Analyse der Aktivitäten des pflegerischen und ärztlichen Personals einer Notaufnahme sowie der Anteile direkten Patientenkontakts und stündlicher Tätigkeitswechsel.

Material und Methoden

Tätigkeitsanalysen auf Basis teilnehmender Beobachtungen (je 90 min) bei Pflegekräften und Ärzt*innen einer interdisziplinären Notaufnahme eines süddeutschen Krankenhauses der Maximalversorgung. Beobachtete Tätigkeiten wurden anhand eines Klassifikationssystems mitsamt Zeitdauern kodiert. Insgesamt wurden 160 Einzelbeobachtungen (mit einer Gesamtzeit von ca. 240 h) durchgeführt; 99 bei Pflegekräften sowie 61 bei Ärzt*innen.

Ergebnisse

Notaufnahmeärzt*innen arbeiten 30 % ihrer Zeit in direktem Patientenkontakt, Pflegekräfte hingegen 44 %. Für die Einzeltätigkeiten entfielen die größten Zeitanteile ärztlicher Tätigkeit auf Dokumentation und Schriftarbeit (29,3 %), interne Kommunikation mit Personal (16,9 %) sowie mit Patient*innen (13,6 %). Pflegekräfte verwenden die meiste Zeit auf therapeutische und Behandlungsaktivitäten (27,6 %) sowie interne Kommunikation (17,9 %). Diese Tätigkeiten waren stark fragmentiert: Im Durchschnitt erfassten wir 41,3 Einzeltätigkeiten pro Stunde mit einer durchschnittlichen Dauer von 1,5 min. Pflegekräfte hatten signifikant kürzere Tätigkeitsdauern als Ärzt*innen (F[df = 1] = 4,5; p = 0,04). Tätigkeitsspezifische Analysen ergaben weitere Professionsunterschiede.

Diskussion

Unsere Ergebnisse liefern erstmalig fundierte Einsichten in die Verteilung und Dauer von ärztlichen sowie pflegerischen Tätigkeiten in der akutmedizinischen Versorgung in der Notaufnahme. Zukünftige Arbeiten sollten sich insbesondere einhergehenden Auswirkungen auf die Leistungsfähigkeit und Beanspruchung des Personals wie auch der Sicherheit und Qualität der Versorgung widmen.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00063-020-00657-4) enthält die Tabelle S1. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

Time-Integrated Neutrino Source Searches with 10 Years of IceCube Data

This Letter presents the results from pointlike neutrino source searches using ten years of IceCube data collected between April 6, 2008 and July 10, 2018. We evaluate the significance of an astrophysical signal from a pointlike source looking for an excess of clustered neutrino events with energies typically above ∼1  TeV among the background of atmospheric muons and neutrinos. We perform a full-sky scan, a search within a selected source catalog, a catalog population study, and three stacked Galactic catalog searches. The most significant point in the northern hemisphere from scanning the sky is coincident with the Seyfert II galaxy NGC 1068, which was included in the source catalog search. The excess at the coordinates of NGC 1068 is inconsistent with background expectations at the level of 2.9σ after accounting for statistical trials from the entire catalog. The combination of this result along with excesses observed at the coordinates of three other sources, including TXS 0506+056, suggests that, collectively, correlations with sources in the northern catalog are inconsistent with background at 3.3σ significance. The southern catalog is consistent with background. These results, all based on searches for a cumulative neutrino signal integrated over the 10 years of available data, motivate further study of these and similar sources, including time-dependent analyses, multimessenger correlations, and the possibility of stronger evidence with coming upgrades to the detector.

Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

PURPOSE

Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research.

METHODS

International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: "AKI diagnosis and evaluation", "Medical management of AKI" and "Renal Replacement Therapy for AKI." Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research.

RESULTS

The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities.

CONCLUSION

Consensus was reached on a future research agenda for the AKI section of the ESICM.

Is there an association between social determinants and care dependency risk?

Background

Despite a growing body of knowledge about the morbidities and functional impairment which frequently lead to care dependency, the role of social determinants is not yet well understood. The purpose of this study was 1) to examine the effect of social determinants on care dependency onset and progression, and 2) to analyse the effect of social determinants on various levels of care dependency.

Methods

We used data from the Berlin Initiative Study (BIS), a prospective, longitudinal, population-based cohort study including 2069 older participants (≥70 years of age) with visits in 2009, 2011 and 2013. Care dependency was assessed if participants require substantial assistance in at least two activities of daily living for 90 minutes daily (level 1) or three hours+ daily (level 2). Social determinants were defined as partnership status, education, income, age and gender. Data were analysed with multi-state time to event regression modeling which simultaneously model several competing events, as well as not only first but also second or third event in one model.

Results

During the study period, 556 participants (27.5%) changed their status of care dependency. Persons who reported having no partner at baseline were care-dependent more often than participants with a partner (43.7% ’no partner’ / 27.1% ’with partner’). In the multiple model having no partner compared to having a partner was associated with a higher risk of transition from no care dependency to level 1 (HR: 1.25, 95%CI: 0.97-1.64), however failed significance. The significant association between care dependency and income and between care dependency and education ceased as well after adjustment for co-morbidities.

Conclusions

Results indicate that older people without a partner tend to be on a higher risk of care dependency onset but not on a higher risk of care dependency progression. Inequality between education and income groups can be explained in terms of morbidity.

Key messages

The significant association between care dependency and income and between care dependency and education can be explained in terms of morbidity. Results indicate that older people without a partner tend to be on a higher risk of care dependency onset but not on a higher risk of care dependency progression.

P5377A SUMO1-SIM motif within the C-terminal alpha-helical domain of S100A1 prevents its proteasomal degradation in cardiomyocytes

Acknowledgement/Funding

DZHK

Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

Background

In traumatic brain injury (TBI) patients desmopressin administration may induce rapid decreases in serum sodium and increase intracranial pressure (ICP).

Aim

In an international multi-centre study, we aimed to report changes in serum sodium and ICP after desmopressin administration in TBI patients.

Methods

We obtained data from 14 neurotrauma ICUs in Europe, Australia and UK for severe TBI patients (GCS ≤ 8) requiring ICP monitoring. We identified patients who received any desmopressin and recorded daily dose, 6-hourly serum sodium, and 6-hourly ICP.

Results

We studied 262 severe TBI patients. Of these, 39 patients (14.9%) received desmopressin. Median length of treatment with desmopressin was 1 [1–3] day and daily intravenous dose varied between centres from 0.125 to 10 mcg. The median hourly rate of decrease in serum sodium was low (− 0.1 [− 0.2 to 0.0] mmol/L/h) with a median period of decrease of 36 h. The proportion of 6-h periods in which the rate of natremia correction exceeded 0.5 mmol/L/h or 1 mmol/L/h was low, at 8% and 3%, respectively, and ICPs remained stable. After adjusting for IMPACT score and injury severity score, desmopressin administration was independently associated with increased 60-day mortality [HR of 1.83 (1.05–3.24) (p = 0.03)].

Conclusions

In severe TBI, desmopressin administration, potentially representing instances of diabetes insipidus is common and is independently associated with increased mortality. Desmopressin doses vary markedly among ICUs; however, the associated decrease in natremia rarely exceeds recommended rates and median ICP values remain unchanged. These findings support the notion that desmopressin therapy is safe.

[Breathing: Ambient Air Pollution and Health - Part III]

The third part of the DGP statement introduces the current body of knowledge on less studied health outcomes associated with exposure to ambient air pollution: the negative impact on metabolism leading to impaired glucose tolerance and diabetes as well as contribution to the development of neurodegenerative disorders and delayed cognitive function in children. Furthermore, prenatal exposure and adverse effects on mother and child are addressed. Finally, the currently discussed biological mechanisms underlying various health effects associated with exposure to air pollution are described.Differing, but often complementary biological mechanisms create the basis for the diverse health outcomes caused by air pollution. Oxidative stress and a subclinical inflammatory response in the lungs and on a systemic level ("low-grade systemic inflammation") are considered to be key mechanisms. They promote secondary alterations in the body, such as vascular or metabolic processes, and may also result in the currently studied epigenetic phenomena or neuroinflammation. In this context, the health significance of soluble particulate matter and the role of ultrafine particles translocated across biological membranes into blood vessel and transported via the circulation to secondary target organs, such as liver, brain or the fetus, are intensively discussed.Diabetes is one of the leading chronic diseases worldwide, with a prevalence of almost 14 % in Germany. Although lifestyle factors are the main causes, current evidence suggests that long-term exposure to air pollution may additionally increase the risk for type 2 diabetes. Supporting evidence for a causal role of air pollution is provided by studies addressing the regulation of the blood glucose levels in metabolically healthy participants, insulin sensitivity, or pregnancy-related diabetes. Experimental studies provide further support for plausible biological mechanisms. However, prospective studies are needed to gain more evidence, taking multiple lifestyle and environmental factors, such as green space and noise, and an improved individual exposure assessment into account.The aging population has an increased risk of neurodegenerative diseases. First studies point towards a contribution of chronic exposure to air pollution, specifically by particulate matter. Several studies report its association with decreased neurocognitive capacity or an increased prevalence of dementia or Alzheimer's disease in adults. However, the studies are inhomogeneous regarding design, exposure and outcome, leading to inconsistent results. With respect to the influence on neurocognitive development of children, first studies suggest an association between the level of air pollution, e. g. at school, and delayed cognitive development.Even though the evidence for the different biological endpoints during pregnancy is still heterogeneous, the studies generally point towards an adverse impact of air pollution on the maternal and fetal organisms. The strongest evidence exists for low birth weight, with small effect sizes of only some grams, and for a higher incidence of reduced birth weight (< 2500 g). An increased risk for gestational hypertension and preeclampsia underscores the possible impact of exposure to air pollution on the maternal organism. However, the current body of evidence does not yet allow a final conclusion on the influence of intrauterine exposure to air pollution regarding early childhood lung function and development of allergies, particularly in light of the fact that it is hard to distinguish in epidemiological studies between the effects of pre- and postnatal exposure.

Reduction of IL-2 fragmentation during manufacturing of a novel immunocytokine by DoE process optimization

Interleukin-2 (IL-2) is a potent molecule in cancer therapy. Clinical application, however, is limited due to its strong side effects during the treatment. We developed an IL-2 variant (IL-2v) immunocytokine to circumvent the drawbacks of the current IL-2 therapy. During the production of the IL-2v immunocytokine in Chinese hamster ovary (CHO) cells, molecules with fragmented IL-2v and therefore reduced cytokine activity can be observed. To control product fragmentation different production process conditions were investigated. By shifting temperature or pH after the cell growth phase to lower values, fragmented species can be reduced from 10% to 12% to about 4%. However, with the adopted process conditions, the effective titer is decreased concomitantly. Moreover, fermentation length and inoculation cell density are parameters to adjust fragmentation and effective titer. A suitable method for efficient process optimization is the design of experiment approach. With this procedure, novel optimal values for temperature, pH value, harvest day, and inoculation cell densities were proposed and tested subsequently. In comparison to the former process, the improved process reduces fragmentation by 66% while keeping the effective titer comparable. In summary, these findings will help to control fragmentation in CHO production processes of different IL-2v or IL-2 containing therapeutic proteins.

PEAT-CLSM: A Specific Treatment of Peatland Hydrology in the NASA Catchment Land Surface Model

Peatlands are poorly represented in global Earth system modeling frameworks. Here we add a peatland-specific land surface hydrology module (PEAT-CLSM) to the Catchment Land Surface Model (CLSM) of the NASA Goddard Earth Observing System (GEOS) framework. The amended TOPMODEL approach of the original CLSM that uses topography characteristics to model catchment processes is discarded, and a peatland-specific model concept is realized in its place. To facilitate its utilization in operational GEOS efforts, PEAT-CLSM uses the basic structure of CLSM and the same global input data. Parameters used in PEAT-CLSM are based on literature data. A suite of CLSM and PEAT-CLSM simulations for peatland areas between 40°N and 75°N is presented and evaluated against a newly compiled data set of groundwater table depth and eddy covariance observations of latent and sensible heat fluxes in natural and seminatural peatlands. CLSM's simulated groundwater tables are too deep and variable, whereas PEAT-CLSM simulates a mean groundwater table depth of -0.20 m (snow-free unfrozen period) with moderate temporal fluctuations (standard deviation of 0.10 m), in significantly better agreement with in situ observations. Relative to an operational CLSM version that simply includes peat as a soil class, the temporal correlation coefficient is increased on average by 0.16 and reaches 0.64 for bogs and 0.66 for fens when driven with global atmospheric forcing data. In PEAT-CLSM, runoff is increased on average by 38% and evapotranspiration is reduced by 19%. The evapotranspiration reduction constitutes a significant improvement relative to eddy covariance measurements.

[Breathing: Ambient Air Pollution and Health - Part II]

The second part of the DGP-statement on adverse health effects of ambient air pollution provides an overview of the current ambient air quality in Germany and its development in the past 20 years. Further, effects of air pollution on the cardiovascular system und underlying pathophysiological mechanisms are introduced. Air pollutants form a highly complex and dynamic system of thousands of organic and inorganic components from natural and anthropogenic sources. The pollutants are produced locally or introduced by long-range transport over hundreds of kilometers and are additionally subjected to local meteorological conditions. According to air quality regulations ambient air quality is monitored under uniform standards including immission of particulate matter, up to 2.5 µm (PM_2.5) or 10 µm (PM₁₀) in aerodynamic diameter, and of nitrogen dioxide (NO₂) or ozone (O₃). The clean air measures of recent years led to a continuous decline of air pollution in the past 20 years in Germany. Accordingly, the focus is nowadays directed at population-related health hazards caused by low concentrations of air pollution. Exceeded limits for sulfur dioxide, carbon monoxide, benzene and lead are not detected anymore. Also the number of days with increased ozone concentration declined, although the annual mean concentration is unaltered. Decreasing concentrations of particulate matter and NO₂ have been observed, however, about 40 % of the monitoring stations at urban traffic sites still measure values exceeding current limits for NO₂. Moreover, the stricter, solely health-based WHO-standards for PM_2.5, PM₁₀ and NO₂ are still not met so that an optimal protection from air pollution-related health hazards is currently not given for the German population. In recent years, the findings of numerous cross-sectional and longitudinal studies underscored adverse effects of air pollution on the cardiovascular system, especially for particulate matter, although the level of evidence still varies for the different health outcomes. Further, the studies show that cardiovascular health hazards on the population level are of higher relevance than those for the respiratory system. The existing evidence for cardiovascular mortality, hospitalization, ischemic heart diseases, myocardial infarction and stroke can be regarded as strong, while that for heart failure is rather moderate. While the evidence for air pollution-related short-term alteration of the cardiac autonomic balance can be considered as sufficient, long-term effects are still unclear. Likewise, the heterogeneous findings on air pollution-related arrhythmia do currently not allow a distinct conclusion in this regard. A large number of studies support the observation that both, short- and long-term air pollution exposure contribute to increased blood pressure, may impair vascular homeostasis, induce endothelial dysfunction and promote the progression of atherosclerotic lesions. These effects provide reasonable biological explanation for the fatal events associated with exposure to air pollution. Short-term exposure may not pose a significant risk on healthy individuals but may be considered as precursor for fatal events in susceptible populations, while repetitive or long-term exposure may contribute to the development of cardiovascular diseases even in healthy subjects.

[Breathing: Ambient Air Pollution and Health - Part I]

Die Exposition gegenüber Luftschadstoffen wird von der Weltgesundheitsorganisation weltweit als eine führende Gesundheitsgefährdung und als der wichtigste umweltbedingte Risikofaktor mit besonders hoher Krankheitslast in Ländern mit niedrigem und mittlerem Einkommen angesehen.

Die Luftschadstoffbelastung besteht aus hochkomplexen Gemischen verschiedenster organischer und anorganischer Bestandteile natürlichen oder anthropogenen Ursprungs, die lokal entstehen oder durch Ferntransport über hunderte von Kilometern regional eingebracht werden können. Zusätzlich wird die Schadstoffkonzentration durch die regionalen, meteorologischen Verhältnisse beeinflusst. Dementsprechend können Schadstoffkonzentration und Zusammensetzung an einem Ort deutlich variieren, zeigen aber typischerweise einen Tages-, Wochen- und Jahresgang.

Mittels gesetzlicher Grenzwerte wie in der „Air Quality Directive“ der Europäischen Union festgelegt, soll eine Gesundheitsgefährdung der Bevölkerung durch die Schadstoffe minimiert werden. Allerdings weichen die Grenzwerte der Europäischen Union von den Empfehlungen der WHO insbesondere für Feinstaub deutlich nach oben ab.

Zur Abschätzung der Luftschadstoffbelastung wird auf einzelne Indikatoren zurückgegriffen, die die partikuläre, wie Feinstaub bis 2,5 µm (PM2.5) bzw. bis 10 µm aerodynamischen Durchmesser (PM10), und die gasförmige Belastung, wie Stickstoffdioxid (NO2) und Ozon (O3), charakterisieren. Für die meisten Luftschadstoffe wurden über die letzten Jahrzehnte in der westlichen Welt abfallende Konzentrationen beobachtet, sodass hier v. a. die Gesundheitsgefährdung bei geringerer Schadstoffbelastung im Vordergrund steht. Insbesondere Ballungsgebiete in Deutschland leiden aber noch unter erhöhter Luftverschmutzung.

Zahlreiche Studien haben in den letzten Jahrzehnten schädliche Auswirkungen von Luftschadstoffen auf die Gesundheit der Bevölkerung belegt. Die Auswirkungen betreffen v. a. den Atemtrakt und das kardiovaskuläre System und reichen von unspezifischen Atemwegs- und kardiovaskulären Symptomen über Beeinträchtigungen der Lungenfunktion, vermehrter Medikamenteneinnahme und akuter Exazerbation von vorbestehenden Lungenerkrankungen, Herzinfarkten und Schlaganfällen bis hin zu Todesfällen. Neuere Studien weisen auf weitere Gesundheitsendpunkte, wie z. B. Atherosklerose, Einschränkungen des fetalen Wachstums, der kognitiven Funktion und neuronalen Entwicklung, Diabetes mellitus sowie auf ein verbessertes Verständnis der zugrundeliegenden pathophysiologischen Mechanismen hin.

In der „Global Burden of Disease Study“ von 2015 wird die Bedeutung der Luftschadstoffbelastung für Mortalität und Morbidität v. a. durch chronische Erkrankungen quantifiziert. Bei der vorzeitigen Mortalität, v. a. aufgrund von kardiovaskulären Todesursachen, lag PM2.5 in der Außenluft weltweit auf Rang 5, unmittelbar hinter den allgemeinen Risikofaktoren erhöhter Blutdruck, Rauchen sowie erhöhte Glukose- und Cholesterinwerte. In Deutschland liegt die Krankheitslast durch Luftverschmutzung an zehnter Stelle der Risikofaktoren und ist damit auch hierzulande der wichtigste umweltbezogene Risikofaktor. Entsprechend zeigen Studien, dass der Einfluss von Luftschadstoffen die Sterblichkeit in Europa erhöht und die mittlere Lebenserwartung um etwa ein Jahr reduzieren kann.

In dem hier vorgestellten Positionspapier fasst die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin den aktuellen Wissensstand zu den Gesundheitseffekten von Luftschadstoffen zusammen und leitet daraus Empfehlungen für einen umweltbezogenen Gesundheitsschutz ab. Der hier vorgestellte erste Teil fokussiert sich auf allgemeine Grundlagen und die Wirkungen im Atemtrakt.

Constraints on Minute-Scale Transient Astrophysical Neutrino Sources

High-energy neutrino emission has been predicted for several short-lived astrophysical transients including gamma-ray bursts (GRBs), core-collapse supernovae with choked jets, and neutron star mergers. IceCube's optical and x-ray follow-up program searches for such transient sources by looking for two or more muon neutrino candidates in directional coincidence and arriving within 100 s. The measured rate of neutrino alerts is consistent with the expected rate of chance coincidences of atmospheric background events and no likely electromagnetic counterparts have been identified in Swift follow-up observations. Here, we calculate generic bounds on the neutrino flux of short-lived transient sources. Assuming an E^{-2.5} neutrino spectrum, we find that the neutrino flux of rare sources, like long gamma-ray bursts, is constrained to <5% of the detected astrophysical flux and the energy released in neutrinos (100 GeV to 10 PeV) by a median bright GRB-like source is <10^{52.5}  erg. For a harder E^{-2.13} neutrino spectrum up to 30% of the flux could be produced by GRBs and the allowed median source energy is <10^{52}  erg. A hypothetical population of transient sources has to be more common than 10^{-5}  Mpc^{-3}  yr^{-1} (5×10^{-8}  Mpc^{-3}  yr^{-1} for the E^{-2.13} spectrum) to account for the complete astrophysical neutrino flux.

[Empirical health services research in emergency and acute medicine : Preliminary results of concomitant monitoring of patient recruitment and sample quality]

BACKGROUND

Up until now, research data on the implementation of empirical health services research in emergency departments in Germany are scarce.

STUDY AIM

A monitoring instrument applied in a multicenter prospective cohort study in emergency departments (EDs) is described and discussed regarding requirements for the control and supervision of data collection.

MATERIALS AND METHODS

Patients with cardiac diseases, respiratory tract infections, and hip fractures were recruited in eight EDs located in a central district of Berlin. Enrolment figures and nonresponder reasons were analyzed through descriptive statistics. Potential sample bias was examined in terms of response rates as well as the distribution of age and sex in the group of participants and nonresponders. Qualitative content analysis was applied to data from routine supervisory and feedback meetings with study nurses.

RESULTS

Within the first 8 months of data collection, 61.1% of the aimed 1104 patients were recruited. Most frequently stated nonresponder reasons were the dense work and care processes in EDs (41.9%) and patients' disease burden (24.7%). Moreover, qualitative results revealed problems with identifying potentially eligible participants and difficulties because of missing research infrastructure in study centers. The response rate of 50.7% and approximately equal distribution of age and sex in participants and nonresponders do not indicate sample biases.

DISCUSSION

The monitoring instrument has proven to be suited for empirical research in EDs and revealed optimization potential. We recommend using qualitative and quantitative data systematically.

Chiral self-sorting behaviour of [2.2]paracyclophane-based bis(pyridine) ligands

[2.2]Paracyclophane-based bis(pyridine) ligands form dinuclear complexes upon coordination to palladium(ii) ions, however, with distinct differences concerning their chiral self-sorting ability.

Search for neutrinos from decaying dark matter with IceCube: IceCube Collaboration

With the observation of high-energy astrophysical neutrinos by the IceCube Neutrino Observatory, interest has risen in models of PeV-mass decaying dark matter particles to explain the observed flux. We present two dedicated experimental analyses to test this hypothesis. One analysis uses 6 years of IceCube data focusing on muon neutrino 'track' events from the Northern Hemisphere, while the second analysis uses 2 years of 'cascade' events from the full sky. Known background components and the hypothetical flux from unstable dark matter are fitted to the experimental data. Since no significant excess is observed in either analysis, lower limits on the lifetime of dark matter particles are derived: we obtain the strongest constraint to date, excluding lifetimes shorter than10 28 s at 90% CL for dark matter masses above 10 TeV .

[Biliary atresia and congenital cholestatic syndromes : Characteristics before, after and during transition]

BACKGROUND

A growing number of patients with biliary atresia and congenital cholestatic syndromes are reaching adulthood. These patients often have a number of typical medical features, including specific characteristics of liver transplantation medicine.

OBJECTIVE

What are the special features in the care of adults suffering from liver diseases with manifestation in childhood and adolescence, both before and after liver transplantation (LTX). How does the progression of individual diseases differ depending on age at manifestation? What are specific aspects following pediatric LTX?

PATIENTS AND METHODS

Evaluation and discussion of existing guidelines and recommendations of the individual disciplines and professional societies as well as the current literature. Joint discussion of the recommendations between disciplines (gastroenterology, pediatric gastroenterology, surgery). Inclusion of center-specific experiences with transition from existing transition outpatient departments and training.

RESULTS

The recommendations are presented specifically for each disease. Special features in individual diseases after LTX are also discussed. Diagnosis-independent general treatment concepts for cholestasis and chronic liver disease are presented.

CONCLUSION

Patients with biliary atresia and congenital cholestatic syndromes have a life-long chronic liver disease with and without LTX and require specific medical care. The patients benefit from the pooling of expertise in the individual disciplines.

Naturally Produced Extracellular Matrix Is an Excellent Substrate for Canine Endothelial Cell Proliferation and Resistance to Shear Stress on PTFE Vascular Grafts

Purpose: Successful development of a vascular prosthesis lined with endothelial cells (EC) may depend on the ability of the attached cells to resist shear forces after implantation. The present study was designed to investigate EC detachment from extracellular matrix (ECM) precoated vascular prostheses, caused by shear stress in vitro and to test the performance of these grafts in vivo. Methods: Bovine aortic endothelial cells were seeded inside untreated polytetrafluoro-ethylene (PTFE) vascular graft (10 X 0.6 cm), PTFE graft precoated with fibronectin (FN), or PTFE precoated with FN and a naturally produced ECM (106 cells/graft). Sixteen hours after seeding the medium was replaced and unattached cells counted. The strength of endothelial cell attachment was evaluated by subjecting the grafts to a physiologic shear stress of 15 dynes/cm2 for 1 h. The detached cells were collected and quantitated. PTFE or EC preseeded ECM coated grafts were implanted in the common carotid arteries of dogs. Results: While little or no differences were found in the extent of endothelial cell attachment to the various grafts (79%, 87% and 94% of the cells attached to PTFE, FN precoated PTFE, or FN+ECM precoated PTFE, respectively), the number of cells retained after a shear stress was significanly increased on ECM coated PTFE (20%, 54% and 85% on PTFE, FN coated PTFE, and FN+ECM coated PTFE, respectively, p <0.01). Implantation experiments in dogs revealed a significant increase in EC coverage and a reduced incidence of thrombus formation on ECM coated grafts that were seeded with autologous saphenous vein endothelial cells prior to implantation. Conclusion: ECM coating significantly increased the strength of endothelial cell attachment to vascular prostheses subjected to shear stress. The presence of adhesive macromolecules and potent endothelial cell growth promoting factors may render the ECM a promising substrate for vascular prostheses.