[German "Triage Act"-Regulation with fatal consequences]. / "Triagegesetz" ­ Regelung mit fatalen Folgen.

With the coming into force of § 5c of the Infection Protection Act (IfSG), the so-called Triage Act, on 14 December 2022, a protracted discussion has come to a provisional conclusion, the result of which physicians and social associations but also lawyers and ethicists are equally dissatisfied. The explicit exclusion of the discontinuation of treatment that has already begun in favor of new patients with better chances of success (so-called tertiary or ex-post triage) prevents allocation decisions with the aim of enabling as many patients as possible to beneficially participate in medical care under crisis conditions. The result of the new regulation is de facto a first come first served allocation, which is associated with the highest mortality even among individuals with limitations or disabilities and was rejected by a large margin as unfair in a population survey. Mandating allocation decisions based on the likelihood of success but which are not permitted to be consistently implemented and prohibiting, for example the use of age and frailty as prioritization criteria, although both factors most strongly determine the short-term probability of survival according to evident data, shows the contradictory and dogmatic nature of the regulation. The only remaining possibility is the consistent termination of treatment that is no longer indicated or desired by the patient, regardless of the current resource situation; however, if a different decision is made in a crisis situation than in a situation without a lack of resources, this practice would not be justified and would be punishable. Accordingly, the highest efforts must be set on legally compliant documentation, especially in the stage of decompensated crisis care in a region. The goal of enabling as many patients as possible to beneficially participate in medical care under crisis conditions is in any case thwarted by the new German Triage Act.

[Bed capacity management in times of the COVID-19 pandemic : A simulation-based prognosis of normal and intensive care beds using the descriptive data of the University Hospital Augsburg]. / Bettenkapazitätssteuerung in Zeiten der COVID-19-Pandemie : Eine simulationsbasierte Prognose der Normal- und Intensivstationsbetten anhand der deskriptiven Daten des Universitätsklinikums Augsburg.

BACKGROUND: Following the regional outbreak in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, presenting the healthcare systems with huge challenges worldwide. In Germany the coronavirus diseases 2019 (COVID-19) pandemic has resulted in a slowly growing demand for health care with a sudden occurrence of regional hotspots. This leads to an unpredictable situation for many hospitals, leaving the question of how many bed resources are needed to cope with the surge of COVID-19 patients. OBJECTIVE: In this study we created a simulation-based prognostic tool that provides the management of the University Hospital of Augsburg and the civil protection services with the necessary information to plan and guide the disaster response to the ongoing pandemic. Especially the number of beds needed on isolation wards and intensive care units (ICU) are the biggest concerns. The focus should lie not only on the confirmed cases as the patients with suspected COVID-19 are in need of the same resources. MATERIAL AND METHODS: For the input we used the latest information provided by governmental institutions about the spreading of the disease, with a special focus on the growth rate of the cumulative number of cases. Due to the dynamics of the current situation, these data can be highly variable. To minimize the influence of this variance, we designed distribution functions for the parameters growth rate, length of stay in hospital and the proportion of infected people who need to be hospitalized in our area of responsibility. Using this input, we started a Monte Carlo simulation with 10,000 runs to predict the range of the number of hospital beds needed within the coming days and compared it with the available resources. RESULTS: Since 2 February 2020 a total of 306 patients were treated with suspected or confirmed COVID-19 at this university hospital. Of these 84 needed treatment on the ICU. With the help of several simulation-based forecasts, the required ICU and normal bed capacity at Augsburg University Hospital and the Augsburg ambulance service in the period from 28 March 2020 to 8 June 2020 could be predicted with a high degree of reliability. Simulations that were run before the impact of the restrictions in daily life showed that we would have run out of ICU bed capacity within approximately 1 month. CONCLUSION: Our simulation-based prognosis of the health care capacities needed helps the management of the hospital and the civil protection service to make reasonable decisions and adapt the disaster response to the realistic needs. At the same time the forecasts create the possibility to plan the strategic response days and weeks in advance. The tool presented in this study is, as far as we know, the only one accounting not only for confirmed COVID-19 cases but also for suspected COVID-19 patients. Additionally, the few input parameters used are easy to access and can be easily adapted to other healthcare systems.

Metabolite-mediated modelling of microbial community dynamics captures emergent behaviour more effectively than species-species modelling.

Personalized models of the gut microbiome are valuable for disease prevention and treatment. For this, one requires a mathematical model that predicts microbial community composition and the emergent behaviour of microbial communities. We seek a modelling strategy that can capture emergent behaviour when built from sets of universal individual interactions. Our investigation reveals that species-metabolite interaction (SMI) modelling is better able to capture emergent behaviour in community composition dynamics than direct species-species modelling. Using publicly available data, we examine the ability of species-species models and species-metabolite models to predict trio growth experiments from the outcomes of pair growth experiments. We compare quadratic species-species interaction models and quadratic SMI models and conclude that only species-metabolite models have the necessary complexity to explain a wide variety of interdependent growth outcomes. We also show that general species-species interaction models cannot match the patterns observed in community growth dynamics, whereas species-metabolite models can. We conclude that species-metabolite modelling will be important in the development of accurate, clinically useful models of microbial communities.

Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty.

BACKGROUND: A subset of total hip arthroplasty patients experience functional impairments past the first postoperative year. Poor hip abductor function is common before and in the early postoperative period. It is not known if abductor impairment is associated with long-term functional impairment. This study evaluated the relationships between static and dynamic abductor function and performance-based and self-reported function >1 year post-total hip arthroplasty. METHODS: Eighteen adults 1-5 years post-total hip arthroplasty participated. Static and dynamic abductor function were assessed through dynamometry and gait analysis, respectively. Subjects completed four physical performance tests and two self-report instruments. FINDINGS: Higher peak isometric abductor strength was associated with better performance-based function (P ≤ 0.001-0.030) and with self-reported function (P ≤ 0.001-0.012). Higher peak external adduction moment was associated with better results on 3 of 4 performance tests (P = 0.007-0.026). Together, static and dynamic abductor function predicted 35-77% of the variation in physical function. Abductor strength best predicted walking test results and self-reported function, while dynamic abductor function best predicted tests involving sit-to-stand INTERPRETATION: Static and dynamic abductor function were associated with physical function 1-5 years after total hip arthroplasty. These results support further investigation of interventions targeting abductor function for persons experiencing persistent impairments.

Seasonal dynamics and potential drivers of ranavirus epidemics in wood frog populations.

Epidemics in wildlife populations often display a striking seasonality. Ranaviruses can cause rapid, synchronous mass mortality events in populations of wood frog (Rana sylvatica) larvae in the summer. While there are several possible explanations for this pattern-from seasonal introductions of the virus to environmental stressors to windows of susceptibility to mortality from infection during development-most studies have focused on single factors in laboratory settings. We characterized the time course of ranavirus epidemics in eight ephemeral ponds in Connecticut, USA, measuring the prevalence and intensity of infections in wood frog larvae and Ranavirus DNA in water samples using environmental DNA methods. We found little evidence that the timing of pathogen introduction affected the timing of epidemics (rising prevalence) or the resulting die-offs. Instead, we observed a pulse in transmission asynchronous with die-offs; prevalence reached high levels (≥ 50%) up to 6 weeks before mortality was observed, suggesting that die-offs may be uncoupled from this pulse in transmission. Rather, mortality occurred when larvae reached later stages of development (hind limb formation) and coinciding water temperatures rose (≥ 15 °C), both of which independently increase pathogenicity (i.e., probability of host mortality) of infections in laboratory experiments. In summary, the strong seasonality of die-offs appears to be driven by development- and/or temperature-dependent changes in pathogenicity rather than occurring chronologically with pathogen introduction, after a pulse in transmission, or when susceptible host densities are greatest. Furthermore, our study illustrates the potential for eDNA methods to provide valuable insight in aquatic host-pathogen systems.

Sex specific associations between biomechanical recovery and clinical recovery after total hip arthroplasty.

BACKGROUND: There are sex-specific gait differences in men and women before and after total hip arthroplasty (THA) but we do not know their impact on clinical outcomes. The objective of this study was to identify sex-specific associations between pre- and postoperative changes in pain and function and (i) gait mechanics, (ii) passive range of motion, and (iii) abductor strength. METHODS: Pre- and one-year postoperative data were identified from a data repository (n = 124; 64 Women; Age 61 (SD 10); BMI 29 (SD 5)). We used linear regression analysis to identify sex-specific associations between Harris Hip Score pain and function subscores, and sagittal plane hip kinematics and 3D hip kinetics during gait, hip abductor strength, and passive hip range of motion (RoM). FINDINGS: Combinations of biomechanical variables predicted up to 24% of the variation in pain improvement and up to 27% of the variation in functional improvement. In men, increased peak external rotation moments were associated with pain improvement. Passive flexion RoM and peak extension moments were associated with functional improvement. In women, increased passive adduction RoM and peak external rotation moments were associated with pain improvement. Peak adduction moments and passive flexion RoM were associated with functional improvement. INTERPRETATIONS: The different associations between improvement in clinical outcomes and improvement in gait, passive RoM, and abductor strength suggest that the biomechanical path to recovery may be different in men and women.

The cosmic ray shadow of the Moon observed with the ANTARES neutrino telescope.

One of the main objectives of the ANTARES telescope is the search for point-like neutrino sources. Both the pointing accuracy and the angular resolution of the detector are important in this context and a reliable way to evaluate this performance is needed. In order to measure the pointing accuracy of the detector, one possibility is to study the shadow of the Moon, i.e. the deficit of the atmospheric muon flux from the direction of the Moon induced by the absorption of cosmic rays. Analysing the data taken between 2007 and 2016, the Moon shadow is observed with 3.5 σ statistical significance. The detector angular resolution for downward-going muons is 0 . 73 ∘ ± 0 . 14 ∘ . The resulting pointing performance is consistent with the expectations. An independent check of the telescope pointing accuracy is realised with the data collected by a shower array detector onboard of a ship temporarily moving around the ANTARES location.

An algorithm for the reconstruction of high-energy neutrino-induced particle showers and its application to the ANTARES neutrino telescope.

A novel algorithm to reconstruct neutrino-induced particle showers within the ANTARES neutrino telescope is presented. The method achieves a median angular resolution of [Formula: see text] for shower energies below 100 TeV. Applying this algorithm to 6 years of data taken with the ANTARES detector, 8 events with reconstructed shower energies above 10 TeV are observed. This is consistent with the expectation of about 5 events from atmospheric backgrounds, but also compatible with diffuse astrophysical flux measurements by the IceCube collaboration, from which 2-4 additional events are expected. A [Formula: see text] C.L. upper limit on the diffuse astrophysical neutrino flux with a value per neutrino flavour of [Formula: see text] is set, applicable to the energy range from 23 TeV to 7.8 PeV, assuming an unbroken [Formula: see text] spectrum and neutrino flavour equipartition at Earth.

Sperm whale long-range echolocation sounds revealed by ANTARES, a deep-sea neutrino telescope.

Despite dedicated research has been carried out to adequately map the distribution of the sperm whale in the Mediterranean Sea, unlike other regions of the world, the species population status is still presently uncertain. The analysis of two years of continuous acoustic data provided by the ANTARES neutrino telescope revealed the year-round presence of sperm whales in the Ligurian Sea, probably associated with the availability of cephalopods in the region. The presence of the Ligurian Sea sperm whales was demonstrated through the real-time analysis of audio data streamed from a cabled-to-shore deep-sea observatory that allowed the hourly tracking of their long-range echolocation behaviour on the Internet. Interestingly, the same acoustic analysis indicated that the occurrence of surface shipping noise would apparently not condition the foraging behaviour of the sperm whale in the area, since shipping noise was almost always present when sperm whales were acoustically detected. The continuous presence of the sperm whale in the region confirms the ecological value of the Ligurian sea and the importance of ANTARES to help monitoring its ecosystems.

Maximizing Information Yield From Pheromone-Baited Monitoring Traps: Estimating Plume Reach, Trapping Radius, and Absolute Density of Cydia pomonella (Lepidoptera: Tortricidae) in Michigan Apple.

Novel methods of data analysis were used to interpret codling moth (Cydia pomonella) catch data from central-trap, multiple-release experiments using a standard codlemone-baited monitoring trap in commercial apple orchards not under mating disruption. The main objectives were to determine consistency and reliability for measures of: 1) the trapping radius, composed of the trap's behaviorally effective plume reach and the maximum dispersive distance of a responder population; and 2) the proportion of the population present in the trapping area that is caught. Two moth release designs were used: 1) moth releases at regular intervals in the four cardinal directions, and 2) evenly distributed moth releases across entire approximately 18-ha orchard blocks using both high and low codling moth populations. For both release designs, at high populations, the mean proportion catch was 0.01, and for the even release of low populations, that value was approximately 0.02. Mean maximum dispersive distance for released codling moth males was approximately 260 m. Behaviorally effective plume reach for the standard codling moth trap was < 5 m, and total trapping area for a single trap was approximately 21 ha. These estimates were consistent across three growing seasons and are supported by extraordinarily high replication for this type of field experiment. Knowing the trapping area and mean proportion caught, catch number per single monitoring trap can be translated into absolute pest density using the equation: males per trapping area = catch per trapping area/proportion caught. Thus, catches of 1, 3, 10, and 30 codling moth males per trap translate to approximately 5, 14, 48, and 143 males/ha, respectively, and reflect equal densities of females, because the codling moth sex ratio is 1:1. Combined with life-table data on codling moth fecundity and mortality, along with data on crop yield per trapping area, this fundamental knowledge of how to interpret catch numbers will enable pest managers to make considerably more precise projections of damage and therefore more precise and reliable decisions on whether insecticide applications are justified. The principles and methods established here for estimating absolute codling moth density may be broadly applicable to pests generally and thereby could set a new standard for integrated pest management decisions based on trapping.

Myeloid PTEN deficiency impairs tumor-immune surveillance via immune-checkpoint inhibition.

Tumor-host interaction is determined by constant immune surveillance, characterized by tumor infiltration of myeloid and lymphoid cells. A malfunctioning or diverted immune response promotes tumor growth and metastasis. Recent advances had been made, by treating of certain tumor types, such as melanoma, with T-cell checkpoint inhibitors. This highlights the importance of understanding the molecular mechanisms underlying the crosstalk between tumors and their environment, in particular myeloid and lymphoid cells. Our aim was to study the contribution of the myeloid PI3K/PTEN-signaling pathway in the regulation of tumor-immune surveillance in murine models of cancer. We made use of conditional PTEN-deficient mice, which exhibit sustained activation of the PI3K-signaling axis in a variety of myeloid cell subsets such as macrophages and dendritic cells (DCs). In colitis-associated colon cancer (CAC), mice deficient in myeloid PTEN showed a markedly higher tumor burden and decreased survival. We attributed this observation to the increased presence of immune-modulatory conventional CD8α(+) DCs in the spleen, whereas other relevant myeloid cell subsets were largely unaffected. Notably, we detected enhanced surface expression of PD-L1 and PD-L2 on these DCs. As a consequence, tumoricidal T-cell responses were hampered or redirected. Taken together, our findings indicated an unanticipated role for the PI3K/PTEN-signaling axis in the functional regulation of splenic antigen-presenting cells (APCs). Our data pointed at potential, indirect, tumoricidal effects of subclass-specific PI3K inhibitors, which are currently under clinical investigation for treatment of tumors, via myeloid cell activation.

Bacterial diversity and antibiotic resistances of abundant aerobic culturable bacteria in input and output samples of 15 German biogas plants.

AIM: Determination of the diversities and antibiotic resistances of the most abundant aerobic culturable bacteria and their survival in 15 German biogas plants (BGPs). METHODS AND RESULTS: Microbiological standard media (complex and selective media) were applied to enumerate mesophilic and oligotrophic bacteria (Enterobacteriaceae, Salmonella, staphylococci and enterococci) in input and output samples of BGPs. Concentrations of aerobic culturable bacteria in outputs were mostly one to two orders of magnitude lower than in input samples. In total, 852 isolates from input and 902 from output samples were identified either by partial 16S rRNA gene sequencing or Matrix-assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) analysis. Antibiotic resistance screening of target families against veterinary relevant antibiotics resulted in similar resistance pattern in input and output samples. CONCLUSIONS: Potentially pathogenic bacteria were detected in output samples of BGPs, but in decreased abundance. The selectivity of the most applied clinical standard media was insufficient. SIGNIFICANCE AND IMPACT OF THE STUDY: Only little is known about the release of antibiotic resistant and potentially pathogenic bacteria from BGPs. However, this study indicates the detection of several potentially pathogenic bacteria in output samples, which showed several antibiotic resistances.

Feasibility of Ultrasound-Guided Sacroiliac Joint Injections in Children Presenting with Sacroiliitis.

PURPOSE: To evaluate the feasibility and effectiveness of US-guided sacroiliac joint injection in the treatment of sacroiliitis in children. MATERIALS AND METHODS: This study was approved by the institutional review board and informed oral and written consent was obtained from the patients and their parents. In 13 patients (7 females and 6 males), 9 - 16 years (mean +/- std 11.39 +/-1.98), 18 sacroiliac joint (SI joint) injections were performed under US guidance. All patients suffered from severe sacroiliitis. US scanning was performed using a linear-array transducer operating at 5 - 18 MHz. Rating of the patients pain using a 0 - 10 dolorimetry scale on a visual analog score (VAS) was recorded before, immediately after and 3 months after injection to monitor severity and therapeutic response. RESULTS: Injection could be performed in all patients without complication and showed good response immediately and 3 months after the injection with a decrease of the VAS (from mean +/- std 9.44 +/- 1.097 to 3.89 +/- 3.82, p < 0.001 and to 0.56 +/- 1.097, p < 0.05, respectively). CONCLUSION: US-guided SI joint injection was feasible in all children, relatively quick and easy to perform and appeared effective in the treatment of children with sacroiliitis.

[Production of accentuated personality traits in baroque opera : Opera buffa Arcifanfano-Re dei matti (1749)]. / Inszenierung von akzentuierten Persönlichkeitszügen in der Barockoper : Opera buffa Arcifanfano - Re dei matti (1749).

BACKGROUND: Madness served primarily as a form of amusement for the spectators in operas of the seventeenth century. This representation was far removed from clinical reality. This circumstance changed in the eighteenth century at the time when tragic madness emerged in numerous operas. MATERIAL AND METHODS: The opera buffa Arcifanfano-Re dei matti (Arcifanfano-King of fools, premiered in 1749 in Venice, text by Carlo Goldoni 1707-1793 and music by Baldassare Galuppi 1706-1785), which continuously enacts a realm of fools and is meant to appear amusing, is riddled with psychopathological abnormalities for which a retrospective diagnosis is methodologically rejected. However, the opera presents many subjects for working out a typology of fools based on outlasting personality traits of the protagonists. The libretto is investigated. A musical analysis is spared. RESULTS: The conceptualized typology of fools in the opera, which is oriented towards the seven main vices or deadly sins serves, in the tradition of moral satire, to critically hold up a mirror to the audience to reflect their own vices by an amusing characterization of the latter. Historically classified, the treatment of fools by means of isolation, custody, locking up in cages as well as authoritarian measures of submission reflects the custom in those days before humanizing the treatment of people with mental illness in the course of the Enlightenment and the French Revolution. CONCLUSION: The opera Arcifanfano is essentially characterized by continuous madness. A typology of the fools can be worked out from the precise depiction of the personalities. A mirror is held up to the spectators in terms of vices, in the tradition of the contemporary baroque opera. At the same time, the opera can be classified psychiatrically and historically as a seismograph of its time when in the seventeenth and eighteenth centuries people with mental illness were isolated and incarcerated.

Body weight estimation based on postmortem CT data--validation of a multiplication factor.

Postmortem computed tomography (pmCT) is increasingly applied in forensic medicine as a documentation and diagnostic tool. The present study investigated if pmCT data can be used to estimate the corpse weight. In 50 forensic cases, pmCT examinations were performed prior to autopsy and the pmCT data were used to determine the body volume using an automated segmentation tool. PmCT was performed within 48 h postmortem. The body weights assessed prior to autopsy and the body volumes assessed using the pmCT data were used to calculate individual multiplication factors. The mean postmortem multiplication factor for the study cases was 1.07 g/ml. Using this factor, the body weight may be estimated retrospectively when necessary. Severe artifact causing foreign bodies within the corpses limit the use of pmCT data for body weight estimations.

Feeding practice and influence on selected blood parameters in show jumping horses competing in Switzerland.

The aim of this study was to compare the nutritional management of show jumping horses in practice with recommendations from the literature. Additionally, the effects of these feeding practices on several blood metabolic parameters before and after exercise were studied. Blood samples were collected in the field from 27 different horses at 71 trials on the level M1 to S2 show jumping competitions in Switzerland and questionnaires on feeding practice of the studied horses were evaluated. The questionnaires revealed that during training and on tournament days horses received on average 3.1 kg of concentrate per day (min. 2.0 kg, max. 6.6 kg) divided into two to three meals. The horses were fed on average 6.9 kg of roughage per day (min. 4.0 kg, max. 13.0 kg). Additionally, it was observed that the horses received the last meal on average 6 h 10 min (min. 1 h 50 min, max. 12 h 30 min) before the start of the first show jumping turn, respectively, 7 h 30 min (min 1 h 50 min, max. 13 h 0 min) before the second turn. Seven horses (35%) had access to hay waiting in the trailer between two turns. The statistical analysis revealed no significant influence of the concentrate feeding time point on lactate, triglyceride and insulin levels, but a significant influence on free fatty acids (FFA) and blood glucose concentrations. Roughage feeding of the show jumping horses 2-4 h prior to exercise revealed the most remarkable changes in blood parameters during the show jumping course. These results received under field conditions should be approved in future under standardized conditions.

X-ray tests of a two-dimensional stigmatic imaging scheme with variable magnifications.

A two-dimensional stigmatic x-ray imaging scheme, consisting of two spherically bent crystals, one concave and one convex, was recently proposed [M. Bitter et al., Rev. Sci. Instrum. 83, 10E527 (2012)]. The Bragg angles and the radii of curvature of the two crystals of this imaging scheme are matched to eliminate the astigmatism and to satisfy the Bragg condition across both crystal surfaces for a given x-ray energy. In this paper, we consider more general configurations of this imaging scheme, which allow us to vary the magnification for a given pair of crystals and x-ray energy. The stigmatic imaging scheme has been validated for the first time by imaging x-rays generated by a micro-focus x-ray source with source size of 8.4 µm validated by knife-edge measurements. Results are presented from imaging the tungsten Lα1 emission at 8.3976 keV, using a convex Si-422 crystal and a concave Si-533 crystal with 2d-spacings of 2.21707 Å and 1.65635 Å and radii of curvature of 500 ± 1 mm and 823 ± 1 mm, respectively, showing a spatial resolution of 54.9 µm. This imaging scheme is expected to be of interest for the two-dimensional imaging of laser produced plasmas.

Persistence of an amphibian ranavirus in aquatic communities.

Host-parasite dynamics can be strongly influenced by interactions with other members of the biotic community, particularly when the parasite spends some fraction of its life in the environment unprotected by its host. Ranaviruses-often lethal viruses of cold-blooded vertebrate hosts transmitted by direct contact, and via water and fomites-offer an interesting system for understanding these community influences. Previous laboratory studies have shown that ranaviruses can persist for anywhere from days to years, depending on the conditions, with much longer times under sterile conditions. To address the role of the biotic community and particulate matter on ranavirus persistence, we experimentally inoculated filter-sterilized, UV-treated, and unmanipulated pond water with a Frog virus 3 (FV3)-like Ranavirus and took samples over 78 d, quantifying viral titers with real-time quantitative PCR and plaque assays. Viral counts dropped quickly in all treatments, by an order of magnitude in under a day in unmanipulated pond water and in 8 d in filter-sterilized pond water. In a second experiment, we measured viral titers over 24 h in virus-spiked spring water with Daphnia pulex. Presence of D. pulex reduced the concentration of infectious ranavirus, but not viral DNA, by an order of magnitude in 24 h. D. pulex themselves did not accumulate the virus. We conclude that both microbial and zooplanktonic communities can play an important role in ranavirus epidemiology, rapidly inactivating ranavirus in the water and thereby minimizing environmental transmission. We suspect that interactions with the biotic community will be important for most pathogens with environmental resting or transmission stages.