Schule neu denken : zu den Auswirkungen von Schulschließungen auf die Kompetenzentwicklung von Grundschülern/- innen und zur Wiederherstellung des gefährdeten Gleichheitsanspruchs der Bildungspolitik

Schulschließungen sind Teil der Maßnahmen zur Bekämpfung der COVID-19-Pandemie. Durch die Einschränkung sozialer Kontakte leisten sie einen Beitrag zur Eindämmung von Infektionsketten. Schulschließungen haben jedoch, insbesondere wenn sie länger dauern, signifikante Nebenwirkungen. Diese können die Lernenden unmittelbar betreffen, da der Unterrichtsausfall zu Einbußen bei schulischen Lernergebnissen führen kann. Unsere empirischen Untersuchungen für die Grundschulzeit verdeutlichen, dass Schulschließungen vor allem in den ersten beiden Klassenstufen herkunftsbedingte Ungleichheiten verstärken könnten. Diese Ungleichheiten betreffen nicht nur die fachlichen Kompetenzen, wie etwa mathematische und sprachliche Fähigkeiten, sondern auch die Ausdauer und die Konzentrationsfähigkeit. Viele Schulen und vor allem engagierte Lehrerinnen und Lehrer versuchen mit Onlineangeboten und digitalem Unterricht Lernalternativen bereitzustellen. Gerade in diesen Fällen könnten jedoch die außerschulischen Faktoren, darunter das Familienumfeld, wieder an Bedeutung gewinnen und Ungleichheiten verstärken. Schulschließungen gefährden somit den Gleichheitsanspruch der Bildungspolitik, insbesondere zu Beginn der Grundschulzeit. Die Bildungspolitik ist daher gefordert, Schule neu zu denken. Angesichts des digitalen Fortschritts ist nun das Potential vorhanden, professionalisierte und didaktisch geprüfte Interaktionen in den Alltag von Grundschülerinnen und -schülern außerhalb des Lernortes Schule hineinzutragen. Schule neu zu denken bedeutet, dem Gleichheitsanspruch vor allem in Zeiten von Schulschließungen gerecht zu werden. Dies lässt sich verwirklichen, indem altersadäquate und qualifizierte Unterrichtung nicht mehr an den Ort Schule gebunden sein muss

Adverse effects of delayed antimicrobial treatment and surgical source control in adults with sepsis: results of a planned secondary analysis of a cluster-randomized controlled trial

BACKGROUND: Timely antimicrobial treatment and source control are strongly recommended by sepsis guidelines, however, their impact on clinical outcomes is uncertain. METHODS: We performed a planned secondary analysis of a cluster-randomized trial conducted from July 2011 to May 2015 including forty German hospitals. All adult patients with sepsis treated in the participating ICUs were included. Primary exposures were timing of antimicrobial therapy and delay of surgical source control during the first 48 h after sepsis onset. Primary endpoint was 28-day mortality. Mixed models were used to investigate the effects of timing while adjusting for confounders. The linearity of the effect was investigated by fractional polynomials and by categorizing of timing. RESULTS: Analyses were based on 4792 patients receiving antimicrobial treatment and 1595 patients undergoing surgical source control. Fractional polynomial analysis identified a linear effect of timing of antimicrobials on 28-day mortality, which increased by 0.42% per hour delay (OR with 95% CI 1.019 [1.01, 1.028], p ≤ 0.001). This effect was significant in patients with and without shock (OR = 1.018 [1.008, 1.029] and 1.026 [1.01, 1.043], respectively). Using a categorized timing variable, there were no significant differences comparing treatment within 1 h versus 1–3 h, or 1 h versus 3–6 h. Delays of more than 6 h significantly increased mortality (OR = 1.41 [1.17, 1.69]). Delay in antimicrobials also increased risk of progression from severe sepsis to septic shock (OR per hour: 1.051 [1.022, 1.081], p ≤ 0.001). Time to surgical source control was significantly associated with decreased odds of successful source control (OR = 0.982 [0.971, 0.994], p = 0.003) and increased odds of death (OR = 1.011 [1.001, 1.021]; p = 0.03) in unadjusted analysis, but not when adjusted for confounders (OR = 0.991 [0.978, 1.005] and OR = 1.008 [0.997, 1.02], respectively). Only, among patients with septic shock delay of source control was significantly related to risk-of death (adjusted OR = 1.013 [1.001, 1.026], p = 0.04). CONCLUSIONS: Our findings suggest that management of sepsis is time critical both for antimicrobial therapy and source control. Also patients, who are not yet in septic shock, profit from early anti-infective treatment since it can prevent further deterioration. Trial registration ClinicalTrials.gov (NCT01187134). Registered 23 August 2010, NCT01187134 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-03901-9

A multifaceted educational intervention improved anti-infectious measures but had no effect on mortality in patients with severe sepsis

Sepsis is a major reason for preventable hospital deaths. A cluster-randomized controlled trial on an educational intervention did not show improvements of sepsis management or outcome. We now aimed to test an improved implementation strategy in a second intervention phase in which new intervention hospitals (former controls) received a multifaceted educational intervention, while controls (former intervention hospitals) only received feedback of quality indicators. Changes in outcomes from the first to the second intervention phase were compared between groups using hierarchical generalized linear models controlling for possible confounders. During the two phases, 19 control hospitals included 4050 patients with sepsis and 21 intervention hospitals included 2526 patients. 28-day mortality did not show significant changes between study phases in both groups. The proportion of patients receiving antimicrobial therapy within one hour increased in intervention hospitals, but not in control hospitals. Taking at least two sets of blood cultures increased significantly in both groups. During phase 2, intervention hospitals showed higher proportion of adequate initial antimicrobial therapy and de-escalation within 5 days. A survey among involved clinicians indicated lacking resources for quality improvement. Therefore, quality improvement programs should include all elements of sepsis guidelines and provide hospitals with sufficient resources for quality improvement. Trial registration: ClinicalTrials.gov, NCT01187134. Registered 23 August 2010, https://www.clinicaltrials.gov/ct2/show/study/NCT01187134

100 Years of Relativistic Cosmology (1917-2017). Part I: From Origins to the Discovery of Universal Expansion (1929)

We are experiencing a period of extreme intellectual effervescence in the area of cosmology. A huge volume of observational data in unprecedented quantity and quality and a more consistent theoretical framework propelled cosmology to an era of precision, turning the discipline into a cutting-edge area of contemporary science. Observations with type Ia Supernovae (SNe Ia), showed that the expanding Universe is accelerating, an unexplained fact in the traditional decelerated model. Identifying the cause of this acceleration is the most fundamental problem in the area. As in the scientific renaissance, the solution will guide the course of the discipline in the near future and the possible answers (whether dark energy, some extension of general relativity or a still unknown mechanism) should also leverage the development of physics. In this context, without giving up a pedagogical approach, we present an overview of both the main theoretical results and the most significant observational discoveries of cosmology in the last 100 years. The saga of cosmology will be presented in a trilogy. In this article (Part I), based on the articles by Einstein, de Sitter, Friedmann, Lema\^itre and Hubble, we will describe the period between the origins of cosmology and the discovery of Universal expansion (1929). In Part II, we will see the period from 1930 to 1997, closing with the old standard decelerated model. The Part III will be entirely devoted to the accelerated model of the universe, the cosmic paradigm of the XXI century.Comment: 18 pages, 10 figures. To appear in Revista Brasileira de Ensino de F\'isica (in Portuguese

Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature

Abstract Background Fever and hypothermia have been observed in septic patients. Their influence on prognosis is subject to ongoing debates. Methods We did a secondary analysis of a large clinical dataset from a quality improvement trial. A binary logistic regression model was calculated to assess the association of the thermal response with outcome and a multinomial regression model to assess factors associated with fever or hypothermia. Results With 6542 analyzable cases we observed a bimodal temperature response characterized by fever or hypothermia, normothermia was rare. Hypothermia and high fever were both associated with higher lactate values. Hypothermia was associated with higher mortality, but this association was reduced after adjustment for other risk factors. Age, community-acquired sepsis, lower BMI and lower outside temperatures were associated with hypothermia while bacteremia and higher procalcitonin values were associated with high fever. Conclusions Septic patients show either a hypothermic or a fever response. Whether hypothermia is a maladaptive response, as indicated by the higher mortality in hypothermic patients, or an adaptive response in patients with limited metabolic reserves under colder environmental conditions, remains an open question. Trial registration The original trial whose dataset was analyzed was registered at ClinicalTrials.gov (NCT01187134) on August 23, 2010, the first patient was included on July 1, 2011

Hemoadsorption in ‘liver indication’: analysis of 109 patients’ data from the CytoSorb international registry

Background: Our aim is to report the results of the ‘liver indication’ subset of patients in the CytoSorb International Registry. Methods: Structured data were recorded. Treatment characteristics and changes from T1 (start of hemoadsorption) to T2 (termination) were evaluated with a special focus on bilirubin, C-reactive protein, procalcitonin, interleukin-6, platelet levels, SOFA scores, mortality, and subjective assessment by the attending physicians. Results: Until January 2021, from the total 1434 patients, 109 (age: 49.2 ± 17.1 years, 57.8% males) received treatment for hyperbilirubinemia. APACHE II-predicted mortality was 49.6 ± 26.8%. In the study, 91% of patients were alive at the termination of hemoadsorption and improvement was observed by the physicians in 75 cases. Overall, 65 (59.6%) patients died in the hospital, and 60 (55.0%) died in the ICU. Patients received a median of two treatments for a median of 43 h (interquartile range: 24–72 h) in total. Serum bilirubin levels reduced significantly to −4.6 (95% CI: −6.329 to −2.8) mg/dL. Thrombocytopenia was reported in four patients as an adverse event. Conclusions: We report the largest case series on hemoadsorption for ‘liver indication’ from the CytoSorb International Registry. The finding of significant bilirubin removal observed in our study could have substantial impact in designing and executing further studies on the effects of hemoadsorption in liver dysfunction, which are certainly warranted

Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings: a cross-sectional study

Background: Little is known about the characteristics and real world life circumstances of ARDS (acute respiratory distress syndrome) patient populations. This knowledge is essential for transferring evidence-based therapy into routine healthcare. The aim of this study was to report socio-demographic and clinical characteristics in an unselected population of ARDS patients and to compare these results to findings from other large ARDS cohorts. Methods: A German based cross-sectional observational study was carried out. A total of 700 ARDS patients were recruited in 59 study sites between September 2014 and January 2016. Socio-demographic, disease and care related variables were recorded. Additionally, characteristics of other large ARDS cohorts identified by a systematic literature search were extracted into evidence tables. Results: Median age of ARDS patients was 58 years, 69% were male. Sixty percent had no employment, predominantly due to retirement. Seventy-one percent lived with a partner. The main cause of ARDS was a pulmonary 'direct' origin (79%). The distribution of severity was as follows: mild (14%), moderate (48%), severe (38%). Overall ICU mortality was calculated to be 34%. The observed prevalence of critical events (hypoxemia, hypoglycemia, re-intubation) was 47%. Supportive measures during ICU-treatment were applied to 60% of the patients. Other ARDS cohorts revealed a high heterogeneity in reported concomitant diseases, but sepsis and pneumonia were most frequently reported. Mean age ranged from 54 to 71 years and most patients were male. Other socio-demographic factors have been almost neglected. Conclusions: The proportion of patients suffering of mild ARDS was lower compared to the only study identified, which also applied the Berlin definition. The frequency of critical events during ICU treatment was high and the implementation of evidence-based therapy (prone positioning, neuro-muscular blockers) was limited. More evidence on socio-demographic characteristics and further studies applying the current diagnostic criteria are desirable

Mordanting of filter dyes in photographic materials

Almost all conventional acid filter dyes can be rendered nondiffusing in emulsion or thin auxiliary layers, without lowering their phys.-mech. properties or interference with their bleachability or washing-out during processing by a small amt. of a mordant (I; R1,R2 = C1-4 alkyl; n = 300-600; and X- = anion). Added as storable 5-10% soln. they have a low water absorption and have little effect on the viscosity of gelatin coatings. Thus, 2 solns. were made both contg. gelatin 100 and a pentamethine dye 8, and as mordant soln. A an imide of maleic anhydride interpolymers of US 3,048,487 (CA 59; 7726b) 4 g, and soln. B I (R1,R2 = Me, n = 300, X = Cl-) 4.15 g. A Yielded a 2.3m filter layer having an optical d. of 1.09, and B one of 2.0m and 0.98, resp. The water absorption of the layers was 4.1 and 3.0 g H2O/m2, and the dye diffusion after 2 wet contacts with a layer of unhardened gelatin 43 and 2% (as optical d.), resp. [on SciFinder (R)

End-of-life perceptions among physicians in intensive care units managed by anesthesiologists in Germany: a survey about structure, current implementation and deficits

Abstract Background Structural aspects and current practice about end-of-life (EOL) decisions in German intensive care units (ICUs) managed by anesthesiologists are unknown. A survey among intensive care anesthesiologists has been conducted to explore current practice, barriers and opinions on EOL decisions in ICU. Methods In November 2015, all members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthesiologists (BDA) were asked to participate in an online survey to rate the presence or absence and the importance of 50 items. Answers were grouped into three categories considering implementation and relevance: Category 1 reflects high implementation and high relevance, Category 2 low and low, and Category 3 low and high. Results Five-hundred and forty-one anesthesiologists responded. Only four items reached ≥90% agreement as being performed “yes, always” or “mostly”, and 29 items were rated “very” or “more important”. A profound discrepancy between current practice and attributed importance was revealed. Twenty-eight items attributed to Category 1, six to Category 2 and sixteen to Category 3. Items characterizing the most urgent need for improvement (Category 3) referred to patient outcome data, preparation of health care directives and interdisciplinary discussion, standard operating procedures, implementation of practical instructions and inclusion of nursing staff and families in the process. Conclusion The present survey affirms an urgent need for improvement in EOL practice in German ICUs focusing on advanced care planning, distinct aspects of changing goals of care, implementation of standard operating procedures, continuing education and reporting of outcome data