Installation of a Feed-and-Turn Dryer: An Option to improve Heat Utilization and Economy of an existing Biogas Plant

Feed-and-turn dryers may be installed in order to use excess heat from biogas CHPs especially in agricultural enterprises with otherwise low heat utilization. These dryers can be used for drying a manifold of agricultural produce. In this case draff, maize silage and saw dust were investigated. The focus was on drying effectiveness, economic benefits and probable changes in chemical composition of the materials investigated. Results demonstrate that the installation of the feed-and-turn dryer is a substantial improvement of the biogas plant. In the case investigated it significantly improves the energy efficiency by increasing heat utilization from 6,669 GJ·a-1 in 2007 to more than 27,542 GJ·a-1 in 2009. It provides, in addition, the agricultural enterprise with valuable equipment for producing high quality and high valuable feed and other products.  Finally, on-farm drying generates an additional income compared to purchasing equivalent products or to external drying

Krankenhaus Rating Report 2008: Qualität und Wirtschaftlichkeit

Der vorliegende Krankenhaus Rating Report 2008 schließt in wesentlichen Punkten an seinen Vorgänger aus dem vergangenen Jahr an, setzt - dem Prinzip der kontinuierlichen Weiterentwicklung verpflichtet - jedoch erneut eigene Akzente. Hauptziel ist die Verbesserung der Transparenz im deutschen Krankenhausmarkt. Daraus abgeleitet ergibt sich der Anspruch, den Entscheidungsträgern auf den verschiedensten Ebenen (Krankenhäuser und deren Geschäftspartner, Politik, Krankenversicherungen, Banken und Investoren) empirisch abgesicherte Erkenntnisse über diesen Markt an die Hand zu geben. In der neuen Ausgabe konnte die Zahl der Jahresabschlüsse, die einem Teil der Analysen zugrunde liegen, weiter gesteigert werden. Wie im vergangenen Jahr soll dem regionalen Kontext der Krankenhausaktivitäten ein besonderes Gewicht eingeräumt werden. Zu diesem Zweck wurden erstmals zusätzlich detaillierte Daten des Statistischen Bundesamts ausgewertet, insbesondere Patientenströme. Damit untersuchen wir, inwieweit Gesundheitsregionen (z. B. Berlin, Hamburg, Ruhrgebiet, Frankfurt oder München) bereits bei Patienten als solche wahrgenommen werden. Regionale Analysen bereiten wir in Form von Deutschlandkarten auf. Von besonderer Bedeutung ist schließlich die Untersuchung des Zusammenhangs zwischen der Leistungsqualität und der Wirtschaftlichkeit der Krankenhäuser. Hierzu korrelieren wir das Rating mit BQS-Qualitätsindikatoren

The Clinical and Socio-Economic Relevance of Increased IPMN Detection Rates and Management Choices

Background: Increased usage of computed tomography and magnetic resonance imaging has led to a large increase in identified pancreatic cysts of up to 25% in population-based studies. The clinical and economic relevance of identifying so many cystic lesions has not been established. Compared to other organs such as liver or kidney, dysontogenetic pancreatic cysts are rare. Pancreatic cysts comprise a variety of benign, premalignant or malignant lesions; however, precise diagnosis before resection has an accuracy of only 80%. The focus of recent research was the malignant potential of intraductal papillary mucinous neoplasms (IPMN) with the aim of establishing clinical pathways addressing risk of malignancy, age and comorbidity, treatment-related morbidity and mortality as well as cost-effectiveness of treatment and surveillance. The focus of this review is to analyze the clinical and socio-economic relevance as well as the cost-benefit relation for IPMNs. Methods: For analysis, the following MESH terms were used to identify original articles, reviews, and guidelines in PubMed: (‘intraductal papillary mucinous neoplasm' OR ‘pancreatic cysts') and (incidence OR relevance OR socio-economic OR economic OR cost-effectiveness OR cost-benefit). The retrieved publications were reviewed with a focus on clinical and socio-economic relevance in relation to the increasing incidence of IPMN. Results: Addressing the increasing prevalence of pancreatic cystic lesions, recent consensus guidelines suggested criteria for risk stratification according to ‘worrisome features' and ‘high-risk stigmata'. Recent prospective cohort studies evaluated whether these can be applied in clinical practice. Evaluation of three different clinical scenarios with regard to costs and quality-adjusted life years suggested a better effectiveness of surveillance after initial risk stratification by endoscopic ultrasound-guided fine-needle aspiration with cyst fluid analysis compared with immediate resection or follow-up without further intervention. Of interest, the ‘immediate surgery' strategy was lowest for cost-effectiveness. Conclusions: The increasing incidence of identified pancreatic cysts requires an improved strategy for non-invasive risk stratification based on advanced imaging strategies. In light of a malignancy risk of 2% for branch-duct IPMN, the socio-economic necessity of a balance between surveillance and resection has to be agreed on

Two novel ADAMTS13 gene mutations in thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome (TTP/HUS)

Two novel ADAMTS13 gene mutations in thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome (TTP/HUS).BackgroundThrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS) are now considered to be variants of one single syndrome called thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome (TTP/HUS). Key features are thrombocytopenia, hemolytic anemia, and subsequently impaired function of different organs, especially the kidneys and the central nervous system (CNS). One possible reason is the deficiency of von Willebrand factor-cleaving protease (vWF-CP) resulting in persistence of uncleaved, ultralarge von Willebrand factor multimers (ULvWFM).MethodsWe report a patient who was initially diagnosed with Evans syndrome (hemolytic anemia and autoimmune thrombocytopenia) as infant. At 10 years of age he developed HUS-like disease with gastrointestinal tract infection, hemolytic anemia, thrombocytopenia,and acute renal failure. However, enteropathogenic Escherichia coli–like or Shiga-like toxins were not detected.ResultsFurther investigations revealed severe deficiency (<3%; normal >40%) of vWF-CP activity caused by compound heterozygosity of two novel ADAMTS13 gene mutations (1170 G>C [W390C] and 3735 G>A [W1245X]. vWF-CP autoantibodies were not detected. Periodic (every 2 weeks) treatment with fresh frozen plasma (FFP) maintained both platelet level and kidney function within normal range and prevented new episodes of TTP/HUS.ConclusionEnteropathogenic E. coli– and Shiga-like toxin-negative patients who present with hemolytic or thrombocytopenic episodes and HUS like symptoms should be tested for vWF-CP deficiency and other noninfectious reasons for TTP/HUS since plasma substitution possibly provides an efficient therapeutic option for this subgroup of patients

Astronomical context of Solar System formation from molybdenum isotopes in meteorite inclusions

Calcium-aluminum–rich inclusions (CAIs) in meteorites are the first solids to have formed in the Solar System, defining the epoch of its birth on an absolute time scale. This provides a link between astronomical observations of star formation and cosmochemical studies of Solar System formation. We show that the distinct molybdenum isotopic compositions of CAIs cover almost the entire compositional range of material that formed in the protoplanetary disk. We propose that CAIs formed while the Sun was in transition from the protostellar to pre–main sequence (T Tauri) phase of star formation, placing Solar System formation within an astronomical context. Our results imply that the bulk of the material that formed the Sun and Solar System accreted within the CAI-forming epoch, which lasted less than 200,000 years

Terrestrial planet formation from lost inner solar system material

Two fundamentally different processes of rocky planet formation exist, but it is unclear which one built the terrestrial planets of the solar system. They formed either by collisions among planetary embryos from the inner solar system or by accreting sunward-drifting millimeter-sized “pebbles” from the outer solar system. We show that the isotopic compositions of Earth and Mars are governed by two-component mixing among inner solar system materials, including material from the innermost disk unsampled by meteorites, whereas the contribution of outer solar system material is limited to a few percent by mass. This refutes a pebble accretion origin of the terrestrial planets but is consistent with collisional growth from inner solar system embryos. The low fraction of outer solar system material in Earth and Mars indicates the presence of a persistent dust-drift barrier in the disk, highlighting the specific pathway of rocky planet formation in the solar system

Two pore domain potassium channels in cerebral ischemia: a focus on K2P9.1 (TASK3, KCNK9)

BACKGROUND: Recently, members of the two-pore domain potassium channel family (K2P channels) could be shown to be involved in mechanisms contributing to neuronal damage after cerebral ischemia. K2P3.1-/- animals showed larger infarct volumes and a worse functional outcome following experimentally induced ischemic stroke. Here, we question the role of the closely related K2P channel K2P9.1. METHODS: We combine electrophysiological recordings in brain-slice preparations of wildtype and K2P9.1-/- mice with an in vivo model of cerebral ischemia (transient middle cerebral artery occlusion (tMCAO)) to depict a functional impact of K2P9.1 in stroke formation. RESULTS: Patch-clamp recordings reveal that currents mediated through K2P9.1 can be obtained in slice preparations of the dorsal lateral geniculate nucleus (dLGN) as a model of central nervous relay neurons. Current characteristics are indicative of K2P9.1 as they display an increase upon removal of extracellular divalent cations, an outward rectification and a reversal potential close to the potassium equilibrium potential. Lowering extracellular pH values from 7.35 to 6.0 showed comparable current reductions in neurons from wildtype and K2P9.1-/- mice (68.31 +/- 9.80% and 69.92 +/- 11.65%, respectively). These results could be translated in an in vivo model of cerebral ischemia where infarct volumes and functional outcomes showed a none significant tendency towards smaller infarct volumes in K2P9.1-/- animals compared to wildtype mice 24 hours after 60 min of tMCAO induction (60.50 +/- 17.31 mm3 and 47.10 +/- 19.26 mm3, respectively). CONCLUSIONS: Together with findings from earlier studies on K2P2.1-/- and K2P3.1-/- mice, the results of the present study on K2P9.1-/- mice indicate a differential contribution of K2P channel subtypes to the diverse and complex in vivo effects in rodent models of cerebral ischemia

Modulation of Calcium-Dependent Inactivation of L-Type Ca2+ Channels via β-Adrenergic Signaling in Thalamocortical Relay Neurons

Neuronal high-voltage-activated (HVA) Ca2+ channels are rapidly inactivated by a mechanism that is termed Ca2+-dependent inactivation (CDI). In this study we have shown that β-adrenergic receptor (βAR) stimulation inhibits CDI in rat thalamocortical (TC) relay neurons. This effect can be blocked by inhibition of cAMP-dependent protein kinase (PKA) with a cell-permeable inhibitor (myristoylated protein kinase inhibitor-(14–22)-amide) or A-kinase anchor protein (AKAP) St-Ht31 inhibitory peptide, suggesting a critical role of these molecules downstream of the receptor. Moreover, inhibition of protein phosphatases (PP) with okadaic acid revealed the involvement of phosphorylation events in modulation of CDI after βAR stimulation. Double fluorescence immunocytochemistry and pull down experiments further support the idea that modulation of CDI in TC neurons via βAR stimulation requires a protein complex consisting of CaV1.2, PKA and proteins from the AKAP family. All together our data suggest that AKAPs mediate targeting of PKA to L-type Ca2+ channels allowing their phosphorylation and thereby modulation of CDI