Qualitätsmanagement nach DIN EN ISO 9001: 2000 an der HNO-Universitätsklinik Frankfurt/Main

Im Jahr 2003 begann die HNO-Universitätsklinik Frankfurt / Main mit der Einführung eines Qualitätsmanagement-Systems, die im August 2005 zur erfolgreichen Zertifizierung nach der vom Klinikumsvorstand geforderten DIN EN ISO 9001:2000 führte. Ziele unseres Qualitätsmanagements waren die Optimierung der internen Betriebsabläufe und die Standardisierung von Arbeitsvorgängen unter Einbeziehung von logistischen Schnittstellen mit externen Strukturen unter Berücksichtigung der besonderen Anforderungen einer Universitätsklinik. Neben einer grundsätzlichen Prüfung und Optimierung sämtlicher Organisationsabläufe wurden für die Kernprozesse unserer Klinik Zielvorgaben festgelegt. Diese Ziele betrafen die Qualität der Arbeitsabläufe für alle Bereiche der HNO-ärztlichen ambulanten und stationären Versorgung ebenso, wie Aufgaben in Forschung und Lehre, die durch ein Ausbildungscurriculum für Mitarbeiter und Sudenten abgebildet wurde. Es wurden aber auch Serviceaspekte, wie Terminvergabe und Befundübermittlung, sowie ökonomische und wirtschaftliche Aspekte unserer Arbeit optimiert. Durch Umstrukturierung und Neuorganisation konnte die Effizienz der Arbeitsabläufe deutlich gesteigert werden, wovon vor allem Patienten und Mitarbeiter erheblich profitieren. Die Einführung eines Qualitätsmanagementsystems in der Frankfurter HNO-Universitätsklinik war zunächst mit einem entsprechenden Arbeitsaufwand verbunden und erforderte ein Umdenken in den einzelnen Funktionsbereichen. Insgesamt überwiegt der positive Einfluss auf die Struktur und Arbeitsabläufe, sodass die Umsetzung eines Qualitätsmanagementsystems in der Universitätsklinik empfehlenswert ist

Predictors and management of post-banding ulcer bleeding in cirrhosis: A systematic review and meta-analysis.

BACKGROUND AND AIMS Post-banding ulcer bleeding (PBUB) is an understudied complication of oesophageal varices endoscopic band ligation (EBL). This systematic review with meta-analysis aimed at: (a) evaluating the incidence of PBUB in patients with cirrhosis treated with EBL in primary or secondary prophylaxis or urgent treatment for acute variceal bleeding and (b) identifying predictors of PBUB. METHODS We conducted a systematic review of articles in English published in 2006-2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were made in eight databases including Embase, PubMed and Cochrane Library. Random-effects meta-analysis was used to determine the incidence, mean interval and predictors of PBUB. RESULTS Eighteen studies (9034 patients) were included. The incidence of PBUB was 5.5% (95% CI 4.3-7.1). The mean time for it to occur was 11 days (95% CI 9.94-11.97). Model for End-stage Liver Disease (MELD) score (OR 1.162, 95% CI 1.047-1.291) and EBL done in emergency setting (OR 4.902, 95% CI 2.99-8.05) independently predicted post-ligation ulcer bleeding. Treatment included drugs, endoscopic procedures and transjugular intrahepatic portosystemic shunt. Refractory bleeding was treated with self-expandable metallic stents or balloon tamponade. Mortality was on average 22.3% (95% CI 14.1-33.6). CONCLUSIONS Patients with high MELD score and receiving EBL in an emergency setting are more prone to develop PBUB. Prognosis is still poor and the best therapeutic strategy to address remains to be ascertained

Time since establishment drives bee and hoverfly diversity, abundance of crop-pollinating bees and aphidophagous hoverflies in perennial wildflower strips

Wildflower strips (WFS) are amongst the most commonly applied measures to promote pollinators and natural enemies of crop pests in agroecosystems. Their potential to enhance these functionally important insect groups may vary substantially with time since establishment of WFS. However, knowledge on their temporal dynamics remains scarce, hampering recommendations for optimized design and management. We therefore examined temporal dynamics of taxonomic and functional groups of bees and hoverflies in perennial WFS ranging from one to ≥6 years since sowing with a standardized species-rich seed mixture of flowering plants in 18 agricultural landscapes in Switzerland. The abundance of wild bees, honeybees and hoverflies declined after the second year by 89%, 62% and 72%, respectively. Declines in bee abundance and hoverfly species richness were linear and those of aphidophagous hoverflies exponential, while wild bee species richness peaked in the third year. Declines over time generally paralleled decreases in flower abundance (-83%) and flowering species richness (-61%) and an increase in grass cover (+70%) in WFS. Flowering plant species richness showed strong positive relationships with dominant crop-visiting wild bees and aphidophagous hoverflies. Furthermore, dominant crop-visiting wild bees, but not aphidophagous hoverflies, were positively related to the proportion of (semi-)open semi-natural habitat in the surrounding landscape (500 m radius), but negatively with forest. We conclude that the effectiveness of perennial WFS to promote pollinator diversity, crop-pollinating bees and aphidophagous hoverflies through foraging resources decreases after the first two to three years, probably due to a decline of diverse and abundant floral resources. Although older perennial WFS may still provide valuable nesting and overwintering opportunities for pollinators and natural enemies, our findings indicate that regular re-sowing of perennial WFS may be necessary to maintain adequate floral resource provisioning for effective pollinator conservation and promotion of crop pollination and natural pest control services in agricultural landscapes

Rotation in an Enantiospecific Self‐Assembled Array of Molecular Raffle Wheels

Tailored nano-spaces can control enantioselective adsorption and molecular motion. We report on the spontaneous assembly of a dynamic system—a rigid kagome network with each pore occupied by a guest molecule—employing solely 2,6-bis(1H-pyrazol-1-yl)pyridine-4-carboxylic acid on Ag(111). The network cavity snugly hosts the chemically modified guest, bestows enantiomorphic adsorption and allows selective rotational motions. Temperature-dependent scanning tunnelling microscopy studies revealed distinct anchoring orientations of the guest unit switching with a 0.95 eV thermal barrier. H-bonding between the guest and the host transiently stabilises the rotating guest, as the flapper on a raffle wheel. Density functional theory investigations unravel the detailed molecular pirouette of the guest and how the energy landscape is determined by H-bond formation and breakage. The origin of the guest\u27s enantiodirected, dynamic anchoring lies in the specific interplay of the kagome network and the silver surface

The Color Variability of Quasars

We quantify quasar color-variability using an unprecedented variability database - ugriz photometry of 9093 quasars from SDSS Stripe 82, observed over 8 years at ~60 epochs each. We confirm previous reports that quasars become bluer when brightening. We find a redshift dependence of this blueing in a given set of bands (e.g. g and r), but show that it is the result of the flux contribution from less-variable or delayed emission lines in the different SDSS bands at different redshifts. After correcting for this effect, quasar color-variability is remarkably uniform, and independent not only of redshift, but also of quasar luminosity and black hole mass. The color variations of individual quasars, as they vary in brightness on year timescales, are much more pronounced than the ranges in color seen in samples of quasars across many orders of magnitude in luminosity. This indicates distinct physical mechanisms behind quasar variability and the observed range of quasar luminosities at a given black hole mass - quasar variations cannot be explained by changes in the mean accretion rate. We do find some dependence of the color variability on the characteristics of the flux variations themselves, with fast, low-amplitude, brightness variations producing more color variability. The observed behavior could arise if quasar variability results from flares or ephemeral hot spots in an accretion disc.Comment: Accepted for publication in ApJ - in press, 17 pages, 14 figures - v2: abstract typo corrected & reference clean-u

Association of pulmonary vein isolation and major cardiovascular events in patients with atrial fibrillation.

BACKGROUND Patients with atrial fibrillation (AF) face an increased risk of adverse cardiovascular events. Evidence suggests that early rhythm control including AF ablation may reduce this risk. METHODS To compare the risks for cardiovascular events in AF patients with and without pulmonary vein isolation (PVI), we analysed data from two prospective cohort studies in Switzerland (n = 3968). A total of 325 patients who had undergone PVI during a 1-year observational period were assigned to the PVI group. Using coarsened exact matching, 2193 patients were assigned to the non-PVI group. Outcomes were all-cause mortality, hospital admission for acute heart failure, a composite of stroke, transient ischemic attack and systemic embolism (Stroke/TIA/SE), myocardial infarction (MI), and bleedings. We calculated multivariable adjusted Cox proportional-hazards models. RESULTS Overall, 2518 patients were included, median age was 66 years [IQR 61.0, 71.0], 25.8% were female. After a median follow-up time of 3.9 years, fewer patients in the PVI group died from any cause (incidence per 100 patient-years 0.64 versus 1.87, HR 0.39, 95%CI 0.19-0.79, p = 0.009) or were admitted to hospital for acute heart failure (incidence per 100 patient-years 0.52 versus 1.72, HR 0.44, 95%CI 0.21-0.95, p = 0.035). There was no significant association between PVI and Stroke/TIA/SE (HR 0.94, 95%CI 0.52-1.69, p = 0.80), MI (HR 0.43, 95%CI 0.11-1.63, p = 0.20) or bleeding (HR 0.75, 95% CI 0.50-1.12, p = 0.20). CONCLUSIONS In our matched comparison, patients in the PVI group had a lower incidence rate of all-cause mortality and hospital admission for acute heart failure compared to the non-PVI group. CLINICALTRIALS GOV IDENTIFIER NCT02105844, April 7th 2014

Orbital-selective Mott transitions: Heavy fermions and beyond

Quantum phase transitions in metals are often accompanied by violations of Fermi liquid behavior in the quantum critical regime. Particularly fascinating are transitions beyond the Landau-Ginzburg-Wilson concept of a local order parameter. The breakdown of the Kondo effect in heavy-fermion metals constitutes a prime example of such a transition. Here, the strongly correlated f electrons become localized and disappear from the Fermi surface, implying that the transition is equivalent to an orbital-selective Mott transition, as has been discussed for multi-band transition-metal oxides. In this article, available theoretical descriptions for orbital-selective Mott transitions will be reviewed, with an emphasis on conceptual aspects like the distinction between different low-temperature phases and the structure of the global phase diagram. Selected results for quantum critical properties will be listed as well. Finally, a brief overview is given on experiments which have been interpreted in terms of orbital-selective Mott physics.Comment: 29 pages, 4 figs, mini-review prepared for a special issue of JLT

Genetic Evidence for a Tight Cooperation of TatB and TatC during Productive Recognition of Twin-Arginine (Tat) Signal Peptides in Escherichia coli

The twin arginine translocation (Tat) pathway transports folded proteins across the cytoplasmic membrane of bacteria. Tat signal peptides contain a consensus motif (S/T-R-R-X-F-L-K) that is thought to play a crucial role in substrate recognition by the Tat translocase. Replacement of the phenylalanine at the +2 consensus position in the signal peptide of a Tat-specific reporter protein (TorA-MalE) by aspartate blocked export of the corresponding TorA(D+2)-MalE precursor, indicating that this mutation prevents a productive binding of the TorA(D+2) signal peptide to the Tat translocase. Mutations were identified in the extreme amino-terminal regions of TatB and TatC that synergistically suppressed the export defect of TorA(D+2)-MalE when present in pairwise or triple combinations. The observed synergistic suppression activities were even more pronounced in the restoration of membrane translocation of another export-defective precursor, TorA(KQ)-MalE, in which the conserved twin arginine residues had been replaced by lysine-glutamine. Collectively, these findings indicate that the extreme amino-terminal regions of TatB and TatC cooperate tightly during recognition and productive binding of Tat-dependent precursor proteins and, furthermore, that TatB and TatC are both involved in the formation of a specific signal peptide binding site that reaches out as far as the end of the TatB transmembrane segment