Tearing down walls: opening the border between hospital and ambulatory care for quality improvement in Germany

The hospital benchmarking system in Germany was originally introduced to detect unintended consequences of reimbursement based on diagnosis-related groups. The new nationwide SQG programme aims to provide information on quality and outcomes of health care provided in hospital, ambulatory specialist and primary care settings, including the healthcare delivery across different sectors. In 2010 the topics for indicator development were cataract surgery, cervical conization, colectoral cancer and percutaneous coronary interventions or coronary angiography. A systematic stepwise modified RAND/UCLA procedure is applied to develop quality indicators in each of these domains. A general framework for data collection is implemented. Benchmarking results are fed back to providers on a regular basis

Airborne measurements of trace gas and aerosol particle emissions from biomass burning in Amazonia

International audienceAs part of the LBA-SMOCC (Large-Scale Biosphere-Atmosphere Experiment in Amazonia ? Smoke, Aerosols, Clouds, Rainfall, and Climate) 2002 campaign, we studied the emission of carbon monoxide (CO), carbon dioxide (CO2), and aerosol particles from Amazonian deforestation fires using an instrumented aircraft. Emission ratios for aerosol number (CN) relative to CO (ERCN/CO) fell in the range 14?32 cm-3 ppb-1 for most of the time, in agreement with values usually found from tropical savanna fires. The number of particles emitted per amount biomass burned was found to be dependant on the fire condition (combustion efficiency). Variability in the ERCN/CO between fires was similar to the variability caused by variations in combustion behavior within each individual fire. This was confirmed by observations of CO-to-CO2 emission ratios (ERCO/CO2), which stretched across the same wide range of values for individual fires as for all the fires observed during the sampling campaign, indicating that flaming and smoldering phases are present simultaneously in deforestation fires. Emission factors (EF) for CO and aerosol particles were computed and a correction was applied for the residual smoldering combustion (RSC) fraction of emissions that are not sampled by the aircraft. The correction, previously unpublished for tropical deforestation fires, suggested an EF about one and a half to twice as large for these species. Vertical transport of biomass-burning plumes from the boundary layer (BL) to the cloud detrainment layer (CDL) and the free troposphere (FT) was found to be a very common phenomenon. We observed a 20% loss in particle number as a result of this vertical transport and subsequent cloud processing, attributable to in-cloud coagulation. This small loss fraction suggests that this mode of transport is very efficient in terms of particle numbers and occurs mostly via non-precipitating clouds. The detrained aerosol particles released in the CDL and FT were larger due to coagulation and secondary growth, and therefore more efficient at scattering radiation and nucleating cloud droplets than the fresh particles. This process may have significant atmospheric implications on a regional and larger scale

Calibration of TCCON column-averaged CO2: the first aircraft campaign over European TCCON sites

The Total Carbon Column Observing Network (TCCON) is a ground-based network of Fourier Transform Spectrometer (FTS) sites around the globe, where the column abundances of CO2, CH4, N2O, CO and O2 are measured. CO2 is constrained with a precision better than 0.25% (1-σ). To achieve a similarly high accuracy, calibration to World Meteorological Organization (WMO) standards is required. This paper introduces the first aircraft calibration campaign of five European TCCON sites and a mobile FTS instrument. A series of WMO standards in-situ profiles were obtained over European TCCON sites via aircraft and compared with retrievals of CO2 column amounts from the TCCON instruments. The results of the campaign show that the FTS measurements are consistently biased 1.1% ± 0.2% low with respect to WMO standards, in agreement with previous TCCON calibration campaigns. The standard a priori profile for the TCCON FTS retrievals is shown to not add a bias. The same calibration factor is generated using aircraft profiles as a priori and with the TCCON standard a priori. With a calibration to WMO standards, the highly precise TCCON CO2 measurements of total column concentrations provide a suitable database for the calibration and validation of nadir-viewing satellite

Tunable anisotropy in inverse opals and emerging optical properties

Using self-assembly, nanoscale materials can be fabricated from the bottom up. Opals and inverse opals are examples of self-assembled nanomaterials made from crystallizing colloidal particles. As self-assembly requires a high level of control, it is challenging to use building blocks with anisotropic geometry to form complex opals, which limits the realizable structures. Typically, spherical colloids are employed as building blocks, leading to symmetric, isotropic superstructures. However, a significantly richer palette of directionally dependent properties are expected if less symmetric, anisotropic structures can be created, especially originating from the assembly of regular, spherical particles. Here we show a simple method to introduce anisotropy into inverse opals by subjecting them to a post-assembly thermal treatment that results in directional shrinkage of the silica matrix caused by condensation of partially hydrated sol-gel silica structures. In this way, we can tailor the shape of the pores, and the anisotropy of the final inverse opal preserves the order and uniformity of the self-assembled structure, while completely avoiding the need to synthesize complex oval-shaped particles and crystallize them into such target geometries. Detailed X-ray photoelectron spectroscopy (XPS) and infrared (IR) spectroscopy studies clearly identify increasing degrees of sol-gel condensation in confinement as a mechanism for the structure change. A computer simulation of structure changes resulting from the condensation-induced shrinkage further confirmed this mechanism. As an example of property changes induced by the introduction of anisotropy, we characterized the optical spectra of the anisotropic inverse opals and found that the optical properties can be controlled in a precise way using calcination temperature

Energy efficient plasma processing of industrial wastes

The paper presents the results of thermodynamic modeling of the process of joint plasma treatment of non-combustible and combustible industrial wastes. The compositions of water-salt-organic compositions based on these wastes and regimes providing their energy-efficient joint treatment in air plasma have been determined

An airborne regional carbon balance for central amazonia

We obtained regional estimates of surface CO2 exchange rates using atmospheric boundary layer budgeting techniques above tropical forest near Manaus, Brazil. Comparisons were made with simultaneous measurements from two eddy covariance towers below. Although there was good agreement for daytime measurements, large differences emerged for integrating periods dominated by the night-time fluxes. These results suggest that a systematic underestimation of night time respiratory effluxes may be responsible for the high Amazonian carbon sink suggested by several previous eddy covariance studies. Large CO2 fluxes from riverine sources or high respiratory losses from recently disturbed forests do not need to be invoked in order to balance the carbon budget of the Amazon. Our results do not, however, discount some contribution of these processes to the overall Amazon carbon budget