Verification of Protective Systems

Discussion Grou

COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use – a protocol for a cross-sectional multi-centre study

BACKGROUND: A casemix classification based on patients’ needs can serve to better describe the patient group in palliative care and thus help to develop adequate future care structures and enable national benchmarking and quality control. However, in Germany, there is no such an evidence-based system to differentiate the complexity of patients’ needs in palliative care. Therefore, the study aims to develop a patient-oriented, nationally applicable complexity and casemix classification for adult palliative care patients in Germany. METHODS: COMPANION is a mixed-methods study with data derived from three subprojects. Subproject 1: Prospective, cross-sectional multi-centre study collecting data on patients’ needs which reflect the complexity of the respective patient situation, as well as data on resources that are required to meet these needs in specialist palliative care units, palliative care advisory teams, and specialist palliative home care. Subproject 2: Qualitative study including the development of a literature-based preliminary list of characteristics, expert interviews, and a focus group to develop a taxonomy for specialist palliative care models. Subproject 3: Multi-centre costing study based on resource data from subproject 1 and data of study centres. Data and results from the three subprojects will inform each other and form the basis for the development of the casemix classification. Ultimately, the casemix classification will be developed by applying Classification and Regression Tree (CART) analyses using patient and complexity data from subproject 1 and patient-related cost data from subproject 3. DISCUSSION: This is the first multi-centre costing study that integrates the structure and process characteristics of different palliative care settings in Germany with individual patient care. The mixed methods design and variety of included data allow for the development of a casemix classification that reflect on the complexity of the research subject. The consecutive inclusion of all patients cared for in participating study centres within the time of data collection allows for a comprehensive description of palliative care patients and their needs. A limiting factor is that data will be collected at least partly during the COVID-19 pandemic and potential impact of the pandemic on health care and the research topic cannot be excluded. TRIAL REGISTRATION: German Register for Clinical Studies trial registration number: DRKS00020517

Planar and Three-Dimensional Printing of Conductive Inks

Printed electronics rely on low-cost, large-area fabrication routes to create flexible or multidimensional electronic, optoelectronic, and biomedical devices1-3. In this paper, we focus on one- (1D), two- (2D), and three-dimensional (3D) printing of conductive metallic inks in the form of flexible, stretchable, and spanning microelectrodes

Fracture of disordered solids in compression as a critical phenomenon: II. Model Hamiltonian for a population of interacting cracks

To obtain the probability distribution of 2D crack patterns in mesoscopic regions of a disordered solid, the formalism of Paper I requires that a functional form associating the crack patterns (or states) to their formation energy be developed. The crack states are here defined by an order parameter field representing both the presence and orientation of cracks at each site on a discrete square network. The associated Hamiltonian represents the total work required to lead an uncracked mesovolume into that state as averaged over the initial quenched disorder. The effect of cracks is to create mesovolumes having internal heterogeneity in their elastic moduli. To model the Hamiltonian, the effective elastic moduli corresponding to a given crack distribution are determined that includes crack-to-crack interactions. The interaction terms are entirely responsible for the localization transition analyzed in Paper III. The crack-opening energies are related to these effective moduli via Griffith's criterion as established in Paper I.Comment: 9 pages, 1 figur

Verification of Protective Systems

Discussion Grou

NF97-343 Returning CRP Land to Crops: Warm-Season Grass Management/Cropping Suggestions

This NebFact has information on returning CRP land to crop production including tillage and no-till recommendations

NF97-343 Returning CRP Land to Crops: Warm-Season Grass Management/Cropping Suggestions

This NebFact has information on returning CRP land to crop production including tillage and no-till recommendations

Structural characteristics and contractual terms of specialist palliative homecare in Germany

Background Multi-professional specialist palliative homecare (SPHC) teams care for palliative patients with complex symptoms. In Germany, the SPHC directive regulates care provision, but model contracts for each federal state are heterogeneous regarding staff requirements, cooperation with other healthcare providers, and financial reimbursement. The structural characteristics of SPHC teams also vary. Aim We provide a structured overview of the existing model contracts, as well as a nationwide assessment of SPHC teams and their structural characteristics. Furthermore, we explore whether these characteristics serve to find specifc patterns of SPHC team models, based on empirical data. Methods This study is part of the multi-methods research project “SAVOIR”, funded by the German Innovations Fund. Most model contracts are publicly available. Structural characteristics (e.g. number, professions, and affiliations of team members, and external cooperation) were assessed via an online database (“Wegweiser Hospiz- und Palliativversorgung”) based on voluntary information obtained from SPHC teams. All the data were updated by phone during the assessment process. Data were descriptively analysed regarding staff, cooperation requirements, and reimbursement schemes, while latent class analysis (LCA) was used to identify structural team models. Results Model contracts have heterogeneous contract partners and terms related to staff requirements (number and qualifications) and cooperation with other services. Fourteen reimbursement schemes were available, all combining different payment models. Of the 283 SPHC teams, 196 provided structural characteristics. Teams reported between one and 298 members (mean: 30.3, median: 18), mainly nurses and physicians, while 37.8% had a psychosocial professional as a team member. Most teams were composed of nurses and physicians employed in different settings; for example, staff was employed by the team, in private practices/nursing services, or in hospitals. Latent class analysis identified four structural team models, based on the team size, team members’ affiliation, and care organisation. Conclusion Both the contractual terms and teams’ structural characteristics vary substantially, and this must be considered when analysing patient data from SPHC. The identified patterns of team models can form a starting point from which to analyse different forms of care provision and their impact on care quality

New Vehicle Characteristics and the Cost of the Corporate Average Fuel Economy Standard

Recent legislation has increased the Corporate Average Fuel Economy (CAFE) standard by 40 percent, which represents the first major increase in the standard since its creation in 1975. Previous analysis of the CAFE standard has analyzed the short run effects (1-2 years), in which vehicle characteristics are held fixed, or the long run effects (10 years or more), when firms can adopt new power train technology. This paper focuses on the medium run, when firms can choose characteristics such as weight and power, and have a limited ability to adopt technology. We first document the historical importance of the medium run and then estimate consumers' willingness-to-pay for fuel efficiency, power and weight. We employ a novel empirical strategy that accounts for the characteristics' endogeneity, which has not been addressed in the literature, by using variation in the set of engine models used in vehicle models. The results imply that an increase in power has a similar effect on vehicle sales to a proportional increase in fuel efficiency. We then simulate the medium run effects of an increase in the CAFE standard. The policy reduces producer and consumer welfare and causes substantial transfers across firms, but the effects are significantly smaller than found in previous studies