Which Cost Components Influence the Cost of Palliative Care in the Last Hospitalization? A Retrospective Analysis of Palliative Care vs. Usual Care at a Swiss University Hospital.

CONTEXT Although the number of studies on the economic impact of palliative care (PC) is growing, the great majority report costs from North America. OBJECTIVES We aimed to provide a comprehensive overview of PC hospital cost components from the perspective of a European mixed funded health care system by identifying cost drivers of PC and quantifying their effect on hospital costs compared to usual care (UC). METHODS We performed a retrospective, observational analysis examining cost data from the last hospitalization of patients who died at a large academic hospital in Switzerland comparing patients receiving PC versus UC. RESULTS Total hospital costs were similar in PC and UC with a mean difference of CHF -2'777 [95% confidence interval (CI) -12'713 to 8'506, p=0.60]. Average costs per day decreased by CHF -3'224 [95% CI -3'811 to -2'631, p<0.001] for PC patients with significant reduction of costs for diagnostic intervention and medication. Higher cost components for PC patients were catering, room, nursing, social counselling and non-medical therapists. In sensitivity analyses, when we restricted PC exposure to 3 days from admission, total costs and average costs per day were significantly lower for PC. CONCLUSION Studies measuring the impact of PC on hospital costs should analyze various cost components beyond total costs in order to understand wanted and potentially unwanted cost-reducing effects. An international definition of a set of cost components, specific for cost-impact PC studies, may help avoid superficial and potentially dangerous cost discussions

Identification and simulation of surface alpha events on passivated surfaces of germanium detectors and the influence of metalisation

Events from alpha interactions on the surfaces of germanium detectors are a major contribution to the background in germanium-based searches for neutrinoless double-beta decay. Surface events are subject to charge trapping, affecting their pulse shape and reconstructed energy. A study of alpha events on the passivated end-plate of a segmented true-coaxial n-type high-purity germanium detector is presented. Charge trapping is analysed in detail and an existing pulse-shape analysis technique to identify alpha events is verified with mirror pulses observed in the non-collecting channels of the segmented test detector. The observed radial dependence of charge trapping confirms previous results. A dependence of the probability of charge trapping on the crystal axes is observed for the first time. A first model to describe charge trapping effects within the framework of the simulation software SolidStateDetectors.jl is introduced. The influence of metalisation on events from low-energy gamma interactions close to the passivated surface is also presented

A common founding clone with TP53 and PTEN mutations gives rise to a concurrent germ cell tumor and acute megakaryoblastic leukemia

We report the findings from a patient who presented with a concurrent mediastinal germ cell tumor (GCT) and acute myeloid leukemia (AML). Bone marrow pathology was consistent with a diagnosis of acute megakaryoblastic leukemia (AML M7), and biopsy of an anterior mediastinal mass was consistent with a nonseminomatous GCT. Prior studies have described associations between hematological malignancies, including AML M7 and nonseminomatous GCTs, and it was recently suggested that a common founding clone initiated both cancers. We performed enhanced exome sequencing on the GCT and the AML M7 from our patient to define the clonal relationship between the two cancers. We found that both samples contained somatic mutations in PTEN (C136R missense) and TP53 (R213 frameshift). The mutations in PTEN and TP53 were present at ∼100% variant allele frequency (VAF) in both tumors. In addition, we detected and validated five other shared somatic mutations. The copy-number analysis of the AML exome data revealed an amplification of Chromosome 12p. We also identified a heterozygous germline variant in FANCA (S858R), which is known to be associated with Fanconi anemia but is of uncertain significance here. In summary, our data not only support a common founding clone for these cancers but also suggest that a specific set of distinct genomic alterations (in PTEN and TP53) underlies the rare association between GCT and AML. This association is likely linked to the treatment resistance and extremely poor outcome of these patients. We cannot resolve the clonal evolution of these tumors given limitations of our data

Temperature Dependence of the Electron-Drift Anisotropy and Implications for the Electron-Drift Model

The electron drift in germanium detectors is modeled making many assumptions. Confronted with data, these assumptions have to be revisited. The temperature dependence of the drift of electrons was studied in detail for an n-type segmented point-contact germanium detector. The detector was mounted in a temperature controlled, electrically cooled cryostat. Surface events were induced with collimated 81 keV photons from a $^{133}$Ba source. A detailed analysis of the rise time of pulses collected in surface scans, performed at different temperatures, is presented. The longitudinal anisotropy of the electron drift decreases with rising temperature. A new approach, making use of designated rise-time windows determined by simulations using SolidStateDetectors.jl, was used to isolate the longitudinal drift of electrons along different axes to quantify this observation. The measured temperature dependence of the longitudinal drift velocities combined with the standard electron drift model as widely used in relevant simulation packages results in unphysical predictions. A first suggestion to modify the electron-drift model is motivated and described. The results of a first implementation of the modified model in SolidStateDetectors.jl are shown. They describe the data reasonably well. A general review of the model and the standard input values for mobilities is suggested

Towards a Congruent Interpretation of Traffic Rules for Automated Driving - Experiences and Challenges

The homologation of automated driving systems for public roads requires a rigorous safety case. Regulations of the United Nations demand to demonstrate the compliance of the developed system with local traffic rules. Hence, evidences for this have to be delivered by means of formal proofs, online monitoring, and other verification techniques in the safety case. In order for such methods to be applicable traffic rules have to be made machine-interpretable. However, that pursuit is highly challenging. This work reports on our practical experiences regarding the formalization of a non-trivial part of the German road traffic act. We identify a central issue when formalizing traffic rules within a development process, coined as the congruence problem, which is concerned with the semantic equality of the legal and system interpretation of traffic rules. As our main contribution, we delineate potential challenges arising from the congruence problem, hence impeding a congruent yet formal interpretation of traffic rules. Finally, we aim to initiate discussions by highlighting steps to partially address these challenges

The investigation of inorganic composition of sediments from Djerdap Lake (Serbia)

Đerdapsko jezero formirano je 1972. godine kada je izgrađena hidroelektrana Đerdap 1 na Dunavu na srpsko-rumunskoj granici. Zapremina jezera je od oko 3.500 miliona m3 sa suspedovanim opterećenjem od oko 8.900 kt a-1. Cilj ovog istraživanja bio je ispitivanje neorganskog sastava sedimenata Đerdapskog jezera sa posebnim akcentom na teške metale u cilju utvrđivanja potencijalnog antropogenog zagađenja u ispitivanim sedimentima. Da bi se dali odgovori na postavljeni cilj sedimenti su uzorkovani iz jezgra dubine 140 cm, tako da sedimentno jezgro predstavlja sedimente koji su se taložili od nastanka jezera do 2016. godine (oko 43 godine). Potom je sedimentno jezgro podeljeno na 11 uzoraka. Sadržaj metala određen je rendgenskom fluorescentnom spektrometrijom (XRF), kvalitativna analiza mineralnog sastava urađena je rendgenskom difraktometrijskom analizom (XRD) i na svim uzorcima je urađena granulometrijska analiza prosejavanjem i pipet analizom. Dobijeni rezultati granulometrijske analize pokazuju da u većini uzorka dominira frakcija ispod 125 μm i da se uzorci uglavnom sastoje od alevrita i glina. Rendgenska difraktometrijska analiza je pokazala da se uzorci sastoje od sledećih minerala: liskuna, hlorita, kalcita, dolomita, feldspata, smektita i kvarca. Određen je sadržaj sledećih teških metala Ni, As, Cd, Zn, Pb, Cu, Hg, Cr, Mn, Ba, Sr i Co.U koncentracijama ispod detekcionog limita za XRF(1 ppm)nalaze se As, Hg i Cd. Posmatrajući promene koncetracije teških metala sa dubinom isti trend imaju Zn, Pb, Cu, Cr i Mn, dok se Ni, Ba i Sr ponašaju drugačije (Slika 1). Najniže koncentracije teških metala primećene su na dubinama od oko 20 m, dok se najviše koncentacije većine teških metala nalaze na dubinama od oko 40 i 120 m. Ispitivani teški metali ne pokazuju korelaciju sa sadržajem organske supstance i frakcije glina. Nađene koncentracije ispitivanih elemenata u najvećoj meri ukazuju na geološko poreklo, i da je antropogeni uticaj mali. Da bi se dali precizniji odgovori buduća istraživanje biće usmerena ka detaljnijim minerološkim analizama, određivanju dostupnih jona i izotopskom određivanju starosti sedimenata da bi se dali odgovorim o potencijalnom zagađenju ispitivanih sedimenata

Correction to: Four Decades of Organic Anthropogenic Pollution: a Compilation for Djerdap Lake Sediments, Serbia" (2020, 231, 2, 67) 10.1007/s11270-020-4420-6

The authors missed to mention that this project received financial support by the Ministry of Education, Science and Technological Development of the Republic of Serbia, Grants 176006, 176019. In addition, the Figure 1 was published erroneously.related to: [ http://cer.ihtm.bg.ac.rs/handle/123456789/3236