Surgeon supply and healthcare quality: Are revision rates for hip and knee replacements lower in hospitals that employ more surgeons?

We study the link between department-wide surgeon supply and quality of care for two major elective medical procedures. Several countries have adopted policies to concentrate medical procedures in high-volume hospitals. While higher patient volumes might translate to higher quality, we provide evidence for a positive relationship between surgeon supply and hospital revision rates for hip and knee replacement surgery. Hence, hospital performance decreases with higher surgeon supply, and this finding holds conditional on patient volumes

Natural variation in circadian rhythms and photoperiodic flowering in tomato and its wild relatives

The circadian clock controls many important aspects of plant physiology and de-velopment. By allowing anticipation of predictable daily and annual seasonal changes it helps plants to appropriately align their daily cycles and to correctly time their development. In this thesis, natural variation in daily and seasonal outputs of the circadian clock was studied in cultivated tomato (Solanum lyco-persicum) and its wild relatives. A key seasonal output of the circadian clock is photoperiodic flowering, which is crucial for many plants, either to synchronize for pollination or to avoid unfavor-able conditions. While all cultivated tomato varieties flower irrespective of daylength, some of its wild relatives, as S. galapagense and S. habrochaites, accel-erate flowering under short days. Under the long day greenhouse conditions used in this thesis, S. galapagense does not flower at all unless grafted onto culti-vated tomato. This indicates that in this species a mobile flowering signal is ac-tive only under short days. Bulk segregant analysis combined with RNA sequencing using an S. galapagense F2 population and quantitative trait locus (QTL) analysis using an S. habrochaites introgression line population revealed loci underlying photoperiodic flowering. Besides photoperiodic flowering, the circadian clock controls many other agro-nomically significant traits. In addition, natural variation in circadian rhythms appears to be important for adaptation to specific environments. Still, quantita-tive variation in circadian rhythms due to artificial selection has not yet been reported. Monitoring of two daily outputs of the circadian clock, leaf movements and transcript rhythms, revealed differences between cultivated tomato and its wild relatives, indicating that domestication or early breeding has had an effect on the tomato circadian clock. QTL analysis identified two loci that appear to be responsible for these differences in circadian rhythms. Fine mapping of one of these loci determined a region containing 13 genes. One of them, the homolog of the Arabidopsis thaliana gene EMPFINDLICHER IM DUNKELROTEN LICHT 1 (EID1), was cloned and transformed into tomato. Strikingly, near isogenic lines (NILs) differing only in EID1 and 12 adjacent genes exhibit differences in seed-ling height under greenhouse conditions. This indicates that the observed varia-tion in circadian rhythms may have an effect on plant growth under natural conditions. In conclusion, this study suggests that humans may have selected for altered circadian rhythms during tomato domestication or early breeding to adapt the species to its agricultural environments

Air-clad fibers: pump absorption assisted by chaotic wave dynamics?

Wave chaos is a concept which has already proved its practical usefulness in design of double-clad fibers for cladding-pumped fiber lasers and fiber amplifiers. In general, classically chaotic geometries will favor strong pump absorption and we address the extent of chaotic wave dynamics in typical air-clad geometries. While air-clad structures supporting sup-wavelength convex air-glass interfaces (viewed from the high-index side) will promote chaotic dynamics we find guidance of regular whispering-gallery modes in air-clad structures resembling an overall cylindrical symmetry. Highly symmetric air-clad structures may thus suppress the pump-absorption efficiency eta below the ergodic scaling law eta proportional to Ac/Acl, where Ac and Acl are the areas of the rare-earth doped core and the cladding, respectively.Comment: High-resolution figures and animations available in the freely available published version (click the DOI link

Ischemia/Reperfusion Injury in Liver Surgery and Transplantation: Pathophysiology

Liver ischemia/reperfusion (IR) injury is caused by a heavily toothed network of interactions of cells of the immune system, cytokine production, and reduced microcirculatory blood flow in the liver. These complex networks are further elaborated by multiple intracellular pathways activated by cytokines, chemokines, and danger-associated molecular patterns. Furthermore, intracellular ionic disturbances and especially mitochondrial disorders play an important role leading to apoptosis and necrosis of hepatocytes in IR injury. Overall, enhanced production of reactive oxygen species, found very early in IR injury, plays an important role in liver tissue damage at several points within these complex networks. Many contributors to IR injury are only incompletely understood so far. This paper tempts to give an overview of the different mechanisms involved in the formation of IR injury. Only by further elucidation of these complex mechanisms IR injury can be understood and possible therapeutic strategies can be improved or be developed

Internet Sanctions on Russian Media:Actions and Effects

As a response to the Russian aggression against Ukraine, the European Union (EU), through the notion of ‘digital sovereignty,’ imposed sanctions on organizations and individuals affiliated with the Russian Federation that prohibit broadcasting content, including online distribution. In this paper, we interrogate the implementation of these sanctions and interpret them as a means to translate the union of states’ governmental edicts into effective technical countermeasures. Through longitudinal traffic analysis, we construct an understanding of how ISPs in different EU countries attempted to enforce these sanctions, and compare these implementations to similar measures in other western countries. We find a wide variation of blocking coverage, both internationally and within individual member states. We draw the conclusion that digital sovereignty through sanctions in the EU has a concrete but distinctly limitedimpact on information flows

Choice of creep or maintenance fluid type and their impact on total daily ICU sodium burden in critically ill patients: A systematic review and meta-analysis

Purpose Maintenance and hidden/creep fluids are a major source of fluid and sodium intake in intensive care unit (ICU) patients. Recent research indicates that low versus high sodium content maintenance fluids could decrease fluid and sodium burden. We conducted a systematic review (SR) with meta-analysis to summarize the impact of maintenance fluid choice on total daily sodium in ICU patients. Materials and methods Systematic literature search in Pubmed, Embase, the Cochrane Library and the Clinical Trials registry. Only controlled clinical trials were included. Exclusion criteria: trials on resuscitation fluids, performed in the emergency department only and in pediatric patients. Primary objective was the reduction in mean total sodium intake with low versus high sodium content maintenance/creep fluids. Results Five studies (1105 patients) were included. Heterogeneity was high.Risk of bias was moderate. Mean daily sodium reduction was 117 mmol (95%Confidence Interval [CI] -174; −59; p < 0.001) with low versus high sodium content maintenance/creep fluids. Incidence of hyperchloremia was lower (OR 0.26; 95%CI 0.1; 0.64) with low sodium. There were no differences in the incidences of hyper−/hyponatremia and fluid balances. Conclusion Using low sodium content maintenance/creep fluids substantially reduces daily sodium burden in adult ICU patients. Significant knowledge/research gaps exist regarding relevance and safety