Is it good to be too light? Birth weight thresholds in hospital reimbursement systems

Birth weight manipulation is common in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hospitals receive more money for cases with weight below the thresholds, having a (reported) weight below a threshold could benefit the newborn. Also, these reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect the quantity and quality of care that newborns receive. Based on the universe of hospital births in Germany from the years 2005–2011, we investigate whether weight below reimbursement relevant thresholds triggers different quantity and quality of care. We find that this is not the case, suggesting that hospitals’ financial incentives with respect to birth weight do not directly impact the care that newborns receive

Genetic programming for fiber-threading for fiber-reinforced plastics

Setting up fiber-threading for a pultrusion line is tedious, error prone and takes a long time. Between 100 and 1000 fibers have to be arranged into a two-dimensional shape, which have to be threaded between several support plates without causing crossovers. When manually planning this process based on intuition, it is hard to keep track of the complexity. This slows the process down to where it can take several hours or several days, and shortening this duration reduces the cost considerably. As planning the setup takes up a large chunk of time, we are proposing a simulation and an algorithm to automatically calculate how the fiber bundles need to be threaded from the creels through the support plates to result in the desired shape. Using a three-dimensional simulation for collision detection in conjunction with a genetic algorithm, we are able to shorten the planning of the fibers to around 10 minutes on a modern 8-core personal computer. Based on this data, further work can be done to further improve, visualize or permanently store the data in a digitized company

Toys as teaching tools in engineering: the cases of Newton’s cradle and the gyroscope

Resumen Los funcionamientos de dos juguetes ampliamente conocidos, el péndulo de Newton y el giroscopio, han servido como modelo, ya sea para el desarrollo de una variedad de aplicaciones en diversas áreas de ciencia e ingeniería, o como herramienta pedagógica para la explicación de los principios físicos que gobiernan estos accesorios. La presentación de estos dos casos destaca una vez más la existencia de otras alternativas educacionales, en ocasiones más claras y de mayor motivación para los estudiantes que las tradicionales, en la descripción de ciertos fenómenos físicos. Abstract The behaviors of two widely known toys, Newton’s cradle and gyroscope, have served as a model, either for the development of a variety of applications in various areas of science and engineering, or as pedagogical tool for the explanation of the physical principles that govern these accessories. The presentation of these two cases highlights once again the existence of educational alternatives, sometimes clearer and having greater motivation for students than the traditional ones, in the description of certain physical phenomena

Hospital capacity reporting in Germany during COVID-19

During the COVID-19 pandemic, hospitals faced a unique predicament. Hospital care was urgently needed and society took efforts to prevent overwhelming hospitals. However, hospitals in case-based reimbursement schemes faced financial problems because of cancelled elective care visits and government regulations to keep capacity free for Covid-19 patients. Therefore, emergency financing measures were implemented in many countries. We analyze how hospitals in Germany responded to a scheme that provided financial support if the intensive care unit (ICU) occupancy rate in a county exceeded 75%. The scheme distributed over seven billion euros to hospitals and was notable because financial support depended on a measure (ICU occupancy rate) that hospitals could directly influence. To analyze hospitals’ reactions to this scheme, we employ event study analyses comparing ICU capacity before and after regions became eligible. We find no evidence of strategic reporting at an economically meaningful and hence empirically detectable scale

Vorsorgelücke während der Coronavirus-Pandemie : Vorsorgeuntersuchungen in der Krise

Die Corona-Pandemie zeigt ihre Auswirkungen in jedem Lebensbereich. Es ist die tiefgreifendste Gesundheitskrise seit Jahrzehnten und das nicht nur für direkt von einer Covid-19-Erkrankung Betroffene; sie schlägt sich auf alle Bereiche des Gesundheitssystems nieder. Zum Weltkrebstag veröffentlichte Zahlen legen nahe, dass präventive Arztbesuche und Vorsorgemaßnahmen während der Pandemie stark abgenommen haben und verschoben wurden (BARMER, 2021; TK, 2021). Da regelmäßige Vorsorgeuntersuchungen oft schwere Krankheitsverläufe verhindern können, besteht die Gefahr, dass die Vorsorgelücke das Mortalitätsrisiko an eigentlich behandelbaren Krankheiten erhöht. In dieser Kurzexpertise geben wir zuerst einen Überblick über die Wichtigkeit von Vorsorgeuntersuchungen und zeigen dann, dass eine Vielzahl von Ergebnissen einen starken Rückgang der Vorsorgeuntersuchungen während der Coronavirus-Pandemie beschreibt. Als nächstes zeigen wir anhand von Google Suchanfragen, dass der Rückgang der Vorsorgeuntersuchungen zumindest teilweise durch das empfundene Risiko sich in der Arztpraxis mit dem Coronavirus anzustecken, erklärt werden kann. Zum Schluss diskutieren wir Vorschläge, wie die Vorsorgelücke geschlossen werden kann

PermeabilityNets: comparing neural network architectures on a sequence-to-instance task in CFRP manufacturing

Carbon fiber reinforced polymers (CFRP) offer highly desirable properties such as weight-specific strength and stiffness. Liquid composite moulding (LCM) processes are prominent, economically efficient, out-of-autoclave manufacturing techniques and, in particular, resin transfer moulding (RTM), allows for a high level of automation. There, fibrous preforms are impregnated by a viscous polymer matrix in a closed mould. Impregnation quality is of crucial importance for the final part quality and is dominated by preform permeability. We propose to learn a map of permeability deviations based on a sequence of camera images acquired in flow experiments. Several ML models are investigated for this task, among which ConvLSTM networks achieve an accuracy of up to 96.56%, showing better performance than the Transformer or pure CNNs. Finally, we demonstrate that models, trained purely on simulated data, achieve qualitatively good results on real data

Inferring material properties from FRP processes via sim-to-real learning

Fiber reinforced polymers (FRP) provide favorable properties such as weight-specific strength and stiffness that are central for certain industries, such as aerospace or automotive manufacturing. Liquid composite molding (LCM) is a family of often employed, inexpensive, out-of-autoclave manufacturing techniques. Among them, resin transfer molding (RTM), offers a high degree of automation. Herein, textile preforms are saturated by a fluid polymer matrix in a closed mold.Both impregnation quality and level of fiber volume content are of crucial importance for the final part quality. We propose to simultaneously learn three major textile properties (fiber volume content and permeability in X and Y direction) presented as a three-dimensional map based on a sequence of camera images acquired in flow experiments and compare CNNs, ConvLSTMs, and Transformers. Moreover, we show how simulation-to-real transfer learning can improve a digital twin in FRP manufacturing, compared to simulation-only models and models based on sparse real data. The overall best metrics are: IOU 0.5031 and Accuracy 95.929 %, obtained by pretrained transformer models

UAV inspection of large components: determination of alternative inspection points and online route optimization

Automation is playing an increasing role in the field of quality assurance. For the visual inspection of larger assemblies such as aircraft fuselages or ship hulls, the use of UAVs is an option. This paper deals with one aspect of the UAV-supported inspection of assemblies in production. Here, newly added components have to be checked for correct assembly. The planning of the shortest possible route from which all components to be inspected can be viewed as well as the estimation of the UAV’s position relative to the component have already been presented in previous work. We propose strategies that can be used if an inspection point cannot be reached by the UAV or the component to be inspected cannot be seen by the UAV’s camera from the inspection point. For this purpose, we generate alternative inspection points that can be used if errors occur during the inspection from the original inspection point. To achieve this, we present a metric that can be used to select an alternative inspection point that is as suitable as possible. We conclude by demonstrating how this strategy works by evoking different failure cases in a simulated environment

When who and how matter: explaining the success of referendums in Europe

This article aims to identify the institutional factors that make a referendum successful. This comparative analysis seeks to explain the success of top-down referendums organized in Europe between 2001 and 2013. It argues and tests for the main effect of three institutional factors (popularity of the initiator, size of parliamentary majority, and political cues during referendum campaigns) and controls for the type of referendum and voter turnout. The analysis uses data collected from referendums and electoral databases, public opinion surveys, and newspaper articles. Results show that referendums proposed by a large parliamentary majority or with clear messages from political parties during campaign are likely to be successful

Carbohydrate Intake in the Etiology of Crohn's Disease and Ulcerative Colitis

Background: Diet may have a role in the etiology of inflammatory bowel disease. In previous studies, the associations between increased intakes of carbohydrates, sugar, starch, and inflammatory bowel disease are inconsistent. However, few prospective studies have investigated the associations between these macronutrients and incident Crohn's disease (CD) or ulcerative colitis (UC). Methods: A total of 401,326 men and women were recruited between 1991 and 1998. At recruitment, dietary intakes of carbohydrate, sugar, and starch were measured using validated food frequency questionnaires. The cohort was monitored identifying participants who developed incident CD or UC. Cases were matched with 4 controls, and odds ratios were calculated for quintiles of total carbohydrate, sugar, and starch intakes adjusted for total energy intake, body mass index, and smoking. Results: One hundred ten participants developed CD, and 244 participants developed UC during follow-up. The adjusted odds ratio for the highest versus the lowest quintiles of total carbohydrate intake for CD was 0.87, 95% CI = 0.24 to 3.12 and for UC 1.46, 95% CI = 0.62 to 3.46, with no significant trends across quintiles for either (CD, Ptrend = 0.70; UC, Ptrend = 0.41). Similarly, no associations were observed with intakes of total sugar (CD, Ptrend = 0.50; UC, Ptrend = 0.71) or starch (CD, Ptrend = 0.69; UC, Ptrend = 0.17). Conclusions: The lack of associations with these nutrients is in agreement with many case–control studies that have not identified associations with CD or UC. As there is biological plausibility for how specific carbohydrates could have an etiological role in inflammatory bowel disease, future epidemiological work should assess individual carbohydrates, although there does not seem to be a macronutrient effect