Post-processing of real-time quantum event measurements for an optimal bandwidth.

Single electron tunneling and its transport statistics have been studied for some time using high precision charge detectors. However, this type of detection requires advanced lithography, optimized material systems and low temperatures (mK). A promising alternative, recently demonstrated, is to exploit an optical transition that is turned on or off when a tunnel event occurs. High bandwidths should be achievable with this approach, although this has not been adequately investigated so far. We have studied low temperature resonance fluorescence from a self-assembled quantum dot embedded in a diode structure. We detect single photons from the dot in real time and evaluate the recorded data only after the experiment, using post-processing to obtain the random telegraph signal of the electron transport. This is a significant difference from commonly used charge detectors and allows us to determine the optimal time resolution for analyzing our data. We show how this post-processing affects both the determination of tunneling rates using waiting-time distributions and statistical analysis using full-counting statistics. We also demonstrate, as an example, that we can analyze our data with bandwidths as high as 175 kHz. Using a simple model, we discuss the limiting factors for achieving the optimal bandwidth and propose how a time resolution of more than 1 MHz could be achieved.

A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents.

BACKGROUND: Among minors, posttraumatic stress symptoms (PTSS) are a common consequence of traumatic events requiring trauma-focused treatment. OBJECTIVE: This meta-analysis quantified treatment effects of trauma-focused cognitive behavioral therapy (TF-CBT) with PTSS as primary outcome and symptoms of depression, anxiety, and grief as secondary outcomes. PARTICIPANTS AND SETTING: Inclusion criteria for individual settings: (1) patients aged between 3 and 21, (2) at least one traumatic event, (3) minimum 8 sessions of (4) TF-CBT according to Cohen, Mannarino and Deblinger (2006, 2017), (5) a quantitative PTSS measure at pre- and post-treatment, (6) original research only. Inclusion criteria for group settings: had to involve (1) psychoeducation, (2) coping strategies, (3) exposure, (4) cognitive processing/restructuring, (5) contain some reference to the manual and no minimum session number was required. METHODS: Searched databases were PsychInfo, MEDLINE, Cochrane Library, PTSDPubs, PubMed, Web of Science, and OpenGrey. RESULTS: 4523 participants from 28 RCTs and 33 uncontrolled studies were included. TF-CBT showed large improvements across all outcomes from pre- to post-treatment (PTSS: g = 1.14, CI 0.97-1.30) and favorable results compared to any control condition including wait-list, treatment as usual, and active treatment at post-treatment (PTSS: g = 0.52, CI 0.31-0.73). Effects were more pronounced for group settings. We give pooled estimates adjusted for risk of bias and publication bias, which initially limited the quality of the analyzed data. CONCLUSIONS: TF-CBT is an effective treatment for pediatric PTSS as well as for depressive, anxiety, and grief symptoms. It is superior to control conditions, supporting international guidelines recommending it as a first-line treatment.

[Liability for chronic working time violations in medicine: when does the risk of fines and imprisonment loom?] / Haftung für chronische Arbeitszeitverstöße in der Medizin ­ wann drohen Bußgelder und Freiheitsstrafen?

Against the background of the changes in the collective bargaining agreement-for municipal hospitals in the version of January 1, 2021, and for university hospitals in the version of March 7, 2020-this article deals with the legal consequences of chronic violations of the German Working Hours Act in medicine, but especially in surgical specialties such as urology. It includes an overview of current law and sanctions for violations and highlights responsibilities as well as exceptions. It is important to clarify the distribution of responsibilities with regard to working hours in the institution concerned in order to avoid fines and, in the worst case, imprisonment. It should also be clear who is liable in specific cases for persistent working time violations. When changing duty models, it is important to bear in mind that this can lead to a considerable deterioration in the opportunities for further training and education of physicians, meaning that in the long term the compatibility of further training in line with working hours can only be achieved with sufficient staffing of the hospitals. In some cases, this is diametrically opposed to economic interests in the health care system and thus presents an almost insoluble dilemma. In the view of the working group, structural changes in the diagnosis-related group (DRG)-based inpatient sector are needed in the near future.

Pushing the Limits in Real-Time Measurements of Quantum Dynamics.

Time-resolved studies of quantum systems are the key to understanding quantum dynamics at its core. The real-time measurement of individual quantum numbers as they switch between certain discrete values, well known as a "random telegraph signal," is expected to yield maximal physical insight. However, the signal suffers from both systematic errors, such as a limited time resolution and noise from the measurement apparatus, as well as statistical errors due to a limited amount of data. Here we demonstrate that an evaluation scheme based on factorial cumulants can reduce the influence of such errors by orders of magnitude. The error resilience is supported by a general theory for the detection errors as well as experimental data of single-electron tunneling through a self-assembled quantum dot. Thus, factorial cumulants push the limits in the analysis of random telegraph data, which represent a wide class of experiments in physics, chemistry, engineering, and life sciences.

The association of depression and all-cause mortality: Explanatory factors and the influence of gender.

BACKGROUND: The association of depression with mortality and the significance of explanatory factors, in particularly gender, have remained an issue of debate. We therefore aimed to estimate the effect of depression on all-cause mortality, to examine potential explanatory factors and to assess effect modification by gender. METHODS: We used Cox regression models to estimate the effect of depression on mortality based on data from the Gutenberg Health Study, which is a prospective cohort study of the adult population in the districts of Mainz and Mainz-Bingen, Germany. Baseline assessment was between 2007 and 2012. Effect modification by gender was measured on both additive and multiplicative scales. RESULTS: Out of 14,653 participants, 7.7% were depressed according to Patient Health Questionnaire 9 (PHQ-9), and 1,059 (7.2%) died during a median follow-up of 10.7 years. Depression elevated the risk of mortality in men and women in age-adjusted models (HR: 1.41, 95%-CI: 1.03-1.92; resp. HR: 1.96, 95%-CI: 1.43-2.69). Adjustment for social status, physical health and lifestyle covariates attenuated the effect and in the fully-adjusted model the hazard ratio was 0.96 (95%-CI: 0.69-1.33) in men and 1.53 (95%-CI: 1.10-2.12) in women. For effect modification by gender, the measure on multiplicative interaction was 0.68 (95%-CI 0.44-1.07) and on additive interaction was RERI=-0.47 (95%-CI -1.24-0.30). LIMITATIONS: The PHQ-9 is a single self-report measure of depression reflecting symptoms of the past two weeks, limiting a more detailed assessment of depression and course of symptoms, which likely affects the association with mortality. CONCLUSIONS: Depression elevates mortality by multifactorial pathways, which should be taken into account in the biopsychosocially informed treatment of depression. Effect modification by gender was not statistically significant.

[Implementation of the new collective agreement in 2021 in urological clinics : Expectations and reality]. / Umsetzung des neuen Tarifvertrags ab 2021 in urologischen Kliniken : Wunsch und Wirklichkeit.

The amendment to the collective agreement is intended to significantly improve the working conditions of physicians and includes longer-term duty scheduling, work on a maximum of two weekends per month, less overtime. Smaller hospitals often have problems implementing these requirements and have to make compromises. At least the overtime is now better paid-overall, an improvement in working conditions can only be achieved by increasing the number of staff, then better and more intensive training is also possible.

Worker-fatigue contributing to workplace incidents in New Zealand Forestry.

PROBLEM: Reports of incidents in dangerous work environments can be analysed to identify common hazards, in turn aiding in the prevention of future accidents. Whilst studies exist that do this, most focus on causes that involve physical risks. In this paper we propose an alternative approach, and illustrate causes of forestry incidents from the perspective of worker-failure and fatigue. METHOD: This paper outlines the analysis of eight years' worth of New Zealand forestry incident data, with a focus on the cause of, and time that, incidents occur. RESULTS: This has resulted in two main findings. First, 70% of incidents can be attributed, at least in part, to worker-failures. Second, 78% of worker-failure based causes show indications of fatigue. This indicates that a significant number of forestry incidents are caused by worker-fatigue. Finally, this dataset showed inconsistencies in data quality, similar to those that exist in other datasets. This did not affect our analysis. However, these types of errors have the potential to affect the data quality in the national reporting system. IMPACT ON INDUSTRY: The results from this study will be used in a larger project on detecting fatigue in forestry workers for injury and incident prevention. It is also our hope that other researchers may find these results of interest for further fatigue prevention research in hazardous industries.

[Training and work conditions of residents in urology in Germany : Results of the second German Society of Residents in Urology e. V. (GeSRU) residency survey from 2020]. / Weiterbildungs- und Arbeitsbedingungen urologischer Ärztinnen und Ärzte in Weiterbildung in Deutschland : Ergebnisse der zweiten Weiterbildungsumfrage der German Society of Residents in Urology e. V. (GeSRU) von 2020.

BACKGROUND: Residency is the fundation for high-quality medical care and also for career development of young urologists. In 2015 the GeSRU (German Society of Residents in Urology) carried out the first nationwide survey among young physicians in urology and described the status quo of their residency. This revised follow-up examination draws an updated picture of the training and working conditions of residents in urology and assesses the development. METHODS: In 2020 the GeSRU conducted an online-based survey of all residents in urology; therefore, the 2015 questionnaire was expanded. The model of the professional gratification crisis was used again. RESULTS: A total of 332 questionnaires were analyzed. Major findings have not changed since 2015. The daily working routine is characterized by high pace and workload and economic considerations. Family- and research-friendly working conditions are largely lacking. 35% of the respondents draw professional consequences. The psychosocial strain remains very high and conveys a risk for physicians' health and patients' quality of care. CONCLUSION: These results demonstrate that there are still systemically immanent burdens for residents in urology, which require adjustments to the working and training conditions. A structured, transparent curriculum for urological residency, remuneration and time for training and models which enable work-life balance should be established.

[New approbation regulations-new concepts in urological undergraduate training?] / Neue Approbationsordnung ­ neue Wege in der urologischen Lehre?

New research findings, changing health care structures and digitalisation are prompting further development of medical studies in Germany. The current amendment of the approbation regulations ("Ärztliche Approbationsordnung") focuses on the promotion of practical relevance and competence orientation of the course content and examinations, the redesign of the practical year and the expansion of general medicine in medical studies. This creates opportunities and challenges for urological training at the undergraduate level in Germany. In order to integrate basic scientific and clinical content, the existing curricula of the medical faculties must be adapted and further developed. There is an opportunity to implement innovative teaching and examination concepts in urological teaching and to attract the next generation of academics via scientific work in urology. In addition, the inclusion of teaching hospitals and outpatient areas can support university hospitals in urological training and show students the full range of the specialty. At the same time, given the limited time available for medical studies, there is the challenge of ensuring sufficient space for urology in the curricula. In order to fully implement the upcoming reform of medical studies, adequate financial and human resources are needed, as well as active commitment on the part of the teaching staff at the medical faculties.

The role of the transversal ligament on the atlantoaxial complex - Bending forces at C1/2 flexion limits in the elderly.

INTRODUCTION: Biomechanical functionality as well as trauma mechanisms of the atlantoaxial complex are still an issue of controversy. The transverse atlantal ligament is the strongest stabilizator. The present study aimed to analyze the bending forces of the transverse atlantal ligament and of the base of the odontoid in elderly specimens. METHODS: In this biomechanical study five cadaveric specimen with a mean age of 72 at death and bone mineral density measuring for 555.3 Hounsfield units on average were used. To analyze the strain of the transverse atlantal ligament and the dense base, strain gauges were used. A custom biomechanical setup was used to test each specimen at C1/2 flexion and the strain of the transverse atlantal ligament and the dens base (µm/m) were measured. FINDINGS: In four out of five, a rupture of the transverse atlantal ligament was observed, the mean force required for the ligament to fall was 175 N (min. 99.8 N; 249.2 N; SD 64.7) by a mean strain of 2102.9 µm/m (min. 1953.5 µm/m; max. 2272.3 µm/m; SD 189.7). In one specimen with the lowest Hounsfield units (155), the dens base fractured before the transverse atlantal ligament ruptured and no strain could be measured at the transversal ligament during movement afterwards. INTERPRETATION: The transverse atlantal ligament fails at an average of 175 N in the elderly, which is less than the value reported previously. In osteoporotic specimen the generated force to rupture the transverse atlantal ligament can fracture the dens itself.

Correlations between microbiota and metabolites after faecal microbiota transfer in irritable bowel syndrome.

Faecal microbiota transfer (FMT) consists of the infusion of donor faecal material into the intestine of a patient with the aim to restore a disturbed gut microbiota. In this study, it was investigated whether FMT has an effect on faecal microbial composition, its functional capacity, faecal metabolite profiles and their interactions in 16 irritable bowel syndrome (IBS) patients. Faecal samples from eight different time points before and until six months after allogenic FMT (faecal material from a healthy donor) as well as autologous FMT (own faecal material) were analysed by 16S RNA gene amplicon sequencing and gas chromatography coupled to mass spectrometry (GS-MS). The results showed that the allogenic FMT resulted in alterations in the microbial composition that were detectable up to six months, whereas after autologous FMT this was not the case. Similar results were found for the functional profiles, which were predicted from the phylogenetic sequencing data. While both allogenic FMT as well as autologous FMT did not have an effect on the faecal metabolites measured in this study, correlations between the microbial composition and the metabolites showed that the microbe-metabolite interactions seemed to be disrupted after allogenic FMT compared to autologous FMT. This shows that FMT can lead to altered interactions between the gut microbiota and its metabolites in IBS patients. Further research should investigate if and how this affects efficacy of FMT treatments.

Cage bedding modifies metabolic and gut microbiota profiles in mouse studies applying dietary restriction.

Experiments involving food restriction are common practice in metabolic research. Under fasted conditions, mice supplement their diet with cage bedding. We aimed at identifying metabolic and microbiota-related parameters affected by the bedding type. We exposed mice housed with wooden, cellulose, or corncob cage beddings to ad libitum feeding, caloric restriction (CR), or over-night (ON) fasting. Additionally, two subgroups of the ON fast group were kept without any bedding or on a metal grid preventing coprophagy. Mice under CR supplemented their diet substantially with bedding; however, the amount varied depending on the kind of bedding. Bedding-related changes in body weight loss, fat loss, cecum size, stomach weight, fecal output, blood ghrelin levels as well as a response to glucose oral tolerance test were recorded. As fiber is fermented by the gut bacteria, the type of bedding affects gut bacteria and fecal metabolites composition of CR mice. CR wood and cellulose groups showed distinct cecal metabolite and microbiome profiles when compared to the CR corncob group. While all ad libitum fed animal groups share similar profiles. We show that restriction-related additional intake of bedding-derived fiber modulates multiple physiological parameters. Therefore, the previous rodent studies on CR, report the combined effect of CR and increased fiber consumption.

[Analysis of European concepts for specialization training in urology with special consideration of intersectoral further education]. / Analyse von europäischen Weiterbildungskonzepten zum Facharzt für Urologie unter besonderer Berücksichtigung der intersektoralen Weiterbildung.

BACKGROUND: The aim of the study is to compare the German specialization training in urology with other European concepts, to analyze regional differences and to evaluate the development of the personnel structure in urology in German hospitals and private practices for the last 5 years. In addition, possibilities for financial funding of residents in the outpatient sector will be analyzed. MATERIALS AND METHODS: After analyzing the changes in the new Urology Specialization Training Regulations (Musterweiterbildungsordnung), the current urology training situation in Germany was evaluated in a European comparison. A trend analysis of the personnel structure in urology has been performed for recent years. Additionally, a possible intersectoral rotation concept was developed. Financial funding possibilities for urological residents were evaluated in a standardized telephone survey. RESULTS: Compared to other European countries, the exceptional position of German urology with its enormous spectrum becomes evident. In some states, there are already possibilities of financial support provided by regional Associations of Statutory Health Insurance Physicians (Krankenversicherung) for the training of urological residents in private practices. CONCLUSIONS: While the organization of specialization training is commonly nation based in other European countries, there is heterogeneity in Germany due to the sovereignty of the states. Due to the shift of many specialization training contents towards the outpatient sector, alliances between clinics and practices in the sense of intersectoral training will become more important in the future. Therefore, the use of already existing funds and-as a long-term objective-a nationwide access to such funding is desirable.

Neural substrates of long-term item and source memory for emotional associates: An fMRI study.

Since Tulving's influential work on the distinction between familiarity and recollection-based retrieval, numerous studies have found evidence for differential contribution of these retrieval mechanisms on emotional episodic memory. Particularly, retrieval advantage for emotional, compared to neutral, information has been related to recollection-, but not familiarity-mediated processes. Neuroimaging studies suggest that this recollection-based retrieval for emotional information is related to stronger engagement of regions in the medial temporal lobe (MTL), posterior parietal cortex (PPC), and prefrontal cortex (PFC). In the present study, we investigated neural correlates related to long-term memory of neutral information that has been associated with emotional and neutral contexts, using functional magnetic resonance imaging (fMRI). During encoding, different neutral objects integrated with emotional or neutral scenes were presented. One week later, the encoded objects were intermixed with new ones and participants had to indicate whether the objects were previously seen or not, using the Remember/Know procedure (item memory). Furthermore, memory for the correct scene background category was also tested (contextual source memory). First, replicating previous findings, we observed a preference for recollection-dependent memory retrieval versus familiarity-dependent memory retrieval for those neutral objects encoded in emotional compared to neutral contexts. Second, consistent with these behavioral effects, objects encoded with emotional, compared to neutral, scenes produced larger memory-related activity in recollection-sensitive brain regions, including PPC and PFC regions. Third, correctly retrieved emotional compared to neutral contextual information was associated with increased activity in these brain areas. Together, these results suggest that memory for information encoded in emotional contexts is remarkably robust over time and mediated by recollection-based processes.

Shame, self-identification with having a mental illness, and willingness to seek help in northeast Germany.

We examined a general population sample (n = 1330) from an epidemiological study (SHIP), investigating whether shame, social distance and reluctance to self-identify as having a mental illness interfere with willingness to seek help for mental health problems. Analyses were stratified for life-time diagnosis of any mental illness. Shame was the strongest negative predictor for willingness to seek help (beta = -0.183, p < .001). Structured Estimation Modelling showed shame being a full mediator of a negative association between social distance and willingness. Our results corroborate the important role of shame as an impediment to help-seeking for mental health problems in the general population.

Type I Diabetes is the Main Cost Driver in Autoimmune Polyendocrinopathy.

CONTEXT: Autoimmune polyendocrinopathy (AP), a chronic complex orphan disease, encompasses at least two autoimmune-induced endocrine diseases. OBJECTIVE: To estimate for the first time total, indirect and direct costs for patients with AP, as well as cost drivers. DESIGN: Cross-sectional cost of illness study. SETTING: Academic tertiary referral center for AP. PATIENTS: 146 consecutive, unselected AP patients. INTERVENTION: Interviews pertaining to patients' socioeconomic situation covered a recall period of 12 months. Both the human capital (HCA) and the friction cost approaches (FCAs) were applied as estimation methods. MAIN OUTCOME MEASURES: Direct and indirect annual costs, and sick leave and medication costs. RESULTS: AP markedly impacts healthcare expenses. Mean overall costs of AP in Germany ranged from €5 971 090 to €29 848 187 per year (HCA). Mean indirect costs ranged from €3 388 284 to €16 937 298 per year (HCA) while mean direct costs ranged from €2 582 247 to €12 908 095/year. Mean direct costs per year were €1851 in AP patients with type 1 diabetes (T1D, 76%) and €671 without T1D, which amounts to additional direct costs of €1209 for T1D when adjusting for concomitant autoimmune disease (95% CI = €1026-1393, P < 0.0001). Sick leave cost estimates for AP patients with T1D exceeded those without T1D by 70% (FCA) and 43% (HCA), respectively. In multiple regression analyses, T1D predicted total and direct costs, medication costs and costs for diabetic devices (all P < 0.001). Overall, AP patients with T1D were 54% (FCA) more expensive than those without T1D. CONCLUSIONS: Public health socioeconomic relevance of AP was demonstrated, with T1D as main cost driver.

Brain imaging of chill reactions to pleasant and unpleasant sounds.

The term 'chill' refers to a short-term bodily event of high arousal, which marks an emotional peak experience when occurring in response to music. Chill responses arise in a clearly circumscribed time frame and can also be reliably elicited by unpleasant sounds. Previous research, however, mostly focused on individually selected stimuli and positive contexts, thus, limiting the scope of interpretation. Hence, we developed a standardized chill paradigm and used fMRI to test neural responses of 16 healthy volunteers to pleasant and unpleasant emotional sound material while collecting subjective reports of chill intensity and skin conductance response data. As predicted, we found chill-associated increases in autonomic arousal regardless of the valence of the sound material. Apart from activity in primary and higher auditory cortices, both pleasant and unpleasant chills were associated with anterior insula, thalamus and basal ganglia activity. In contrast, amygdala responses were observed only in association with chills elicited by unpleasant sounds. Thus, chills elicited by pleasant and unpleasant sounds share activity in a neural network that may be specifically involved in the arousal component of an emotional experience.

Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child's health.

BACKGROUND: As early as pregnancy, maternal mental stress impinges on the child's development and health. Thus, this may cause enhanced risk for premature birth, lowered fetal growth, and lower fetal birth weight as well as enhanced levels of the stress hormone cortisol and lowered levels of the bonding hormone oxytocin. Maternal stress further reduces maternal sensitivity for the child's needs which impairs the mother-child-interaction and bonding. Therefore, prevention and intervention studies on mental stress are necessary, beginning prenatally and applying rigorous research methodology, such as randomized controlled trials, to ensure high validity. METHODS: A randomized controlled trial is used to assess the impact of psychotherapy and telemedicine on maternal mental stress and the child's mental and physical health. Mentally stressed pregnant women are randomized to an intervention (IG) and a not intervened control group. The IG receives an individualized psychotherapy starting prenatal and lasting for 10 months. Afterwards, a second randomization is used to investigate whether the use of telemedicine can stabilize the therapeutic effects. Using ecological momentary assessments and video recordings, the transfer into daily life, maternal sensitivity and mother-child-bonding are assessed. Psycho-biologically, the synchronicity of cortisol and oxytocin levels between mother and child are assessed as well as the peptidome of the colostrum and breast milk, which are assumed to be essential for the adaptation to the extra-uterine environment. All assessments are compared to an additional control group of healthy women. Finally, the results of the study will lead to the development of a qualification measure for health professionals to detect mental stress, to treat it with low-level interventions and to refer those women with high stress levels to mental health professionals. DISCUSSION: The study aims to prevent the transgenerational transfer of psychiatric and somatic disorders from the mother to her child. The effects of the psychotherapy will be stabilized through telemedicine and long-term impacts on the child's and mothers' mental health are enhanced. The combination of psychotherapy, telemedicine and methodologies of ecological momentary assessment, video recording and bio banking are new in content-related and methodological manner. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00017065. Registered 02 May 2019. World Health Organization, Universal Trial Number: U1111-1230-9826. Registered 01 April 2019.

Optical Detection of Single-Electron Tunneling into a Semiconductor Quantum Dot.

The maximum information of a dynamic quantum system is given by real-time detection of every quantum event, where the ultimate challenge is a stable, sensitive detector with high bandwidth. All physical information can then be drawn from a statistical analysis of the time traces. We demonstrate here an optical detection scheme based on the time-resolved resonance fluorescence on a single quantum dot. Single-electron resolution with high signal-to-noise ratio (4σ confidence) and high bandwidth of 10 kHz make it possible to record the individual quantum events of the transport dynamics. Full counting statistics with factorial cumulants gives access to the nonequilibrium dynamics of spin relaxation of a singly charged dot (γ_{↑↓}=3 ms^{-1}), even in an equilibrium transport measurement.