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Documented rituals in pediatric intensive care: a decade of sacramental and symbolic practices in a pluralistic clinical setting
No full textBackground
Rituals with spiritual or symbolic meaning form an integral part of pediatric intensive care, yet their timing, initiators, and contextual functions remain insufficiently described. In secularizing and religiously diverse societies, understanding how such practices are documented and enacted is essential for ethically grounded care. This study characterizes sacramental and symbolic rituals in a German tertiary neonatal and pediatric intensive care unit (NICU/PICU), examining initiation patterns, faith alignment, and survival-related timing.
Methods
We conducted a retrospective descriptive analysis of 135 neonates and infants who received a documented ritual between 2013 and 2024. Rituals were categorized as sacramental or symbolic. Initiators, performers, clinical context, and survival category were recorded. Faith alignment was defined by the correspondence between family affiliation and ritual performer. Data from chaplaincy and clinical documentation were analyzed descriptively.
Results
Most rituals were initiated by healthcare staff (≈ 67%) and performed by clergy (≈ 70%). Rituals occurred across the full range of survival outcomes but clustered in intermediate prognostic categories, where uncertainty was greatest. Symbolic and staff-led rituals were used predominantly in time-critical situations, particularly when clergy were unavailable or denominational alignment was unclear. Cross-faith rituals were rare and mainly observed in acute phases. Ritual–faith congruence increased with longer survival trajectories. No distinct non-sacramental religious rituals were documented, likely reflecting under-capture of informal practices.
Conclusions
Ritual practice in pediatric intensive care extends well beyond last rites, encompassing symbolic, anticipatory, and adaptively tailored acts integrated into routine clinical care. These patterns reflect the influence of urgency, availability, and cultural diversity on ritual expression. Documentation gaps limit full quantification and underscore the need for prospective, mixed-methods studies and inclusive institutional frameworks for culturally and spiritually responsive care
When can we and when do we adapt? Evidence that conflict adaptation can transcend contexts early in childhood
No full textFocusing on relevant and ignoring irrelevant information is crucial for navigating ever-changing environments. This ability can be studied using conflict tasks in which the relevant and irrelevant information in a trial either align or compete. In this cross-sectional study conflict processing and adaptation were investigated across different contexts and developmental stages. In three experiments, three groups of participants (6–7-year-olds, 9–10-year-olds, adults; N = 273) processed pairs of conflict tasks. The context similarity of the tasks was manipulated based on whether they shared relevant and irrelevant dimensions. Performance was assessed using mouse-tracking measures of latency (movement time, initiation time) and trajectory (maximum absolute deviation, changes of direction). Contrary to predictions, congruency effects and within-task conflict adaptation effects generally increased or remained stable with age (with an exception in one experiment in latency measures). Across-task conflict adaptation showed a complex pattern that only partially aligned with predictions based on context similarity. Adults demonstrated across-task adaptation primarily in high-similarity contexts, while children showed evidence of across-task adaptation even across dissimilar tasks. These results provide first evidence of across-task conflict adaptation in children as young as 6 years when sensitive mouse-tracking measures are employed. Overall, conflict adaptation effects are small and appear to be influenced by context. Results are interpreted with respect to modes of control and the predictability of upcoming tasks. Furthermore, the age-related variation across mouse-tracking measures, with trajectory measures capturing the effects in children more consistently than latency measures, underscores the value of assessing various mouse-tracking variables when investigating conflict processing
Determining the global economic burden of external health effects of food consumption in 204 countries and territories
No full textBackground/Objectives: Every country and territory worldwide is affected by varying degrees of under- and overconsumption of food. A substantial share of the economic burden of unsustainable malnutrition arises from diet-related health impacts, although existing research has largely focused on environmental consequences.
Methods: This study addresses this gap by combining cost-of-illness (COI) and True Cost Accounting (TCA) approaches, as well as Global Burden of Disease (GBD) data, to estimate external diet-induced health costs. A comprehensive database covering 204 countries and territories is established, quantifying health costs by disease category and dietary risk factor.
Results: The results indicate that USD 1719.94 billion in annual global health costs are attributable to poor diets. This corresponds to an average burden of USD 211.08 per capita per year. Cardiovascular diseases (CVDs) constitute the largest share of costs, followed by diabetes mellitus (DM). In absolute and per capita terms, the United States contributes disproportionately. Regionally, North America bears 44.36% of the global monetary burden, while Oceania accounts for only 1.22%. The highest per-capita costs occur in North America, Europe, and Oceania. The most influential dietary risk factors are the overconsumption of processed and red meat, and the underconsumption of whole grains. A strong positive correlation is observed between diet-related health costs and national prosperity levels.
Conclusions: This framework represents a novel approach to standardized and holistic valuation, providing a robust basis for deriving policy-relevant insights to inform sustainable nutrition strategies and advance the United Nations (UN) Sustainable Development Goals (SDGs), especially the second SDG, zero hunger
Retrospektive Analyse des Auftretens von Nahtinsuffizienzen und deren Einflussfaktoren nach operativer Versorgung einer Stanford Typ A Dissektion der Patienten der Herz- und Thoraxchirurgie des Universitätsklinikums Augsburg
No full textHintergrund:
Die Stanford Typ A Dissektion ist eine akut lebensbedrohliche Erkrankung, die einer sofortigen chirurgischen Therapie mit dem Ziel des Verschlusses des primären Entry bedarf. In einigen Fällen kommt es im Verlauf zu einer Nahtinsuffizienz der Anastomo-sen, die zu Pseudoaneurysmen oder sogar Aortenrupturen führen können. Die Risiko-faktoren hierfür sind noch weitgehend unklar.
Fragestellung:
Ziel dieser Arbeit ist es Risikofaktoren für die Entstehung einer Nahtinsuffizienz nach Versorgung einer Stanford Typ A Dissektion zu benennen um diesen zukünftig entge-gen zu wirken und damit hochrisikoreiche Reoperationen vermeiden zu können.
Material und Methoden:
Alle Patienten, die im Zeitraum vom 01.01.2018 bis 31.12.2020 am Universitätsklinikum Augsburg mit einer Stanford Typ A Dissektion behandelt wurden, wurden in die Auswer-tung einbezogen und deren Daten anhand der ICD- und OPS-Kodierung durch das in-trahospital eingesetzte Programm ORBIS gefiltert.
Es wurde eine Datenmatrix mit Angaben zu Person, Operation, stationärem Verlauf und Histologie erstellt. Mittels CT-Verlaufskontrollen wurden die Patienten mit postoperativer Nahtinsuffizienz identifiziert und anschließend mittels Wilcox-Test für kontinuierliche Variablen und Fisher-Test für binäre Variablen auf Signifikanz bezüglich des Auftretens einer postoperativen Nahtinsuffizienz analysiert.
Ergebnisse:
Von den 96 eingeschlossenen Patienten waren 53 (55,21%) männlich und 43 (44,79%) weiblich. 26 (27,08%) Patienten verstarben im Beobachtungszeitraum, davon 16 (16,67%) unmittelbar postoperativ. Bei zwei Patienten lag kein Verlaufs-CT vor, so dass bei insgesamt 18 Patienten keine Aussage über das Auftreten einer Nahtinsuffizienz getroffen werden kann. 17 (21,79%) der 78 Patienten entwickelten eine Nahtinsuffizi-enz. Für die vermuteten Risikofaktoren wie Hämostyptika, Reoperationen, Bindege-webserkrankungen oder DSWI konnte keine Signifikanz nachgewiesen werden. Über-raschenderweise jedoch für die postoperative ECMO-Therapie und die Patientengröße.
Schlussfolgerung:
Zur Bekräftigung dieser Ergebnisse sind weitere Studien notwendig. In diesen sollte der Fokus nicht auf Infektionen oder Hämostyptika liegen, sondern auf dem Patientengut an sich und bestehender Strömungsprofile innerhalb der Aorta bei ECMO Therapie
Fremdkörperingestionen bei psychischen Störungen: was wissen wir und was sollen wir tun?
No full textHybrid digital twin framework for real-time indoor air quality monitoring and filtration optimization
No full textThis study presents a hybrid digital twin system designed for real-time indoor air quality (IAQ) monitoring and filtration optimization within a residential environment. Using a network of low-cost sensors, physics-based simulations, and machine learning models, the system dynamically replicates the indoor environment to enable continuous assessment and optimization of key pollutants, including particulate matter, volatile organic compounds, and carbon dioxide. The system architecture integrates mass balance and decay models, computational fluid dynamics simulations, regression models, and neural network algorithms, all evaluated under both filtering and non-filtering conditions. A graphical user interface allows users to interact with the system, test air purifier placements, and visualize air quality dynamics in real time. The results demonstrate that, within this system, simpler models, such as linear regression, outperform more complex architectures under data-limited conditions, achieving test-set coefficients of determination ranging from 0.97 to 0.99 across multiple IAQ parameters. At the same time, the hybrid modelling approach enhances interpretability and robustness. Overall, this digital twin system contributes to smart building management by offering a scalable, interpretable, and cost-effective solution for proactive IAQ control and personalized decision-making
Recalibration of low-cost O3 and PM2.5 sensors: linking practices to recent air sensor test protocols
No full textThe appropriate period of collocation of a low-cost air sensor (LCS) with reference measurements is often unknown. Previous LCS studies have shown that due to sensor ageing and seasonality of environmental interferences periodical sensor calibration needs to be performed to guarantee sufficient data quality. While the limitations are well-established it is still unclear how often a recalibration of a sensor needs to be carried out. In this study, we demonstrate how widely used air sensors (OX-B431 and SPS30) for the relevant air pollutants ozone (O3) and fine particulate matter (PM2.5) by two manufacturers (Alphasense and Sensirion) should be recalibrated for real-world monitoring applications. Sensor calibration functions were built using Multiple Linear Regression, Ridge Regression, Random Forest and Extreme Gradient Boosting. We use multiple novel test protocols for air sensors provided by the United States Environmental Protection Agency and the European Committee for Standardization for evaluative guidance and to identify possible applications for OX-B431 and SPS30 sensors. We conducted a yearlong collocation campaign at an urban background air and climate monitoring station next to the University Hospital Augsburg, Germany. LCSs were exposed to a wide range of environmental conditions, with air temperatures between -10 and 36 °C, relative air humidity between 19 % and 96 % and air pressure between 937 and 983 hPa. The ambient concentration ranges for O3 and PM2.5 were up to 82 ppb and 153 µg m−3, respectively. For the baseline single training of 5 months, the calibrated O3 and PM2.5 sensors were able to reflect the hourly reference data well during the training (R2: O3 = 0.92–1.00; PM2.5 = 0.93–0.97) and the following test period (R2: O3 = 0.93–0.98; PM2.5 = 0.84–0.93). Additionally, the sensor errors were generally acceptable during the training (RMSE: O3 = 0.80–4.35 ppb; PM2.5 = 1.45–2.51 µg m−3) and the following test period (RMSE: O3 = 3.62–5.84 ppb; PM2.5 = 2.04–3.02 µg m−3). We investigated different recalibration cycles using a pairwise calibration strategy, which is an uncommon method for recurrent LCS calibration. Our results indicate that a regular in-season recalibration is required to obtain the highest quantitative validity and broadest range of applications (indicative and non-regulatory supplemental measurements) for the analysed LCSs. Monthly recalibrations are observed to be the most suitable approach. The measurement uncertainties of the calibrated O3 LCSs and PM2.5 LCSs were able to meet the data quality objective for indicative measurements for different calibration models. In-season recalibration, rather than reliance on a single pre-deployment calibration, should be adopted by end-user communities. This approach is required for certain real-world applications to be performed reliably by LCSs and to achieve sufficient information content
Assessing palliative care needs in Swabia: a data-driven simulation framework for hospice and specialized outpatient palliative care demand
No full textBackground
The impact of demographic change has far-reaching consequences for the entire healthcare system. One of the areas particularly affected is palliative and hospice care. To meet the demand for palliative and hospice care services, adequate capacity planning in inpatient and outpatient settings is essential. However, the available capacities per one million inhabitants in Germany vary significantly within the individual regions.
Methods
For an improved assessment of care needs, we propose a simulation-based analysis, carried out both retrospectively for 2019 and prospectively for 2039 for the southern German region of Swabia, and calculate the required capacities of hospices and specialized outpatient palliative care. We focus on cancer patients, as this group represents the largest proportion of patients requiring palliative and hospice care.
Results
Driven by demographic change and the increasing incidence of cancer in older age groups, the number of patients requiring palliative care is expected to increase substantially. Accordingly, our results indicate a marked rise in the demand for hospice and specialized outpatient palliative care for cancer patients up to the year 2039. This projected trend underscores the growing care needs within this patient population in the coming decades.
Conclusion
Our study introduces a simulation-based framework for estimating demand for hospice and specialized outpatient palliative care. By offering a quantitative, mathematical-statistical perspective, the approach complements existing qualitative research and supports informed decision making in palliative care planning