Regular Units Research Articles

Synthesis of lipid-linked oligosaccharides by a compartmentalized multi-enzyme cascade for the in vitro N-glycosylation of peptides

A wide range of glycoproteins can be recombinantly expressed in aglycosylated forms in bacterial and cell-free production systems. To investigate the effect of glycosylation of these proteins on receptor binding, stability, efficacy as drugs, pharmacodynamics and pharmacokinetics, an efficient glycosylation platform is required. Here, we present a cell-free synthetic platform for the in vitro N-glycosylation of peptides mimicking the endoplasmic reticulum (ER) glycosylation machinery of eukaryotes. The one-pot, two compartment multi-enzyme cascade consisting of eight recombinant enzymes including the three Leloir glycosyltransferases, Alg1, Alg2 and Alg11, expressed in E. coli and S. cerevisiae, respectively, has been engineered to produce the core lipid-linked (LL) oligosaccharide mannopentaose-di-(N-acetylglucosamine) (LL-Man5). Pythanol (C20H42O), a readily available alcohol consisting of regular isoprenoid units, was utilized as the lipid anchor. As part of the cascade, GDP-mannose was de novo produced from the inexpensive substrates ADP, polyphosphate and mannose. To prevent enzyme inhibition, the nucleotide sugar cascade and the glycosyltransferase were segregated into two compartments by a cellulose ester membrane with 3.5 kDa cut-off allowing for the effective diffusion of GDP-mannose across compartments. Finally, as a proof-of-principle, pythanyl-linked Man5 and the single-subunit oligosaccharyltransferase Trypanosoma brucei STT3A expressed in Sf9 insect cells were used to in vitro N-glycosylate a synthetic peptide of ten amino acids bearing the eukaryotic consensus motif N-X-S/T.

이승만 박정희 정부의 한국군 베트남 파병 추진과 국회의 대응 - 의용군 파병논의를 중심으로 -

Analyzed in this article is the discussion that took place inside the Republic of Korea’s National Assembly over the issue of sending volunteer soldiers to Vietnam, in the wake of the Lee Seung-man and Park Jeong-Hi regimes’ intention and preparations to send Korean troops to the said country.<BR> The former government’s proposal to send troops to Indochina was related to the issue of founding the Asian People’s Anti-Communist Alliance, as Lee Seung-man was interested in forming an organization of virtual ‘Anti-Communist Crusaders’ with Jiang Jieshi to fight the Chinese Communist party. However, sending troops abroad required legal -either international or domestic- bases, and without those he could not send troops anywhere. So, in order to circumvent such obstacle, Lee proposed that the troops which would be sent would be volunteers. The Eisenhower administration of U.S. considered Lee Seung-man’s offer but did not want the Indochina dispute to spread to other regions. So the U.S. government supported Lee’s plan to establish an anti-Communist military alliance, but rejected his proposal to dispatch Korean soldiers. Asian People’s Anti-Communist Alliance remained as a civilian body.<BR> The Kennedy administration, on the other hand, asked that Korean troops to be sent to Vietnam. In order to secure a relief program from the U.S., President Park Jeong-hi agreed to such demand. After examining certain precedence from the Lee Seung-man era, his government created a domestic legal foundation that would enable the regime to send troops abroad, and began training anti-insurgence exercises as well. But on the international front, legal foundation that would justify a country to send troops beyond its boundaries was still lacking. So the Park Jeong-hi regime also considered sending volunteers to Vietnam, but at the request of U.S., it was decided that Korea would dispatch regular army units.<BR> The National Assembly of Korea was against the idea of sending Korean troops, citing a number of problems. Certain representatives also suggested dispatching volunteers as a compromise. But the Park Jeong-hi administration and the governing Republican (Gong’hwa-dang) party enforced the issue, and the National Assembly was not able to block it.

Organizational and Legal Principles of Soviet Militia Dispatch Center’s Functioning during 1969–1991

The normative and legal provision, organization and activity of militia dispatch centers of Soviet Ukraine in 1969–1991 have been studied.&#x0D; Various forms, methods and directions of activity of militia dispatch centers in 1961–1991 have been analyzed; and the activity of the militia in ensuring the protection of public order and the fight against crime has been reconsidered. The author has characterized the functions of militia dispatch centers, which were performed by them in the period from 1969 to 1991. The peculiarities of personnel and logistical provision of the militia dispatch centers in the specified historical period have been highlighted.&#x0D; The analysis of archival materials has demonstrated that the implementation of the function of the dispatch center was associated with the implementation of an increased number of tasks. However, the combination of the duties of a duty officer with performing the duties in another position led to the overburdening of a militiaman, which had a negative impact on law enforcement activity.&#x0D; Improving the organizational forms of the Soviet militia dispatch centers was carried out in several areas: 1) the creation of regular police units in all militia agencies, the number of which depended on the population, as well as changes in the operative situation; 2) increase in the number of regular shifts; 3) bringing the premises, equipment and logistics of dispatch centers in line with the established requirements; 4) the introduction of additional structures within dispatch centers, caused by an increase in the workload on dispatch centers as a result of the growth in crime rates; 5) increase of requirements to personnel of dispatch centers.&#x0D; In terms of reforming the law enforcement system, miscalculations and mistakes of the past years should be avoided. The specifics of dispatch centers’ activity is that it represents the interests of all services, combines the goals and objectives of public order, prevention and detection of crimes, as well as coordinates their actions in case of emergencies. The efficiency of crime detection, assistance to victims and detention of perpetrators depends on the effective organization of interaction between services and units.&#x0D; Thus, the creative use of obtained experience to improve the activities of the dispatch centers of internal affairs agencies will to some extent avoid mistakes and miscalculations made in previous historical periods.

Implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training course in a regular endoscopy unit.

Several scientific societies have endorsed non-anesthesiologist sedation (NAS) during gastrointestinal endoscopy, considering it a safe procedure when administered by adequately trained personnel. This study aimed to evaluate the occurrence of adverse events after implementation of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) sedation training program. From January 2017 to August 2018, data from all consecutive endoscopic procedures in adults (≥ 18 years) performed at our endoscopy unit were collected using an electronic reporting system. All staff (physicians and nurses) completed the ESGE-ESGENA sedation course. In total, 12 132 patients underwent endoscopic procedures, 10 755 (88.6 %) of which were performed in a non-anesthesiological setting. Of these, about 20 % used moderate sedation with midazolam + fentanyl and 80 % used deep sedation with additional propofol. No sentinel, 5 (0.05 %) moderate risk, and 18 (0.17 %) minor risk adverse events occurred, all during moderate or deep sedation, and all managed by endoscopy staff without the need for anesthesiologist assistance. After completing the ESGE-ESGENA sedation training program, the rate of adverse events was very low in our institution. The findings support implementation of the program in all digestive endoscopy units and inclusion in the curriculum for physicians and nurses to ensure safe endoscopic procedures.

Geometry effects on luminescence solar concentrator efficiency: analytical treatment.

Luminescence solar concentrators act as semitransparent photovoltaic cells of interest for modern urban environments. Here, their efficiencies were analytically derived for different regular unit shapes as simple, integral-free expressions. This allowed analysis of the shape and size effect on the device performance. All regular shapes appear to have a similar efficiency as revealed by optical path distribution formulas, despite differences in the perimeter length. Rectangles of the same area feature higher efficiency due to reduced average optical path. It comes with the cost of a longer perimeter, and the relation between these two is provided. An explicit formula for the critical size of an LSC unit, above which its inner part becomes inactive, has been obtained. For square geometry with matrix absorption coefficient α this critical size is ∼2.7/α, corresponding to 70-90 cm for common polymer materials. Obtained results can be used for treatment of individual units as well as for analysis of tiling for large areas.

Critical Reliability Issues of Common Type Alcohol-Based Handrub Dispensers

BackgroundHand hygiene can only be efficient if the whole hand surface is treated with sufficient alcohol-based handrub (ABHR); therefore, the volume of handrub applied is a critical factor in patient safety. The proper amount of ABHR should be provided by handrub dispensers. The aim of this study was to investigate the dispensing performance of wall-mounted ABHR dispensers commonly employed in hospital settings.MethodIn a multicenter study, we tested 46 dispensers (22 in laboratory and 24 in clinical environments), measuring dispensed ABHR volume during continuous use and after a period of non-use. The influence of the pumping mechanism, liquid level, ABHR formats, handrub composition, temperature, and atmospheric pressure was investigated.ResultsA total of 7 out of the 22 investigated dispensers (32%) lost a significant amount of handrub; greater than 30% of the nominal volume after 8 h of non-use, thus frequently dispensing suboptimal volume, as measured in laboratory settings. Key influencing factors were found to be handrub format (gel or liquid), handrub level in the container and type of dispenser. When gel ABHR was used, after 4 h of non-use of the dispensers, the volume of the dispensed amount of ABHR insignificantly changed (97% of the original amount), while it technically decreased to zero in the case of liquid ABHR (1% of the original amount). The liquid level had a medium effect on the dispensed volume in each investigated case; the magnitude of this effect varied widely depending on the dispensing mechanism. When dispensers were in continuous use, they dispensed a cumulated 3 mL of ABHR from two consecutive pushes, while when they were not in use for 1 h, up to 4 consecutive pushes were necessary to provide a total of 3 mL ABHR. Design and production quality were also identified as important contributing factors with respect to the volume dispensed. Data collected in clinical settings confirmed these findings, for multiple types of dispensers.ConclusionAll ABHR dispensers should be regularly audited to control the reference volume distributed, with particular attention paid to regular mechanical pump units filled with liquid handrub.

Surface effects on the elastic modulus of regular polygonal prism nanoporous materials

Nanoporous materials exhibit remarkable mechanical properties, which are influenced by their surface effects and microstructures. Here, we theoretically analyze Young’s modulus of various regular polygonal prism structures, which represent the first-level (conventional) nanoporous material and higher-level hierarchical nanoporous material. The effects of surface elastic modulus, porosity, residual surface stress, and side number on Young’s modulus of a regular polygonal prism unit cell are investigated in detail. The results reveal that Young’s modulus is controlled by the surface elastic modulus, but it is not sensitive to the residual surface stress. This trend is in good consistency with the existing work. Moreover, the effective modulus strongly depends upon the surface elastic modulus. Under the certain range of high porosity, maximum Young’s modulus always relies on a critical side number of 6, regardless of the surface effect and hierarchical structure. Interestingly, for different regular polygonal prism structures, the difference in effective modulus tends to decrease with the increasing porosity. The current findings provide insights to improve the mechanical properties of nanoporous materials via tuning microstructure, porosity, and surface elastic modulus.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

Targeting Misconduct in Prison by Modifying Occupational Factors in Correctional Facilities.

Misconduct in prison is a phenomenon, which by its nature is hard to observe. Little is known about its origins and its modifiability. This study presents data on the level of misconduct in prison perceived by staff members and examines its impact on occupational factors. Data from officers, which also included i.e. team climate, job satisfaction, self-efficacy, and sick days, was collected at three different correctional units in Berlin, Germany (N = 60). The study reveals higher rates of perceived misconduct in prison on regular units as compared to treatment units within the observed facilities. In addition, regression analysis provides evidence for an association of rates of misconduct in prison, sick days, and low self-efficacy. Results are discussed in terms of providing a model that supports the idea of a network entailing occupational factors and misconduct in prison and which can be utilized to target misconduct in prison with suitable interventions.

Deviance detection in physiologically identified cell types in the rat auditory cortex

Auditory deviance detection is a function of the auditory system that allows reduction of the processing demand for repetitive stimuli while stressing unpredictable ones, which are potentially more informative. Deviance detection has been extensively studied in humans using the oddball paradigm, which evokes an event-related potential known as mismatch negativity (MMN). The same stimulation paradigms are used in animal studies that aim to elucidate the neuronal mechanisms underlying deviance detection. In order to understand the circuitry responsible for deviance detection in the auditory cortex (AC), it is necessary to determine the properties of excitatory and inhibitory neurons separately. Measuring the spike widths of neurons recorded extracellularly from the anaesthetized rat AC, we classified them as fast spiking or regular spiking units. These two neuron types are generally considered as putative inhibitory or excitatory, respectively. In response to an oddball paradigm, we found that both types of units showed similar amounts of deviance detection overall. When considering each AC field separately, we found that only in A1 fast spiking neurons showed higher deviance detection levels than regular spiking neurons, while in the rest of the fields there was no such distinction. Interpreting these responses in the context of the predictive coding framework, we found that the responses of both types of units reflect mainly prediction error signaling (i.e., genuine deviance detection) rather than repetition suppression.

КАДРОВА РЕОРГАНІЗАЦІЯ РОСІЙСЬКИХ ЗБРОЙНИХ СИЛ НАПРИКІНЦІ 50-х – НА ПОЧАТКУ 60-х РОКІВ ХІХ СТОЛІТТЯ

The paper considers transformation processes going on in the Russian Imperial Army from the middle of 1850s after the diplomatic and military defeat in the Eastern (Crimean) War against the coalition of European states. The author outlines the measures undertaken by the Government and Military Ministry in order to cut down the number of personnel in military units, formation of necessary legislative background to regulate the status of a military man on vacation outside the military unit. Special attention focuses on the attempts of the Russian Army to transform the principles of regular units formation, in particular improvement of officer personnel. The paper shows the way former soldiers and officers used to be employed in civil life and how provincial and local authorities facilitated it offering them jobs in the structures of aristocratic and rural management. Imperial military forces reformation resulted in the social structure of towns, cities and villages, the increased number of former military men influenced their relations with local population.Maintenance of a big army is proved to be a sufficient expenditure from the state budget so striving to make the correspondence between quantity and costs has been of top importance. The Russian Imperial Army of the early 19th century during the reign on Nikolai the First where the number of the military and the term of their service were the priority of the army construction was an excellent example, and serfdom was a social basis. The Eastern (Crimean) War made clear that such army was not effective and the number of soldiers was not a crucial advantage in front of contemporary armament and organization of the Europeans. As a result, the number of the allies defeated the Russians. Thus, the historic practice of quick army reformation (reduction) may serve an example for the Ukrainian military forces when the external threats disappear and there arises a necessity of transformation according to up-to-date optimal models of European armies.Military conflict between the Russian Empire and European countries in the middle of the 19th century exposed the drawbacks in the Russian military forces. The vacation system and formation of emergency and reserve troops during 20-50ies were rather effective maintaining the army in the proper combat readiness and preserving its necessary number. Hence, the Crimean War disclosed several key reasons of false military strategy based on serfdom. First, weak reserves and burdensome vast number of local troops not meant for war. Second, the serfdom prevented the reduction of service terms and training enough number of the military for reserves formation. Third, during active military actions it was impossible to reduce the number of local troops by recruiting them into the army regiments as far as they were used to powerfully support the serfdom in the rears. Therefore the army reformation reflected thorough social and economic shifts in the Russian state mechanism. Anachronistic serfdom evidently backed off all spheres of life. The crucial changes in the military forces did not strengthen the defensive potential of the country but served to prepare for new conquering wars as an instrument of Russian imperial politics in the 19th century.

Islamic Geometric Patterns in Higher Dimensions

The purpose of this paper is to develop the Islamic geometric patterns from planar coordinates to three or higher dimensions through their repeat units. We use historical plane methods, polygons in contact (PIC) and point-joined, in our deductive approaches. The mentioned approach makes use of a novel method of tessellation that generates 3D Islamic patterns called “interior polyhedral stellations”. The outputs showed that both the PIC and point-joined methods have strengths and weaknesses. Point-joined stellations are more efficient for regular repeat units and PIC is suitable for complex designs. These two methods can produce a large range of patterns and can be employed simultaneously. This study effectively answers the question regarding the gap between planar design from Muslim achievements and contemporary demands in modern art and architecture. We also propose techniques for constructing aperiodic three-dimension Islamic geometric patterns tessellation and two-point family.

Injury Causes and Severity in Pediatric Traumatic Brain Injury Patients Admitted to the Ward or Intensive Care Unit: A Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study.

Background: Traumatic brain injury (TBI) is the leading cause of death and disability in children. It includes a range of different pathologies that differ considerably from adult TBI. Analyzing and understanding injury patterns of pediatric TBI is essential to establishing new preventive efforts as well as to improve clinical management.Methods: The multi-center, prospectively collected CENTER-TBI core and registry databases were screened and patients were included when younger than 18 years at enrollment and admitted to the regular ward (admission stratum) or intensive care unit (ICU stratum) following TBI. Patient demographics, injury causes, clinical findings, brain CT imaging details, and outcome (GOSE at 6 months follow-up) were retrieved and analyzed. Injury characteristics were compared between patients admitted to the regular ward and ICU and multivariate analysis of factors predicting an unfavorable outcome (GOSE 1-4) was performed. Results from the core study were compared to the registry dataset which includes larger patient numbers but no follow-up data.Results: Two hundred and twenty seven patients in the core dataset and 687 patients in the registry dataset were included in this study. In the core dataset, road-traffic incidents were the most common cause of injury overall and in the ICU stratum, while incidental falls were most common in the admission stratum. Brain injury was considered serious to severe in the majority of patients and concurrent injuries in other body parts were very common. Intracranial abnormalities were detected in 60% of initial brain CTs. Intra- and extracranial surgical interventions were performed in one-fifth of patients. The overall mortality rate was 3% and the rate of unfavorable outcome 10%, with those numbers being considerably higher among ICU patients. GCS and the occurrence of secondary insults could be identified as independent predictors for an unfavorable outcome. Injury characteristics from the core study could be confirmed in the registry dataset.Conclusion: Our study displays the most common injury causes and characteristics of pediatric TBI patients that are treated in the regular ward or ICU in Europe. Road-traffic incidents were especially common in ICU patients, indicating that preventive efforts could be effective in decreasing the incidence of severe TBI in children.

COVID-19-Response - Strategies of the Task-Force Coronavirus and experiences upon implementation in the management of 115 cases at the University Medical Center Freiburg

Zusammenfassung Hintergrund Das neue, pandemische Coronavirus SARS-CoV-2 und die damit einhergehende Erkrankung COVID-19 (Coronavirus Disease 2019) stellt die medizinischen Versorgungssysteme vor große Herausforderungen. Die vorliegende Arbeit fasst die Strategie, Organisation und Maßnahmen der COVID-Taskforce des Universitätsklinikums Freiburg zusammen und berichtet über Erfahrungen und Behandlungsergebnisse von der Versorgung der ersten 115 COVID-19-Patienten. Methoden Retrospektive, narrative Prozessbeschreibung und -analyse des Zeitraums Ende Januar bis Anfang April 2020, durchgeführt unter Mitwirken der beteiligten Departments, Kliniken und Institute des Universitätsklinikums Freiburg. Ergänzend erfolgte eine retrospektive Beobachtungsstudie mit deskriptiver statistischer Auswertung der epidemiologischen und klinischen Daten aller bis 31. März 2020 hospitalisierten COVID-19-Patienten. Ergebnisse Durch eine interdisziplinär zusammengesetzte Taskforce Coronavirus wurden Maßnahmen in den Bereichen ambulante Testung und Beratung, Separierung der Patientenströme sowie Eskalation der Versorgungskapazitäten auf Normal- und Intensivstationen im Sinne eines dynamischen Stufenmodells angeregt und umgesetzt. Die Versorgung der ersten 115 Patienten gelang somit ohne Entstehung von Engpässen. Diskussion Durch Zusammenwirken sämtlicher Disziplinen und Abteilungen des Universitätsklinikums Freiburg konnte eine adäquate Versorgung von COVID-19-Patienten sichergestellt und die Handlungsfähigkeit des Klinikums in der aktuellen Ausbruchsituation erhalten werden.

Oliferov's Raid on the Territory of Kuzbass in the Winter of 1920–1921: Why the Red Failed

The present article features the raid of the White Guard rebels attempted by Lieutenant-Colonel Oliferov on the territory of Kuzbass (Mariinsky and Shcheglovsky districts) in the winter of 1920–1921. The research objective was to identify the reasons why the Red Army forces failed to promptly crush the rebellion. The methodology was based on the classical principles of historicism and objectivity represented by the typological, comparative-historical, and chronological methods. The authors managed to restore the course of events related to the raid and its progress. The article focuses on the measures taken by the Soviet government to eliminate the White rebels. The analysis of rare archival materials proved that the Soviet military units, represented by special forces, internal service units, and regular military units, failed to coordinate their actions. The irregular Soviet military units were known for their weak discipline, poor training, and frequent cases of desertion. Each of the Red commanders tried to lead the entire operation, thus letting the well-organized and disciplined White detachment to repeatedly avoid the chase and win the battles.

COVID-19: How can a department of general surgery survive in a pandemic?

COVID-19: How can a department of general surgery survive in a pandemic?

ІНФОРМАЦІЙНА СКЛАДОВА ПІДГОТОВКИ РОСІЙСЬКОГО ВТОРГНЕННЯ ДО ГРУЗІЇ У 2008 РОЦІ

The article reflects the main stages of the Russian Federation’s preparation for the invasion into Georgia in 2008, describes the information component of this preparation, its features, and the Russian Federation’s struggle to control the in- formation space for obtaining its geopolitical dividends. Before the start of the August military operation, the Russian Federation became the organizer of active multi-faceted anti-Georgian information “throw-in”, using diplomatic resources and media controlled by the leadership of the Russian Federation and pro-Russian media in Abkhazia and South Ossetia. The article analyzes facts from Russian and Western sources about the causes and prerequisites for the outbreak of the conflict exactly in August 2008, which Russia has planned and carefully prepared. The purpose of the article is to analyze the information component of the preparation of the Russian invasion into Georgia in August 2008. Determination of its main stages, conducted by the Russian Federation in the pre-war period, the causes and prerequisites for outbreak of the conflict.The Russian Federation has historically used separatism and post-colonial claims in neighboring countries to blackmail and, if necessary, dismember them. This be- came evident in Russia’s approach to using the “concept of a strong state” in foreign policy towards Moldova, Georgia and Ukraine. In the case of Georgia, the historical fact is that regular military units of the Russian armed forces that did not have the status of peacekeepers invaded the territory of another state before August 7, 2008 without the permission or notification from the Georgian leadership. Thus, was car- ried out an act of aggression in accordance with international law.

Environmental and economic comparison of reusable and disposable blood pressure cuffs in multiple clinical settings

ObjectiveTo assess the environmental and economic impacts of reusable and disposable blood pressure cuffs. SettingOut-patient clinic and ambulatory procedure rooms, and five-day in-patient regular ward and intensive care unit (ICU) health care encounters. MethodsEnvironmental modeling using life cycle assessment was employed to estimate greenhouse gas (GHG) emissions and other environmental impacts, from cuff manufacturing, packaging, transportation, use, cleaning, and landfill or incineration waste management. Cuff, cleaning, and packaging materials were identified and weighed directly. Both per-encounter and per-day low-level disinfection scenarios were performed. Life cycle costs were determined with hospital data, including procurement, labor (time-motion observations), and waste disposal. ResultsFor all use and cleaning scenarios, the reusable cuff was environmentally preferable in terms of GHG emissions and other impact categories, in some cases by a factor of 40. Disposable cuff emissions are dominated by materials manufacturing, while reusable cuff emissions are dominated by production of disinfection wipes. Reusable cuffs are far cheaper than disposables in the out-patient settings. Disposable cuffs are slightly lower cost in the in-patient setting where reusable BP cuffs are shared among patients and therefore require frequent cleaning. However, reusable cuffs are also more economical in the in-patient settings when patients have dedicated personal equipment (i.e., stays with them during their entire health care encounter) whether cleaned daily or at the end of their stay. ConclusionLife cycle assessment and costing highlight environmental and financial trade-offs between manufacturing and cleaning when comparing reusable and disposable BP cuffs.

COVID-19 rehabilitation units are twice as expensive as regular rehabilitation units.

The COVID-19 pandemic has caused significant motor, cognitive, psychological, neurological and cardiological disabilities in many infected patients. Functional rehabilitation of infectious COVID-19 patients has been implemented in the acute care wards and in appropriate, ad hoc, multidisciplinary COVID-19 rehabilitation units. However, because COVID-19 rehabilitation units are a clinical novelty, clinical and organizational benchmarks are not yet available. The aim of this study is to describe the organizational needs and operational costs of such a unit, by comparing its activity, organization, and costs with 2 other functional rehabilitation units, in San Raffaele Hospital, Milan, Italy. The 2-month activity of the COVID-19 Rehabilitation Unit at San Raffaele Hospital, Milan, Italy, which was created in response to the emergency need for rehabilitation of COVID-19 patients, was compared with the previous year's activity of the Cardiac Rehabilitation and Motor Rehabilitation Units of the same institute. The COVID-19 Rehabilitation Unit had the same number of care beds as the other units, but required twice the amount of staff and instrumental equipment, leading to a deficit in costs. The COVID-19 Rehabilitation Unit was twice as expensive as the 2 other units studied. World health systems are organizing to respond to the pandemic by expanding capacity in acute intensive care and sub-intensive care units. This study shows that COVID-19 rehabilitation units must be organized and equiped according to the clinical and rehabilitative needs of patients, following specific measures to prevent the spread of infection amongs patients and workers.

Late decisions about treatment limitation in patients with cancer: empirical analysis of end-of-life practices in a haematology and oncology unit at a German university hospital

BackgroundDecisions to limit treatment (DLTs) are important to protect patients from overtreatment but constitute one of the most ethically challenging situations in oncology practice. In the Ethics Policy for Advance Care Planning and Limiting Treatment study (EPAL), we examined how often DLT preceded a patient’s death and how early they were determined before (T1) and after (T2) the implementation of an intrainstitutional ethics policy on DLT.MethodsThis prospective quantitative study recruited 1.134 patients with haematological/oncological neoplasia in a period of 2×6 months at the University Hospital of Munich, Germany. Information on admissions, discharges, diagnosis, age, DLT, date and place of death, and time span between the initial determination of a DLT and the death of a patient was recorded using a standardised form.ResultsOverall, for 21% (n=236) of the 1.134 patients, a DLT was made. After implementation of the policy, the proportion decreased (26% T1/16% T2). However, the decisions were more comprehensive, including more often the combination of ‘Do not resuscitate’ and ‘no intense care unit’ (44% T1/64% T2). The median time between the determination of a DLT and the patient’s death was similarly short with 6 days at a regular ward (each T1/T2) and 10.5/9 (T1/T2) days at a palliative care unit. For patients with solid tumours, the DLTs were made earlier at both regular and palliative care units than for the deceased with haematological neoplasia.ConclusionOur results show that an ethics policy on DLT could sensitise for treatment limitations in terms of frequency and extension but had no significant impact on timing of DLT. Since patients with haematological malignancies tend to undergo intensive therapy more often during their last days than patients with solid tumours, special attention needs to be paid to this group. To support timely discussions, we recommend the concept of advance care planning.