Right-handed neutrino production rate at T > 160 GeV

The production rate of right-handed neutrinos from a Standard Model plasma at a temperature above a hundred GeV has previously been evaluated up to NLO in Standard Model couplings (g ~ 2/3) in relativistic (M ~ πT) and non-relativistic regimes (M ≫ πT), and up to LO in an ultrarelativistic regime (M ≲ gT). The last result necessitates an all-orders resummation of the loop expansion, accounting for multiple soft scatterings of the nearly light-like particles participating in 1↔2 reactions. In this paper we suggest how the regimes can be interpolated into a result applicable for any right-handed neutrino mass and at all temperatures above 160GeV. The results can also be used for determining the lepton number washout rate in models containing right-handed neutrinos. Numerical results are given in a tabulated form permitting for their incorporation into leptogenesis codes. We note that due to effects from soft Higgs bosons there is a narrow intermediate regime around M ~g 1/2 T in which our interpolation is phenomenological and a more precise study would be welcome.

Endstation Notfallstation: Perzeption und Rezeption des Begriffs «palliativer Patient» sowie Ansätze zur Verbesserung der interdisziplinären Zusammenarbeit – ein Survey unter notfallmedizinischem Personal auf einer Schweizer Notfallstation

Hintergrund: Wegen sich verändernder Strukturen im Spitalbereich sowie im Bereich der Hausarztabdeckung als auch infolge zunehmenden Drucks auf das Gesundheitssystem kommen mehr Patienten auf die Notfallstationen, die aufgrund ihrer Grunderkrankung und des fortgeschrittenen Krankheitsstadiums von einem palliativen Behandlungskonzept profitieren. Eine wesentliche Herausforderung ist hierbei bereits die Definition von «Palliative Care» (PC), sowie die Klärung, was genau die palliative Versorgung beinhaltet. Häufig vermischt wird der Terminus «Palliative Care» mit «End of life care». Die vorliegende Studie ist eine Standortbestimmung im Universitären Notfallzentrum des Inselspitals Bern (UNZ), das jährlich rund 32 400 Patienten versorgt. Ziel ist es, mehr über den Wissensstand und die persönliche Einstellung der Mitarbeiter zu palliativen Fragestellungen und speziell zum Begriff «Palliative Care» zu erhalten. Methodik: Die Mitarbeiter des Universitären Notfallzentrums des Inselspitals Bern (UNZ) wurden mittels einer Online-Umfrage durch eine spitalexterne Fachinstitution interviewt. Diese Befragung basiert auf einem Instrument [1], das in einer vergleichbaren Studie auf einer Notfallstation in den USA entwickelt und validiert wurde. Resultate: Von 154 Mitarbeitenden (Pflege und Ärzte) füllten 60 Mitarbeitende die Befragung vollständig aus, entsprechend einer Antwortrate von 39%. Die Definition von Palliative Care (von n=60) war sehr heterogen und konnte in sechs Themenbereiche eingeteilt werden. Bei den Fragen nach spezifischen Leistungsangeboten äusserten die Mitarbeitenden den Wunsch nach einem erleichterten Zugang zu bestehenden Patientendaten, nach einem 24-Stunden-Palliative-Care-Konsiliardienst und nach mehr Besprechungszeit für Fragestellungen der PC im klinischen Alltag. Schlussfolgerungen: Die heterogene Begriffsdefinition von «Palliative Care» bestätigt sich. Es besteht kein klares Vorgehen, und zudem lässt sich ein Zeitmangel für ausführliche Patientengespräche in palliativen Situationen im UNZ feststellen. Der Patientenwunsch oder Patientenverfügungen mit DNR/DNI-Prozedere stehen nicht im Widerspruch zu den persönlichen Wertvorstellungen der meisten Mitarbeitenden. Die 24-Stunden-Verfügbarkeit eines spezialisierten PC-Teams, das Erarbeiten von Guidelines und vermehrtes Training für PC würde von den UNZ-Mitarbeitenden begrüsst.

Land deals intensify competition for scarce resources

Since the worldwide food price crisis of 2008, foreign investors have rushed to acquire large amounts of agricultural land in poorer countries. Some observers welcome this, claiming that outside investment in ostensibly underused land will jump-start local development. Others regard such investments as land grabs, stressing that the areas are rarely empty and that local people have little say. This brief identifies the types of land targeted by investors and reveals key socio-ecological patterns of such deals. The evidence indicates that foreign investments are intensifying competition for the best land. Ensuring that such deals instead contribute to sustainable, inclusive use of land requires strong public guidance and oversight.

Approaches to Ensure Quality Standards for Standardized/ Simulated Patient Performance in High Stakes Objective Structured Clinical Exams (OSCEs)

Introduction To meet the quality standards for high-stakes OSCEs, it is necessary to ensure high quality standardized performance of the SPs involved.[1] One of the ways this can be assured is through the assessment of the quality of SPs` performance in training and during the assessment. There is some literature concerning validated instruments that have been used to assess SP performance in formative contexts but very little related to high stakes contexts.[2], [3], [4]. Content and structure During this workshop different approaches to quality control for SPs` performance, developed in medicine, pharmacy and nursing OSCEs, will be introduced. Participants will have the opportunity to use these approaches in simulated interactions. Advantages and disadvantages of these approaches will be discussed. Anticipated outcomes By the end of this session, participants will be able to discuss the rationale for quality control of SPs` performance in high stakes OSCEs, outline key factors in creating strategies for quality control, identify various strategies for assuring quality control, and reflect on applications to their own practice. Who should attend The workshop is designed for those interested in quality assurance of SP performance in high stakes OSCEs. Level All levels are welcome. References Adamo G. 2003. Simulated and standardized patients in OSCEs: achievements and challenges:1992-2003. Med Teach. 25(3), 262- 270. Wind LA, Van Dalen J, Muijtjens AM, Rethans JJ. Assessing simulated patients in an educational setting: the MaSP (Maastricht Assessment of Simulated Patients). Med Educ 2004, 38(1):39-44. Bouter S, van Weel-Baumgarten E, Bolhuis S. Construction and validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients' ability to role-play and provide feedback to students. Acad Med: Journal of the Association of American Medical Colleges 2012. May W, Fisher D, Souder D: Development of an instrument to measure the quality of standardized/simulated patient verbal feedback. Med Educ 2012, 2(1).

Developing Synaesthesia

Synaesthesia is a condition in which a stimulus elicits an additional subjective experience. For example, the letter E printed in black (the inducer) may trigger an additional colour experience as a concurrent (e.g., blue). Synaesthesia tends to run in families and thus, a genetic component is likely. However, given that the stimuli that typically induce synaesthesia are cultural artefacts, a learning component must also be involved. Moreover, there is evidence that synaesthetic experiences not only activate brain areas typically involved in processing sensory input of the concurrent modality; synaesthesia seems to cause a structural reorganisation of the brain. Attempts to train non-synaesthetes with synaesthetic associations have been successful in mimicking certain behavioural aspects and posthypnotic induction of synaesthetic experiences in non-synaesthetes has even led to the according phenomenological reports. These latter findings suggest that structural brain reorganization may not be a critical precondition, but rather a consequence of the sustained coupling of inducers and concurrents. Interestingly, synaesthetes seem to be able to easily transfer synaesthetic experiences to novel stimuli. Beyond this, certain drugs (e.g., LSD) can lead to synaesthesia-like experiences and may provide additional insights into the neurobiological basis of the condition. Furthermore, brain damage can both lead to a sudden presence of synaesthetic experiences in previously non-synaesthetic individuals and a sudden absence of synaesthesia in previously synaesthetic individuals. Moreover, enduring sensory substitution has been effective in inducing a kind of acquired synaesthesia. Besides informing us about the cognitive mechanisms of synaesthesia, synaesthesia research is relevant for more general questions, for example about consciousness such as the binding problem, about crossmodal correspondences and about how individual differences in perceiving and experiencing the world develop. Hence the aim of the current Research Topic is to provide novel insights into the development of synaesthesia both in its genuine and acquired form. We welcome novel experimental work and theoretical contributions (e.g., review and opinion articles) focussing on factors such as brain maturation, learning, training, hypnosis, drugs, sensory substitution and brain damage and their relation to the development of any form of synaesthesia.

Transition from adolescence to adulthood in congenital heart disease - Many roads lead to Rome

More than 90% of children born with heart defects reach adulthood. They continue to require specialized medical care. In most countries, their care has to be transferred from the pediatric care environment to specialized adult clinics. This transfer of care usually occurs at a time when adolescents become young adults. Supporting adolescents and emerging adults with congenital heart disease through transition has been recognized as an important task of their treating teams in recent years. An environment where adolescents feel welcome and where education and patient participation are fostered is crucial. For an optimal transition process, patients, their families and all health care providers need to be involved. Different models for transition programs have emerged, depending on local policies and resources. The authors offer insight into established transition programs in Bern and Zurich, Switzerland. Advantages and challenges of different models of care and transition programs are presented.

Towards an Earlier Diagnosis of Primary Ciliary Dyskinesia: Which Patients Should Undergo Detailed Diagnostic Testing?

Primary ciliary dyskinesia is a rare heterogeneous recessive genetic disorder of motile cilia, leading to chronic upper and lower respiratory symptoms. Prevalence is estimated at around 1:10,000, but many patients remain undiagnosed, while others receive the label incorrectly. Proper diagnosis is complicated by the fact that the key symptoms such as wet cough, chronic rhinitis and recurrent upper and lower respiratory infection, are common and nonspecific. There is no single gold standard test to diagnose PCD. Presently, the diagnosis is made by augmenting the medical history and physical examination with in patients with a compatible medical history following a demanding combination of tests including nasal nitric oxide, high- speed video microscopy, transmission electron microscopy, genetics, and ciliary culture. These tests are costly and need sophisticated equipment and experienced staff, restricting use to highly specialised centers. Therefore, it would be desirable to have a screening test for identifying those patients who should undergo detailed diagnostic testing. Three recent studies focused on potential screening tools: one paper assessed the validity of nasal nitric oxide for screening, and two studies developed new symptom-based screening tools. These simple tools are welcome, and hopefully remind physicians whom to refer for definitive testing. However, they have been developed in tertiary care settings, where 10 to 50% of tested patients have PCD. Sensitivity and specificity of the tools are reasonable, but positive and negative predictive values may be poor in primary or secondary care settings. While these studies take an important step forward towards an earlier diagnosis of PCD, more remains to be done before we have tools tailored to different health care settings.