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Im Anschluss an die arbeitsrechtlichen Jahresübersichten der vergangenen Jahre (NWB 5/2019 S. 266; NWB 8/2020 S. 557) gibt der nachfolgende Beitrag einen Überblick über relevante Entwicklungen im Arbeitsrecht des Jahres 2020. Der erste Teil beschäftigt sich hierbei mit gesetzlichen Änderungen. Neben Regelungen, die auf die COVID-19-Pandemie zurückgeführt werden können, hat der Gesetzgeber auch andere Vorhaben umgesetzt. So wurde u. a. das Arbeitnehmerentsenderecht reformiert. Für Diskussionen sorgt(e) zudem das Gesetzesvorhaben zur Regelung mobiler Arbeit. Im zweiten Teil werden für die Praxis wichtige höchstrichterliche Gerichtsentscheidungen zum Arbeitsrecht erläutert, alphabetisch sortiert von A (wie Antidiskriminierungsrecht) bis U (wie Urlaub).
Der arbeitsrechtlich richtige Umgang mit Zeiten einer Dienstreise kann in der betrieblichen Praxis Probleme bereiten. Ob die Reisezeiten als solche Arbeitszeit i. S. des Arbeitszeitgesetzes (ArbZG ) darstellen, also bspw. auf die tägliche Höchstarbeitszeit angerechnet werden müssen oder nicht, ist oftmals genauso unklar wie die Frage, ob und inwieweit Reisezeiten vergütungspflichtig sind. Aber auch, ob ein Arbeitnehmer überhaupt zur Durchführung einer Dienstreise verpflichtet werden kann, ist ein möglicher Anlass von Streitigkeiten zwischen den Arbeitsvertragsparteien, wie verschiedene Gerichtsentscheidungen zeigen. Der nachfolgende Beitrag beantwortet die aufgeworfenen Fragen und gibt hierzu einen praxisorientierten Überblick.
Magnetic nanoparticle relaxation in biomedical application: focus on simulating nanoparticle heating
(2021)
Background:
Additional stabilization of the “comma sign” in anterosuperior rotator cuff repair has been proposed to provide biomechanical benefits regarding stability of the repair.
Purpose:
This in vitro investigation aimed to investigate the influence of a comma sign–directed reconstruction technique for anterosuperior rotator cuff tears on the primary stability of the subscapularis tendon repair.
Study Design:
Controlled laboratory study.
Methods:
A total of 18 fresh-frozen cadaveric shoulders were used in this study. Anterosuperior rotator cuff tears (complete full-thickness tear of the supraspinatus and subscapularis tendons) were created, and supraspinatus repair was performed with a standard suture bridge technique. The subscapularis was repaired with either a (1) single-row or (2) comma sign technique. A high-resolution 3D camera system was used to analyze 3-mm and 5-mm gap formation at the subscapularis tendon-bone interface upon incremental cyclic loading. Moreover, the ultimate failure load of the repair was recorded. A Mann-Whitney test was used to assess significant differences between the 2 groups.
Results:
The comma sign repair withstood significantly more loading cycles than the single-row repair until 3-mm and 5-mm gap formation occurred (P≤ .047). The ultimate failure load did not reveal any significant differences when the 2 techniques were compared (P = .596).
Conclusion:
The results of this study show that additional stabilization of the comma sign enhanced the primary stability of subscapularis tendon repair in anterosuperior rotator cuff tears. Although this stabilization did not seem to influence the ultimate failure load, it effectively decreased the micromotion at the tendon-bone interface during cyclic loading.
Clinical Relevance:
The proposed technique for stabilization of the comma sign has shown superior biomechanical properties in comparison with a single-row repair and might thus improve tendon healing. Further clinical research will be necessary to determine its influence on the functional outcome.
In positron emission tomography improving time, energy and spatial detector resolutions and using Compton kinematics introduces the possibility to reconstruct a radioactivity distribution image from scatter coincidences, thereby enhancing image quality. The number of single scattered coincidences alone is in the same order of magnitude as true coincidences. In this work, a compact Compton camera module based on monolithic scintillation material is investigated as a detector ring module. The detector interactions are simulated with Monte Carlo package GATE. The scattering angle inside the tissue is derived from the energy of the scattered photon, which results in a set of possible scattering trajectories or broken line of response. The Compton kinematics collimation reduces the number of solutions. Additionally, the time of flight information helps localize the position of the annihilation. One of the questions of this investigation is related to how the energy, spatial and temporal resolutions help confine the possible annihilation volume. A comparison of currently technically feasible detector resolutions (under laboratory conditions) demonstrates the influence on this annihilation volume and shows that energy and coincidence time resolution have a significant impact. An enhancement of the latter from 400 ps to 100 ps leads to a smaller annihilation volume of around 50%, while a change of the energy resolution in the absorber layer from 12% to 4.5% results in a reduction of 60%. The inclusion of single tissue-scattered data has the potential to increase the sensitivity of a scanner by a factor of 2 to 3 times. The concept can be further optimized and extended for multiple scatter coincidences and subsequently validated by a reconstruction algorithm.
Thrombogenic complications are a main issue in mechanical circulatory support (MCS). There is no validated in vitro method available to quantitatively assess the thrombogenic performance of pulsatile MCS devices under realistic hemodynamic conditions. The aim of this study is to propose a method to evaluate the thrombogenic potential of new designs without the use of complex in-vivo trials. This study presents a novel in vitro method for reproducible thrombogenicity testing of pulsatile MCS systems using low molecular weight heparinized porcine blood. Blood parameters are continuously measured with full blood thromboelastometry (ROTEM; EXTEM, FIBTEM and a custom-made analysis HEPNATEM). Thrombus formation is optically observed after four hours of testing. The results of three experiments are presented each with two parallel loops. The area of thrombus formation inside the MCS device was reproducible. The implantation of a filter inside the loop catches embolizing thrombi without a measurable increase of platelet activation, allowing conclusions of the place of origin of thrombi inside the device. EXTEM and FIBTEM parameters such as clotting velocity (α) and maximum clot firmness (MCF) show a total decrease by around 6% with a characteristic kink after 180 minutes. HEPNATEM α and MCF rise within the first 180 minutes indicate a continuously increasing activation level of coagulation. After 180 minutes, the consumption of clotting factors prevails, resulting in a decrease of α and MCF. With the designed mock loop and the presented protocol we are able to identify thrombogenic hot spots inside a pulsatile pump and characterize their thrombogenic potential.
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with early and delayed brain injury due to several underlying and interrelated processes, which include inflammation, oxidative stress, endothelial, and neuronal apoptosis. Treatment with melatonin, a cytoprotective neurohormone with anti-inflammatory, anti-oxidant and anti-apoptotic effects, has been shown to attenuate early brain injury (EBI) and to prevent delayed cerebral vasospasm in experimental aSAH models. Less is known about the role of endogenous melatonin for aSAH outcome and how its production is altered by the pathophysiological cascades initiated during EBI. In the present observational study, we analyzed changes in melatonin levels during the first three weeks after aSAH.
Cardiopulmonary bypass (CPB) is a standard technique for cardiac surgery, but comes with the risk of severe neurological complications (e.g. stroke) caused by embolisms and/or reduced cerebral perfusion. We report on an aortic cannula prototype design (optiCAN) with helical outflow and jet-splitting dispersion tip that could reduce the risk of embolic events and restores cerebral perfusion to 97.5% of physiological flow during CPB in vivo, whereas a commercial curved-tip cannula yields 74.6%. In further in vitro comparison, pressure loss and hemolysis parameters of optiCAN remain unaffected. Results are reproducibly confirmed in silico for an exemplary human aortic anatomy via computational fluid dynamics (CFD) simulations. Based on CFD simulations, we firstly show that optiCAN design improves aortic root washout, which reduces the risk of thromboembolism. Secondly, we identify regions of the aortic intima with increased risk of plaque release by correlating areas of enhanced plaque growth and high wall shear stresses (WSS). From this we propose another easy-to-manufacture cannula design (opti2CAN) that decreases areas burdened by high WSS, while preserving physiological cerebral flow and favorable hemodynamics. With this novel cannula design, we propose a cannulation option to reduce neurological complications and the prevalence of stroke in high-risk patients after CPB.