Prevention of Acute Hematoma After Face-Lifts

Acute hematoma remains one of the most frequently encountered complications after face-lift surgery. Several risk factors inherent to the patient and omission of certain intraoperative regimens are considered to cause hematoma. Significant risk factors include high blood pressure and male gender. Possible intraoperative regimens for the prevention of hematoma include tumescence infiltration without adrenaline, clotting of raw surfaces with fibrin glue, usage of drains, and application of compression bandages. However, little attention has been paid to postoperative measures. To examine whether different regimens in the postoperative phase can influence the incidence of hematoma, all face-lift patients who underwent surgery by a single surgeon in two different clinics (n=376) with two different postoperative regimens were evaluated over the course of 3years. In group 1 (n=308), all postoperative medication was administered on request including medication for pain control, blood pressure stabilization, and prevention of nausea and vomiting as well as postoperative restlessness and agitation. In group 2 (n=68), this medication was administered prophylactically at the end of the operation before extubation. The hematoma rate was 7% in group 1 and 0% in group 2. This study showed that the prophylactic use of medications (e.g., analgesics, antihypertonics, antiemetics, and sedatives) during the postoperative phase is superior to making drugs available to patients on request and can decrease the occurrence of acute hematoma in face-lift patient

Development and structure of karstification of the Dong Van Karst Plateau UNESCO Global Geopark, North Vietnam based on cave survey data

This paper presents a quantitative study of the relationship between the cave system and the tectonic and karst evolution of the Dong Van Karst Plateau based on analysis and statistics of geometric parameters and orientation of cave passages. The region is located in northern Vietnam and belongs to the extended part of the South China karst belt (Yunnan karst plateau), which is composed mainly of carbonate rocks. Cave classification based on cave conduits geometric parameters shows that caves developed mainly in the vadose zone (27 vadose branchwork caves, 10 mixed caves developed under the control of fault systems, and 12 water-table caves). The degree of correlation between cave levels and planation surfaces suggests that the development of horizontal cave passages is related to two levels of planation surfaces, including one at 1250–1450 masl (equivalent to cave level at 1350–1450 masl), and at 1000–1250 masl (corresponding to cave level at 1200–1250 masl). Additionally, cave passage orientation shows that the cave system formed and developed under the influence of tectonic activities in the Cenozoic. The dominant orientation trend is roughly in the East–West direction and occurred in the early phase (Eocene–Miocene). Next is a trend roughly North–South that occurred in the late phase (Pliocene–Quaternary). The last orientation trend follows the NW–SE direction due to the reactivation of paleo-fault systems in the same direction. Although there are limitations due to accessibility and the level of cave exploration, this research suggests that analysis and statistics of the geometric parameters and orientation of cave passages based on cave survey data can be one of the effective approaches used to identify the development and structure of karstification in the karst region

Technical Note: Field experiences using UV/VIS sensors for high-resolution monitoring of nitrate in groundwater

peer-reviewedTwo different in situ spectrophotometers are compared that were used in the field to determine nitrate-nitrogen (NO3-N) concentrations at two distinct spring discharge sites. One sensor was a double wavelength spectrophotometer (DWS) and the other a multiple wavelength spectrophotometer (MWS). The objective of the study was to review the hardware options, determine ease of calibration, accuracy, influence of additional substances and to assess positive and negative aspects of the two sensors as well as troubleshooting and trade-offs. Both sensors are sufficient to monitor highly time-resolved NO3-N concentrations in emergent groundwater. However, the chosen path length of the sensors had a significant influence on the sensitivity and the range of detectable NO3-N. The accuracy of the calculated NO3-N concentrations of the sensors can be affected if the content of additional substances such as turbidity, organic matter, nitrite or hydrogen carbonate significantly varies after the sensors have been calibrated to a particular water matrix. The MWS offers more possibilities for calibration and error detection but requires more expertise compared with the DWS.The authors would like to acknowledge the Teagasc Walsh Fellowship scheme for funding the study in Ireland, and the German federal Ministry of Education and Research (BMBF) for sponsoring the SMART-project (grant no. 02WM1079-1086, 02WM1211-1212) for the study in Jordan.Teagasc Walsh Fellowship Programm

Dynamics of water fluxes and storages in an Alpine karst catchment under current and potential future climate conditions

Karst aquifers are difficult to manage due to their unique hydrogeological characteristics. Future climate projections suggest a strong change in temperature and precipitation regimes in European karst regions over the next decades. Alpine karst systems can be especially vulnerable under changing hydro-meteorological conditions since snowmelt in mountainous environments is an important controlling process for aquifer recharge and is highly sensitive to varying climatic conditions. Our paper presents the first study to investigate potential impacts of climate change on mountainous karst systems by using a combined lumped and distributed modeling approach with consideration of subsurface karst drainage structures. The study site is characterized by high-permeability (karstified) limestone formations and low-permeability (non-karst) sedimentary Flysch. The model simulation under current conditions demonstrates that a large proportion of precipitation infiltrates into the karst aquifer as autogenic recharge. Moreover, the result shows that surface snow storage is dominant from November to April, while subsurface water storage in the karst aquifer dominates from May to October. The climate scenario runs demonstrate that varied climate conditions significantly affect the spatiotemporal distribution of water fluxes and storages: (1) the total catchment discharge decreases under all evaluated future climate conditions. (2) The spatiotemporal discharge pattern is strongly controlled by temperature variations, which can shift the seasonal snowmelt pattern, with snow storage in the cold season (December to April) decreasing significantly under all change scenarios. (3) Increased karst aquifer recharge in winter and spring, and decreased recharge in summer and autumn, partly offset each other. (4) Impacts on the karst springs are distinct; the lowest permanent spring presents a robust discharge behavior, while the highest overflow outlet is highly sensitive to changing climate. This analysis effectively demonstrates that the impacts on subsurface flow dynamics are regulated by the characteristic dual flow and spatially heterogeneous distributed drainage structure of the karst aquifer. Overall, our study highlights the fast groundwater dynamics in mountainous karst catchments, which make them highly vulnerable to future changing climate conditions. Additionally, this work presents a novel holistic modeling approach, which can be transferred to similar karst systems for studying the impact of climate change on local karst water resources with consideration of their individual hydrogeological complexity and hydraulic heterogeneity.</p

Ecohydrogeology: The interdisciplinary convergence needed to improve the study and stewardship of springs and other groundwater-dependent habitats, biota, and ecosystems

This essay discusses the need for, advantages and challenges of integrating the scientific disciplines of ecology and hydrogeology in the study of groundwater-dependent ecosystems (GDEs). We provide a definition for ecohydrogeology as \u201ca unifying, synthetic field of study integrating the approaches from the ecological and hydrogeological sciences in the study of groundwater (GW)-related ecosystems, habitats, and organisms to advance science, stewardship, and policy\u201d. We selected specific case studies to illustrate first how hydrogeological approaches can favour in-depth understanding and modelling of springs and crenobiontic (spring-dependent) species distribution, assemblage composition and organization. Second, this essay also examines how taxa and assemblages serve as bioassays and ecosystem indicators to infer hydrogeological aspects of GW flow and discharge, as well as quantitative and qualitative human impacts. We consider both types of features and parameters as ecohydrogeological indicators. The examples presented include topics related to springs and other GDE geomorphological types and classification, GW quality influences on crenobiont distribution, phreatophyte (= plant species the roots of which reach to and into the water table) ecophysiology in relation to water table depth, and flow variability in karstic systems, to nutrient dynamics in relation to dinoflagellate blooms in GDE montane lakes. Conceptual approaches that integrate ecology with hydrogeology include the investigation of GDE distribution and ecology, groundwater-surface water (GW-SW) interactions, and the development of the discipline of ecohydrology. Despite widespread applications, the scientific community still lacks a complete or effective integration of the principles described in the fields of groundwater hydrogeology with ecology, ecophysiology, and environmental biology. Springs are aquatic-wetland-riparian habitats that link shallow subsurface-surface processes and assemblages, often functioning as biodiversity hotspots, ecotones, keystone, and refugial ecosystems, for which coordination between studies of hydrogeology and ecology are both obvious and essential. Over the past century, springs ecosystem ecology has been largely ignored by hydrologists, and, conversely, hydrogeology has been under-emphasized by ecologists. Recent global recognition of the extraordinary biodiversity and socio-cultural significance of springs, coupled with their globally highly threatened conservation status, stimulated this inquiry into how to better integrate hydrogeology with springs ecosystem ecology. Acknowledging the highly threatened status of springs ecosystems around the world, there is an urgent need to integrate and invigorate the union of these disciplines into ecohydrogeology, the study of groundwater-dependent organisms, habitats, ecosystems, and management policy

Urgent plea for global protection of springs

Springs, keystone ecosystems, are rapidly disappearing mainly due to overexploitation, and need global protection

Ethnic Differences in Leaving Home: Timing and Pathways

The dynamics of leaving home for youth from migrant families in the Netherlands are examined using individual administrative data on the 1977 and 1983 birth cohorts for the period 1999–2004. A competing-risks approach is applied to distinguish leaving home for union formation, to live independently, and to share with others. Migrant youth, and particularly Turkish and Moroccan youth, leave home at a significantly younger age than Dutch youth, given the relevant background variables. This is remarkable, given the older ages at which young people in the origin countries leave the parental home. The result may be seen as evidence of how the potential effects of cultural norms are counter-affected by other factors, such as the facilities of the welfare state and the awkward position of migrant youth between two cultures. Considering the pathways out of home, the analysis largely confirms the expected pattern: Turkish and Moroccan youth leave home more often for union formation and particularly marriage, while this pathway is of minor importance for Dutch youth at early ages

Characteristics and treatment of new-onset arthritis after checkpoint inhibitor therapy

Immune checkpoint inhibitors (ICIs) may cause immune-related adverse events (IRAEs). Characterisation and data on treatment of musculoskeletal IRAEs are scarce. In this cohort study, patients receiving ICI therapy who experienced arthralgia were evaluated for the presence of synovitis. Data on demographics, ICI regime, time of onset, imaging and response to therapy of synovitis were prospectively collected. Arthritis was demonstrated in 14 of 16 patients of whom 7 showed monarthritis, 5 had oligoarthritis and 2 had polyarthritis. Patients with ICI-induced arthritis were predominantly male (57%) and seronegative (69%). Regarding the detection of synovitis in staging imaging, moderate sensitivity for contrast-enhanced CT with PET-CT as reference was observed. Disease burden at baseline was high and was significantly reduced after anti-inflammatory treatment. Nine patients were treated with systemic and eight patients with intra-articular glucocorticoids. Six patients who flared on glucocorticoid treatment on tapering were given methotrexate resulting in long-term remission. Patients with synovitis were more likely to have good tumour response. Patients with ICI-induced arthritis were predominantly male and seronegative showing different patterns of arthritis with high disease burden. Good efficacy and safety was observed for methotrexate, particularly for ICI-induced polyarthritis

Intergenerational family caregiving in welfare policy context

Definition Intergenerational family caregiving refers to exchanges up and down family lines aimed at nurturing the needs of others. Caregiving is more than a task; it involves emotional and relationship work

The World Karst Aquifer Mapping project : concept, mapping procedure and map of Europe

Karst aquifers contribute substantially to freshwater supplies in many regions of the world, but are vulnerable to contamination and difficult to manage because of their unique hydrogeological characteristics. Many karst systems are hydraulically connected over wide areas and require transboundary exploration, protection and management. In order to obtain a better global overview of karst aquifers, to create a basis for sustainable international water-resources management, and to increase the awareness in the public and among decision makers, the World Karst Aquifer Mapping (WOKAM) project was established. The goal is to create a world map and database of karst aquifers, as a further development of earlier maps. This paper presents the basic concepts and the detailed mapping procedure, using France as an example to illustrate the step-by-step workflow, which includes generalization, differentiation of continuous and discontinuous carbonate and evaporite rock areas, and the identification of non-exposed karst aquifers. The map also shows selected caves and karst springs, which are collected in an associated global database. The draft karst aquifer map of Europe shows that 21.6% of the European land surface is characterized by the presence of (continuous or discontinuous) carbonate rocks; about 13.8% of the land surface is carbonate rock outcrop