The impact of COVID-19 pandemic on vascular registries and clinical trials.

Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients

Rifting under steam – how rift magmatism triggers methane venting from sedimentary basins

During opening of a new ocean magma intrudes into the surrounding sedimentary basins. Heat provided by the intrusions matures the host rock creating metamorphic aureoles potentially releasing large amounts of hydrocarbons. These hydrocarbons may migrate to the seafloor in hydrothermal vent complexes in sufficient volumes to trigger global warming, e.g. during the Paleocene Eocene Thermal Maximum (PETM). Mound structures at the top of buried hydrothermal vent complexes observed in seismic data off Norway were previously interpreted as mud volcanoes and the amount of released hydrocarbon was estimated based on this interpretation. Here, we present new geophysical and geochemical data from the Gulf of California suggesting that such mound structures could in fact be edifices constructed by the growth of black-smoker type chimneys rather than mud volcanoes. We have evidence for two buried and one active hydrothermal vent system outside the rift axis. The vent releases several hundred degrees Celsius hot fluids containing abundant methane, mid-ocean-ridge-basalt (MORB)-type helium, and precipitating solids up to 300 m high into the water column. Our observations challenge the idea that methane is emitted slowly from rift-related vents. The association of large amounts of methane with hydrothermal fluids that enter the water column at high pressure and temperature provides an efficient mechanism to transport hydrocarbons into the water column and atmosphere, lending support to the hypothesis that rapid climate change such as during the PETM can be triggered by magmatic intrusions into organic-rich sedimentary basins

A randomised controlled trial of six weeks of home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer: report on a pilot and feasibility study.

BACKGROUND: Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients. The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre randomised controlled trial to evaluate routine home enteral nutrition in these patients. METHODS: Patients undergoing oesophagectomy or total gastrectomy were randomised to either six weeks of home feeding through a jejunostomy (intervention), or treatment as usual (control). Intervention comprised overnight feeding, providing 50 % of energy and protein requirements, in addition to usual oral intake. Primary outcome measures were recruitment and retention rates at six weeks and six months. Nutritional intake, nutritional parameters, quality of life and healthcare costs were also collected. Interviews were conducted with a sample of participants, to ascertain patient and carer experiences. RESULTS: Fifty-four of 112 (48 %) eligible patients participated in the study over the 20 months. Study retention at six weeks was 41/54 patients (76 %) and at six months was 36/54 (67 %). At six weeks, participants in the control group had lost on average 3.9 kg more than participants in the intervention group (95 % confidence interval [CI] 1.6 to 6.2). These differences remained evident at three months (mean difference 2.5 kg, 95 % CI -0.5 to 5.6) and at six months (mean difference 2.5 kg, 95 % CI -1.2 to 6.1). The mean values observed in the intervention group for mid arm circumference, mid arm muscle circumference, triceps skin fold thickness and right hand grip strength were greater than for the control group at all post hospital discharge time points. The economic evaluation suggested that it was feasible to collect resource use and EQ-5D data for a full cost-effectiveness analysis. Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial: 1) a positive experience, 2) the reasons for taking part, and 3) uncertainty of the study process. CONCLUSIONS: This study demonstrated that home enteral feeding by jejunostomy was feasible, safe and acceptable to patients and their carers. Whether home enteral feeding as 'usual practice' is a cost-effective therapy would require confirmation in an appropriately powered, multi-centre study. TRIAL REGISTRATION: UK Clinical Research Network ID 12447 (main trial, first registered 30 May 2012); UK Clinical Research Network ID 13361 (qualitative substudy, first registered 30 May 2012); ClinicalTrials.gov NCT01870817 (first registered 28 May 2013)

Welfare payments and school attendance: an analysis of experimental policy in Indigenous education

Making the welfare payments of Indigenous people conditional on measures such as their children’s school attendance is becoming an increasingly popular policy measure in Australia. The stated aims of such an approach include ensuring that money is spent on essentials such as food, clothing and housing, and increasing children’s participation in school. The former Coalition Federal Government supported the introduction of such schemes - most publicly, as part of its intervention in the Northern Territory. The Rudd Labor Government has continued this policy approach, with Minister for Families, Housing, Community Services and Indigenous Affairs, Jenny Macklin, confirming support for three ‘income management’ models in Western Australia, Queensland and the Northern Territory. Though such schemes have been regularly characterised as trials, there has been little public information or discussion about their underpinning policy rationale. This approach marks an unprecedented new phase in welfare policy in Australia. This Issues Paper will set out the increasing influence of the concept of mutual obligation in Australia and its particular application to Indigenous policy. It canvasses the current trials linking welfare payments to school attendance and outlines what evaluations have indicated about such schemes to date. It then provides an analysis of key concerns about the approach - namely its lack of basis in evidence, the fact that measures introduced under such schemes do not necessarily serve its overall aims, that there are particular human rights implications for such an approach. It also points to the reality that the resources and attention focused on such schemes combined with the ongoing issue of chronic under-resourcing in Indigenous policy generally is unlikely to ‘close the gap’ for Indigenous communities

Personalführung in vermarktlichten Arbeitsbeziehungen: Lernen von den Creative Industries

No abstract available

RUVIVAL Publication Series Volume 3

RUVIVAL Publication Series is a compilation of literature reviews on topics concerned with the revitalisation of rural areas. RUVIVAL Publication Series is part of the e-learning project RUVIVAL and each of the three contributions in this publication is connected to further interactive multimedia material, which can be reached under http://www.hoou.de. The first literature review is concerned with urine utilisation as a fertiliser in agriculture. Urine contains four important nutrients for plant growth: nitrogen (N), phosphorus (P), potassium (K) and sulphur (S) and its use as fertiliser can not only recover these nutrients, but also reduce the use of chemical fertilisers and freshwater, as well as minimise the wastewater and excreta contamination of surface and open waters. However, if not managed properly, the risk of pathogen transmission, soil salinisation and pharmaceutical contamination, as well as strong and offensive odour, can cause significant health problems and discomfort. The second literature review introduces a biowaste/sanitation system from a highly advanced ancient culture, Terra Preta Sanitation. TPS shows great potential for soil building and nutrient recycling from excreta. Lactic acid fermentation (LAF) and vermicomposting as sanitisation options are examined in more detail. This literature review gives an overview of the current state of research conducted at the Institute for Wastewater Management and Water Protection (AWW) at the Hamburg University of Technology. The third literature review paper discusses the responses, methods, policies and proposed and practiced alternatives, as well as the corresponding difficulties and limitations, to increase water efficiency in agricultural irrigation. Irrigation management has varying effects on different stakeholders according to ample components affecting the irrigation management scheme, such as: soil type, climate, water availability, crop type and socio-economical influences in an area. One technique may be beneficial for short-term purposes, but cause negative consequences in the long run – this must be taken into consideration before implementation.Die RUVIVAL-Publikationsreihe ist eine Zusammenstellung von Literaturübersichten zu Themen, die sich mit der Revitalisierung ländlicher Gebiete befassen und ist ein Teil des E-Learning-Projekts RUVIVAL. Jeder der drei Beiträge in dieser Publikation ist mit weiteren interaktiven Lerninhalten verbunden, die unter http://www.hoou.de einzusehen sind. Die erste Literaturübersicht befasst sich mit der Verwendung von Urin als Düngemittel in der Landwirtschaft. Urin enthält vier Nährstoffe, die sich positiv auf das Pflanzenwachstum auswirken: Stickstoff (N), Phosphor (P), Kalium (K) und Schwefel (S). Die Verwendung von Urin als Dünger kann nicht nur diese Nährstoffe zurückgewinnen, sondern auch den Einsatz von chemischen Düngemitteln und Frischwasser reduzieren sowie die Abwasser- und Exkrementbelastung von Oberflächengewässern und offenen Gewässern minimieren. Bei unsachgemäßem Umgang kann jedoch das Risiko der Übertragung von Krankheitserregern, der Versalzung des Bodens und der Verunreinigung von Arzneimitteln sowie starker und unangenehmer Gerüche zu erheblichen Gesundheitsproblemen und Unannehmlichkeiten führen. Die zweite Literaturübersicht stellt ein Bioabfall-/Sanitärsystem aus einer hoch entwickelten alten Kultur vor, das System der Terra Preta - Sanitäranlagen. TPS weisen ein großes Potenzial für die Bodenbildung und die Nährstoffrückgewinnung aus Exkrementen auf. Milchsäurevergärung (LAF) und Vermikompostierung als Abwasser-Sanitisierungsoptionen werden näher untersucht. Diese Literaturübersicht gibt einen Überblick über den aktuellen Stand der Forschung am Institut für Abwasserwirtschaft und Gewässerschutz (AWW) der Technischen Universität Hamburg-Harburg. Die dritte Literaturübersicht erörtert die Reaktionen, Methoden, Strategien und vorgeschlagenen und praktizierten Alternativen sowie die entsprechenden Schwierigkeiten und Einschränkungen, um die Nutzungseffizienz in der landwirtschaftlichen Bewässerung zu erhöhen. Das Management der Bewässerung hat unterschiedliche Auswirkungen auf die verschiedenen Interessengruppen, je nach den zahlreichen Komponenten, die das Bewässerungssystem beeinflussen, wie z.B.: Bodentyp, Klima, Wasserverfügbarkeit, Kulturart und sozioökonomische Einflüsse in einem Gebiet. Eine Technik kann kurzfristig vorteilhaft sein, langfristig aber negative Folgen haben - dies muss vor der Umsetzung berücksichtigt werden