Staged Concept for Treatment of Severe Postsaphenectomy Wound Infection

The saphenous vein remains the most commonly used conduit in coronary artery bypass surgery. Vein harvest is a critical component with significant morbidity associated with leg wounds from open technique. Occurring complications are hematoma, postoperative pain, skin changes, neuropathy, and septic or nonseptic wound complications. Within the context of a recent case, we present our approach to postsaphenectomy wound management

Lønnsomhetsvurdering ved omregulering av det norske pengespillmarkedet: En empirisk studie av pengespillmarkedet, med erfaringer fra Danmark og Sverige

I denne utredningen har vi analysert lønnsomheten knyttet til omregulering av det norske pengespillmarkedet. Markedet er regulert slik at Norsk Tipping har enerett på pengespill og kasino, men det er ikke slik at dette hindrer uregulerte utenlandske aktører i å tiltrekke seg norske kunder. En forutsetning for å omregulere markedet er at det ikke går på bekostning av midlene som hvert år går fra Norsk Tipping og Norsk Rikstoto til samfunnsnyttige formål (Kultur- og Likestillingsdeparmentet, 2016). Samtidig er det viktig at en omregulering ikke går på bekostning av hensynet til spilleavhengige. Ved omregulering av markedet har vi tatt utgangspunkt i at dette vil gjelde for spillområdene sport- og instaspill, da det er på disse områdene at man opplever utfordringer i dagens enerettsmodell. Vi har sett på hvordan omreguleringen av disse spillområdene vil påvirke inntekten til samfunnsnyttige formål når pengespillmodellen endres fra enerett til å møte konkurranse fra utenlandske aktører. Lønnsomheten av omregulering er uttrykt gjennom endring i netto nåverdi, sammenlignet med en videreføring av dagens enerettsmodell. Funnene i analysen viser at inntekten til samfunnsnyttige formål vil øke dersom man velger å omregulere markedet. Vi har valgt å se på tre ulike skattesatser for de lisensierte selskapene, 15%, 20%, og 25%. Våre funn antyder at en omregulering vil være lønnsomt uavhengig av valgt skattesats, men at inntekten vil være størst ved en skattesats på 25%. Norske myndigheter ønsker å ivareta hensynet til de spilleavhengige og de samfunnsøkonomiske kostnadene som følge av dette. Funnene i analysen antyder at en optimal skattesats vil ligge mellom 15% og 25% avhengig av hvor mye man verdsetter hensynet til spillavhengige opp mot inntektsmaksimering. Etter omregulering vil prisene i det regulerte markedet reduseres, noe som vil gagne spillerne. En lisensmodell med skattesats 20% hvor prisen på spill er 6%, vil gi samfunnet en merinntekt på i overkant av 1,1 milliarder kroner i perioden 2021-2025, sammenlignet med en videreføring av dagens enerettsmodell.nhhma

Body Composition Profiling in the UK Biobank Imaging Study

Objective To investigate the value of imaging-based multivariable body composition profiling by describing its association with coronary heart disease (CHD), type 2 diabetes (T2D), and metabolic health on individual and population levels. Methods The first 6,021 participants scanned by UK Biobank were included. Body composition profiles (BCPs) were calculated including abdominal subcutaneous adipose tissue, visceral adipose tissue (VAT), thigh muscle volume, liver fat, and muscle fat infiltration (MFI), determined using magnetic resonance imaging. Associations between BCP and metabolic status were investigated using matching procedures and multivariable statistical modelling. Results Matched control analysis showed higher VAT and MFI was associated with CHD and T2D (p<0.001). Higher liver fat was associated with T2D (p<0.001) and lower liver fat with CHD (p<0.05), matching on VAT. Multivariable modelling showed lower VAT and MFI was associated with metabolic health (p<0.001), liver fat was non-significant. Associations remained significant adjusting for sex, age, BMI, alcohol, smoking, and physical activity. Conclusions Body composition profiling enabled an intuitive visualization of body composition and showed the complexity of associations between fat distribution and metabolic status, stressing the importance of a multivariable approach. Different diseases were linked to different BCPs, which could not be described by a single fat compartment alone

Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse §

Abstract Objective: We sought to compare the outcomes of minimally invasive mitral valve (MV) surgery for anterior (anterior mitral leaflet, AML), posterior (posterior mitral leaflet, PML) or bileaflet (BL) MV prolapse. Methods: Between August 1999 and December 2007, 1230 patients who presented with isolated AML (n = 156, 12.7%), isolated PML (n = 672, 54.6%) or BL (n = 402, 32.7%) MV prolapse underwent minimally invasive MV surgery. The preoperative mitral regurgitation (MR) grade was 3.3 AE 0.8, left ventricular ejection fraction (LVEF) was 62 AE 12% and mean age was 58.9 AE 13.0 years; 836 patients (68.0%) were male. Mean follow-up time was 2.7 AE 2.1 years, and the follow-up was 100% complete. Results: Overall, the MV repair rate was 94.0% (1156 patients). Seventy-four patients (6.0%) received MV replacement. MV repair for PML prolapse was accomplished in 651 patients (96.9%), for AML in 142 patients (91%) and for BL in 363 patients (90.3%). Repair techniques consisted predominantly of leaflet resection and/or implantation of neochordae, combined with ring annuloplasty. Concomitant procedures were tricuspid valve surgery (n = 56), atrial fibrillation ablation (n = 286) and closure of an atrial septal defect or patent foramen ovale (PFO) (n = 89). The overall duration of cardiopulmonary bypass was 127 AE 40 min and aortic cross-clamp time was 78 AE 33 min. The mean postoperative hospital stay was 11.6 AE 9.7 days for the overall group. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3 AE 0.5. For the overall group, 5-year survival rate was 87.3% (95% CI: 83.9-90.1) and 5-year freedom from cardiac reoperation rate was 95.6% (95% CI: 94.1-96.7). The log-rank test revealed no significant difference between the three groups regarding long-term survival or freedom from reoperation. Conclusions: Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse.

Die Potenziale der Energieeinsparung in der Abwasserwirtschaft

Welche Potenziale birgt die Abwasserwirtschaft im Sinne der Klimaschutzziele? Und welche rechtlichen Rahmenbedingungen sind dabei zu berücksichtigen? Durch innovative Ansätze sowie die Einbindung in den Energiemarkt können erhebliche Effizienzpotenziale ausgeschöpft werden

The MUSICA IASI CH4 and N2O products and their comparison to HIPPO, GAW and NDACC FTIR references

This work presents the methane (CH4) and nitrous oxide (N2O) products as generated by the IASI (Infrared Atmospheric Sounding Interferometer) processor developed during the project MUSICA (MUlti-platform remote Sensing of Isotopologues for investigating the Cycle of Atmospheric water). The processor retrieves CH4 and N2O with different water vapour and water vapour isotopologues (as well as HNO3) and uses a single a priori data set for all the retrievals (no variation in space and time). Firstly, the characteristics and errors of the products are analytically described. Secondly, the products are comprehensively evaluated by comparisons to the following reference data measured by different techniques and from different platforms as follows: (1) aircraft CH4 and N2O profiles from the five HIAPER Pole-to-Pole Observation (HIPPO) missions; (2) continuous in situ CH4 and N2O observations performed between 2007 and 2017 at subtropical and mid-latitude highmountain observatories (Izaña Atmospheric Observatory and Jungfraujoch, respectively) in the framework of the WMO–GAW (World Meteorological Organization–Global Atmosphere Watch) programme; (3) ground-based FTIR (Fouriertransform infrared spectrometer) measurements made between 2007 and 2017 in the framework of the NDACC (Network for the Detection of Atmospheric Composition Change) at the subtropical Izaña Atmospheric Observatory, the mid-latitude station of Karlsruhe and the Kiruna polar site. The theoretical estimations and the comparison studies suggest a precision for the N2O and CH4 retrieval products of about 1.5–3% and systematic errors due to spectroscopic parameters of about 2 %. The MUSICA IASI CH4 data offer a better sensitivity than N2O data. While for the latter the sensitivity is mainly limited to the UTLS (upper troposphere–lower stratosphere) region, for CH4 we are able to prove that at low latitudes the MUSICA IASI processor can detect variations that take place in the free troposphere independently from the variations in the UTLS region.We demonstrate that the MUSICA IASI data qualitatively capture the CH4 gradients between low and high latitudes and between the Southern Hemisphere and Northern Hemisphere; however, we also find an inconsistency between low- and high-latitude CH4 data of up to 5 %. The N2O latitudinal gradients are very weak and cannot be detected. We make comparisons over a 10-year time period and analyse the agreement with the reference data on different timescales. The MUSICA IASI data can detect day-to-day signals (only in the UTLS), seasonal cycles and long-term evolution (in the UTLS and for CH4 also in the free troposphere) similar to the reference data; however, there are also inconsistencies in the long-term evolution connected to inconsistencies in the used atmospheric temperature a priori data. Moreover, we present a method for analytically describing the a posteriori-calculated logarithmic-scale difference of the CH4 and N2O retrieval estimates. By correcting errors that are common in the CH4 and N2O retrieval products, the a posteriori-calculated difference can be used for generating an a posteriori-corrected CH4 product with a theoretically better precision than the original CH4 retrieval products. We discuss and evaluate two different approaches for such a posteriori corrections. It is shown that the correction removes the inconsistencies between low and high latitudes and enables the detection of day-to-day signals also in the free troposphere. Furthermore, they reduce the impact of short-term atmospheric dynamics, which is an advantage, because respective signals are presumably hardly comparable to model data. The approach that affects the correction solely on the scales on which the errors dominate is identified as the most efficient, because it reduces the inconsistencies and errors without removing measurable real atmospheric signals. We give a brief outlook on a possible usage of this a posterioricorrected MUSICA IASI CH4 product in combination with inverse modelling

The MUSICA IASI CH4 and N2O products and their comparison to HIPPO, GAW and NDACC FTIR references

This work presents the methane (CH4) and nitrous oxide (N2O) products as generated by the IASI (Infrared Atmospheric Sounding Interferometer) processor developed during the project MUSICA (MUlti-platform remote Sensing of Isotopologues for investigating the Cycle of Atmospheric water). The processor retrieves CH4 and N2O with different water vapour and water vapour isotopologues (as well as HNO3) and uses a single a priori data set for all the retrievals (no variation in space and time). Firstly, the characteristics and errors of the products are analytically described. Secondly, the products are comprehensively evaluated by comparisons to the following reference data measured by different techniques and from different platforms as follows: (1) aircraft CH4 and N2O profiles from the five HIAPER Pole-to-Pole Observation (HIPPO) missions; (2) continuous in situ CH4 and N2O observations performed between 2007 and 2017 at subtropical and mid-latitude high-mountain observatories (Izaña Atmospheric Observatory and Jungfraujoch, respectively) in the framework of the WMO–GAW (World Meteorological Organization–Global Atmosphere Watch) programme; (3) ground-based FTIR (Fourier-transform infrared spectrometer) measurements made between 2007 and 2017 in the framework of the NDACC (Network for the Detection of Atmospheric Composition Change) at the subtropical Izaña Atmospheric Observatory, the mid-latitude station of Karlsruhe and the Kiruna polar site.This work has strongly benefited from funding by the European Research Council under FP7/(2007–2013)/ERC grant agreement no. 256961 (project MUSICA); by the Deutsche Forschungsgemeinschaft for the project MOTIV (Geschäftszeichen SCHN 1126/2-1); by the Ministerio de Economía y Competitividad from Spain trough the projects CGL2012-37505 (project NOVIA) and CGL2016-80688-P (project INMENSE); by the Ministerio de Educación, Cultura y Deporte (programa “José Castillejo”, CAS14/00282); and by EUMETSAT under its Fellowship Programme (project VALIASI)

Low-valent homobimetallic Rh complexes: influence of ligands on the structure and the intramolecular reactivity of Rh–H intermediates

Supporting two metal binding sites by a tailored polydentate trop-based (trop - 5H-dibenzo[a,d] cyclohepten-5-yl) ligand yields highly unsymmetric homobimetallic rhodium(I) complexes. Their reaction with hydrogen rapidly forms Rh hydrides that undergo an intramolecular semihydrogenation of two C≡C bonds of the trop ligand. This reaction is chemoselective and converts C≡C bonds to a bridging carbene and an olefinic ligand in the first and the second semihydrogenation steps, respectively. Stabilization by a bridging diphosphine ligand allows characterization of a Rh hydride species by advanced NMR techniques and may provide insight into possible elementary steps of H₂ activation by interfacial sites of heterogeneous Rh/C catalysts