Základy půdní úrodnosti

Zvyšování půdní úrodnosti bylo pro průkopníky ekologického zemědělství základem veškerého jejich úsilí. Přesto zachování úrodné půdy mnohdy nebyla věnována dostatečná pozornost. Ekologické zemědělství je však na přirozené půdní úrodnosti závislé. Oslabená a poškozená půda nám nemůže poskytnout to, co od ní očekáváme. Udržet úrodnost půdy vyžaduje velkou péči. Předkládaná brožura ukazuje půdní úrodnost z různých úhlů pohledu. Naším záměrem však nebylo vytvořit obecně platný „návod k použití“. Informace mají být mnohem spíše podnětem k tomu, aby se o vztahu člověka k půdě smýšlelo jinak a aby se tento vztah utvářel ve prospěch budoucnosti

Grundlagen zur Bodenfruchtbarkeit - Die Beziehung zum Boden gestalten

Die Broschüre beleuchtet die Bodenfruchtbarkeit aus verschiedenen wissenschaftlichen und bäuerlichen Blickwinkeln. Die Informationen wollen praktische Beobachtungen der Landwirte ergänzen und dazu anregen, die Beziehung zum Boden zu überdenken und eine wirklich nachhaltige Bodenkultur zu praktizieren

A system for improving the rating of small and medium-sized companies

Im ersten Kapitel wird in die Thematik dieser Diplomarbeit eingeführt, es sollen die vorherrschenden Probleme erörtert werden. Anschließend wird klar definiert, welche Themen in dieser Diplomarbeit behandelt werden. Im Kapitel „Gang der Untersuchung“ wird erläutert, wie sich der gewählte Aufbau und die Struktur dieser Arbeit zusammensetzen. Zum Abschluss werden einige grundlegende Begriffe erklärt, die fundamental für das Verständnis dieser Arbeit sin

Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Background Pain relief in the prehospital setting is often insufficient, as the administration of potent intravenous analgesic drugs is mostly reserved to physicians. In Australia, inhaled methoxyflurane has been in routine use by paramedics for decades, but experience in Central European countries is lacking. Thus, we aimed to assess whether user friendliness and effectiveness of inhaled methoxyflurane as sole analgesic match the specific capabilities of local ground and air-based EMS systems in Austria. Methods Observational study in adult trauma patients (e.g. dislocations, fracture or low back pain following minor trauma) with moderate to severe pain (numeric rating scale [NRS] ≥4). Included patients received a Penthrop® inhaler containing 3 mL of methoxyflurane (maximum use 30 min). When pain relief was considered insufficient (NRS reduction < 3 after 10 min), intravenous analgesics were administered by an emergency physician. The primary endpoint was effectiveness of methoxyflurane as sole analgesic for transport of patients. Secondary endpoints were user friendliness (EMS personell), time to pain relief, vital parameters, side effects, and satisfaction of patients. Results Median numeric pain rating was 8.0 (7.0–8.0) in 109 patients. Sufficient analgesia (reduction of NRS ≥3) was achieved by inhaled methoxyflurane alone in 67 patients (61%). The analgesic effect was progressively better with increasing age. Side effects were frequent (n = 58, 53%) but mild. User satisfaction was scored as very good when pain relief was sufficient, but fair in patients without benefit. Technical problems were observed in 16 cases (14.7%), mainly related to filling of the inhaler. In every fifth use, the fruity smell of methoxyflurane was experienced as unpleasant. No negative effects on vital signs were observed. Conclusion In prehospital use, inhaled methoxyflurane as sole analgesic is effective for transport of trauma patients (62%) with moderate to severe pain. Older patients benefit especially from inhaled methoxyflurane. Side effects are mild and vital parameters unaffected. Thus, inhaled methoxyflurane could be a valuable device for non-physician EMS personnel rescue services also in the central Europe region.publishedVersio

Comparing the McGrath Mac Video Laryngoscope and Direct Laryngoscopy for Prehospital Emergency Intubation in Air Rescue Patients: A Multicenter, Randomized, Controlled Trial

Objectives: Tracheal intubation in prehospital emergency care is challenging. The McGrath Mac Video Laryngoscope (Medtronic, Minneapolis, MN) has been proven to be a reliable alternative for in-hospital airway management. This trial compared the McGrath Mac Video Laryngoscope and direct laryngoscopy for the prehospital setting. Design: Multicenter, prospective, randomized, controlled equivalence trial. Setting: Oesterreichischer Automobil- und Touring Club (OEAMTC) Helicopter Emergency Medical Service in Austria, 18-month study period. Patients: Five-hundred fourteen adult emergency patients (≥ 18 yr old). Interventions: Helicopter Emergency Medical Service physicians followed the institutional algorithm, comprising a maximum of two tracheal intubation attempts with each device, followed by supraglottic, then surgical airway access in case of tracheal intubation failure. No restrictions were given for tracheal intubation indication. Measurements Main Results: The Primary outcome was the rate of successful tracheal intubation; equivalence range was ± 6.5% of success rates. Secondary outcomes were the number of attempts to successful tracheal intubation, time to glottis passage and first end-tidal Co2 measurement, degree of glottis visualization, and number of problems. The success rate for the two devices was equivalent: direct laryngoscopy 98.5% (254/258), McGrath Mac Video Laryngoscope 98.1% (251/256) (difference, 0.4%; 99% CI, –2.58 to 3.39). There was no statistically significant difference with regard to tracheal intubation times, number of attempts or difficulty. The view to the glottis was significantly better, but the number of technical problems was increased with the McGrath Mac Video Laryngoscope. After a failed first tracheal intubation attempt, immediate switching of the device was significantly more successful than after the second attempt (90.5% vs 57.1%; p = 0.0003), regardless of the method. Conclusions: Both devices are equivalently well suited for use in prehospital emergency tracheal intubation of adult patients. Switching the device following a failed first tracheal intubation attempt was more successful than a second attempt with the same device. Tracheal intubation (TI) remains the golden, but challenging and rare (2–12%) standard of care for securing the airway and ensuring appropriate ventilation in the prehospital emergency setting (1–4). Lacking routine (even < 12 intubations per physician and year) and the specific prehospital setting (5–7) may contribute to difficult TIs, with the literature documenting up to 50% as being impossible (8–10). Consequently, identification of devices that may facilitate TI appears to be of utmost importance. Presently, video laryngoscopes (VLs) are considered to be effective alternatives to direct laryngoscopes (DLs) when a difficult airway is presumed (11,12). Yet, in-hospital findings, even in the emergency department (13), as well as manikin studies (14,15) obviously may not be transferred to the prehospital setting. The few available randomized controlled trials (RCTs) evaluating VL there (16–18) failed to prove superiority or at least equality to DL. Nevertheless, VL have become part of standard Emergency Medical Service (EMS) equipment (19–21). The Austrian Air Rescue provider OEAMTC (Austrian Automobile, Motorcycle and Touring Club) implemented the McGrath Mac VL (McGrathVL; Medtronic, Minneapolis, MN) for prehospital airway management in its Helicopter EMS (HEMS) program in 2015. This offered the opportunity to compare the McGrathVL and the DL for prehospital TI in the skilled hands of the OEAMTC HEMS crews. The hypothesis of this multicenter, RCT was that both the McGrathVL and the DL (Medicon, Tuttlingen, Germany) have equivalent success rates for TI in the prehospital emergency environment. Primary outcome was the TI success rate for each device. Secondary outcome variables were the total number of TI attempts, time until passage of the tracheal tube through the glottis and to first end-tidal Co2 as a surrogate variable for successful TI. Additionally, the median category of visualization of the glottis, the median category of HEMS physician’s subjective assessment of TI performance, technical difficulties, and any harm during TI were documented.publishedVersio

UDP-Glucosyltransferases from Rice, Brachypodium, and Barley: Substrate Specificities and Synthesis of Type A and B Trichothecene-3-O-β-d-glucosides

Trichothecene toxins are confirmed or suspected virulence factors of various plant-pathogenic Fusarium species. Plants can detoxify these to a variable extent by glucosylation, a reaction catalyzed by UDP-glucosyltransferases (UGTs). Due to the unavailability of analytical standards for many trichothecene-glucoconjugates, information on such compounds is limited. Here, the previously identified deoxynivalenol-conjugating UGTs HvUGT13248 (barley), OsUGT79 (rice) and Bradi5g03300 (Brachypodium), were expressed in E. coli, affinity purified, and characterized towards their abilities to glucosylate the most relevant type A and B trichothecenes. HvUGT13248, which prefers nivalenol over deoxynivalenol, is also able to conjugate C-4 acetylated trichothecenes (e.g., T-2 toxin) to some degree while OsUGT79 and Bradi5g03300 are completely inactive with C-4 acetylated derivatives. The type A trichothecenes HT-2 toxin and T-2 triol are the kinetically preferred substrates in the case of HvUGT13248 and Bradi5g03300. We glucosylated several trichothecenes with OsUGT79 (HT-2 toxin, T-2 triol) and HvUGT13248 (T-2 toxin, neosolaniol, 4,15-diacetoxyscirpenol, fusarenon X) in the preparative scale. NMR analysis of the purified glucosides showed that exclusively β-D-glucosides were formed regio-selectively at position C-3-OH of the trichothecenes. These synthesized standards can be used to investigate the occurrence and toxicological properties of these modified mycotoxins.© 2018 by the author

Elucidation of the genetic causes of bicuspid aortic valve disease.

AIMS The present study aims to characterize the genetic risk architecture of bicuspid aortic valve (BAV) disease, the most common congenital heart defect. METHODS AND RESULTS We carried out a genome-wide association study (GWAS) including 2236 BAV patients and 11 604 controls. This led to the identification of a new risk locus for BAV on chromosome 3q29. The single nucleotide polymorphism rs2550262 was genome-wide significant BAV associated (P = 3.49 × 10-08) and was replicated in an independent case-control sample. The risk locus encodes a deleterious missense variant in MUC4 (p.Ala4821Ser), a gene that is involved in epithelial-to-mesenchymal transformation. Mechanistical studies in zebrafish revealed that loss of Muc4 led to a delay in cardiac valvular development suggesting that loss of MUC4 may also play a role in aortic valve malformation. The GWAS also confirmed previously reported BAV risk loci at PALMD (P = 3.97 × 10-16), GATA4 (P = 1.61 × 10-09), and TEX41 (P = 7.68 × 10-04). In addition, the genetic BAV architecture was examined beyond the single-marker level revealing that a substantial fraction of BAV heritability is polygenic and ∼20% of the observed heritability can be explained by our GWAS data. Furthermore, we used the largest human single-cell atlas for foetal gene expression and show that the transcriptome profile in endothelial cells is a major source contributing to BAV pathology. CONCLUSION Our study provides a deeper understanding of the genetic risk architecture of BAV formation on the single marker and polygenic level

Simulation-based training of the rapid evaluation and management of acute stroke (stream)—a prospective single-arm multicenter trial

Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2–3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period. Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the “door-to-needle” time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire. Interventions: We are applying a multi-level intervention in cooperation with three “STREAM multipliers” from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2–3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings. Clinical Trial Registration: STREAM is a registered trial at https://clinicaltrials.gov/ct2/show/NCT03228251

I Fondamenti della fertilità del terreno

La fertilità del suolo è riconosciuta come valore fondante sin dai pionieri dell'agricoltura biologica ma, ancor oggi, alla conservazione di un suolo fertile non viene attribuita abbastanza attenzione. Eppure l'agricoltura biologica dipende da una buona e naturale fertilità del suolo