Разработка научного обоснования оптимизации природопользования особо охраняемых природных территорий регионального значения

В условиях Кемеровской области, где большая часть территорий распределена между природопользователями, организация мероприятий по ограничению хозяйственного использования на новых участках крайне затруднительна. В этой связи единственным реальным подходом снижения комплексных антропогенных воздействий, в том числе и рекреационных, может быть разработка и внедрение новых механизмов оптимизации сохранения природных комплексов.In the Kemerovo region, where most of the territories are distributed among nature users, the organization of measures to limit economic use in new areas is extremely difficult. In this regard, the only realistic approach to reducing complex anthropogenic impacts, including recreational ones, can be the development and implementation of new mechanisms for optimizing the conservation of natural complexes

TELnet@NRW

Germany’s socio-demographic challenges are reflected in a growing discrepancy between the supply and demand of medical services: the demand is constantly growing but meets limited and insufficient human resources. Taking these obstacles into account, telemedicine is a possible solution to face the sociodemographic challenges of the 21st century. Telemedicine offers innovative approaches to achieve long-term quality in healthcare. On the basis of the TELnet@NRW best-practice project, the requirements and potentials of tele-intensive care medicine were demonstrated, and then implemented in practice. TELnet@NRW shows that telemedical procedures improve the interdisciplinary exchange and thus increase quality and efficiency in health care. These care optimizations lead to increased quality of life for patients and ensure medical expertise also in remote areas at the same time. With the nationwide establishment of telemedical applications, new structures are being created in our healthcare system, which will enable a more efficient use of existing resources. TELnet@NRW was funded with €19.5 million from February 2017 to January 2020. Experts of the Aachen and Münster university hospitals, together with 17 cooperating hospitals and two physician networks, conducted daily expert teleconsultations. In order to improve evidence-based care, availability is provided 24/7, 365 days per year, accompanied by regular training for doctors and nursing staff. Communication takes place via a highly encrypted audio-video conference system and a certified data-exchange platform FallAkte Plus. The aim of TELnet@NRW was to establish a cross-sector telemedical network as a new digital form of care. A more than 150,000 patients were included in TELnet@NRW. With TELnet@NRW, we have taken a major step towards a sustainable healthcare system that allows us to provide patients with top quality health care close to their homes.Die soziodemographischen Herausforderungen in Deutschland spiegeln sich in einer wachsenden Diskrepanz zwischen Nachfrage und Angebot medizinischer Leistungen wider. Der steigenden Nachfrage steht eine begrenzte und unzureichende personelle Ressource gegenüber. Unter Berücksichtigung dieser Hindernisse ist die Telemedizin eine mögliche Option, den soziodemographischen Herausforderungen des 21. Jahrhunderts mit innovativen Ansätzen zur langfristigen Qualitätssicherung und -verbesserung zu begegnen. Anhand des Best-Practice-Projekts TELnet@NRW werden die Anforderungen und Potenziale in der Tele-Intensivmedizin aufgezeigt und praktisch umgesetzt. TELnet@NRW zeigt, dass telemedizinische Verfahren den interdisziplinären Austausch verbessern und dadurch eine Steigerung von Qualität und Effizienz in der Gesundheitsversorgung hervorrufen. Diese System- und Versorgungsoptimierungen führen zu einem Anstieg an Lebensqualität bei den Patientinnen und Patienten und sichern zu gleich die medizinische Expertise in der Fläche. Mit der flächendeckenden Etablierung von telemedizinischen Anwendungen werden neue Strukturen im Gesundheitswesen geschaffen, die eine effizientere Nutzung der vorhandenen Ressourcen ermöglichen. TELnet@NRW wurde in dem Zeitraum von Februar 2017 bis Januar 2020 mit einer Summe von ca. 20 Mio. € gefördert. Die Experten der beiden Universitätskliniken Aachen und Münster führen gemeinsam mit den 17 Kooperationskrankenhäusern und zwei Ärztenetzen tagtäglich Televisiten und -konsile durch. Eine 24/7/365 Verfügbarkeit, begleitet von regelmäßigen Schulungen für Ärzte und Pflegepersonal, die auf eine Verbesserung der evidenzbasierten Versorgung abzielen, wurde bereitgestellt. Die Kommunikation erfolgte über ein hochverschlüsseltes Audio-Video-Konferenzsystem und die zertifizierte Datenaustauschplattform FallAkte Plus. Ziel von TELnet@NRW ist der Aufbau eines sektorenübergreifenden telemedizinischen Netzwerks als neue digitale Versorgungsform. Insgesamt wurden mehr als 150.000 Patienten in TELnet@NRW eingeschlossen. Mit TELnet@NRW konnte ein großer Schritt in Richtung zukunftssicherer Gesundheitsversorgung gemacht werden und das heißt für uns, den Patientinnen und Patienten eine qualitativ hochwertige Spitzenversorgung in Wohnortnähe zu ermöglichen

Welcome: Representative DGAI and German Society for Telemedicine

Leopoldina Symposium Mission – Innovation: Telematics, eHealth and High-Definition Medicine in Patient-Centered Acute Medicine, Berlin, February 28th and 29th, 2020 - Openin

Clean and efficient extraction of copper ions and deposition as metal

AbstractA simple, clean and efficient one-pot process is offered as an alternative to the conventional complex processing presently used to extract copper ions from copper containing materials, like copper concentrate or slag, and to form copper metal. The alternative process uses a eutectic molten salt of potassium chloride, sodium chloride and zinc chloride as the reaction fluid which is recyclable, low in cost, environmentally benign, low melting (melting point 204°), high boiling (vapor pressure is only a few psi at 800°) and chemically, thermally and physically stable. The metal completely dissolves out of copper concentrate or slag in the aerobic eutectic molten chloride salt in a graphite or glassy carbon pot, which serves as a cathode, with a graphite anode, to reduce the metal ions to metal which sinks to the bottom of the graphite pot. The total efficiency for extraction and deposition is virtually 100% as determined by elemental and gravimetric analyses

Fluid-induced coagulopathy: does the type of fluid make a difference?

Crystalloid and colloid solutions are used for resuscitation of the critically ill. One set of options, widely used today, are different preparations of hydroxyethyl starch (HES). However, the safety of HES regarding impairment of blood coagulation remains incompletely elucidated, a circumstance that limits its clinical use. Understanding mechanisms and potential differences between low-molecular and low-substituted HES and other HES solutions seems clinically relevant

Efficacy and safety of early target-controlled plasma volume replacement with a balanced gelatine solution versus a balanced electrolyte solution in patients with severe sepsis/septic shock: study protocol, design, and rationale of a prospective, randomized, controlled, double-blind, multicentric, international clinical trial

Col·loides; Gelatina; SèpsiaColoides; Gelatina; SepticemiaColloids; Gelatine; SepsisBackground Sepsis is associated with capillary leakage and vasodilatation and leads to hypotension and tissue hypoperfusion. Early plasma volume replacement is required to achieve haemodynamic stability (HDS) and maintain adequate tissue oxygenation. The right choice of fluids to be used for plasma volume replacement (colloid or crystalloid solutions) is still a matter of debate, and large trials investigating the use of colloid solutions containing gelatine are missing. This study aims to investigate the efficacy and safety of plasma volume replacement using either a combined gelatine-crystalloid regime (1:1 ratio) or a pure crystalloid regime. Methods This is a prospective, controlled, randomized, double-blind, international, multicentric phase IV study with two parallel groups that is planned to be conducted at European intensive care units (ICUs) in a population of patients with hypovolaemia in severe sepsis/septic shock. A total of 608 eligible patients will be randomly assigned to receive either a gelatine-crystalloid regime (Gelaspan® 4% and Sterofundin® ISO, B. Braun Melsungen AG, in a 1:1 ratio) or a pure crystalloid regime (Sterofundin® ISO) for plasma volume replacement. The primary outcome is defined as the time needed to achieve HDS. Plasma volume replacement will be target-controlled, i.e. fluids will only be administered to volume-responsive patients. Volume responsiveness will be assessed through passive leg raising or fluid challenges. The safety and efficacy of both regimens will be assessed daily for 28 days or until ICU discharge (whichever occurs first) as the secondary outcomes of this study. Follow-up visits/calls will be scheduled on day 28 and day 90. Discussion This study aims to generate evidence regarding which regimen—a gelatine-crystalloid regimen or a pure crystalloid regimen—is more effective in achieving HDS in critically ill patients with hypovolaemia. Study participants in both groups will benefit from the increased safety of target-controlled plasma volume replacement, which prevents fluid administration to already haemodynamically stable patients and reduces the risk of harmful fluid overload.In this clinical study, B. Braun Melsungen AG, Carl-Braun Str. 1, D-34212 Melsungen acts as the sponsor, funder and data holder of this study. Additionally, it is the manufacturer of IMP, as well as the co-author and medical writer of this manuscript. B. Braun Melsungen AG organized protocol development and contracted a contract research organization (CRO) for clinical trial application, monitoring, and collection/analysis of study data. Investigational tests and reference products will be produced and delivered by B. Braun Melsungen AG to all participating sites. Open Access funding enabled and organized by Projekt DEAL