Bispectral index versus COMFORT score to determine the level of sedation in paediatric intensive care unit patients: a prospective study

INTRODUCTION: Most clinicians give sedatives and analgesics according to their professional experience and the patient's estimated need for sedation. However, this approach is prone to error. Inadequate monitoring of sedation and analgesia may contribute to adverse outcomes and complications. With this in mind, data obtained continuously using nonstimulating methods such as bispectral index (BIS) may have benefits in comparison with clinical monitoring of sedation. The aim of this prospective observational trial was to evaluate the use of electroencephalographic (EEG) BIS for monitoring sedation in paediatric intensive care unit (PICU) patients. METHODS: Forty paediatric patients (<18 years) were sedated for mechanical ventilation in a cardiac surgical and general PICU. In each paediatric patient BIS and COMFORT score were obtained. The study protocol did not influence ongoing PICU therapy. BIS and corresponding COMFORT score were collected three times for each patient. Measurements with the best starting EEG impedances were analyzed further. Deep sedation was defined as a COMFORT score between 8 and 16, and light sedation as a score between 17 and 26. Biometric and physiological data, and Pediatric Risk of Mortality III scores were also recorded. RESULTS: There was a good correlation (Spearman's rho 0.651; P = 0.001) between BIS and COMFORT score in the presence of deep sedation and low starting impedance. Receiver operating characteristic (ROC) analysis revealed best discrimination between deep and light sedation at a BIS level of 83. CONCLUSION: In the presence of deep sedation, BIS correlated satisfactorily with COMFORT score results if low EEG impedances were guaranteed

False Hopes, Missed Opportunities: How Economic Models Affect the IPCC Proposals in Special Report 15 “Global Warming of 1.5 °C” (2018). An Analysis From the Scientific Advisory Board of BUND

The 2018 IPCC Special Report SR15 developed four scenarios how temperature increases could either be limited to 1.5°, or, in the case of overshoot, could be brought back to that level by 2100. However, the Carbon Dioxide Removal options discussed to achieve “negative emissions” will affect not only the climate system, but also biodiversity and the ecosystem services it provides. Unfortunately, the Integrated Assessment Models, and in particular the economic models incorporated in them were capable of integrating only a selective fraction of these effects, and ignore potential tipping points triggering irreversible processes, policies beyond economic instruments and consumption changes to happen over the next 80 years. Our analysis is based on an interdisciplinary expert elicitation, analysing the options suggested by the IPCC one by one. We find that most of them are associated with biodiversity loss, hazardous chemicals dispersion, enhanced energy consumption and/or other severe other damages. We suggest which measures can be applied sustainably, which should be dropped, and which additional ones have been omitted by the report

Factors associated with worse lung function in cystic fibrosis patients with persistent staphylococcus aureus

Background Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads. Methods Therefore, we conducted an observational prospective longitudinal multi-center study and assessed the association between lung function and S. aureus bacterial density in respiratory samples, co-infection with other CF-pathogens, nasal S. aureus carriage, clinical status, antibiotic therapy, IL-6- and IgG-levels against S. aureus virulence factors. Results 195 patients from 17 centers were followed; each patient had an average of 7 visits. Data were analyzed using descriptive statistics and generalized linear mixed models. Our main hypothesis was only supported for patients providing throat specimens indicating that patients with higher density experienced a steeper lung function decline (p<0.001). Patients with exacerbations (n = 60), S. aureus small-colony variants (SCVs, n = 84) and co-infection with Stenotrophomonas maltophilia (n = 44) had worse lung function (p = 0.0068; p = 0.0011; p = 0.0103). Patients with SCVs were older (p = 0.0066) and more often treated with trimethoprim/sulfamethoxazole (p = 0.0078). IL-6 levels positively correlated with decreased lung function (p<0.001), S. aureus density in sputa (p = 0.0016), SCVs (p = 0.0209), exacerbations (p = 0.0041) and co-infections with S. maltophilia (p = 0.0195) or A. fumigatus (p = 0.0496). Conclusions In CF-patients with chronic S. aureus cultures, independent risk factors for worse lung function are high bacterial density in throat cultures, exacerbations, elevated IL-6 levels, presence of S. aureus SCVs and co-infection with S. maltophilia

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Naturnahe Entwicklung der Wälder in Hessen : Leitfaden für die Beteiligung von Vertretern der Naturschutzverbände an Forsteinrichtungsverfahren im Rahmen des § 29 Bundesnaturschutzgesetz / hrsg. von der Botanischen Vereinigung für Naturschutz in Hessen (BVNH) und dem Bund für Umwelt und Naturschutz Deutschland (BUND). Jochen Godt ...

Die Hessische Landesforstverwaltung hat mit Erlaß vom 14.4.1983 - Az.: III B 3 - 3378 - F 36 - die Verbandsbeteiligung gemäß § 29 Bundesnaturschutzgesetz freiwillig auf die Mitwirkung im Forsteinrichtungsverfahren erweitert. Damit haben erstmalig in der Bundesrepublik Deutschland Naturschutzverbände auch Gelegenheit, direkt bei dieser wichtigen forstlichen Planung aktiv mitzuwirken. Es ist das Anliegen der Naturschutzverbände, auch bei der Bewirtschaftung der Wälder ökologische Wertvorstellungen zu verankern. Zwar gilt Wald als besonders naturnahe Form von Landbewirtschaftung, dennoch wissen wir, daß auch jede noch so naturnahe Bewirtschaftung von Waldbeständen mit einem erheblichen Artenverlust verbunden ist. Darüber hinaus möchten die Naturschutzverbände alle Bemühungen unterstützen, den Laubwaldanteil in hessischen Wäldern zu erhalten und langfristig wieder zu erhöhen, denn die ursprünglichen, natürlichen Wälder Hessens sind nun einmal - auf ganz wenigen Standorten in Südhessen ausgenommen - reine Laubwälder, die den typischen, ursprünglichen Lebensraum für fast alle bei uns heimischen Waldpflanzen und -tiere darstellen. Die Verbände verkennen dabei nicht, daß auf vielen Standorten die nicht heimischen Nadelbaumarten einen wichtigen Beitrag zur Versorgung mit einem nachwachsenden, unentbehrlichen Rohstoff darstellen. Für einen ökologisch orientierten Waldbau ist aber wesentlich, daß - die noch vorhandenen Laubwaldflächen als solche erhalten bleiben, - keine Nadelwald-Reinbestände mehr begründet werden, - die naturnahen Laubwaldreste im Rahmen des bundesweiten Naturwaldreservate-Programms gesichert werden, - von der Kahlschlagwirtschaft Abstand genommen und naturnahe Waldbewirtschaftung verbindlich gemacht wird und - der Totholzanteil im Laubwald landesweit deutlich erhöht wird. In diesem Sinne verstehen die Verfasser diesen Leitfaden, der für mehr "Naturschutz im Walde" und für eine konstruktive Zusammenarbeit zwischen Forstleuten und Naturschützern in Hessen führen sollte

Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study.

ObjectiveThe aim of this study was to examine the incidence trends of type 1 diabetes diagnosed with ketoacidosis in Saxony, Germany from 1999 to 2016.MethodsThe population based Childhood Diabetes Registry of Saxony comprising valid data for all children aged 0-14 years diagnosed with type 1 diabetes from1999 to 2016 were used for the analyses. Direct age-standardized incidence rates were calculated and the effects of age, sex, calendar year, home districts and family history of any types of diabetes on the incidence were modelled using Poisson regression. Trend analyses for standard rate ratios of children with moderate and severe diabetic ketoacidosis versus children with type 1 diabetes with non-diabetic ketoacidosis were performed using join point regression.ResultsThe rate of ketoacidosis at the time of the type 1 diabetes diagnosis was high with 35.2% during the entire observation period in Saxony. The Poisson regression analysis indicated a statistically significant increased occurrence of diabetic ketoacidosis for younger age-groups, but no statistically significant differences between boys and girls. The join point trend analyses show that the proportion of severe and moderate ketoacidosis is increasing disproportionally to the increase in incidence of type 1 diabetes over the years.ConclusionDue to the observed increasing incidence of diabetes as well of diabetic ketoacidosis, an educational prevention campaign is needed in Saxony as soon as possible to aid pediatricians, general physicians as well as general public to identify the early signs of type 1 diabetes