Kontinuierliche Spinalanästhesie mit Bupivacain und kombinierte Spinal- Epiduralanästhesie mit Bupivacain supplementiert mit Sufentanil in modifizierter Dosis:zur postoperativen Schmerztherapie nach Totaler Endoprothese der Hüfte im Vergleich - prospektiv-randomisierte klinische Studie -

Fragestellung: Vergleich der CSA mit der CSE bezüglich der Qualität der postop. Analgesie sowie Inzidenz der Nebenwirkungen. Methode: Von 74 Patienten, die sich einer Hüftgelenksimplantation unterzogen, erhielt Gruppe A postop. eine CSA mit 10 ml Bupivacain 0,25 %/24h, Gruppe B eine CSE mit 40 ml Bupivacain 0,25 % und 5 ml Sufenta mite 10 (25 ug) 4 ml/h. Die Effektivität der Analgesie wurde anhand eines Schmerzfragebogens erfasst, Nebenwirkungen/Komplikationen dokumentiert. Ergebnis: Am OP-Tag und am 1. postop. Tag zeigte die Auswertung des Fragebogens ein signifikant niedrigeres Schmerzniveau bei CSE. Fazit: Die CSE und die CSA erwiesen sich als sichere Verfahren. Die CSE war am OP-Tag und 1. postop. Tag das effektivere Verfahren

Rock snot and lake mud: exploring the history of recent blooms of didymosphenia geminata using information contained in lake sediments

Ecosystem managers have often considered the nuisance diatom species, Didymosphenia gemi¬nata (didymo) as being introduced to the natural environment through human activities; however, observations from early 20th-century surveys challenge this characterization. We use diatoms pre¬served in lake sediment cores to investigate the history of didymo blooms from Gaspésie, Quebec. Relative abundances of diatoms were examined from the dated sediments of Lac Humqui and Lac au Saumon (a lake with an inflowing river currently supporting blooms). Didymo was observed throughout the Lac au Saumon core, demonstrating that it has been present in the region well before the first reports of blooms in 2006. Lac Humqui diatom assemblages experienced a shift in composition with declines in benthic taxa (attached to substrates) and increases in planktonic (free floating) diatoms that began ~1970. Strong relationships between this diatom shift, and increases in regional air temperatures and earlier river ice-out dates were consistent with the expected effects of climate warming on aquatic systems. Our paleolimnological evidence shows that climate warming, rather than human introduction, likely plays an important role in triggering didymo blooms

Geriatric patients' expectations of their physicians: findings from a tertiary care hospital in Pakistan

<p>Abstract</p> <p>Background</p> <p>Geriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric patients from their physicians and the factors associated with patient satisfaction in this particular age bracket.</p> <p>Methods</p> <p>A cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pre-tested questionnaires. All consenting individuals aged 65 years or above were recruited into the study. Convenience sampling was used to draw the sample. The data was analyzed using SPSS version 16. Geriatric patient's expectations from physicians were elicited using a set of 11 questions that were graded on a scale of 1-3 where 1 = not important, 2 = important, 3 = very important.</p> <p>Results</p> <p>Three hundred and eighty geriatric patients were interviewed. The response rate of this study was 89.8%. The mean age of the respondents was 73.4 ± 6.8 years. Two hundred and forty eight respondents (65.3%) were female. Diabetes mellitus (53.7%), hypertension (59.5%), arthritis (40.5%) and renal disease (32.1%) were common ailments among geriatric patients. More than 50% of the patients were visiting their physicians once every two to three months. Discussing treatment options and letting patients make the final decision (79.2%), prescribing minimum possible medications (84.5%), physician's holistic knowledge about the spectrum of care issues for geriatric patients (79.2%), being given a realistic but optimistic picture of future health by physicians (85.5%) were ranked as very important expectations by patients from their physicians. Cumulative household income (p = 0.005), most important health complaint (p = 0.01) and frequency of experiencing health complaint (p < 0.001) emerged as independent predictors of the satisfaction of geriatric patients from care provided by physicians.</p> <p>Conclusion</p> <p>We have documented the expectations of the geriatric patients from their physicians in a developing country. Physicians belonging to all disciplines should keep these expectations in mind during clinical encounters with geriatric patients.</p

Arctic Holocene proxy climate database &ndash; New approaches to assessing geochronological accuracy and encoding climate variables

We present a systematic compilation of previously published Holocene proxy climate records from the Arctic. We identified 170 sites from north of 58° N latitude where proxy time series extend back at least to 6 cal ka (all ages in this article are in calendar years before present - BP), are resolved at submillennial scale (at least one value every 400 ± 200 years) and have age models constrained by at least one age every 3000 years. In addition to conventional metadata for each proxy record (location, proxy type, reference), we include two novel parameters that add functionality to the database. First, "climate interpretation" is a series of fields that logically describe the specific climate variable(s) represented by the proxy record. It encodes the proxy-climate relation reported by authors of the original studies into a structured format to facilitate comparison with climate model outputs. Second, "geochronology accuracy score" (chron score) is a numerical rating that reflects the overall accuracy of 14C-based age models from lake and marine sediments. Chron scores were calculated using the original author-reported 14C ages, which are included in this database. The database contains 320 records (some sites include multiple records) from six regions covering the circumpolar Arctic: Fennoscandia is the most densely sampled region (31% of the records), whereas only five records from the Russian Arctic met the criteria for inclusion. The database contains proxy records from lake sediment (60%), marine sediment (32%), glacier ice (5%), and other sources. Most (61%) reflect temperature (mainly summer warmth) and are primarily based on pollen, chironomid, or diatom assemblages. Many (15%) reflect some aspect of hydroclimate as inferred from changes in stable isotopes, pollen and diatom assemblages, humification index in peat, and changes in equilibrium-line altitude of glaciers. This comprehensive database can be used in future studies to investigate the spatio-temporal pattern of Arctic Holocene climate changes and their causes. The Arctic Holocene data set is available from NOAA Paleoclimatology. © Author(s) 2014

Climate-driven regime shifts in the biological communities of arctic lakes

Fifty-five paleolimnological records from lakes in the circumpolar Arctic reveal widespread species changes and ecological reorganizations in algae and invertebrate communities since approximately anno Domini 1850. The remoteness of these sites, coupled with the ecological characteristics of taxa involved, indicate that changes are primarily driven by climate warming through lengthening of the summer growing season and related limnological changes. The widespread distribution and similar character of these changes indicate that the opportunity to study arctic ecosystems unaffected by human influences may have disappeared. © 2005 by The National Academy of Sciences of the USA