Der Stellenwert von Midazolam als Komponente in einem modernen Sedierungskonzept von postoperativ nachbeatmeten, allgemeinchirurgischen Patienten

Hintergrund. Die in der Intensivmedizin häufig angewendete analgetische und sedative Therapie ist assoziiert mit einer Immobilisation des Patienten, einer erhöhten Morbidität, einer verlängerten Beatmungszeit, einer verlängerten Krankenhausverweildauer und erhöhten Krankheitskosten. Die meisten Sedierungsprotokolle basieren auf der Verwendung von Benzodiazepinen mit einer mittleren oder langen Halbwertszeit, welche ein zügiges Weaning verhindern. Das Ziel unserer Studie ist, ein alternatives, Benzodiazepin-freies Sedierungsprotokoll zu entwerfen. Material und Methoden. Im Jahr 2008 wurden 134 Patienten mittels eines konventionellen Sedierungsprotokolls unter Verwendung von Benzodiazepinen und Propofol behandelt (Kohorte2008>72+). Im Jahr 2009 haben wir eine neue Sedierungsstrategie eingeführt, welche auf der Verwendung von Sufentanil, nichtsteroidalen Antirheumatika, Neuroleptika und Antidepressiva beruht. Diese wurde an 140 Patienten angewandt (Kohorte2009>72-). Die Phase in tiefer Sedierung, die Dauer der maschinellen Beatmung, sowie die Verweildauer auf Intensivstation und im Krankenhaus wurden retrospektiv analysiert. Die statistischen Berechnungen wurden unter Anwendung des Log-Rank-Tests und des Wald-Chi-Quadrat-Tests auf Signifikanz überprüft. Ergebnisse. Kohorte2008>72+ zeigt im Vergleich zur Kohorte2009>72- sowohl eine längere Phase in tiefer Sedierung (18,7±2,5 Tage vs 12,6±1,85 Tage, p=0,031) als auch eine längere, kontrollierte Beatmungsdauer (311,35±32,69 vs 143,96±20,76 Stunden, p<0,0001). Des Weiteren tendiert Kohorte2008 auch zu einer längeren, insgesamten Beatmungsphase als Kohorte2009 (653,66±98,37 Stunden vs 478,89±68,92 Stunden, p=0,128). Die mittlere Verweildauer auf Intensivstation lag im Jahr 2008 bei 35,30±4,26 Tagen und im Jahr 2009 bei 33,24±2,93 Tagen (n.s.). Die mittlere Krankenhausverweildauer betrug in Kohorte2008 57,0±9,8 Tage und in Kohorte2009 64,3±8,1 Tage (n.s.). Schlussfolgerung. Ein Benzodiazepin-freies Sedierungsprotokoll verkürzt sowohl die Phase der tiefen Sedierung als auch die Dauer der kontrollierten Beatmung. Es werden jedoch größer angelegte Studien benötigt, um zu untersuchen, ob dieses neue Protokoll auch die Beatmungstage insgesamt signifikant reduzieren kann

Bauelementarchitekturen für Polymer-Tandemsolarzellen

Der Schwerpunkt dieser Arbeit liegt auf der Entwicklung von Tandemsolarzellen, einem vielversprechenden Konzept zum Erreichen konkurrenzfähiger Wirkungsgrade in der organischen Photovoltaik. Während organische Tandemsolarzellen auf Basis von vakuumsublimierten kleinen Molekülen derzeit zur Marktreife gebracht werden, werden hier halbleitende Polymere verwendet, die eine potentiell kostengünstige Rolle-zu-Rolle-Fertigung von Solarmodulen mittels Druck- und Beschichtungsprozessen ermöglichen

Survival, functional outcome and satisfaction of first revision total knee arthroplasty at a mean eleven-year follow-up.

PURPOSE Providing long-term outcome data after rTKA and compare one- versus two-stage and septic versus aseptic revisions. METHODS This study represents a single-center retrospective study of first rTKAs performed for any reason with a final follow-up of a minimum of five years. Outcome parameters included stability assessment ROM, radiologic assessment, HSS score, KSS score, OKS score, EQ-5D-3L and VAS. 44 patients were included in the study. Subgroups analysis of one- versus two-stage revision and septic versus aseptic revision was performed. RESULTS The leading causes of rTKA in this mean 11 year follow-up study were aseptic loosening (36%) and periprosthetic joint infection (27%). At the final follow-up, there was a 89% survivorship of the implants. Patients showed a ROM of 114 ± 13°, HSS score of 78 ± 12, KKS objective score of 77 ± 16, KSS expectation and satisfaction score of 32 ± 11, KSS functional activity score of 50 ± 20, OKS of 30 ± 9, VAS of 53 ± 25 and EQ-5D index of 0.649. Functional outcome scores were not significantly altered in the analyzed subgroups. CONCLUSIONS In our 11 years follow-up, we obtained 89% implant survivorship. Measurements regarding functional outcome and pain showed results in the medium range of the respective scores, while patient satisfaction lay in the upper third. No significant differences in outcome scores between one- and two-stage revisions and septic versus aseptic revisions were observed. Level of Evidence Level III, retrospective cohort study

Indications, clinical outcome and survival of rotating hinge total knee arthroplasty in a retrospective study of 63 primary and revision cases.

PURPOSE The purpose of this study is to report and compare outcome data of both primary and revision cases using a rotating hinge knee (RHK) implant. METHODS This study retrospectively analyzed 63 cases (19 primary, 44 revisions) at a mean follow-up of 34 ± 8 months after RHK implantation. Outcome parameters were stability, range of motion (ROM), loosening, Hospital of Special Surgery Score (HSS), Knee Society Score (KSS), Oxford Knee Score (OKS), EQ-5D-3L, and Visual Analog Scale (VAS) for overall function. Revision rates and implant survival are reported. RESULTS Eleven percent showed medio-lateral instability < 5 mm, a mean ROM of 115° ± 17° and radiologic loosening occurred in 8% (2% symptomatic). PROMS showed the following results: HSS 79 ± 18, KSS 78 ± 27, OKS 26 ± 10, EQ-5D index 0.741 ± 0.233 and VAS 70 ± 20. Primary cases revealed better outcomes in HHS (p = .035) and OKS (p = 0.047). KSS, EQ-5D index and VAS did not differ between primary and revision cases (p = 0.070; p = 0.377; p = 0.117). Revision rate was 6.3% with an implant survival of 96.8%. CONCLUSIONS RHK arthroplasty can be performed with good clinical outcome and low revision rate in revision and complex primary cases. RHK is an option in cases where standard arthroplasty and even implants with a higher degree of constraint have reached their limits. LEVEL OF EVIDENCE Level III, retrospective cohort study

Soil moisture observation in a forested headwater catchment: combining a dense cosmic-ray neutron sensor network with roving and hydrogravimetry at the TERENO site Wüstebach

Cosmic-ray neutron sensing (CRNS) has become an effective method to measure soil moisture at a horizontal scale of hundreds of metres and a depth of decimetres. Recent studies proposed operating CRNS in a network with overlapping footprints in order to cover root-zone water dynamics at the small catchment scale and, at the same time, to represent spatial heterogeneity. In a joint field campaign from September to November 2020 (JFC-2020), five German research institutions deployed 15 CRNS sensors in the 0.4 km2 Wüstebach catchment (Eifel mountains, Germany). The catchment is dominantly forested (but includes a substantial fraction of open vegetation) and features a topographically distinct catchment boundary. In addition to the dense CRNS coverage, the campaign featured a unique combination of additional instruments and techniques: hydro-gravimetry (to detect water storage dynamics also below the root zone); ground-based and, for the first time, airborne CRNS roving; an extensive wireless soil sensor network, supplemented by manual measurements; and six weighable lysimeters. Together with comprehensive data from the long-term local research infrastructure, the published data set (available at https://doi.org/10.23728/b2share.756ca0485800474e9dc7f5949c63b872; Heistermann et al., 2022) will be a valuable asset in various research contexts: to advance the retrieval of landscape water storage from CRNS, wireless soil sensor networks, or hydrogravimetry; to identify scale-specific combinations of sensors and methods to represent soil moisture variability; to improve the understanding and simulation of land–atmosphere exchange as well as hydrological and hydrogeological processes at the hillslope and the catchment scale; and to support the retrieval of soil water content from airborne and spaceborne remote sensing platforms

Soil moisture observation in a forested headwater catchment: combining a dense cosmic-ray neutron sensor network with roving and hydrogravimetry at the TERENO site Wüstebach

Cosmic-ray neutron sensing (CRNS) has become an effective method to measure soil moisture at a horizontal scale of hundreds of metres and a depth of decimetres. Recent studies proposed operating CRNS in a network with overlapping footprints in order to cover root-zone water dynamics at the small catchment scale and, at the same time, to represent spatial heterogeneity. In a joint field campaign from September to November 2020 (JFC-2020), five German research institutions deployed 15 CRNS sensors in the 0.4 km2 Wüstebach catchment (Eifel mountains, Germany). The catchment is dominantly forested (but includes a substantial fraction of open vegetation) and features a topographically distinct catchment boundary. In addition to the dense CRNS coverage, the campaign featured a unique combination of additional instruments and techniques: hydro-gravimetry (to detect water storage dynamics also below the root zone); ground-based and, for the first time, airborne CRNS roving; an extensive wireless soil sensor network, supplemented by manual measurements; and six weighable lysimeters. Together with comprehensive data from the long-term local research infrastructure, the published data set (available at https://doi.org/10.23728/b2share.756ca0485800474e9dc7f5949c63b872; Heistermann et al., 2022) will be a valuable asset in various research contexts: to advance the retrieval of landscape water storage from CRNS, wireless soil sensor networks, or hydrogravimetry; to identify scale-specific combinations of sensors and methods to represent soil moisture variability; to improve the understanding and simulation of land–atmosphere exchange as well as hydrological and hydrogeological processes at the hillslope and the catchment scale; and to support the retrieval of soil water content from airborne and spaceborne remote sensing platforms

Soil moisture observation in a forested headwater catchment: combining a dense cosmic-ray neutron sensor network with roving and hydrogravimetry at the TERENO site Wüstebach

Cosmic-ray neutron sensing (CRNS) has become an effective method to measure soil moisture at a horizontal scale of hundreds of metres and a depth of decimetres. Recent studies proposed operating CRNS in a network with overlapping footprints in order to cover root-zone water dynamics at the small catchment scale and, at the same time, to represent spatial heterogeneity. In a joint field campaign from September to November 2020 (JFC-2020), five German research institutions deployed 15 CRNS sensors in the 0.4 km2 Wüstebach catchment (Eifel mountains, Germany). The catchment is dominantly forested (but includes a substantial fraction of open vegetation) and features a topographically distinct catchment boundary. In addition to the dense CRNS coverage, the campaign featured a unique combination of additional instruments and techniques: hydro-gravimetry (to detect water storage dynamics also below the root zone); ground-based and, for the first time, airborne CRNS roving; an extensive wireless soil sensor network, supplemented by manual measurements; and six weighable lysimeters. Together with comprehensive data from the long-term local research infrastructure, the published data set (available at https://doi.org/10.23728/b2share.756ca0485800474e9dc7f5949c63b872; Heistermann et al., 2022) will be a valuable asset in various research contexts: to advance the retrieval of landscape water storage from CRNS, wireless soil sensor networks, or hydrogravimetry; to identify scale-specific combinations of sensors and methods to represent soil moisture variability; to improve the understanding and simulation of land–atmosphere exchange as well as hydrological and hydrogeological processes at the hillslope and the catchment scale; and to support the retrieval of soil water content from airborne and spaceborne remote sensing platforms

Analyse, Bewertung und Sicherung alpiner Freiräume durch Raumordnung und räumliche Planung

Alpine Freiräume werden zusehends knapper. Diese Aussage gilt in den Alpen für den naturgemäß raren Dauersiedlungsraum, der z.B. in Tirol nur 11,8 % des Staatsgebietes umfasst. Die Bevölkerung wächst in vielen Talschaften und damit auch die erforderliche Infrastruktur. Aber auch die Freiräume, die in den darüber gelegenen Höhenstufen der Alpen liegen, werden sukzessiv zerschnitten und mit technischen Anlagen (z.B. Seilbahnen, hydroelektrischen Anlagen) bzw. immer intensiveren Nutzungen (z.B. EMountainbikes) erschlossen. Im Freistaat Bayern begann die alpenweite Erhaltung von Freiräumen mit der Implementierung des Alpenplans als raumordnerische Zielsetzung bereits im Jahr 1972. Die dadurch betriebene Zonierung des gesamten bayerischen Alpenraums nach drei Intensitätsstufen der verkehrlichen Nutzung war eine echte Innovation des Normgebers. Sie zielte mit ihrer sogenannten Zone C auf den damals noch jungen Naturschutz und die Verringerung alpiner Naturgefahren ab. In der Hauptsache jedoch galt diese planerische Initiative der nicht anlagengebundenen, landschaftsbezogenen Erholung, das heißt Freizeit- und Tourismusaktivitäten in der Natur. Heute bestehen mehr oder weniger erfolgreiche, verwandte Initiativen in allen deutschsprachigen Alpenstaaten und der Schweiz. Sie zu analysieren, ihre Festlegung, Funktionsweise und planerische Umsetzung vergleichend zu beschreiben sowie kritisch zu hinterfragen ist die Zielsetzung dieser Arbeit. Weil der Erhalt von Freiräumen ein transnationales Thema darstellt, gerade in den vielfach von politischen Grenzen durchzogenen Alpen, wird dabei auch auf die rahmensetzenden Vorgaben der völkerrechtlich verbindlichen Alpenkonvention aus dem Jahr 1991 abgehoben und die neue EU-Initiative EUSALP sowie deren potenzielle Auswirkungen erörtert. Im Fokus steht aber die Zusammenführung von Ansätzen zum Erhalt von Freiräumen für den Menschen (Einheimische und ihre traditionellen Wirtschaftsweisen, aber auch Besucher) und das Naturerbe. Die heute gängigen Praktiken im Umgang mit alpinen Freiräumen in Raumordnung und räumlicher Planung im deutschsprachigen Alpenraum und der Schweiz werden aufgezeigt sowie kritisch bewertet. Zudem werden künftige Möglichkeiten von grenzüberschreitenden harmonisierten Verfahrensweisen debattiert.The analysis, evaluation and safeguarding of Alpine open spaces through regional and spatial planning Alpine open spaces are becoming noticeably scarcer. This statement applies to the inherently restricted area of permanent settlement in the Alps, which, e.g., covers only 11.8 % of the territory of the Tyrol. The population is growing in many of the valleys and with it the infrastructure required. However, the open spaces, situated at altitudes above the settlements, are also being successively broken up and exploited using technical equipment (e.g. cable cars, hydro-electric facilities) or increasingly intensive types of use (e.g. e-mountain bikes). In Bavaria the conservation of open space began as early as 1972 with the implementation of the Alpine plan (Alpenplan), which set spatial planning objectives for the entire Alpine area. This led to the division of the Bavarian Alpine area into three zones of varying intensity of traffic use, a true legislative innovation. The so-called Zone C was intended for nature protection, still in its infancy at that time, and also aimed to reduce natural Alpine hazards. Primarily, however, this planning initiative was related to the role of the landscape for recreation, i. e. to leisure and touristic activities in natural surroundings. Today, there are similar initiatives of varying success in all the Germanspeaking Alpine states and in Switzerland. This paper aims to analyse these initiatives, comparing and critically assessing their stipulation, functioning and planning implementation. As the conservation of open space is a transnational issue, especially in the Alps, which are dissected by many political borders, reference is also made to the framework provisions of the internationally binding Alpine Convention from 1991 and to the new EU initiative EUSALP, and their potential consequences. The focus of attention is, however, on bringing together approaches for conserving open space for people (local inhabitants and their traditional economic activities, but also visitors) and natural heritage. Presentday regional and spatial planning practices related to Alpine open spaces in the Germanspeaking Alps and in Switzerland are presented and critically evaluated and future options for harmonising approaches across the borders are discussed