Are homeopathics able to replace antibiotics in the therapy of bovine mastitis? A placebo controlled randomized double-blind trial

To evaluate the effects of homeopathics on clinical mastitis cows and herd udder health this investigation was conducted in a Brandenburg bio-dyn herd of about 300 cows in two phases using a randomized doubleblind control trial design. After the first part in July 2002 the results preliminarily were evaluated and then the whole concept due to unsatisfying results was adapted. In Phase 1 a number of 121 clinical mastitis cases with 137 affected quarters matched the including criteria, in Phase 2 the number was 126 cows with 148 quarters. These animals were allocated to a code number which classified the case to Verum (n=65 and n=60) or placebo group (n=56 and n=66). In case of clinical mastitis cows were treated either by the oral dilution contending the required combined homeopathics or placebo. Animals were treated twice a day for 5 to 14 days (Phase 2: 1 to 7 days) depending on development of disease. In case of therapy failure in Phase 1 all animals were treated by an not coded homeopathic preparation and in Phase 2 by antibiotics according to bacteriological findings. Milk samples (double samples) for bacteriological and cell count investigation were taken before treatment (M1), 4 to 5 weeks after treatment termination (M2) and 7 to 8 weeks after treatment termination (M3). To evaluate the herd situation additional samples were taken after calving and before dry off. Healing criteria on the cow level was the clinical cure without secondary therapy and release to production. On quarter level the cure was determined by bacterial findings (BCR) and additional by cytological findings. A quarter was determined as „completely cured“, if no bacteria were found AND the cell count was below 100.000/ml. To assess the reduction of antibiotics within the concept it was hypothetically assumed that the mastitis cows had an average milk yield of 20,5 kg per day, was treated under conventional conditions by antibiotics over 3 days with a mean withdrawal time of 5 days (organic conditions x2). Afterwards, these theoretical values were compared to the extrapolated antibiotics input within our concept. Results While there is no difference between the cows in phase 1, on quarter level the verum group showed a significant higher complete cure rate than placebo group in Phase 2. These results are balanced by additional antibiotics treatment in case of therapy failure in the placebo group. The complete cure rate in the verum group after 8 weeks was 32% compared to 13% in placebo group (p<0.05). The limited cure results in single cows did not lead to an udder health depression of the herd. During the study the mean of somatic cell count could decreased by 100.000 cells/ml while the milk yield increased slightly by 250 kg/cow to 6.500 kg/cow/year. The number of actual antibiotic treatments during observation time compared to the number of mastitis cases which would be treated by antibiotics under conventionel conditions showed a reduction by 75%. The extrapolated reduction of milk loss by withdrawal was 25.000kg and the reduction of contaminated milk during treatment time was 13.100 kg per year for the herd. Discussion and Conclusions The increasing cure rates in the second part of the study are influenced by the enhancement of environmental preconditions in combination with the simplified therapy scheme. The therapists seemed to be more familiar with the fixed combinations of homeopathics so that positive effects of the homeopathics can be seen in this phase. After additional antibiotic treatments in case of therapy failure in specific infections (i.e. streptococci and staph. aureus) the cure rates could be elevated to a satisfying level. This fact shows that the limited and controlled use of antibiotics in organic herds can be helpful in the mastitis control. Regardless the conceptual modification to an antibiotic emergency concept, the massive reduction of antibiotics in combination with an increase of herd udder health justifies the therapy protocol in the second phase of the study. Hypothetically, the self cure of the animals is higher than known. The interaction between farmer or therapist and the cow could be a crucial criterion for the positive development of disease. As a conclusion, the integrated system consisting of preventive herd measures and complementary therapy added by limited antibiotic therapy. The precondition for the success is the attendance to optimize environmental conditions. The therapy system should be transparent, simple and easy to use. However, it is necessary to reflect every single mastitis case as a special one

Effects of Head Extension on Peak Airway Pressure During Mask-Ventilation: A Prospective, Randomized, Clinical Single-Centre Trial

Background: Rescuers with basic skills may have difficulties to perform efficient and safe mask ventilation. This study aimed at determining the best head position for ventilation, while avoiding stomach inflation. Methods: Forty healthy patients were mechanically ventilated with a face mask (7 mL.kg-1). The head was positioned either with n = 20 or without a cushion support (n = 20), and in three different head extension positions. Results: Head angles differed more with no cushion support at 12°; 95% CI 6 - 18°), 25° (95% CI 17 - 33°) and 32° (95% CI 27 - 37°); P &lt; 0.05) when compared with cushion support at 5° (95% CI 3 - 7°), 16° (95% CI 13 - 20°), and 22° (95% CI 18 - 26°); P &lt; 0.05. Without cushion support, peak airway pressure in neutral position was higher (20 cmH2O, 95% CI 17 to 23 cmH2O) than in the anesthesiologist’s favorite position (16 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000) or in extension (16 _ 7 cmH2O, 95% CI 13 to 19 cmH2O; P = 0.000). Stomach inflation correlated with body mass index in the neutral position, and in the anesthesiologist’s preferred position without cushion support. Conclusions: Our data suggested that maximal head extension with no cushion support yields the lowest and thus safest peak airway pressure during mask ventilation. Trial Registration: ClinicalTrials.govNCT01909310, registered on July 24th, 201

Cross-Talk between Staphylococcus aureus and Other Staphylococcal Species via the agr Quorum Sensing System

Staphylococci are associated with both humans and animals. While most are non-pathogenic colonizers, Staphylococcus aureus is an opportunistic pathogen capable of causing severe infections. S. aureus virulence is controlled by the agr quorum sensing system responding to secreted auto-inducing peptides (AIPs) sensed by AgrC, a two component histidine kinase. agr loci are found also in other staphylococcal species and for Staphylococcus epidermidis, the encoded AIP represses expression of agr regulated virulence genes in S. aureus. In this study we aimed to better understand the interaction between staphylococci and S. aureus, and show that this interaction may eventually lead to the identification of new anti-virulence candidates to target S. aureus infections. Here we show that culture supernatants of 37 out of 52 staphylococcal isolates representing 17 different species inhibit S. aureus agr. The dog pathogen, Staphylococcus schleiferi, expressed the most potent inhibitory activity and was active against all four agr classes found in S. aureus. By employing a S. aureus strain encoding a constitutively active AIP receptor we show that the activity is mediated via agr. Subsequent cloning and heterologous expression of the S. schleiferi AIP in S. aureus demonstrated that this molecule was likely responsible for the inhibitory activity, and further proof was provided when pure synthetic S. schleiferi AIP was able to completely abolish agr induction of an S. aureus reporter strain. To assess impact on S. aureus virulence, we co-inoculated S. aureus and S. schleiferi in vivo in the Galleria mellonella wax moth larva, and found that expression of key S. aureus virulence factors was abrogated. Our data show that the S. aureus agr locus is highly responsive to other staphylococcal species suggesting that agr is an inter-species communication system. Based on these results we speculate that interactions between S. aureus and other colonizing staphylococci will significantly influence the ability of S. aureus to cause infection, and we propose that other staphylococci are potential sources of compounds that can be applied as anti-virulence therapy for combating S. aureus infections

Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support: a case report.

BACKGROUND We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support. CASE PRESENTATION A 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team. After extrication, he suffered a witnessed cardiac arrest with ventricular fibrillation. Immediate defibrillation and cardiopulmonary resuscitation were started. His core temperature was 26.0 °C. Due to weather conditions, air transport to an extracorporeal life support center was not possible. Thus, he was rewarmed with conventional rewarming methods in a rural hospital. Auto-defibrillation occurred at a core temperature of 29.8 °C after 5 hours and 44 minutes of continued cardiopulmonary resuscitation. With a core temperature of 33.4 °C, he was finally admitted to a level 1 trauma center and extracorporeal life support was no longer required. Seven weeks following the accident, he was discharged home with complete neurological recovery. CONCLUSIONS Successful rewarming from severe hypothermia without extracorporeal life support use as performed in this case suggests that patients with primary hypothermic cardiac arrest have a chance of a favorable neurological outcome even after several hours of cardiac arrest when cardiopulmonary resuscitation and conventional rewarming are performed continuously. This may be especially relevant in remote areas, where extracorporeal life support rewarming is not available

Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients : The HOPE score

Aims: Currently, the decision to initiate extracorporeal life support for patients who suffer cardiac arrest due to accidental hypothermia is essentially based on serum potassium level. Our goal was to build a prediction score in order to determine the probability of survival following rewarming of hypothermic arrested patients based on several covariates available at admission. Methods: We included consecutive hypothermic arrested patients who underwent rewarming with extracorporeal life support. The sample comprised 237 patients identified through the literature from 18 studies, and 49 additional patients obtained from hospital data collection. We considered nine potential predictors of survival: age; sex; core temperature; serum potassium level; mechanism of hypothermia; cardiac rhythm at admission; witnessed cardiac arrest, rewarming method and cardiopulmonary resuscitation duration prior to the initiation of extracorporeal life support. The primary outcome parameter was survival to hospital discharge. Results: Overall, 106 of the 286 included patients survived (37%; 95% CI: 32-43%), most (84%) with a good neurological outcome. The final score included the following variables: age, sex, core temperature at admission, serum potassium level, mechanism of cooling, and cardiopulmonary resuscitation duration. The corresponding area under the receiver operating characteristic curve was 0.895 (95% CI: 0.859-0.931) compared to 0.774 (95% CI: 0.720-0.828) when based on serum potassium level alone. Conclusions: In this large retrospective study we found that our score was superior to dichotomous triage based on serum potassium level in assessing which hypothermic patients in cardiac arrest would benefit from extracorporeal life support. External validation of our findings is required.Peer reviewe

Thermodynamic Model of a Solar Receiver for Superheating of Sulfur Trioxide and Steam at Pilot Plant Scale

Within the European research project SOL2HY2, key components for a solar hybrid sulfur cycle are being developed and demonstrated at pilot scale in a real environment. Regarding the thermal portion, a plant for solar sulfuric acid decomposition is set up and initially operated at the research platform of the DLR Solar Tower in Jülich, Germany. One major component is the directly irradiated volumetric receiver, superheating steam and SO3 coming from a tube-type evaporator to above 1000 °C. At the design flow rate of sulfuric acid (50%-wt.) of 1 l/min, a nominal solar power of 57 kW is required at the receiver. With a flat ceramic absorber made from SiC and a flat quartz glass window, the design is based on lab scale reactors successfully demonstrated at the solar furnace of the German Aerospace Centre (DLR) in Cologne, Germany. A flexible lumped thermodynamic tool representing the receiver, compiled to assess different configurations, is presented in detail. An additional raytracing model has been established to provide the irradiation boundaries and support the design of a conical secondary concentrator with an aperture diameter of 0.6 m. A comparison with first experimental data (up to 65% nominal power), obtained during initial operation, indicates the models to be viable tools for design and operational forecast of such systems. With a provisional method to account for the efficiency of the secondary concentrator, measured fluid outlet temperatures (up to 1000 °C) are predicted with deviations of ±60 °C. Respective absorber front temperatures (up to 1200 °C) are under-predicted by 100-200 °C, with lower deviations at higher mass flows. The measured window temperature (up to 700 °C) mainly depends on the absorber front temperature level, which is well predicted by the model

Solarthermische Kraftwerke

[PDF] von wupperinst.org Solarthermische Kraftwerke Autoren Robert Pitz-Paal, Thomas Wetzel, Peter Nitz, Julia C Terrapon-Pfaff, Thomas Fink, Ole Soukup Publikationsdatum 2018/7/10 Beschreibung Der Schutz des Klimas und die dafür erforderliche Umstellung der Energieversorgung auf erneuerbare Energien ist eine globale Herausforderung, welche nach maßgeschneiderten Lösungen für die unterschiedlichen Klimazonen und Märkte der Erde verlangt. Die verstärkte Solarenergienutzung spielt dabei eine maßgebliche Rolle. Die Rolle Deutschlands als Exportnation beschränkt sich hierbei nicht auf die Klimawende im eigenen Land, sondern beinhaltet auch den weltweiten Export erneuerbarer Energietechnologien. Die Kosten der photovoltaischen Stromerzeugung (PV) und der Windkraft sind in den vergangenen Jahren erfreulicherweise deutlich gesunken, entsprechend wurden in vielen Ländern große Kapazitäten zugebaut. Die resultierende stark gestiegene Einspeisung fluktuierender Erzeuger stellt Netzbetreiber vor neue Herausforderungen, insbesondere durch die extremen Lastschwankungen für plan-und steuerbare, heute größtenteils fossil befeuerte konventionelle Kraftwerke

Lightning accidents in the Austrian alps - a 10-year retrospective nationwide analysis

Background: Lightning strikes are rare but potentially lethal. The risk for suffering a lightning strike in a mountain environment is unknown. The aim of this nationwide study was to analyse all lightning accidents in the Austrian Alps from 2005 to 2015, to assess the circumstances of the accident, the injury pattern as well as the outcome. Methods: From 2005 to 2015, data from the national Austrian Alpine Police database as well as the Clinical Information System of Innsbruck Medical University Hospital were searched for the keywords lightning injury, lightning strike, lightning as well as ICD-10 Code T75.0. Additionally, the archive data of Innsbruck Medical University Hospital was searched manually. Results: The Austrian Alpine Police database, containing 109.168 patients for the years 2005-2015, was screened for lightning accidents. Sixty-four patients had been hit by lightning in the Austrian Alps, 54 were male. Four persons died on scene;survival rate was 93.8%. Two deceased persons were hunters, who were killed by the same lightning strike. Sixty-three patients suffered a lightning strike while doing a recreational activity, mostly hiking (n = 55), a few hunting and only one doing occupational timberwork. Sixty-three patients suffered a lightning strike between June and August with nearly half (46.9%) of the accidents happening on a Saturday or Sunday, and mainly (95.3%) between 12:00 and 22:00 h. Discussion: Persons who perform recreational outdoor and occupational activities in an alpine environment during summer and after noon incur a higher risk of sustaining a lightning strike. The primary risk group includes young male mountaineers and hunters. The mortality rate was low

Vancomycin gene selection in the microbiome of urban <i>Rattus norvegicus</i> from hospital environment

Background and objectives: Widespread use of antibiotics has resulted in selection pressure on genes that make bacteria non-responsive to antibiotics. These antibiotic-resistant bacteria are currently a major threat to global health. There are various possibilities for the transfer of antibiotic resistance genes. It has been argued that animal vectors such as Rattus norvegicus (R. norvegicus) living in hospital sewage systems are ideal for carrying pathogens responsible for fatal diseases in humans. Methodology: Using a metagenomic sequencing approach, we investigated faecal samples of R. norvegicus from three major cities for the presence of antibiotic resistance genes. Results: We show that despite the shared resistome within samples from the same geographic locations, samples from hospital area carry significantly abundant vancomycin resistance genes. Conclusions and implications: The observed pattern is consistent with a selection for vancomycin genes in the R. norvegicus microbiome, potentially driven by the outflow of antibiotics and antibiotic-resistant bacteria into the wastewater systems. Carriage of vancomycin resistance may suggest that R. norvegicus is acting as a reservoir for possible transmission to the human population

Solarthermische Kraftwerke

Der Schutz des Klimas und die dafür erforderliche Umstellung der Energieversorgung auf erneuerbare Energien ist eine globale Herausforderung, welche nach maßgeschneiderten Lösungen für die unterschiedlichen Klimazonen und Märkte der Erde verlangt. Die verstärkte Solarenergienutzung spielt dabei eine maßgebliche Rolle. Die Rolle Deutschlands als Exportnation beschränkt sich hierbei nicht auf die Klimawende im eigenen Land, sondern beinhaltet auch den weltweiten Export erneuerbarer Energietechnologien. Die Kosten der photovoltaischen Stromerzeugung (PV) und der Windkraft sind in den vergangenen Jahren erfreulicherweise deutlich gesunken, entsprechend wurden in vielen Ländern große Kapazitäten zugebaut. Die resultierende stark gestiegene Einspeisung fluktuierender Erzeuger stellt Netzbetreiber vor neue Herausforderungen, insbesondere durch die extremen Lastschwankungen für plan- und steuerbare, heute größtenteils fossil befeuerte konventionelle Kraftwerke. Hier bieten solarthermische Kraftwerke Lösungen