Multiscale Drivers of Water Chemistry of Boreal Lakes and Streams

The variability in surface water chemistry within and between aquatic ecosystems is regulated by many factors operating at several spatial and temporal scales. The importance of geographic, regional-, and local-scale factors as drivers of the natural variability of three water chemistry variables representing buffering capacity and the importance of weathering (acid neutralizing capacity, ANC), nutrient concentration (total phosphorus, TP), and importance of allochthonous inputs (total organic carbon, TOC) were studied in boreal streams and lakes using a method of variance decomposition. Partial redundancy analysis (pRDA) of ANC, TP, and TOC and 38 environmental variables in 361 lakes and 390 streams showed the importance of the interaction between geographic position and regional-scale variables. Geographic position and regional-scale factors combined explained 15.3% (streams) and 10.6% (lakes) of the variation in ANC, TP, and TOC. The unique variance explained by geographic, regional, and local-scale variables alone was <10%. The largest amount of variance was explained by the pure effect of regional-scale variables (9.9% for streams and 7.8% for lakes), followed by local-scale variables (2.9% and 5.8%) and geographic position (1.8% and 3.7%). The combined effect of geographic position, regional-, and local-scale variables accounted for between 30.3% (lakes) and 39.9% (streams) of the variance in surface water chemistry. These findings lend support to the conjecture that lakes and streams are intimately linked to their catchments and have important implications regarding conservation and restoration (management) endeavors

Rencontre autour des inégalités scolaires au Luxembourg

10. Reduced inequalitie

German-language version of the compensatory health belief scale

This study constitutes the first psychometric examination of the German-language version of the Compensatory Health Belief (CHB) scale to assess the belief that unhealthy behavior can be compensated for by engaging in healthy behavior. Data from four different Swiss samples of 1,571 adolescents/students (age range 15 – 55 years), collected between 2007 and 2009, were used. Confirmatory factor analysis did not support either the hypothesized 4-factor structure or a second-order factor structure with a latent overall variable for the German-language CHB scale. These results support the inconsistent patterns of CHBs found across European cultures. Thus, the development of behavior-specific scales might be of advantage. Further recommendations for an improvement of the measurement of compensatory health beliefs are discussed

Success rates of pre-hospital difficult airway management: a quality control study evaluating an in-hospital training program

Abstract Background Competence in emergency airway management is key in order to improve patient safety and outcome. The scope of compulsory training for emergency physicians or paramedics is quite limited, especially in Austria. The purpose of this study was to review the difficult airway management performance of an emergency medical service (EMS) in a region that has implemented a more thorough training program than current regulations require, comprising 3 months of initial training and supervised emergency practice and 3 days/month of on-going in-hospital training as previously reported. Methods This is a subgroup analysis of pre-hospital airway interventions performed by non-anesthesiologist EMS physicians between 2006 and 2016. The dataset is part of a retrospective quality control study performed in the ground EMS system of Wiener Neustadt, Austria. Difficult airway missions recorded in the electronic database were matched with the hospital information system and analyzed. Results Nine hundred thirty-three of 23060 ground EMS patients (4%) required an airway intervention. In 48 cases, transient bag-mask-valve ventilation was sufficient, and 5 patients needed repositioning of a pre-existing tracheostomy cannula. Eight hundred thirty-six of 877 patients (95.3%) were successfully intubated within two attempts; in 3 patients, a supraglottic airway device was employed first line. Management of 41 patients with failed tracheal intubation comprised laryngeal tubes (n = 21), intubating laryngeal mask (n = 11), ongoing bag-mask-valve ventilation (n = 8), and crico-thyrotomy (n = 1). There was no cannot intubate/cannot ventilate situation. Blood gas analysis at admission revealed hypoxemia in 2 and/or hypercapnia in 11 cases. Conclusion During the 11-year study period, difficult airways were encountered in 5% but sufficiently managed in all patients. Thus, the training regime presented might be a feasible and beneficial model for training of non-anesthesiologist emergency physicians as well as paramedics

Multifrequency frequency-domain spectrometer for tissue analysis

In this paper we describe the modification and assessment of a standard multidistance frequency-domain near infrared spectroscopy (NIRS) instrument to perform multifrequency frequency-domain NIRS measurements. The first aim of these modifications was to develop an instrument that enables measurement of small volumes of tissue such as the cervix, which is too small to be measured using a multidistance approach. The second aim was to enhance the spectral resolution to be able to determine the absolute concentrations of oxy-, deoxy- and total hemoglobin, water, and lipids. The third aim was to determine the accuracy and error of measurement of this novel instrument in both in vitro and in vivo environments. The modifications include two frequency synthesizers with variable, freely adjustable frequency, broadband high-frequency amplifiers, the development of a novel avalanche photodiode (APD) detector and demodulation circuit, additional laser diodes with additional wavelengths, and a respective graphic user interface to analyze the measurements. To test the instrument and algorithm, phantoms with optical properties similar to those of biological tissue were measured and analyzed. The results show that the absorption coefficient can be determined with an error of <10%. The error of the scattering coefficient was <31%. Since the accuracy of the chromophore concentrations depends on the absorption coefficient and not on the scattering coefficient, the <10% error is the clinically relevant parameter. In addition, the new APD had similar accuracy as the standard photomultiplier tubes. To determine the accuracy of chromophore concentration measurements we employed liquid Intralipid® phantoms that contained 99% water, 1% lipid, and an increasing concentration of hemoglobin in steps of 0.010 mM. Water concentration was measured with an accuracy of 6.5% and hemoglobin concentration with an error of 0.0024 mM independent of the concentration. The measured lipid concentration was negative, which shows that the current setup is not suitable for measuring lipids. Measurements on the forearm confirmed reasonable values for water and hemoglobin concentrations, but again not for lipids. As an example of a future application, chromophore concentrations in the cervix were measured and comparable values to the forearm were found. In conclusion the modified instrument enables measurement of water concentration in addition to oxy- and deoxyhemoglobin concentrations with a single source-detector distance in small tissue samples. Future work will focus on resolving the lipid component

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study

Abstract Background Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer’s qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. Methods In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems. Results From 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5–42.5) vs. 19.0 (15.0–27.0) during initial training; 62.0 (41.8–86.5) vs. 33.5 (18.0–54.5) during the first, and 64.0 (34.5–93.8) vs. 27 (12.5–56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0–14.8) TIs vs. 0.0 (0.0–0.0) SGA cases during the first, and 9.0 (7.0–13.8) TIs vs. 0.0 (0.0–0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%. Discussion Number of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to minimize failure rates. Thus, a fixed amount of working days in anesthesia seems crucial to maintain proficiency. Conclusions In-hospital training programs are mandatory for non-anesthetist EMS physicians to gain competence in airway management and emergency anesthesia.Our results might be helpful when discussing the need for regulation and financing with the authorities