Do different subjective evaluation criteria reflect distinct constructs?

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Annoyance due to noise and air pollution to the residents of heavily frequented streets

The residents of different streets with varying traffic density and building density were questioned about annoyance due to traffic noise and air pollution. Results show that annoyance felt is dependent not only on the measured noise levels and/or air pollution concentrations, but that there do exist interactions between the residential quarters and annoyance. These interactions should be considered when fixing the limits and standards

Winter precipitation trends for two selected European regions over the last 500 years and their possible dynamical background

Summary: We analyse winter (DJF) precipitation over the last 500 years on trends using a spatially and temporally highly resolved gridded multi-proxy reconstruction over European land areas. The trends are detected applying trend matrices, and the significance is assessed with the Mann-Kendall-trend test. Results are presented for southwestern Norway and southern Spain/northern Morocco, two regions that show high reconstruction skill over the entire period. The absolute trend values found in the second part of the 20th century are unprecedented over the last 500 years in both regions. During the period 1715-1765, the precipitation trends were most pronounced in southwestern Norway as well as southern Spain/northern Morocco, with first a distinct negative trend followed by a positive countertrend of similar strength. Relating the precipitation time series to variations of the North Atlantic Oscillation Index (NAOI) and the solar irradiance using running correlations revealed a couple of instationarities. Nevertheless, it appears that the NAO is responsible in both regions for most of the significant winter precipitation trends during the earlier centuries as well as during recent decades. Some of the significant winter precipitation trends over southwestern Norway and southern Spain/northern Morocco might be related to changes in the solar irradianc

Investigating the consistency between proxy-based reconstructions and climate models using data assimilation: a mid-Holocene case study

The mid-Holocene (6 kyr BP; thousand years before present) is a key period to study the consistency between model results and proxy-based reconstruction data as it corresponds to a standard test for models and a reasonable number of proxy-based records is available. Taking advantage of this relatively large amount of information, we have compared a compilation of 50 air and sea surface temperature reconstructions with the results of three simulations performed with general circulation models and one carried out with LOVECLIM, a model of intermediate complexity. The conclusions derived from this analysis confirm that models and data agree on the large-scale spatial pattern but the models underestimate the magnitude of some observed changes and that large discrepancies are observed at the local scale. To further investigate the origin of those inconsistencies, we have constrained LOVECLIM to follow the signal recorded by the proxies selected in the compilation using a data-assimilation method based on a particle filter. In one simulation, all the 50 proxy-based records are used while in the other two only the continental or oceanic proxy-based records constrain the model results. As expected, data assimilation leads to improving the consistency between model results and the reconstructions. In particular, this is achieved in a robust way in all the experiments through a strengthening of the westerlies at midlatitude that warms up northern Europe. Furthermore, the comparison of the LOVECLIM simulations with and without data assimilation has also objectively identified 16 proxy-based paleoclimate records whose reconstructed signal is either incompatible with the signal recorded by some other proxy-based records or with model physics

Low molecular weight heparin-induced skin necrosis—a systematic review

Background: Low molecular weight heparins (LMWHs) are currently used as a standard for anti-thrombotic therapy. Skin necrosis caused by LMWH is a rare and probably under-reported complication. The aim of our systematic review is to analyse the present literature for cases of LMWH-induced skin necrosis, emphasising the pathogenesis, clinical pattern, and management of this rare side effect. Methods: We performed a Medline literature search (PubMed database) and manual cross-referencing to identify all articles related to LMWH-induced skin necrosis. Data were analysed for type of LMWH used, time until skin necrosis occurred, localisation, size, laboratory findings, switch anticoagulant, complications, and outcome. Additionally, the case of a patient from our hospital is presented. Results: We included a total of 20 articles (21 cases) reporting on LMWH-induced skin necrosis. Skin necrosis occurred locally and distant from the injection site. Heparin-induced antibodies were frequently observed (positive 9/11 articles, negative 2/11). However, severe thrombocytopenia (platelet count <100,000cells/ml) occurred in only four cases, while platelet count remained normal in 50% of the cases. After patients had been switched to other anti-thrombotic drugs, the clinical course was usually benign; however, reconstructive surgery was necessary in two cases. Conclusion: LMWH-induced skin necrosis may occur as part of the heparin-induced thrombocytopenia (HIT) syndrome, but other pathomechanisms, including allergic reactions and local trauma, may also be involved. When HIT is excluded, unfractionated heparin is a safe switch anticoagulant. Otherwise, non-heparin preparations such as hirudin or fondaparinux should be preferre

Wet season Mediterranean precipitation variability: influence of large-scale dynamics and trends

Abstract : The influence of the large-scale atmospheric circulation at several tropospheric levels on wet season precipitation over 292 sites across the Mediterranean area is assessed. A statistical downscaling model is designed with an objective methodology based on empirical orthogonal functions and canonical correlation analysis (CCA) and tested by means of cross-validation. In all 30% of the total Mediterranean October to March precipitation variability can be accounted for by the combination of four large-scale geopotential height fields and sea level pressure. The Mediterranean sea surface temperatures seem to be less relevant to explain precipitation variability at interannual time scale. It is shown that interdecadal changes in the first CCA mode are related to variations in the North Atlantic Oscillation index and responsible for comparable time scale variations of the Mediterranean precipitation throughout the twentieth century. The analysis reveals that since the mid-nineteenth century precipitation steadily increased with a maximum in the 1960s and decreased since then. The second half of the twentieth century shows a general downward trend of 2.2mm·month-1·decade-

Brief compression-only cardiopulmonary resuscitation training video and simulation with homemade mannequin improves CPR skills.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training has traditionally involved classroom-based courses or, more recently, home-based video self-instruction. These methods typically require preparation and purchase fee; which can dissuade many potential bystanders from receiving training. This study aimed to evaluate the effectiveness of teaching compression-only CPR to previously untrained individuals using our 6-min online CPR training video and skills practice on a homemade mannequin, reproduced by viewers with commonly available items (towel, toilet paper roll, t-shirt). METHODS: Participants viewed the training video and practiced with the homemade mannequin. This was a parallel-design study with pre and post training evaluations of CPR skills (compression rate, depth, hand position, release), and hands-off time (time without compressions). CPR skills were evaluated using a sensor-equipped mannequin and two blinded CPR experts observed testing of participants. RESULTS: Twenty-four participants were included: 12 never-trained and 12 currently certified in CPR. Comparing pre and post training, the never-trained group had improvements in average compression rate per minute (64.3 to 103.9, p = 0.006), compressions with correct hand position in 1 min (8.3 to 54.3, p = 0.002), and correct compression release in 1 min (21.2 to 76.3, p \u3c 0.001). The CPR-certified group had adequate pre and post-test compression rates (\u3e100/min), but an improved number of compressions with correct release (53.5 to 94.7, p \u3c 0.001). Both groups had significantly reduced hands-off time after training. Achieving adequate compression depths (\u3e50 mm) remained problematic in both groups. Comparisons made between groups indicated significant improvements in compression depth, hand position, and hands-off time in never-trained compared to CPR-certified participants. Inter-rater agreement values were also calculated between the CPR experts and sensor-equipped mannequin. CONCLUSIONS: A brief internet-based video coupled with skill practice on a homemade mannequin improved compression-only CPR skills, especially in the previously untrained participants. This training method allows for widespread compression-only CPR training with a tactile learning component, without fees or advance preparation

Minimal-invasive, ballonassistierte Aufrichtung und innere Fixation von Tibiaplateaufrakturen

Zusammenfassung: Aufgrund der häufig insuffizienten Weichteilsituation im Rahmen von Tibiaplateaufrakturen und der damit assoziierten höheren Rate an postoperativen Wundheilungsstörungen und Weichteilinfektionen ist ihre operative Behandlung nicht selten eine herausfordernde Aufgabe. Die klassische offene Reposition und Plattenosteosynthese beinhaltet eine ausgiebige Weichteilpräparation und partielle Periostablösung, um so die abgesunkenen Fragmente zu bergen und aufzurichten. Die Wiederherstellung der Gelenkfläche gestaltet sich dabei häufig als schwierig. In der vorliegenden Arbeit beschreiben wir eine neuartige operative Technik, in der das eingesunkene Tibiaplateau durch einen perkutan eingebrachten Ballon in Kombination mit einer minimal-invasiven Plattenosteosynthese versorgt wird. Darüber hinaus berichten wir über 5Fälle, welche mit diesem Verfahren bislang behandelt wurde