Nachhaltige Wasserwirtschaft durch Synergie. - Moegliche Kooperationen bei der Wasserver- und Entsorgung

The function of communal water supply utilities is to provide consumers with high quality drinking water in sufficient quantities. On the other hand communal wastewater disposal utilities have to dispose the wastewater. In addition to this water prices and wastewater charges shall also give financial incentives to water avoidance. The existing cost problem results of the structure of German water supply system and wastewater disposal systemwhich are in contrast to other European countries highly decentralised. Cooperation is one instrument to improve efficiency and effectiveness towards a sustainable water management. Cooperation is mainly directed to relationships between water utilities, independent of size and organization and should be realised on a voluntary basis. A cooperation could take place between two water supply utilities or between two wastewater disposal utilities or and between a water supply utility and a wastewater disposal utility. If necessary, communal and fiscal legislation have to be adapted to open the way for this strategic instrument. The key topic of this paper is to show possibilities for realizing synergies through cooperation in water and wastewater management on the example of the city Augsburg and the municipalities in the administrative districts Augsburg, Aichach-Friedberg, Donau-Ries and Dillingen. Based on an own survey the results are judged by the context of a sustainable water management.Nachhaltigkeit, Wasserwirtschaft, Wasserversorgung, Abwasse-rentsorgung, Wasserpreise, Abwassergebuehren, Kooperation, Synergie, sustainability, water management, water supply, wastewater disposal, water prices, wastewater charges, cooperation, synergies

Trainee Surgeons Affect Operative Time but not Outcome in Minimally Invasive Total Hip Arthroplasty

Training of young surgeons in total hip arthroplasty (THA) is crucial, but might affect operative time and outcome especially in minimally invasive (MIS) THA. We asked whether the learning curve of orthopaedic residents trained on MIS THA has an impact on (1) operative time (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of over 1000 MIS THAs from our institutional joint registry, operative time, complication rates, patient reported outcome measures (Western Ontario and McMaster Universities Arthritis Index [WOMAC] and Euro-Qol 5D-5L [EQ-5D]) within the first year and responder rates for positive outcome as defined by the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus responder (OMERACT-OARSI) criteria were compared between trainee and senior surgeons. Mean operative time was nine minutes longer for trainees compared to senior surgeons (78.1 +/- 25.4 min versus 69.3 +/- 23.8 min, p < 0.001). Dislocation (p = 0.21), intraoperative fracture (p = 0.84) and infection rates (p = 0.58) were comparably low in both groups. Both trainee and senior THAs showed excellent improvement of EQ-5D (0.34 +/- 0.26 versus 0.32 +/- 0.23, p = 0.40) and WOMAC (45.9 +/- 22.1 versus 44.9 +/- 20.0, p = 0.51) within the first year after surgery without clinical relevant differences. Similarly, responder rates for positive outcome were comparable between trainees with 92.9% and senior surgeons with 95.2% (p = 0.17). MIS THA seems to be a safe procedure during the learning curve of young orthopaedic specialists, but requires higher operative time

The KiVa antibullying program in primary schools in Chile, with and without the digital game component: study protocol for a randomized controlled trial.

BACKGROUND: Bullying is a major problem worldwide and Chile is no exception. Bullying is defined as a systematic aggressive behavior against a victim who cannot defend him or herself. Victims suffer social isolation and psychological maladjustment, while bullies have a higher risk for conduct problems and substance use disorders. These problems appear to last over time. The KiVa antibullying program has been evaluated in Finland and other European countries, showing preventive effects on victimization and self-reported bullying. The aims of this study are (1) to develop a culturally appropriate version of the KiVa material and (2) to test the effectiveness of the KiVa program, with and without the online game, on reducing experiences of victimization and bullying behavior among vulnerable primary schools in Santiago (Chile), using a cluster randomized controlled trial (RCT) design with three arms: (1) full KiVa program group, (2) partial KiVa (without online game) program group and (3) control group. METHODS AND DESIGN: This is a three-arm, single-blind, cluster randomized controlled trial (RCT) with a target enrolment of 1495 4th and 5th graders attending 13 vulnerable schools per arm. Students in the full and partial KiVa groups will receive universal actions: ten 2-h lessons delivered by trained teachers during 1 year; they will be exposed to posters encouraging them to support victims and behave constructively when witnessing bullying; and a person designated by the school authorities will be present in all school breaks and lunchtimes using a visible KiVa vest to remind everybody that they are in a KiVa school. KiVa schools also will have indicated actions, which consist of a set of discussion groups with the victims and with the bullies, with proper follow-up. Only full KiVa schools will also receive an online game which has the aim to raise awareness of the role of the group in bullying, increase empathy and promote strategies to support victimized peers. Self-reported victimization, bullying others and peer-reported bullying actions, psychological and academic functioning, and sense of school membership will be measured at baseline and 12 months after randomization. DISCUSSION: This is the first cluster RCT of the KiVa antibullying program in Latin America. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT02898324 . Registered on 8 September 2016

Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland.

Background: Following the spread of the coronavirus disease 2019 (COVID-19) pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). In the absence of trials, evidence for treatment remains scarce. Purpose: To develop best practice recommendations for the diagnosis and treatment of children with PIMS-TS in Switzerland. It is acknowledged that the field is changing rapidly, and regular revisions in the coming months are pre-planned as evidence is increasing. Methods: Consensus guidelines for best practice were established by a multidisciplinary group of Swiss pediatric clinicians with expertise in intensive care, immunology/rheumatology, infectious diseases, hematology, and cardiology. Subsequent to literature review, four working groups established draft recommendations which were subsequently adapted in a modified Delphi process. Recommendations had to reach &gt;80% agreement for acceptance. Results: The group achieved agreement on 26 recommendations, which specify diagnostic approaches and interventions across anti-inflammatory, anti-infectious, and support therapies, and follow-up for children with suspected PIMS-TS. A management algorithm was derived to guide treatment depending on the phenotype of presentation, categorized into PIMS-TS with (a) shock, (b) Kawasaki-disease like, and (c) undifferentiated inflammatory presentation. Conclusion: Available literature on PIMS-TS is limited to retrospective or prospective observational studies. Informed by these cohort studies and indirect evidence from other inflammatory conditions in children and adults, as well as guidelines from international health authorities, the Swiss PIMS-TS recommendations represent best practice guidelines based on currently available knowledge to standardize treatment of children with suspected PIMS-TS. Given the absence of high-grade evidence, regular updates of the recommendations will be warranted, and participation of patients in trials should be encouraged

α-Tocopherol transfer protein does not regulate the cellular uptake and intracellular distribution of α- and γ-tocopherols and -tocotrienols in cultured liver cells

Liver cells express a cytosolic α-tocopherol transfer protein (αTTP) with high binding affinity for α-tocopherol (αT) and much lower affinities for the non-αT congeners. The role of αTTP in the intracellular distribution of the different vitamin E forms is currently unknown. We therefore investigated the intracellular localization of αT, γ-tocopherol (γT), α-tocotrienol (αT3), and γ-tocotrienol (γT3) in cultured hepatic cells with and without stable expression of αTTP. We first determined cellular uptake of the four congeners and found the methylation of the chromanol ring and saturation of the sidechain to be important factors, with tocotrienols being taken up more efficiently than tocopherols and the γ-congeners more than the α-congeners, irrespective of the expression of αTTP. This, however, could perhaps also be due to an observed higher stability of tocotrienols, compared to tocopherols, in culture media rather than a higher absorption. We then incubated HepG2 cells and αTTP-expressing HepG2 cells with αT, γT, αT3, or γT3, isolated organelle fractions by density gradient centrifugation, and determined the concentrations of the congeners in the subcellular fractions. All four congeners were primarily associated with the lysosomes, endoplasmic reticulum, and plasma membrane, whereas only αT correlated with mitochondria. Neither the chromanol ring methylation or sidechain saturation, nor the expression of αTTP were important factors for the intracellular distribution of vitamin E. In conclusion, αTTP does not appear to regulate the uptake and intracellular localization of different vitamin E congeners in cultured liver cells. Keywords: Endoplasmic reticulum, HepG2 liver cells, Intracellular localization, Lysosomes, Mitochondria, Plasma membrane, α-Tocopherol transfer protein, Tocotrienols, Trafficking, Vitamin

Surgical training does not affect operative time and outcome in total knee arthroplasty.

Training the next generation of orthopaedic surgeons in total knee arthroplasty (TKA) is crucial, but might affect operative time and outcome. We hypothesized that the learning curve of residents in TKA has an impact on (1) operative time, (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of 738 primary TKAs from our institutional joint registry, operative time, complication rates, patient-reported outcome measures (EQ-5D, WOMAC) within the first year and responder rates for positive outcome as defined by the OMERACT-OARSI criteria were compared between trainee and senior surgeons differentiating between conventional and navigated TKA. Mean operative time was 69.5±18.5min for trainees compared to 77.3±25.8min for senior surgeons (95%CI of the difference 1.5-13.9min, p = 0.02) in conventional TKA and 80.4±22.1min to 84.1±27.6min (95%CI of the difference -0.9-8.2min, p = 0.12) for navigated TKA, respectively. Intraoperative fracture (p≥0.36), thrombosis (p≥0.90), neurological deficits (p≥0.90) and infection rates (p≥0.28) were comparably low in both groups. Patient-reported outcome measures one year after TKA were similar for trainee and senior surgeons with EQ-5D 0.83±0.17 to 0.80±0.21 (p = 0.25) and WOMAC 74.85±18.60 to 72.77±20.12 (p = 0.44) for conventional TKA and EQ-5D 0.80±0.20 to 0.82±0.18 (p = 0.23) and WOMAC 72.71±18.52 to 75.77±17.78 (p = 0.07) for navigated TKA, respectively. Similarly, responder rates for positive outcome were comparable between trainees and senior surgeons (90.7% versus 87.0% p = 0.39 for conventional TKA, 88.7% versus 89.4% p = 0.80 for navigated TKA). Supervised TKA is a safe procedure during the learning curve of young orthopaedic surgeons

Improvement of patient reported outcome measures (WOMAC, EQ-5D) within the first year after TKA in relation to surgical experience.

<p>Improvement of patient reported outcome measures (WOMAC, EQ-5D) within the first year after TKA in relation to surgical experience.</p

Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Euro-Qol 5D-5L (EQ-5D) by surgeon grade preoperative and 1 year after conventional (Conv) and navigated (Nav) TKA^*.

<p>Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Euro-Qol 5D-5L (EQ-5D) by surgeon grade preoperative and 1 year after conventional (Conv) and navigated (Nav) TKA^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0197850#t003fn001" target="_blank">*</a>}.</p

Multivariable analysis of risk factors associated with responder rate.

<p>Multivariable analysis of risk factors associated with responder rate.</p

Surgical training does not affect operative time and outcome in total knee arthroplasty - Fig 1

<p>Conventional (a) and navigated (b) TKA.</p