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BACKGROUND: Behaviour management is widely agreed to be a key factor in providing dental care for children. Indeed, if a child's behaviour in the dental surgery/office cannot be managed then it is difficult if not impossible to carry out any dental care that is needed. It is imperative that any approach to behavioural management for the dental child patient must be rooted in empathy and a concern for the well being of each child. REVIEW: Based on various presentations given at Congresses of the European Academy of Paediatric Dentistry (EAPD), documents reviewing behaviour management prepared by the Clinical Affairs Committee of the EAPD, and written submissions to the Executive Board of the EAPD, a review of the various approaches to the behaviour management of the child dental patient was completed. All aspects of non-pharmacological behavioural management techniques described in the literature over the past 80 years were reviewed. FINDINGS: There is a very wide diversity of techniques used but not all are universally accepted by specialist paediatric and general dentists. Wide cultural and philosophical differences are apparent among European paediatric dentists that seem difficult to bridge when forming agreed guidelines. Accordingly, this review highlights those behaviour techniques that are universally accepted such as tell, show, do (TSD) or positive reinforcement, but nevertheless describes the most commonly mentioned techniques for which there are descriptions in the literature. CONCLUSION: A wide variety of behavioural management techniques are available to paediatric dentists which must be used as appropriate for the benefit of each child patient, and which, importantly, must take into account all cultural, philosophical and legal requirements in the country of dental practice of every dentist concerned with dental care of children. [ABSTRACT FROM AUTHOR]

Indicators by themselves tell us little about how well a system is progressing in relation to the goal of sustainability. Especially at the regional level, existing indicator frameworks do not typically permit the inclusion of relevant region-specific information. Furthermore, they do not provide comprehensive information on overall system sustainability. The real challenge is not to identify indicators-there are hundreds of good lists-but to seek out the best way to put all of them to work. The INSURE project, carried out in four case-study regions in Europe (including the Limburg region of The Netherlands), attempted to develop an adaptive indicator framework for integrated monitoring of sustainable development. During the project, it became increasingly clear that indicators are not only more meaningful when viewed within the context of the whole system, but also that science and policy play different, but complementary, roles. This article discusses the challenges and the lessons learned during the Limburg project. [ABSTRACT FROM AUTHOR]

Over the past decade, the spotted-wing drosophila, Drosophila suzukii Matsumara has become one of the most important pests of soft- and stone fruits throughout Europe. Currently, the majority of growers still rely heavily on a limited portfolio of chemical foliar spray insecticides. Alternative strategies such as attract and kill (pull) or behavioral control systems that repel or deter D. suzukii from damaging fruits (push) are less common. We evaluated the potential of hop (Humulus lupulus L.), as a repellent for the Integrated Pest Management of D. suzukii , in controlled greenhouse conditions as well as at commercial field sites. In greenhouse cage tests on fruit or attractant medium, the positive controls thymol and 1-octen-3-ol as well as certain hops significantly reduced larval infestation levels compared to an untreated control, while other hop products showed only numerical reduction in infestation. A controlled field trial on raspberries (Rubus idaeus L.) failed to replicate these results, both for the positive control repellents as for the hop samples. In field experiments in commercial raspberry and blackberry (Rubus fruticosus L.) plantations, no significant reduction in oviposition or differences in population density could be observed for the hop treated plots as compared to the untreated. Through SPME headspace analysis of the hops, a number of compounds were associated with the efficacy observed in the greenhouse, even though different hop varieties were found to have notably different volatile profiles. [ABSTRACT FROM AUTHOR]

Human-induced changes in the global climate system pose a range of health risks. Irrespective of any actions, which may soon be taken to reduce or halt these environmental changes, human populations will be exposed to some degree of climate change over the coming decades.Objectives: In June 2001 the EC funded project (EVK-2000-00070) started to a) to identify the vulnerability to adverse impacts of climate change on human health; b) to review current measures, technologies, policies and barriers to improve the adaptive capacity of human populations to climate change; c) to identify for European populations the most appropriate measures, technologies and policies, as well as the most effective approaches to implementation, in order to successfully adapt to climate change; d) to provide estimates of the health benefits of specific strategies or combinations of strategies for adaptation for vulnerable populations under different climate change scenarios; e) to estimate the costs (due to climate-related damage and the implementation of adaptive measures) and benefits (both of climate change and of adaptation strategies) including co-benefits independent of climate change Methods: In order to reach the objectives, epidemiological methods from time series analysis to event-based assessments have been used to identify populations at risk and to estimate the health impacts of weather, climate variability and potential changes. The presentation will deal with the different methods used as well as illustrate some results. Results: The attribution of health outcomes to climate change is difficult. Most of our knowledge and methods deal with health impacts of particular weather parameters. There is a need of further better integrated assessment tools. The assistance of many other scientists will be acknowledged during the presentation. [ABSTRACT FROM AUTHOR]

The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)

The analysis of changes in the timing of life cycle-events of organisms (phenology) has been able to contribute significantly to the assessment of potential impacts of climate change on ecology. These phenological responses of species to changes in climate are likely to have significant relevance for socio-economic issues such as agriculture, forestry and human health and have proven able to play a role in raising environmental awareness and education on climate change. This paper presents the European Phenology Network (EPN), which aims to increase the efficiency, added value and use of phenological monitoring and research, and to promote the practical use of phenological data in assessing the impact of global (climate) change and possible adaptation measures. The paper demonstrates that many disciplines have to deal with changes in the timing of life-cycle events in response to climate change and that many different user groups are involved. Furthermore, it shows how EPN addresses issues such as (1) raising public awareness and education, (2) the integration and co-operation of existing observing systems, (3) integration and access to phenological information and (4) communication.

Introduction: Advances in early defibrillation access, key to the "Chain of Survival", will depend on innovations in defibrillation waveforms, because of their impact on device size and weight. This study compared standard monophasic waveform automatic external defibrillators (AEDs) to an innovative biphasic waveform AED., Material and Methods: Impedance-compensated biphasic truncated exponential (ICBTE) and either monophasic truncated exponential (MTE) or monophasic damped sine (MDS) AEDs were prospectively, randomly assigned by date in four emergency medical services. The study design compared ICBTE with MTE and MDS combined. This subset analysis distinguishes between the two classes of monophasic waveform, MTE and MDS, and compares their performance to each other and to the biphasic waveform, contingent on significant overall effects (ICBTE vs. MTE vs. MDS). Primary endpoint: Defibrillation efficacy with < or =3 shocks. Secondary endpoints: shock efficacy with < or =1 shock, < or =2 shocks, and survival to hospital admission and discharge. Observations included return of spontaneous circulation (ROSC), refibrillation, and time to first shock and to first successful shock., Results: Of 338 out-of-hospital cardiac arrests, 115 had a cardiac aetiology, presented with ventricular fibrillation, and were shocked by an AED. Defibrillation efficacy for the first "stack" of up to 3 shocks, for up to 2 shocks and for the first shock alone was superior for the ICBTE waveform than for either the MTE or the MDS waveform, while there was no difference between the efficacy of MTE and MDS. Time from the beginning of analysis by the AED to the first shock and to the first successful shock was also superior for the ICBTE devices compared to either the MTE or the MDS devices, while again there was no difference between the MTE and MDS devices. More ICBTE patients achieved ROSC pre-hospital than did MTE patients. While the rates of ROSC were identical for MTE and MDS patients, the difference between ICBTE and MDS was not significant. Rates of refibrillation and survival to hospital admission and discharge did not differ among the three populations., Conclusions: ICBTE was superior to MTE and MDS in defibrillation efficacy and speed and to MTE in ROSC. MTE and MDS did not differ in efficacy. There were no differences among the waveforms in refibrillation or survival.

EURO.NIS, is conceived as a multicentric, prospective evaluation of the real incidence of pneumonia in I.C.U.'s all over Western Europe. As one of the 29 Belgian participants in this study, we performed the registration as required by the standard protocol, but also investigated our local incidence of nosocomial pneumonia in more detail. All patients hospitalized in the ICU for more than 24 hours during a survey period of 1 month are included. Recorded at the end of the first 24 hours are sex, year of birth, clinical classification, risk factors, severity score; at discharge from the ICU are recorded: mechanical ventilation and humidification equipment, sedation and relaxation, gastrointestinal bleeding prophylaxis and SDD, data on pneumonia and outcome; finally three days after discharge are clinical signs of pneumonia and survival status recorded. The overall European incidence rate of pneumonias acquired in the ICU's is 11.8%; the incidence rate in the Belgium ICU's is 10.2% and as for Bruges it is 12.8%. The incidence rate of deaths associated with pneumonia is respectively 3.5%, 3% and 3.2%. These results warrant further study of causes and prevention of nosocomial infections in our ICU.