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Rezension zu: Alexandra Pesch unter Mitarbeit von Jan Peder Lamm, Maiken Fecht (†) und Barbara Armbruster, Die Kraft der Tiere. Völkerwanderungszeitliche Goldhalskragen und die Grundsätze germanischer Kunst. Mit einem Beitrag von Lars O. Lagerqvist. Kataloge vor- und frühgeschichtlicher Altertümer, Band 47. Schriften des Archäologischen Landesmuseums, Band 12. Verlag Schnell und Steiner, Regensburg 2015. 671 Seiten mit 238 meist farbigen Abbildungen, zahlreiche Katalogillustrationen, 52 Farbtafeln., Bonner Jahrbücher, Bd. 217.2017(2018): Bonner Jahrbücher

Beschreibung: Hochwertige systematische Reviews (SR) werden mit viel Aufwand erstellt. Sie dienen als Grundlage für weitere Entscheidungen und Instrumente des Wissenstransfers, z.B. Evidenzsynthesen, Leitlinien oder Patienteninformationen. Zu manchen Fragestellungen finden sich jedoch bei sehr [zum vollständigen Text gelangen Sie über die oben angegebene URL], Who cares? – EbM und Transformation im Gesundheitswesen; 22. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Organized convective systems produce heavier downpours and can become more intense with climate change. While organized convection is well studied in the tropics and mid-latitudes, few studies have focused on the physics and climate change impacts of pan-Arctic convective systems, where they can produce flash flooding, landslides, or ignite wildfires.We use a convection-permitting model to simulate Alaska’s climate under current and end of the century high emission scenario conditions. We apply a precipitation tracking algorithm to identify intense, organized convective systems, which are projected to triple in frequency and extend to the northernmost regions of Alaska under future climate conditions. The present study assesses the reasons for this rapid increase in organized convection by investigating dynamic and thermodynamic changes within future storms and their environments, in light of canonical existing theories for mid-latitude and tropical deep convection. In a future climate, more moisture originates from Arctic marine basins and relative humidity over continental Alaska is projected to increase due to sea ice loss, which is in sharp contrast to lower-latitude land regions that are expected to become drier. This increase in relative humidity favors the onset of organized convection through more unstable thermodynamic environments, increased low-level buoyancy, and weaker downdrafts.Our confidence in these results is increased by showing that these changes can be analytically derived from basic physical laws. This suggests that organized thunderstorms might become more frequent in other pan-Arctic continental regions highlighting the uniqueness and vulnerability of these regions to climate change.

Background: Continuous epidural infusion (CEI) is the standard application mode for epidural analgesia. A modified application mode, the programmed intermittent epidural bolus application (PIEB), showed reduced local anesthetic consumption and improved patient satisfaction in obstetric analgesia. Objective: To compare postoperative analgesia quality, local anesthetic consumption, as well as side effects of PIEB and CEI mode after major gynecological surgery. Methods: 60 patients with surgery under combined epidural and general anesthesia were randomized to 2 groups. In the CEI group basal medication was given with a continuous epidural dose of 6 ml/h ropivacaine 0.2 %; in the PIEB group, this dose was injected hourly at a bolus at a rate of 210 ml/h. In addition to basal medication, patient-controlled bolus administration with a bolus volume of 4ml and a lock-out time of 30min was possible in both groups. Data on local anesthetic consumption, pain scores, satisfaction side effects were collected until the evening of the second postoperative day. Results: 41 data sets were included in the intention-to-treat analysis (CEI: n = 20, PIEB: n = 21). There was no significant group difference (PIEB: 12 ml (6-32ml) vs CEI: 28ml (5-44ml, p=0.244) for the primary endpoint "cumulative PCEA bolus volume until day 2". Total volume was significantly reduced in the PIEB group compared to the CEI group (PIEB: 306 ml (259- 322.1 ml) vs. CEI: 355 ml (330.1-379.7 ml), p = 0.004), as well as the used basal volume (PIEB: 306ml (259ml) 322.1ml), CEI: 325.7ml (314.2-337.8ml), p = 0.005) Pain scores and satisfaction were comparable at each time point in both groups. There were no clinically relevant differences with regard to side effects such as postoperative nausea or vomiting, hypotension, and motor impairment. Conclusion: The programmed intermittent epidural application was found to be an effective analgesic procedure with reduced total ropivacaine consumption in this study. The PCEA bolus volume reduction, analgesia quality, and reported adverse events did not show any clinically relevant benefits over the continuous mode., Hintergrund: Das Standardapplikationsverfahren der epiduralen Analgesie ist die kontinuierliche epidurale Infusion (CEI). In der geburtshilflichen Anästhesie zeigte ein modifiziertes Applikationsverfahren, die programmierte intermittierende epidurale Bolusapplikation (PIEB), einen reduzierten Lokalanästhetikabedarf und eine höhere Patientinnenzufriedenheit. Zielsetzung: Ziel der vorliegenden Studie Untersuchung war es, postoperative Analgesiequalität, Lokalanästhetikaverbrauch sowie Nebenwirkungen von PIEB und CEI-Modus nach großen gynäkologischen Tumoroperationen zu vergleichen. Methodik: 60 Patientinnen mit Operation unter kombinierter Epidural- und Allgemeinanästhesie wurden in zwei Gruppen randomisiert. In der CEI- Gruppe erfolgte die Basalmedikation mit einer kontinuierlichen epiduralen Gabe von 6ml/h Ropivacain 0,2%; in der PIEB-Gruppe wurde diese Dosis stündlich als Bolus mit einer Rate von 210ml/h infundiert. Zusätzlich zur Basalmedikation war in beiden Gruppen eine patientenkontrollierte Bolusgabe mit einem Bolusvolumen von 4ml und einer Lock-Out-Zeit von 30min möglich. Folgende Daten wurden bis zum Abend des zweiten postoperativen Tages erhoben: Lokalanästhetikaverbrauch, Schmerzscore, Zufriedenheit, Nebenwirkungen. Ergebnisse: 41 Datensets wurden in die Intention-to-treat Analyse einbezogen (CEI: n=20, PIEB: n=21). Bezüglich des primären Endpunkts „kumulatives PCEA-Bolusvolumen bis Tag 2 zeigte sich kein signifikanter Gruppenunterschied (PIEB: 12 ml (6-32 ml) vs. CEI: 28 ml (5-44 ml, p = 0,244). Das Gesamtvolumen war in der PIEB-Gruppe signifikant niedriger als in der CEI-Gruppe (PIEB: 306ml (259-322,1ml) vs. CEI: 355ml (330,1- 379,7ml), p=0,004), ebenso das verbrauchte Basalvolumen (PIEB: 306ml (259-322,1 ml), CEI: 325.7 ml (314,2-337,8 ml), p = 0,005). Schmerzscores und Zufriedenheit waren zu jedem Erhebungszeitpunkt in beiden Gruppen vergleichbar. Bei den erfassten Nebenwirkungen, wie postoperative Übelkeit oder Erbrechen, Hypotonien, motorische Beeinträchtigung zeigten sich keine klinisch relevanten Unterschiede. Schlussfolgerung: Die programmierte intermittierende Epiduralapplikation erwies sich in dieser Studie als effektives Analgesieverfahren mit im Vergleich zur kontinuierlichen Applikation reduziertem Ropivacainverbrauch. Für die Senkung des PCEA-Bolusvolumens, der Analgesiequalität, sowie die erfassten Nebenwirkungen konnten keine klinisch relevanten Vorteile gegenüber dem kontinuierlichen Verfahren dargestellt werden.

This chapter outlines the truth games of globalized agriculture and asks about the conditions under which the counter-narrative of food sovereignty can gain ground against the dominant narrative of food security. To begin, Food Security and Food Sovereignty are situated within the current neoliberal global food regime with attention paid to their history and content. Then, using Foucault the discourses of globalized agriculture are criticized and Food Sovereignty as subjugated knowledge is described. The chapter then introduces Ricœur´s narrative theory to show how narratives are constitutive for the discourses of truth games, and the possibility of how the concept of subjugated knowledge can be expanded with regard to the characteristics of narratives. Philanthrocapitalist foundations and La Via Campesina are used as an illustrative purpose in showing how narratives and counter-narratives both aim at opening up possible worlds thereby creating distinct plots, and notions of time and space. This work is an attempt to combine the concept of food sovereignty with both Foucault’s genealogy and the concept of counter-narratives to demonstrate the productivity of such a combined approach.

The growth of uterine fibroids is sex hormone-dependent and commonly associated with highly incapacitating symptoms. Most treatment options consist of the control of these hormonal effects, ultimately blocking proliferative estrogen signaling (i.e., oral contraceptives/antagonization of human gonadotropin-releasing hormone receptor [hGnRH-R] activity). Full hGnRH-R blockade, however, results in menopausal symptoms and affects bone mineralization, thus limiting treatment duration or demanding estrogen add-back approaches. To overcome such issues, we aimed to identify novel, small-molecule hGnRH-R antagonists. This led to the discovery of compound BAY 1214784, an orally available, potent, and selective hGnRH-R antagonist. Altering the geminal dimethylindoline core of the initial hit compound to a spiroindoline system significantly improved GnRH-R antagonist potencies across several species, mandatory for a successful compound optimization in vivo. In a first-in-human study in postmenopausal women, once daily treatment with BAY 1214784 effectively lowered plasma luteinizing hormone levels by up to 49%, at the same time being associated with low pharmacokinetic variability and good tolerability.

In most observations of diffusive convection in the ocean and in lakes, the characteristic diffusive staircases evolve over long time scales under quasi-stationary background conditions. In the Baltic Sea, however, diffusive staircases develop inside the flanks of intermittent intrusions that induce strong inverse temperature gradients over a vertical range of a few meters, varying on time scales of hours to days. Here, results are discussed from an extensive field campaign conducted in summer 2016 in the southern Baltic Sea, including temperature microstructure data from ocean gliders and an autonomous profiling platform. We find conditions favorable for diffusive instability in the vicinity of warm and cold intrusions with density ratios as small as Rρ = 1.3. The staircases evolving under these conditions are characterized by a small number of steps (typically 1–4) with order 0.1–1-m thickness, temperature differences exceeding 1 K across individual diffusive interfaces, and exceptionally large diffusive heat fluxes of order 10 W m−2. The standard heat flux parameterization of Kelley agrees within a factor of 2 with the directly observed interfacial heat fluxes, except for large fluxes at low Rρ, which are strongly overestimated. The glider surveys reveal a surprisingly small lateral coherency of order 100 m of the staircase patterns, and a spreading of the diffusively unstable intrusions across isopycnals.

Objective Concussion diagnosis and management in sports largely relies on neurocognitive testing. In the absence of baseline assessment, only norm values of the general population are available for comparison with scores of concussed athletes. To evaluate whether (elite) sport specific norm values are needed, cognitive performance was compared between top-level football players and the general population. Methods Cognitive performance of 425 top-level football players was evaluated using the computerized test battery CNS Vital Signs. Players were split into two age groups (15-19 and 20-29 years) and test results were compared with a norm sample (n = 268) by means of age-standardized scores using Cohen's d effect size statistics. Results The younger age group outperformed the norm sample in all domains, with small to moderate effects on tests of processing speed (d = 0.58, 95% CI = 0.31,0.85), cognitive flexibility (d = 0.27, 95% CI = 0.01,0.53) and psychomotor speed (d = 0.97, 95% CI = 0.69,1.24). In the older age group, no differences were found on four out of six domains; a moderate positive effect was found for psychomotor speed (d = 0.74, 95% CI = 0.54,0.93), a small negative effect for reaction time (d = -0.47, 95% CI = -0.66,-0.28). Relative to the norm, older football players scored lower than younger football players on all test domains. Conclusion Cognitive performance of elite football players may be different from the general population. It is recommended to use football-specific norm scores for comparison with test results of concussed players, and to choose an adequate control group when investigating effects of contact sport on cognition. Studies with older/retired football players are needed to further analyze potential sport-specific age effects.

BACKGROUND Despite standard of care chemoprophylaxis, postoperative VTEs occur in ∼4% of IBD patients, and little data on current practices in IBD has been reported. We cultivated a baseline cohort to inform power calculations for a forthcoming prospective, multicenter trial of VTE prophylaxis comparing the efficacy & safety of standard of care vs. aspirin (SAVES-IBD Trial). In this initial report we describe the current standard of care VTE prophylaxis practice patterns in our collaborative. METHODS The National Surgical Quality Improvement Program (NSQIP) IBD Collaborative designed and implemented 6 VTE specific-variables including 1) Inpatient VTE chemoprophylaxis, 2) extended (post-discharge) prophylaxis, 3) length of time on primary prophylaxis, 4) VTE location, and 30-days bleeding requiring 5) transfusion or 6) reoperation. Data was collected prospectively from Sept 2020 – Mar 2021. Patients age >18 undergoing elective or emergent colectomy or proctectomy with a post-op IBD diagnosis were included. Patients with VTE present at admission (n=10, 2.3%) were excluded. RESULTS Over 6-months, 434 patients from 13 centers were accrued; median 22 cases, IQR 18.5 – 28. Demographics: median age 41.5 years, 50% female, median BMI 24.7 kg/m2. Diagnoses: 263 (60.9%) Crohn’s vs. 169 (39%) UC/IBDu, while 359 (82.7%) and 75 (17.3%) patients underwent colectomy and proctectomy, respectively including 69 (15.9%) IPAAs and 256 (59.0%) ileostomies, and 21 (4.8%) emergency cases. IBD Medications: 237 (54.6%) biologics, 233 (53.7%) steroids, 51 (11.8%) immunomodulators. A total of 395 (91.4%) received inpatient chemoprophylaxis including LMWH in 236 (59.7%), UFH in 158 (40.0%), DOAC in 1 (0.3%), and aspirin (none), and no chemoprophylaxis in 37 (8.5%). Extended chemoprophylaxis was utilized in 209 (48.7%) and included LMWH in 179 (85.6%), DOAC in 18 (8.6%), aspirin in 7 (3.3%), and UFH in 5 (2.4%). Overall, bleeding complications occurred in 38 (8.8%) patients with 34 (8.4%) requiring transfusion and 9 (2.1%) needing reoperation. Postoperatively, VTEs were diagnosed in 19 (4.4%) patients. VTE locations: portomesenteric vein thrombosis 8 (42%), upper extremity 3 (15.8%) or lower extremity 3 (15.8%) DVT, pulmonary embolism 2 (10.5%), and other 3 (15.8%). Univariate analysis of risk factors is shown in Table 1. Patients with 0-2 risk factors had a VTE rate of 2.9%, while in those with >2 risk factors, 31.8% developed VTE (p CONCLUSION In this cohort of surgical IBD patients from IBD specialty centers, we observed a 2.3% rate of pre-operative, and a 4.4% rate of post-operative, VTE. These rates have informed the SAVES-IBD power calculations. We also observed that almost half of IBD surgery patients in these centers were prescribed extended chemoprophylaxis, most commonly with enoxaparin, rarely with aspirin. Validation of the prophylaxis variables is in-progress.