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Constructed wetlands (CW) treating runoff from agricultural catchments can efficiently reduce nitrate contamination, however, most wetlands are inherently net sources of methane (CH4), which is of environmental concern due to its potent global warming capacity. For the mitigation of this negative aspect of CWs we need investigations on the CH4 emission dynamics and environmental conditions governing CH4 production and consumption in CWs.This study integrates results from 4-years (2014-2017) investigations in an off-stream CW in Rampillon, France (0.53 ha, depth 0.3-0.8 m, est. 2010) and from 4-years (2018-2021) studies in an in-stream CW in Vända, Estonia (0.45 ha, depth 0.1-0.6 m, est. 2015). In Rampillon, during four 2-weeks measurement campaigns throughout all seasons CH4 fluxes were measured using floating automated chambers connected to the QCLAS laser system. In addition, gas was sampled twice day from manual floating chambers for further analysis in lab. In Vända in-stream CW, CH4 fluxes were measured twice a month using manual chambers and gas-chromatographs.The average annual CH4 emission in Rampillon for 2014-2015 was 7.7 g CH4-C m-2 yr-1, showing highest values from deeper (0.5-1.0 m) parts in summer and autumn. The highest values reached up to 180 mg CH4-C m-2 h-1, mainly due to ebullition. The emissions in winter and spring were up to 10 times lower, however no negative values were observed. There was an increasing trend in CH4 fluxes: in 2017 the average emission reached to 12.0 g CH4-C m-2 y-1. Differences between the emission values gathered from authomated chambers were about 10% higher than those measured from manual chambers.In Vända in-stream CW, a clear increase in average annual emissions was found: from 0.4 in2018 to 10.5 g CH4-C m-2 yr-1 in 2021. It was correlated with increasing Typha latifolia-dominated vegetation cover. Emissions showed strong correlation with air and water temperature while no clear relationship was found with the depth of various parts.Large CH4 emission from CWs is a major concern and therefore a smart management is needed. Our previous studies in surface flow CWs treating nitrate-contaminated runoff demonstrate that above-ground biomass harvesting of plants can decrease the CH4. The end of growing season is likely the best time for biomass harvesting while avoiding the excessively high CH4 emissions that the summer harvest may produce.

Rapid large-scale development presents challenges for traffic engineers to accurately forecast design-year traffic volumes. Prevailing forecasting methods, such as the ITE Trip Generation Manual, tend to exaggerate local traffic impacts on large developments and do not account for regional influences. This presentation outlines the methodologies for developing the design level forecast of two large freeway projects amid largescale private developments. This approach provides significant improvements over traditional trip generation methods and model-based forecasts.

Väitekirja elektrooniline versioon ei sisalda publikatsioone, Ühiskonna suurenenud toiduvajadus on suurendanud põllumaade osakaalu ning väetiste kasutamist. Intensiivne või halvasti ajastatud väetamine mõjutab pinnavett ja suurendab veekogude eutrofeerumist. Põllumajandusliku hajukoormuse leevendamiseks ja vee kvaliteedi parandamiseks on tõhus meede tehismärgalade rajamine. Need aitavad parandada vee kvaliteeti looduslike protsesside abil ning pakuvad muidki ökosüsteemi hüvesid (suurendavad bioloogilist mitmekesisust, puhverdavad sademevett ja toimivad veereservuaarina). Doktoritöö uuris vahetult voolusängi rajatud Vända avaveelise tehismärgalargala toimet: toitainete vähenemist ja kasvuhoonegaaside (KHG) heitkoguseid mõjutavaid parameetreid. Varasemast on teada, et tehismärgalades sõltuvad toitainete eemaldamise tõhusus ja KHG heitkogused vee parameetritest ja märgalade kujundusest. Vända märgala vähendas tõhusalt fosforit, millel oli selge hooajaline dünaamika. Tõhusamalt eemaldas fosforit soojal perioodil ja külmal perioodil oli tõhusus väiksem. Fosfori eemaldamise efektiivsus oli suurem väikese vooluhulga korral, sest siis aeglane vool soodustas settimis- ja filtreerimisprotsesse. Lämmastiku eemaldamine oli ootustele vastupidine, kuna märgalas suurenes lämmastiku hulk väljavoolu suunas. Lämmastiku lisandumine toimus tõenäoliselt nitraadirikka põhjavee sissevoolu tõttu. Fosfori puhastusefektiivsus sõltus ka taimkattest – mida rohkem taimi, seda tõhusam. Taimestik levis märalal aastate jooksul ning see soodustas fosfori eemaldamist. Metaani (CH4) ja dilämmastikoksiidi (N2O) puhul ilmnes sesoonne dünaamika – soojal perioodil oli lendumine suurem ja külmal perioodil väiksem. N2O heitkogused sõltusid vee sügavusest, voolukiirusest ja vee temperatuurist. Suvel kui mikroobne aktiivsus on suur, täheldati oluliselt suuremaid N2O emissioone., Water quality has degraded due to increased proportion of agricultural lands in some regions, if more fertilizer is used. Intensive or poorly timed fertilization affects surface waters and increases eutrophication in water bodies. Diffuse agricultural pollution is difficult to locate and control due to its diffuse nature, climate conditions and strong anthropogenic influence. In order to maintain or improve surface water quality, it is important to find and use effective measures. One of the best measures for improving water quality is using constructed wetlands. Constructed wetlands help to improve water quality through natural treatment processes, among several other benefits. They increase biodiversity, buffer storm water and act as a water reservoir. The aim of this thesis was to investigate the efficiency of in-stream free water surface flow Vända constructed wetland and study the parameters affecting nutrient reduction and greenhouse gas (GHG) emissions. Long-term monitoring results show that in in-stream CWs, nutrient removal efficiency and GHG emissions are highly dependent on water parameters and wetland design. Vända CW effectively reduced phosphorus that had clear seasonal dynamics. Higher removal efficiency occurred during the warm period and lower values were seen during the cold period. Higher removal efficiency values for phosphorus were seen when the flow rate was lower. With a lower flow rate, sedimentation and filtration processes are favoured. The results for nitrogen removal were contrary to expectations because CW acted more as a source of nitrogen. The addition of nitrogen was suspected to come from groundwater that was contaminated with nitrate. Phosphorus removal had a strong positive correlation with vegetation coverage. Through years’ vegetation spread over the wetland and that promoted phosphorus removal processes. For methane (CH4) and nitrous oxide (N2O), clear seasonal dynamics were seen, with higher emissions during the warm period and lower emissions during the cold period. N2O emissions were strongly related to water depth, flow rate and water temperature. During summer, with high microbial activity, significantly higher N2O emissions were seen.

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Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p p = 0.002) and had more dementia (18.7% vs. 7.2%, p p p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.

The coronavirus disease 2019 (COVID-19) pandemic is a major challenge for global healthcare systems. Early and safe triage in the emergency department (ED) is crucial for proper therapy. However, differential diagnosis remains challenging. Rapid antigen testing (RAT) may help to improve early triage and patient safety. We performed a retrospective study of 234 consecutive patients with suspected COVID-19 who presented to our ED in November 2020. All underwent SARS-CoV-2-nasopharyngeal swab testing using both RAT and reverse transcription polymerase chain reaction (RT-PCR). The inpatient treatment was established according to an empirically developed triage algorithm. The accuracy of the suggested algorithm was analyzed based on the rate of outpatients returning within 7 days and inpatients staying for less than 48 hours. COVID-19 inpatients and outpatients were compared for symptoms, vital signs, and C-reactive protein levels. Of the 221 included patients with suspected COVID-19 infection, the diagnosis could be confirmed in 120 patients (54.3%) by a positive RT-PCR result, whereas only 72% of those had a positive antigen test. Of the 56 COVID-19 outpatients, three returned within 7 days with the need for hospital treatment due to clinical deterioration. Among the 64 COVID-19 inpatients, 4 were discharged within 48 hours, whereas 60 stayed longer (mean duration 10.2 days). The suggested triage algorithm was safe and efficient in the first 234 consecutive patients. RAT can confirm a diagnosis in 72% of PCR proven COVID-19 patients and allows early cohort isolation as an important way to save hospital capacity. CA Fistera

Einleitung Mit weit mehr als 1400 stationär behandelten COVID-19-Patienten ist die Universitätsmedizin Essen der größte COVID-19-Versorger der Region Rhein-Ruhr. Wir präsentieren die Daten unserer Patienten aus den ersten 12 Monaten der Pandemie und die hieraus entstandenen praktischen Konzepte. Methode Retrospektive Analyse aller 1396 stationären COVID-19-Patienten, die zwischen dem 1. März 2020 und 28. Februar 2021 versorgt wurden, im Hinblick auf Komorbiditäten, Überleben und Komplikationen im Verlauf. Es erfolgte ein Gruppenvergleich zwischen Patienten auf Normalstation und Überwachungs-/ Intensivstation. Ergebnisse Bei einer Gesamtmortalität von 19,8 % (277/1396) starben 10,6 % (93/877) der Patienten auf Normalstation und 35,5 % (184/519) der Patienten auf Intensiv- und Überwachungsstationen im klinischen Verlauf. Hierbei waren ein Alter über 60 Jahre, Adipositas, maschinelle Beatmung, NO-Therapie, ECMO-Therapie sowie akutes Nierenversagen und Apoplex im Therapieverlauf unabhängige Prädiktoren für Mortalität. Fazit Die Mortalität unseres Kollektivs auf Normal- bzw. Intensivstationen liegt im Rahmen international publizierter Daten. Sowohl die hohe Rate von Komplikationen bei schwerem Verlauf als auch die große Bedeutung einfacher Komorbiditäten kann eindrücklich gezeigt werden. Das mittlere Alter der Patienten ist mit 60 Jahren auf Normalstation und 63 Jahren auf Intensivstationen überraschend niedrig. Maximaler Patienten- und Personalschutz, eine rasche und effektive Teststrategie im Rahmen der primären Triage, standardisierte Abläufe von der Notaufnahme bis zur Intensivstation sowie eine dynamische tagesaktuelle Anpassung der Ressourcen können eine hohe Versorgungsqualität, auch während der Pandemie, sichern.

Scleroderma renal crisis (SRC) is an acute life-threatening manifestation of systemic sclerosis (SSc) caused by obliterative vasculopathy and thrombotic microangiopathy. Evidence suggests a pathogenic role of immunoglobulin G (IgG) targeting G-protein coupled receptors (GPCR). We therefore dissected SRC-associated vascular obliteration and investigated the specific effects of patient-derived IgG directed against angiotensin II type 1 (AT1R) and endothelin-1 type A receptors (ETAR) on downstream signaling events and endothelial cell proliferation. SRC-IgG triggered endothelial cell proliferation via activation of the mitogen-activated protein kinase (MAPK) pathway and subsequent activation of the E26 transformation-specific-1 transcription factor (Ets-1). Either AT1R or ETAR receptor inhibitors/shRNA abrogated endothelial proliferation, confirming receptor activation and Ets-1 signaling involvement. Binding of Ets-1 to the tissue factor (TF) promoter exclusively induced TF. In addition, TF inhibition prevented endothelial cell proliferation. Thus, our data revealed a thus far unknown link between SRC-IgG-induced intracellular signaling, endothelial cell proliferation and active coagulation in the context of obliterative vasculopathy and SRC. Patients’ autoantibodies and their molecular effectors represent new therapeutic targets to address severe vascular complications in SSc.

Wetlands that are restored for carbon sequestration or created for water treatment are an important sources of greenhouse gases, especially methane. The emission of nitrous oxide (N

Background: Medulloblastoma, a genetically heterogeneous tumor, is the most frequent malignant brain tumor in children. Although several studies have been carried out, the molecular mechanism underlying medulloblastoma tumorigenesis is not completely known. microRNA (miRNA) expression profiles have been associated with development, progression, and prognosis of human cancers, including medulloblastoma. However, the role of miRNAs in pediatric medulloblastoma has been poorly explored.Methods: Global miRNA expression in 24 microdissected medulloblastoma specimens (19 pediatric and 5 adult specimens) was evaluated by microarray assay. miR-512-3p, the most differentially expressed miRNA in these two groups, was analyzed by qRT-PCR in a cohort of 51 consecutive pediatric medulloblastoma samples and 7 pediatric non-neoplastic cerebellum control samples, and its clinical significance was assessed. Further in silico miRNA prediction of target genes was performed with bioinformatics tools.Results: Compared to the controls, miR-512-3p was significantly downregulated in the pediatric medulloblastoma samples. Higher miR-512-3p was associated with incomplete degree of resection, high risk group classification, and poor overall survival. In silico analysis in an independent cohort of medulloblastoma identified that some of the miR-512-3p target genes (SMAD9, SSX2IP, MAPK10, PTCH1, CCDC6, and BMPR2) were statistically correlated with overall survival, metastasis, and death.Conclusions: For the first time, our results have shown that miR-512-3p is significantly associated with poor clinical outcome in pediatric medulloblastoma, suggesting that miR-512-3p is a potential biomarker of prognosis.

Background and Purpose: Considering the highly time-dependent therapeutic effect of endovascular treatment in patients with large vessel occlusion–associated acute ischemic stroke, prehospital identification of large vessel occlusion and subsequent triage for direct transport to a comprehensive stroke center offers an intriguing option for optimizing patient pathways. Methods: This prospective in-field validation study included 200 patients with suspected acute ischemic stroke who were admitted by emergency medical service to a comprehensive stroke center. Ambulances were equipped with smartphones running an app-based Field Assessment Stroke Triage for Emergency Destination scale for transmission prior to admission. The primary measure was the predictive accuracy of the transmitted Field Assessment Stroke Triage for Emergency Destination for large vessel occlusion and the secondary measure the predictive accuracy for endovascular treatment. Results: A Field Assessment Stroke Triage for Emergency Destination ⩾4 revealed very good accuracy to detect large vessel occlusion–related acute ischemic stroke with a sensitivity of 82.4% (95% confidence interval = 65.5–93.2), specificity of 78.3% (95% confidence interval = 71.3–84.3), and an area under the curve c-statistics of 0.89 (95% confidence interval = 0.85–0.94). Field Assessment Stroke Triage for Emergency Destination ⩾4 correctly identified 84% of patients who received endovascular treatment [73.5% specificity (95% confidence interval = 66.4–79.8)] with an area under the curve c-statistics of 0.82 (95% confidence interval = 0.74–0.89). In a hypothetical triage model of an urban setting, one secondary transportation would be avoided with every fifth patient screened. Conclusion: A smartphone app-based stroke triage completed by emergency medical service personnel showed adequate quality for the Field Assessment Stroke Triage for Emergency Destination to identify large vessel occlusion–associated acute ischemic stroke. We demonstrate feasibility of the use of a medical messaging service in prehospital stroke care. Based on these first results, a randomized trial evaluating the clinical benefit of such a triage system in an urban setting is currently in preparation. Clinical Trial Registration: https://clinicaltrials.gov Unique identifier: NCT04404504. OA Förderung 2021 in press

Background Current ESC guidelines for non-ST-segment elevation myocardial infarction suggest the utilization of echocardiography in patients with inconclusive initial electrocardiography and cardiac enzymes. Besides detection of alternative pathologies associated with chest pain, echocardiography can screen for wall motion abnormalities (WMA) as sign of myocardial necrosis. Purpose We evaluated the ability of the assessment of regional WMA, detected via transthoracic echocardiography, to predict the presence of culprit lesions in patients presenting with acute chest pain to the emergency department. Methods In this prospective single-centre observational cohort study, we included consecutive patients presenting to the emergency department of our University Hospital with acute chest pain, suggestive of an acute coronary syndrome, between December 2018 and August 2020. Patients with ST-elevation myocardial infarction, hemodynamic instability, or known coronary artery disease were excluded. As part of initial workup, patients received bedside echocardiography for the assessment of regional WMA by a dedicated study physician, blinded to all patients' characteristics. The primary endpoint was defined as the presence of culprit lesions as detected in subsequent invasive coronary angiography, requiring coronary revascularization therapy. Logistic regression analysis was performed in different models adjusted for traditional cardiovascular risk factors, cardiac biomarkers as well as established risk scores. Area under the receiver operating characteristics curve (AUC) was calculated to assess a potential improvement in the prediction of culprit lesions. Results Overall, 657 patients (age 58.06±18.04 years, 53% male) were included in our study. WMA were detected in 76 patients (11.6%). Patients with WMA were older (66.92±13.85 vs. 56.90±18.21 years, p Conclusion WMA strongly and independently predict the presence of culprit lesions in patients presenting with acute chest pain to the emergency department. Our results suggest that routine bedside echocardiography for assessment of WMA in emergency department may improve diagnostic algorithms in suspected acute coronary syndrome. Funding Acknowledgement Type of funding sources: None.

Embora o acometimento do nervo fibular seja uma das neuropatias mais comuns nos membros inferiores, a lesão bilateral ainda é pouco citada na literatura. Apresentamos uma mulher jovem com doença de nervo fibular comum pouco tempo após a descompressão cirúrgica bem sucedida no membro contralateral. O principal achado é o déficit motor, com a típica marcha escarvante. A eletroneuromiografia continua sendo a propedêutica ideal, considerando atualmente novas modalidades em estudo. Mesmo que em diferentes apresentações, até o momento, a descompressão cirúrgica do nervo fibular parece ser a modalidade terapêutica de melhor resultado.

Introdução: O conhecimento, as percepções e atitudes sobre saúde bucal expressas pelas figuras maternas são importantes e merecem atenção. O planejamento de ações e a compreensão dos valores, atitudes e crenças em saúde são fenômenos sociais e biológicos vividos culturalmente. A educação em saúde bucal no ambiente domiciliar é uma opção promissora para o processo educativo devido à facilidade de aprendizagem por parte das crianças. Objetivo: Verificar o conhecimento das mães sobre saúde bucal na infância, observando as práticas e cuidados domiciliares estabelecidos por essas mulheres com a saúde oral de seu filho. Método: Foi uma pesquisa qualitativa e quantitativa que analisou os dados relacionados às práticas e cuidados maternos domiciliares com a higiene bucal de crianças, internadas num Hospital no Distrito Federal – DF. Resultados: Revelou-se 98% das mães responderam que seus filhos têm os dentes limpos quando estão em casa e 2% responderam que não. Obteve-se que 67% das mães executam os procedimentos de higienização bucal domiciliar em seus filhos, 15% é a própria criança. Através da pesquisa obteve-se que 53% das crianças já visitaram o dentista pelo menos uma vez na vida e 47% nunca foram ao dentista. Conclusão: Com o estudo proposto foi possível observar que apesar do grande percentual de crianças nunca terem ido ao dentista existe uma grande adesão às práticas de limpeza bucais domiciliares, sendo a mãe a principal figura familiar responsável pelos cuidados com seu filho. Descritores: Percepção social; Relações mãe-filho; Saúde bucal; Conhecimentos, atitudes e prática em saúde.