Infection Prevention in the Emergency Department.

Infection prevention remains a major challenge in emergency care. Acutely ill and injured patients seeking evaluation and treatment in the emergency department (ED) not only have the potential to spread communicable infectious diseases to health care personnel and other patients, but are vulnerable to acquiring new infections associated with the care they receive. This article will evaluate these risks and review the existing literature for infection prevention practices in the ED, ranging from hand hygiene, standard and transmission-based precautions, health care personnel vaccination, and environmental controls to strategies for preventing health care-associated infections. We will conclude by examining what can be done to optimize infection prevention in the ED and identify gaps in knowledge where further research is needed. Successful implementation of evidence-based practices coupled with innovation of novel approaches and technologies tailored specifically to the complex and dynamic environment of the ED are the keys to raising the standard for infection prevention and patient safety in emergency care.

Treatment modalities for T1N0 esophageal cancers: a comparative analysis of local therapy versus surgical resection

BACKGROUND To investigate the role of nonsurgical treatment for early-stage esophageal cancer, we compared the outcomes of local therapy to esophagectomy, using a large, national database. METHODS Five-year cancer-specific and overall survival (OS) of patients, with T1N0M0 squamous cell or adenocarcinoma of the mid or distal esophagus treated with either surgery or local therapy, with ablative and/or excision techniques, in the Surveillance Epidemiology and End Results cancer registry from 1998 to 2008, were compared using the Kaplan-Meier approach, and multivariable and propensity-score adjusted Cox proportional hazard, and competing risk models. RESULTS Of 1458 patients with T1N0 esophageal cancer, 1204 (83%) had surgery and 254 (17%) had local therapy only. The use of local therapy increased significantly from 8.1% in 1998 to 24.1% in 2008 (p < 0.001). The 5-year OS after local excisional therapy and surgery was not significantly different (55.5% versus 64.1% respectively, p = 0.07), and 5-year cancer-specific survival (CSS) also did not differ (81.7% versus 75.8%, p = 0.10). However, after propensity-score adjustment, CSS was better for patients who underwent local therapy compared with those who underwent surgery (hazard ratio: 0.46, 95% confidence interval: 0.27-0.77, p = 0.003), whereas OS remained similar. CONCLUSION The use of local therapy for T1N0 esophageal cancers increased significantly from 1998 to 2008. Compared with those treated with esophagectomy, patients treated with local therapy had similar OS but improved CSS, indicating a higher chance of dying from other causes. Further studies are needed to confirm the oncologic efficacy of local therapy when used in patients whose lifespans are not limited by conditions other than esophageal cancer.

Unterricht in der Judensprache und Schrift : zum Gebrauch für Gelehrte und Ungelehrte

[von Carl Wilhelm Friedrich]

Über Moses Mendelssohn's Jerusalem

von Johann Friedrich Zöllner

Ueber Herrn Moses Mendelssohns Jerusalem, politisch religiöse Macht, Judenthum und Christenthum

[Verf.[[Elektronische Ressource]] : August Georg Uhle]

Halakot mezuzah

Wittenberg, Univ., Diss., 1674

The largest floods in the High Rhine basin since 1268 assessed from documentary and instrumental evidence

The magnitudes of the largest known floods of the River Rhine in Basel since 1268 were assessed using a hydraulic model drawing on a set of pre-instrumental evidence and daily hydrological measurements from 1808. The pre-instrumental evidence, consisting of flood marks and documentary data describing extreme events with the customary reference to specific landmarks, was “calibrated” by comparing it with the instrumental series for the overlapping period between the two categories of evidence (1808–1900). Summer (JJA) floods were particularly frequent in the century between 1651–1750, when precipitation was also high. Severe winter (DJF) floods have not occurred since the late 19th century despite a significant increase in winter precipitation. Six catastrophic events involving a runoff greater than 6000 m 3 s-1 are documented prior to 1700. They were initiated by spells of torrential rainfall of up to 72 h (1480 event) and preceded by long periods of substantial precipitation that saturated the soils, and/or by abundant snowmelt. All except two (1999 and 2007) of the 43 identified severe events (SEs: defined as having runoff > 5000 and < 6000 m 3 s -1) occurred prior to 1877. Not a single SE is documented from 1877 to 1998. The intermediate 121-year-long “flood disaster gap” is unique over the period since 1268. The effect of river regulations (1714 for the River Kander; 1877 for the River Aare) and the building of reservoirs in the 20th century upon peak runoff were investigated using a one-dimensional hydraulic flood-routing model. Results show that anthropogenic effects only partially account for the “flood disaster gap” suggesting that variations in climate should also be taken into account in explaining these features.

Hochwasser-«Katastrophen» in Basel vom 13. bis 21. Jahrhundert Rekonstruktion, Deutung und Lerneffekte

Magnitudes of peak discharges of 43 non-instrumentally measured Rhine river floods at Basel were reconstructed. The methodology is based on a range of different historic sources, containing flood information (including traditional urban inundation reference points from flood reports of medieval and early modern period chroniclers as well as 19th century journalists, flood marks, paintings and drawings, town maps, longitudinal and cross profiles etc.). These traditional pre-instrumental “flood information systems” still existed in the 19th century, when in 1808 the first instrumental hydrological measurements started. They thus could be calibrated with instrumental measurements in the 19th century overlapping period. The result is a 743 year long quantified Rhine river flood series. Floods of both periods (pre-instrumental as well as instrumental) can thus be directly compared for the very first time. The long-range consequences of rivers Kander and Aare deviations in 1714 and 1878 are reflected in a distinct change of magnitudes of peak discharges in Basel. A clear flood “disaster gap” appears in the 20th century. The lack of any extreme floods for such a long time is completely unique during the 743-year period of analysis. This result will influence the statistical assessment of once-in-a-century events, which might be of great interest for insurance campanies.

De Beruria Judaeorum doctissima foemina, ad historiam literariam eius gentis seculo secundo post C.n.

Altdort, Univ., Diss., 1714

Johannis Coccei ... Lexicon & commentarius sermonis hebraici et chaldaici : utpote in qua 1. Infinita menda sublata, 2. Significationes ... 3. Voces omissae restitutae, 4. Auctores notae lexicae subiunctae, 5. Animadversiones & supplemata adiecta sunt

Opera atque studio ... Johannis Henrici Maji ...