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River deltas belong to the most densely settled places on earth. Although they only account for 5% of the global land surface, over 550 million people live in deltas. These preferred livelihood locations, which feature flat terrain, fertile alluvial soils, access to fluvial and marine resources, a rich wetland biodiversity and other advantages are, however, threatened by numerous internal and external processes. Socio-economic development, urbanization, climate change induced sea level rise, as well as flood pulse changes due to upstream water diversion all lead to changes in these highly dynamic systems. A thorough understanding of a river delta's general setting and intra-annual as well as long-term dynamic is therefore crucial for an informed management of natural resources. Here, remote sensing can play a key role in analyzing and monitoring these vast areas at a global scale. The goal of this study is to demonstrate the potential of intra-annual time series analyses at dense temporal, but coarse spatial resolution for inundation characterization in five river deltas located in four different countries. Based on 250 m MODIS reflectance data we analyze inundation dynamics in four densely populated Asian river deltas-namely the Yellow River Delta (China), the Mekong Delta (Vietnam), the Irrawaddy Delta (Myanmar), and the Ganges-Brahmaputra (Bangladesh, India)-as well as one very contrasting delta: the nearly uninhabited polar Mackenzie Delta Region in northwestern Canada for the complete time span of one year (2013). A complex processing chain of water surface derivation on a daily basis allows the generation of intra-annual time series, which indicate inundation duration in each of the deltas. Our analyses depict distinct inundation patterns within each of the deltas, which can be attributed to processes such as overland flooding, irrigation agriculture, aquaculture, or snowmelt and thermokarst processes. Clear differences between mid-latitude, subtropical, and polar deltas are illustrated, and the advantages and limitations of the approach for inundation derivation are discussed.
Background
There are not enough clinical data from rare critical events to calculate statistics to decide if the management of actual events might be below what could reasonably be expected (i.e. was an outlier).
Objectives
In this project we used simulation to describe the distribution of management times as an approach to decide if the management of a simulated obstetrical crisis scenario could be considered an outlier.
Design
Twelve obstetrical teams managed 4 scenarios that were previously developed. Relevant outcome variables were defined by expert consensus. The distribution of the response times from the teams who performed the respective intervention was graphically displayed and median and quartiles calculated using rank order statistics.
Results
Only 7 of the 12 teams performed chest compressions during the arrest following the 'cannot intubate/cannot ventilate' scenario. All other outcome measures were performed by at least 11 of the 12 teams. Calculation of medians and quartiles with 95% CI was possible for all outcomes. Confidence intervals, given the small sample size, were large.
Conclusion
We demonstrated the use of simulation to calculate quantiles for management times of critical event. This approach could assist in deciding if a given performance could be considered normal and also point to aspects of care that seem to pose particular challenges as evidenced by a large number of teams not performing the expected maneuver. However sufficiently large sample sizes (i.e. from a national data base) will be required to calculate acceptable confidence intervals and to establish actual tolerance limits.
Prof. em. Dr. Theodor Berchem (*1935) promovierte 1963 in Paris und habilitierte sich 1966 an der Universität Erlangen-Nürnberg. Von 1967 bis 2003 war er Inhaber des Lehrstuhls für Romanische Sprachwissenschaft an der Universität Würzburg. Daneben bekleidete er eine große Anzahl weiterer Ämter: Er war Präsident der Universität Würzburg (1975-2003), Präsident des DAAD (1988-2007), Vorsitzender der Bayerischen Rektorenkonferenz (1978-1982) sowie Vizepräsident (1979-1983) und Präsident (1983-1987) der Westdeutschen Rektorenkonferenz. Zu seinen Forschungsschwerpunkten gehören Dialektologie, Phonetik/Phonologie, Morphosyntax, Stilistik und Wortgeschichte.
Background and Aims
Chronic kidney disease (CKD) is a risk factor for development and progression of heart failure (HF). CKD and HF share common risk factors, but few data exist on the prevalence, signs and symptoms as well as correlates of HF in populations with CKD of moderate severity. We therefore aimed to examine the prevalence and correlates of HF in the German Chronic Kidney Disease (GCKD) study, a large observational prospective study.
Methods and Results
We analyzed data from 5,015 GCKD patients aged 18-74 years with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73m\(^{2}\) or with an eGFR >= 60 and overt proteinuria (>500 mg/d). We evaluated a definition of HF based on the Gothenburg score, a clinical HF score used in epidemiological studies (Gothenburg HF), and self-reported HF. Factors associated with HF were identified using multivariable adjusted logistic regression. The prevalence of Gothenburg HF was 43% (ranging from 24% in those with eGFR >90 to 59% in those with eGFR<30 ml/min/1.73m2). The corresponding estimate for self-reported HF was 18% (range 5%-24%). Lower eGFR was significantly and independently associated with the Gothenburg definition of HF (p-trend <0.001). Additional significantly associated correlates included older age, female gender, higher BMI, hypertension, diabetes mellitus, valvular heart disease, anemia, sleep apnea, and lower educational status.
Conclusions
The burden of self-reported and Gothenburg HF among patients with CKD is high. The proportion of patients who meet the criteria for Gothenburg HF in a European cohort of patients with moderate CKD is more than twice as high as the prevalence of self-reported HF. However, because of the shared signs, symptoms and medications of HF and CKD, the Gothenburg score cannot be used to reliably define HF in CKD patients. Our results emphasize the need for early screening for HF in patients with CKD.