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Volkmar Küppers,1 Michael Kemper,2 Christoph Abels2 1Gynecological Practice, Dysplasia-Clinic, Düsseldorf, Germany; 2Dr August Wolff GmbH & Co KG Arzneimittel, Bielefeld, Germany Abstract: Inadequate hygiene, aggressive cleansing, and chafing skin folds, as well as urine, feces, and sweat may trigger irritative contact dermatitis in the anogenital area. Serious recommendations for protection of the skin toward irritants include hygienic aspects and the use of appropriate skin care. Furthermore, preventing an accumulation of irritants on unprotected skin is mandatory. An intraindividual comparison study with 30 participants (17 female, 13 male; age: 44.2±8.3 years) was performed to evaluate the properties of a newly developed water-in-oil (W/O) balm on artificial sodium dodecyl sulfate-damaged epidermal barrier. The balm was applied 14 days twice daily, and transepidermal water loss and erythema were investigated. A significant improvement of both parameters after 12 days and even after 21 days could be confirmed. Two major clinical trials were performed to evaluate the safety and efficacy regarding protective and regenerative properties of the W/O balm on irritated skin in the anogenital area. Therefore, 29 children were enrolled (14 male, 15 female, age: 15.5±7.8 months) in an open-labeled 4-week clinical study. The balm was used in the area under disposable diapers at least after diaper change or if required. Furthermore, in a second open, multicenter study, 43 women (mean age: 46.2±16.9) with predisposition to skin irritation in the outer anogenital region were included. The product was applied for 4 weeks 1–2 times daily. In both studies, skin tolerability, applicability, scent, spreadability, and removability of the balm were evaluated by participants and practitioners predominantly as good or even very good, also skin hydration, protection, and regeneration were judged positively. The studies confirmed that the newly developed W/O balm exhibits excellent tolerability and is easy to remove. At the same time, excellent properties with respect to efficacy regarding regeneration and protection could be observed, without any undesired effects at any time. Keywords: intimate care, diaper rash, dermatitis, epidermal barrier

The study aimed to compare the differential effectiveness of explicit and implicit instruction of two Dutch spelling rules. Students with and without spelling disabilities were instructed a spelling rule either implicitly or explicitly in two experiments. Effects were tested in a pretest-intervention-posttest control group design. Experiment 1 suggested that explicit instruction of a morphological spelling rule led to instance-based knowledge in students with spelling disabilities and to rule-based knowledge in students without. Implicit instruction led to instance-based knowledge in students with spelling disabilities, and in the group without spelling disabilities no learning at all occurred. Experiment 2 revealed that explicit and implicit instruction of an orthographical spelling rule were equally effective in both groups and that the spelling knowledge they had acquired was instance-based. Findings suggest that explicit instruction is more effective than implicit instruction for the teaching of spelling rules when generalization is aimed at. (Contains 8 tables.)

The ability of Bacillus subtilis cell walls to bind metal cations is studied. Transmission electron microscopy, energy-dispersive x-ray spectroscopy and inductively coupled plasma atomic-emission spectroscopy were used on two metallic ions on control cells. It was found that the walls of the nonliving cells and those with deenergized membranes retained more metals compared to their living counterparts.

Gromov hyperbolic spaces have become an essential concept in geometry, topology and group theory. Herewe extend Ancona’s potential theory on Gromov hyperbolic manifolds and graphs of bounded geometry to a large class of Schrödinger operators on Gromov hyperbolic metric measure spaces, unifying these settings in a common framework ready for applications to singular spaces such as RCD spaces or minimal hypersurfaces. Results include boundary Harnack inequalities and a complete classification of positive harmonic functions in terms of the Martin boundary which is identified with the geometric Gromov boundary.

Introduction: Charging defibrillators prior to analyzing heart rhythms may decrease the no-flow time during rhythm check pauses while resuscitating in cardiac arrest. Although this anticipatory method is already used in some centers little is known about its safety. This study was carried out to confirm the safety and feasibility of the anticipatory method. It was hypothesized that this anticipatory method results in shorter total no-flow times, while other parameters of defibrillation efficacy including defibrillator safety and minimization of peri-shock pauses are unchanged.Methods: This manikin study assigned 243 medical students randomly to study groups, 121 to the anticipatory method and 122 to the recommended European Resuscitation Council (ERC) algorithm. Of these 237 students ultimately underwent training (112 anticipatory method vs. 125 ERC algorithm). Participants were assessed and video recorded during a simulated cardiac arrest scenario which included three different heart rhythms (ventricular fibrillation [VF], pulseless ventricular tachycardia [pVT], asystole) in randomized order. Video and software analyses were performed. Defibrillation safety was assessed using a 17-item checklist defined beforehand.Results: A total of 203 simulated cardiac arrests (75 anticipatory method and 128 ERC 2010 algorithm) were analyzed. The anticipatory method did not significantly reduce no-flow time (25.8 s, standard deviation, SD 7.4 s vs. 27.4 s SD 8.4 s, p = 0.19); however, peri-shock pauses were significantly longer in the anticipatory group compared to the ERC 2010 group (9.5 s SD 2.8 s vs. 3.3 s SD 1.9 s, p < 0.001). No significant difference concerning defibrillation safety between the groups was observed according to the 17-item checklist (14.6 SD 1.6 vs. 15.0 SD 1.4, p = 0.07).Conclusion: Charging defibrillators before rhythm analysis did not decrease total no-flow time in simulated cardiac arrests but resulted in significantly longer peri-shock pauses exceeding 5 s. No significant differences in defibrillation safety were observed between the groups. [ABSTRACT FROM AUTHOR]

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Background: Airway exchange catheters (AEC) and fiberoptic bronchoscopes (FOB) for tracheal intubation are selected so that there is only a minimal gap between their outer and inner diameter of endotracheal tube (ETT) to minimize the risk of impingement during airway instrumentation. This study aimed to test the ease of passage of FOBs and AECs through paediatric ETT of different sizes and from different manufacturers when using current recommendations for dimensional equipment compatibility taken from text books and manufacturers information.Methods: Twelve different brands of cuffed and uncuffed ETT sized ID 2.5 to 5.0 mm were evaluated in an in vitro set-up. Ease of device passage as well as the locations of an impaired passage within the ETT were assessed. Redundant samples were used for same sized ETT and all measurements were triple-checked in randomized order.Results: In total, 51 paired samples of uncuffed as well as cuffed paediatric ETT were tested. There were substantial differences in the ease of ETT passage concordantly for FOBs and AECs among different manufacturers, but also among the product lines from the same manufacturer for a given ID size. Restriction to passage most frequently was found near the endotracheal tube tip or as a gradually increasing resistance along the ETT shaft.Conclusions: Current recommendations for dimensional equipment compatibility AECs and FOBs with ETTs do not appear to be completely accurate for all ETT brands available. We recommend that specific equipment combinations always must be tested carefully together before attempting to use them in a patient. [ABSTRACT FROM AUTHOR]

In June 2018, the Peruvian provinces of Arequipa and Puno in the southern Andean region were affected by heavy snowfall, which caused severe damage to people and livelihoods in several communities. Using the Forecast-based Financing approach, the Peruvian Red Cross implemented its pre-defined early action protocol before this event, after receiving an extreme snowfall warning (Level 4) from the Peruvian meteorological service. Here, we provide a case study of the approach and event itself, documenting the decision-making thresholds as well as the actions taken. This warning activated the thresholds established in the protocol, and Peruvian Red Cross prioritized 10 communities for pre-disaster support based on the forecasted severity of the event in combination with vulnerability and exposure information. The activation took place 2 days before the extreme snowfall in the communities, and the Red Cross distributed veterinary kits for 50 heads of cattle per family, tarpaulins, tool kits to install a temporary awning for alpacas to protect them from the cold wind and snow, protection kits for alpaca herders and warm clothing for children under five, pregnant women, the elderly, and people with chronic and infectious diseases in 430 highly vulnerable households. This article presents the results of a household survey following the impact of the extreme snowfall. We document the early actions taken by these communities to protect their livelihoods, health, and assets. The evaluation also presents descriptive statistics of household-level outcomes for households receiving pre-snowfall support and those that did not receive any intervention or only received post-disaster assistance. While most households took action to protect their assets, there were fewer extreme losses of alpaca herds reported in the communities who received the early support, and these communities also reported fewer adults suffering from respiratory illnesses. More in-depth research on this type of early action is necessary on a wider scale, especially to evaluate the utility of different support measures and the necessary quantity of support needed. This case study can inform government, civil society, and humanitarian actors of how early action is happening before disasters occur and provide a direction for further investment in research and practice to make use of hydro-meteorological forecasts for the benefit of the most vulnerable.