关键词： Einsatzorte   Gaffen   Notfalleinsatz   Rettungsdienst   Schaulust   Bystander   Emergency medical services   Gawking   Paramedics   Rubbernecking  

摘要： Disturbances caused by "gawkers" during rescue operations are an ongoing subject of intense and emotional discussions. However, there is no recent empirical evidence on the actual quantity and quality of the problem. Drawing on mixed methods data collected over 15 months from 10 German federal states, this study sheds light on the matter. The analyses of representative population surveys (N = 1032 and N = 1012), interviews with paramedics (N = 48), operational reports (N = 281) and weekly logs (N = 39) show associations to typical locations and paramedical indications: Rescue missions with "gawkers" primarily take place in public spaces, especially during accidents, fire, and psychiatric emergencies. Younger people, primarily men, tend to watch at the scene of the accident, mostly from a distance. Digitalization (smartphones, social media) amplifies the problem. However, mission logs show that serious interference caused by rubbernecking is rather rare. In almost 50% of the weeks, not a single incident involving watching bystanders occurred. In most of the other cases, 1-5 onlookers are present. Taking photographs or filming is much less common;2% of the lay population reported as having been photographed or filmed themselves during rescue operations. The data do not reveal a correlation between the number of bystanders and the size of the community. Even though the overall extent of problems caused by "gawkers" at emergency sites does not seem to be enormous, these insights may help to customize future prevention programs.

摘要： Rising atmospheric and ocean temperatures have caused substantial changes in terrestrial water circulation and land surface water fluxes, such as precipitation and evapotranspiration, potentially leading to abrupt shifts in terrestrial water storage. The European Centre for Medium-Range Weather Forecasts (ECMWF) Reanalysis v5 (ERA5) soil moisture (SM) product reveals a sharp depletion during the early 21st century. During the period 2000 to 2002, soil moisture declined by approximately 1614 gigatonnes, much larger than Greenland's ice loss of about 900 gigatonnes (2002-2006). From 2003 to 2016, SM depletion continued, with an additional 1009-gigatonne loss. This depletion is supported by two independent observations of global mean sea level rise (similar to 4.4 millimeters) and Earth's pole shift (similar to 45 centimeters). Precipitation deficits and stable evapotranspiration likely caused this decline, and SM has not recovered as of 2021, with future recovery unlikely under present climate conditions.

摘要： Als essenzieller Teil des Schulsystems ist auch der offene Ganztag mit seinen Bewegungs‑, Spiel- und Sportangeboten dazu aufgefordert, einen inklusiven Rahmen bereitzustellen, der allen Kindern gleichberechtigte Teilhabe ermöglicht. Allerdings ist kaum etwas darüber bekannt, ob dieser Verpflichtung in den Angeboten nachgekommen wird. Es mangelt an Studien, die untersuchen, welche Relevanz Inklusion – im Sinne eines breiten Begriffsverständnisses – in den Bewegungs‑, Spiel- und Sportangeboten des Ganztags hat und inwiefern strukturelle Rahmenbedingungen wie das Schulprogramm und die Trägerschaft mit der Relevanzzuschreibung in Verbindung stehen. Diese Forschungsdesiderate werden im vorliegenden Beitrag auf Basis einer Fragebogenerhebung mit Leitungen des offenen Ganztags an Grundschulen aus vier nordrhein-westfälischen Städten aufgegriffen. Die statistischen Auswertungen zeigen, dass Inklusion im Kontext der Bewegungs‑, Spiel- und Sportangebote von vielen Befragten Zustimmung erfährt und als bedeutsam erachtet wird. Gleichwohl offenbaren die Daten, dass Inklusion nicht überall priorisiert wird. Der Zuspruch variiert teilweise entlang spezifischer struktureller Rahmenbedingungen. Besonders positiv wird die inklusive Ausrichtung der Angebote dort wahrgenommen, wo Inklusion fest im Schulprofil verankert ist. Zudem betonen Ganztagsschulen in der Trägerschaft von Sportvereinen oder -verbänden inklusionsbezogene Ziele besonders stark. Die Befunde liefern Hinweise dafür, dass Inklusion noch nicht systematisch in den Kulturen und Strukturen der Bewegungs‑, Spiel- und Sportangebote des offenen Ganztags verankert ist. Um die Relevanz von Inklusion in diesem Feld zu stärken, könnte es sinnvoll sein, das Thema systematisch in Schul- und Ganztagskonzepte einzubinden. Sportvereine und -verbände können eine wichtige Rolle bei der Umsetzung von Inklusion im Ganztagsbereich einnehmen.

关键词： Cardiogenic shock   Primary percutaneous coronary intervention   Anticoagulation   ST-elevation myocardial infarction  

摘要： IntroductionCardiogenic shock (CS) is a lethal complication of ST-elevation myocardial infarction (STEMI). The impact of post-procedure anticoagulants (PPAC) in STEMI-CS patients undergoing primary percutaneous coronary intervention (PPCI) remains *** the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome registry (2014-2019), STEMI patients with CS on admission undergoing PPCI were stratified into two groups based on the use of PPAC or not. The primary outcome was all-cause mortality during hospitalization. Other outcomes including major bleeding were also *** 36,873 patients with STEMI, 855 eligible patients with CS undergoing PPCI were included in our study, among which 614 patients were treated by PPAC and 241 were not. Adjusted by multi-variable Cox regression, PPAC was associated with a lower risk of in-hospital all-cause mortality (14.9% vs. 30.3%;adjusted HR: 0.60;95% CI: 0.37 to 0.97;p = 0.037), while a non-significant difference in major bleeding (4.6% vs. 7.0%;adjusted HR: 1.05;95% CI: 0.36 to 3.05;p = 0.925) was observed between PPAC and non-PPAC. Consistent results were observed in the sensitivity analyses adjusted by propensity score matching and inverse probability of treatment *** study suggested the use of PPAC in STEMI-CS patients undergoing PPCI was associated with a lower risk of in-hospital all-cause mortality without increasing the risk of major *** ***, NCT02306616. Registered 29 November 2014.