Suchergebnisse

Abstract
Background
Floods, especially flash floods, are the major transporting agent for fluvial sediments, whose pollution is a global concern. As floods result in the dispersion of and exposure to these sediments, a profound understanding of sedimentary dynamics during flood events and the related pollutant dispersion is of relevance. However, the characteristics of extreme flood events concerning pollutant dynamics are insufficiently known so far.

Results
In a Central European catchment impacted by intense industrial activities and former mining, over the course of five years, we surveyed six high-discharge events, five of them approx. bankfull discharge and one major flash flood event, supplemented by sampling of bank sediments. Fluvial sediments were analyzed for elemental composition by X-Ray fluorescence and for grain size distribution of the fine faction by laser diffraction. By applying a local enrichment factor, trace metal(loid) signatures in these sample sets were compared. Furthermore, Positive Matrix Factorization was used to investigate the trace metal(loid)s' sources.
The sediments deposited by minor flooding had continual trace metal(loid) signatures. However, for the extreme event, significant divergencies arose and persisted for the following years: The enrichment of anthropogenically influenced elements increased, with a slowly decreasing trend in the subsequent two years. Naturally dominated metal(oid)s decrease in enrichment without indicating a return to original levels. In contrast, other elements were insensitive to the extreme event. Positive Matrix Factorization identified anthropogenic influences in elements originating from copper and lead processing and mining activities. Furthermore, bed sediments and a natural background factor were found to dominate the non-anthropogenically influenced metal(loid)s.

Conclusions
In between extreme events, winnowing processes slowly alter the elemental composition of bed sediments. The depletion of such sediments due to the flash flood proves catchment-wide flushing, which induces a natural resetting of the geochemical signals. This ability to renew is an integral part of resilience in fluvial systems. This mechanism is disturbed by industrial activities in floodplains. The exceptional flooding reaches infrastructure that is assumed to be safe and, therefore, unprotected. These additional sources can shift flood sediments' trace metal(loid) signature, which has a long-lasting impact on the catchment sediments. However, the modifications depend on the flooding extent, possible emitters, and protection measures.

Die Etablierung palliativmedizinischer Versorgungsstrukturen im ambulanten Bereich hat in den vergangenen Jahren die ärztliche Betreuung von Palliativpatienten deutlich verändert. Eine an den spezifischen Bedürfnissen schwerstkranker Patienten orientierte Versorgung im häuslichen Umfeld erfordert es, bestehende gesetzliche Regelungen zu hinterfragen, anzupassen oder fortzuentwickeln. Kontrovers diskutiert wird, wie das Grundanliegen des Betäubungsmittelrechts Schutz der Bevölkerung vor Abhängigkeit und Missbrauch sowie Sicherstellung der notwendigen medizinischen Versorgung mit dem palliativmedizinischen Selbstverständnis der Gewährung einer bestmöglichen Behandlung von Schmerzpatienten in Einklang gebracht werden kann. In diesem Spannungsfeld fasst der Band die Beiträge eines Expertenworkshops zusammen, der 2012 von der Klinik für Palliativmedizin sowie dem Zentrum für Medizinrecht der Georg-August-Universität Göttingen veranstaltet wurde. Ergänzt um Beiträge weiterer Autoren werden aktuelle Konfliktbereiche im Verhältnis von (Betäubungsmittel-)Recht und Palliativmedizin aufgegriffen und im interdisziplinären Dialog beleuchtet.

The collection is related to a workshop at the Georg-August-University Göttingen from 2012 and refers to the use of narcotics in palliative care. Experts of law and medicine discuss the situation of doctors leaving narcotics at their patients home, the prevailing legal norms and the need for reform.

Mit dem Eintritt in das Zeitalter einer hochtechnisierten, auf ständige Optimierung ausgerichteten medizinischen Versorgung wachsen die Herausforderungen an die Finanzierbarkeit eines leistungsfähigen modernen Gesundheitswesens. Der Wunsch nach bestmöglicher Versorgung trifft unsanft auf die Erkenntnis, dass das System in Zukunft nicht mehr alles für alle wird leisten können. Nicht nur im Hinblick auf die Ausgestaltung der Leistungskataloge der gesetzlichen Kranken- und Pflegeversicherung, sondern ebenso für den Bereich der Transplantationsmedizin muss schon heute die Frage beantwortet werden, wie sich der Anspruch auf eine gerechte Verteilung der knapper werdenden Gesundheitsgüter in Zukunft noch einlösen lässt.

Abstract
The primary objective of the US refugee resettlement program is for beneficiaries to achieve economic self-sufficiency. Yet, little research has examined the extent to which this objective has been achieved, nor the programmatic and contextual variables that influence this outcome. This study examines how beneficiaries' individual and job characteristics are associated with the likelihood of job retention after 90 days of employment. Data were obtained on 1787 refugees served by the International Institute of New England from March 2015 to January 2019. Logistic regression models were used to examine the predictors of retention in four cities (Boston, MA; Lowell, MA; Manchester, NH; and Nashua, NH). Different patterns emerged across cities, related to factors such as pay, educational level, legal immigration status, job permanency, and gender. The concept of self-sufficiency is closely linked to the context of resettlement and thus requires more careful articulation as a goal of the refugee resettlement program.

Abstract
Background
Because of global climate change, extreme flood events are expected to increase in quantity and intensity in the upcoming decades. In catchments affected by ore mining, flooding leads to the deposition of fine sediments enriched in trace metal(loid)s. Depending on their concentration, trace metal(loid)s can be a health hazard. Therefore, exposure of the local population to flood sediments, either by ingestion (covering direct ingestion and consuming food grown on these sediments) or via inhalation of dried sediments contributing to atmospheric particulate matter, is of concern.

Results
The extreme flood of July 2021 deposited large amounts of sediment across the town of Eschweiler (western Germany), with the inundation area exceeding previously mapped extreme flood limits (HQextreme). These sediments are rich in fine material (with the < 63 µm fraction making up 32% to 96%), which either can stick to the skin and be ingested or inhaled. They are moderately to heavily enriched in Zn > Cu > Pb > Cd > Sn compared to local background concentrations. The concentrations of Zn, Pb, Cd, Cu, and As in flood sediments exceed international trigger action values. A simple assessment of inhalation and ingestion by humans reveals that the tolerable daily intake is exceeded for Pb. Despite the enrichment of other trace elements like Zn, Cu, Cd, and Sn, they presumably do not pose a risk to human well-being. However, exposure to high dust concentrations may be a health risk.

Conclusions
In conclusion, flood sediments, especially in catchments impacted by mining, may pose a risk to the affected public. Hence, we propose to (I) improve the flood mapping by incorporating potential pollution sources; (II) extend warning messages to incorporate specific guidance; (III) use appropriate clean-up strategies in the aftermath of such flooding events; (IV) provide medical support, and (V) clue the public and medical professionals in on this topic accordingly.

Graphical Abstract