Improving the accUracy of Referrals to the emerGency departmEnt of patieNts with chesT pain using the modified HEART score in Emergency Medical Transport (URGENT 2.0): protocol for a multicentre randomised controlled trial.

Introduction: Ischaemic heart disease is the single most common cause of death worldwide. Traditionally, distinguishing patients with cardiac ischaemia from patients with less alarming disease, in prehospital triage of chest pain, is challenging for both general practitioners and ambulance paramedics. Less than 20% of patients with chest pain, transferred to the emergency department (ED), have an acute coronary syndrome (ACS) and the transportation and analysis at the ED of non-ACS patients result in substantial healthcare costs and a great patient burden.

Successful spinal anaesthesia for caesarean section in a patient with a dorsal root ganglion stimulation implant: A case report.

Neurostimulation, for example dorsal root ganglion stimulation (DRGS), is increasingly used for managing chronic pain, including among women of reproductive age. We present the case of a 33-year-old patient with complex regional pain syndrome (CRPS) implanted with DRGS who subsequently became pregnant twice. Both pregnancies resulted in the delivery of healthy newborns via caesarean section under successful spinal anaesthesia, with no (device) complications.

Investigating a propagation of emerging carbapenemase-producing Enterobacteriaceae in Dutch broiler production pyramid through stochastic simulation.

Simulating resistant bacteria transmission in livestock informs surveillance strategies for emerging threats like Carbapenem-resistant Enterobacteriaceae (CPE), aiding targeted surveillance and detecting CPE through active methods. We employed a simulation model to assess three potential scenarios for introducing CPE: 1) a single import of live animals, 2) the use of contaminated feed, and 3) multiple imports of live animals. Employing the SimInf package, we constructed a population model for broiler production, encompassing rearing farms, multiplier farms, hatcheries, and broiler farms.

Successful NH abatement policies and regulations in German agriculture.

Anthropogenic ammonia (NH) emissions, of which about 95 % are from agriculture, have led to environmental pollution, resulting in tremendous damage to human health and ecosystems. Thus, the NEC Directive 2016/2284/EU sets national reduction targets for NH emissions in individual EU countries. To implement the NEC Directive for NH emission targets, Germany amended the Fertilizer Application Ordinance in 2017 and 2020 (DüV_amended) and set the air pollution control regulation, Technical Instructions on Air Quality Control (TA_Luft).

The evolving landscape of neuromodulation for pain care.

Here, we present five different insights on the use of neuromodulation strategies for effective pain management in clinical practice. Experts briefly illustrate the various techniques available and the complexities involved in evaluating their effectiveness. Additionally, they highlight the challenges for widespread adoption in clinical practice and explore some future directions.