In the next 5-10 years the UK is going to see dramatic changes to many of its large industrial sectors, such as automotive, aerospace, and energy generation, as we move from a fossil-fuel-driven society to an electrically driven one. Many of these industries will be dependent on technology-critical metals (TCMs), for example, cobalt and lithium for the batteries in electric vehicles and rare-earths used in the magnets for electric motors and wind turbines. Many regions of the world, including the EU, have been developing strategies to access these technology-critical metals for their key industries, while the UK has lagged behind. The challenges already faced around access to key technology metals are potentially complicated for the UK by the nation’s exit from the EU, and the uncertainty that this has created with regard to trading relationships around the globe. It is in this challenging context that the UK must now fashion its own independent policy for access to technology critical metals.

Background: Patients with trisomy 18 who are older than one-year of age represent a rarity in clinical routine. This is due to the high mortality in the first year of age. Case reports and recommendations are rare, complicating the therapy and management of this high-risk patient group. Case presentation: We present a case report concerning the anaesthesiological management of a seven-year-old girl with trisomy 18, presenting with inspiratory stridor for otorhinolaryngological diagnostics. Upper airway endoscopy revealed a stenosis of the posterior glottis. So far an association of this malformation with trisomy 18 is unknown. Conclusion: Anaesthesia for patients with rare underlying diseases or syndromes requires adequate conditions in the designated institution. The preoperative evaluation is demanding and should include an interdisciplinary cooperation to minimise perioperative risks. In this context the authors recommend to consider possible unexpected findings, like a glottis stenosis in this case, while planning airway management in trisomy 18 patients.

Background: To guarantee contemporary medical emergency medicine, technical innovations undergo a continuous riskbenefit-analysis by the medical directors of the emergency services (MEDS) in the individual emergency medical service districts. Besides medical evidence and economic aspects, application security has to be assured. Following a first online-based survey regarding the technical configuration of the particular emergency medical service district in 2009, we present a follow up online survey. Method: The survey was carried out as an anonymous nationwide online survey among the MEDS in Germany after postal approach and twofold recall by email. The evaluations of actual and scheduled availability of modern medical technology in the administered emergency medical districts were assessed. Focuses were airway management, acute coronary syndrome, cardiogenic shock, cardiopulmonary resuscitation, trauma and operational documentation. Results were analysed descriptively and compared to the data of the prior survey in 2009. Results: Mails were sent to a total of 192 MEDS, 189 of whom were reached. 73 (39%) filled out the total survey. Enclosed MEDS were predominantly located in rural areas. In comparison to the preceding survey the follow-up documents an increasing availability of video laryngoscopes, ultrasound devices, automatic mechanical compression devices for cardiopulmonary resuscitation and digital documentation assists. Extraglottic respiratory assist devices represent a standard equipment, non-invasive ventilation can be performed in the majority of the districts. Extracorporeal-Life-Support-Systems are marginally used. Conclusion: The survey results provide an update of the evaluation, availability and distribution of modern technical devices in Germany's emergency medical districts. The comparison allows conclusions about current trends in prehospital emergency medicine in Germany.

Trotz steigender Inzidenz von Patienten, die unter einer Dauertherapie mit einem direkten oralen Antikoagulans (DOAK) ein akutes Koronarsyndrom („acute coronary syndrome“, ACS) erleiden, existieren keine einheitlichen Empfehlungen für die antikoagulatorische Therapie dieser Patientengruppe. Ziel dieser Studie ist es, die aktuelle Praxis der präklinischen Therapie des ACS bei Patienten unter DOAK-Therapie zu erfassen. Es handelt sich bei dieser Studie um eine internet- und papierbasierte Befragung von Notärzten sowie Internisten, Anästhesisten und Intensivmedizinern zu deren prähospitalen Therapie des ACS bei Patienten unter einer DOAK-Dauertherapie. Insgesamt wurden 284 Umfragebogen beantwortet. Es existierten wesentliche Unterschiede in der Therapie des ACS unter DOAK-Dauertherapie. Von den Befragten gaben 39 % an, eine Kombinationstherapie aus Heparin und Acetylsalicylsäure (ASS) zu verabreichen, während 36 % auf die Gabe von Heparin verzichteten. Wurde ein Medikament in der Dosis reduziert, gaben 71 % der Befragten an, Heparin zu reduzieren. Auch im Falle eines ST-Strecken-Hebungs-Myokardinfarktes verzichteten 48 % der Befragten auf die Gabe von Heparin. Aktuell ist in Deutschland eine heterogene Akutbehandlungspraxis in Bezug auf die Gabe von Heparin und ASS bei bereits oral antikoagulierten ACS-Patienten festzustellen. Es sollten seitens der medizinischen Fachgesellschaften Handlungsempfehlungen für die prähospitale medikamentöse Notfalltherapie des ACS bei oral antikoagulierten Patienten definiert und geschult werden, welche den Bedürfnissen der Patienten und Notärzte entsprechen.

Das „Gesetz über den Beruf der Notfallsanitäterin und des Notfallsanitäters“ ermöglicht es den Ländern, in ihren Rettungsdienstbereichen den Notfallsanitätern erweiterte Handlungskompetenzen zu übertragen. Dies geschieht auf der Basis standardisierter Handlungsanweisungen (sHA), welche die Art, den Umfang und die Durchführung anzuwendender heilkundlicher Maßnahmen vorgeben. Die Formulierung dieser sHA und die Festlegung des damit verbundenen Ausbildungsaufwands stellen die verantwortlichen Ärzte vor medizinische, juristische und organisatorische Herausforderungen. Das Ziel dieser Studie war die Statuserfassung bezüglich des Umfangs vorhandener sHA und der dazugehörigen Ausbildungsmodalitäten im deutschen Rettungsdienst.

Scrap containing NdFeB is a valuable resource for the production of NdFeB magnets as the demand for these materials grows. One of the challenges is to recover the rare earths or the NdFeB alloy powder in a clean and cost effective manner so that it can be re-processed into new magnets rather than becoming lost to landfill. Work on using hydrogen to process scrap magnets (HPMS) has been shown to be successful when targeting hard disk drives. Currently, there is a lack of information on reliable methods to separate out NdFeB from other scrap sources such as automotive drives. In the near future, with increasing sales and electrification of cars, the automotive sector could be an important source for Dy containing magnets. In this paper, the hydrogen processing of scrap magnets has been demonstrated as an extraction method for NdFeB from automotive rotors for the first time, with the aim to examine the viability of this recycling process and learn lessons for design for recycling. Thus leading to the sustainable production of these components. Significant challenges were outlined when applying the hydrogen process to rotors with embedded magnets. After the extraction, further process steps may also be needed to separate epoxy coatings, as sieving could only reduce the carbon content to 1420 ppm, compared to 770 ppm in the base alloy. The gravimetric measurements also confirmed that Dy additions increase both the initiation and absorption time for hydrogen decrepitation. Hence, a higher hydrogen pressure will be required to speed up the process. (C) 2020 Elsevier Ltd. All rights reserved.

Objective For emergency medicine personnel (EMP), there is little evidence concerning the adequate timing for refresher courses to maintain routine in the application of extraglottic airways. The aim of this study was to evaluate the efficacy and long-term results of a simulator-based education concept teaching the basic airway management skills with extraglottic airways for EMP and also to draw conclusions concerning the adequate time interval for refresher courses. Methods By use of an explorative, prospective simulator-study with nonphysician EMP, airway management skills using the Larynxmaske Supreme (R) (LMA-S) after an introduction lecture were examined. The application of an endotracheal tube (ETT) served as control. Time for preparation of the airway devices, insertion success, and resulting apnea time were assessed immediately after the first introduction lecture (t1) and unannounced 9-12 months thereafter (t2). Results Comparison of the times for preparation of the LMA-S at t1 and t2 demonstrated similar results. After the introduction lecture, all paramedics were able to insert the LMA-S successfully after maximal 2 attempts; 9-12 months later success rates with the LMA-S were unchanged. Apnea time during airway management was shorter with the LMA-S compared to the ETT (p< 0.01). Times needed for preparation of the airway devices were similar. Conclusion The results of this simulator study indicate that a standardized introduction lecture is appropriate to ensure long-lasting procedural skills up to 12 months, so that subsequent refresher courses in basic airway management with the LMA-S once a year may be adequate. A simulator-based education in basic airway management skills with extraglottic airways is recommended for facilitation of further clinical education according to the current guidelines.

Ziel dieser Studie war es, die Effektivität und Nachhaltigkeit eines außerklinischen simulatorbasierten Ausbildungskonzepts im Rahmen der Einführung extraglottischer Atemwege hinsichtlich grundlegender Anwenderfertigkeiten zu untersuchen, um somit ggf. ein geeignetes Nachschulungsintervall definieren zu können.

Ischemia of intestinal organs is a main cause of complications in surgical intensive care patients. Changes in the tonus of arteries contributing to vascular resistance play an important role in the determination of blood flow and thus oxygen supply of various abdominal organs. It is generally acknowledged that hypoxia itself is able to alter arterial tonus and thus blood flow.

Zusammenfassung Zielsetzung Ziel dieser Studie war es, die Effektivität und Nachhaltigkeit eines außerklinischen simulatorbasierten Ausbildungskonzepts im Rahmen der Einführung extraglottischer Atemwege hinsichtlich grundlegender Anwenderfertigkeiten zu untersuchen, um somit ggf. ein geeignetes Nachschulungsintervall definieren zu können. Methodik In einer explorativen prospektiven Simulatorstudie wurden die Anwenderfähigkeiten des Rettungsdienstpersonals mit der Larynxmaske Supreme® (LMA‑S) nach erfolgter Einführungsschulung untersucht. Als Kontrolle galt die bereits etablierte Anwendung des Endotrachealtubus (ETT). Zielparameter waren die notwendige Zeit zur Vorbereitung der Atemwegshilfen, der Insertionserfolg und die bei Insertion provozierte Apnoezeit. Die Datenerhebung erfolgte unmittelbar nach einer Einführungsschulung (t1) und unangekündigt 9–12 Monate später (t2). Ergebnisse Die Vorbereitungszeiten der LMA‑S vor Insertion war zu den Zeitpunkten t1 und t2 vergleichbar. Der Insertionserfolg nach der Einführungsschulung (100 % nach maximal 2 Versuchen) konnte nach 9–12 Monaten im Rahmen der unangekündigten Reevaluation auf gleichem Niveau reproduziert werden. Bei ähnlichen Vorbereitungszeiten provozierte die Insertion der LMA-S im Szenario im Vergleich zum ETT eine kürzere Apnoezeit ( p < 0,01). Schlussfolgerung Die Ergebnisse der Simulationsstudie weisen darauf hin, dass eine einmalige standardisierte Anwenderschulung beim nichtärztlichen Rettungsdienstpersonal hinsichtlich grundlegender Fertigkeiten bei der Anwendung der LMA‑S einen nachhaltigen Effekt erreicht. Sie legen zudem nahe, dass zum Erhalt dieser Fertigkeiten jährliche Auffrischungsfortbildungen ausreichen. Für die Praxis sollte das simulatorbasierte Ausbildungskonzept mit einer klinischen Weiterbildung gemäß geltender Empfehlungen kombiniert werden.

E. Herraiz, M. Degri, A. Bradshaw, R.S. Sheridan, V.S.J. Mann, I.R. Harris, A. Lixandru, I. Poenaru, K. Guth, R. Gauss, O. Gutfleisch, A. Walton 1 School of Metallurgy and Materials, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK 2 Fraunhofer ISC, Projektgruppe für Wertstoffkreisläufe und Ressourcenstrategie IWKS, Rodenbacher Chaussee 4, 63457 Hanau, Germany 3 Technische Universität Darmstadt, Materialwissenschaft, Alarich-Weiß-Str. 16, 64287 Darmstadt, Germany Abstract In this work, sintered neodymium-iron-boron-type (Nd-Fe-B) magnets, from voice coil motors (VCM) of hard disk drives (HDD), were recycled using the hydrogen processing of magnet scrap (HPMS) route previously described. A hydrogenated NdFeB powder was generated from the VCM magnets, which was milled and sieved to a range of particle sizes. The powder was subsequently re-sintered into new magnets at 1060 °C in vacuum. The magnets produced from smaller particle sizes demonstrated an increase in remanence, density and maximum energy product compared to those from larger particle sized powders. However in all cases the re-sintered Nd-Fe-B magnets showed a decrease of density, remanence, coercivity and maximum energy product in comparison to the starting material. The decrease in magnetic properties has previously been reported to be due to a loss of Nd-rich grain boundary phase as a result of oxidation. In order to alleviate this effect and to optimise magnetic properties, neodymium hydride (NdH2.7) was systematically added to the recovered hydrogenated Nd-Fe-B powder in this study to replace the grain boundary phase and to allow for liquid phase sintering. At between 2 to 3 at% NdH2.7 additions the coercivity was fully recovered, at the expense of remanence which fell by 12.4-13.4 % respectively.

Adults suffering from congenital heart diseases (CHD) represent a challenge to anesthesiologists because of the diverse pathologies, complex pathophysiology and special treatment strategies. Due to improved therapeutic options for CHD, patient quality of life and life expectancy is increasing, leaving them as a growing population including pregnant patients with CHD. This article presents the main principles of the pathophysiology and anesthesiological management of pregnant patients living with a Fontan circulation based on a case report, which was complicated by an aortic coarctation and atonic uterine hemorrhage.

Extraglottische Atemwege (EGA) sind aufgrund ihrer Anwenderfreundlichkeit in der prähospitalen Notfallversorgung nicht nur Alternativverfahren für den schwierigen Atemweg. Sie können in bestimmten Situationen je nach Ausbildungsstand des Anwenders auch die Erstwahlmittel für die Atemwegssicherung sein. Die Vielzahl an Herstellern und Typen von EGA machen die Identifizierung des optimalen EGA für den eigenen Rettungsdienstbereich schwierig.

The rare earth metals have been identified by the European Union and the United States as being at greatest supply risk of all the materials for clean energy technologies. Of particular concern are neodymium and dysprosium, both of which are employed in neodymium–iron–boron based magnets. Recycling of magnets based on these materials and contained within obsolete electronic equipment, could provide an additional and secure supply. In the present work, hydrogen has been employed as a processing agent to decrepitate sintered neodymium–iron–boron based magnets contained within hard disk drives into a demagnetised, hydrogenated powder. This powder was then extracted mechanically from the devices with an extraction efficiency of 90 ± 5% and processed further using a combination of sieves and ball bearings, to produce a powder containing <330 parts per million of nickel contamination. It is then possible for the extracted powder to be re-processed in a number of ways, namely, directly by blending and re-sintering to form fully dense magnets, by Hydrogenation, Disproportionation, Desorption, Recombination processing to produce an anisotropic coercive powder suitable for bonded magnets, by re-melting; or by chemical extraction of the rare earth elements from the alloy. For example, it was shown that, by the re-sintering route, it was possible to recover >90% of the magnetic properties of the starting material with significantly less energy than that employed in primary magnet production. The particular route used will depend upon the magnetic properties required, the level of contamination of the extracted material and the compositional variation of the feedstock. The various possibilities have been summarised in a flow diagram.