[Triage, screening, and assessment of geriatric patients in the emergency department]. / Triage, Screening und Assessment des alten Menschen in der Notaufnahme.

BACKGROUND: Geriatric patients are increasingly dominating the daily routine in German emergency departments (ED). With their typical characteristics multimorbidity, polypharmacy, vulnerability, frailty and cognitive impairment, especially delirium, they are a special challenge for the processes in the ED. Though some emergency physician might consider "the old patient" as not exciting, there is a broad consensus that pragmatic geriatric screening tools are required. This consensus exists not only among the medical societies but also within the German Society for Emergency Medicine itself. In this article the characteristics of the geriatric patient, the pitfalls of triage systems and the difficulties to screen geriatric patients in a sensible manner are described. DISCUSSION: The common triage systems and the screening tools that have been developed for geriatric emergency patients have disadvantages. In Manchester Triage System (MTS) and Emergency Severity Index (ESI) geriatric patients are at risk of incorrect triage, though both systems, e.g., name acute cognitive impairment as a high-risk factor. The ESI has been validated for geriatric patients. The correct use of the triage algorithms is crucial, but for a triage nurse, acute cognitive impairment, e.g., might be difficult to identify. One reason for that is that many of the existing screening tools are not applicable in the ED or are without immediate benefit for the patient. More practical tools will have to be developed in the future.

IAEA's ALMERA network: Supporting the quality of environmental radioactivity measurements.

The International Atomic Energy Agency coordinates and provides methodological and analytical quality support to the network of Analytical Laboratories for the Measurement of Environmental Radioactivity (ALMERA), comprising 150 laboratories in 84 countries. Annual proficiency tests (PTs) are organized for the network laboratories using sets of different samples typically encountered in environmental and food monitoring laboratories. The PT system is designed to respond to the needs of the network for rapid response and reliable measurement results, and to metrological principles and international standards and guides. Comparison of performance of ALMERA and non-ALMERA laboratories in PTs indicates that the "PT - method development - training - PT" strategy adopted for capability building is beneficial to the network.

Isotopic, geophysical and biogeochemical investigation of submarine groundwater discharge: IAEA-UNESCO intercomparison exercise at Mauritius Island.

Submarine groundwater discharge (SGD) into a shallow lagoon on the west coast of Mauritius Island (Flic-en-Flac) was investigated using radioactive ((3)H, (222)Rn, (223)Ra, (224)Ra, (226)Ra, (228)Ra) and stable ((2)H, (18)O) isotopes and nutrients. SGD intercomparison exercises were carried out to validate the various approaches used to measure SGD including radium and radon measurements, seepage rate measurements using manual and automated meters, sediment bulk conductivity and salinity surveys. SGD measurements using benthic chambers placed on the floor of the Flic-en-Flac Lagoon showed discharge rates up to 500 cm/day. Large variability in SGD was observed over distances of a few meters, which were attributed to different geomorphological features. Deployments of automated seepage meters captured the spatial and temporal variability of SGD with a mean seepage rate of 10 cm/day. The stable isotopic composition of submarine waters was characterized by significant variability and heavy isotope enrichment and was used to predict the contribution of fresh terrestrially derived groundwater to SGD (range from a few % to almost 100%). The integrated SGD flux, estimated from seepage meters placed parallel to the shoreline, was 35 m(3)/m day, which was in reasonable agreement with results obtained from a hydrologic water balance calculation (26 m(3)/m day). SGD calculated from the radon inventory method using in situ radon measurements were between 5 and 56 m(3)/m per day. Low concentrations of radium isotopes observed in the lagoon water reflected the low abundance of U and Th in the basalt that makes up the island. High SGD rates contribute to high nutrients loading to the lagoon, potentially leading to eutrophication. Each of the applied methods yielded unique information about the character and magnitude of SGD. The results of the intercomparison studies have resulted a better understanding of groundwater-seawater interactions in coastal regions. Such information is an important pre-requisite for the protection and management of coastal freshwater resources.

Characterisation of submarine groundwater discharge offshore south-eastern Sicily.

A complex approach in characterisation of submarine groundwater discharge (SGD) off south-eastern Sicily comprising applications of radioactive and non-radioactive tracers, direct seepage measurements, geophysical surveys and a numerical modelling is presented. SGD fluxes in the Donnalucata boat basin were estimated by direct seepage measurements to be from 4 to 12Ls(-1), which are comparable with the total SGD flux in the basin of 17Ls(-1) obtained from radon measurements. The integrated SGD flux over the Donnalucata coast estimated on the basis of Ra isotopes was around 60m(3)s(-1) per km of the coast. Spatial variations of SGD were observed in the Donnalucata boat basin, the average (222)Rn activity concentration in seawater varied from approximately 0.1kBqm(-3) to 3.7kBqm(-3) showing an inverse relationship with salinity. The continuous monitoring carried out at the site closest to the coast has revealed an inverse relationship of (222)Rn activity concentration on the tide. The (222)Rn concentrations in seawater varied from 2.3kBqm(-3) during high tides to 4.8kBqm(-3) during low tides, thus confirming an influence of the tide on submarine groundwater discharge. Stable isotopes (delta(2)H and delta(18)O) showed that SGD samples consist up to 50% of groundwater. Geo-electrical measurements showed a spatial variability of the salt/fresh water interface and its complex transformation in the coastal zone. The presented results imply that in the studied Donnalucata site there are at least two different sources of SGD, one superficial, represented by mixed fresh water and seawater, and the second one which originates in a deeper limestone aquifer.

Teacher-induced countertransference in clinical teaching.

Although it is acknowledged that clinical teaching is an interpersonal process that is relational in nature, little has been written regarding the conflicts and feelings that can exist within the student-teacher relationship. The article is a discussion of the concept of countertransference in psychotherapy, specifically as to how it may be applied to understanding clinical teachers' subjective responses to students. The authors present arguments to support the fit between the concept of countertransference and clinical teaching, focusing on the negative effects of a teacher's countertransference in clinical teaching. The implications of the concept of countertransference in clinical nursing education is explored.