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Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears.

Crop-livestock production systems are the largest cause of human alteration of the global nitrogen (N) and phosphorus (P) cycles. Our comprehensive spatially explicit inventory of N and P budgets in livestock and crop production systems shows that in the beginning of the 20th century, nutrient budgets were either balanced or surpluses were small; between 1900 and 1950, global soil N surplus almost doubled to 36 trillion grams (Tg)·y-1 and P surplus increased by a factor of 8 to 2 Tg·y-1. Between 1950 and 2000, the global surplus increased to 138 Tg·y-1 of N and 11 Tg·y-1 of P. Most surplus N is an environmental loss; surplus P is lost by runoff or accumulates as residual soil P. The International Assessment of Agricultural Knowledge, Science, and Technology for Development scenario portrays a world with a further increasing global crop (+82% for 2000-2050) and livestock production (+115%); despite rapidly increasing recovery in crop (+35% N recovery and +6% P recovery) and livestock (+35% N and P recovery) production, global nutrient surpluses continue to increase (+23% N and +54%P), and in this period, surpluses also increase in Africa (+49% N and +236% P) and Latin America (+75% N and +120% P). Alternative management of livestock production systems shows that combinations of intensification, better integration of animal manure in crop production, and matching N and P supply to livestock requirements can effectively reduce nutrient flows. A shift in human diets, with poultry or pork replacing beef, can reduce nutrient flows in countries with intensive ruminant production.

The impact of conventional, integrated and organic practices on groundwater quality were studied in northwestern Germany. Between 1993 and 1997 nitrogen budgets and the nitrate content of the unsaturated zone (soil sampling and porous suction cups) were measured in two field trials located on a clayey loam and a loamy sand, respectively. In each year of investigation three main crops per farming system were compared according to the defined site(soil)-adapted crop rotation. There was little decrease in the NO3-concentration of the percolate and the amount of leached N (15% less) by shifting from conventional practice to integrated farming. Converting to organic farming reduced leaching losses of nitrogen by more than 50 %. Yields of the organic field plots were lower, but comparing the cash crop yields in relation to the amount of leached nitrate, the production efficiency (nitrate-N leached related to yield of crops) of the organic farming system was still clearly higher. from: HAAS, G., M. BERG & U. KÖPKE 2002: Nitrate leaching: comparing conventional, integrated and organic agricultural production systems. In: Agricultural Effects on Ground and Surface Waters - Research at the Edge of Science and Society. S. 131-136. International Association of Hydrological Science 273.