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Organic matter (OM) cycling has a large impact on the cycling of mercury (Hg) in the environment. Hence, it is important to have a thorough understanding on how changes in, e.g., catchment vegetation - through its effect on OM cycling - affect the behavior of Hg. To test whether shifts in vegetation had an effect on Hg-transport to lakes we investigated a sediment record from Herrenwieser See (Southern Germany). This lake has a well-defined Holocene vegetation history: at ~8700years BP Corylus avellana (hazel) was replaced by Quercus robur (oak), which was replaced by Abies alba (fir) and Fagus sylvatica (beech) ~5700years BP). We were particularly interested in testing if coniferous vegetation leads to a larger export of Hg to aquatic systems than deciduous vegetation. When hazel was replaced by oak, reduced soil erosion and increased transport of DOM-bound mercury from the catchment resulted in increases in both Hg-concentrations and accumulation rates (61ngg(-1) and 5.5ngcm(-2)yr.(-)(1) to 118ngg(-1) and 8.5ngcm(-2)yr.(-)(1)). However, even if Hg-concentrations increased also in association with the introduction of fir and beech (173ngg(-1)), as a result of higher Hg:C, there was no increase in Hg-accumulation rates (7.6ngcm(-2)yr.(-)(1)), because of a decreased input of OM. At around 2500years BP Hg-accumulation rates and Hg-concentration indicated an additional input of Hg to the sediment (316ngg(-1) and 10.3ngcm(-2)yr.(-)(1)), which might be due to increased human activities in the area, e.g., forest burning or mining. Our results contrast those of several paired-catchment studies that suggest a higher release of Hg from coniferous than deciduous forest, and there is a need for studies with a long-term perspective to increase our understanding of the effects of slow and gradual processes on mercury cycling., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The appearance of animal bite injuries varies in regard to location and extent. Injuries with puncture wounds involving the extremities carry great risk of infection. Managing the complications often requires substantial medical treatment and increased costs. The aim of this study is the evaluation of the course of disease, medical care, and treatment costs in patients with infected bite injuries. In the year 2000, 16 patients were treated for infection after bite injuries of the extremities. Fourteen patients received substandard therapy because of incorrect assessment of the extent of the bite wound. Because of infection, the average time needed for treatment before returning to work was 3 months, including 12 days of hospitalization and 16 days of out-patient treatment. The average treatment costs exceeded 6,100 Euro for the health insurance companies. Because of its increasing prevalence and inadequate treatment, this type of injury has become a serious public health problem.

Objective: Cost diaries administered by patients have been used as a method to measure costs for different diseases. Our aim was to test the application of a patient cost diary in patients with inflammatory bowel disease (IBD) and to measure disease specific resource utilization and costs., Patients and Methods: A specific patient cost diary for IBD was developed and tested in a prospective pilot study. 105 outpatients with IBD of a University Hospital agreed to participate over a 4 week follow-up period. They were asked to report weekly their use of medical care and costs related to their illness. Visits to health care providers, hospitalizations, drug use, costs due to absence from paid and unpaid work, travel costs as well as out-of-pocket expenses were considered., Results: The response rate was 90 %. Almost 70 % of the patients estimated the diary as easy to fill in. Compared with other data sources, the cost measurement using the cost diary showed good agreement regarding costs of drug therapy and outpatient hospital treatment. Mean costs due to illness were estimated to be 1,500 Euro per 4 weeks. This corresponds to total costs of about 20,000 Euro per year of care. 69 % of total costs were indirect costs due to illness-related absence from work, days of inactivity at home, and early retirement. Direct health care and direct non health care costs (e. g. travel costs) were responsible for 27 % and 4 % of costs, respectively., Discussion and Conclusion: The presented instrument offers a suitable and practical method of assessing IBD-related resource utilization. The prospectively obtained data for direct medical and non medical, as well as indirect costs allow a cost measurement from the societal perspective. The presented cost diary can be used for measuring costs for economic evaluations of medical interventions.

Methodology of clinical studies is highly sophisticated in drug research. But clinical trials are also necessary to demonstrate efficacy and safety of rehabilitation treatment. The call for evidence based medicine has also reached rehabilitation. However, in rehabilitation medicine it is much more difficult to design and conduct clinical trials with a high methodological standard. Among the reasons are: A comparable control group is necessary because spontaneous healing and unspecific measures contribute to therapeutic success, too. But what could "placebo rehabilitation" look like? The masking of therapies (blinded studies) will hardly ever be possible. Therefore, it is more difficult to achieve the same treatment and observation for the treatment and control group. Treatments in rehabilitation take longer to become effective than a drug and maybe the success will disappear after some time. Therefore, long-term trials and follow-ups are necessary. Such studies are expensive, need a strong organisation, and drop-outs are unavoidable. An appropriate outcome variable does not always exist. "Return to work" is an important, reliable and valid variable, but it delivers only one bit of information per patient. As a consequence, smaller progress in rehabilitation can only be demonstrated with large sample sizes. Outcome variables based on time enable studies with reasonable sample sizes. Sometimes it is more difficult to obtain acceptance of randomisation in rehabilitation patients than in acute patients. Some rehabilitation hospitals have only recently begun to take an interest in controlled clinical trials, hence are not so experienced. Nevertheless, controlled clinical trials delivering convincing results are possible in rehabilitation medicine as well. But biometrical consultation is necessary e.g. for study design, study conduction and evaluation. Most important points are the methodology of the study design and its practicability. Especially in these topics rehabilitation physicians and biometrician have to cooperate.

The Rehabilitation Research Network of Ulm on "Bausteine der Reha" consists of several departments of the University of Ulm, and various rehabilitation hospitals and cooperates with a pension insurance institute (LVA Wuerttemberg). The aim of this interdisciplinary approach is to evaluate process and outcome of rehabilitation measures considering specific clinical and rehabilitative questions with main emphasis on epidemiological and economic aspects. The Rehabilitation Research Nétwork of Ulm is subdivided into clinical projects and cross-sectional subjects. The clinical studies deal with cardiovascular and neurological rehabilitation and rehabilitation in disorders of the musculoskeletal system. The cross-sectional topics contain special fields such as biometry, health economics, epidemiology and occupational rehabilitation. All participating institutions have access to a central database with uniform structure of the data.