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In this work, the seasonal performance of different grid-connected photovoltaic technologies installed both in the warm climate of Nicosia, Cyprus, and in the moderate climate of Stuttgart, Germany, was evaluated. The technologies presented include mono-crystalline-silicon, multi-crystalline-silicon and thin-film amorphous-silicon, cadmium-telluride and copper-indium gallium-diselenide technologies. The crystalline-silicon technologies exhibited maximum performance ratio (PR) peaks during the winter and minimum peaks during the warmer summer seasons in Nicosia. This signifies that the performance of these technologies installed in the warm climate is strongly dependent on temperature. The identical type crystalline-silicon technologies in Stuttgart exhibited a similar behaviour as in Nicosia with the exception of rapid decreases in performance due to snow in the winter. In contrast, the amorphous-silicon thin-film technologies exhibited a different seasonal performance compared with the remaining installed technologies, as their operating PR was higher during the summer and autumn months and lower during the winter. [ABSTRACT FROM PUBLISHER]

Study Aim: The aim of this study was to describe the characteristics of future occupational physicians and to evaluate their expectations from and motivations for undertaking postgraduate medical education courses in occupational medicine. This will provide a basis for further increasing the attractiveness of occupational medicine as a discipline in preventive medicine and counteracting the shortage of occupational medical physicians., Methods: At five locations in Germany, physicians in postgraduate medical education courses in occupational medicine were asked about their expectations from occupational medicine, their reasons for starting postgraduate medical education courses, and their assessment of these courses. The survey took place between 2018 and 2021. The data were analysed descriptively, and a cluster analysis was applied to identify the types of motives for continuing postgraduate medical education courses in occupational medicine., Results: Of the 233 respondents, the majority were female (68.5%) and the mean age was 43.1 years (SD 7.9 years). The response at the State Chamber of Physicians of Saxony was 50% and at the remaining four academies was between 18% and 23%. The analysis revealed four different types of motives: "career & interest", "work & life balance", "self-employment" and "desire for change". Two-thirds of the participants were in favour of a greater integration of occupational medicine into medical school curriculum., Conclusions: The results suggest that there are different motives that lead physicians to pursue continuing education in occupational medicine. These motives should be considered when recruiting young occupational physicians., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Noise annoyance is the second-highest cause of lost disability-adjusted life-years due to environmental noise in Europe. Evidence on exposure-response relationships (ERRs) for traffic noise annoyance with more accurate exposure values is still needed., Objectives: In an analysis of the population-based LIFE-Adult study in Leipzig, Germany, we aimed to investigate the effect of road, railway (train and tram), and aircraft noise on high annoyance (HA)., Methods: Traffic exposure data was taken for 2012 and data on noise annoyance was evaluated between 2018 and 2021. HA was defined according to international standardized norms. We calculated risk estimates using logistic regression, controlling for age, sex, and socioeconomic status, and compared our ERRs with those from the last WHO review on this topic., Results: Aircraft noise had the highest relative risk for noise-related HA (OR = 12.7, 95% CI: 9.37-17.10 per 10 dB L den increase). The road and railway traffic risk estimates were similar to each other (road: OR = 3.55, 95% CI: 2.78-4.54; railway: OR = 3.31, 95% CI: 2.77-3.97 per 10 dB L den increase). Compared to the WHO curves, the proportion of highly annoyed individuals was somewhat lower for road and rail traffic noise, but higher for aircraft noise., Discussion: Aircraft noise is particularly annoying. There were differences between our study's ERRs and those in the WHO review, especially for aircraft noise. These differences may be partly explained by the improved accuracy of the exposure values, as we considered secondary road networks and tram noise, and by a lack of a nighttime flight ban at the Leipzig airport. Geographical, regional and climatic variations, inconsistency in HA cut-offs, as well as temporal developments in the annoyance experience may also explain the differences. Since ERRs serve as a basis for decision making in public policies, regular updates of the curves based on new evidence is recommended., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Andreas Seidler reports financial support was provided by German Environment Agency., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Healthcare workers seem to be more affected by stigma due to the Covid-19 pandemic compared to other occupational groups. However, there is very little research on this topic. The aims of the present study were to investigate pandemic-related stigmatization experiences among nursing and medical staff in Germany and determine the type and effects of stigmatization as well as appropriate prevention and intervention measures., Methods: The interviews were conducted by a semi-structured interview guide and evaluated using qualitative content analysis., Results: Sixteen nurses participated in the interviews. Sources of stigmatization were friends and acquaintances, family members, executives, colleagues, patients and their relatives, strangers and public media. Some of the interviewed persons reported self-stigmatization. A common cause of stigma in the private environment was the fear of infection. In the context of the work, illness-related absence was also named as one of the causes of stigma. The interviewees reported about distancing and avoiding contact, as well as allegations they were faced with. As a result, they suffered from negative feelings and partially from psychosomatic complaints. Some interviewees tried to avoid stigmatization by concealing their own profession or place of work. Help was offered in private and professional context in form of conversations and encouragement., Conclusion: Stigmatization of healthcare professionals during the pandemic has hardly been explored in Germany. There is a particular need for research to quantify the extent, manifestations and effects of work-related stigmatization and to develop suitable preventive measures at workplace and outside of work., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Road-traffic-noise exposition is widespread in Germany and can have harmful health effects. As guidance for informed decision-making, we estimated the environmental burden of disease attributable to road-traffic noise in Hesse, Germany as disability-adjusted life-years (DALYs). Using detailed road-traffic-noise exposure data provided by the Hessian Agency for Nature Conservation, Environment, and Geology (HLNUG), we calculated the DALYs due to road-traffic noise > 40 dB(A) L 24h (unweighted average 24 h noise level) and other noise metrics for endpoints with known dose-response functions and evidence in the literature (NORAH-study on disease risks and WHO reviews): cardiovascular disease, depressive disorders, road-traffic annoyance, and sleep disturbance. We calculated the population-attributable fractions (PAF) for road-noise-related cardiovascular disease (hypertensive heart disease, ischemic heart disease, and stroke) and depressive disorders in the population using published relative risk estimates. We multiplied the PAFs with the Hessian proportion of the 2015 WHO DALY estimates for Germany in people aged ≥ 40 years. For high annoyance and high sleep disturbance, we used published dose-response functions to determine the burden for residents of all ages. For Hesse, we found a total of 26,501 DALYs attributable to road-traffic noise or 435 DALY per 100,000 persons for the reference year, 2015. Further, we estimated that a hypothetic uniform road-traffic-noise reduction of 3 dB would prevent 23% of this burden of disease.

Aim: In Germany, traffic noise-related threshold values are currently set at 70 decibels (dB) during the day and 60 dB at night. According to recent study results, these threshold values might not sufficiently protect against disease risks. The model calculation presented here aimed to estimate the effects of 3 specific noise-protection measures on annoyance, sleep disorders, and cardiovascular diseases., Methods: For road traffic noise and railway noise, 3 noise reduction approaches were modeled: (1) weighted 24 hours noise levels (LDEN) of at most 65 dB, and nightly sound pressure levels (LNight) of 55 dB; (2) LDEN of at most 60 dB and LNight of 50 dB; and (3) a general reduction of road and railway noise pressure levels by 3 dB. As an example, the effects of approaches (1) to (3) were determined for the study population of the NORAH study on disease risks (Rhine-Main area). The health consequences were estimated based on the results of the WHO Noise Guidelines (2018) and the NORAH study on disease risks., Results: The model calculations showed that noise protection approach (1) could reduce the number of people suffering from sleep disturbances as a result of nightly traffic noise and of those highly annoyed as well as the number of people suffering from traffic-related cardiovascular disease by 5 to 10%. Noise protection approach (2) could reduce traffic-related cardiovascular diseases by at least about 10%; according to the WHO Noise Guidelines, it would even be possible to reduce road traffic noise-related ischemic heart disease by more than 30%. All of these measures would be of particular benefit to the highly exposed population - an already vulnerable group due to their limited socio-economic resources. With the general reduction of traffic noise pressure levels by 3 dB, the incidence of annoyance, sleep disturbances and cardiovascular diseases could be reduced particularly among those exposed to low to medium noise pressure levels., Conclusions: Considering the different objectives and target groups of the investigated noise protection measures, the introduction and implementation of specific threshold values should be supplemented by general noise reduction measures in the range below the threshold values., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis., Background: Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place., Method(s): An international qualitative descriptive study based on the positive deviance approach conducted in 2019-2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC., Results: Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC., Conclusion: Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other., Implications for Nursing Management: Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required., (© 2020 John Wiley & Sons Ltd.)

Background: Adequate immunity to so-called childhood diseases can lower the occupational risk of vaccine-preventable infectious diseases in persons who work in day-care centers for children., Methods: A systematic literature survey was carried out in PubMed and Embase for the period January 2000 to February 2019. Studies on immune status and vaccination status were included. In addition, data from the first wave of the German Health Interview and Examination Survey for Adults (Studie zur Gesundheit Erwachsener in Deutschland, DEGS1) and surveillance data on notifiable infections in Germany were evaluated., Results: Six studies and the DEGS1 analysis of vaccination or immune status for varicella zoster, rubella, hepatitis A (HAV), pertussis, measles, and mumps in persons caring for children in day-care centers, most of whom are women, were included in this review. According to DEGS1, childcare workers are more commonly vaccinated against HAV and pertussis than the general female population (prevalence ratios [PR]: 1.46 [1.12; 1.90] and 1.57 [1.05; 2.36]), yet 57% had not been vaccinated against HAV and 77% had not been vaccinated against pertussis. Childcare workers were found to be less commonly vaccinated against rubella than the general female population, although the difference was not statistically significant (PR: 0.87 [0.71; 1.07]). In a Canadian study, positive HAV serology was found to be correlated with the duration of activity as a childcare worker. In the DEGS1 study, large proportions of the younger childcare workers in particular were seronegative against measles (16%), mumps (19%), and HAV (37%). Notifiable disease statistics show that those working in community facilities had a markedly higher risk of mumps, pertussis, and varicella (relative risk [RR]: 1.8-2.6) and a somewhat higher risk of rubella and HAV (RR: 1.47 and 1.21, respectively)., Conclusion: Childcare workers have a higher occupational risk of infection but do not always receive the appropriate vaccinations. In particular, women of child-bearing age working in day-care centers should be made more aware of the need for vaccination.

Objective: Delirium has been characterized into its subtypes-hypoactive, hyperactive, mixed, or no motor subtype-along with the use of the Delirium Motor Symptom Scale (DMSS). The German version of this scale (DMSS-G), however, has not yet been validated. Method: We determined internal consistency, reliability, and validity of the DMSS-G in the surgical intensive care unit, using DSM-IV-TR criteria and the Delirium Rating Scale-Revised-98. Results: In total, 289 patients were included, and out of these, 122 were delirious. The DMSS-G showed excellent internal consistency (Cronbach's α = 0.92) and interrater reliability (Fleiss κ = 0.83). Additionally, the overall concurrent validity was substantial (Cramer's V = 0.69); within subtypes, hyperactive, hypoactive, or mixed, the concurrent validity remained at least substantial (Cohen's κ = 0.73-0.82) and the sensitivity ranged from 60% to 97%. In contrast, in those with no motor subtype, we found the concurrent validity (Cohen's κ = 0.31) and sensitivity to be low (22%). Overall, specificity for all individual subtypes was high (82% to 100%). The DMSS was very sensitive in both rating hyperactive and hypoactive motor symptoms of delirium. Conclusion: The DMSS-G is a highly reliable and valid instrument for detecting motor symptoms in delirium, which provides an accurate instrument to classify the motor subtypes of delirium.

Many epidemiological studies find that people exposed to aircraft, road or railway traffic noise are at increased risk of illness, including cardiovascular disease (CVD) and depression. It is unclear how the combined exposure to these different types of traffic noise affects disease risks. This study addresses this question with a large secondary data-based case-control study ("NORAH disease risk study"). The Akaike information criterion (AIC) is used to compare two different models estimating the disease risks of combined traffic noise. In comparison with the conventional energetic addition of noise levels, the multiplication of CVD risks as well as depression risks reveals a considerably better model fit as expressed by much lower AIC values. This is also the case when risk differences between different types of traffic noise are taken into account by applying supplements or reductions to the single traffic noise pressure levels in order to identify the best fitting energetic addition model. As a consequence, the conventionally performed energetic addition of noise levels might considerably underestimate the health risks of combined traffic noise. Based on the NORAH disease risk study, "epidemiological risk multiplication" seems to provide a better estimate of the health risks of combined traffic noise exposures compared to energetic addition. If confirmed in further studies, these results should imply consequences for noise protection measures as well as for traffic planning., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Objective: The importance of the proper identification of delirium, with its high incidence and adversities in the intensive care setting, has been widely recognized. One common screening instrument is the Intensive Care Delirium Screening Checklist (ICDSC); however, the symptom profile and key features of delirium dependent on the level of sedation have not yet been evaluated., Method: In this prospective cohort study, the ICDSC was evaluated versus the Diagnostic and Statistical Manual, 4th edition, text revision, diagnosis of delirium set as standard with respect to the symptom profile, and correct identification of delirium. The aim of this study was to identify key features of delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale levels of sedation: drowsiness versus alert and calmness.ResultThe 88 delirious patients of 225 were older, had more severe disease, and prolonged hospitalization. Irrespective of the level of sedation, delirium was correctly classified by items related to inattention, disorientation, psychomotor alterations, inappropriate speech or mood, and symptom fluctuation. In the drowsy patients, inattention reached substantial sensitivity and specificity, whereas psychomotor alterations and sleep-wake cycle disturbances were sensitive lacked specificity. The positive prediction was substantial across items, whereas the negative prediction was only moderate. In the alert and calm patient, the sensitivities were substantial for psychomotor alterations, sleep-wake cycle disturbances, and symptom fluctuations; however, these fluctuations were not specific. The positive prediction was moderate and the negative prediction substantial. Between the nondelirious drowsy and alert, the symptom profile was similar; however, drowsiness was associated with alterations in consciousness.Significance of resultsIn the clinical routine, irrespective of the level of sedation, delirium was characterized by the ICDSC items for inattention, disorientation, psychomotor alterations, inappropriate speech or mood and symptom fluctuation. Further, drowsiness caused altered levels of consciousness.

Aim: To examine the stroke risks associated with aircraft, road traffic, and railway noise exposure in a large case-control study., Materials and Methods: All people aged ≥40 years living around the Frankfurt airport that were insured by one of three large statutory health insurance funds between 2005 and 2010 were included in the study (n = 1,026,670). Address-specific exposure to aircraft, road, and railway traffic noise was estimated for 2005. We used insurance claim data to identify 25,495 newly diagnosed cases of stroke between 2006 and 2010 and compared them with 827,601 control participants. Logistic regression analysis was used to calculate the odds ratios adjusted for age, sex, local proportion of people receiving unemployment benefits, and if available individual indicators of socioeconomic status (education, occupation)., Results: For 24-h continuous aircraft noise exposure, neither increased risk estimates nor a positive linear exposure-risk relation was found. However, stroke risk was statistically significantly increased by 7% [95% confidence intervals (95%CI): 2-13%] for people who were exposed to <40 dB of 24-h continuous aircraft noise, but ≥6 events of maximum nightly sound pressure levels ≥50 dB. For road and railway traffic noise, there was a positive linear exposure-risk relation: Per 10 dB the stroke risk increased by 1.7% (95%CI: 0.3-3.2%) for road traffic noise and by 1.8% (95%CI: 0.1-3.3%) for railway traffic noise. The maximum risk increase of 7% (95%CI: 0-14%) for road traffic noise and 18% (95%CI: 2-38%) for railway traffic noise was found in the exposure category ≥65 to <70 dB., Conclusion: This large case-control study indicates that traffic noise exposure may lead to an increase in stroke risk. It furthermore suggests that maximum aircraft noise levels at night increase the stroke risk even when continuous noise exposure is low, and thus highlights the relevance of maximum noise levels for research and policies on noise protection., Competing Interests: There are no conflicts of interest

Background: Rehabilitative health care is paying increasing attention to multimorbid people with 2 and more coexistent chronic diseases of sociomedical relevance., Methods: Terms, requirements, design, configuration, challenges and supply of sociomedical rehabilitation were described in part I. A project group of the Medical Advisory Board of the Federal Rehabilitation Council describes manifold fields of actions to be taken in the rehabilitation of persons with multimorbidity., Results: The actions proposed range from reviewing existing forms of management to identifying rehabilitative needs and initiating accurately fitting interventions, sensitizing and enlarging competences of involved personnel, considering multimorbidity in guidelines and further research on questions still open., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Rehabilitative health care is increasingly focusing its attention on multimorbid people with 2 and more coexistent chronic diseases of sociomedical relevance., Methods: After defining the term "multimorbidity" in the context of rehabilitative health care, an exploratory overview of the prevalence and clinical implication of this condition as reported in the literature was drafted. Based on a case history, special attention was paid to general as well as special challenges regarding design, configuration and supply of sociomedical rehabilitative care. Consensus was achieved with the Health Advisory Board of the German Federal Rehabilitation Council., Results: The proposed actions necessary for the healthcare of persons with multimorbidity include specific function-oriented individual assessment of needs via the distinctive allocation, selection and performance of rehabilitative procedures as well as post-rehabilitative care until the patient's reintegration into his social environment., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: This trial investigated the effect of a stroke support service on physical functioning in post-stroke outpatients., Methods: The randomized trial took place in two urban hospitals in Germany. The intervention covered a post-discharge stroke support service including following components: outreach work (via telephone contact and home-visit), informational events, training sessions, online portal, and written patient information. The control group received optimized standard care by written patient information. The primary outcome measure was physical function assessed by the physical scale of the stroke impact scale (SIS) 2.0 at baseline and after 12 months follow-up. Secondary outcomes covered health-related quality of life, depression, somatization, reinfarcts, and mortality. Use of health services was recorded., Results: A total of 265 patients were randomized either to the intervention (n = 130) or to the control group (n = 135); n = 230 patients were analyzed after 12 months. The mean group difference on the physical SIS scale was - 2.7 points (95% CI, - 5.5-0.2) in favor of the control group. The overall risk of mortality in the control versus the intervention group was 11.6and 3.9%, respectively (hazard ratio 0.32, 95% CI, 0.12-0.88). All other outcomes were neither statistically nor clinically relevant, different between the two study groups., Conclusion: An additional stroke support service did not improve physical function, health-related quality of life, depression, somatization, or reinfarcts in stroke patients. Data suggest a lower overall risk of mortality in the intervention group.

Ostrich farming and keeping in Germany is of increasing interest. Ostrich farming includes keeping the animals as agricultural livestock (production of meat, leather, eggs), for display, hobby farming and keeping in zoological collections. Based on scientific research there is a steady increase in knowledge of keeping ratites according to sophisticated standards in terms of animal welfare legislation. Legislation and recommondations for keeping of ratitae are described.

Objectives: For patients undergoing vulva surgery the quality of life (QoL) is generally accepted as an important outcome parameter in addition to long-term survival, mortality and complication rates. Less radical operative treatment can reduce morbidity and thereby improve quality of life. This study focuses on outcome in terms of QoL in patients comparing wide local excision (WLE) with radical vulvectomy and waiver of lymphonodectomy (LNE) with inguinofemoral lymphonodectomy., Methods: In a retrospective single-center study from 2000 to 2010, 199 patients underwent surgery for vulvar cancer. To assess QoL, the EORTC QLQ-C30 and a tumor-specific module questionnaire were sent to all patients in the follow-up period., Results: Women who underwent WLE have a superior QoL with regard to global health status and physical, role, emotional and cognitive functioning than those who underwent radical vulvectomy. Less radical surgery also implies less fatigue, nausea/vomiting, pain, insomnia, appetite loss, diarrhea and financial difficulties. After radical vulvectomy 89% of patients have sexual complications., Conclusion: Radical operative treatment, such as radical vulvectomy, causes deterioration in the QoL of these patients. An individualized, less radical surgery must be the aim in the treatment of vulvar cancer., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: An aftercare programme following medical rehabilitation may be beneficial in order to reinforce and stabilize the positive effects of rehabilitation and to encourage individual health-related modifications of behaviour and lifestyle. Medical rehabilitation and the aftercare programme of the German Pension Insurance Fund primarily are intended to sustain earning capacity. As part of an evaluation of the Intensified Rehabilitation Aftercare Programme (IRENA) established by the German Pension Insurance Fund, work-related aspects in orthopaedic patients were analyzed based on various data sources. Firstly, the significance of institutional and individual conditions for utilization of IRENA alongside work was of interest. Secondly, the IRENA participants' judgements of the changes of work-related parameters due to the programme were examined, differentiating specifically by extent of earning capacity impairments as well as by particular work problems., Methods: The data set used for the analysis is composed of person-related routine data of the German Pension Insurance Fund relative to IRENA records of the year 2007 (n=30 663), interview data from orthopaedic rehabilitation centres providing IRENA (n=225), and questionnaires of IRENA participants (n=750) that were either collected during a broad evaluation of the IRENA programme or provided by the German Pension Insurance Fund., Results: The results show that the compatibility of IRENA and work is facilitated by the institutional conditions. However, differences between inpatient and outpatient settings have to be recognized. The possibilities to participate in IRENA throughout the day frequently are more diverse in an outpatient setting. In contrast to inpatient centres, outpatient rehabilitation centres see clearly better chances for patients to return to work and to participate in IRENA alongside. With respect to the work-related parameters (work ability, periods of sick leave), clear improvements were reported by participants from the start of rehabilitation to the survey time after the end of IRENA. Particular work problems were reported by 33% of the IRENA participants. The work ability at the end of rehabilitation was found to have been the essential factor for improvement of work ability following IRENA. Particular work problems, however, had no influence, these individuals profited from IRENA to an equal extent., Conclusions: Institutional and individual view show that IRENA is compatible with utilization alongside work. Also, IRENA combined with prior medical rehabilitation will bring about subjective improvements in health and work-related parameters., (© Georg Thieme Verlag KG Stuttgart · New York.)

A common approach for remediation of groundwater contamination with volatile organic compounds (VOCs) is contaminant stripping by means of in situ air sparging (IAS). For VOC stripping, pressurized air is injected into the contaminated groundwater volume, followed by the extraction of the contaminant-loaded exhaust gas from the vadose soil zone and its immediate on-site treatment. Progress assessment of such remediation measure necessitates information (i) on the spatial range of the IAS influence and (ii) on temporal variations of the IAS efficiency. In the present study it was shown that the naturally occurring noble gas radon can be used as suitable environmental tracer for achieving the related spatial and temporal information. Due to the distinct water/air partitioning behaviour of radon and due to its straightforward on-site detectability, the radon distribution pattern in the groundwater can be used as appropriate measure for assessing the progression of an IAS measure as a function of space and time. The presented paper discusses both the theoretical background of the approach and the results of an IAS treatment accomplished at a VOC contaminated site lasting six months, during which radon was applied as efficiency indicator., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Introduction: A number of occupational risk factors are discussed in relation to the development and progress of knee joint diseases (for example, working in a kneeling or squatting posture, lifting and carrying heavy weights). Besides the occupational factors, a number of individual risk factors are important. The distinction between work-related and other factors is crucial in assessing the risk and in deriving preventive measures in occupational health., Methods: In a case-control study, patients with and without symptomatic knee osteoarthritis (OA) were questioned by means of a standardised questionnaire complemented by a semi-standardised interview. Controls were matched and assigned to the cases by gender and age. Conditional logistic regression was used in analysing data., Results: In total, 739 cases and 571 controls were included in the study. In women and men, several individual and occupational predictors for knee OA could be described: obesity (odds ratio (OR) up to 17.65 in women and up to 12.56 in men); kneeling/squatting (women, OR 2.52 (>8,934 hours/life); men, 2.16 (574 to 12,244 hours/life), 2.47 (>12,244 hours/life)); genetic predisposition (women, OR 2.17; men, OR 2.37); and sports with a risk of unapparent trauma (women, OR 2.47 (>or=1,440 hours/life); men, 2.58 (>or=3,232 hours/life)). In women, malalignment of the knee (OR 11.54), pain in the knee already in childhood (OR 2.08), and the daily lifting and carrying of loads (>or=1,088 tons/life, OR 2.13) were related to an increased OR; sitting and smoking led to a reduced OR., Conclusions: The results support a dose-response relationship between kneeling/squatting and symptomatic knee OA in men and, for the first time, in women. The results concerning general and occupational predictors for knee OA reflect the findings from the literature quite well. Yet occupational risks such as jumping or climbing stairs/ladders, as discussed in the literature, did not correlate with symptomatic knee OA in the present study. With regards to occupational health, prevention measures should focus on the reduction of kneeling activities and the lifting and carrying of loads as well as general risk factors, most notably the reduction of obesity. More intervention studies of the effectiveness of tools and working methods for reducing knee straining activities are needed.

Groundwater discharge into an open pit lignite mining lake was investigated using radon-222 as a naturally occurring environmental tracer. The chosen study site was a meromictic lake, i.e., a water body that is divided horizontally into two separate layers--the upper mixolimnion (with seasonal mixing) and the lower monimolimnion (without seasonal mixing). For the estimation of groundwater discharge rates into the lake, a simple box model including all radon sinks and sources related to each layer was applied. Two field investigations were performed. During the October campaign, the total groundwater discharge into the lake was found to be 18.9 and 0.7 m(3) d(-1) for the mixolimnion and monimolimnion, respectively. During the December campaign, the groundwater discharge into the mixolimnion was 15.0 m(3) d(-1), whereas no discharge at all was observed into the monimolimnion. Based on the given water volumes, the residence time of lake water was 5.3 years for the monimolimnion and varies between 0.9 and 1.1 years for the mixolimnion. The investigation confirmed radon to be a useful environmental tracer for groundwater and surface water interactions in meromictic lake environments.

Introduction: This is a four-year follow-up of 25 men who received parenteral testosterone undecanoate (TU), 1000 mg every 12 weeks for at least four years. This study was a continuation of a 30-week study wherein the effects of TU had been compared to those of parenteral testosterone enanthate., Methods & Results: Plasma testosterone (T) trough values of the injection interval of 12 weeks): median 11.9 - 15.9 nmol/L (N 10.0-30.0). E2 and SHBG were stable. Body weight, BMI, waist-to-hip ratio remained stable. Total cholesterol, and triglycerides were unchanged but plasma LDL declined while HDL, after an initial reduction over the first 30 weeks, had increased significantly after three years. Leptin levels, bone mineral density, blood pressure, liver function tests, haemoglobin and haematocrit levels remained stable without values above the upper limit of normal. Over the first 12 months of the study there was an increase in prostate volume from 19.7 +/- 8.8 mL to 22.0 +/- 8.4 mL (p < 0.05) but thereafter volumes remained stable, paralleled by an increase in PSA from 0.67 +/- 0.38 microg/dL to 0.75 +/- 0.35 microg/dL (p < 0.05) without any further changes after 12 months., Conclusion: TU appears to be a stable and safe treatment modality of hypogonadal men.

The "patient-individual neurological care pathways" are a concept for qualified decision-making about rational rehabilitative strategies in the treatment of neurological diseases. Such clinical pathways include available scientific evidence and treatment guidelines. In neurological rehabilitation all treatments have a decidedly interdisciplinary character. All members of the team need highly specialized knowledge, a high potential for teamwork, as well as efficient organisation of work time. Here, computer aided decision-making tools such as the "patient-individual neurological care pathways" facilitate rational decisions and reduce the need for reorganization of therapies. In rehabilitation of neurological patients a symptom-oriented and function-related perspective of the individual treatment goals is indispensable for optimal choice of therapy approaches. This function-oriented classification of patients and creation of individual treatment plans are realized within the Excel-based care pathways. This system has been proved on the one hand as an instrument for streamlining and optimisation and, on the other, as a useful tutoring tool in the medical rehabilitation process.

Service utilization and total direct cost of care was assessed in 270 patients suffering from depressive disorder. Patients were recruited from primary care physicians or family doctors (n = 43) or psychiatrists (n = 23) in office practice, from three different regions in Germany (county of Düren and city of Aachen, Lörrach-county, city of Munich). A detailed catalogue of unit costs (including inpatient, outpatient and rehabilitative services) was used for calculating total cost of care on an individual basis. Service utilization and costs referred to 2001. Mean cost of total medical care of the study patients was euro 3849 (excluding cost of drugs for physical illness). The cost for treating depressive disorders and additional psychiatric co-morbidity (which is included into the total cost of care) was euro 2073 per patient and year. When cross-checking with ICD-10 criteria for depressive disorders, the original diagnosis by family doctors or psychiatrists could be confirmed in 186 patients of the total sample (n = 270), suggesting that there is a high amount of falsely diagnosed patients in primary and specialized care of depressive patients in Germany. Direct cost of the 186 confirmed patients was higher (total care cost: euro 4715, cost for treatment of depression and psychiatric co-morbidity: euro 2541) than in the total group and should be considered as reference cost, when discussing cost of care in depressive patients in Germany. Results suggest to analyse cost of care in depressive patients further and to discuss a more efficient allocation of health budgets in the field.