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A medical complex is defined as a set of related activities in a given locality which performs the three functions of education, research and health care. Its economic significance include the globalization of research and production and the clustering of activities in the area. While the economic potentials of health care facilities in Rotterdam, UK, have been recognized, its health care industry remains insignificant to the city's economy. Rotterdam may capitalize on its medical complex to achieve economic growth., INTRODUCTION An industrial complex is a network of mutual interdependent activities around a key manufacturing industry (CHARDONNET, 1953). The dynamics of an industrial complex, manifested in scale and agglomeration advantages, [...]

Recognizing a stimulus as familiar is an important capacity in our everyday life. Recent investigation of visual processes has led to important insights into the nature of the neural representations of familiarity for human faces. Still, little is known about how familiarity affects the neural dynamics of non-face stimulus processing. Here we report the results of an EEG study, examining the representational dynamics of personally familiar scenes. Participants viewed highly variable images of their own apartments and unfamiliar ones, as well as personally familiar and unfamiliar faces. Multivariate pattern analyses were used to examine the time course of differential processing of familiar and unfamiliar stimuli. Time-resolved classification revealed that familiarity is decodable from the EEG data similarly for scenes and faces. The temporal dynamics showed delayed onsets and peaks for scenes as compared to faces. Familiarity information, starting at 200 ms, generalized across stimulus categories and led to a robust familiarity effect. In addition, familiarity enhanced category representations in early (250-300 ms) and later (>400 ms) processing stages. Our results extend previous face familiarity results to another stimulus category and suggest that familiarity as a construct can be understood as a general, stimulus-independent processing step during recognition., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Forage maize is often infected by mycotoxin-producing Fusarium fungi during plant growth, which represent a serious health risk to exposed animals. Deoxynivalenol (DON) and zearalenone (ZEN) are among the most important Fusarium mycotoxins, but little is known about the occurrence of their modified forms in forage maize. To assess the mycotoxin contamination in Northern Germany, 120 natural contaminated forage maize samples of four cultivars from several locations were analysed by liquid chromatography-high resolution mass spectrometry (LC-HRMS) for DON and ZEN and their modified forms deoxynivalenol-3-glucoside (DON3G), the sum of 3- and 15-acetyl-deoxynivalenol (3+15-AcDON), α- and β-zearalenol (α-ZEL, β-ZEL). DON and ZEN occurred with high incidences (100 and 96%) and a wide range of concentrations, reaching levels up to 10,972 and 3910 µg/kg, respectively. Almost half of the samples (46%) exceeded the guidance value in complementary and complete feeding stuffs for ZEN (500 µg/kg), and 9% for DON (5000 µg/kg). The DON related mycotoxins DON3G and 3+15-AcDON were also present in almost all samples (100 and 97%) with amounts of up to 3038 and 2237 µg/kg and a wide range of concentrations. For the ZEN metabolites α- and β-ZEL lower incidences were detected (59 and 32%) with concentrations of up to 423 and 203 µg/kg, respectively. Forage maize samples were contaminated with at least three co-occurring mycotoxins, whereby 95% of all samples contained four or more mycotoxins with DON, DON3G, 3+15-AcDON, and ZEN co-occurring in 93%, together with α-ZEL in 57% of all samples. Positive correlations were established between concentrations of the co-occurring mycotoxins, especially between DON and its modified forms. Averaged over all samples, ratios of DON3G/DON and 3+15-AcDON/DON were similar, 20.2 and 20.5 mol%; cultivar-specific mean ratios ranged from 14.6 to 24.3 mol% and 15.8 to 24.0 mol%, respectively. In total, 40.7 mol% of the measured DON concentration was present in the modified forms DON3G and 3+15-AcDON. The α-ZEL/ZEN ratio was 6.2 mol%, ranging from 5.2 to 8.6 mol% between cultivars. These results demonstrate that modified mycotoxins contribute substantially to the overall mycotoxin contamination in forage maize. To avoid a considerable underestimation, it is necessary to analyse modified mycotoxins in future mycotoxin monitoring programs together with their parent forms.

Fusarium mycotoxins and their derivatives are frequently detected in freshly harvested forage maize. This study assessed the time course effects during ensiling of forage maize on the fate of Fusarium mycotoxins, using laboratory-scale silos and artificially contaminated raw material. A multi-mycotoxin liquid chromatography-high-resolution mass spectrometry (LC-HRMS) method was used to determine the levels of deoxynivalenol (DON), zearalenone (ZEN) and their derivatives DON-3-glucoside, 3-acetyl-DON, 15-acetyl-DON, deepoxy-DON, α-zearalenol and β-zearalenol. A significant increase of DON was observed during ensiling, whereas the levels of DON-3-glucoside and its acetylated forms proportionally decreased. In contrast, levels of ZEN, α-zearalenol and β-zearalenol were not affected by the ensiling process. Based on these findings, ensiling is not a practical method for reducing the total amount of Fusarium mycotoxins present at harvest.

Fusarium head blight (FHB) is one of the most important diseases of wheat, causing yield losses and mycotoxin contamination of harvested grain. A complex of different toxigenic Fusarium species is responsible for FHB and the composition and predominance of species within the FHB complex are determined by meteorological and agronomic factors. In this study, grain of three different susceptible winter wheat cultivars from seven locations in northern Germany were analysed within a five-year survey from 2013 to 2017 by quantifying DNA amounts of different species within the Fusarium community as well as deoxynivalenol (DON) and zearalenone (ZEA) concentrations. Several Fusarium species co-occur in wheat grain samples in all years and cultivars. F. graminearum was the most prevalent species, followed by F. culmorum , F. avenaceum and F. poae , while F. tricinctum and F. langsethiae played only a subordinate role in the FHB complex in terms of DNA amounts. In all cultivars, a comparable year-specific quantitative occurrence of the six detected species and mycotoxin concentrations were found, but with decreased DNA amounts and mycotoxin concentrations in the more tolerant cultivars, especially in years with higher disease pressure. In all years, similar percentages of DNA amounts of the six species to the total Fusarium DNA amount of all detected species were found between the three cultivars for each species, with F. graminearum being the most dominant species. Differences in DNA amounts and DON and ZEA concentrations between growing seasons depended mainly on moisture factors during flowering of wheat, while high precipitation and relative humidity were the crucial meteorological factors for infection of wheat grain by Fusarium . Highly positive correlations were found between the meteorological variables precipitation and relative humidity and DNA amounts of F. graminearum , DON and ZEA concentrations during flowering, whereas the corresponding correlations were much weaker several days before (heading) and after flowering (early and late milk stage).

Septoria tritici is the most important diseases in winter wheat in Schleswig-Holstein (northern Germany) and in many other regions over the world. But the disease severity as well as the timing of the epidemic progression varies between locations and seasons and so he influence on yield parameters like absolute yield or yield loss. To optimize the disease management a quantitative knowledge of the factors affecting the disease progression is necessary. Weather is the driving force of the disease progression, the weather from sowing until stem elongation influence mostly the disease severity on the lower leaves whereas the weather during the vegetation period determines the epidemic disease patterns of the upper yield relevant leaves (F-3 to flag leaf). The epidemic disease progression occurs in several pushes, also recognized as "sudden outbreaks", where such an increase is initiated by a weather scenario called infection cycle. The object of this study is the identification of the most important factors of each part of the disease progression and their interaction. So that weather scenarios as well as cropping parameters can be evaluated and recommendations for the disease management can be made.

Septoria tritici epidemics were monitored on winter wheat cv. Ritmo between 1995 and 2003 at 8 to 11 locations per year in Northern Germany (area between 53.70 and 54.38°N latitude and 8.83 and 10.88°E longitude) by counting the number of pycnidia on the leaves of plants obtained from plots under natural infection. Furthermore, meteorological data (leaf wetness, temperature, and precipitation) were recorded within the same period at the same locations. Groups of similar meteorological events were identified by hierarchical cluster analysis. The temporal distance of those clusters from the point of time when an increase of more than 70 S. tritici pycnidia was observed per leaf within 1 week was calculated for all epidemiological case studies and meteorological clusters. A cluster with average temperature = 13.62 ± 2.30°C, leaf wetness = 92.39 ± 4.15%, and precipitation = 0.04 ± 0.10 mm per day was consistently observed at 20.35 ± 4.15 days before epidemic outbreaks. This estimate of a latent period was significantly affected by geographic latitude, average temperature during infection, average temperature during the latent period, year, and precipitation, but not by leaf layer and longitude. On average, an increase in temperature during the infection period by 1°C decreased latent periods by 0.95 day. Latent periods were decreased by 0.2 day upon an increase of the average temperature by 1°C during the latent period. Average latent periods decreased by 1.7 days per degree of north latitude. Latent period estimates had lower coefficients of variation than temperature sums accumulated over latent periods. The usefulness of the approach described above for general epidemiology and for increasing fungicide efficacy by improving the timing of applications is discussed.

Many asthma patients remain symptomatic despite maintenance therapy with inhaled corticosteroids (ICS) and salbutamol as rescue medication. In the present study the relative efficacy and preference for as-needed formoterol compared with salbutamol was examined. In total, 211 patients with a mean age of 45 yrs (mean forced expiratory volume in one second (FEV1) 77% predicted normal), using ICS, were randomised to 3 weeks' double-blind treatment with as-needed formoterol 4.5 microg Turbuhaler and with as-needed salbutamol 100 mug Turbuhaler in a cross-over fashion. Overall, lung function and symptom control were better with as-needed formoterol than with as-needed salbutamol. During as-needed formoterol treatment daytime and night-time symptom scores were lower, peak expiratory flow and FEV1 were higher and patients experienced fewer disturbed nights (34%) compared with as-needed salbutamol. Patients preferred the formoterol treatment to salbutamol. Of the 162 patients expressing a preference, formoterol was preferred by 68% (95% confidence interval: 60-75). Subjective assessment of effectiveness also favoured formoterol, which was perceived as slightly faster acting than salbutamol. In conclusion, as-needed formoterol improved symptoms and lung function compared with salbutamol and was perceived as more effective and at least as fast acting for symptom relief.

A 65-year-old man with chronic obstructive pulmonary disease who had frequently been treated with prednisone for recurrent exacerbations was admitted to hospital with a pneumothorax. This proved to be a complication of a chronic necrotizing pulmonary aspergillosis. Despite maximal therapy the patient died 15 months after diagnosis from total respiratory insufficiency, the end stage of the bullous emphysema.

Under the primary utilisation of phytosanitary production factors such as selection of variety, crop rotation and N fertilisation according to plant requirements, the IPM Wheat Model comprises the elements diagnosis (qualitative = type of pathogen, quantitative = disease severity), scientifically grounded treatment thresholds which, as critical values in pathogen development, can be applied to define the optimum time of fungicide application, and pathogen-specific effective fungicides and application amounts. This leads to the location and year-specific optimised control of the pathogen and of the associated yield performance. After several years of development in Bavaria (from 1985 on) and Schleswig-Holstein (1993-1999), the model was tested as part of a project involving the Universities of Bonn and Kiel and the plant protection services of the German states of Lower Saxony, North Rhine-Westphalia and Schleswig-Holstein in a three-year study (1999-2001) in interregional locations (usually nine per state) with the winter wheat variety Ritmo (interregional indicator variety) and a further variety of regional importance in different variations (untreated control, three to four times growth stage-oriented variants for the determination of the absolute damage potential, IPM-variant). In exact records (approx. 12 dates per vegetation period), the disease epidemics were recorded weekly. With the genetically uniform indicator variety Ritmo, the results documented substantially differing year- and location-specific disease and yield patterns. Interregionally, a broad wheat pathogen spectrum (Puccinia striiformis, P. recondita, Septoria tritici, Stagonospora (syn. Septoria) nodorum, Blumeria (syn. Erysiphe) graminis, Pseudocercosporella herpotrichoides, Drechslera tritici-repentis) in differing composition, disease severity and damage effect was demonstrated. The heterogeneity of the infection and damage patterns was increased in the case of the second variety, in association with the genetic variability. The epidemiologically-orientated indications (average two, reduced application amounts) according to the IPM Wheat Model in association with time-diverging progressions led, on an interregional basis, with minimum input and in association with the diverging dynamics, to a biologically and economically optimised fungicide application. In the context of economic and ecological performance, the comprehensive results of the project demonstrated the valuable functionality of the IPM Wheat Model.

The breathing cassette (Hyperfree) was tested on 10 persons suffering from hyperventilation syndrome. Each subject performed a hyperventilation provocation of two minutes on three separate occasions. Immediately after the hyperventilation provocation the subject was asked to terminate the hyperventilation, firstly with no aid at all, later using a plastic bag or the breathing cassette. The %vol. CO2 in the exhaled air was recorded with a capnograph. The use of the plastic bag and the breathing cassette resulted in an equal restoration of the %vol. CO2. After using the cassette for six weeks the patients completed a questionnaire. All patients stated that they intended to continue using the breathing cassette, and that it was easy and handy to use. Most patients carried the cassette always with them, since it made them feel comfortable.