Lifestyle behaviour and prevalence of cardiovascular risk factors - a pilot study comparing Kiribati and European seafarers.

BACKGROUND: According to internal observations within a German shipping company, obvious risk-behaviour persists among the crew members coming from the Pacific Island State of Kiribati and representing a large part of the crew aboard merchant vessels of this company. These observations were related to excessive eating habits. This study aims to assess the cardiovascular risk among seafarers and to compare lifestyle factors between Kiribati and European crew members. METHODS: In the present maritime field study 81 sailors (48 Kiribati, 33 European, average age at 38.9 and 36.8 years respectively) were examined from April until August 2014 aboard four container ships crossing the Atlantic Ocean (participation rate of 90.9%). RESULTS: Based on the number of established risk factors, 35.4% of the Kiribati and 16.7% of the European crew members were regarded as a high risk group for cardiovascular diseases. The HDL-values of Kiribati were found to be considerably lower (34.9 mg/dl) than the references values given by the WHO and in comparison to the European crew members (44.8 mg/dl) (p = 0.002). 91.7% of Kiribati and 51.5% of European participants were found to be overweight according to WHO-criteria - with a mean Body Mass Index (BMI) of 30.3 kg/m2 and 25.6 kg/m2 (p <  0.001). Regarding lifestyle factors Kiribati often claimed to eat significantly larger amounts of food aboard while most European sailors stated to eat less or about the same during their shipboard stay (p = 0.017). Daily sleeping hours were slight on both sides; however with a mean of 5.2 h a day Kiribati crew members had significant fewer sleep (p = 0.038). The examined Kiribati sailors had a mean increase in weight of 6 kg over a 12 months period of observation. CONCLUSIONS: In total the compiled data points towards a higher risk of cardiovascular diseases particularly due to alimentary habits within the Kiribati crew members. The distinct weight-gain measured among the Kiribati in spite of higher energy consumption levels at sea is alarming. Thus, the results of this study confirm the necessity of health-improving interventions aboard cargo vessels.

Enhancing the photoluminescence of surface anchored metal-organic frameworks: mixed linkers and efficient acceptors.

We present two approaches to enhance the photoluminescence quantum yield (PLQY) of surface-anchored metal-organic frameworks (SURMOFs). In the first approach we fabricate SURMOFs from a mix of an emissive linker with an optically-inert linker of equivalent length, diluting the emissive linker while maintaining the SURMOF structure. This approach enhances the internal PLQY. However, the increase in internal PLQY is achieved at the expense of a drastic reduction in optical absorption, thus the external PLQY remains low. To overcome this limitation, a second approach is explored wherein energy-accepting guest chromophores are infiltrated into the framework of the active linker. At the correct acceptor concentration, an internal PLQY of 52% - three times higher than the previous approach - is achieved. Additionally, the absorption remains strong leading to an external PLQY of 8%, an order of magnitude better than the previous approach. Using this strategy, we demonstrate that SURMOFs can achieve PLQYs similar to their precursor chromophores in solution. This is of relevance to SURMOFs as emitter layers in general, and we examine the optimized emitter layer as part of a photon upconversion (UC) SURMOF heterostructure. Surprisingly, the same PLQY is not observed after triplet-triplet annihilation in the UC heterostructure as after its normal photoexcitation (although the UC layers exhibit low thresholds consistent with those reported in our previous work). We discuss the potential bottlenecks in energy transport that could lead to this unexpected reduction in PLQY after excitation via triplet-triplet annihilation, and how future design of SURMOF UC multilayers could overcome these limitations.

Seafarer deaths at sea: a German mortality study.

BACKGROUND: Seafarers face numerous hazards during their work at sea. AIMS: To demonstrate the frequency and causes of mortality in German seafarers. METHODS: The deaths of all German seafarers from 1998 to 2008 were counted and evaluated using the German central civil register in Berlin. RESULTS: The study cohort comprised a total of 159588 seafarer-years. During the 11 year period, 68 male seafarers died on board. The average age was 48.5 years (SD 12.7 years) and comprised 35 deck officers, 16 engine officers and 17 general crew members (i.e. non-officers from the deck and engine room crew and galley staff). Cause of death was documented in 45 cases (66%): 26 were due to unnatural causes (occupational accidents, suicides) and 19 due to natural causes (particularly, ischaemic heart disease). The crude annual mortality rate for German seamen was 65 per 100000 seafarer-years. For cardiac causes, this rate was significantly higher among deck and engine officers (24 and 38) than among crew ranks (7 per 100000 seafarer-years) (P < 0.05). Deck and engine offi-cers also showed a higher mortality rate for accidents (28 and 22) than crew ranks (15) (P < 0.05). The age-stratified fatal accident rate of German seafarers aboard was 10 times higher than the mortality of the German general population on shore. CONCLUSIONS: Seafaring constitutes an occupation with a high risk for serious accidents. Due to the unexpectedly high mortality rate among officers associated with work-related accidents, this occupational group should receive more effective education on safety behaviour on board.

Comparison of hospitalization among German coastal and deep sea fishermen.

PURPOSE: This study aims to compare the hospitalization of German fishermen employed on German-flagged fishing vessels with that of the general German population in consideration of differences between coastal and deep sea fishery. METHODS: By means of a database from the health insurance company for seafarers, diagnoses of German fishermen treated in German hospitals were determined from January 1997 to December 2007. Compared with the general German population, the fishermen's risk for specific diseases leading to hospitalization was calculated as standardized hospitalization ratio (SHR). RESULTS: Compared with the German reference population, German fishermen showed a considerably high SHR for malignant neoplasms at all sites (SHR 1.46; 95% CI 1.37-1.56), for respiratory cancer, and for non-Hodgkin lymphoma (NHL). Furthermore, they had more often been hospitalized due to diabetes mellitus, diseases of the respiratory and digestive systems as well as due to injury and poisoning. The risk for respiratory cancer and NHL among coastal fishermen exceeded that of deep sea fishermen, whereas the latter displayed a considerably higher SHR for diabetes mellitus, diseases of the respiratory system and metabolic and nutritional disorders. In contrast, the SHR for hypertensive and ischemic heart diseases was decreased among deep sea fishermen. Less qualified deep sea fishermen displayed a considerably higher SHR for malignant neoplasms at all sites than more highly qualified ones. CONCLUSIONS: Fishery is still an occupation which poses a high risk for malignant neoplasms and injuries. This is likely due to lifestyle and work-related factors. Further studies are needed to evaluate the different working and living conditions of coastal and deep sea fishermen.

Systematic review of maritime field studies about stress and strain in seafaring.

PURPOSE: The aim of this study was to summarize and evaluate the current scientific literature on stress and strain on seafarers on board as defined by maritime field surveys. METHODS: Using a systematic review, 109 studies on the stress and strain experienced by seafarers were identified for the period January 1990 to January 2012. RESULTS: Only 13 of the identified maritime studies were conducted as field studies, and in 10 of these studies, the focus was on the watch system and/or on fatigue. According to the study results, sleepiness tends to be stronger in the 2-watch system than in the 3-watch system (particularly between 4:00 and 6:00 a.m.). Occasional short sleep episodes appear to provide adequate recovery. Fatigue does not appear to depend on the seafarers' age and is often associated with poor sleep quality; noise and night shifts are also considered to contribute to fatigue. Stress among the seafarers was primarily recorded in sleep diaries (9 times) and with devices for measuring physical activity (4 times). As a rule, a questionnaire was used to assess the strain on the crew on board; 7 studies also additionally recorded biometrical parameters. Only in 6 cases were several groups with different ranks on board investigated. CONCLUSION: The conducted literature review makes it clear that most maritime field studies have focused on fatigue and watch systems in the shipping industry--in each case as univariate parameters. Thus, scientific field studies with comprehensive multivariate stress and strain analyses on board are required.

Burnout syndrome in seafarers in the merchant marine service.

PURPOSE: As seafarers face a wide range of psychosocial stressors on board, they may be endangered to develop burnout syndrome. This study aims to investigate respective indicators. METHODS: In a cross-sectional study, 251 seafarers were asked about demographic data and job-related stressors. Particularly, the subscale emotional exhaustion (EE) of the Maslach Burnout Inventory and the Epworth Sleepiness Scale were used to assess the respective risks of job-related burnout and daytime sleepiness among seafarers. The statistical analysis was carried out using multiple logistic regression. RESULTS: Within the whole study group, the EE score was elevated in 10.8 %. A higher EE score was found in 10.7 % of officers, in 4.5 % of lower crew ranks and in 25.0 % of the galley staff (p = 0.05). Furthermore, long working days were associated with an elevated EE score [OR 3.83 (CI 1.46-10.03)]. Emotional exhaustion was associated with a subjective perception of enough sleep on board [OR 3.33 (CI 1.17-9.46)], lack of care taken by the shipboard superiors and/or the shipping company [OR 1.19 (CI 1.04-1.36)], with high responsibility for work organisation of those involved in leadership [OR 1.46 (CI 1.20-1.78)] and with social problems due to the long periods of separation from their families [OR 1.19 (CI 1.02-1.39)], taking into account relevant demographic parameters. CONCLUSIONS: Compared with the majority of on-shore occupations, the burnout risk in seafaring seems to be moderate. To reduce the EE among seafarers, it is recommended to extend the sleeping time, to avoid long working hours, to improve the superiors' communication and leadership skills, to diminish the superiors' stress load caused by organisational duties and to support low-price telecommunication possibilities at home.

Assessment of three conventional automated external defibrillators in seafaring telemedicine.

BACKGROUND: Germany was the first country worldwide to issue a directive regulating the provision of automated external defibrillators (AEDs) on board merchant ships. AIMS: To test the applicability and suitability for telemedicine in seafaring, including long-term electrocardiogram (ECG) monitoring, of three currently available AEDs. METHODS: Sixty nautical officers were asked to record and transmit a one-lead ECG with one of three AEDs under test. Subsequently, they evaluated the user-friendliness of the devices. RESULTS: The number of steps required for ECG transmission (as a pdf file) varied from three to six between the various AEDs. Correspondingly, differences were found in the subjects' understanding of the AED software. After theoretical instruction in the use of the AEDs, 55 officers (92%) succeeded in telemedical transmission of the pdf file without any help. At the time of our investigation, long-term ECG monitoring was possible with only one of the AEDs. CONCLUSIONS: The study results suggest that most trained lay rescuers can use conventional AEDs effectively for ECG transmission.

Role and responsibility of oncologists in assisted suicide. Practice and views among members of the German Society of Haematology and Medical Oncology.

BACKGROUND: Physician-assisted suicide (PAS) is a controversial practice and regulatory frameworks differ regarding assigned physicians' roles. This study explores clinical experience and views of German oncologists concerning ethically and legally relevant aspects of PAS after change of the law. MATERIALS AND METHODS: An online survey was conducted among members of the German Society of Haematology and Medical Oncology (DGHO) in March 2021. Descriptive analysis, bivariate and multivariable logistic regression of quantitative data on determinants related to (un)willingness to assist with suicide as well qualitative analysis of free-text comments were carried out. RESULTS: Seven hundred and forty-five of 3588 DGHO members responded (20.8%). Of these, 29.9% reported requests for a lethal drug and 3.0% (n = 22) reported to have assisted with suicide. Almost half of them (47.0%, n = 350) objected to providing PAS, whereas 45.9% indicated a willingness at least under certain conditions. Of those respondents who did not object to PAS, 25.4% would also consider assistance if those willing to die had a psychiatric disease and 10.2% if requestors had no disease at all. A majority viewed a role for physicians regarding different tasks associated with assisted suicide. Respondents with <10 years of professional experience, working in hospital with religious affiliation and with subspecialisation in palliative care were significantly less frequently willing to assist suicide. CONCLUSIONS: Respondents are divided in their personal attitudes towards PAS but a majority supports involvement of physicians regarding different tasks related to assisted suicide. Data about the practice and envisaged professional role may inform development of an acceptable ethico-legal framework for a controversial practice.

Characteristics of source-separated household wastewater flows: a statistical assessment.

Knowledge of concentrations or loads in wastewater flows is a basic prerequisite for the design of wastewater treatment units and the assessment of the environmental impacts. With respect to new sanitation concepts that are based on the source-separation of domestic wastewater flows not much general data is available yet on characteristics or design values of the different flows. A desk study of more than 130 references was carried out in order to arrive at design values for different source-separated wastewater flows including the fractions urine, faeces and greywater. The evaluation was carried out focussing on European data. The different values were analysed by the use of statistical parameters. In order to arrive at design values for different parameters, the median as well as minimum-maximum ranges of the available data were calculated. The collected data include volumes and characteristics like organic pollution (COD and BOD), nutrients (N, P, K & S) and heavy metals for the different source-separated flows. Loads and concentrations are listed respectively. A comparison is drawn between data from different regions in order to assess the impact of differences in nutrition and habits.

EU demonstration project for separate discharge and treatment of urine, faeces and greywater--part I: results.

The main aim of this EU demonstration project was to test two new sanitation concepts to determine if these concepts are more sustainable, compared with the conventional sanitation system, particularly with regard to nutrient recycling. Two different sanitation concepts were tested. One concept comprised the use of gravity separation toilets, the other used vacuum separation toilets. Results from a life-cycle-assessment investigation show that the new sanitation concepts are more sustainable. A cost analysis for an existing residential area did not prove lower costs for the new sanitation concepts in this special case. The experience from this demonstration project shows that prior to a widespread use of the new sanitation concepts, several improvements have to be made. One important issue is the improvement of separation toilets. Since nutrient recycling, water saving and reuse as well energy reduction become more and more important, further research should be undertaken in this field.

EU demonstration project for separate discharge and treatment of urine, faeces and greywater--part II: cost comparison of different sanitation systems.

The experience from the EU demonstration project was used for a cost analysis of different sanitation systems with regard to nutrient recycling. The analysis was made for an existing residential area, for which the different sanitation systems have been applied. The cost calculations were made for a lifetime of 50 years. The multiple sewer systems cause higher investment costs, mainly for the installation of the additional facilities; the investment costs for the treatment are lower. The cost analysis did not prove lower costs for the new sanitation concepts in this special case in comparison with the conventional system. Economic benefits are demonstrated for the operation costs. The result will be reinforced by the consideration of an increase of the energy costs. The revenues for the nutrient related products have only a very small impact on the result.

[Tumor-like bone lesions of the forearm after karate training]. / Tumorartige Knochenalterationen am Unterarm nach Karatetraining.

INTRODUCTION: Differentiation between malignant bone tumors and tumor-like lesions after repetitive microtrauma following sport activities can be difficult just using radiographic methods. METHODS: We present the case of a fifteen year old karate fighter, who was examined by imaging diagnostics because of a progressive swelling and pain in the distal right forearm. RESULTS: A tumor-like appearance with bone mass formation in the x-ray, an enhancement in the surrounding tissue shown in the MRI and an increased activity in the bone scintigraphy made the diagnosis of an osteosarcoma very likely. Blood tests were not helpful. Only the evaluation of a bone biopsy could demonstrate hypertrophic reparative bone formation after multiple osseous microtrauma. Cast immobilisation reduced the osseous alteration. With the start of the training the swelling reappeared again but then finally vanished after modifying the training technique. DISCUSSION: The case demonstrates that even modern imaging techniques cannot always distinguish between tumor and tumor-like lesions caused by sports. It also stresses the importance of a correct technique in sports like karate.

Structure of the bovine eye lens gamma s-crystallin gene (formerly beta s).

The organization of a number of crystallin genes has already been resolved. One of the remaining genes of which the structure was hitherto unknown is the gamma s gene (formerly beta s). We determined the complete sequence of the bovine gamma s-crystallin-coding gene, apart from the middle region of the first intron. Since it contains three exons and two introns, we conclude that the former beta s, also at the gene level is gamma-crystallin-like. However, it is located on chromosome 3, in contrast to other gamma genes which occur in tandem on the human chromosome 2.

New Cleavase Fragment Length Polymorphism method improves the mutation detection assay.

Cleavase Fragment Length Polymorphism (CFLP) analysis is a convenient, accurate and highly sensitive method for the detection and localization of nucleic acid mutations. The assay is well suited for high-throughput screening and can be used to detect mutations in known and unknown nucleic acid samples. A recent improvement in the CFLP assay termed "temperature ramping" or "ramping" is reported here. This procedural improvement eliminates the need for time and temperature optimizations before the actual sample analysis. In this study, we compare the CFLP ramping procedure to the conventional CFLP optimization procedure and demonstrate equal, and in some cases improved, detection of point mutations. With ramping, CFLP reactions are identical for all DNA fragments analyzed, which allows for increased sample throughput, decreased assay time and lower overall cost.

Comparison study for identifying promoter allelic polymorphism in interleukin 10 and tumor necrosis factor alpha genes.

Cytokines such as tumor necrosis factor (TNF)-alpha and Interleukin (IL)-10 play significant roles in autoimmunity and transplantation tolerance. Allelic polymorphisms that occur in the regulatory regions of these cytokine genes are closely associated with acute and chronic transplant rejection. The presence of a G-to-A polymorphism at position -308 in the promoter region of the TNF-alpha gene can increase transcription six- to sevenfold. Likewise, the G-A polymorphism at position -1082 of the IL-10 promoter results in lower levels of IL-10 protein. Accordingly, a genotype that dictates the production of high levels of TNF-alpha with low IL-10 capabilities is most likely to generate an inflammatory environment that is less receptive to the transplant. The potential for determining a patient's haplotype before transplantation may be an effective way of monitoring the post-transplant status of such patients. A variety of methodologies that address the detection of mutations have been used both in research and clinical diagnostic tests. This study analyzes the genetic variations in cytokines using two methodologies: the traditional allele-specific oligonucleotide (ASO) polymerase chain reaction (PCR) and the newer and more flexible Invader technology. The sensitivity and specificity of the Invader assay for simultaneous investigation of multiple targets makes it a useful tool in such analyses.

The neural cell adhesion molecule NCAM in multiple myeloma.

The Neural Cell Adhesion Molecule NCAM is a membrane glycoprotein and belongs to the immunoglobulin superfamily. It is expressed on neural cells as well as on various neuroendocrine tumors and can be detected in sera of patients with small cell lung cancer. Its role is attributed to tumor invasion and formation of metastases. Malignant plasma cells and a subset of plasma cells from patients with monoclonal gammopathy exhibit surface expression of NCAM whereas normal plasma cells do not express NCAM. Expression as measured by flow cytometry using anti-CD56 antibodies does not seem to correlate with clinical course, however leukemic myelomas and myeloma cell lines tend to loose NCAM surface expression. An isoform of NCAM which is rich in polysialic acids and characteristic for embryonal NCAM (eNCAM) has been shown to be elevated in sera of patients with multiple myeloma using a chemiluminescence immunoassay. Patients with progressive myeloma tend to have high serum NCAM levels above the normal range of 20 U/ml. Analysis of 125 myeloma patients suggest that serum NCAM is a valuable parameter for tumor progression rather than tumor mass. Increase in serum NCAM may be associated with loss of adhesive function.

Innovative technologies for decentralised water-, wastewater and biowaste management in urban and peri-urban areas.

Avoiding the comingling of water flows coming from different sources and thus obtaining flows with a very low dilution factor is the first and major step key to technical solutions for adequate treatment of household wastewaters. Through their decentral structure and effective recovery of water, energy and fertiliser these systems can be highly cost efficient. Fresh water consumption can be reduced by up to 80% while nutrients can be recovered to a large extent. Source control is also advantageous for hygienic reasons: low volumes are far easier to sanitise. Source separation technology in municipal waste water treatment does often lead decentralised or semicentral systems. The first essential step is the separate collection and treatment of toilet waste in households, which contains almost all pathogens and nutrients. New toilet systems with very low dilution factors, ranging from vacuum- through urine sorting to dry toilets, have been introduced in several projects and proven feasible. New ideas such as the black- and greywater cycle systems are presently under research at the Technical University Hamburg Harburg. Such modular, integrated and small scale systems are only possible through recent advances in membrane technology and, due to their small scale, do have the potential to be installed in densely populated regions. These technologies are options for following the principles of ecological sanitation, to contain, to sanitise and to reuse also in urban areas (EcoSanRes, 2003).

Computer-based patient information. Legal basis, concept and 10 years' experience.

Culpable deficits of the preoperative information cause a complete illegality of the whole medical intervention and lead to liability for any resulting damage. In cases of controversy it's the physician's due to prove the correct preoperative information. To reduce these liability-risks a computer based information system has been developed. With its help an working sheet is provided which is individually adjusted for the patient. Based upon this record the real preoperative information takes place. After the patient signed the record the physician keeps it at his disposal for proving the contents of the preoperative information. The conception's use over many years shows that overlooking essential aspects and misunderstanding can grossly be excluded for the patient and a high quality of information can be reached.