Methane emissions from MBT landfills.

Within the scope of an investigation for the German Federal Environment Agency ("Umweltbundesamt"), the basics for the estimation of the methane emissions from the landfilling of mechanically and biologically treated waste (MBT) were developed. For this purpose, topical research including monitoring results regarding the gas balance at MBT landfills was evaluated. For waste treated to the required German standards, a methane formation potential of approximately 18-24 m(3)CH(4)/t of total dry solids may be expected. Monitoring results from MBT landfills show that a three-phase model with differentiated half-lives describes the degradation kinetics in the best way. This is due to the fact that during the first years of disposal, the anaerobic degradation processes still proceed relatively intensively. In addition in the long term (decades), a residual gas production at a low level is still to be expected. Most of the soils used in recultivation layer systems at German landfills show a relatively high methane oxidation capacity up to 5 l CH(4)/(m(2)h). However, measurements at MBT disposal sites indicate that the majority of the landfill gas (in particular at non-covered areas), leaves the landfill body via preferred gas emission zones (hot spots) without significant methane oxidation. Therefore, rather low methane oxidation factors are recommended for open and temporarily covered MBT landfills. Higher methane oxidation rates can be achieved when the soil/recultivation layer is adequately designed and operated. Based on the elaborated default values, the First Order Decay (FOD) model of the IPCC Guidelines for National Greenhouse Gas Inventories, 2006, was used to estimate the methane emissions from MBT landfills. Due to the calculation made by the authors emissions in the range of 60,000-135,000 t CO(2-eq.)/a for all German MBT landfills can be expected. This wide range shows the uncertainties when the here used procedure and the limited available data are applied. It is therefore necessary to generate more data in the future in order to calculate more precise methane emission rates from MBT landfills. This is important for the overall calculation of the climate gas production in Germany which is required once a year by the German Government.

[On the prognosis of hip fractures. Assessment of mortality after hip fractures by analyzing overlapping segments of longitudinal data]. / Zur Prognose der Schenkelhalsfraktur. Beurteilung der Mortalität nach Schenkelhalsfraktur durch sektorübergreifende Datenzusammenführung.

BACKGROUND: Data on the treatment of hip fractures in acute care settings have been collected in a report card system for quality assurance in Germany since the beginning of the 1990s. However, there are no data on the long-term outcome and long-term quality of care. MATERIAL AND METHOD: In a retrospective study, data on 1393 patients from 1999 were collected from different sources: from the department of quality assurance at the medical association of Westfalia-Lippe, the Statutory Health Insurance Funds (AOK), and the Medical Review Board of the Statutory Health Insurance Funds (Medizinischer Dienst der Krankenkasse, MDK). Statistical analyses were performed by the Center for Clinical Studies of the University of Düsseldorf. RESULTS: Uni- and multivariate analyses reveal the following prognostic parameters for survival after hip fracture: sex, age, nursing care dependency, living in a nursing home, risk stratification according to ASA, and postoperative complications. Timing of the operation had no affect on survival. CONCLUSIONS: Prognostic factors for the outcome after hip fracture can only be obtained by analyzing data from the hospital stay and the post-hospital setting as well. Chances of survival can be significantly improved by rehabilitative care.

Pollutant release and pollutant reduction--impact of the aeration of landfills.

The in situ stabilization of old deposits aims for a lasting and controlled reduction of pollutant emissions from the deposited waste in order to diminish expenditure and the duration of landfill aftercare measures. The stabilization operation so far, observed over a period of 1-2 years at three landfills in Germany, shows that leachate contamination is permanently reduced, biodegradation processes are significantly accelerated and main settlements take place within a short period of time.

Genetic distinction of wildcat (Felis silvestris) populations in Europe, and hybridization with domestic cats in Hungary.

The genetic integrity and evolutionary persistence of declining wildcat populations are threatened by crossbreeding with widespread free-living domestic cats. Here we use allelic variation at 12 microsatellite loci to describe genetic variation in 336 cats sampled from nine European countries. Cats were identified as European wildcats (Felis silvestris silvestris), Sardinian wildcats (F. s. libyca) and domestic cats (F. s. catus), according to phenotypic traits, geographical locations and independently of any genetic information. Genetic variability was significantly partitioned among taxonomic groups (FST = 0.11; RST = 0.41; P < 0.001) and sampling locations (FST = 0.07; RST = 0.06; P < 0.001), suggesting that wild and domestic cats are subdivided into distinct gene pools in Europe. Multivariate and Bayesian clustering of individual genotypes also showed evidence of distinct cat groups, congruent with current taxonomy, and suggesting geographical population structuring. Admixture analyses identified cryptic hybrids among wildcats in Portugal, Italy and Bulgaria, and evidenced instances of extensive hybridization between wild and domestic cats sampled in Hungary. Cats in Hungary include a composite assemblage of variable phenotypes and genotypes, which, as previously documented in Scotland, might originate from long lasting hybridization and introgression. A number of historical, demographic and ecological conditions can lead to extensive crossbreeding between wild and domestic cats, thus threatening the genetic integrity of wildcat populations in Europe.

[Does hospital structure influence the outcome of operative treatment of femoral neck fractures?]. / Bestimmt die Klinikstruktur die Qualität der chirurgischen Behandlung der Schenkelhalsfraktur? - Ergebnisse der externen Qualitätssicherung im Arztekammerbereich Westfalen-Lippe.

UNLABELLED: Data on 32 007 patients suffering from a medial fracture of the femoral neck have been collected between 1993 and 1999 in a database for external quality assurance organized by the chamber of physicians in Westfalia-Lippe. A statistical analysis (ANOVA, chi-square-test) has been performed to find out whether factors like specialization, annual volume or level of the hospital (primary, secondary or tertiary hospital) influence the outcome. RESULTS: Patients with higher preoperative risk-factors are treated more often in primary hospitals. These clinics perform conservative treatment significantly more often than tertiary hospitals (6.5 % vs. 3.8 %). Osteosyntheses are performed more often in departments specialized in traumatology (13 %) or tertiary hospitals (16.8 %). Preoperative length of stay was 0.5-0.7 days shorter in these hospitals. There is no significant difference in postoperative complications all together (23.2-25.6 %), but a significantly lower rate in postoperative complications after osteosynthesis performed by departments specialized in traumatology (11.3 % vs. 18.8 %). A volume load of more than 50 cases per year correlates with a significant decline in postoperative complications (22.5 % vs. 28.2 %). Risk adjusted mortality does not show significant differences among the different levels of hospitals. CONCLUSIONS: There are distinct differences regarding the way of treatment and procedural quality, but not concerning the short-term outcome between hospitals of different levels.

[Does quantity mean quality? An analysis of 116,000 patients regarding the connection between the number of cases and the quality of results]. / Ist viel gleich gut?--Eine Analyse von 116.000 Patienten zum Zusammenhang zwischen Fallzahl und Ergebnisqualität.

METHODS: Between 1993 and 1998 data of 27,000 patients with hip fractures and 89,000 patients undergoing cholecystectomy were collected by the department of external quality assurance at the chamber of physicians of Westphalia-Lippe. The data were analyzed for the relationship between volume and outcome, specified as mortality and morbidity. Logistic regression was used to adjust the results for demographic and clinical risk factors. RESULTS: The risk-adjusted probability of death from cholecystectomy was 89% higher in the group of small volume clinics (less than 30 procedures per year) than in the group of large volume clinics (more than 120 procedures per year) (odds ratio 1.89; 95% CI 1.19-3.00). Mortality from hip fractures was 33% higher (odds ratio 1.33, 95% CI 1.09-1.63) for the group of small volume clinics (less than 15 procedures per year) than the group of large volume clinics (more than 45 procedures per year). Among the group of small volume hospitals were some with excellent results, but they are more likely to be found in the group of large volume hospitals. On the other hand there were some departments with poorer results in the group of large hospitals. CONCLUSIONS: There is no threshold for good results. In general there is an inverse relationship between volume and outcome. High volume, though, is not a substitute for good results. It is not possible to infer good quality from high volume alone. Small-volume departments should document quality of care and results thoroughly.

[Risk adjustment in external quality assurance with multivariate analysis]. / Risikoadjustierung in der externen Qualitätssicherung mit multivariaten Analyseverfahren.

Surgical clinics throughout Germany are under political and economical pressure. Comparing outcomes across clinics or ranking become more and more popular although there are no generally accepted and scientifically valid methods how to compare. Using original data of the external quality assurance project of the chamber of physicians of Westfalia-Lippia it is shown in this article that comparing raw data is often misleading. Differences in risk factors (case mix) have to be taken into consideration. A model using logistic regression methods to adjust for case mix in legality and morbidity of hip fractures is proposed. A ranking list before and after adjusting for risk factors shows partly dramatic changes. One clinic for example changed from position 97 (out of one hundred) to position 26.

[Value of current quality assurance for surgery]. / Wert der heutigen Qualitätssicherung für die Chirurgie.

In a quality assurance project in Westfalia-Lippia more than 200,000 data of surgical patients with one of the following tracer diagnoses have been analyzed: inguinal hernia, hip fracture and cholecystectomy. Results of the analysis and improvements in outcome are presented. Further developments in the field of quality assurance are being discussed.

[General practice-relevant conclusions based on 74,400 documented biliary surgery interventions]. / Praxisrelevante Schlussfolgerungen anhand von 74,400 erfassten gallenchirurgischen Eingriffen.

A statewide report card system for cholecystectomy as a surgical tracer has been established in Westfalia-Lippe as part of a program of external quality assurance. 74,400 data between 1993 and 1997 were analyzed. Pathologic findings in preoperative diagnostics (sonography, elevated bilirubin) do not lead to therapeutic splitting in a sufficient number of cases. Removal of bile duct stones should happen at the latest during cholecytectomy. Preoperative gastroscopy is performed in just about 40%. Higher rates of morbidity and lethality in the aged favour an early elective operation of symptomatic stones.

[General practice continuing education--initial experiences with problem-based learning in a continuing education program]. / Kursweiterbildung Allgemeinmedizin--erste Erfahrungen mit dem problemorientierten Lernen in einem Weiterbildungsgang.

In May 1994, the regional chamber of physicians of Westfalia/Lippe, Germany, introduced their qualifying course in family medicine with a new didactic approach: It changed from a more traditional lecture-based style to the emphasis of problem-based learning. The decision to do this was mainly driven by two reasons: firstly, the common experience of a declining attendance during regular whole day lectures and, secondly, the goal to implement regional quality-seminars following the course. In addition, the federal chamber of physicians published a guidebook with recommendations favoring a more problem-based approach to family medicine in order to implement changes. Although there is still much hesitance in Germany towards the implementation of problem-based learning, we think that this approach cannot only facilitate factual learning but also stimulates other important goals of medical education. Because of time restrictions, it was not possible to assess the outcome. However, participants valued their experience relatively high in a process-evaluation conducted during and after the course.

[Does quality assurance modify clinical research, medical progress and medical graduate education in surgery?]. / Beeinflusst Qualitätssicherung die klinische Forschung, den medizinischen Fortschritt und die ärztliche Fortbildung in der Chirurgie?

For years, external safeguard of quality has been continuously practised in the field of surgery by several local medical societies. Beside its original task of comparing and reviewing given standards of all surgical departments, other clinically or scientifically relevant questions can be answered on the basis of the enormous numerical data, too. The patient data, available to the chamber of physicians of Westphalia-Lippe, German, are showing that the experiences of clinical research rapidly and almost ubiquitously find their expression in the daily routine work of surgeons. Examples like the introduction of routine thrombosis prophylactics of changes in the surgical techniques for inguinal rupture and gallstone show how progress in medicine by postgraduate medical education is realized in the daily clinical workday routine.

Automated zone-electrophoretic sample treatment for the analysis of biological samples by high-performance liquid chromatography.

The automation of zone-electrophoretic sample treatment for liquid chromatography is described. The procedure is completely controlled from a liquid chromatograph. The carry-over of proteins from human serum under different experimental conditions was studied. The influence of the presence of proteins in the sample is illustrated with the anionic compound salicylic acid and the increase in selectivity for cationic compounds is demonstrated with the determination of ephedrine, norephedrine and amphetamine in urine.

[Organization of systematic after-care of cancer patients in a general hospital]. / Organisation einer systematischen Nachsorge für Karzinom-Patienten an einem Allgemeinkrankenhaus.

For better care and control of our cancer-patients we have built up an organization for systematic follow-up. Two years' experiences are reported. After some difficulties in the beginning we now are able to follow-up and record the further course of the disease in all cancer-patients. Systematic oncologic follow-up contributes to greater living quality of the patients and leads the physician always to compare the treatment with that of other clinics and hospitals; it also enhances interdisciplinary exchange and -last not least-scientific evaluation of the therapeutic results.

[Appendicitis in the aged (author's transl)]. / Altersappendizitis.

In cases of partially uncharacteristic clinical symptoms with no typical leukocytosis and no ESR elevation, laparotomy reveals not seldom an acute phlegmonous appendix. As compared with the similar disease in younger people appendicitis of the aged presents more complications and a higher mortality rate which can partially explained by clinically meaningful secondary findings and a lesser degree of peritoneal inflammation. The mortality rate of appendicitis in the aged could be markedly reduced. This may be attributed to emergency operation of clinically diagnosed appendicitis in the aged, to improve anaesthetic technique, to infusion therapy and parenteral feeding and last not least postoperative administering of antibiotics.

[Pregnancies without complications of patients with jejuno-ileal bypass because of extreme obesity (author's transl)]. / Komplikationslos verlaufende Schwangerschaften bei bestehendem jejunoilealem Bypass wegen extremer Fettsucht.

Report about 3 pregnancies without complications of patients, who had been treated by jejuno-ileal bypass because of extreme obesity. There is no increased risk for the successful finishing of a pregnancy of these patients. A close cooperation between the treating doctors is necessary to cope with possible problems.

[Stenosis of the celiac artery as cause of chronic recurrent pancreatitis (author's transl)]. / Stenose des Truncus coeliacus als Ursache einer chronisch rezidivierenden Pankreatitis.

Report on three clinical examples of the interrelation between chronic recurrent pancreatitits and external compression which cause a stenosis of the celiac artery. If clarification of the etiology of recurrent pancreatitis with the usual examinations is impossible, angiography is very important. A causal therapy is only possible by means of surgical treatment of the stenosis.

[Sacrococcygeal chordoma. Radical operation, a problem]. / Das sacrococcygeale Chordom Die Radikaloperation ein Problem

A sacrococcygeal chordoma was observed over a 7-year follow-up period. Primarily there were only local recurrences. The long-term results of the treatment of sacrococcygeal chordoma are bad. The indication of hemipelvectomy or hemicorporectomy as surgical treatment is therefore discussed.