Dynamics of device-based treatments for Parkinson's disease in Germany from 2010 to 2017: application of continuous subcutaneous apomorphine, levodopa-carbidopa intestinal gel, and deep brain stimulation.

Parkinson's disease (PD) is a very common extrapyramidal movement disorder and currently the world's fastest growing neurological disorder. In the course of disease progression, a majority of PD patients develop severe motor fluctuations which often cannot be adequately treated with common oral anti-Parkinsonian medications. With continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel infusion (LCIG), and deep brain stimulation (DBS), there exist three effective treatment options for advanced PD patients with motor fluctuations. In this study, we analyze the dynamics of implementation for these treatments in Germany over the years 2010-2017 based on the diagnosis-related group statistics and structured quality reports. All three intensified therapy measures are increasingly applied in Germany. The mean age of therapy implementation is rising and more male than female patients receive treatments. Although DBS is provided primarily in university hospitals with a caseload of at least two procedures per month, there exists a substantial proportion of DBS procedures which is conducted in hospitals with only a low caseload. Most of the drug pump implementations (CSAI and LCIG) are conducted in a large number of hospitals with an overall low case number. As we detect a strong rise of the implementation of these device-based therapies, it will be a challenging task to satisfy patient need and perpetuate high standards for these specialized procedures in the future.

Urban cemeteries: The forgotten but powerful cooling islands.

Urban parks play a key role in UHI mitigation. However, the role of other prominent types of urban green infrastructure has not been comprehensively studied. Thus, the main objective of this study was to evaluate the role of cemeteries and allotments as cooling islands compared to the well-studied park areas. We assessed the LST of cemeteries, allotments and parks based on Landsat 8 TM images across the five largest German cities during summertime. Random forest regressions explain the LST spatial variability of the different urban green spaces (UGS) with spectral indices (NDVI, NDMI, NDBaI) as well as with tree characteristics (tree type, tree age, trunk circumferences, trunk height or canopy density). As a result, allotments were identified as the hottest UGS with the city means varying between 23.1 and 26.9 °C, since they contain a relatively high proportion of sealed surfaces. The LST spatial variability of allotment gardens was best explained by the NDVI indicating that fields with a higher percentage of flowering shrubs and trees reveal lower LST values than those covered by annual crops. Interestingly, cemeteries were characterized as the coolest UGS, with city means between 20.4 and 24.7 °C. Despite their high proportion of sealed surfaces, they are dominated by old trees resulting in intensive transpiration processes. Parks show heterogeneous LST patterns which could not be systematically explained by spectral indices due to the variability of park functionality and shape. Compared to parks, the tree-covered areas of cemeteries have a higher cooling potential since cemeteries as cultural heritage sites are well-protected allowing old tree growth with intensive transpiration. These findings underline the relevance of cemeteries as cooling islands and deepen the understanding of the role of tree characteristics in the cooling process.

Soil texture mediates the surface cooling effect of urban and peri-urban green spaces during a drought period in the city area of Hamburg (Germany).

Urban green spaces (UGS) and peri-urban green spaces (P-UGS) play a crucial role in reducing the land surface temperature within the urban environment, especially during heat waves. Although their cooling effect generally is due to shading and evaporation, the role of soil texture and soil water availability on surface cooling remains largely unexplored. This study investigated the impact of soil texture on the spatio-temporal patterns of LST in different UGSs and P-UGSs in Hamburg (Germany) during a hot summer drought period. The LST and the Normalized Differentiated Moisture and Vegetation Indices (NDMI, NDVI) were calculated based on two Landsat 8 OLI/TIRS images from July 2013. Non-spatial and spatial statistical approaches such as stepwise backward regression or Hotspot (Getis-Ord Gi*) analyses were applied explaining LST distributions in relation to soil texture within each UGS and P-UGS. All GSs were clearly characterized as surface cooling islands whereas, for each GS, an individual thermal footprint was observed. Within all GSs, the LST patterns showed a significant negative relationship to NDMI values, whereas the NDVI values and the elevation were of minor importance. Soil texture was found to influence the LST distribution significantly in most UGSs and P-UGSs, where sites on clay-rich soils showed the highest LST values compared to sites on sand- or silt-rich soils. For example, in parks, clayey soils showed a mean LST of 25.3 °C whereas sand-dominated sites had a mean LST of only 23.1 °C. This effect was consistent throughout all statistical approaches, for both dates and across most GSs. This unexpected result was explained by the very low unsaturated hydraulic conductivity in clayey soils which limits plant water uptake and transpiration rates responsible for the evaporative cooling effect. We concluded that soil texture has to be considered for understanding and managing the surface cooling capacity of UGSs and P-UGSs.

Waste effects on the behavior of 17beta-estradiol, estrone, and 17alpha-ethinylestradiol in agricultural soils in long- and short-term setups.

Natural and synthetic estrogens can reach agricultural soils with manures, biosolids, or wastewater. This study evaluates (i) the effects of long-term field application of such organic soil amendments and (ii) the short-term effects of 14 different organic amendments in one agricultural soil on mineralization and sorption of (14)C-labeled 17beta-estradiol, estrone, and 17alpha-ethinylestradiol. Long-term organic waste applications resulted in increasing soil organic carbon (SOC) contents, causing increased estrogen sorption. The mineralization of the estrogens was enhanced by up to 147% or depressed by up to 50%, depending on site and organic waste, but not related to changes in sorption parameters. Short-term organic waste amendments directly increased estradiol mineralization to up to 70% in the treated soil compared with 5% in the untreated control. Estradiol sorption increased with the amount of incorporated organic waste, but the log K(oc) values of 3.1-3.2 L kg(-1) for organic wastes showed a lower sorption potential for estrogens compared with 3.5 L kg(-1) in the untreated soil. The effects of organic waste amendments on estrogen behavior depend on amendment type and aging. Short-term organic waste applications to soil resulted in enhanced microbial estrogen mineralization likely due to cometabolic processes. In soils with a long history of organic waste amendments, the controlling factor for estrogen sorption is an increased SOC content. The observed positive or negative effects on estrogen mineralization in these soils are not well understood. Surprisingly, the increase in estrogen sorption to the soil solid phase either through short-term or long-term organic waste application does not control estrogen mineralization.

Effects of soil organic carbon (SOC) content and accessibility in subsoils on the sorption processes of the model pollutants nonylphenol (4-n-NP) and perfluorooctanoic acid (PFOA).

Subsoils control the release of hydrophobic pollutants to groundwater systems, but the role of subsoil soil organic carbon (SOC) in sorption processes of hydrophobic organic pollutants remains unclear. Thus, this study aimed to understand the role of subsoil SOC in sorption processes of 4-n-nonylphenol (NP) and perfluorooctanoic acid (PFOA) as model pollutants. To characterize the sorption behavior of NP and PFOA, 42 sub- and 54 topsoil samples were used for batch experiments. Differences in NP and PFOA sorption between sub- and topsoil samples and its mechanisms were identified using multiple regression analysis. Generally, the sorption of NP and PFOA was linear in all samples. The sorption of NP to soil samples (logKD = 1.78-3.68) was significantly higher and less variable than that of PFOA (logKD = -0.97-1.44). In topsoils, SOC content had the highest influence on NP and PFOA sorption. For NP, hydrophobic interactions between NP and SOC were identified as the most important sorption mechanism. For PFOA, hydrophobic as well as electrostatic interactions were determined depending on soil pH. In subsoils, the relevance of SOC content for pollutant sorption decreased drastically. For NP, not SOC content but rather SOC quality was relevant in SOC poor subsoils. For PFOA, clay and iron oxide content were found to be relevant for pollutant interactions with the solid phase. Thus, especially in SOC depleted subsoils, the sorption potential for PFOA remained unpredictable.

Long-term sewage sludge application and wastewater irrigation on the mineralization and sorption of 17beta-estradiol and testosterone in soils.

The disposal of animal manures, wastewater and sewage sludge to agricultural land can lead to the transfer of steroid hormones like 17beta-estradiol and testosterone into soils, surface and groundwaters. The objective of this study was to investigate the effects of different site histories like wastewater irrigation and sewage sludge application on hormone mineralization and sorption in soils. Two agricultural sites with different long-term treatment histories with wastewater and sewage sludge were sampled. The mineralization of (14)C-17beta-estradiol and (14)C-testosterone was studied during incubations at 20 degrees C over three weeks. Despite the structural resemblance of both hormones the mineralization rate of 17beta-estradiol was about an order of magnitude lower than that of testosterone in all four soils, reaching 5-7% vs. 50-59%, respectively. Estradiol mineralization was significantly lower in soils with long-term wastewater irrigation than in the corresponding soil with freshwater irrigation. Pre-incubation of the soils with unlabeled hormones or application of the hormones within a wastewater matrix had only minor effects on their mineralization. The results indicate that estradiol mineralization occurs co-metabolically and is limited by sorption, whereas testosterone appears to be utilized directly by soil microorganisms. Sorption of (14)C-17beta-estradiol and (14)C-testosterone to sterile and unsterile soils was determined in batch experiments with CaCl(2) or wastewater solution with hormone concentrations of 0.13-0.0013 mug mg(-1). FREUNDLICH sorption isotherms and parameters like K(F) and log K(oc) values were used to describe the results. The K(F) values for estradiol sorption were generally about 1.2 to 1.6-fold higher than for testosterone. The SOC-normalized partition coefficients K(oc) also differ accordingly and indicate quite large differences in soil organic matter qualities relating to hormone sorption between the soils and treatments. When the hormones were added to the soil within a wastewater matrix less estradiol was sorbed in the solid phase than in the controls with pure water, thus indicating that wastewater contains soluble sorbents.

Dissolved organic carbon from sewage sludge and manure can affect estrogen sorption and mineralization in soils.

In this study, effects of sewage sludge and manure borne dissolved organic carbon (DOC) on 17beta-estradiol (E2) and 17alpha-ethinylestradiol (EE2) sorption and mineralization processes were investigated in three agricultural soils. Batch equilibrium techniques and equilibrium dialysis methods were used to determine sorption mechanisms between DOC, estrogens and the soil solid phase. It was found that that the presence of organic waste borne DOC decreased estrogen sorption in soils which seems to be controlled by DOC/estrogen complexes in solution and by exchange processes between organic waste derived and soil borne DOC. Incubation studies performed with (14)C-estrogens showed that DOC addition decreased estrogen mineralization, probably due to reduced bioavailability of estrogens associated with DOC. This increased persistence combined with higher mobility could increase the risk of estrogen transport to ground and surface waters.

Factors controlling the biodegradation of 17beta-estradiol, estrone and 17alpha-ethinylestradiol in different natural soils.

We conducted a series of laboratory microcosm incubations with [(14)C]-labeled 17beta-estradiol (E2), estrone (E1) and 17alpha-ethinylestradiol (EE2) in 17 different natural soils to characterize hormone mineralization. A significantly higher mineralization was observed for E1 (2.0-37.6%) and E2 (4.2-50.2%) than for EE2 (0.5-2.6%) in all test soils after 21 days. Soil physical or chemical parameters were not related to estrogen mineralization. Although sorption parameters varied greatly for E2 (K(F)=21.9-317.5 mL g(-1)), for E1 (K(F)=46.0-517.5 mL g(-1)) and for EE2 (K(F)=29.9-326.1 mL g(-1)) this apparently did not control estrogen bioavailability since it showed no effects on hormone mineralization. In order to elucidate the controlling factors, experiments with combined additions of radiolabeled estrogens and different substrates were conducted. Additions of ammonium nitrate or alanine to soil samples generally increased EE2 mineralization, thus indicating N-limitation. Additions of glucose induced higher E2 and EE2 degradation in comparison to control samples which is attributed to co-metabolism. Additions of saw dust, catechol or streptomycin influenced the microbial population in the test soils and affected the mineralization of E2 and EE2. Thus, we clearly demonstrate that different microbial communities are responsible for E2 and EE2 degradation in soils. We suggest that EE2 is mineralized by white-rot fungi and E2 by bacteria.