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.

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.