Temporal and Spatial Synchronicity in West Nile Virus Cases Along the Central Flyway, USA.

This study of West Nile virus (WNV) examined the possibility of avian transmission to explain synchronicity in the year-to-year variability of WNV case numbers from Texas northward to the Dakotas, and reasons for the large case numbers on the northern Great Plains. We determined correlation coefficients between annual disease incidence per 100,000 people among states within the Great Plains Region, as well as the Central Flyway. There was spatial and temporal synchronicity, as evidenced by Pearson "r," with values along the core of the Central Flyway (Oklahoma, Kansas, Nebraska, and South Dakota) varying between 0.69 and 0.79. Correlations for North Dakota (r = 0.6), however, were affected by local conditions. The concept of relative amplification is helpful in explaining why northerly states along the Central Flyway have larger annual case numbers per 100,000 than Texas but preserve the temporal signal. States differed in their capacity for amplifying the temporal signal in case numbers. For example, Nebraska, South Dakota, and North Dakota case numbers were commonly amplified relative to Texas, with Oklahoma and Kansas deamplified. Relative amplification factors for all states increased as a function of increasing case numbers in Texas. Thus, increased numbers of initially infected birds in Texas likely led to the rapid intensification of the zoonotic cycle as compared to more typical years. The study also confirmed the importance of winter weather in locally modulating disease cases. North Dakota appeared most impacted by these factors to the extent of reducing WNV case numbers in colder years and years with deep snow.

Utility of Photon-Counting Detector CT Myelography for the Detection of CSF-Venous Fistulas.

CSF-venous fistulas are an increasingly recognized type of CSF leak that can be particularly challenging to detect, even with recently improved imaging techniques. Currently, most institutions use decubitus digital subtraction myelography or dynamic CT myelography to localize CSF-venous fistulas. Photon-counting detector CT is a relatively recent advancement that has many theoretical benefits, including excellent spatial resolution, high temporal resolution, and spectral imaging capabilities. We describe 6 cases of CSF-venous fistulas detected on decubitus photon-counting detector CT myelography. In 5 of these cases, the CSF-venous fistula was previously occult on decubitus digital subtraction myelography or decubitus dynamic CT myelography using an energy-integrating detector system. All 6 cases exemplify the potential benefits of photon-counting detector CT myelography in identifying CSF-venous fistulas. We suggest that further implementation of this imaging technique will likely be valuable to improve the detection of fistulas that might otherwise be missed with currently used techniques.

Suicidal thoughts and attempts in First Nations communities: links to parental Indian residential school attendance across development.

The Indian residential school (IRS) system in Canada ran for over a century until the last school closed in 1996. Conditions in the IRSs resulted in generations of Indigenous children being exposed to chronic childhood adversity. The current investigation used data from the 2008-2010 First Nations Regional Health Survey to explore whether parental IRS attendance was associated with suicidal thoughts and attempts in childhood, adolescence and in adulthood among a representative sample of First Nations peoples living on-reserve across Canada. Analyses of the adult sample in Study 1 (unweighted n=7716; weighted n=186,830) revealed that having a parent who attended IRS was linked with increased risk for suicidal thoughts and attempts in adolescence and adulthood. Although females were negatively affected by having a parent who attended IRS, the link with suicidal ideation in adulthood was greater for males. Analyses of the youth sample in Study 2 (unweighted n=2883; weighted n=30,190) confirmed that parental IRS attendance was associated with an increased risk for suicidal ideation and attempts. In contrast to the adult sample, parental IRS attendance had a significantly greater relation with suicidal ideation among female youth. A significant interaction also emerged between parental IRS attendance and age in the youth sample, with the influence of parental attendance being particularly strong among youth ages 12-14, compared with those 15-17 years. These results underscore the need for culturally relevant early interventions for the large proportions of Indigenous children and youth intergenerationally affected by IRSs and other collective traumas.

Mitigating Undesignated Trail Use: The Efficacy of Messaging and Direct Site Management Actions in an Urban-Proximate Open Space Context.

The use and creation of undesignated recreational trails can lead to erosion, vegetation damage, unsafe trail conditions, and impacts to local wildlife. The mitigation of undesignated trail use is typically addressed indirectly through minimum-impact visitor education programs such as Leave No Trace, or directly through closures or sanctions. In this study, researchers collaborated with City of Boulder, Colorado Open Space and Mountain Parks (OSMP) staff to develop a quasi-experimental field study that examined the effectiveness of indirect (messaging) and direct (barriers) management approaches to mitigating undesignated trail use. The study applied a Theory of Planned Behavior framework, utilized Leave No Trace messaging, and employed a method to pair survey and direct observation data. A total of 2232 visitor parties were observed, and 147 surveys were collected. The combined direct (barrier) and indirect (messaging) intervention was the most effective at mitigating undesignated trail use. Implications for management and future research are discussed.

Leaching potential of pervious concrete and immobilization of Cu, Pb and Zn using pervious concrete.

This paper investigates the leaching potential of pervious concrete and its capacity for immobilizing Cu, Pb and Zn, which are common contaminants in urban runoff. Batch experiments showed that the leachability of Cu, Pb and Zn increased when pH<8. According to PHREEQC equilibrium modeling, the leaching of major ions and trace metals was mainly controlled by the dissolution/precipitation and surface complexation reactions, respectively. A 1-D reactive transport experiment was undertaken to better understand how pervious concrete might function to attenuate contaminant migration. A porous concrete block was sprayed with low pH water (pH=4.3±0.1) for 190 h. The effluent was highly alkaline (pH~10 to 12). In the first 50 h, specific conductance and trace-metal were high but declined towards steady state values. PHREEQC modeling showed that mixing of interstitial alkaline matrix waters with capillary pore water was required in order to produce the observed water chemistry. The interstitial pore solutions seem responsible for the high pH values and relatively high concentrations of trace metals and major cations in the early stages of the experiment. Finally, pervious concrete was sprayed with a synthetic contaminated urban runoff (10 ppb Cu, Pb and Zn) with a pH of 4.3±0.1 for 135 h. It was found that Pb immobilization was greater than either Cu or Zn. Zn is the most mobile among three and also has the highest variation in the observed degree of immobilization.

Risk of femoral shaft and subtrochanteric fractures among users of bisphosphonates and raloxifene.

UNLABELLED: Prior studies have suggested an association between bisphosphonate use and subtrochanteric fractures. This cohort study showed an increased risk of subtrochanteric and femoral shaft fractures both before and after the start of drugs against osteoporosis including bisphosphonates. This may suggest an effect of the underlying disease rather than the drugs used. INTRODUCTION: The objective of this study is to determine the association between drugs against osteoporosis and the risk of femoral shaft and subtrochanteric fractures. No separation was made between atypical and typical fractures. METHODS: Nationwide cohort study from Denmark with all users of bisphosphonates and other drugs against osteoporosis between 1996 and 2006 (n = 103,562) as exposed group and three age- and gender-matched controls from the general population (n = 310,683). Adjustments were made for prior fracture, use of systemic hormone therapy, and use of systemic corticosteroids. RESULTS: After initiation of therapy, an increased risk of subtrochanteric fractures was seen for alendronate (hazard ratio (HR) = 2.41, 95% confidence interval (CI) 1.78-3.27), etidronate (HR = 1.96, 95% CI 1.62-2.36), and clodronate (HR = 20.0, 95% CI 1.94-205), but not for raloxifene (HR = 1.06, 95% CI 0.34-3.32). However, an increased risk of subtrochanteric fractures was also present before the start of alendronate (OR = 2.36, 95% CI 2.05-2.72), etidronate (OR = 3.05, 95% CI 2.59-3.58), clodronate (OR = 10.8, 95% CI 1.14-103), raloxifene (OR = 1.90, 95% CI 1.07-3.40), and strontium ranelate (OR = 2.97, 95% CI 1.07-8.27). Similar trends were seen for femoral shaft fractures and overall fracture risk. After the start of etidronate, no dose-response relationship was present (p for trend, 0.54). For alendronate, a decreasing risk was present with increasing average daily dose (p for trend, <0.01). CONCLUSIONS: Although an increased risk of femoral shaft and subtrochanteric fractures are seen with the use of several types of bisphosphonates, the increased risk before the start of the drugs may point at an effect of the underlying disease being treated. The increased risk may, thus, perhaps be due to confounding by indication.

Gender muscle recovery during isokinetic exercise.

The purpose of this study was to examine the effect of two between set rest intervals (RI) on isokinetic knee extension peak torque (PT) produced by sedentary women and men. Seventeen young women (27.18 ± 4.05 yrs) and 16 young men (26.75 ± 4.73 yrs) performed 3 sets of 10 unilateral isokinetic knee extension at 60° and 180°/s. The RI between sets was 60 and 120 s, counterbalanced across 2 testing days. Statistical evaluation of the data was performed using a 3-way mixed factor ANOVA (gender x rest interval x sets). Males and females exhibited decreases (p<0.05) in PT with 120 s RI at 60°/s. There was no significant decline in PT in the female group during both RI at 180°/s. Men showed a significant decrease in PT only with 60 s RI. Young women and men require more than 120 s of RI to recover full PT at 60°/s. However, full quadriceps's muscle strength recovery can be attained with a 60 and 120 s at 180°/s in women, but in men only with a 120 s at the same velocity.

[Are American physicians more satisfied?--results from an International Study of Physicians in University Hospitals]. / Sind amerikanische Arzte zufriedener?--Ergebnisse einer internationalen Studie unter Arzten an Universitätskliniken.

Understanding the factors that affect physicians' job satisfaction is important not only to physicians themselves, but also to patients, health system managers, and policy makers. Physicians represent the crucial resource in health-care delivery. In order to enhance efficiency and quality in health care, it is indispensable to analyse and consider the motivators of physicians. Physician job satisfaction has significant effects on productivity, the quality of care, and the supply of physicians. The purpose of our study was to assess the associations between work-related monetary and non-monetary factors and physicians' work satisfaction as perceived by similar groups of physicians practicing at academic medical centres in Germany and the U.S.A., two countries that, in spite of differing health-care systems, simultaneously experience problems in maintaining their physician workforce. We used descriptive statistics, factor and correlation analyses to evaluate physicians' responses to a self-administered questionnaire. Our study revealed that overall German physicians were less satisfied than U.S. physicians. With respect to particular work-related predictors of job satisfaction we found that similar factors contributed to job satisfaction in both countries. To improve physicians' satisfaction with working conditions, our results call for the implementation of policies that reduce the time burden on physicians to allow more time for interaction with patients and colleagues, increase monetary incentives, and enhance physicians' participation in the development of care management processes and in managerial decisions that affect patient care.

Characteristics of permanganate oxidation of TCE at low reagent concentrations.

A controlled-release technique using potassium permanganate (KMnO4) has been recently developed as a long-term and semi-passive remediation scheme for dilute groundwater plumes of chlorinated solvents such as trichloroethylene (TCE) and perchloroethylene. Batch experiments were performed to evaluate TCE removal efficiencies of a low concentration of permanganate (MnO4-) solution and to estimate the optimum dose of permanganate required to remove low levels of TCE from groundwater plumes without leaving intermediate organic forms. Experimental results indicated that when the molar ratio of [MnO4-]0/[TCE]0 was about 10, 95% of the TCE in the plume was removed within less than 90 min, and about 90% of the chloride in the organic forms was converted into inorganic ions, while the TCE removal rates and the chloride conversion rates were considerably lower when the [TCE]0/ [MnO4-]0 values were lower. These data suggested that the [MnO4-]0 and the [MnO4-]0/[TCE]0 values would have strong effects on the efficiency and completeness of TCE oxidation. Further detailed investigations of the effect of [MnO4-]0 and [MnO4-]0/[TCE]0 values on the removal efficiencies and completeness of the TCE oxidation are warranted for successful application of the controlled-release KMnO4 technique in practice.

[The historical development of the German health care system and respective reform approaches]. / Zur historischen Entwicklung der deutschen Gesundheitsversorgung und ihrer Reformansätze.

Starting with the 19th century, the following article provides a short overview on the reform history of health care in Germany. The focus is on the influence of predominant societal values, structures and medical concepts as well as pressing social problems on the development of the German social insurance system. As a consequence of industrialization, the 19th century was shaped by the impoverishment of a large part of the population. Domestically pressured by the growing organization of the workforce, the first nationwide health insurance was founded in 1883. After this, national associations of physicians were established to counterbalance the dominating position of the health insurance companies. After the abolition of self-government during the period of National Socialism, health politics in western Germany after 1945 was shaped by medical practices run by individual physicians and free self-government by organizations and corporations. Since the 1980s, on the one hand, the self-determination and responsibility of patients has been growing. On the other hand, health care is increasingly influenced by the standardization of medical processes and products and evidence based decision-making processes. Today the health care sector is perceived as a stand-alone economic sector, in which the patient as a consumer is becoming a central figure. Overall it is outlined that the health care sector was less influenced by the conceptions of medical and other health care professionals, but it was shaped by the economic, political and societal context and the resultant concepts. This is still valid today.

Novel CDH3 mutations in hypotrichosis with juvenile macular dystrophy.

BACKGROUND: Hypotrichosis with juvenile macular dystrophy (HJMD) is a rare autosomal recessive disorder characterized by sparse and short hair, heralding progressive degeneration of the retinal pigment epithelium, which leads to blindness by the second decade of life. The disorder is caused by mutations in CDH3, a gene encoding P-cadherin, a major component of adherens junctions. Most HJMD cases reported to date have been shown to be caused by homozygous CDH3 mutations segregating in consanguineous families. AIM AND METHODS: To elucidate the genetic basis of HJMD in two nonconsanguineous families, we established the coding sequence of CDH3 in four patients and their healthy siblings. RESULTS: The four patients demonstrated markedly variable degrees of visual acuity impairment. Novel biallelic recessive mutations were identified in all affected individuals. One patient in the first family was found to carry two heterozygous mutations, IVS2 + 1G-->A and p.E504K; the other three patients in the second family were compound heterozygous for a missense mutation, p.H575R, and a nonsense mutation, p.R221X. CONCLUSION: This paper expands the spectrum of known mutations in CDH3 and points to the existence of clinical heterogeneity in this syndrome.

[Possibilities for intervention in depression among adolescents and young adults from a public health point of view]. / Interventionsmöglichkeiten bei Depressionen im Jugend- und jungen Erwachsenenalter aus Public-Health-Sicht.

When considering measures to decrease the burden of disease that is caused by depression, the depressive diseases of adolescents and young adults are of increasing interest. The prevalence in this group is high and an increase in prevalence has to be considered. The prognosis for juvenile depression is particularly bad. This review discusses the potentials to influence the burden of disease through interventions such as therapy, indicated, selective and universal prevention and health promotion for adolescents and young adults. The most impact can thereby be expected from an effective treatment of depression and other mental diseases that have high co-morbidity with depression. There is some evidence for the effectiveness of preventive interventions for depression, however, most approaches currently seem to be unsuitable for wide implementation in the population. However, as open measures, they can offer individual benefit. Health promotion that focuses on political, living and societal conditions should be directed at the family. Policy measures that improve the living conditions of parents also promote the mental health of children. Finally, the discussion about the burden of disease that is caused by depression should be held by considering current societal norms. In this context, it is of special interest as to how much depression and how much loss of function should be still considered as normal and not eligible for intervention.

DPPIV inhibitors extend GLP-2 mediated tumour promoting effects on intestinal cancer cells.

BACKGROUND: The glucagon-like peptides-1 and -2 (GLP-1 and -2) are co-secreted after food intake from intestinal L cells. Since both peptides are rapidly degraded by dipeptidyl peptidase-IV (DPPIV), research is focused on the development of DPPIV inhibitors or DPPIV resistant. AIMS: In this study we investigated, whether the inhibition of DPPIV activity and the resulting increased half-life of DPPIV substrates may influence cancer development and progression. METHODS: We examined proliferation and migratory activity of two human colon cancer cell lines (SW480, HT29) after stimulation with GLP-2 in combination with or without DPPIV inhibitors. RESULTS: Migratory activity was increased by 25% from 20% matrix induced activity to a maximum of 45% (100 nM GLP-2). In cells expressing CD26, migration was prolonged by addition of DPPIV inhibitors in a concentration dependent manner. After treatment with GLP-2 doubling time decreased from 2.4 to 1.5 days - and addition of DPPIV inhibitors enhanced the effect of GLP-2. CONCLUSIONS: The use of DPPIV inhibitors together with GLP-2 led to increased proliferation as well as elevated migratory activity. Therefore, the use of DPPIV inhibitors could increase the risk of promoting an already existing intestinal tumour and may support the potential of colon cancer cells to metastasize.

[Performance and costs of outpatient clinics of university hospitals for medical care, teaching, research activities]. / Leistungen und Kosten der Hochschulambulanzen in Forschung, Lehre und Versorgung -- Ergebnisse der Hochschulambulanzenstudie.

BACKGROUND: Outpatient clinics of university hospitals (Hochschulambulanzen) play a significant role in the German health care system. Universities have in contrast to other hospitals the right to implement an outpatient clinic, but the health care services they can render are restricted to clinical research and teaching activities. The university outpatient clinic study evaluates the intensity of medical care, teaching, research activities, and the related costs. METHOD AND DATABASE: 6 university hospitals with 51 outpatient departments in Germany were included. The prospective documentation of consultations was restricted to 800 visits per department. A total of 26,312 consultations with approximately 40,000 diagnoses and 150,000 services were documented. Furthermore, data concerning costs, teaching activities and research facilities were documented. RESULTS: Clinical treatment without any correlation to research or teaching activities amounted to about 81 % of the working time in the outpatient department (research 11 %; teaching 8 %). The primary task of the university outpatient clinics takes up less than 20 % of the working time. The physicians documented that the disease of every fourth visit was in accordance with their main field of research. 6.9 % of the visits were asked to take part in clinical trials, of these 1.25 % were included for the first time, 3.7 % were already included. 6.5 % of the visits were addressed to participate in specific teaching activities. The average total costs per case added up to 149 Euro. No outpatient clinic could cover the total per case costs with the lump sum payments. On the average 31 % of these costs were covered by lump sum payments (without cases concerning research and teaching). CONCLUSION: Treatment in outpatient departments of university clinics is far beyond research and teaching activities required by law. However, the ability of outpatient departments of universities to provide excellent outpatient services should have a more dominant role in the health care system. Therefore access to care should be deregulated for the patients and reimbursement schemes should be adjusted to adjust for the present losses.

Modeling the fate and transport of organic and nitrogen species in soil aquifer treatment process.

Soil aquifer treatment (SAT) is a promising technique for wastewater reclamation and reuse. This treatment strategy takes advantage of physicochemical and biological processes in the subsurface. The model employed in this study is based on MODFLOW-SURFACT (HydroGeoLogic, Inc.), a three-dimensional model for variably saturated flow and reactive mass transport. The model accounts for reactions including the nitrification of ammonium, the denitrification of nitrate, and the oxidation of organic carbon. Concentration of dissolved oxygen and biomasses involved in aerobic and anaerobic biological reactions forms the basis for estimates of nonlinear reaction rates formulated using a multiple-Monod expression. Illustrative simulations were conducted in a two-dimensional cross-sectional domain, with unsaturated and saturated zones. They examine the effects that site and operational conditions have on the performance of a SAT system. The parameters and conditions of concern included length of the wet/dry cycle, ground surface condition, and infiltration rate. From the simulations, we found that organic carbon was effectively removed in all cases. The availability of oxygen was a key factor in predicting the production and removal of nitrate. Overall, the model successfully described the fate and transport of the key constituents during the wet/dry operational periods in both unsaturated and saturated subsurface.

[Exercise. Prevention and health promotion--pathways to innovation in public health?]. / Bewegung. Prävention und Gesundheitsförderung-Wege zur Innovation im Gesundheitswesen?

Besides appropriate nutrition, adequate exercise is the universal remedy. Regular endurance training elicits positive effects in numerous organs and tissue systems in the sense of primary prevention. Nevertheless, a lack of exercise and obesity are widespread among the German population. In addition to the individual's own responsibility, measures for disease-oriented prevention as well as for preserving health should be improved based on broad social consensus. To begin with, improved research on treatment and prevention should be required. This national challenge should not only be financed by health insurance funds but also by taxes and levies (e.g., tobacco tax). Only then can the constantly spiralling costs of public health be met.

Use of acute hospital beds does not increase as the population ages: results from a seven year cohort study in Germany.

OBJECTIVES: (1) To compare the number of hospital days used by survivors with those by persons in their last, second last, and third last year of life in relation to age; (2) to analyse lifelong hospital utilisation in relation to life expectancy. DESIGN: Cohort study using a 10% sample (stratified by age and sex) of persons insured by one sickness fund. SETTING: Germany, 1989-1995. SUBJECTS: 69,847 survivors (with a minimum of three more years to live), 1385 persons in last, 1368 in second last, and 1333 in third last year of life. RESULTS: The number of days spent in hospital in the last year of life was lowest for the young (24.2 days under age 25) and the old (23.2 days at age 85+) and was greatest at ages 55-64 (40.6 days). The ratio of days to survivors was highest at age 35-44 (31.0) and fell continuously thereafter to 4.3 at age 85+. Similar patterns were seen for hospital days in the second and third year before death, except that peaks were at 35-44 years (22.5 and 13.7 days respectively). Calculated lifelong number of hospital days increased with age from 54.8 (death at age 20) to 201.0 (age 90). Numbers of hospital days per year of life, averaged over the entire lifespan, were stable at 2.0-2.2 for deaths between age 50 and 90 (and up to 2.7 at age 20). CONCLUSIONS: Lifelong hospital utilisation for persons who die at 50 or later is directly proportional to the number of years lived. These data contradict results from cross sectional studies that suggest an exponential rise in health care costs as longevity increases. They have important implications for projections of future health care expenditure.