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For the first time, the palaeographic/codicological analysis of three manuscripts of "Der Welsche Gast" were scientifically confirmed by non-invasive methods. While nIR microscopy is able to discriminate between possible ink types, e.g. carbon, plant, and iron-gall ink, XRF spectroscopy further provides the analysis of the elemental composition of the later, and therefore can be used for a correlation between the scribal hands and inks used by the scribes. The underlying dataset can be viewed here: Scientific analysis of three manuscripts of "Der Welsche Gast", Universitätsbibliothek Heidelberg, Cod. Pal. germ. 330 and Cod. Pal. germ. 389, and Württembergische Landesbibliothek Stuttgart, Cod.poet.et.phil.fol.1 This paper was presented at the International Medieval Congress 2022 in Leeds (IMC 2022) within the session 'Bridging Borders, I: Natural Sciences and Humanities' (Session Number: 1511) on 7 July 2022. Session Abstract: The Cluster of Excellence 'Understanding Written Artefacts' follows a comparative approach to studying how the production of written artefacts has shaped human societies and cultures, and how these in turn have adapted written artefacts to their needs. This session presents recent collaborative research by scientists from STEM subjects and scholars of the humanities that bridges the gap between these fields and sheds new light on medieval material culture, both within and beyond Europe. The focus will be on how scientific analysis of paper or ink can widen our perspective on different medieval cultures. Sponsor: Centre for the Study of Manuscript Cultures (CSMC) / Exzellenzcluster 'Understanding Written Artefacts', Universität Hamburg Session Organiser: Andreas Janke Centre for the Study of Manuscript Cultures (CSMC), Exzellenzcluster 'Understanding Written Artefacts', Universität Hamburg Moderator: Stefano Valente, Centre for the Study of Manuscript Cultures (CSMC), Exzellenzcluster 'Understanding Written Artefacts', Universität Hamburg Paper -a Title: Early Paper Production in the Himalayas Language: English Speaker(s): Agnieszka Helman-Wazny, Centre for the Study of Manuscript Cultures (CSMC), Exzellenzcluster 'Understanding Written Artefacts', Universität Hamburg; Paper -b Title: Revealing More than Text: New Insights to Imaging Techniques for the Classification of Ink Types in Medieval Manuscripts Language: English Speaker(s): Ivan Shevchuk, Centre for the Study of Manuscript Cultures (CSMC), Exzellenzcluster 'Understanding Written Artefacts', Universität Hamburg; Paper -c Title: The Inks of 'Der Welsche Gast': Non-Invasive Analysis by XRF Spectroscopy and nIR Microscopy Language: English Speaker(s): Sebastian Bosch, Centre for the Study of Manuscript Cultures (CSMC), Exzellenzcluster 'Understanding Written Artefacts', Universität Hamburg, This research was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG), first as part of Sonderforschungsbereich 950 (SFB 950) and then under Germany's Excellence Strategy programme (EXC 2176 "Understanding Written Artefacts: Material, Interaction and Transmission in Manuscript Cultures", project no. 390893796). The research was conducted within the scope of the work conducted at the Centre for the Study of Manuscript Cultures (CSMC) at Hamburg University.

This study examined associations between criminal recidivism after discharge from forensic treatment and variables related to either the time before the current forensic treatment, or the current forensic treatment, or the follow‐up after discharge. Participants were treated in 12 forensic clinics according to section 63 of the German penal code. A patient was classified as a criminal recidivist when the patient or the aftercare reported that the patient was delinquent at follow‐up. Patients without criminal recidivism were patients for which both perspectives (patient and aftercare) reported no delinquency at follow‐up. Mann–Whitney U‐tests and Fisher's exact tests were performed. Data to classify patients were available for N = 249 patients. Fifteen patients (6%) were classified as criminal recidivists. The follow‐up was M = 12.58 (SD = 1.84) months, and the criminal acts occurred M = 6.00 (SD = 5.55) months after discharge. Differences between patients with and without criminal recidivism were found in pretreatment (young age at first crime, early onset of mental disorder, previous forensic treatments), treatment‐related (disorder due to psychoactive substance use, gradual release abuses, outbreaks, assaults against staff, criminal act during treatment, type of discharge, outcome ratings), as well as follow‐up variables (no specified housing situation, not being abstinent from psychoactive substances, inpatient readmission, course of outpatient treatment, course of mental disorder) (all p

We developed a method to better estimate the carbon stocks of in-use harvested wood products (HWP) by using the Eora multiregional input-output tables to link global HWP production and end uses, compared to existing global-scale studies that focused on semifinished HWP. Using the new method, we allocated global HWP to country-specific end uses, including solid HWP used in (1) construction, (2) furniture production, and (3) other end uses, and as (4) household and sanitary paper and (5) other paper and paper products, while the HWP carbon stocks in these end uses were estimated using the Stock Change Approach. We reported that HWP produced globally contained an annual average of 277.7 teragram carbon in 1992-2015, of which 63.0, 12.6, 76.7, 9.1, and 116.3 teragram carbon were consumed by the above five end uses, respectively. By 2015, the carbon stocks of global in-use HWP produced since 1992 accumulated to 2938 teragrams of carbon, of which the above five HWP end uses accounted for 1489, 268, 890, 0, and 291 teragrams of carbon, respectively. Country-specific HWP production and consumption varied significantly, with the eight leading consuming countries (United States, China, Japan, Canada, Germany, Russia, United Kingdom, and France) accounting for 69% of the global in-use HWP carbon stocks. published

The German Network for Bioinformatics Infrastructure (de.NBI) is a national initiative funded by the German Federal Ministry of Education and Research (BMBF). The mission of de.NBI is (i) to provide high-quality bioinformatics services to users in basic and applied life sciences research from academia, industry and biomedicine; (ii) to offer bioinformatics training to users in Germany and Europe through a wide range of workshops and courses; and (iii) to foster the cooperation of the German bioinformatics community with international network structures such as the European life-sciences Infrastructure for biological Information (ELIXIR). The network was launched by the BMBF in March 2015 and now includes 40 service projects operated by 30 project partners that are organized in eight service centers. The de.NBI staff develops further and maintains almost 100 bioinformatics services for the human, plant and microbial research fields and provides comprehensive training courses to support users with different expertise levels in bioinformatics. In the future, de.NBI will expand its activities to the European level, as the de.NBI consortium was assigned by the BMBF to establish and run the German node of ELIXIR. The Author 2017. Published by Oxford University Press.

Thermal papers (e.g. point of sale receipts, adhesive labels, tickets) significantly contribute to contamination of paper material cycles and the environment with substances of (eco-) toxicological concern. In particular, they contain color developers like endocrine disrupting bisphenols in typical concentrations of about 1–2 percent per weight (wt%). Bisphenol A (BPA) was used as the common color developer over the last decades, but it will be restricted for thermal paper application in the European Union to a limit of 0.02 wt% from 2020 onwards. Consequently, a variety of BPA substituents such as bisphenol S (BPS) and its derivatives gain importance in thermal paper application. In this study, a rapid, reliable and cost-effective method for identification and quantification of BPA, alternative color developers and related substances like sensitizers is presented based on HPLC separation coupled with diode array detection (DAD) and Corona charged aerosol detection (CAD). Quantification was performed with regard to the intended use of the substances in thermal papers. Besides traditional UV external calibration using reference standards, alternative quantification approaches, in particular UV chromophore concentration for BPS derivatives and CAD universal response technique for low-volatile color developers, were applied and compared in order to allow quantification without reference substances. A market analysis for intended used color developers and sensitizers was performed on thermal paper samples (n = 211) collected in Germany during 2018 and 2019. Pergafast 201 (in 41.7% of the samples) was the most common color developer with concentrations above 0.02 wt%, followed by BPA (36.0%), BPS (13.3%) and other BPS derivatives known as D8, D-90, BPS-MAE and TGSA, that are mainly present in adhesive labels. Sensitizers were determined in over 90% of the samples.

Objective Clinical experience reveals a gap between recommended psychosocial care and actual support for psycho‐oncology. Physicians are essential for managing psychosocial distress and for the successful implementation of psycho‐oncology. The aim was to explore physician's attitudes towards psycho‐oncology, their self‐perceived barriers towards referral to psycho‐oncology, and their personal psychosocial competencies in a maximum‐care hospital. Method Semistructured interviews informed the development of a questionnaire administered to a monocentric sample of 120 physicians at the University Hospital Frankfurt. The data were exploratively analysed. Results One hundred two physicians completed the questionnaire. Physicians provided high ratings concerning the value of psycho‐oncology, beliefs about its efficacy, and their personal commitment to psycho‐oncology. Physicians noticed especially barriers that originated from patients themselves. They estimated their own psychosocial education and knowledge as moderate but rated their psychosocial skills and abilities as higher. Frequency of integration of psychosocial care was most strongly influenced by physicians' psychosocial competencies and their personal commitment to psycho‐oncology. Integration of psycho‐oncological issues occurs in 43% of patients. Conclusion Physicians are an important indicator of successful implementation. The discrepancy between the positive evaluation and actual support for psycho‐oncology may be explained by several factors, eg, the lack of support from clinic leaders. Patient‐related barriers, most often identified by physicians, seem to be an indication of actual lack of psychosocial competencies. Physicians' psychosocial competencies positively affect the implementation of psycho‐oncology. Sound knowledge of psychosocial topics may result in increased integration of psychosocial aspects into treatment. Therefore, medical training should focus more on psychosocial issues.

2,4,7,9-Tetramethyl-5-decyne-4,7-diol (TMDD) is a non-ionic surfactant which is preferentially used as defoamer in paints and printing ink and for the treatment of surfaces. Effluents of wastewater treatment plants (WWTPs) have been identified as the domination point sources for TMDD in rivers since the removal rate of the compound in the WWTPs is in general less than 70%. However, the dominating entry pathways of TMDD into the sewage were unknown so far. In this study effluents from both, municipal WWTPs with and without treatment of indirect industrial dischargers and from industrial WWTPs with direct discharge of wastewater into receiving rivers were analyzed for the first time to identify the proportions of TMDD coming from domestic wastewater and from various industrial sources. Moreover, rivers were samples before and after the influent of sewage water from WWTPs. The TMDD concentrations in the water samples were measured using solid phase extraction (SPE) followed by gas chromatography/mass spectrometry (GC/MS). High TMDD concentrations were found in rivers (up to 63.5 μg/L), and in effluents of WWTPs (up to 310 μg/L) affected by wastewater from paper recycling industry and factories producing paint and printing ink. Concentrations of TMDD revealed to be far higher in wastewater from factories processing recycled paper (up to 113 μg/L) compared to wastewater from factories not processing recycled paper (0.066 μg/L). The results indicate that the use of recycling paper in the paper production process is the dominating reason for increased TMDD concentrations in wastewaters and receiving rivers due to the wash out of TMDD from the paper impregnated with printing ink. Very high TMDD concentrations (up to 3300 μg/L) were also detected in wastewater from a printing ink factory and a paint factory.

To investigate if paper-based documentation in the authors' emergency medical service (EMS) satisfies scientific requirements.From 1 July 2007 to 28 February 2008, data from all paper-based protocols of a physician-run EMS in Aachen, Germany, were transferred to a SQL database (n=4815). Database queries were conducted after personal data had been anonymised. Documentation ratios of 11 individual parameters were analysed at two points in time (T1, scene; T2, arrival in emergency department). The calculability of the Mainz Emergency Evaluation Score (MEES, embracing seven vital parameters) was investigated. The calculability of the Revised Trauma Score (RTS) was also determined for all trauma patients (n=408). Fisher's exact test was used to compare differences in ratios at T1 versus T2.The documentation ratios of vital parameters ranged from 99.33% (Glasgow Coma Scale, T1) to 40.31% (respiratory rate, T2). The calculability of the MEES was poor (all missions: 28.31%, T1; 22.40%, T2; p0.001). In missions that required cardiopulmonary resuscitation (n=87), the MEES was calculable in 9.20% of patients at T1 and 29.89% at T2 (p0.001). In trauma missions, the RTS was calculable in 37.26% at T1 and 27.70% at T2 (p=0.004).Documentation of vital parameters is carried out incompletely, and documentation of respiratory rate is particularly poor, making calculation of accepted emergency scores infeasible for a significant fraction of a given test population. The suitability of paper-based documentation is therefore limited. Electronic documentation that includes real-time plausibility checks might improve data quality. Further research is warranted.

BACKGROUND: The Moorehead-Ardelt II (MA-II) questionnaire is the most frequently applied instrument to assess quality of life (QoL) in bariatric surgery patients. Our aim was to validate the Czech, German, Italian, and Spanish version of the MA-II. METHODS: A total of 893 patients were enroled in a prospective cross-sectional European study. Two thirds of the patients (n = 591) were postsurgical cases. In addition to demographic and clinical data, QoL data was collected using the MA-II questionnaire, the EuroQoL-5D (EQ-5D),and the Short Form 36 Health Survery (SF-36). Statistical parameters for contingency (Cronbach's alpha),construct and criterion validity (Pearson's r),and responsiveness (standardised effect sizes) were calculated for each language version. RESULTS: In the different languages, Cronbach's alpha ranged from 0.817 to 0.885 for the MA-II. These values were higher than those obtained for the SF-36 (0.418–0.607). The MA-II was well correlated to the EQ-5D (r = 0.662) and to 3 of the 8healthdomains of the SF-36 (0.615, 0.548, and 0.569 for physical functioning, physical role, and general health, respectively). As expected, there was a negative correlation between the MA-II and the BMI (r = −0.404 for all patients), but no significant correlation with age was found. When comparing both the heaviest and the lightest third of the patients, mean responsiveness was higher for the MA-II (−1.138) than for the domains of the SF-36 (range −0.111 to −1.070) and the EQ-5D (−0.874). CONCLUSION: The Czech, German, Italian, and Spanish version of the MA-II questionnaire are valid instruments and should be preferred to generic questionnaires as they provide better responsiveness.

CONSTRUCT: In this study, we examine the differences in test performance between the paper-based and the computer-based version of the Berlin formative Progress Test. In this context it is the first study that allows controlling for students' prior performance.Computer-based tests make possible a more efficient examination procedure for test administration and review. Although university staff will benefit largely from computer-based tests, the question arises if computer-based tests influence students' test performance.A total of 266 German students from the 9th and 10th semester of medicine (comparable with the 4th-year North American medical school schedule) participated in the study (paper = 132, computer = 134). The allocation of the test format was conducted as a randomized matched-pair design in which students were first sorted according to their prior test results. The organizational procedure, the examination conditions, the room, and seating arrangements, as well as the order of questions and answers, were identical in both groups.The sociodemographic variables and pretest scores of both groups were comparable. The test results from the paper and computer versions did not differ. The groups remained within the allotted time, but students using the computer version (particularly the high performers) needed significantly less time to complete the test. In addition, we found significant differences in guessing behavior. Low performers using the computer version guess significantly more than low-performing students in the paper-pencil version.Participants in computer-based tests are not at a disadvantage in terms of their test results. The computer-based test required less processing time. The reason for the longer processing time when using the paper-pencil version might be due to the time needed to write the answer down, controlling for transferring the answer correctly. It is still not known why students using the computer version (particularly low-performing students) guess at a higher rate. Further studies are necessary to understand this finding.

The use of cotton swabs is well known as a cause of a traumatic membrane perforation. More reasons are known. A detailed description of the aetiology and therapy in Germany does not exist. The treatment consist of a readaptation of the perforation an splinting of the tympanic membrane with paper sheets or silicon foils.238 patients with an acute tympanic membrane perforation were included in this retrospective study. They were treated between 2005 and 2010.The mean causes of a traumatic tympanic membrane perforation were slaps with the open hand (37.4%), the use of a cotton swab (19.3%) and high diving (13.0%). The perforations have been splinted with paper sheets or silicon foils. The rate of complete wound closure after splinting with different materials are comparable (71.9% and 81.8%). The side effects are low.This is the first study about the aetiology of traumatic tympanic membrane perforations in Germany. There is no statistic difference between the 2 materials for tympanic membrane splinting. A traumatic tympanic membrane perforation should be treatet at least to improve the air conduction threshold.

The River Saale is the Elbe's major tributary flowing through the state of Thuringia, Germany and receives organics inputs from several industrial facilities including pulp and paper mills. Resin acids constitute a major class of polar organics and environmental toxins derived primarily from pulp and paper processing of softwoods. Since wastewater treatment methods at pulp and paper mills are not always capable of removing the persistent resin acids prior to effluent discharge, alternative or complementary degradation methods may be required. Here, the facile photodegradation of four resin acids--abietic, dehydroabietic, isopimaric, and pimaric--was observed with pseudo-first-order kinetics when exposed to broad band and UV254-radiation. Further experimentation in rotating annular biofilm reactors with UV-exposed and unexposed River Saale water spiked with abietic and dehydroabietic acids indicated that photolysis is an effective pretreatment method for resin acid biodegradation. The bacterial toxicity of the aqueous resin acids solutions as measured with Microtox luminescence assays decreased with exposure time. Consequently, photo- and biodegradation of the resin acids did not generate any notable amounts of toxic intermediates and/or the intermediates formed were further degraded into compounds of lower toxicity than the parents. With tandem photo- and biological treatment at pulp and paper mills, as well as in-situ degradation by solar radiation and natural biofilms within the River Saale, resin acid inputs can be reduced in both concentration and toxicity to near undetectable levels with little or no ecological significance.

Aims: To correlate the prevalence of respiratory tract symptoms and diseases with dust and fibre exposure in the soft tissue industry in Germany. Methods: Ambient monitoring was performed for inhalable, respirable dust and fibres in seven soft tissue producing factories. In 441 workers (72 controls, 90 moderate, 279 high exposure) a standardised questionnaire on respiratory symptoms, diseases, occupational history, and smoking habits was used. Crude differences in the prevalence of respiratory symptoms and diseases were assessed. Logistic regression analysis was used to determine the relation between the respiratory symptoms/diseases and the cumulative dust and fibre exposure, respectively, while adjusting for age, gender, smoking habits, and factory. The effects of exposure intensity and duration were differentiated by categorising dust/fibre concentrations and years of exposure separately and setting up logistic regression models. Results: The mean concentrations for inhalable, respirable, and fibrous dusts were 10.3 mg/m 3 , 0.22 mg/m 3 , and 415 000 fibres/m 3 . Adjusted odds ratios (OR) with relation to cumulative dust exposure intensity were significantly raised for blocked nose (18.2), mucosal irritation (6.5), dry nose (8.9), cough (3.5), phlegm (7.5), exercise induced dyspnoea (2.6), hoarseness (11.3), and sneezing attacks (7.9) (ORs for highest exposure categories). Cumulative dust or fibre exposure had no significant effects on the prevalence of respiratory diseases. For all symptoms with significantly raised ORs, combined effects of intensity and duration of exposure were found. Conclusions: Because of the high prevalence of respiratory symptoms a reduction of dust exposures is recommended. Chronic exposure effects could not be found in this study, however, a healthy worker effect has to be considered.

National audience

BACKGROUND: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany) since January 1, 2005. METHODS: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short-and long-term out comes were investigated. RESULTS: During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m(2) in 2005 to 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall). CONCLUSION: As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

International audience

Introduction: Multiple-choice-examinations are still fundamental for assessment in medical degree programs. In addition to content related research, the optimization of the technical procedure is an important question. Medical examiners face three options: paper-based examinations with or without computer support or completely electronic examinations. Critical aspects are the effort for formatting, the logistic effort during the actual examination, quality, promptness and effort of the correction, the time for making the documents available for inspection by the students, and the statistical analysis of the examination results. Methods: Since three semesters a computer program for input and formatting of MC-questions in medical and other paper-based examinations is used and continuously improved at Wuerzburg University. In the winter semester (WS) 2009/10 eleven, in the summer semester (SS) 2010 twelve and in WS 2010/11 thirteen medical examinations were accomplished with the program and automatically evaluated. For the last two semesters the remaining manual workload was recorded. Results: The cost of the formatting and the subsequent analysis including adjustments of the analysis of an average examination with about 140 participants and about 35 questions was 5-7 hours for exams without complications in the winter semester 2009/2010, about 2 hours in SS 2010 and about 1.5 hours in the winter semester 2010/11. Including exams with complications, the average time was about 3 hours per exam in SS 2010 and 2.67 hours for the WS 10/11. Discussion: For conventional multiple-choice exams the computer-based formatting and evaluation of paper-based exams offers a significant time reduction for lecturers in comparison with the manual correction of paper-based exams and compared to purely electronically conducted exams it needs a much simpler technological infrastructure and fewer staff during the exam.

Retrospective assessment of adverse childhood experiences is widely used in research, although there are concerns about its validity. In particular, recall bias is assumed to produce significant artifacts. Data from a longitudinal cohort (the British National Child Development Study; N = 7,710) and the retrospective Mainz Adverse Childhood Experiences Study ( N = 1,062, Germany) were compared on 10 adverse childhood experiences and psychological adjustment at age 42 yr. Between the two methods, no significant differences in risk effects were detected. Results held for bivariate analyses on all 10 childhood adversities and a multivariate model; the later comprises the childhood adversities which show significant long-term sequelae (not always with natural parent, chronically ill parent, financial hardship, and being firstborn) and three covariates. In conclusion, the present data did not show any bias in the retrospective assessment.

The applicability of the Whole Effluent Assessment concept for the proof of compliance with the “best available techniques” has been analysed with paper mill wastewater from Germany by considering its persistency (P), potentially bio-accumulative substances (B) and toxicity (T). Twenty wastewater samples from 13 paper mills using different types of cellulose fibres as raw materials have been tested in DIN or ISO standardised bioassays: the algae, daphnia, luminescent bacteria, duckweed (Lemna), fish-egg and umu tests with lowest ineffective dilution (LID) as test result. The potentially bio-accumulative substances (PBS) were determined by solid-phase microextraction and referred to the reference compound 2,3-dimethylnaphthalene. Usually, a primary chemical–physical treatment of the wastewater was followed by a single or multi-stage biological treatment. One indirectly discharged wastewater sample was pre-treated biologically in the Zahn–Wellens test before determining its ecotoxicity. No toxicity or genotoxicity at all was detected in the acute daphnia and fish egg as well as the umu assay. In the luminescent bacteria test, moderate toxicity (up to LIDlb = 6) was observed. Wastewater of four paper mills demonstrated elevated or high algae toxicity (up to LIDA = 128), which was in line with the results of the Lemna test, which mostly was less sensitive than the algae test (up to LIDDW = 8). One indirectly discharged wastewater sample was biodegraded in the Zahn–Wellens test by 96% and was not toxic after this treatment. Low levels of PBS have been detected (median 3.27 mmol L−1). The colouration of the wastewater samples in the visible band did not correlate with algae toxicity and thus is not considered as its primary origin. Further analysis with a partial wastewater stream from thermomechanically produced groundwood pulp (TMP) revealed no algae or luminescent bacteria toxicity after pre-treatment of the sample in the Zahn–Wellens test (chemical oxygen demand elimination 85% in 7 days). Thus, the algae toxicity of the respective paper mill cannot be explained with the TMP partial stream; presumably other raw materials such as biocides might be the source of algae toxicity. Comparative data from wastewater surveillance of authorities confirmed the range of ecotoxicity observed in the study. Wastewater from paper mills generally has no or a moderate ecotoxicity (median LID 1 and 2) while the maximum LID values, especially for the algae and daphnia tests, are considerably elevated (LIDA up to 128, LIDD up to 48). Wastewater from paper mills generally is low to moderately ecotoxic to aquatic organisms in acute toxicity tests. Some samples show effects in the chronic algae growth inhibition test which cannot be explained exclusively with colouration of the samples. The origin of elevated algae ecotoxicity could not be determined. In the algae test, often flat dose–response relationships and growth promotion at higher dilution factors have been observed, indicating that several effects are overlapping. At least one bioassay should be included in routine wastewater control of paper mills because the paper manufacturing industry is among the most water consuming. Although the algae test was the most sensitive test, it might not be the most appropriate test because of the complex relationship of colouration and inhibition and the smooth dose–effect relationship or even promotion of algae growth often observed. The Lemna test would be a suitable method which also detects inhibitors of photosynthesis and is not disturbed by wastewater colouration.

Thanks to multiple recirculation of process water, the German paper industry has succeeded in decreasing the specific fresh water demand from an average of 50 m3/t thirty years ago to 13 m3/t today. Although the increasing closure of white water loops creates many problems, it is bound to be part of the German paper industry's ongoing development. For a few years, in the production of packaging paper, two paper mills have been running with a totally closed water system including different process water treatment plants as ‘kidneys’. This paper presents a comprehensive survey of the pros and cons of closed process water systems followed by significant examples of effluent-free production of corrugating medium and test liner. Additionally, operation experiences and economic aspects are discussed.

To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population.Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%).BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV.BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.

Objective: To document and critically analyse the impact of the revised WHO 2000 histological classification for meningiomas on postoperative radiotherapy/radiosurgery indications and MRI follow up protocols. Methods: The current (2000) WHO classification was used to grade 57 meningiomas treated surgically at one institution. These had been reviewed previously in 1999. All German neurosurgical departments carrying out intracranial microsurgery were asked to detail their guidelines for radiation therapy and follow up for meningiomas of different WHO grades. Results: Use of the current criteria downgraded seven of 15 atypical meningiomas (WHO grade II, MII) to grade I (MI), and four of six anaplastic tumours (WHO grade III, MIII) to grade II. Indications for radiotherapy/radiosurgery and MRI follow up protocols varied substantially with the histological grade and between institutions—for example, after an incomplete resection, radiotherapy/radiosurgery recommendations differed between MI and MII in 30 of 58 units (52%), and between MII and MIII in 34 of 56 units (61%). Conclusions: Correlative studies combining treatment and outcome data with a standardised histopathological analysis are warranted to define properly the indications for radiotherapy/radiosurgery and follow up protocols after surgery for meningiomas of different histological grades. The use of changing grading paradigms during recent years renders decision making based on local and published experience difficult. The relatively large number of meningiomas classified as atypical/WHO grade II in current practice would argue against an uncritically aggressive approach to these tumours.

This paper gives a proposal for a standardised agar diffusion susceptibility testing method with 25 micrograms fluconazole discs. The methodology compiles the results of several years of work to develop a reliable and reproducible routine-method for the microbiology laboratory. In this proposal, in addition, the critics and experiences of a collaborative study for susceptibility testing of fluconazole with 21 laboratories from Germany and Austria are included.