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The aim of this study is to investigate the user requirements of individuals with blindness regarding the information to be mapped on audio-tactile maps of city centers and neighborhoods/residential areas. Beyond that specific scope, this study aims at covering a wider research gap. That is, the investigation of the usefulness that individuals with blindness attribute to different spatial information (items) of differentiated environments: city centers and neighborhoods/residential areas. A total of 115 adults with blindness took part in the research. Participants came from four countries: Greece, Cyprus, Turkey, and Germany. The researchers listed 222 pieces of information concerning city centers and 226 pieces concerning neighborhoods/residential areas and address them in survey by conducting two respective questionnaires. Participants were asked to evaluate the information regarding the usefulness of the information with regard to safety, location of services, and orientation/wayfinding during movement. The result of the study is the definition of the most useful information that should be included in orientation and mobility (O&M) aids. Thus, the findings of this study will be particularly important for designers of O&M aids, O&M specialists, rehabilitation specialists, and teachers who design and construct O&M aids for their students with blindness. [ABSTRACT FROM AUTHOR]

The release of reactive nitrogen compounds into the atmosphere, soil and water belongs to one of the biggest environmental challenges in Germany. Consequences are the loss of biodiversity due to eutrophication and acidification of terrestrial and aquatic ecosystems, impaired groundwater quality and impacts on human health. Responsible for the emissions of reactive nitrogen compounds are primarily agricultural activities and combustion processes. A number of European environmental targets and objectives in the context of nitrogen are clearly being missed. It is urgently necessary to increase the efforts to reduce nitrogen emissions and to protect biodiversity and human health. Important processes are a further development of European clean air policies and the implementation of the European Nitrate Directive and Water Framework Directive in Germany. A national nitrogen strategy could be a good starting point to increase efforts to solve the nitrogen problem and for a better integration of existing protection policies. [ABSTRACT FROM AUTHOR]

Abstract: A newly developed indicator of the pesticide risk for aquatic biocenosis in surface water bodies is applied within an economic sector model, and is used to evaluate alternative designs for an environmental policy programme. For rural districts (‘Landkreise’) across Germany, different widths of riparian buffer zones adjacent to surface water bodies are evaluated in terms of efficient cost/risk ratios. The indicator is defined as acute risk under worst-case input conditions and is based on combining a sectoral model, a national survey on pesticide use and a toxicological risk assessment model. The nation-wide survey provides data on pesticide use by agricultural crop. On this basis, crop-specific risk indices for aquatic biocenosis are calculated by means of eco-toxic criteria for indicator organisms and aggregated through crop patterns to the rural-district level. GIS is used to calculate the influences of natural site factors (e.g. soil types, land use distance to water bodies, etc.) on pesticide input in surface water and to calculate the regional risk potentials at regional level. An economic cost–impact analysis is conducted based on the new indicator. Opportunity costs of converting agricultural land to riparian buffer strips are estimated using the agricultural sector model RAUMIS, for buffer strip widths of 3, 30 and 50m, as per the European the environmental programme EC 99/1257/EEC. These costs are then compared with estimated risk reduction potentials at the regional level of administrative districts. Results show that cost–impact ratios are most efficient for 3m buffer strips and in those regions with the lowest costs from changing agricultural land use (e.g. through reduced livestock production). A major future research need in this area is a higher spatial resolution at the grid-level. [Copyright &y& Elsevier]

Reducing pesticide loads in surface waters implies identifying the pathways responsible for the pollution. The current study documents the pesticide contamination of the river Zwester Ohm, a 4917‐ha catchment in Germany with 41% of the land used for crop production. Discharges and concentrations of 19 pesticides were measured continuously at three locations for 15 mo. The load detected at the outlet of the catchment amounted to 9048 g a.i. The losses represent 0.22% of the pesticides applied by the farmers. The contamination showed a seasonal pattern following the pesticide application times. The wastewater treatment plant system (WWTPS) in the catchment (two wastewater treatment plants [WWTP], 14 combined sewer overflows (CSO), four CSO tanks) emits during dry weather periods purified sewage and during storm events sewage mixed with stormwater runoff into the river. The contribution by the WWTPS to the pesticide load was defined as point‐source pollution (PSP). The load was dominated by PSP with at least 77% of the total pollution. No significant interdependencies between intrinsic properties of the pesticides, hydrometeorological factors, and the loads occurring in the stream could be found. Therefore, it is not possible to predict PSP for other catchments based on the results from this study. Whereas 65% of the total load entered the river via the WWTP, a portion of 12% was attributed to the CSO. The study points out that the influence of CSO on PSP should be taken into account in future catchment studies in areas with comparable agricultural structure. [ABSTRACT FROM AUTHOR]

In the EU, several environmental regulations aim at protecting the environment from agricultural nitrogen and phosphorus losses. The German regulation on farmers' nutrient management, especially implementing the EU Nitrates Directive, was revised in 2017. It comprises considerable tightening of numerous measures and costs for farmers to comply with. We provide the first systematic farm-level analysis of compliance costs of the recent revision in a case study for the federal state of North Rhine-Westphalia. To do so, we apply a bio-economic optimisation model at farm level to a representative sample of specialized dairy and pig farms. The sample is derived by Latin Hypercube sampling based on the observed distribution of farm characteristics from official agricultural statistics. Modelling results are evaluated by grouping of farms and a statistical meta-model. Results show highly heterogeneous compliance costs reaching from 0 to 2.66 Euro per pig and 0 to 0.83 cent per kg milk. 47.3% of pig and 38.4% of dairy farms do not face any costs. Pig farms with high compliance costs are characterized by high stocking density, the absence of low-emission manure application techniques and phosphorus-enriched soils. Dairy farms with high compliance costs have no low-emission manure application techniques and a high share of grassland. For dairy farms, stricter thresholds for nutrient application do not cause any compliance costs. The meta-model reveals the large effect of prices and assumptions regarding the fertilizer management on compliance costs. Results are of relevance beyond the case study area as other regions in the EU have a similar agricultural structure and need to fulfill the same EU directives. Policymakers need to be aware that high compliance costs increase the incentive of non-compliance and also consider heterogeneous impacts when designing complementary policies. Future research should focus on long-term adaption of farmers and include transaction costs as well as technical progress. • German implementation of the Nitrates Directive was revised in 2017. • On-farm compliance costs are highly heterogeneous between farms. • For pig and dairy farms, existing manure application technique is major cost driver. • Pig farms with high stocking density face costs to lower phosphate surplus. • Sampling approach generates representative farm sample under restricted data access. [ABSTRACT FROM AUTHOR]

Abstract: The location of first generation processing plants for biogas using bulky inputs is a prominent example of locational decisions of plants that face high per unit transport costs of feedstock and simultaneously depend to a large extent on feedstock availability. Modelling the resulting regional feedstock markets then requires a spatially explicit representation of demand. With production capacities of plants small in comparison to market size, large numbers of possible type-location combinations need to be considered, requiring considerable computation time under existing integer programming-based approaches. Therefore, in this paper we aim to present an alternative, faster and more flexible iterative solution approach to simulate location decisions for processing plants. And with greater flexibility, this approach is able to take into account spatially heterogeneous transport costs depending on total demand. The approach is implemented in a modelling framework for biogas production from green maize in Germany, which currently accounts for ca. five per cent of Germany’s agricultural area. By modifying green maize prices, demand functions are derived and intersected with regional supply functions from an agricultural model to simulate market clearing prices and quantities. The application illustrates that our approach efficiently simulates markets characterised by small-scale demand units and high, spatially heterogeneous transport costs. [Copyright &y& Elsevier]

Importance Dental neglect and high levels of unmet dental needs are becoming increasingly prevalent among elderly residents of long-term care facilities, although frail, elderly, and dependent populations are the most in need of professional dental care. Little is known about the validity of teledentistry for diagnosing dental pathology in nursing home residents. Objectives To evaluate the accuracy of teledentistry for diagnosing dental pathology, assessing the rehabilitation status of dental prostheses, and evaluating the chewing ability of older adults living in nursing homes (using direct examination as a gold standard). Design Multicenter diagnostic accuracy study performed in France and Germany. Setting Eight nursing homes in France and Germany. Participants Nursing home residents with oral or dental complaints, self-reported or reported by caregivers, willing to receive oral or dental preventive care. In total, 235 patients were examined. The mean age was 84.4 ± 8.3 years, and 59.1% of the subjects were female. Intervention The patients were examined twice. Each patient was his or her own control. First, the dental surgeon established a diagnosis by reviewing a video recorded in the nursing home and accessed remotely. Second, within a maximum of 7 days, patients were examined conventionally (face-to-face) by the same surgeon who established the initial diagnosis. Measurements All residents received a comprehensive clinical examination in their home by a trained geriatrician and underwent a dental hygiene evaluation that used the Silness-Loe and Greene-Vermillion dental hygiene assessment indices. The diagnoses established via the video recording and in the face-to-face setting were compared. The main outcome measure was number of dental pathologies. Results In total, 128 (55.4%) patients had a dental pathology. The sensitivity of teledentistry for diagnosing dental pathology was 93.8% (95% confidence interval [CI] 90.7–96.9), and the specificity was 94.2% (95% CI 91.2–97.2). Among the 128 cases of dental pathology identified by teledentistry, 6 (4.8%) were false positives. The teledentistry assessments were quicker than the face-to-to-face examinations (12 and 20 minutes, respectively). Conclusions Teledentistry showed excellent accuracy for diagnosing dental pathology in older adults living in nursing homes; its use may allow more regular checkups to be carried out by dental professionals. [ABSTRACT FROM AUTHOR]

Background: COVID-19 infection may cause severe respiratory distress and is associated with increased morbidity and mortality. Impaired cardiac function and/or pre-existing cardiovascular disease may be associated with poor prognosis. In the present study, we report a comprehensive cardiovascular characterization in the first consecutive collective of patients that was admitted and treated at the University Hospital of Tübingen, Germany., Methods: 123 consecutive patients with COVID-19 were included. Routine blood sampling, transthoracic echocardiography and electrocardiography were performed at hospital admission., Results: We found that impaired left-ventricular and right-ventricular function as well as tricuspid regurgitation > grade 1 were significantly associated with higher mortality. Furthermore, elevated levels of myocardial distress markers (troponin-I and NT pro-BNP) were associated with poor prognosis in this patient collective., Conclusion: Impaired cardiac function is associated with poor prognosis in COVID-19 positive patients. Consequently, treatment of these patients should include careful guideline-conform cardiovascular evaluation and treatment. Thus, formation of a competent Cardio-COVID-19 team may represent a major clinical measure to optimize therapy of cardiovascular patients during this pandemic.

This report focuses on the topic of Public Health in practice. The article summarizes the discussion of the Working Group 12. A first diagram shows how broad the definition of "Public Health practice" can be. Challenges as well as visions were articulated. In order to ensure individual and diverse health promotion for all, public health must be integrated as a central vision for the future in the daily routine and in the various living environments of the people as part of social life. To achieve this goal, public health actors in general and the public health service in particular must work closely with policy makers, cost-bearers, science and teaching and complement each other's work, while respecting their spheres of action. A precondition is adequate financial and human resources. Public health therefore deals with the design of living environments as well as with political structures and strategies., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Severe autonomic failure (SAF) refers to combined abnormalities in reflex and tonic autonomic function. SAF indicates increased risk of death in post-infarction and heart failure patients, but has not been studied in aortic stenosis (AS). Here, we investigated SAF in patients with AS and tested its correlation with hemodynamic and biochemical markers., Methods: We prospectively enrolled 174 patients with moderate to severe AS in sinus rhythm (age 76 ± 9 years; mean aortic valve area 0.9 ± 0.3 cm(2)). Heart rate turbulence (as marker of autonomic reflex activity) and deceleration capacity (as marker of autonomic tonic activity) were calculated from 24-h Holter recordings. According to the previously published technology, SAF was considered present if both factors were abnormal., Results: 44 (25.3%) of the 174 patients had signs of SAF. Patients with SAF had lower left ventricular ejection fraction (LVEF: 48.1 vs. 54.8%; p = 0.002), lower mean aortic gradients (28 vs. 34 mmHg, p = 0.019), higher systolic pulmonary artery pressures (46.8 vs. 40.9 mmHg, p = 0.028), higher levels of brain natriuretic peptide (905 vs. 407 ng/l; p = 0.003) and higher levels of high sensitive troponin I (0.65 vs. 0.24 μg/l; p = 0.013). Impaired LVEF (≤50%) was the only independent factor associated with SAF, but only explained autonomic abnormalities in less than half of the patients., Conclusions: In patients with moderate to severe AS prevalence of SAF is high. SAF correlates with hemodynamic and biochemical markers indicating increased risk. Future studies should evaluate the prognostic value of SAF in patients with AS.

Background: The purpose of this observational study was to test the diagnostic performance of the Elecsys® troponin T high-sensitive system combined with copeptin measurement for early exclusion of acute myocardial infarction (MI) in clinical practice., Methods: Troponin T high-sensitive (diagnostic cutoff: <14 pg/mL) and copeptin (diagnostic cutoff: <14 pmol/L) levels were determined at admission in addition to other routine laboratory parameters in patients with suspected acute MI presenting to the emergency department of a general hospital over a period of five months., Results: Data from 142 consecutive patients (mean age 71.2 ± 13.5 years, 76 men) were analyzed. Final diagnoses were acute MI in 13 patients (nine ST elevation MI, four non-ST elevation MI, 9.2%) unstable angina pectoris in three (2.1%), cardiac symptoms not primarily associated with myocardial ischemia in 79 (55.6%), and noncardiac disease in 47 patients (33.1%). The patients with acute MI were younger and had higher troponin T high-sensitive and copeptin values than patients without acute MI. Seventeen patients had very high copeptin values (>150 pmol/L), one of whom had a level of >700 pmol/L and died of pulmonary embolism. A troponin T high-sensitive level of <14 pg/mL in combination with copeptin <14 pmol/L at initial presentation ruled out acute MI in 45 of the 142 patients (31.7%), each with a sensitivity and negative predictive value of 100%., Conclusion: According to this early experience, a single determination of troponin T high-sensitive and copeptin may enable early and accurate exclusion of acute MI in one third of patients, even in an emergency department of a general hospital.