[Navigational health literacy of the population in Germany]

AIM

Many health care systems are characterized by their high complexity and intransparency. Finding one's way through the multitude of services and finding the right place requires high navigational health literacy (NHL). NHL is defined as the ability to manoeuvre through the health care system and deal with the information required to do so. However, so far, there has been a lack of data on the population's NHL. The objective of this article is to analyse empirically the NHL in Germany and its association with socio-demographic and economic factors.

METHOD

NHL was surveyed with an instrument (HLS19-NAV) newly developed by an international working group, measuring the self-assessed difficulties in relation to 12 navigation-related information tasks. The HLS19-NAV has already been used in 8 countries, including Germany. In Germany, data on NHL was collected from 2,151 adult residents in a representative cross-sectional study. The relationship between socio-demographic and economic factors, and NHL was examined by using methods of analysis of variance and multivariate linear regression analysis.

RESULTS

Approximately 80% of the respondents showed low NHL with a mean score of 41.5 out of a possible 100 points. Those with low socio-economic resources, people of advanced age, people who had migrated to Germany or who were limited by health issues had a particularly low NHL. However, even people with good resources had a relatively low NHL. In contrast, the mean score was significantly higher among health professionals.

CONCLUSIONS

In recent years, numerous efforts have been made to reduce navigational difficulties and to better guide patients through the German health care system. However, according to the results of the study, there is still need for further action. Above all, structural measures are required: this includes the creation of sufficient, reliable information on the health care system and its organizations as well as the implementation of navigation aids, health care pathways and the creation of a health-literate health care system including organizations and health professionals that contribute to strengthening NHL in general.

Health literacy and the role of social support in different age groups: results of a German cross-sectional survey

BACKGROUND

Scholars demand more focus on context-related factors of health literacy as the management of health information is seen as a social practice. One prominent factor is social support that is expected to be particularly relevant for persons vulnerable for low health literacy. It was shown that health literacy can differ across the life span and especially older people have been demonstrated to be vulnerable for low health literacy. Therefore, health literacy and the relation of social support on health literacy in different age groups should be investigated.

METHODS

In a German nationwide survey 2,151 adults were interviewed face-to-face. General comprehensive health literacy was measured with the HLS19-Q47 which differentiates single steps of health information management - access, understand, appraise, and apply. Social support was measured with the Oslo 3 Social Support Scale. Bivariate and multivariate analyses were performed for all respondents and for five age groups.

RESULTS

Health literacy is relatively low in all age groups but particularly low among old-old people (76 + years). Also, the youngest adults (18-29 years) have slightly lower health literacy than middle-aged adults. On average, health literacy is higher among people with higher social support but this association varies between age groups. It tends to be quite strong among younger adults (18-45 years) and young-old persons (65-75 years) but is weak among older middle-aged (46-64 years) and old-old persons. The association also differs between steps of information management. It is stronger for accessing and applying information but there are differences in age groups as well.

CONCLUSIONS

Social support is a relevant aspect to improve individuals' health literacy and therefore should be addressed in interventions. However, it is necessary to differentiate between age groups. While both young adults and particularly old-old persons are challenged by health information management, young adults can strongly profit from social support whereas it can barely compensate the low health literacy of old-old persons. In addition, different challenges in information management steps in different age groups need to be considered when designing health literacy interventions. Thus, target group specific services and programs are needed.

[Health Literacy of People with Former Soviet Union and Turkish Migration Background in Germany]

AIM

So far, there are hardly any data on the health literacy of persons with a migration background in Germany. The aim of the article was to analyse the health literacy of this population group - particularly persons who originate in Turkey and the former Soviet Union (FSU).

METHODOLOGY

In summer 2020, face-to-face interviews with 525 persons with FSU and 512 persons with Turkish migration background above the age of 18 were carried out across Germany. The interviews were conducted in German, Russian or Turkish. Health literacy was assessed using the internationally developed HLS19-Q47 instrument. Bivariate and multivariate analyses were carried out for each immigration group separately considering demographic, socioeconomic, linguistic and migration-specific variables.

RESULTS

Overall, around half of the respondents had low health literacy, with no differences between the immigration groups. In both groups, low educational levels, socioeconomic disadvantages, limited German literacy skills, older age, multiple chronic illnesses and personal experience of immigration were linked with lower health literacy. In multivariate analyses, associations between health literacy and literacy skills, social status, financial deprivation, and chronic illness remained; however, after adjustment, no significant difference persisted by immigration generation.

CONCLUSION

While a significant proportion of persons with Turkish or FSU migration background in Germany have difficulty dealing with health information, compared with existing studies, they do not have a lower health literacy than the population without a migration background. People with a migration background are therefore not to be regarded as vulnerable to low health literacy in general. Particularly socioeconomically disadvantaged subgroups display low health literacy. Interventions should therefore target these subgroups specifically and consider their living conditions. In addition, people with low literacy skills and German proficiency have greater difficulties in processing health information. This highlights the need for multilingual information, but also for multimedia materials in plain language. Structural measures are necessary for a health-literate health system and for reducing health inequalities.

Leftward, rightward, and complete exit-time distributions of jump processes

First-passage properties of continuous stochastic processes confined in a one-dimensional interval are well described. However, for jump processes (discrete random walks), the characterization of the corresponding observables remains elusive, despite their relevance in various contexts. Here we derive exact asymptotic expressions for the leftward, rightward, and complete exit-time distributions from the interval [0,x] for symmetric jump processes starting from x_{0}=0, in the large x and large time limit. We show that both the leftward probability F_{[under 0]̲,x}(n) to exit through 0 at step n and rightward probability F_{0,[under x]̲}(n) to exit through x at step n exhibit a universal behavior dictated by the large-distance decay of the jump distribution parametrized by the Levy exponent μ. In particular, we exhaustively describe the n≪(x/a_{μ})^{μ} and n≫(x/a_{μ})^{μ} limits and obtain explicit results in both regimes. Our results finally provide exact asymptotics for exit-time distributions of jump processes in regimes where continuous limits do not apply.

Observing many researchers using the same data and hypothesis reveals a hidden universe of uncertainty

This study explores how researchers' analytical choices affect the reliability of scientific findings. Most discussions of reliability problems in science focus on systematic biases. We broaden the lens to emphasize the idiosyncrasy of conscious and unconscious decisions that researchers make during data analysis. We coordinated 161 researchers in 73 research teams and observed their research decisions as they used the same data to independently test the same prominent social science hypothesis: that greater immigration reduces support for social policies among the public. In this typical case of social science research, research teams reported both widely diverging numerical findings and substantive conclusions despite identical start conditions. Researchers' expertise, prior beliefs, and expectations barely predict the wide variation in research outcomes. More than 95% of the total variance in numerical results remains unexplained even after qualitative coding of all identifiable decisions in each team's workflow. This reveals a universe of uncertainty that remains hidden when considering a single study in isolation. The idiosyncratic nature of how researchers' results and conclusions varied is a previously underappreciated explanation for why many scientific hypotheses remain contested. These results call for greater epistemic humility and clarity in reporting scientific findings.

Health literacy among migrants in Germany – results of the quantitative cross-sectional HLS-MIG study

Background

Health literacy (HL) is considered an important prerequisite for health. HL research often identifies migrants as vulnerable for low HL. However, in-depth data on HL among migrants and its determinants are still scarce, especially in Germany. Therefore, the analysis presents first time data on HL among migrants in Germany, specifically in the domains of health care, disease prevention and health promotion, considering migrant-specific and universal factors, such as social and psychological aspects.

Methods

Around 1.000 first- and second-generation adult migrants from two of the largest migrant groups in Germany, from Turkey and former Soviet Union (FSU), were interviewed face-to-face in German, Turkish or Russian in late summer 2020. HL was measured using the HLS19-Q47 instrument. Bi- and multivariate statistical analyses were conducted.

Results

More than half of the migrants have limited general HL on average. HL in disease prevention and health promotion was lower than in health care. Low social status, financial deprivation, low literacy skills and low self-efficacy were negatively correlated with each HL domain. Social integration, by contrast, goes along with a higher HL. Duration of stay in Germany and country of origin were only partly associated with HL.

Conclusions

Our study goes beyond existing studies by analyzing HL in its domains and including the explanatory power of self-efficacy and social integration for migrants’ HL. Moreover, we reveal that migrants can't generally be considered as vulnerable, as oftentimes outlined. There is need for targeted interventions, e.g. enhancing usability of health information, for the abovementioned subgroups regarding differences in domains.

Key messages

• HL among migrants varies across domains and is only partly linked to migrant-specific features but mainly associated with universal aspects.

• Measures to increase HL should consider differences in domains and address vulnerable subgroups including targeted interventions, respectively.

Health literacy time trends in Germany

Background

Health literacy (HL) is becoming increasingly important in the European public health sector. Since the Health information landscape is changing constantly there is a need for monitoring HL regularly in order to observe the influence of these changes, to enable trend statements and to obtain precise information on the societal and individual factors. For the first time, this has been done for the population in Germany.

Methods

Cross-sectional data collected in the adult population in Germany in 2014 (n = 1.940) and 2020 (n = 504) was used. The instrument HLS-EU-Q47 was used to measure HL in the domains of health care, disease prevention and health promotion. Changes between time points were analysed on the population level as well as in several population groups.

Results

The HL of the German population has become lower within the observed six years. This is evident in all three domains but is most pronounced in health promotion literacy. This trend is particularly visible among people with low social status and financial deprivation. Single health information tasks that are precepted as more difficult involve the evaluation of information and handling information from the media.

Conclusions

Over time, dealing with health and disease-related information has become more difficult. As this development is mainly driven by socioeconomically disadvantaged population groups, it has apparently increased social inequality in the health sector. Due to more complex and demanding health information, which lately result in an ‘infodemic’, it seems that these groups in particular are overburdened and cannot raise the resources and skills to adequately engage with health information.

Key messages

• HL interventions should focus on socioeconomically disadvantaged population groups to counteract the increasing health inequality.

• Monitoring HL should be included in public health surveillance to determine needs and challenges for health policies as well as achievements of interventions.

Splitting Probabilities of Symmetric Jump Processes

We derive a universal, exact asymptotic form of the splitting probability for symmetric continuous jump processes, which quantifies the probability π_{0,[under x]_}(x_{0}) that the process crosses x before 0 starting from a given position x_{0}∈[0,x] in the regime x_{0}≪x. This analysis provides in particular a fully explicit determination of the transmission probability (x_{0}=0), in striking contrast with the trivial prediction π_{0,[under x]_}(0)=0 obtained by taking the continuous limit of the process, which reveals the importance of the microscopic properties of the dynamics. These results are illustrated with paradigmatic models of jump processes with applications to light scattering in heterogeneous media in realistic 3D slab geometries. In this context, our explicit predictions of the transmission probability, which can be directly measured experimentally, provide a quantitative characterization of the effective random process describing light scattering in the medium.

Differences in health literacy domains among migrants and their descendants in Germany

Background

Health literacy (HL) is considered to be an important precondition for health. HL research often identifies migrants as vulnerable for low HL. However, in-depth data on HL among migrants especially in its domains of health care, disease prevention and health promotion and its determinants are still scarce.

Objective

The aim of this study was therefore to analyse the current status of HL among migrants and their descendants from Turkey and from the former Soviet Union (FSU) in Germany and factors associated with it. This has not been studied using large-scale data and bilingual interviews. We differentiate between dimensions of HL, namely the domains of health care, disease prevention and health promotion which goes beyond many previous studies. In addition, we explore new mechanisms by testing the explanatory power of self-efficacy and interethnic contacts for migrants' HL.

Methods

The study includes 825 first- and second-generation adult migrants from two of the largest immigration groups in Germany, from Turkey and FSU, who were interviewed face-to-face in German, Turkish or Russian in late summer 2020. HL was measured using the HLS19-Q47 instrument. Age, gender, educational level, social status and financial deprivation, chronic illness, health-related literacy skills, self-efficacy, interethnic contacts, migration generation, duration of stay and region of origin were considered as possible determinants. Ordinary least square regressions were estimated.

Results

The average general HL score was 65.5. HL in health promotion and disease prevention was lower than in health care. Low financial deprivation, health-related literacy skills, and self-efficacy were positively correlated with each HL domain. Educational level, social status, age, gender, duration of stay and interethnic contacts were positively correlated with HL in some domains. Region of origin was only correlated with the domain of disease prevention until interethnic contact was accounted for.

Conclusion

Our study contributes to the existing knowledge by analyzing different domains of HL and testing its correlations with self-efficacy and interethnic contact among migrants. We reveal that migrants cannot generally be considered as vulnerable for low HL, as oftentimes outlined. There is a need for interventions e.g. to enhance the understanding of health information among subgroups with lower HL.

Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations-International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA

The Russian language is the eighth most spoken language in the world. Russian speakers reside in Russia, across the former Soviet Union republics, and comprise one of the largest populations of international migrants. However, little is known about their health literacy (HL) and there is limited research on HL instruments in the Russian language. The purpose of this study was to adapt the Health Literacy Questionnaire (HLS₁₉-Q) developed within the Health Literacy Survey 2019–2021 (HLS₁₉) to the Russian language to study HL in Russian-speaking populations in Germany, Israel, Kazakhstan, Russia, and the USA. The HLS₁₉-Q was translated either from English or from a national language to Russian in four countries first and then critically reviewed by three Russian-speaking experts for consensus. The HLS₁₉ protocol and “team approach” method were used for linguistic and cultural adaptation. The most challenging was the adaptation of HLS₁₉-Q questions to each country’s healthcare system while general HL questions were flexible and adaptable to specific contexts across all countries. This study provides recommendations for the linguistic and cultural adaptation of HLS₁₉-Q into different languages and can serve as an example of international collaboration towards this end.

Joint statistics of space and time exploration of one-dimensional random walks

The statistics of first-passage times of random walks to target sites has proved to play a key role in determining the kinetics of space exploration in various contexts. In parallel, the number of distinct sites visited by a random walker and related observables has been introduced to characterize the geometry of space exploration. Here, we address the question of the joint distribution of the first-passage time to a target and the number of distinct sites visited when the target is reached, which fully quantifies the coupling between the kinetics and geometry of search trajectories. Focusing on one-dimensional systems, we present a general method and derive explicit expressions of this joint distribution for several representative examples of Markovian search processes. In addition, we obtain a general scaling form, which holds also for non-Markovian processes and captures the general dependence of the joint distribution on its space and time variables. We argue that the joint distribution has important applications to various problems, such as a conditional form of the Rosenstock trapping model, and the persistence properties of self-interacting random walks.

Gesundheitskompetenz der Bevölkerung in Deutschland im Zeitvergleich der Jahre 2014 und 2020

Ziel In dem Artikel werden die Ergebnisse von zwei Erhebungen der Gesundheitskompetenz (GK) der Bevölkerung in Deutschland im Zeitvergleich analysiert. Die erste Erhebung erfolgte 2014, die zweite 2020. Untersucht werden die Veränderungen der GK, gemessen über den Grad der subjektiv eingeschätzten Schwierigkeiten bei einzelnen Informationsaufgaben in den drei Bereichen Krankheitsbewältigung/Versorgung, Prävention, Gesundheitsförderung, in der Gesamtbevölkerung und in einzelnen Teilgruppen.

Methodik Die Analysen basieren auf bevölkerungsrepräsentativen Querschnittsdaten, die 2014 im HLS-GER 1 und 2020 im HLS-GER 1‘ erhoben wurden. Dabei kam das international abgestimmte Instrument HLS-EU-Q47 zur Messung der GK zum Einsatz. Veränderungen in den Bevölkerungsgruppen wurden in einer Trendanalyse sowohl uni- und bivariat als auch multivariat analysiert.

Ergebnisse Die GK der Bevölkerung in Deutschland hat sich im Zeitvergleich innerhalb von sechs Jahren statistisch signifikant verschlechtert. Dies lässt sich in allen drei untersuchten Handlungsbereichen beobachten. Der Effekt zeigt sich besonders bei Menschen mit niedrigem Sozialstatus und finanzieller Deprivation.

Schlussfolgerung Im Zeitverlauf ist der Umgang mit gesundheits- und krankheitsbezogenen Informationen schwieriger geworden. Diese Entwicklung ist besonders stark bei sozioökonomisch benachteiligten Bevölkerungsgruppen zu beobachten, was die soziale Ungleichheit im Gesundheitsbereich verstärkt. Die Förderung der GK ist – wie diese und andere Studien zeigen – gesellschaftlich wichtiger denn je und sollte den genannten Bevölkerungsgruppen besondere Beachtung schenken.

[Digital Health Literacy of the Population in Germany: Results of the HLS-GER 2]

AIM

While the availability and variety of digital information on health offers a range of opportunities, they also pose a number of challenges, because the need for digital health literacy (DHL) is increasing along with the growing range of information possibilities. The aim of this study was to analyze the extent of DHL in the German population, key determinants, and consequences for the use of digital health information resources.

METHODOLOGY

The analysis was based on data from the Second Health Literacy Survey Germany (HLS-GER 2), consisting of a representative sample of n=2,151. A questionnaire developed as part of the international comparative study HLS₁₉ was used to measure DHL, its determinants, and the use of digital health information resources. Bivariate and multivariate analyses were conducted.

RESULTS

Overall, 75.8% of the population had low DHL. In particular, low literacy skills, older age, a lower level of education and social status were associated with low DHL. Multivariate analysis also indicated a strong association between DHL and general health literacy (HL). Low DHL led to lower use of digital health information resources.

CONCLUSION

The results underscore the importance of promoting DHL in the general population and especially among groups with low DHL. Efforts in this area should include general HL, as it is closely related to DHL. Strengthening DHL is also a socially important task in order to increase the still low use of digital health information resources in Germany and, in general, to meet the increasing digitalization of the health care system.

Health Literacy in Germany-Findings of a Representative Follow-up Survey

BACKGROUND

Studies have shown that the health literacy of the German population is low. The aim of this article is to analyze current developments in health literacy on the basis of recent data.

METHODS

The Health Literacy Survey Germany 2 (HLS-GER 2) is a representative quantitative survey of the German-speaking resident population of Germany aged 18 and above. It was carried out in December 2019 and January 2020 by paper-assisted personal oral interview (PAPI). Data on health literacy and sociodemographic characteristics were acquired with an internationally coordinated questionnaire. The instrument for measuring general health literacy consisted of 47 questions that reflect an individual's ability to access, understand, appraise, and apply health-related information. The associations between general health literacy and sociodemographic factors were analyzed using bivariate and multivariate statistical tests.

RESULTS

58.8% of the participants had low health literacy, characterized by rating at least onethird of the questions as "difficult" or "very difficult." Many respondents stated that they had difficulties accessing (48.3%), understanding (47.7%), and applying (53.5%) information, and even more of them (74.7%) reported difficulties appraising information. The correlation coefficients reveal that health literacy is weakly associated with the following variables: age, sex, social status, literacy, level of education, financial deprivation, migration background, and the presence of one or more chronic diseases.

CONCLUSION

The findings of the HLS-GER 2 highlight the need for action in promoting health literacy in the healthcare system. As the explanation of variance is low, there are presumably other important determinants of health literacy that were not taken into account. Further studies should be performed to investigate societal conditions of supplying health information, for example, or social and personal characteristics.

Core-binding factor leukemia hijacks the T-cell-prone PU.1 antisense promoter

The blood system serves as a key model for cell differentiation and cancer. It is orchestrated by precise spatiotemporal expression of crucial transcription factors. One of the key master regulators in the hematopoietic systems is PU.1. Reduced levels of PU.1 are characteristic for human acute myeloid leukemia (AML) and are known to induce AML in mouse models. Here, we show that transcriptional downregulation of PU.1 is an active process involving an alternative promoter in intron 3 that is induced by RUNX transcription factors driving noncoding antisense transcription. Core-binding factor (CBF) fusions RUNX1-ETO and CBFβ-MYH11 in t(8;21) and inv(16) AML, respectively, activate the PU.1 antisense promoter that results in a shift from sense toward antisense transcription and myeloid differentiation blockade. In patients with CBF-AML, we found that an elevated antisense/sense transcript and promoter accessibility ratio represents a hallmark compared with normal karyotype AML or healthy CD34+ cells. Competitive interaction of an enhancer with the proximal or the antisense promoter forms a binary on/off switch for either myeloid or T-cell development. Leukemic CBF fusions thus use a physiological mechanism used by T cells to decrease sense transcription. Our study is the first example of a sense/antisense promoter competition as a crucial functional switch for gene expression perturbation by oncogenes. Hence, this disease mechanism reveals a previously unknown Achilles heel for future precise therapeutic targeting of oncogene-induced chromatin remodeling.

[Health Literacy in Germany before and during the COVID-19 Pandemic]

AIM

The aim of this study was to compare the general and digital health literacy (HL) of the German population before the outbreak of the COVID-19 pandemic and during its persistence and to investigate different changes in population groups.

METHODOLOGY

The analyses are based on population representative cross-sectional data collected in 2019/2020 before and 2020 during the pandemic. An internationally coordinated questionnaire (HLS₁₉) was used. Changes in groups were analyzed bivariate.

RESULTS

The results showed that the HL of the population in Germany tended to improve during the pandemic. This effect was especially evident with regard to the evaluation of health information and in the area of digital HL. Women, people with low or medium education, younger people and those with a migration background appeared to have benefited to a more than average extent. For older people, there was no change, and for those with multiple chronic conditions, the results even indicated a worsening.

CONCLUSION

The systematic exposure to clearly structured and continuously repeated health information during the COVID-19 pandemic seems to have improved the ability to process health-related information in the German population. In particular, there has been an increase in competence in dealing with digital information media, which are being increasingly used to communicate health information. However, there are some large differences between different population groups.

Distribution of the span of one-dimensional confined random processes before hitting a target

We derive the distribution of the number of distinct sites visited by a random walker before hitting a target site of a finite one-dimensional (1D) domain. Our approach holds for the general class of Markovian processes with connected span-i.e., whose trajectories have no "holes." We show that the distribution can be simply expressed in terms of splitting probabilities only. We provide explicit results for classical examples of random processes with relevance to target search problems, such as simple symmetric random walks, biased random walks, persistent random walks, and resetting random walks. As a by-product, explicit expressions for the splitting probabilities of all these processes are given. Extensions to reflecting boundary conditions, continuous processes, and an example of a random process with a nonconnected span are discussed.

Significance and challenges of assessing health literacy among migrants

Background

People with a migration background account for a large part of the population in many European countries. Although health literacy - knowledge, motivation, and competencies to process health information - is a key determinant of health, research on health literacy specifically among migrants in Europe is scarce. The aim is therefore to review and further develop the concept and assessment of migrant-specific health literacy for future use in a migrant health literacy survey (HLS-MIG) in Germany.

Methods

A literature search in Pubmed was performed in April 2019 to identify studies regarding health literacy, health outcomes and knowledge among migrant populations in Europe. A special focus was put on the conceptualization and operationalization of health literacy among migrants.

Results

So far, health literacy among migrants has mostly been measured using general health literacy measurement tools, that is, performance-based and self-assessment instruments as the HLS-EU-Q. Migration-specific competences, such as finding information about health in mother tongue, or outcomes of deficient HL have so far received little attention, except for e.g. the GMK-12, developed as a complement to the HLS-EU-Q16 in the Austrian context.

Conclusions

The use of performance-based instruments in the local language primarily provides information about existing linguistic deficits, but hardly on competencies and abilities in dealing with health information. General self-assessment tools, on the other hand, allow the identification of such competences, difficulties and challenges. However, it is necessary to take greater account of migration-specific competences, habits and obstacles in the future, in order to develop tailored interventions for individuals and organizational aspects, supporting health information processing among migrants. Furthermore, studies also need to pay attention to migrant specific health problems and prerequisites.

Key messages

Research focussing on migrant health literacy is scarce. More attention needs to be paid to migrant specific competencies, habits and challenges.

Muography of different structures using muon scattering and absorption algorithms

In recent decades, muon imaging has found a plethora of applications in many fields. This technique succeeds to infer the density distribution of big inaccessible structures where conventional techniques cannot be used. The requirements of different applications demand specific implementations of image reconstruction algorithms for either multiple scattering or absorption-transmission data analysis, as well as noise-suppression filters and muon momentum estimators. This paper presents successful results of image reconstruction techniques applied to simulated data of some representative applications. In addition to well-known reconstruction methods, a novel approach, the so-called μCT, is proposed for the inspection of spent nuclear fuel canisters. Results obtained based on both μCT and the maximum-likelihood expectation maximization reconstruction algorithms are presented.This article is part of the Theo Murphy meeting issue 'Cosmic-ray muography'.

INFN muon tomography demonstrator: past and recent results with an eye to near-future activities

A short description of the muon tomography demonstrator at the INFN Laboratori Nazionali di Legnaro near Padua, Italy, is given and the principal achievements owing to the data collected at that experimental facility are presented. In particular, the feasibility studies for several applications based on the muon-tomographic technology, within national and European projects, are discussed. The experimental problems and the procedures used to improve the performance are underlined. In addition, new activities and the related detector optimization are illustrated.This article is part of the Theo Murphy meeting issue 'Cosmic-ray muography'.

Isotopic constraints on water source mixing, network leakage and contamination in an urban groundwater system

Water supply in developing countries is prone to large water losses due to leaky distribution networks and defective sewers, which may affect groundwater quality and quantity in urban areas and result in complex subsurface mixing dynamics. In this study, a multi-stable isotope approach was used to investigate spatiotemporal fluctuations of surface and sub-surface water source partitioning and mixing, and to assess nitrogen (N) contamination in the urban water cycle of As-Salt, Jordan. Water import from the King Abdullah Canal (KAC), mains waters from the network, and wastewater are characterized by distinct isotopic signatures, which allowed us to quantify city effluents into the groundwater. Temporal variations in isotopic signatures of polluted groundwater are explained by seasonally fluctuating inflow, and dilution by water that originates from Lake Tiberias and enters the urban water cycle via the KAC. Isotopic analysis (N and O) and comparison between groundwater nitrate and nitrate from mains water, water imports and wastewater confirmed that septic waste from leaky sewers is the main contributor of nitrate contamination. The nitrate of strongly contaminated groundwater was characterized by highest δ¹⁵N_NO3 values (13.3±1.8‰), whereas lowest δ¹⁵N_NO3 values were measured in unpolluted groundwater (6.9‰). Analogously, nitrate concentration and isotopic ratios were used for source partitioning and qualitatively confirmed δD_H2O and δ¹⁸O_H2O-based estimates. Dual water isotope endmember mixing calculations suggest that city effluents from leaky networks and sewers contribute 30-64% to the heavily polluted groundwater. Ternary mixing calculations including also chloride revealed that 5-18% of the polluted groundwater is wastewater. Up to two thirds of the groundwater originates from mains, indicating excessive water loss from the network, and calling for improved water supply management.

Muon-Induced Neutrons Do Not Explain the DAMA Data

We present an accurate model of the muon-induced background in the DAMA/LIBRA experiment. Our work challenges proposed mechanisms which seek to explain the observed DAMA signal modulation with muon-induced backgrounds. Muon generation and transport are performed using the MUSIC/MUSUN code, and subsequent interactions in the vicinity of the DAMA detector cavern are simulated with Geant4. We estimate the total muon-induced neutron flux in the detector cavern to be Φ(n)(ν)=1.0 × 10(-9)  cm(-2) s(-1). We predict 3.49 × 10(-5)  counts/day/kg/keV, which accounts for less than 0.3% of the DAMA signal modulation amplitude.

Ultra-narrow linewidth, stable and tunable laser source for optical communication systems and spectroscopy

A novel ultra-narrow linewidth, stable and tunable single-line laser source is demonstrated and experimentally performed. The single spectral line laser is achieved by selecting and amplifying one spectral comb line of a femtosecond-fiber laser via polarization pulling assisted stimulated Brillouin scattering. Stabilization and tuning is performed by additional modulation. First proof of concept results show possible linewidths below 1 Hz and an SNR of 47 dB with a tunability of more than 100 nm and a relative stability of ±160  mHz over 5 h. Such a laser source gives high potential for many different applications like spectroscopy and optical communications.

Integrating groundwater into urban water management

The management of urban groundwater resources is directly linked to urban water supply and drainage concepts. A proper integration of groundwater into urban water management plans is recommended for long-term planning. The paper describes the development of a new modelling suite which addresses the urban water and solute balance in a holistic way. Special focus has been placed on the assessment of the impact of sewer leakage on groundwater in four case study cities. Tools for the prediction of sewer leakage including the assessment of uncertainties are now available. Field investigations in four European case study cities were able to trace the influence of sewer leakage on urban groundwater using microbiological indicators and pharmaceutical residues.

Pharmacokinetics of human growth hormone administered subcutaneously with two different injection systems

The bioavailability of recombinant human growth hormone (somatropin, CAS 12629-01-5) was compared between a transcutaneous jet injection device and subcutaneous cannula injection. Thirteen healthy male subjects received 8.64 IU somatropin once with jet and once with cannula injection in a randomized cross-over study. Baseline-corrected somatropin serum concentrations were evaluated with non-compartmental and compartmental methods. The 90% confidence intervals with two one-sided t-tests around the ratios of injection devices were 91-120% for maximum concentration, 94-110% for area-under-curve until 14 h, and 92-103% for area-under-curve to infinity. Somatropin has a known metabolic half-life of ca. 20-30 min while the observed terminal half-lives were 2-4 h. Absorption and elimination rate constants were similar. Times of maximum concentrations, terminal half-lives and lag times to start of absorption appeared to be shorter and the absorption rate constant appeared to be larger for jet than for cannula injection. In conclusion, the kinetics of somatropin from subcutaneous tissue had a "flip-flop" characteristic. Bioavailability of somatropin after jet injection was equivalent to cannula injection.

[Irritable bowel syndrome]

Irritable bowel syndrome is a functional disease with highly variable symptoms and difficult to diagnose. The clinical picture is fundamental to reach a correct diagnosis and discard other gastrointestinal diseases. It etiology is not well known; psychological problems and stress probably play an important role in the development of the disease. Irritable bowel syndrome impairs the quality of life of patients and is a frequent cause of consultation in primary care. Its therapy is basically symptomatic and requires psychological support. The physician must warn his/her patients that immediate results are rarely obtained and that a prolonged clinical follow up may be necessary.

Experiments on induced modulational instability of an incoherent optical beam

We report the observation of modulational instability (MI) of a partially spatially incoherent beam induced by seeding noise through cross-phase modulation. We show experimentally that a threshold exists for such induced incoherent MI to occur that depends on the degree of spatial coherence as well as on the strength of the nonlinearity. Above threshold, the induced MI leads to the formation of ordered and disordered patterns of incoherent light.

[Collagenous sprue. Clinical case]

A 47 years old female, treated in 1984 for a non Hodgkin lymphoma, presented in 1993 with diarrhea with features of steatorrhea. The initial assessment concluded that the patient had a gluten induced enteropathy and she had a good clinical response to a gluten free diet. In 1996, while still on gluten free diet, steatorrhea appeared. A new intestinal biopsy showed sub epithelial collagen deposition. After an empiric treatment with prednisone and sulphasalazine, steatorrhea abated but subepithelial collagen deposition persisted in intestinal biopsies.

Exaggerated pulmonary hypertension with monocrotaline in rats susceptible to chronic mountain sickness

Hilltop (H) strain Sprague-Dawley rats are more susceptible to chronic mountain sickness than are the Madison (M) strain rats. It is unclear what role pulmonary vascular remodeling, polycythemia, and hypoxia-induced vasoconstriction play in mediating the more severe pulmonary hypertension that develops in the H rats during chronic hypoxia. It is also unclear whether the increased sensitivity of the H rats to chronic mountain sickness is specific for a hypoxia effect or, instead, reflects a general propensity toward the development of pulmonary hypertension. Monocrotaline (MCT) causes pulmonary vascular remodeling and pulmonary hypertension. We hypothesized that the difference in the pulmonary vascular response to chronic hypoxia between H and M rats reflects an increased sensitivity of the H rats to any pulmonary hypertensive stimuli. Consequently, we expected the two strains to also differ in their susceptibility to MCT-induced pulmonary hypertension. Pulmonary arterial pressures in conscious H and M rats were measured 3 wk after a single dose of MCT, exposure to a simulated high altitude of 18,000 ft (barometric pressure = 380 mmHg), and administration of a single dose of saline as a placebo. The H rats had significantly higher pulmonary arterial pressures and right ventricular weights after MCT and chronic hypoxia than did the M rats. The H rats also had more pulmonary vascular remodeling, i.e., greater wall thickness as a percentage of vessel diameter, after MCT and chronic hypoxia than did the M rats. The H rats had significantly lower arterial PO2 than did the M rats after MCT, but the degree of hypoxemia was mild [arterial PO2 of 72.5 +/- 0.8 (SE) Torr for H rats vs. 77.4 +/- 0.8 Torr for M rats after MCT]. The H rats had lower arterial PCO2 and larger minute ventilation values than did the M rats after MCT. These ventilatory differences suggest that MCT caused more severe pulmonary vascular damage in the H rats than in the M rats. These data support the hypothesis that the H rats have a general propensity to develop pulmonary hypertension and suggest that differences in pulmonary vascular remodeling account for the increased susceptibility of H rats, compared with M rats, to both MCT and chronic hypoxia-induced pulmonary hypertension.

Molecular cloning of the human immunodeficiency virus subtype 2 strain HIV-2UC2

An infectious molecular clone was derived from the HIV-2UC2 isolate that previously was found to persistently infect and induce an AIDS-like disease syndrome in baboons. The molecularly cloned virus (HIV-2UC2mc) showed in vitro properties similar to those of the parental isolate with regard to T-cell tropism, cytopathicity, and the ability to infect primary baboon PBMC. Nevertheless, when inoculated into two baboons, the cloned virus showed a limited ability to replicate in these animals. DNA sequence analysis revealed a defective vpr gene in the UC2mc as well as in the pathogenic parental UC2 strain. Thus, the vpr gene is not required for the induction of disease in baboons. The attenuated infectious molecular clone of UC2 should be useful for future studies designed to map the genetic determinants of HIV-2 pathogenesis in the baboon model and to evaluate vaccine strategies.

Investigation of the efficacy of oxerutins compared to placebo in patients with chronic venous insufficiency treated with compression stockings

The aim of this study was to investigate, if the the combined treatment of compression stockings and drug treatment with oxerutins (O-(beta-hydroxyethyl)-rutosides, Venoruton) provides additional benefit for patients with chronic venous insufficiency (CVI) compared to compression treatment alone. Oxerutins belong to the group of oedema protective agents and possess anti-exudative and membrane protective activity. A total of 133 female patients with CVI grade II participated in this double-blind, randomised, multi-centre, parallel-group study with two treatment groups. The whole study lasted for 19 weeks, and consisted of a one week placebo run-in phase, 12 weeks treatment phase, followed by a 6 weeks treatment-free follow-up period. All patients received a basis compression therapy that consisted of standard compression stockings. In order to standardise initial fitting of stockings in this multi-centre setting, stockings were fitted after one week of standard diuretics starting at baseline and then stockings were worn for the following 11 weeks. Patients were randomised to receive oxerutins (2 x 500 mg daily) or matching placebo. Leg volumes (water displacement) and associated subjective symptoms (visula analogue scale) were measured during a placebo run-in period at enrolment (week - 1) and half a week later (week - 1/2), at baseline week 0), at 4, 8, 12 weeks on treatment, and again after a 3- and 6-weeks treatment-free follow-up. The primary efficacy criterion, the area under the baseline from week 0 to week 18 (AUB0-18) of leg volume changes, as measurement of the global change of leg oedema during the study, resulted in a superior reduction of -5589 ml.d for the combined treatment with oxerutins compared to -2101 ml.d for placebo (p = 0.012). The mean change of leg volume compared to baseline after 12 weeks of treatment was -63.9 ml for stockings and oxerutins, and -32.9 ml for the patients who received stockings and placebo (p < 0.05). Oxerutins showed a prolonged effect in the follow-up phase compared to placebo, with mean AUB values for week 12 to week 18 of -1769 ml.d versus -133 ml.d (p < 0.01). The study demonstrated that the combined therapy of compression stockings and drug treatment with oxerutins is significantly superior in reducing leg oedema resulting from chronic venous insufficiency compared to compression treatment alone.

Distribution and abundance of neutral endopeptidase (EC 3.4.24.11) in the alimentary tract of the rat

The distribution of neutral endopeptidase (NEP; EC 3.4.24.11) was examined in the alimentary tract of the rat. Immunoreactive NEP and NEP mRNA were localized to epithelial cells of the small intestine and to muscle cells in the stomach, small intestine, and colon by immunohistochemistry and in situ hybridization histochemistry. NEP antisera recognized a protein on Western blots of membranes from gastric, jejunal, and colonic mucosa and gastric muscle with an electrophoretic mobility identical to that of recombinant human NEP (approximately 95 kDa). An antisense cRNA probe to NEP hybridized to RNA of approximately 3.5 kb and approximately 6.5 kb, corresponding to the primary transcripts of rat NEP, on Northern blots of total RNA from the jejunal mucosa. NEP message was detected in mRNA from jejunal and colonic mucosa and gastric, jejunal, and colonic muscle using a ribonuclease protection assay. NEP enzymatic activity, assessed by DL-thiorphan-inhibitable degradation of glutaryl-Ala-Ala-Phe-4-methoxy-2-naphthylamine, was highest in homogenates of jejunal mucosa (868 +/- 98 pmol.h-1 x micrograms protein-1) and was between 49- and 413-fold lower in other gastrointestinal tissues. The cellular origin of NEP in the gastric and colonic mucosa could not be determined.

[Treatment of gastric ulcer with sucralfate and famotidine]

We conducted a double blind random study on 79 patients with gastric ulcer: 39 received sucralfate, 1 g 4 times a day (Group 1) and 40 received a single evening dose of famotidine, 40 mg (Group 2). At 4 weeks, endoscopy revealed healing of the ulcer in 46% of patients in Group 1 and 40% in Group 2 (NS). At 8 weeks, corresponding figures were 90% and 75% (NS). All patients were able to complete treatment and minor side effects were reported from all patients, 36% with sucralfate and 28% with famotidine. Thus, sucralfate and famotidine are equally effective for therapy of gastric ulcer. The higher percentage of healing with sucralfate observed in this study was not statistically significant.

[Primary biliary cirrhosis. The clinical experience in 31 patients]

We analyzed 31 patients with a diagnosis of primary biliary cirrhosis, 29 of them males, aged 23 to 72 years. Liver biopsy was diagnostic in all showing initial findings of the disease in 5. Echotomography and cholangiography demonstrated a patent biliary, tract. Anti-mitochondrial antibodies were present in 94% of patients. Alkaline phosphatase and biliary acid levels were useful for diagnosis. Pruritus was present with varying intensity in all patients, with premenstrual exacerbations in 5 females who had cholestasis of pregnancy or hepatitis caused by progestin drugs before developing cirrhosis. Recurrent urinary tract infection was present in 8 patients, osteoporosis in 24, Sjogren's syndrome in 24 and Crest syndrome in 4. Survival ranged from 1 to 12 years, death being caused by ruptured esophageal varices in 12 patients and by liver failure in 7. Persistence of pruritus and altered liver function tests after cholestasis of pregnancy or hepatitis caused by progestins should lead to investigation of biliary cirrhosis.