Data scarce modelling the impact of present and future groundwater development on Jordan multiaquifer groundwater resources

Rapidly growing demands and climate change stresses water resources worldwide and leads to highly competitive situations between the environment and socio-economic development of a region, calling for a smart and modelling driven water resources management. However, data scarcity often prevents the realisation of a comprehensive, nation-wide resources model, which provides reliable and spatially discretized results of water resources development. We present a workflow approach to set up a large-scale multi-aquifer model, overcoming data shortage by stepwise calibration and integrating hydrological and numerical groundwater flow modelling into a coupled system. The study aims to develop such a system to assess how groundwater resources react on anthropogenic impacts on the example of the Kingdom of Jordan, one of the water poorest countries on globe. Simulated heads reliably resembled the monitored ones in >70 % of the observation wells. That makes us confident, the model represents all the states well from 1970, prior to the intense development of the country until 2015. The water balance shows an annual deficit of 1.16 million cubic meter (MCM) due to an overdraft. The discharge to the Dead Sea increased from 564 MCM/yr to 696 MCM/yr over the time period. Regional drawdowns of >250 m and groundwater depression with an extension of approx.100 km are observable in both large aquifer complexes. Most severe areas in the upper calcareous aquifer are located in the north of Amman and practically in all urban and agricultural agglomerations across the country. Groundwater tables in the deeper sandstone aquifer are particularly affected in the south as well as in the wider vicinity of the Dead Sea as consequence of its continuous dropping. Simulations of the future development of the groundwater tables indicate a severe deterioration of the situation with further declines in groundwater levels of up to 70 m.

Estimating trends in working life expectancy based on health insurance data from Germany – Challenges and advantages

Against the backdrop of population aging and growing strain on pension systems, monitoring the development of Working Life Expectancy (WLE) is vital to assess whether the policies taken are effective. This is the first study investigating time trends and educational inequalities in WLE based on German health insurance data. The analyses are based on the data of the AOK Lower Saxony (N = 3,347,912) covering three time periods (2006-08, 2011-13, and 2016-18). WLE is defined as years spent in the labor force (i.e. in employment and unemployment) and was calculated for each age between 18 and 69 years for the three periods to depict changes over time using multistate life table analysis. Educational inequalities in 2011-13 are reported for two educational levels (8–11 years and 12–13 years of schooling). WLE increased in both sexes with increases being stronger among women. This holds irrespective of whether WLE at age 18 (35.8–38.3 years in men, 27.5–34.0 years in women) or the older working-age (e.g. at age 50 10.2–11.7 years in men, 7.8–10.5 years in men) is considered. Among women at all ages and men from their mid-20s onwards, WLE was higher among higher-educated individuals. Inequalities were most pronounced among women (e.g. Δ3.1 years in women, Δ1.3 years in men at age 50). The study supports previous research indicating that measures to extend working life are effective, but that noticeable inequalities in WLE exist. Health insurance data represent a valuable source for such research that has so far remained untapped. The data provide a suitable basis to investigate trends and inequalities in WLE. Future research should build on the strengths of the data by broadening the research towards a more comprehensive analysis of the development of WLE from a health perspective.

•

Working Life Expectancy has increased substantially since the mid-2000s.

•

The gender gap narrowed over time, but men still spend considerably more years in the labor force than women.

•

Educational inequalities in WLE exist in both sexes, but are larger in women.

•

Measures to increase labor force participation should focus especially on lower-educated women, as WLE is low in this group.

•

Prevention should be strengthened for vulnerable groups to reduce health inequalities and early labor market exits.

Topographical Mapping of the cardiac autonomic innervation for selective cardiac neuromodulation in pigs and rabbits using MicroCT

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020- EU H2020-EU.1.2.2. - FET Proactive

"NeuHeart" Nr. 824071

Background & Introduction

In recent years, Vagus Nerve Stimulation (VNS) has proved to be a potential therapeutic approach for the treatment of cardiovascular diseases, such as Heart Failure or atrial fibrillation [1]. However, the lack of specific anatomical knowledge of the cervical VN [2, 3] and thus, of the cardiac autonomic innervation aggravates the side effects of unselective cervical VNS.

Purpose

The goal of this study was to investigate the cardiac vagus nerve branches for selective cardiac VNS stimulation using micro-computed tomography (µCT) and 3D renderings.

Methods

Vagus nerve specimens (n= 11 pig nerves, n= 5 rabbit nerves) were harvested from the nodose ganglion down to the cardiac branches in domestic pigs and New Zealand White rabbits on both sides, and the cardiac autonomic innervation was mapped µCT and 3D renderings.

Results

Our results provide anatomical and topographical key features on the cervical and cardiac autonomic innervation including course of the cardiac branch, cardiac branching patterns, fascicle number, and size of the autonomic nerves. We also compared these aforementioned anatomical parameters between pigs and rabbits and highlighted key anatomical differences among individuals within pigs. In pigs, the cardiac branches were partly composed of both nerves even when they branched off the VN whereas in rabbits, the two nerves were completely separated and the cardiac branch was solely parasympathetic. Finally, we generated a 3D model of various parts of the VN specimen and compared them to images of the native nerves taken during VN dissection surgery.

Conclusions

Here we present an imaging approach to map the anatomy and topography of the cardiac Vagus Nerve for selective stimulation of cardiac VN branches. We also characterized the morphology of the VN, the sympathetic trunk (ST), and the cardiac branch (CB) at the level of the cardiac branching point to highlight the complex interplay between the nerves. Our data provide one possible reason for unwanted side effects of cervical VNS. However, future studies are required to broaden the knowledge in this specific research field of selective cardiac VNS.

Development of Comorbidities in Type 2 Diabetes: Morbidity Expansion or Dynamic Equilibrium?

Background

Different hypotheses have been proposed about the future development of morbidity associated with the temporal improvement in life expectancy. However, many studies have focused on general morbidity while testing these hypotheses. In type 2 diabetes (T2D), one of the most prevalent chronic diseases, research points towards an increasing prevalence over time with a simultaneous increase in life expectancy among this population. While morbidity compression in T2D can thus be ruled out, it remains unclear whether morbidity expansion or dynamic equilibrium applies, which could be the case with a decrease in personal disease burden despite increasing prevalence. Against this background, this study aims to examine how the prevalence of T2D-related comorbidities is developing over time.

Methods

Using claims data of a large statutory insurance provider in the state of Lower-Saxony, Germany, the period prevalence of nine T2D-related comorbidities was examined for the time periods 2005-2007, 2010-2012, and 2015-2017 in 240241, 295868, and 308134 individuals with T2D, respectively. The temporal development of comorbidities was examined by logistic regression analysis. The change in the number of comorbidities over time was examined by ordered logistic regression. Analyses were stratified by gender and three age groups.

Results

Over the three time periods, age-adjusted predicted probabilities for more severe cardiovascular diseases (CVDs) decreased in men and women with T2D while those for less severe CVDs and other vascular diseases such as retinopathy, polyneuropathy any nephropathy increased significantly in all subgroups. Among all subgroups, the predicted probability of having more comorbidities over time also increased significantly.

Conclusions

Despite differences in the way CVDs are developing, the results are in favour of the morbidity expansion hypothesis for this population. Further research is needed to examine the reasons behind the observed trends.

Key messages

The developement of comorbidities in individuals with type 2 diabetes points towards morbidity expansion among this population. Future studies should examine whether the change is socioeconomic status, medication use and lifestyle risk factors are contributing to these trends.

Socioeconomic inequalities in type 2 diabetes among different population subgroups

Background

Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic status (SES) groups being more affected. Considering specific population subgroups to examine prevalence and SES inequalities in T2D is rare. In addition, using only one indicator to depict SES inequalities in health has been a common practice despite evidence on differences in what different indicators measure. This study examines the prevalence of and SES (school education, occupation and income) inequalities in T2D in the three population subgroups: employed individuals, nonworking spouses and pensioners. This study also determines the SES indictor with the highest explanatory power.

Methods

This study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. T2D prevalence in the period between 2013 and 2017 was examined in 1,345,841 employed individuals, 180,949 nonworking spouses and 773,427 pensioners. Multivariate logistic regression analysis was applied to examine SES inequalities in T2D in the three subgroups. Explanatory power of the three SES indicators was compared by deviance analysis.

Results

T2D prevalence was four times higher in male nonworking spouses (24.2%) and 2.6 times higher in female nonworking spouses (12.7%) compared to employed men (6.4%) and women (4.7%) respectively, while it accounted for 40% of men and 36% of women in pensioners. Clear gradients in T2D inequalities emerged for all three SES indicators and were observed in the three population subgroups. School education had the highest explanatory power in employed men and women and male nonworking spouses.

Conclusions

Nonworking spouses are an important target group in T2D prevention interventions. The three SES indicators differ in their explanatory power where low school education appears to be a major risk factor. It can be discussed that health literacy and the associated health behavior play a role in mediating the association between education and T2D.

Key messages

The population subgroup “nonworking spouses” is an important target group for type 2 diabetes prevention interventions. The level of school education is a substantial determinant of socioeconomic inequalities in type 2 diabetes.

Hypothalamus enlargement in mood disorders

OBJECTIVE

The purpose of this study was to determine, in vivo, whether the hypothalamus volume is reduced in patients with mood disorders.

METHODS

The cross-sectional study included 20 unmedicated (MDDu) and 20 medicated patients with major depressive disorder, 21 patients with bipolar disorder, and 23 controls. Twenty of the controls were matched to the MDDu. Seven Tesla, T1-weighted magnetic resonance images were acquired and processed using methods specifically developed for high-precision volumetry of the hypothalamus.

RESULTS

An overall group difference was observed for the left hypothalamus volume corrected for intracranial volume. Planned contrasts identified that the left hypothalamus was approximately 5% larger in each patient group compared with the control group. A paired t-test with the 20 matched pairs of MDDu and controls and without correction for covariates confirmed the larger left hypothalamus volume in MDDu.

CONCLUSIONS

Contrary to our expectations, the hypothalamus volume was increased in patients with uni- and bipolar affective disorders. The effect was left-sided and independent of medication status or statistical correction for covariates. Supported by emerging evidence that the stress response may be related to structural and functional asymmetry in the brain, our finding suggests a crucial role of the hypothalamus in mood disorders.

Maintenance therapy with decitabine in younger adults with acute myeloid leukemia in first remission: a phase 2 Cancer and Leukemia Group B Study (CALGB 10503)

In this prospective phase 2 clinical trial conducted by Cancer and Leukemia Group B (CALGB, now the Alliance), we studied decitabine as maintenance therapy for younger adults with acute myeloid leukemia (AML) who remained in first complete remission (CR1) following intensive induction and consolidation. Given that decitabine is clinically active in AML and with hypomethylating activity distinct from cytotoxic chemotherapy, we hypothesized that one year of maintenance therapy would improve disease-free survival (DFS) for AML patients <60 years who did not receive allogeneic stem cell transplantation (alloHCT) in CR1. After blood count recovery from final consolidation, patients received decitabine at 20mg/m² IV daily for 4–5 days, every 6 weeks for 8 cycles. One-hundred-thirty-four patients received decitabine, 85 (63%) had favorable risk AML. The median number of cycles received was 7 (range, 1–8), and the primary reason for discontinuation was relapse. DFS at 1-year and 3-years was 79% and 54%, respectively. These results are similar to the outcomes in the historical control comprised of similar patients treated on recent CALGB trials. Thus, maintenance with decitabine provided no benefit overall. Standard use of decitabine maintenance in younger AML patients in CR1 is not warranted. This trial was registered at www.clinicaltrials.gov as NCT00416598.

[Mid-Term Clinical Results after Open Rotator Cuff Reconstruction in Double-Row Technique with Titanium Anchor Screws]

BACKGROUND

The double-row rotator cuff repair is discussed controversially. Despite improved biomechanical properties, reduced re-tear rates and higher costs, no significant difference compared to single-row fixation in the clinical results is found. Mid-term results of an open double-row fixation with titanium anchor screws are presented.

MATERIAL AND METHODS

237 patients (m = 142, f = 95, median age: 56.3 years) were operated in 2007 with this technique by the senior author (M. G.). Preoperatively, 2 years and 4,5 years postoperatively a subjective shoulder score (SSG) with follow-up rates of 86, 87 and 83 %, was evaluated. 5.1 years postoperatively an objective evaluation of 131 patients using the Constant-Murley scores (CS), the simple shoulder tests (SST), Gerber's shoulder value and the evaluation with school grades followed. The integrity of the cuff was checked with ultrasound. The absolute (re-tears and partial re-tears) and the relative (re-tears, partial re-tears, thinning and thickening of the cuff) re-tear rates were evaluated.

RESULTS

In SSG a highly significant improvement from 51 to 83 points was found (p < 0.001). In CS 80 points (min.: 18; max.: 100), and in SST 11 points (min.: 2; max.: 12) were achieved. The shoulder value of Gerber increased significantly from preoperative 28.1 to 84.5 % 5.1 years postoperative (p < 0.001).The absolute re-tear rate, evaluated in ultrasound was 7.6 %, the relative re-tear rate 17.6 %. For primary rotator cuff reconstructions a higher CS with 82 points and a lower relative re-tear rate with 10.5 % were found. The patient's age had no significant influence on the clinical outcome. The rupture size showed a significant impact on the re-tear rate and the scores (p < 0.05). Between the operated and healthy shoulder neither strength nor mobility were found to be significantly different. Men reached a highly significant better strength than women (p < 0.001) which also resulted in a significantly better outcome in the CS (p < 0.01). The costs for open titanium transfixation technique with 330 € per case are markedly less than for arthroscopic suture bridge technique with 600 to 1000 € per case.

CONCLUSION

Open double-row cuff repair with titanium screws is a safe and cost effective technique with a low re-tear rate with comparable clinical results regarding open and arthroscopic procedures.

Photolithographic patterning of 3D-formed polycarbonate films for targeted cell guiding

A facile photolithographic platform for the design of cell-guiding polymeric substrates is introduced. Specific areas of the substrate are photo-deactivated for the subsequent growth of bioresistant polymer brushes, creating zones for cell proliferation, and protein adhesion.

[Career perspectives of hospital health workers after maternity and paternity leave: survey and observational study in Germany]

OBJECTIVE

A term of maternity and paternity (parental) leave becomes frequent on the career paths of medical personnel. Hospitals are highly competitive environments. The question employees universally face is how such a leave will alter their personal work situation and prospects upon return.

DESIGN AND PARTICIPANTS

We questioned 709 leave-takers and 88 department heads of a German university hospital (2009-12; full data sets: n = 406 and n = 63) about their experiences. This data was validated by epidemiology data extraction and expert interviews, also in a Swiss and in a Norwegian institution.

RESULTS

Parental leave elicited high emotionality (score: 4.0 +/- 2 out of 5). Superiors' appraisal of employees' parental leave was more positive than negative (p < 0.001, mean + 0.8 +/- 0.9 on a bipolar Likert scale (BLS) from - 2 to + 2). However, the annual labor turnover in leave takers doubled to 39 %; 51 % of leave-takers experienced significant task profile changes. 58 % of doctors thought about changing their employer and 17 % of leave-taking executives lost status after return. Employees' "power" and "influence" dropped significantly (p < 0.05; determined on BLS) whereas the "professional workload" increased (p < 0.001). Consequently, after return career perspectives (measured on a bipolar visual analogue scale from - 5 to + 5) were perceived significantly more negative than positive (p < 0.0001, mean: - 1.3 +/-  2), especially by high-commitment staff (i. e. female executives, mean: - 2.1 +/- 2, pΔ < 0.05 vs. others). These perceptions significantly influenced future choices concerning further terms of leave. The Swiss and Norwegian comparators appeared to have more liberal substitution and part-time schemes than the German institution.

DISCUSSION

A competitive hospital environment can effectively demote leave-taking medical employees in their jobs. Despite sufficient financial arrangements high-commitment staff will only take parental leave of adequate length when an institutional framework protects their status. Data support four requirements: 1. Formal recognition of the leave taker's status pre-leave. 2. Establishment of a written ("claimable") return policy. 3. Substitution scheme for each individual, preferably by a locum. 4. Redirection of funds to facilitate part-time work schemes temporarily after return.

The embryogenesis of the equine femorotibial joint: The equine interzone

REASONS FOR PERFORMING STUDY

Articular cartilage regeneration is the focus and goal of considerable research effort. Since articular chondrocytes descend from a distinct cohort of progenitor cells located in embryonic nascent joints (interzones), establishing the timing of equine interzone formation is an essential first step towards understanding equine joint and articular cartilage development.

OBJECTIVES

To establish the time frame during which the equine femorotibial interzone forms.

STUDY DESIGN

Descriptive anatomical study.

METHODS

Equine embryos were harvested at 37 (E37), 40, 42, 45, 50 and 65 days' gestation. The femorotibial interzone was examined using high-resolution episcopic microscopy of E37, E42, E45, E50 and E65. Additional histology and collagen-II-immunohistochemistry were performed on E42.

RESULTS

At E37, the femorotibial interzone is first visible as a uniform layer, while at E42 the interzone is fully formed and consists of 3 morphologically distinct layers. The first evidence of cavitation was seen at E45. At E50, the cruciate ligaments were well formed and by E65, joint formation appeared complete.

CONCLUSIONS

The embryogenesis of the equine femorotibial joint is similar to the developmental timeline of stage-matched human and murine embryos. Further studies looking at interzone formation on a cellular and molecular level may further our understanding of the intricate developmental patterns and pathways of articular cartilage development.

[How "representative" are SHI (statutory health insurance) data? Demographic and social differences and similarities between an SHI-insured population, the population of Lower Saxony, and that of the Federal Republic of Germany using the example of the AOK in Lower Saxony]

Using data obtained from a statutory health insurance (AOK) in the federal state of Lower Saxony, this study examined whether there were differences between the insured population compared with that of Lower Saxony (Niedersachsen) and of Germany with respect to social structural characteristics. Data for the comparisons were provided by the statistical office of Germany, and all datasets were coded according to the same criteria. The differences in gender distribution and age distribution between the AOK, Lower Saxony, and Germany were small. The share of employed individuals among the insured compared with those of Lower Saxony and Germany did not differ for males, but it was lower in women. In the insured population a higher proportion of individuals had lower qualification levels than in Lower Saxony or in Germany; the number of individuals with higher qualifications was, however, sufficient to permit statistical analyses. There were differences in the distributions of social structural characteristics between the health insurance population on the one hand and the populations of Lower Saxony and of Germany on the other. Due to the high number of cases, it is nevertheless possible to analyze associations between social structural variables, health impairments, and patterns of health care utilization.

Electron- and proton-impact excitation of hydrogenlike uranium in relativistic collisions

The K shell excitation of H-like uranium (U(91+)) in relativistic collisions with different gaseous targets has been studied at the experimental storage ring at GSI Darmstadt. By performing measurements with different targets as well as with different collision energies, we were able to observe for the first time the effect of electron-impact excitation (EIE) process in the heaviest hydrogenlike ion. The large fine-structure splitting in H-like uranium allowed us to unambiguously resolve excitation into different L shell levels. State-of-the-art calculations performed within the relativistic framework which include excitation mechanisms due to both protons (nucleus) and electrons are in good agreement with the experimental findings. Moreover, our experimental data clearly demonstrate the importance of including the generalized Breit interaction in the treatment of the EIE process.

[Why do mothers smoke? Analyzing the influence of living circumstances and psychological factors on tobacco consumption among mothers with minor children]

Using a cross-sectional population sample of 3,129 women with minor children, this paper analyzes the impact of social and psychological factors on maternal smoking. Pearson's χ(2) was used for testing significance of differences between smoking prevalence and social as well as psychological factors. Adjusted effects of these factors were calculated by means of multiple logistic regression analysis. About 30% of mothers smoked daily and about 11% were heavy smokers ( ≥ 20 cigarettes/day). Lower educational degree was the most important predictor for daily tobacco consumption. But also fulltime employment, low income, distress due to conflicts with (former) partner, job-related burdens, and single motherhood enhanced the risk of maternal smoking, while household-related stress and having a young child was associated with less tobacco use. With respect to personal factors, dysfunctional coping patterns and depression showed a significant impact on tobacco use. Against expectations, active coping styles were not associated with lower but with increased smoking rates. In conclusion, it can be stated that maternal smoking has multiple causes, and that intervention programs should target both current living circumstances and psychological factors.

[Social living conditions and health among mothers in Germany : findings from a population sample]

This paper reports findings from a population sample of mothers with underage children living in Germany (n=3,129). The objective of the study was to analyze whether social and familiar living conditions are associated with enhanced health risks for mothers. The sample is representative with respect to German federal states, school education, marital status, age of mothers, and number of children. Health problems were assessed in terms of physical disabilities and discomforts, anxiety and depression, and self-rated health. About 27% of mothers perceived physical disabilities and discomfort, 21% reported high levels of anxiety, and 22% high levels of depression. About 6% assessed their health as poor or very poor. Particularly single motherhood, unemployment, sole responsibility for household and family as well as low income and low school education increased the risk of poor health. The findings suggest that for specific subgroups of mothers parenting may be a vulnerable phase of life reflecting the need for a life stage orientation in health inequality research.

FC25-03 - Detrimental effects of anxiety disorders on ability to work associated with a protective effect on mortality in the middle decades of life

Aims

Most available data about psychiatric mortality and invalidity concerns inpatients, although the majority of patients are treated as outpatients only.

It was the aim of this study to estimate the effect of anxiety disorders on early retirement and premature death in the working population with special emphasis on outpatients.

Methods

125.019 workes between age 16 and 58 were followed for an average of 6.4 years. Excess risks of death and permanent disability were calculated with multivariate Cox regression models.

Results

Outpatient and inpatient treatment for anxiety disorders (OR 1.40 resp. OR 2.10) were associated with higher risks of early retirement. Males generally were more often affected by this bad outcome than females.

Further analysis showed decreased risks of premature death for outpatients with an anxiety disorder (OR 0.33). The effect tended to be most prominent during the middle decades of life and got smaller with older age, at which all-cause mortality approximated that of the control group. No significant effect on mortality could be shown for inpatients.

Conclusions

Patients with outpatient treatment for anxiety disorders have an elevated risk of permanent disability early in life, while all-cause mortality is lower. This beneficial effect can only be partly explained by different risk-taking behaviors. Different causes of death early in life and their connections with these disorders need to be discussed, too. Treatment should have a strong focus on preserving ability to work.