Three-dimensional gravity modelling of a Quaternary overdeepening fill in the Bern area of Switzerland discloses two stages of glacial carving.

The geometry of glacial overdeepenings on the Swiss Plateau close to Bern was inferred through a combination of gravity data with a 3D gravity modelling software. The target overdeepenings have depths between 155 and > 270 m and widths between 860 and 2400 m. The models show incisions characterized by U-shaped cross-sectional geometries and steep to over-steepened lateral flanks. Existing stratigraphic data reveals that the overdeepenings were formed and then filled during at least two glacial stages, which occurred during the Last Glacial Maximum (LGM) within the Marine Isotope Stage (MIS) 2, and possibly MIS 6 or before. The U-shaped cross-sectional geometries point towards glacial erosion as the main driver for the shaping of the overdeepenings. The combination of the geometries with stratigraphic data suggests that the MIS 6 (or older) glaciers deeply carved the bedrock, whereas the LGM ice sheet only widened the existing valleys but did not further deepen them. We relate this pattern to the different ice thicknesses, where a thicker MIS 6 ice was likely more powerful for wearing down the bedrock than a thinner LGM glacier. Gravity data in combination with forward modelling thus offers robust information on the development of a landscape formed through glaciers.

Mid-infrared fiber-optic evanescent field spectroscopy for in situ monitoring of tetrahydrofuran hydrate formation and dissociation.

Tetrahydrofuran is a relevant auxiliary molecule when storing carbon dioxide or hydrocarbons as gas hydrates. The present study demonstrates the application of in situ mid-infrared fiber-optic evanescent field absorption spectroscopy for studying the formation and dissociation of THF hydrates. Thereby, the utility of this analytical technique for providing unique molecular-level insight even under harsh environmental conditions is evidenced.

Technology-based measurements for screening, monitoring and preventing frailty.

BACKGROUND AND OBJECTIVE: Sensor technology, in particular wearable inertial sensors, has the potential to help researchers objectively assess the functionality of older adults. The following review provides an overview about the possible use of sensor technology to detect and prevent pre-frailty and frailty. METHOD: A systematic literature search in PubMed and the Cochrane Library was conducted. Articles were selected according to the following criteria: frail and/or pre-frail population, use of wearable and non-wearable sensor technology to measure or enhance human movements or activities of daily living and a focus on frailty assessment. RESULTS: A total of 28 publications were found. Sensor-derived parameters obtained during assessment of gait, functional performances and physical activity were reported to be relevant for screening and monitoring pre-frailty and frailty; however, current findings are limited to cross-sectional studies, which do not allow establishment of a causal relationship between motor performance, physical activity and specific frailty states. No study monitored specific activities of daily living. DISCUSSION: Outcome variables from technology-based assessment seem to provide valuable information for frailty assessment. Strenuous testing conditions as well as increased variability in gait, functional performance and physical activity may be useful in identifying frailty. Outcome variables derived from gait, motor assessment and physical activity must still be validated in large cohorts and under daily living conditions in order to develop robust screening tools for pre-frailty and frailty. Further research should focus on specific activities of daily living in pre-frail or frail older adults and technology-based approaches for intervention and prevention.

Model development to study strategies of younger and older adults getting up from the floor.

BACKGROUND: Long lies after a fall remain a public health challenge. Many successful fall prevention programmes have been developed but only few of them include recovery strategies after a fall. Once better understood, such movement strategies could be implemented into training interventions. AIMS: A model of motion sequences describing successful movement strategies for rising from the floor in different age groups was developed. Possible risk factors for poor rising performance such as flexibility and muscle power were evaluated. METHODS: Fourteen younger subjects between 20 and 50 years of age and 10 healthy older subjects (60+ years) were included. Movement strategies and key components of different rising sequences were determined from video analyses. The temporal parameters of transfers and number of components within the motion sequences were calculated. Possible explanatory variables for differences in rising performance were assessed (leg extension power, flexibility of the knee- and hip joints). RESULTS: Seven different components were identified for the lie-to-stand-walk transfer, labelled as lying, initiation, positioning, supporting, elevation, or stabilisation component followed by standing and/or walking. Median time to rise was significantly longer in older subjects (older 5.7s vs. younger 3.7s; p < 0.001), and leg extension power (left p = 0.002, right p = 0.013) and knee flexibility (left p = 0.019, right p = 0.025) were significantly lower. The number of components for rising was correlated with hip flexibility (r = 0.514) and maximal power (r = 0.582). The time to rise was correlated with minimal goniometric knee angle of the less flexible leg (r = 0.527) and maximal leg extension power (r = 0.725). CONCLUSIONS: A motion sequence model containing seven different components identified by individual key-frames could be established. Age-related differences in rising strategies and performance were identified.

Development of a standard fall data format for signals from body-worn sensors : the FARSEEING consensus.

Objective measurement of real-world fall events by using body-worn sensor devices can improve the understanding of falls in older people and enable new technology to prevent, predict, and automatically recognize falls. However, these events are rare and hence challenging to capture. The FARSEEING (FAll Repository for the design of Smart and sElf-adapaive Environments prolonging INdependent livinG) consortium and associated partners strongly argue that a sufficient dataset of real-world falls can only be acquired through a collaboration of many research groups. Therefore, the major aim of the FARSEEING project is to build a meta-database of real-world falls. To establish this meta-database, standardization of data is necessary to make it possible to combine different sources for analysis and to guarantee data quality. A consensus process was started in January 2012 to propose a standard fall data format, involving 40 experts from different countries and different disciplines working in the field of fall recording and fall prevention. During a web-based Delphi process, possible variables to describe participants, falls, and fall signals were collected and rated by the experts. The summarized results were presented and finally discussed during a workshop at the 20th Conference of the International Society of Posture and Gait Research 2012, in Trondheim, Norway. The consensus includes recommendations for a fall definition, fall reporting (including fall reporting frequency, and fall reporting variables), a minimum clinical dataset, a sensor configuration, and variables to describe the signal characteristics.

[Patients with dementia as a secondary diagnosis. Care in geriatric inpatient rehabilitation]. / Patienten mit Begleitdiagnose Demenz : Versorgung in der stationären geriatrischen Rehabilitation.

More than one-third of geriatric inpatients suffer from dementia as a secondary diagnosis. The number of patients with dementia and other age-related diseases is increasing as the population ages. Geriatric inpatient rehabilitation has been recognized as an efficient tool to restore functional impairment and improve outcomes related to functional dependence in old age. For patients with cognitive impairment, the situation is still controversial. Inpatient rehabilitation specifically designed for older adults with cognitive impairment, addressing the specific needs of this group, is still lacking. This review summarizes the current state of research and introduces an inpatient rehabilitation model developed and evaluated for patients with mild to moderate dementia as secondary diagnosis.

Test-retest reliability and minimal detectable change of repeated sit-to-stand analysis using one body fixed sensor in geriatric patients.

A majority of geriatric patients experience difficulty in performing sit-to-stand (SiSt) transitions. A detailed assessment of SiSt ability is a prerequisite for successful rehabilitation. Body fixed sensors (BFSs) are increasingly used to assess functional performances. As to date there is no system which analyzes clinically relevant phases of SiSt, the aim of this study was to determine the reliability of an automated approach for quantifying durations and angular velocities of trunk flexion and extension during repeated SiSt transitions using one BFS (DynaPort® Hybrid). Forty multimorbid geriatric patients aged 84.1 ± 6.6 years were included. Each patient participated in two test sessions with a 5 min rest period in between. Intra- and interrater reliability was assessed. Intraclass correlation coefficients (ICCs), absolute and relative standard measurement errors (SEMs, SEMs%) and minimal detectable changes (MDCs(95), MDCs(95)%) were calculated. ICCs were good to excellent for all variables in the total sample (0.80-0.94). The intraobserver group (50%) showed a higher number of excellent ICCs (≥.9) compared to the interobserver subgroup (10%). SEM% was low for all variables (6.9-12.7%). MDC(95)% ranged 19.2-34.4% and more variables ≤30% were found in the intra- (80%) compared to the inter-observer group (60%). Study results demonstrate that the BFS system provides a reliable analysis of SiSt phases in geriatric patients, and is a substantial improvement over the stopwatch approach used in clinical practice today.

[Recommendation of an assessment protocol to describe geriatric inpatient rehabilitation of lower limb mobility based on ICF: an interdisciplinary consensus process]. / Empfehlungen für die Durchführung des motorischen Assessments der unteren Extremität zur ICF-basierten Verlaufsbeurteilung der Mobilität in der stationären geriatrischen Rehabilitation: Bericht eines interdisziplinären Konsensusprozesses.

Because of the growing demand of geriatric rehabilitation, objective and clear indication decisions are needed with respect to limited financial resources. The aim of an interdisciplinary consensus group was to critically evaluate the most commonly used tests of functional performance of the lower limbs and to recommend useful tests to document progress of inpatient rehabilitation. Assessment of standing, walking, walking with a dual-task, sit-to-stand transfer, lying-to-sit-to-stand transfer, and stair climbing were recommended to document functional performance of the lower limbs and to describe rehabilitation targets. Future research is needed, because reasonably validated assessment tools do not exist for all of these domains. In addition to a standardized assessment of physical capacity, physical activity and participation with regard to the International Classification of Functioning, Disability, and Health (ICF) context have to be assessed. Body fixed sensors seem to be a promising assessment tool to objectively document progress in rehabilitation.

Designing studies on the effectiveness of physical training in patients with cognitive impairment.

The literature provides conflicting results on the effectiveness of physical training in cognitively impaired older individuals. Cognitive impairment has been shown to be a negative predictor of rehabilitation outcome in these persons. However, the evidence on which this discussion is based is scarce. The methodology used in previous studies shows substantial shortcomings. The presented study protocol documents the methodology of one of the largest intervention studies worldwide in this research field with a standardized specific training program in cognitively impaired subjects including short- and long-term follow-up examinations. The selected sensitive evaluation tools for motor, cognitive and emotional status have all been validated for use in older persons. Most of these tests have been validated in cognitively impaired persons. In contrast to most previously published RCTs only study participants within a comparable level of cognitive impairment will be included in the study. The primary aim of the study is to evaluate a specific training program to improve motor performance (strength and functional performance) in persons with cognitive impairment. Secondary study endpoints include the reduction of falls, improvement of cognitive as well as psychological status and the documentation of physical activity. The training program is based on previous successful intervention studies of the research group, was complemented and modified with respect to specific deficits of cognitively impaired persons and focuses on motor improvements. The article gives a rationale for interventions using physical training and study methodology in persons with dementia.

Diagnostic relevance of the determination of lymphocyte subpopulations in environmental medicine.

Earlier hopes that determination of lymphocyte subpopulations might become a strong diagnostic tool in environmental medicine have not been fulfilled in recent years. Analysis of the scientific literature rather shows that there are only few examples for environmental exposures causing reproducible shifts of lymphocyte subpopulations. Moreover, current knowledge suggests that "environmental diseases" are not associated with characteristic changes of subpopulation patterns. If lymphocyte subpopulations are analyzed, each diagnostic step, including indication, sample handling, analytic procedure and data-interpretation, should adhere to good quality criteria. Taking all together, the determination of lymphocyte subpopulations in the context of environmental medicine comes under category IV of the criteria of the Commission for Methods and Quality Assurance in Environmental Medicine of the German federal health authority (Robert Koch-Institute; RKI): "A procedure cannot be recommended because there is not sufficient information to justify it" (here: no solid trends in epidemiological examinations), "and because theoretical considerations speak against an application" (here: high physiological variability and missing exposure or substance specificity).

[Multiple Chemical Sensitivity (MCS) -- scientific and health policy aspects]. / Multiple Chemical Sensitivity (MCS) -- wissenschaftliche und gesundheitspolitische Aspekte.

Multiple Chemical Sensitivity (MCS) is characterized by an increased sensitivity towards chemicals. Many patients with severed unspecific symptoms ascribe these to MCS. At present there is neither a generally accepted diagnosis nor a therapeutic concept. The ENT doctor should look at the nasal airflow resistance, nasal mucosa and olfactory system.

Rapid, high-dose intravenous iron sucrose therapy in 2 Jehovah's Witness patients with severe anemia, iron deficiency and chronic kidney disease.

AIMS: Two patients with chronic kidney disease presented with severe anemia and iron deficiency. Because of their religious beliefs, red blood cell transfusions were not possible, and an aggressive therapeutic regimen of iron replenishment was instituted. MATERIAL AND METHODS: The regimen included epoetin, folic acid and high-dose intravenous iron sucrose infusions over multiple successive days (total dosages of 2 and 3.5 g). RESULTS: The patients' iron stores were replenished and an erythropoietic response ensued subsequent to this aggressive and unique therapeutic regimen. There were no side effects observed which could be attributed to iron sucrose, and both patients stabilized and were discharged after 3 - 4 weeks. CONCLUSION: In patients with chronic kidney disease who are severely anemic and iron-deficient and where transfusions are not possible, an aggressive regimen of multiple high-dose iron sucrose infusions may be both safe and effective.

[Exposition and sensitisation to indoor allergens, house dust mite allergen and cat allergens]. / Exposition und Sensibilisierung gegenüber Milben- und Katzenallergenen bei Kindern in Baden-Württemberg.

The study examined the exposure to biological indoor air agents and their possible role for allergies and respiratory tract illnesses of children. It was conducted as a case control study (atopic vs non-atopic children) at the four surveillance public health departments in Baden-Württemberg in the winter season 1999/2000 and included 379 children of the fourth class. The concentrations of the house dust mite antigens Der F1, Der p1, and Der Gr2 as well as cat allergen Fel d1 were determined in the children's bedrooms on the ground and in the mattress. Specific IgE-antibodies against allergens from house dust, mites and cat were determined in the serum of the children. For mite allergens the following medians ( micro g/g) were estimated in floor dust: Der p1 = 0.6, Der f1 = 2.3, Gr2 = 0.1; in mattresses: Der p1 = 1.2, Der f1 = 3.4, Gr2 = 0.3. The median of Fel d1 in floor dust was 0.2 microg/g, in mattresses 0.1 microg/g. Sensitisation to dust mite allergen was found to be more prevalent than sensitisation to cat. The distribution of sensitisation among the cases and controls is different. Among the cases, more subjects were sensitised to dust mites (32.9 %) and cat (13.1 %). Among the controls, 17.1 % were sensitised to dust mites and 4.1 % to cat. The results showed no direct association between the prevalence of allergies or respiratory tract illnesses and the indoor concentrations of the allergens. Possible reasons for these findings are discussed.

[10 years of observation by public health offices in Baden-Württemberg--assessment of human biomonitoring for mercury due to dental amalgam fillings and other sources]. / 10 Jahre Beobachtungsgesundheitsämter in Baden-Württemberg--Beurteilung der Human-Biomonitoring-Untersuchungen bezüglich der Quecksilber-Belastung durch Amalgamfüllungen und andere Quellen.

Since 1992, in Baden-Württemberg, ten-year old children have been surveyed in the project "Sentinel Health Departments" to study their exposure to environmental pollutants and possible health effects. In the four study areas 1200 children have been investigated every year initially, since 1996 every second year. The data for mercury in body fluids are reported here. The decrease in the body burden of mercury as a result of the declining usage of dental amalgam fillings, was been verified. In 1992/93, of all the children who had been surveyed, the 95 percentile for the body burden of mercury was 3.1 microg/l and in 2000/01 1.35 microg/l. Also to be discussed is the reason why mercury-based cosmetic ointments seriously exceed the HBM-II-intervention-value. Because of using these ointments, concentrations of mercury in urine up to 1400 microg/l were found. A study within the project "Sentinel Health Departments" compared the concentrations of mercury in the urine of adults with those in blood and salvia. The results support the opinion that mercury in urine is appropriate for estimating the mercury uptake from dental amalgam fillings. It can be assumed that these results reflect the situation in the entire Federal Republic of Germany. The ten years' experience confirms that the concept of the "Sentinel Health Departments" is excellently suited to obtain data relevant for environmental health of children. Environmental health protection and the essential gathering of data for future health observation in Baden-Württemberg.

[Nutritional ecology: chances of public health services to shape procedures]. / Ernährungsökologie: Gestaltungsmöglichkeiten des Gesundheitsamtes.

Nutrition ecology is the science that studies the impacts of human nutrition on the environment, on human health and on social systems. Environmental impacts are usually the result of intensive food production, food transport and food packaging; they include soil contamination and erosion, energy consumption, air contamination and waste disposal. Health impacts of contemporary western eating behavior concern nutrition-related diseases (diabetes, hypertension, gout, overweight etc) and their psychological and social consequences; nutrition ecology aims at a balanced diet and suitable eating behavior to reduce the risks of chronic disease. The social impacts of nutrition concern the effects of feed trade on poor working conditions and poverty, especially in developing countries. The strategies of nutrition ecology agree in many points with those of the agenda 21 and of Consumer Protection. As nutrition-related diseases are increasing further, the public health services in Germany discover nutrition as an important topic in health promotion and prevention. They will contribute remarkably to a sustainable development if they include the strategies of nutrition ecology in their projects.

[Acute myocardial infarction after blunt polytrauma -- successful coronary intervention]. / Akuter Myokardinfarkt bei stumpfem Polytrauma mit erfolgreicher katheterinterventioneller Therapie.

Acute myocardial infarction following blunt chest trauma is a well reported but rare finding. Especially in severely injured patients the optimal therapy of the myocardial infarction is not well established, since anticoagulants, platelet aggregation inhibitors or thrombolytics are frequently contraindicated under these conditions. We report a case of a 41-year-old man, who presented with an acute myocardial infarction in combination with a severe polytrauma (multiple rib fractures, hematothorax, pelvic bone fractures, multiple injuries of intestinal organs) after a motorcycle accident with a blunt chest and abdominal trauma. After surgical treatment of the injuries of the bones and the intestinal organs a coronary angiography was immediately performed. The left anterior descending and the circumflex coronary artery were occluded in the mid-portion of the vessels. Coronary recanalization by PTCA and the implantation of coronary stents were successful in both vessels. Despite of a non-optimal blood flow after recanalization and stenting in one vessel (LAD TIMI II flow after recanalization), and a non-optimal accompanying medical therapy, during and after intervention (intravenous heparin starting 8 hours after the coronary intervention and platelet inhibitors starting 4 days after the intervention) the coronary angiogram after 2 months documented both vessels patent without a reocclusion or a restenosis. The case report documents, that in traumatic myocardial infarctions the treating of both, the attending injuries and the myocardial ischemia, is feasible. Early coronary angiography and coronary interventions, with or without stent-implantation, are indicated, even in cases in which an adequate accompanying medical therapy with heparin and platelet inhibitors is contraindicated.

Children as a sensitive subgroup and their role in regulatory toxicology: DGPT workshop report.

There is increasing discussion that children might be considered as a specific subgroup in public health regulations which could be more sensitive than the average "adult" human being. Differences between children and adults, with regard to susceptibility towards toxicants, may result from a combination of toxicokinetic, toxicodynamic and exposure factors. Kinetic factors are of importance mainly in the early postnatal period, largely as the result of immature elimination systems, i.e. metabolising enzymes and/or renal function. Specific vulnerability may prevail during several time periods, related to the development and maturation of organs (for example, brain, bone, endocrine system). For some substances, it has been shown that children at a specific age are less sensitive than adults. Specific exposures of toddlers to environmental chemicals may be high due to their moving behaviour and hand-to-mouth activities. Existing scenarios and models for exposure of children should be improved, in particular with respect to different ages. The outcome of model calculations must be verified by human biomonitoring analysis. At present, there is ongoing discussion of toxicological test models suitable to delineate human postnatal development. Experience with infant-orientated test systems is scarce (for example in developmental neurotoxicity). In general, tools for predicting toxicological sensitivity of children must be further improved. Regulators should also be aware that reduction of lifestyle-related toxic exposures such as smoking and drug abuse in children and adolescents is now an increasing public health problem in many countries.