Export of Plastic Debris by Rivers into the Sea

A substantial fraction of marine plastic debris originates from land-based sources and rivers potentially act as a major transport pathway for all sizes of plastic debris. We analyzed a global compilation of data on plastic debris in the water column across a wide range of river sizes. Plastic debris loads, both microplastic (particles 5 mm) are positively related to the mismanaged plastic waste (MMPW) generated in the river catchments. This relationship is nonlinear where large rivers with population-rich catchments delivering a disproportionately higher fraction of MMPW into the sea. The 10 top-ranked rivers transport 88-95% of the global load into the sea. Using MMPW as a predictor we calculate the global plastic debris inputs form rivers into the sea to range between 0.41 and 4 X 106 t/y. Due to the limited amount of data high uncertainties were expected and ultimately confirmed. The empirical analysis to quantify plastic loads in rivers can be extended easily by additional potential predictors other than MMPW, for example, hydrological conditions

Comparison of tools for assessing the methodological quality of primary and secondary studies in health technology assessment reports in Germany

Health care policy background: Findings from scientific studies form the basis for evidence-based health policy decisions. Scientific background: Quality assessments to evaluate the credibility of study results are an essential part of health technology assessment reports and systematic reviews. Quality assessment tools (QAT) for assessing the study quality examine to what extent study results are systematically distorted by confounding or bias (internal validity). The tools can be divided into checklists, scales and component ratings. Research questions: What QAT are available to assess the quality of interventional studies or studies in the field of health economics, how do they differ from each other and what conclusions can be drawn from these results for quality assessments? Methods: A systematic search of relevant databases from 1988 onwards is done, supplemented by screening of the references, of the HTA reports of the German Agency for Health Technology Assessment (DAHTA) and an internet search. The selection of relevant literature, the data extraction and the quality assessment are carried out by two independent reviewers. The substantive elements of the QAT are extracted using a modified criteria list consisting of items and domains specific to randomized trials, observational studies, diagnostic studies, systematic reviews and health economic studies. Based on the number of covered items and domains, more and less comprehensive QAT are distinguished. In order to exchange experiences regarding problems in the practical application of tools, a workshop is hosted. Results: A total of eight systematic methodological reviews is identified as well as 147 QAT: 15 for systematic reviews, 80 for randomized trials, 30 for observational studies, 17 for diagnostic studies and 22 for health economic studies. The tools vary considerably with regard to the content, the performance and quality of operationalisation. Some tools do not only include the items of internal validity but also the items of quality of reporting and external validity. No tool covers all elements or domains. Design-specific generic tools are presented, which cover most of the content criteria. Discussion: The evaluation of QAT by using content criteria is difficult, because there is no scientific consensus on the necessary elements of internal validity, and not all of the generally accepted elements are based on empirical evidence. Comparing QAT with regard to contents neglects the operationalisation of the respective parameters, for which the quality and precision are important for transparency, replicability, the correct assessment and interrater reliability. QAT, which mix items on the quality of reporting and internal validity, should be avoided. Conclusions: There are different, design-specific tools available which can be preferred for quality assessment, because of its wider coverage of substantive elements of internal validity. To minimise the subjectivity of the assessment, tools with a detailed and precise operationalisation of the individual elements should be applied. For health economic studies, tools should be developed and complemented with instructions, which define the appropriateness of the criteria. Further research is needed to identify study characteristics that influence the internal validity of studies

Factors influencing deceased organ donation rates in OECD countries:a panel data analysis

Objectives: This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the necessary data to facilitate the development of more efficient strategies for improving deceased organ donation rates. Design:Retrospective study. Setting:Publicly available secondary annual data.Participants:The study includes 36 OECD countries as panel members for data analysis. Outcome measures:Multivariable panel data regression analysis was employed, encompassing data from 2010 to 2018 for all investigated variables in the included countries. Results:The following variables had a significant influence on deceased organ donation rates: 'opt-in' system (β=-4.734, p&lt;0.001, ref: 'opt-out' system), only donation after brain death (DBD) donors allowed (β=-4.049, p=0.002, ref: both DBD and donation after circulatory death (DCD) donors allowed), number of hospital beds per million population (pmp) (β=0.002, p&lt;0.001), total healthcare employment pmp (β=-0.00012, p=0.012), World Giving Index (β=0.124, p=0.008), total tax revenue as a percentage of gross domestic product (β=0.312, p=0.009) and percentage of population aged .65 years (β=0.801, p&lt;0.001) as well as high education population in percentage (β=0.118, p=0.017). Conclusions:Compared with the promotion of socioeconomic factors with a positive significant impact on deceased organ donation rates, the following policies have been shown to significantly increase rates of deceased organ donation, which could be further actively promoted: the adoption of an 'opt-out' system with presumed consent for deceased organ donation and the legal authorisation of both DBD and DCD for transplantation.</p

Interventions for increasing uptake in screening programmes

Introduction: Opportunities for the early detection of disease are not sufficiently being taken advantage of. Specific interventions could increase the uptake of prevention programmes. A comprehensive analysis of effectiveness and cost-effectiveness of these interventions with reference to Germany is still needed. Objectives: This report aimed to describe and assess interventions to increase uptake in primary and secondary prevention and to explore the assessment of their cost-effectiveness. Methods: 29 scientific databases were systematically searched in a wide strategy. Additional references were located from bibliographies. All published systematic reviews and primary studies were assessed for inclusion without language restrictions. Teams of two reviewers identified the literature, extracted data and assessed the quality of the publications independently. Results: Four HTA reports and 22 systematic reviews were identified for the medical evaluation covering a variety of interventions. The economic evaluation was based on two HTA-reports, one meta-analysis and 15 studies. The evidence was consistent for the effectiveness of invitations and reminders aimed at users, and for prompts aimed at health care professionals. These interventions were the most commonly analysed. (Financial) Incentives for users and professionals were identified in a small number of studies. Limited evidence was available for cost-effectiveness showing incremental costs for follow-up reminders and invitations by telephone. Evidence for ethical, social and legal aspects pointed to needs in vulnerable populations. Discussion: The material was heterogeneous regarding interventions used, study populations and settings. The majority of references originated from the United States and focused on secondary prevention. Approaching all target groups by invitations and reminders was recommended to increase uptake in prevention programmes in general. Conclusions: Further research should aim to focus on primary prevention. Future research should also focus on specific interventions aiming to include vulnerable target groups and individuals, who have not previously made use of opportunities for prevention

Lifestyle interventions for patients with non-alcoholic steato-hepatitis-Design, rationale and protocol of the study "target group-specific optimisation of lifestyle interventions for behavior change in non-alcoholic steato-hepatitis (OPTI-NASH)"

BACKGROUND: Non-alcoholic steato-hepatitis (NASH) is the inflammatory, progressive form of non-alcoholic fatty liver disease (NAFLD). A delayed diagnose interval is typical for the majority of the patients because of the asymptomatic natural course. However, serious sequelae may develop such as cirrhosis or hepatocellular carcinoma. NASH is also associated with an increased risk of metabolic diseases. Obesity developed due to a lack of exercise or a disadvantageous diet often leads to NAFLD or NASH, thereby interventions including enhanced physical activity and calorie reduction form the actual gold standard of treatment. To date, patients rarely use these. The project aims to model lifestyle interventions based on the preferences of the NASH patients. METHODS: Based on a systematic review and focus group discussions, two discrete choice experiments (DCE) will be designed, one on aspects influencing successful uptake of lifestyle interventions and one to analyses parameters contributing to long-term participation. An online survey will be used to elicit patient's preferences on program design and on motivational aspects in a cross-sectional design. The recruitment will take place in nine certified specialist practices and hospital outpatient clinics aiming to reach a sample size of n = 500 which is also required for the DCE design. DISCUSSION: The results will provide an overview of the NASH patient's preferences regarding the successful uptake and long-term implementation of lifestyle interventions. Recommendations for optimized lifestyle change programs will be derived and an intervention manual will be developed to facilitate target group-specific inclusion in programs in practice.</p

Forty-five minutes of physical activity at school each day? Curricular promotion of physical activity in grades one to four

Aim: According to the US Department of Health and Human Services (2008) and the World Health Organization (2008), regular physical activity is essential to the healthy development of children and contributes to the reduction of chronic diseases throughout their life span. However, coordinated comprehensive national and international programs to promote physical activity and sports participation are lacking. According to the German Sports Federation (2006), physical education (PE) classes at German schools are increasingly being canceled or taught outside the school. "fit for pisa" is a German intervention developed in response to the demand for scientific evaluation of interventions like daily physical education. Its goal is to provide quality management-secured, structured and standardized PE instruction by qualified instructors. Subjects and methods: The "fit for pisa" intervention has been implemented at five primary schools in Göttingen, Germany, since 2003. This daily physical education intervention is based on quality standards. At the five primary schools participating in "fit for pisa," students receive a supplementary 3 class hours of PE/week in addition to the mandatory 2 class hours/week for the entire school term. In other words, the children now receive one 45-min session of PE each school day. Daily physical education is now a part of their mandatory school curriculum. The curriculum content and teaching methods have been continuously developed and optimized based on the state guidelines for Lower Saxony. Results: Teacher training is held at the participating schools once a month to promote standardized implementation and quality management of the intervention program. Additional monthly meetings are held so that the teachers can discuss any problems, deviations or other issues occurring in the classes. Checklists are provided for the teachers and external trainers to document the content and objectives of each lesson. Supervisors evaluate the checklists at regular intervals. Using these instruments, the results of the 4-year intervention program were evaluated at the five participating primary schools. Conclusions: This study provides important data for recommendations to implement additional physical education in primary schools, for the corresponding quality assurance instruments and for the optimization of physical education guidelines for primary schools

Comparable outcome of liver transplantation with Histidine-Tryptophan-Ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trial

I studien har 12 elevgrupper från 10 kommunala skolor i Malmö studerats statistiskt frånläsåren 2005/06 till 2013/14. Utifrån elevernas socioekonomiska bakgrund undersöktes effekten av skolornas resursutbud för PISA-resultaten i årskurs 9. Genom teorier om skolan som arena för social reproduktion av medelklassens värden, visade analysen att skolan inte uppväger för arbetarklasselever utan eftergymnasialt utbildade föräldrar. Slutsatserna visade att observationsgruppernas höga lärarbehörighet kombinerat med ökad lärartäthet för utsatta elevgrupper, inte ensamt utjämnar bakgrundsrelaterad skolsegregation. Som insatskomplement bör skolornas elevsammansättning ses som en administrativt förändringsbar resurs, jämte utökat arbete för bredare konsensus mellan hem och skola kring utbildningens betydelse och form.This study carries out a Qualitative Comparative Analysis [QCA] of 12 groups of studentsfrom 10 public schools in Malmoe. Based on students’ socioeconomic background, the study examines the effect of school resources across 9 years of elementary school; on PISA results in grade 9. Using the theoretical framework that school is an institution to promote social reproduction of middle-class values; the analysis demonstrates that school does not compensate working class students. The study's conclusions where that the observation groups generally high teaching qualifications; combined with increased teacher ratio for vulnerable student groups, not alone were sufficient resources to equalize background related school segregation. These need to be complemented with a broader consensus between home and school about the importance of education and its execution. Also the school pupil homogeneous composition should thereto be seen as an administrative opportunity to level the playing field in the present segregated school situation

Hochspezialisierte ambulante Versorgung in Krankenhäusern: eine empirische Abschätzung von Kosten, Erlösen und mögliche Strategien

'Ambulante Behandlungen im Krankenhaus werden vom Gesetzgeber zunehmend gefördert. Angesichts möglicher Kostenunterdeckungen und Mengenbudgetierungen ist die Wahl der besten Strategie für Krankenhäuser bisher unklar. Auf der Basis von 16.171 an 6 Hochschulkliniken in Deutschland prospektiv dokumentierten Konsultationen in Ermächtigungsambulanzen (3.219 Konsultationen) und Hochschulambulanzen (12.952 Konsultationen) wurden von den Autoren Kosten und Erlöse gegenüber gestellt. Der Deckungsgrad lag je nach Ambulanzart bei 27% bis 29% bezogen auf die Gesamtkosten (44% bis 47% bezogen auf die Primärkosten). Da diese Unterdeckung zu einer Unterversorgung der Bevölkerung bei spezialisierter ambulanter Behandlung führen kann, ist auch aus gesundheitspolitischer Sicht eine Überprüfung der Finanzierung sinnvoll.' (Autorenreferat)'The delivery of ambulatory care in hospitals is broadened by legislative actions in Germany. However, best strategies for hospitals are unclear due to consideration of costs, reimbursements and budgeting. We included 16,171 prospectively documented consultations from six university hospitals in Germany. The ratio of reimbursement to total cost was 27% to 29%, concerning to the type of ambulatory care. (44% to 47% concerning to variable costs). This financial deficit could cause a shortage of highly specialized ambulatory services. Health policy interventions might be necessary.' (author's abstract)

Heparin based prophylaxis to prevent venous thromboembolic events and death in patients with cancer - a subgroup analysis of CERTIFY

<p>Abstract</p> <p>Background</p> <p>Patients with cancer have an increased risk of VTE. We compared VTE rates and bleeding complications in 1) cancer patients receiving LMWH or UFH and 2) patients with or without cancer.</p> <p>Methods</p> <p>Acutely-ill, non-surgical patients ≥70 years with (n = 274) or without cancer (n = 2,965) received certoparin 3,000 UaXa o.d. or UFH 5,000 IU t.i.d. for 8-20 days.</p> <p>Results</p> <p>1) Thromboembolic events in cancer patients (proximal DVT, symptomatic non-fatal PE and VTE-related death) occurred at 4.50% with certoparin and 6.03% with UFH (OR 0.73; 95% CI 0.23-2.39). Major bleeding was comparable and minor bleedings (0.75 vs. 5.67%) were nominally less frequent. 7.5% of certoparin and 12.8% of UFH treated patients experienced serious adverse events. 2) Thromboembolic event rates were comparable in patients with or without cancer (5.29 vs. 4.13%) as were bleeding complications. All cause death was increased in cancer (OR 2.68; 95%CI 1.22-5.86). 10.2% of patients with and 5.81% of those without cancer experienced serious adverse events (OR 1.85; 95% CI 1.21-2.81).</p> <p>Conclusions</p> <p>Certoparin 3,000 UaXa o.d. and 5,000 IU UFH t.i.d. were equally effective and safe with respect to bleeding complications in patients with cancer. There were no statistically significant differences in the risk of thromboembolic events in patients with or without cancer receiving adequate anticoagulation.</p> <p>Trial Registration</p> <p>clinicaltrials.gov, <a href="http://www.clinicaltrials.gov/ct2/show/NCT00451412">NCT00451412</a></p