Die Arbeitsverhältnisse der kirchlichen Dienstnehmer in der Rechtsprechung der Gerichte der Bundesrepublik Deutschland

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Grand Bahama Post-Hurricane Dorian: A Comparison of Fresh Water in Two Primary Wellfields

Freshwater lenses, a layer of fresh water that floats atop saline groundwater, are vulnerable sources of drinking water for small islands. The threats to freshwater lenses, and their recovery following catastrophic events, is not well documented. Due to storm surge and flooding during the Category 5 Hurricane Dorian in September 2019, the freshwater lenses of Grand Bahama were inundated with salt water, removing the freshwater source of drinking water for the island. This study builds on previous work to monitor the recovery of the freshwater lenses three years after the hurricane by assessing tidal lag, as well as stable isotopes in water (δ2H and δ18O), to understand the hydrologic characteristics of the FWL in Grand Bahama. Results from electrical conductivity revealed that the tidal lag, or the time it takes for the tidal effect to be observed in groundwater, was approximately 2.5 hours on average. Through stable isotope analysis of precipitation samples, we determined a local meteoric water line of δ2H = 8.2 * δ18O + 12.2, which is close to the global meteoric water line. Groundwater samples did not show evidence of significant evaporation from precipitation. These results serve as baseline data for additional monitoring and recovery efforts on Grand Bahama

Quality measures for dental care: A systematic review

Objectives: This systematic review aimed to (a) provide an overview of existing quality measures in the field of oral health care, and to (b) evaluate the scientific soundness and applicability of these quality measures. Methods: A systematic search was conducted in three electronic databases MEDLINE (via PubMed), EMBASE (via OVID) and LILACS (via BIREME). The search was restricted to articles published between 2002 and 2018. Publications reporting on the development process or clinimetric properties of oral health care quality measures for outpatient oral health care in dental practices were included. The identified publications reporting on oral health care quality measures were critically appraised with the Appraisal of Indicators through Research and Evaluation 2.0 (AIRE 2.0) instrument to evaluate the soundness and applicability of the measures. Results: The search strategy resulted in 2541 unique and potentially relevant articles. In total, 24 publications were included yielding 215 quality measures. The critical appraisal showed a large variation in the quality of the included publications (AIRE scores ranging from 38 to 78 out of 80 possible points). The majority of measures (n = 71) referred to treatment and preventive services. Comparably, few measures referred to the domain patient safety (n = 3). The development process of measures often exhibited a lack of involvement of patients and dental professionals. Few projects reported on the validity (n = 2) and reliability (n = 3) of the measures. Four projects piloted the measures for implementation in practice. Conclusions: This systematic review provides an overview of the status quo with respect to existing quality measures in oral health care. Potential opportunities include the piloting and testing of quality measures and the establishment of suitable information systems that allow the provision of transparent routine feedback on the quality of oral health care

The geographic scale of genetic variation in common plant species – Implications for genebanks and restoration

Genebanks for plant seeds are a necessary tool to support the conservation of biodiversity. In the last decades also the importance of intraspecific diversity within the genebank collections was emphasised. Even though background information on the distribution of genetic diversity within and between populations was scarce for common plant species, seed provenances have been delineated for seed collection and production. Seeds have to be used in the same provenance, where they were collected for restoration projects, agriculture and forestry. The present study aims to elucidate distribution of intraspecific genetic diversity in three common plant species over different geographic scales. In the last part, further intraspecific differences in seed traits were investigated. Chapter 2 dealt with the distribution of genetic diversity within and between populations of Sedum album in its distribution range in Europe and the history of Central European populations. With a combination of neutral and chloroplast specific markers, we reconstructed postglacial processes that lead to the present distribution pattern in S. album. Distinct haplotypes could be detected on the Iberian Peninsula and in Eastern and Southern Europe. Central European populations have their origin in Southern Europe and show meanwhile high influence of Eastern lineages. A clear East/West subdivision was found with hybrid zone in Western Europe. Glacial refugia have been detected on the Iberian Peninsula and in the mountains of Liguria (Northern Italy). Further refugia can be assumed in south-eastern Europe, and northern refugia in small-scaled areas in Germany and Eastern Europe. In chapter 3 and 4 we used AFLP markers to examine the distribution of genetic diversity in and between populations of Lathyrus pratensis and Hepatica nobilis in Bavaria. Correlation of genetic diversity with seed provenances was tested. The studies of two perennial, cross-pollinated plants revealed differences in genetic diversity within and between populations. In L. pratensis within population diversity was ordinary compared to other plants with similar life history traits. However, differentiation between populations was very high, what can be ascribed to the limited dispersal of the heavy seeds. Moreover, the influence of nearby anthropogenic populations can, therefore, be excluded. Gene flow was present within 110km, resembling the northern and the southern part of Bavaria (delineated by the river “Danube”). We found that the group of populations in southern Bavarian is located in and delineated by one of the official seed production areas. For L. pratensis the production zone is sufficient. Nevertheless, material for restoration should be taken as near as possible due to high differentiation between populations. Collections for genebanks should be undertaken from both northern and southern Bavaria, with an emphasis on southern parts, where genetic variation within populations was higher. For H. nobilis, there were no correlations with official provenances or production zones. Gene flow was very limited, obviously due to the seed dispersal by ants, which agitate within few square metres. Genetic diversity within populations was high, while differentiation between populations was moderate. The pattern can be explained by random, long-distance dispersal, e.g. of plants, which have been used in horticulture for many centuries. Because ex-situ storage of seeds is difficult for H. nobilis, it is important to conserve high variation in in-situ populations in old forests. Intraspecific differences in seed traits were examined in chapter 5. Seed quality and longevity were tested in two experimental setups. We measured percentage of filled seeds with x-ray analysis, 1000-seed-weight, initial and maximum germination rates to infer seed quality. To measure longevity seeds were conducted to accelerated aging. We collected data from wild lowland and alpine populations and from common garden populations, which were cultivated from seeds of the same populations. Percentage of filled seeds and seed weight was not different for lowland and alpine, or wild and common garden populations. Nevertheless, initial and maximal germination was higher in seeds from wild populations. Further, longevity tended to be higher in seeds from lowland than alpine and common garden than wild populations, respectively. Nevertheless, we could show that differences in longevity are environmentally influenced to some extent, because common garden populations of different origin differed less than wild populations. In a second setup, seeds were collected in consecutive years from the same populations. Seed data were compared with climate data. We used model approaches based on results of former studies. Mean annual temperature and total annual rainfall, and mean annual temperature together with total rainfall and total sunshine within 90 days prior to harvest explained some variation in our data. In chapter 6, I conclude that history of populations and plant traits have more influence than recent anthropogenic events on the distribution of genetic diversity in common plants. For conservation of intraspecific diversity in common plants, plant traits should be considered in collections for genebanks and in the usage of seeds for restoration. The collection of more data concerning quality and longevity of wild plant species would improve future collections. Costs for testing, regrowth and recollection in genebanks would be reduced

A process model for acquiring international administrative routine data for health services research

Objectives: To describe a practical and standardized approach for acquiring international administrative routine data from different data owners for research.Methods: Best practice approach based on the experiences gained during the EU-funded ADVOCATE ("Added Value for Oral Care") project that involved the collection of routinely collected administrative data from health insurance providers, health funds or health authorities in six European countries.Results: A general process for data acquisition that contains four phases was developed: First, the conditions for data usage and access are determined. These conditions are subsequently tested by sharing and analyzing a data sample (quality and validity audit). After optimizing the process model, full-scale data access and analysis are performed.Conclusions: The general data acquisition approach has successfully been applied in the ADVOCATE project to acquire claims data from eight data owners, which prescribed different usage conditions in each case. The approach aims to make a contribution to a standardized process model for acquiring administrative routine data for research and providing researchers with a methodological framework.Ziel: Konzeption eines anwendbaren und standardisierten Ansatzes zur Akquise internationaler administrativer Routinedaten von verschiedenen Dateneigentümern für die Forschung.Methoden: Best-Practice-Ansatz auf Grundlage der Erfahrungen aus dem EU-Projekt ADVOCATE (Added Value for Oral Care), bei dem administrative Routinedaten von Krankenkassen, Krankenversicherungen oder Gesundheitsbehörden aus sechs europäischen Ländern erhoben wurden.Ergebnisse: Es wurde ein allgemeines, vierstufiges Verfahren zur Datenakquise entwickelt: Zunächst werden die Bedingungen für die Datennutzung und den Datenzugriff festgelegt. Diese Bedingungen werden anschließend durch den Austausch und die Analyse einer Stichprobe mit anschließender Datenqualitätsprüfung getestet. Nach der Optimierung des Prozesses erfolgt der vollständige Datenzugriff und die Analyse.Schlussfolgerungen: Das entwickelte Verfahren zur Datenakquise wurde erfolgreich im ADVOCATE- Projekt angewandt, um administrative Routinedaten von acht Dateneigentümern zu akquirieren, die jeweils unterschiedliche Nutzungsbedingungen vorschrieben. Ziel des Ansatzes ist es, einen Beitrag zu einem standardisierten Verfahren zur Akquise von Routinedaten für die Forschung zu leisten

Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults

Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants (n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20–39, 40–59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28–0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03–8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people’s dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted

Affordability of essential medicines: The case of fluoride toothpaste in 78 countries

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