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The Balasore coastal groundwater basin in Orissa, India is under a serious threat of overdraft and seawater intrusion. The overexploitation resulted in abandoning many shallow tubewells in the basin. The main intent of this study is the development of a 2-D groundwater flow and transport model of the basin using the Visual MODFLOW package for analyzing the aquifer response to various pumping strategies. The simulation model was calibrated and validated satisfactorily. Using the validated model, the groundwater response to five pumping scenarios under existing cropping conditions was simulated. The results of the sensitivity analysis indicated that the Balasore aquifer system is more susceptible to the river seepage, recharge from rainfall and interflow than the horizontal and vertical hydraulic conductivities and specific storage. Finally, based on the modeling results, salient management strategies are suggested for the long-term sustainability of vital groundwater resources of the Balasore groundwater basin. The most promising management strategy for the Balasore basin could be: a reduction in the pumpage from the second aquifer by 50% in the downstream region and an increase in the pumpage to 150% from the first and second aquifer at potential locations.

Common questions that arise regarding treatment of gastroesophageal reflux disease (GERD) include which medications are most effective, when surgery may be indicated, which patients should be screened for Barrett esophagus and Helicobacter pylori infection, and which adverse effects occur with these medications. Proton pump inhibitors (PPIs) are the most effective medical therapy, and all PPIs provide similar relief of GERD symptoms. There is insufficient evidence to recommend testing for H. pylori in patients with GERD. In the absence of alarm symptoms, endoscopy is not necessary to make an initial diagnosis of GERD. Patients with alarm symptoms require endoscopy. Screening for Barrett esophagus is not routinely recommended, but may be considered in white men 50 years or older who have had GERD symptoms for at least five years. Symptom remission rates in patients with chronic GERD are similar in those who undergo surgery vs. medical management. PPI therapy has been associated with an increased risk of hip fracture, hypomagnesemia, community-acquired pneumonia, vitamin B12 deficiency, and Clostridium difficile infection.

An examination of U.S. real estate investment trust (REIT) efficiency as a portfolio component from the perspective of all G-7 countries for the period 1985 through 1994 indicates that U.S. REITs offer both an inflation hedge and diversification. Nevertheless, including REITs in test portfolios did not yield statistically significant increases in risk-adjusted return over the period as a whole. Subperiod analyses indicated large temporal differences in REIT efficiency as a portfolio component.

Der ärztliche Bildungsweg gliedert sich in die Ausbildung (Studium der Humanmedizin), die Weiterbildung zum Facharzt und die kontinuierliche Fortbildung. Hier sollen alle wissenschaftlichen Kenntnisse und praktischen Fertigkeiten erworben werden, die zur eigenverantwortlichen fachärztlichen Tätigkeit befähigen. In der vorliegenden Arbeit werden die vorgeschriebenen Lehrinhalte mit Blick auf medizintechnische Themen analysiert, weil die klinische Medizintechnik mittlerweile in der modernen Patientenversorgung eine zentrale Stellung hat. Diese Stellung ist mit der Bedeutung der Pharmakotherapie vergleichbar und resultiert aus dem enormen wissenschaftlichen und technischen Fortschritt. Die vorliegende Auswertung zeigt, dass vorgeschriebene Lehrinhalte zur klinischen Medizintechnik bislang in den ärztlichen Ausbildungsordnungen unterrepräsentiert sind und zukünftig in der ärztlichen Aus-, Weiter- und Fortbildung stärker berücksichtigt werden sollten. Hierfür werden mögliche Lösungsansätze vorgestellt.

ABSTRACT One hundred ninety-five consecutive patients underwent 195 primary unilateral total hip arthroplasties between January 1988 and December 1993. Patients were divided into three groups based on the type of anesthesia utilized for their procedure. Group I consisted of 108 patients (59 women and 49 men; average age 56 years) who had general endotracheal anesthesia alone. Group Il consisted of 70 patients (41 women and 29 men, average age 58 years) who had general endotracheal anesthesia with epidural augmentation intraoperativeiy and postoperatively. Group III consisted of 17 patients (6 women and 11 men, average age 62 years) who had epidural anesthesia only. Data were analyzed by anesthesia group to compare a variety of clinically relevant factors. No statistically significant differences among groups were noted regarding average age at surgery, the underlying diagnoses leading to joint replacement, the number of preexisting medical conditions, length of hospitalization, nonsurgical operating room time, intraoperative blood transfusions, intraoperative femur fractures, deep venous thrombosis, deep infections, death, or the prevalence of postoperative urinary tract infections. Postoperative urinary tract infections correlated with duration of Foley catheterization, but not the duration of epidural catheterization. Significant differences among anesthesia groups were observed for two factors: 1) estimated intraoperative blood loss was highest for Group I (P < .05) and was primarily a function of surgical time (P < .0001), and 2) postoperative Hemovac output (over the first and second postoperative 24-hour periods) was greatest for Group II (P < .05). Epidural anesthesia appears to be a safe modality in patients undergoing primary unilateral total hip replacement.

Every man has to consume a certain quatity of water every day. This use constitutes the most basic need for water. In households water is also used for basic hygiene, washing, cleaning, and for the transport of sewage. Water is used in industry for cooling, generating electric power, for the production of a large variety of goods, and other purposes. The greatest demand for water results from irrigation. To satisfy these demands, an increasing quantity of ground-water is used. It is available at many places, where far extended subsurface reservoirs exist; it is better protected against pollution than surface water. But even though ground-water exists in many geological formations, which seem to be infinite, the availability is limited. The recharge of ground-water is dependent on the supply of atmospheric moisture. Especially in semiarid and arid zones this component of the hydrologic cycle determines the availability of ground-water. Besides natural conditions, technical and economic factors such as drilling of boreholes and the cost of pumping of ground-water have to be considered. Also political decisions can limit the availability of ground-water. If, for instance, wetlands are destroyed by drawdown of ground-water, nontechnical and noneconomical aspects are involved. We face undesirable effects because of ground-water pumping. Whether these effects are tolerable or intolerable depends on the decision-making processes on a political level.

In many areas, the water demand of households, industries and farms is satisfied by ground water. Because of many human activities ground-water quality decreases, it is necessary to protect it. The quantity of pollutants entering the aquifers can be minimized by technical and legal measures. But it seems to be almost impossible to solve the problem regionally or nationwide. The delineation of protection zones around existing or planned wells is a more effective way. The intake area of wells or well fields have to be protected by legal measures against all activities which may affect ground-water quality. Regarding the migration of viruses and bacteria, it is well known that these biological pollutants have a distinct limited lifetime in aquifers, which is for West Germany estimated at 50 days. Because during this limited time they can move with the ground water, transfer diseases, and cause epidemics, certain zones around wells must be kept free from activities which may introduce bacteria into the subsurface systems. These zones are generally smaller than the catchments. For the determination of the zones, careful studies and calculations of the distance-velocity of ground water are necessary. Primary methods are the use of tracers and simple calculations. Examples are given for calculating the distance to the 50-day line, based on West German experience.

It has been shown that Fusarium lini B. grown on an artificial stock culture medium when supplemented with thiamin provides adequate amounts of the B-complex vitamins for normal growth, reproduction and lactation in mice, and that it compares very favorably with brewer's yeast in its food value.