According to the central aim of the European Water Framework Directive, the protection and sustained management of the aquatic ecological system, the ecological condition of a specific type of water, will be the primary parameter in future. Aiming at good ecological status in surface water bodies, population diversity and abundance of fish and macroinvertebrates is decisive. Free passage in river systems, to allow the natural migration of fish and all other aquatic organisms, is a prerequisite. To achieve this for the Ruhr River Basin a study has been commissioned in order to develop a master plan for river continuum restoration. Sustainable development aimed at promoting biodiversity in the surface water body system is a key objective. This project is complemented by investigations of the sediment--which is the nursery of the fish--in the rivers to identify river sections or tributaries which obviously provide a suitable habitat for the successful reproduction of big Salmonidae. The master plan illustrates the inherent problems of projects aimed at the restoration of fish passage in water bodies which are strongly affected by anthropogenic modifications. The results obtained may as well be transferred to other catchments with similar use patterns.

A70318 CCG centres across the UK in an England/Scotland Lipohypertrohy Audit (ESLA) we developed a robust patient and HCP questionnaire that aimed to quantify the important role proper injection technique has in achieving and maintaining optimal glycemic control. A prospective, 3 visit audit study was conducted composed of 3 distinct phases: Study nurse training, patient recruitment, and finish study (patient exit). The primary endpoint was reduction in insulin usage. The secondary endpoint was reduction in HbA1c. These were comparted to baseline as well as modelled against a 13,000+ Injection Technique questionnaire to determine healthcare system savings and cost reductions. Results: The ESLA audits yielded an n of 75, and the ITQ yielded an n of 13,289. The results were comparable across both sample sizes. The prevalence of Lipohypertrophy was 50% on entry to the audit, and was reduced to 33% on exit. Mean insulin reduction related to ESLA ranged from 2 units per person per day to 17 units per person per day. ConClusions: Medical device value is materially impacted by the level of additional training and HCP support. The higher the training, the more aligned efficacy and effectiveness data become. This makes intuitive sense, as practice replicates the idea setting of a controlled trial. It is therefore highly recommended that additional training and HCP support be a key variable in the value assessment of medical devices.objeCtives: The unbalanced distribution of medical technologies and devices between rural and urban areas is a major problem for developing countries including Turkey. After the establishment of Public Hospital Unions (PHUs) in Turkey, legislative changes were made to improve the autonomy of public hospitals. This study utilizes spatial analysis to assess the distribution of medical device use in Turkey using PHUs as a decision making unit. Methods: Data from the PHUs' statistics year book for the year 2014 was assessed. The total number of PHUs is 89. A Hierarchical cluster analysis was performed to classify PHUs according to the total number of medical devices. The Euclidean distance measure and Wards methods were used in the analysis for classification. Results: Study results show that, in Turkey, PHUs were categorized into two clusters based on the total number of medical devices available. Regarding the spatial distribution of the clusters, the first cluster represents PHUs in rural areas, and the second represents PHUs located in urban areas of Turkey. PHUs representing large cities with high population density were included in one cluster, and all other PHUs were included in the second. Statistical test results indicated that the two clusters differ according to the total number of magnetic resonance imaging (MRI: t= -14.10, p< 0.01), computed tomography (CT) scan (t= -15.75, p< 0.01), mammography (t= -11.40, p< 0.01), ultrasonography (t= -14.62, p< 0.01), and electrocardiography (EKG; t= -12.29, p< 0.01) equipment available. ConClusions: It is advisable for health policy makers and heal...

The protection and sustainable management of the aquatic ecosystems is the central aim of the European Water Framework Directive. Due to the aspiration for good ecological status of the water bodies free fish passage will play an important part in river basin management. The Ruhr River has seen severe anthropogenic modifications due to urbanisation and industrialisation in the 19th and 20th centuries leading in the existence of approx. 1300 weirs within the Ruhr River Basin. The majority of the barriers are assessed as not passable or restricted passable. Against this background the Ruhrverband made a holistic approach towards restoring fish passage within the Ruhr catchment. Besides the scientific and technical aspects, such as the determination of potential (spawning) habitats and the development of measures in order to reach them, they also considered cost-benefit-ratio considerations for the Ruhr catchment as a whole as well as for site-specific designs of fish passage structures. Various benefits were evaluated taking into account different fields of economic interest. The model of financing all necessary measures should involve all responsible parties benefiting from the water utilizations. Such a mutual procedure delivers a fair cost distribution as well as an efficient implementation of measures.

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