Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract.

Introduction: Integrated care solutions need supportive financial incentives. In this paper, we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal.

Description Of Integrated Care Case: Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications.

Use of molecular beacons to image effects of titanium surface microstructure on beta1 integrin expression in live osteoblast-like cells.

This study used molecular beacon technology to examine substrate-dependent changes in integrin subunit expression in living cells. Molecular beacons are oligonucleotide probes that can be delivered into live cells to allow for real-time imaging of mRNA. They have a stem-loop hairpin structure with a fluorophore-quencher pair, which opens when bound to the target mRNA sequence, resulting in a fluorescent signal upon excitation.

The characteristics of online sex offenders: a meta-analysis.

There is much debate as to whether online offenders are a distinct group of sex offenders or if they are simply typical sex offenders using a new technology. A meta-analysis was conducted to examine the extent to which online and offline offenders differ on demographic and psychological variables. Online offenders were more likely to be Caucasian and were slightly younger than offline offenders.

What determines observer-rated social performance in individuals with social anxiety disorder?

Clark and Wells (1995) proposed that cognitive variables and safety behaviors are related to social performance in social anxiety disorder (SAD). Here, we tested this relationship by concurrent assessment of cognitive, behavioral, and physiological variables and social performance in a prototypical social interaction situation. 103 participants with SAD and 23 healthy controls interacted with a confederate.

An evidence-based practice primer for infusion nurses.

Evidence-based practice (EBP) is the process of using current, best evidence to guide nursing care and improve patient outcomes. This article discusses the differences between research and EBP, reviews the process of EBP, and applies EBP guidelines to central catheter infections, a clinical problem relevant to infusion nursing.

Cerebral processing of pain in school-aged children with neonatal nociceptive input: an exploratory fMRI study.

Due to maturation-related plasticity of the developing nociceptive system, neonatal nociceptive input, as induced by medical procedures in the neonatal intensive care unit (NICU), may cause long-term alterations in pain processing. Using functional magnetic resonance imaging, this study investigated the cerebral pain response in school-aged children and adolescents (11-16 yr) with experience in a NICU after preterm (or=37 weeks gestational age, N=9) as compared to fullterm control children without early hospitalization (N=9). NICU children had been recruited retrospectively among former patients of the Children's University Hospital Mannheim.

[Pott's puffy tumor - severe course of a sinusitis].

The disease pattern <> describes a local frontal-bone osteomyelitis that arises from an external infection with consecutive sub-periostal expansion. Symptoms may develop slowly or not at all with a mostly indolent protuberance on the patient's forehead. Symptomatic illness often indicates secondary morbidities.

Web-based audiovisual patient information system--a study of preoperative patient information in a neurosurgical department.

Background: In the current climate of increasing awareness, patients are demanding more knowledge about forthcoming operations. The patient information accounts for a considerable part of the physician's daily clinical routine. Unfortunately, only a small percentage of the information is understood by the patient after solely verbal elucidation.

Growth temperature-dependent expression of structural variants of Listeria monocytogenes lipoteichoic acid.

Investigating the expression of lipoteichoic acid (LTA) from Listeria monocytogenes, we found two distinct structural variants of LTA (LTA1 and LTA2) using NMR and MS technology. While both LTA consisted of a poly-glycerophosphate backbone (differing in length) bound via a disaccharide to a diacyl-glycerol moiety, one LTA type (LTA2) possessed a second diacyl-glycerol moiety linked to the disaccharide via a phosphodiester. As examined in vitro, LTA2 in contrast to LTA1 failed to activate the L-ficolin dependent pathway of complement.

Chlamydia pneumoniae-induced memory CD4+ T-cell activation in human peripheral blood correlates with distinct antibody response patterns.

Chlamydia pneumoniae is a frequent pathogen of the respiratory tract, and persistent infections with this obligate intracellular bacterium have been associated with different severe sequelae. Although T-cell activation during acute C. pneumoniae infections has been described, little is known about the frequency or the role of the C.

The mesenchymal stem cell antigen MSCA-1 is identical to tissue non-specific alkaline phosphatase.

We have recently identified 2 distinct CD271(bright)MSCA-1(dim)CD56(+) and CD271(bright)MSCA-1(bright)CD56(-) MSC subsets in primary femur-derived bone marrow (BM), which differ in their expression pattern and morphology as well as in their clonogenic and differentiation capacity. Here, we show that MSCA-1 is identical to tissue non-specific alkaline phosphatase (TNAP), an ectoenzyme known to be expressed at high levels in liver, bone, and kidney as well as in embryonic stem (ES) cells. SDS-PAGE of WERI-RB-1 cell lysate and supernatant from phosphatidylinositol-specific phospholipase C (PI-PLC)-treated WERI-RB-1 cells resulted in the appearance of a prominent 68-kDa band.

Comparative analysis of annexin-1 in neuroepithelial tumors shows altered expression with the grade of malignancy but is not associated with survival.

In various types of cancer, the expression of members of the annexin family of calcium- and phospholipid-binding anti-inflammatory proteins is dysregulated. Annexin-1 (ANXA1, lipocortin-1) is involved in proliferation, differentiation and apoptosis. It serves as a substrate for the epidermal growth factor receptor (EGFR), which is frequently amplified in primary gliomas.

Mating system variability in a mouthbrooding cichlid fish from a tropical lake.

Intraspecific variability in mating behaviour and disparities between social and reproductive behaviour add complexity to the description of animal mating systems. A previously published field study on a population of the maternally mouthbrooding cichlid fish Ctenochromis horei in the north of Lake Tanganyika suggested mate monopolization by the most dominant male. In the present study, genetic reconstructions of paternity in a population in the south of the lake provided no evidence for male mate monopolization, as none of the inferred sires had offspring in more than one brood.

[Web based audiovisual patient information system--a pilot study of the preoperative patient information].

A considerable part of the medical clinical daily routine incorporates the information of patients about medical diagnosis and especially about the scheduled operative intervention. The disease pattern, the course in the hospital before and after surgery and the operation itself will be discussed during these conversations. The patient has to be informed about all potential complications from a medico legal point of view.

Intraoperative use of packed red blood cell transfusion and mortality in patients undergoing abdominal or thoracoabdominal aortic aneurysm surgery.

Aim: A direct association between intraoperative use of red blood cell (RBC) transfusion and perioperative mortality in patients undergoing aortic aneurysm surgery has not been studied before.

Methods: One thousand patients (mean age, 69.0 +/- 10.

Erythropoietin receptor is expressed in meningiomas and lower levels are associated with tumour recurrence.

Aims: The Epo-EpoR pathway plays a role in tumour growth, metastasis and treatment resistance and is a potential target in oncological treatment. As the EpoR status in human meningiomas is unknown, our aim was to characterize EpoR expression in these tumours.

Methods: We examined 131 meningioma samples of all WHO grades from 116 patients by immunohistochemistry for EpoR.

Flowcytometric assessment of fetomaternal hemorrhage during external cephalic version at term.

External cephalic version (ECV) at term is a safe procedure and reduces the incidence of cesarean sections for breech presentation. One of the known complications, however, is an ECV-related disruption of the placental barrier and a subsequent transfusion of fetal blood into maternal circulation. While the incidence of ECV-related fetomaternal hemorrhage (FMH) has been determined recently in a large trial using a manual Kleihauer-Betke test (KBT), questions remain on the amount of ECV-related FMH.

Cholinergic modulation of the cerebral metabolic response to citalopram in Alzheimer's disease.

Pre-clinical and human neuropharmacological evidence suggests a role of cholinergic modulation of monoamines as a pathophysiological and therapeutic mechanism in Alzheimer's disease. The present study measured the effects of treatment with the cholinesterase inhibitor and nicotinic receptor modulator, galantamine, on the cerebral metabolic response to the selective serotonin reuptake inhibitor, citalopram. Seven probable Alzheimer's disease patients and seven demographically comparable controls underwent two positron emission tomography (PET) glucose metabolism scans, after administration of a saline placebo infusion (Day 1) and after citalopram (40 mg, IV, Day 2).

Do burn injuries during infancy affect pain and sensory sensitivity in later childhood?

Studies in animals and humans suggest that neonatal and early infant pain or stress experiences can induce long-term alterations in somatosensory and pain processing. We studied pain and sensory sensitivity in school-aged children (9-16 years) who had suffered moderate (N=24) or severe (N=24) burn injuries in infancy (6-24 months of age) and 24 controls. Quantitative sensory testing entailing detection and pain thresholds for thermal and mechanical stimuli and perceptual sensitization to tonic heat and repetitive mechanical stimuli was performed.

In-hospital smoking cessation programs: what do VA patients and staff want and need?

In preparation for delivering an inpatient smoking cessation intervention, surveys and interviews of general inpatients and staff were conducted in two Veterans Affairs (VA) hospitals to determine the motivation of veterans to quit smoking and to identify facilitators and barriers to inpatient staff delivery of inpatient cessation services. Seventy percent of inpatients were "motivated smokers" (thinking of quitting in the next 30 days), yet only 17% stated that they received cessation services during their hospitalization. Most staff said that VA should do more to assist patients to quit, yet less than half said that they personally provided cessation services due to lack of confidence/training and hesitancy to upset patients.

[Developing training in critical appraisal for GP trainees in the Eastern Region of Denmark].

In 2004 training in critical appraisal became a mandatory part of the Danish medical specialist training. In this article we describe how the course was designed and implemented on the basis of experience from previous research training initiatives targeting GPs and GP-trainees; and how we continuously develop the course and tailor the training of teachers for the course using a multi-method participatory evaluation design, theoretically based on Stenhouse's definition of the curriculum as a process and the teachers as researchers.

IL-10 release requires stronger toll-like receptor 4-triggering than TNF: a possible explanation for the selective effects of heterozygous TLR4 polymorphism Asp(299)Gly on IL-10 release.

The toll-like receptor 4 Asp(299)Gly polymorphism results in an inactive receptor. Heterozygosis is associated with reduced LPS-inducible IL-10 protein and IL-10 mRNA from blood leukocytes and isolated monocytes, while numerous other mediators are not affected. We could exclude that this effect is due to the differences in the kinetics of IL-10 release, in the expression of total surface TLR4 or in LPS-binding to monocytes between subjects heterozygous for the Asp(299)Gly polymorphism or homozygous carriers of the wild-type allele.

Emerging functional roles of cathepsin E.

Cathepsin E is an intracellular aspartic protease of the endolysosomal pathway. It has been implicated in several physiological and pathological processes however, its exact functional role is yet to be elucidated. The present review gives an account of the major physiological functions that are associated to cathepsin E by various research groups and highlights the conditions developed in cathepsin E deficiency or the conditions where overexpression of cathepsin E is observed.

Frequencies of genetic polymorphisms of TLR4 and CD14 and of HLA-DQ genotypes in children with celiac disease, type 1 diabetes mellitus, or both.

Objectives: Besides the central role of the adaptive immune system, a disturbance of innate immunity is also involved in the pathogenesis of celiac disease (CD). Inasmuch as CD and type 1 diabetes mellitus (T1DM) frequently coexist because of a common genetic predisposition, our aim was to study the frequency of CD14 C-260T and TLR4 A+896G single nucleotide polymorphisms (SNPs) and the distribution of HLA-DQ genotypes in children affected by CD, T1DM, or both.

Patients And Methods: TLR4 and CD14 SNPs were tested by polymerase chain reaction, followed by restriction fragment length polymorphism analysis in 80 children with T1DM, 100 children with CD, and 47 children with both CD and T1DM.