The German health care Innovation Fund – An incentive for innovations to promote the integration of health care

Purpose – Many health systems face challenges such as rising costs and lacking quality, both of which can be addressed by improving the integration of different health care sectors and professions. The purpose of this viewpoint is to present the German health care Innovation Fund (IF) initiated by the Federal Government to support the development and diffusion of integrated health care. Design/methodology/approach – This article describes the design and rationale of the IF in detail and provides first insights into its limitations, acceptance and implementation by relevant stakeholders. Findings – In its first period, the IF offered V 1.2 billion as start-up funding for model implementation and evaluation over a period of four years (2016–2019). This period was recently extended to a second round until 2024, offering V 200 million a year as from 2020. The IF is triggering the support of relevant insurers for the development of new integrated care models. In addition, strict evaluation requirements have led to a large number of health service research projects which assess structural and process improvements and thus enable evidence-based policy decisions. Originality/value – This article is the first of its kind to present the German IF to the international readership. The IF is a political initiative through which to foster innovations and promote integrated health care

Quantitatively Measured Anatomic Location and Volume of Optic Disc Drusen: An Enhanced Depth Imaging Optical Coherence Tomography Study

Optic disc drusen (ODD) are found in up to 2.4% of the population and are known to cause visual field defects. The purpose of the current study was to investigate how quantitatively estimated volume and anatomic location of ODD influence optic nerve function. Anatomic location, volume of ODD, and peripapillary retinal nerve fiber layer and macular ganglion cell layer thickness were assessed in 37 ODD patients using enhanced depth imaging optical coherence tomography. Volume of ODD was calculated by manual segmentation of ODD in 97 B-scans per eye. Anatomic characteristics were compared with optic nerve function using automated perimetric mean deviation (MD) and multifocal visual evoked potentials. Increased age (P = 0.015); larger ODD volume (P = 0.002); and more superficial anatomic ODD location (P = 0.007) were found in patients with ODD visible by ophthalmoscopy compared to patients with buried ODD. In a multivariate analysis, a worsening of MD was significantly associated with larger ODD volume (P <0.0001). No association was found between MD and weighted anatomic location, age, and visibility by ophthalmoscopy. Decreased ganglion cell layer thickness was significantly associated with worse MD (P = 0.025) and had a higher effect on MD when compared to retinal nerve fiber layer thickness. Large ODD volume is associated with optic nerve dysfunction. The worse visual field defects associated with visible ODD should only be ascribed to larger ODD volume and not to a more superficial anatomic ODD location

Amnesia, flashbacks, nightmares, and dissociation in aging concentration camp survivors.

Abstract The current study examined to what extent war memories of Dutch survivors of Japanese/Indonesian concentration camps display characteristics that are often believed to be typical for traumatic memories. Twenty-nine survivors were interviewed about amnesia, flashbacks, nightmares and the sensory quality of their most upsetting war memories. In addition, they completed self-report scales measuring post-traumatic stress symptoms and dissociation. In contrast to prevailing notions, amnesia, flashbacks and nightmares were not typical for this sample. Neither were traumatic memories characterized by a particularly strong sensory loading. Post-traumatic stress symptoms were not related to dissociative experiences. At least for this group of aging survivors, it appears that the pathogenic potential of traumatic memories has more to do with their extremely aversive content than with a qualitatively different type of organization of these memories

Betydningen av unike hotellkonsepter

I denne oppgaven har vi valgt å undersøke hvilken betydning unikhet i hotellkonsept vil ha for betalingsviljen i ferie- og fritidsmarkedet. Hotellmarkedet har i senere tid endret seg fra det å være et sted å sove, til å skape unike hotellopplevelser. Basert på Hotelia-rapporten 2019 kan vi se at de unike hotellkonseptene på markedet viser til best resultater gjennom det siste året, noe som ga oss en indikasjon på at dette er noe som kan være relevant å utforske nærmere. Vi ønsker derfor å se nærmere på hvilke faktorer som kan bidra til å skape et unikt konsept og hvilken betydning serviceleveransen har for et hotell for å kunne fremstå som unikt. Vi har i denne oppgaven benyttet oss av kvalitativt forskningsdesign og semistrukturerte intervjuer med et fenomenologisk perspektiv. Basert på våre kriterier for intervjuguiden, har vi intervjuet fem personer fra bransjen som hadde relevant erfaring, kompetanse og stilling. Vi presenterte de samme spørsmålene til alle for å få best mulig sammenligningsgrunnlag, men varierte noe på oppfølgingspørsmålene ved behov. Basert på teori og informasjon fra informantene, danner dette grunnlaget for funnene våres i denne oppgaven og konklusjonen på vår problemstilling. Vi samlet svarene fra informantene etter en kodegruppering for å sammenligne og trekke ut de viktigste funnene. Etter å ha analysert datamaterialet har vi kommet frem til at det er flere faktorer som spiller inn i hvilken grad et hotellkonsept kan anses som unikt, hvor vi også kan konkludere med at mye samsvarer med teorien. Det er blant annet vesentlig å kunne skille seg ut fra konkurrentene ved ulike differensierende faktorer som eksempelvis historie, kultur, beliggenhet eller design. Viktigheten av å jobbe strategisk med verdikommunikasjon kommer tydelig frem, for å kunne tiltrekke seg riktig segment. Gjennom verdikommunikasjon vil man kunne skape en forventningsavklaring til gjesten, som skal sette standarden for hva man kan vente seg av hotellopplevelsen og servicen som medfølger. I tillegg kom det frem at det er vesentlig å ha en god prisstruktur som representerer god verdi for gjesten. Ved å ha en tydelig prispolitikk vil det skape forutsigbarhet for gjesten som øker sannsynligheten for at de aksepterer prisen som er satt. Nøkkelkundene ser produktet for dets best potensielle verdi og er et godt verktøy for å forbedre produktet for å nå sitt best mulig potensiale, og ved å vedlikeholde disse relasjonene vil det skape lønnsomme inntekter i fremtiden

Piscine orthoreovirus infection in Atlantic salmon (Salmo salar) protects against subsequent challenge with infectious hematopoietic necrosis virus (IHNV)

Abstract Infectious hematopoietic necrosis virus (IHNV) is endemic in farmed rainbow trout in continental Europe and in various salmonid fish species at the Pacific coast of North America. IHN has never occurred in European Atlantic salmon (Salmo salar) farms, but is considered as a major threat for the European salmon industry. Another virus, Piscine orthoreovirus (PRV), is widespread in the sea phase of Atlantic salmon, and is identified as the causative agent of heart and skeletal muscle inflammation. The aim of this study was to investigate the interactions between a primary PRV infection and a secondary IHNV infection under experimental conditions. A PRV cohabitation challenge was performed with Atlantic salmon. At peak of PRV viremia the fish were challenged by immersion with an IHNV genogroup E isolate. Clinical signs and morbidity were monitored. Target organs were sampled at selected time points to assess viral loads of both pathogens. Antiviral immune response and presence of histopathological findings were also investigated. Whereas the PRV-negative/IHNV positive group suffered significant decrease in survival caused by IHNV, the PRV infected groups did not suffer any morbidity and showed negligible levels of IHNV infection. Antiviral response genes were induced, as measured in spleen samples, from PRV infected fish prior to IHNV challenge. In conclusion, PRV-infection protects Atlantic salmon against IHNV infection and morbidity, most likely by inducing a protective innate antiviral response

Molecular and antigenic characterization of Piscine orthoreovirus (PRV) from rainbow trout (Oncorhynchus mykiss)

Piscine orthoreovirus (PRV-1) causes heart and skeletal muscle inflammation (HSMI) in farmed Atlantic salmon (Salmo salar). Recently, a novel PRV (formerly PRV-Om, here called PRV-3), was found in rainbow trout (Oncorhynchus mykiss) with HSMI-like disease. PRV is considered to be an emerging pathogen in farmed salmonids. In this study, molecular and antigenic characterization of PRV-3 was performed. Erythrocytes are the main target cells for PRV, and blood samples that were collected from experimentally challenged fish were used as source of virus. Virus particles were purified by gradient ultracentrifugation and the complete coding sequences of PRV-3 were obtained by Illumina sequencing. When compared to PRV-1, the nucleotide identity of the coding regions was 80.1%, and the amino acid identities of the predicted PRV-3 proteins varied from 96.7% (λ1) to 79.1% (σ3). Phylogenetic analysis showed that PRV-3 belongs to a separate cluster. The region encoding σ3 were sequenced from PRV-3 isolates collected from rainbow trout in Europe. These sequences clustered together, but were distant from PRV-3 that was isolated from rainbow trout in Norway. Bioinformatic analyses of PRV-3 proteins revealed that predicted secondary structures and functional domains were conserved between PRV-3 and PRV-1. Rabbit antisera raised against purified virus or various recombinant virus proteins from PRV-1 all cross-reacted with PRV-3. Our findings indicate that despite different species preferences of the PRV subtypes, several genetic, antigenic, and structural properties are conserved between PRV-1 and-3

Infection experiments with novel Piscine orthoreovirus from rainbow trout (Oncorhynchus mykiss) in salmonids

A new disease in farmed rainbow trout (Onchorhyncus mykiss) was described in Norway in 2013. The disease mainly affected the heart and resembled heart and skeletal muscle inflammation (HSMI) in Atlantic salmon (Salmo salar L.). HSMI is associated with Piscine orthoreovirus (PRV), and a search for a similar virus in the diseased rainbow trout led to detection of a sequence with 85% similarity to PRV. This finding called for a targeted effort to assess the risk the new PRV-variant pose on farmed rainbow trout and Atlantic salmon by studying infection and disease pathogenesis, aiming to provide more diagnostic knowledge. Based on the genetic relationship to PRV, the novel virus is referred to as PRV-Oncorhynchus mykiss (PRV-Om) in contrast to PRV-Salmo salar (PRV-Ss). In experimental trials, intraperitoneally injected PRV-Om was shown to replicate in blood in both salmonid species, but more effectively in rainbow trout. In rainbow trout, the virus levels peaked in blood and heart of cohabitants 6 weeks post challenge, along with increased expression of antiviral genes (Mx and viperin) in the spleen, with 80-100% of the cohabitants infected. Heart inflammation was diagnosed in all cohabitants examined 8 weeks post challenge. In contrast, less than 50% of the Atlantic salmon cohabitants were infected between 8 and 16 weeks post challenge and the antiviral response in these fish was very low. From 12 weeks post challenge and onwards, mild focal myocarditis was demonstrated in a few virus-positive salmon. In conclusion, PRV-Om infects both salmonid species, but faster transmission, more notable antiviral response and more prominent heart pathology were observed in rainbow trout