Parnassius apollo in Bayern und einigen Grenzbezirken

Als H. Stichel im Jahre 1899 den mitteleuropäischen Parn. apollo von der nordischen Rasse unter dem Namen geminus abtrennte, hat diese Teilung nicht die uneingeschränkte Anerkennung der Entomologen gefunden und als er dann später im Jahre 1906 noch die Unterart melliculus aufstellte, bedeutete diese Neuerung „ einen Stich ins Wespennest , wie er sich selbst ausdrückte. Der Grund hier-für ist jedoch kaum in einem Mangel der Zweckmäßigkeit begründet, sondern der ungenauen vom Autor selbst nur als relativ brauchbar bezeichneten Diagnose zuzuschreiben. Für SticheI bedeutete geminus einen Kollektivbegriff für „ die Gesamtheit der den europä-ischen Hoch- und Mittelgebirgen angehörigen Formen mit Ausnahme der schwedischen Rasse. Die spätere Beschränkung dieser Kollektiv-form auf die Hoch- und Mittelgebirge Mittel - Europas *) trägt zur Klärung der Analyse nicht bei. Daß bei der großen Veränderlichkeit des Apollofalters und bei dem tatsächlichen Bestehen einer Anzahl territorialer Formen mit diesem Sammelbegriff für die Systematik nicht viel anzufangen ist, liegt auf der Hand. Brauchbar indessen wird die Trennung, wenn wir auf den anderen Teil der Analyse: ,,namentlich des Deutsch-österreichischen Alpengebietes die ausschließliche Betonung legen. In dem Sinne, daß unter geminus die Form des deutsch-österreichischen Alpengebietes, dem noch das schweizerische Alpenland beizuziehen wäre, zu verstehen ist, hat sie ihre volle Berechtigung

Justification and reporting of subgroup analyses were lacking or inadequate in randomized controlled trials

Objectives: The aim of the article was to assess the appropriateness and rationales of subgroup analyses planned in protocols of randomized controlled trials and reported in subsequent corresponding trial publications. Study Design and Setting: We searched PubMed to identify trial protocols published in journals during 2006–2017. From a total of 3,774 initially identified records, we included a random sample of 479 protocols and identified 280 trial publications corresponding to the included protocols. Results: Subgroup analyses were specified in 19% of the protocols and reported in 21% of the trial publications. Of the 94 protocols with planned subgroup analyses, 32% mentioned testing for interaction, and only three considered statistical power. Subgroup analyses were not prespecified in 56% of the 59 trial publications with subgroup analyses. Subgroup analyses were stated as prespecified in nine trial publications, without support evidence from the corresponding protocols. Subgroup analyses were often reported insufficiently for assessing the consistency of subgroup effects across studies. Justifications for subgroup analyses were provided in only four trial protocols and seven trial publications. Conclusion: Inappropriate specification and reporting of subgroup analyses remain problematic in protocols and reports of randomized controlled trials. Justifications or rationales for subgroup analyses were only rarely provided in trial protocols and reports

Bridging the mental health treatment gap: Effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city

OBJECTIVE: To analyse temporal trends in diagnosis and treatment of mental disorders in primary care following implementation of a collaborative care intervention (matrix support). DESIGN: Dynamic cohort design with retrospective time-series analysis. Structured secondary data on medical visits to general practitioners of all study clinics were extracted from the municipal electronic records database. Annual changes in the odds of mental disorders diagnoses and antidepressants prescriptions were estimated by multiple logistic regression at visit and patient-year levels with diagnoses or prescriptions as outcomes. Annual changes during two distinct stages of the intervention (stage 1 when it was restricted to mental health (2005-2009), and stage 2 when it was expanded to other areas (2010-2015)) were compared by adding year-period interaction terms to each model. SETTING: 49 primary care clinics in the city of Florianópolis, Brazil. PARTICIPANTS: All adults attending primary care clinics of the study setting between 2005 and 2015. RESULTS: 3 131 983 visits representing 322 100 patients were analysed. At visit level, the odds of mental disorder diagnosis increased by 13% per year during stage 1 (OR 1.13, 95% CI 1.11 to 1.14, p<0.001) and decreased by 5% thereafter (OR 0.95, 95% CI 0.94 to 0.95, p<0.001). The odds of incident mental disorder diagnoses decreased by 1% per year during stage 1 (OR 0.99, 95% CI 0.98 to 1.00, p=0.012) and decreased by 7% per year during stage 2 (OR 0.93, 95% CI 0.92 to 0.93, p<0.001). The odds of antidepressant prescriptions in patients with a mental disorder diagnosis increased by 7% per year during stage 1 (OR 1.07, 95% CI 1.05 to 1.20, p<0.001); this was driven by selective serotonin reuptake inhibitor prescriptions which increased 14% per year during stage 1 (OR 1.14, 95% CI 1.12 to 1.18, p<0.001) and 9% during stage 2 (OR 1.09, 95% CI 1.08 to 1.10, p<0.001). The odds of incident antidepressant prescriptions did not increase during stage 1 (OR 1.00, 95% CI 0.97 to 1.02, p=0.665) and increased by 3% during stage 2 (OR 1.03, 95% CI 1.00 to 1.04, p<0.001). Changes per year were all significantly greater during stage 1 than stage 2 (p values for interaction terms <0.05), except for antidepressant prescriptions during visits (p=0.172). CONCLUSION: The matrix support intervention may increase diagnosis and treatment of mental disorders when inter-professional collaboration is adequately supported. Competing demands to the primary care teams can subsequently reduce these effects. Future studies should assess clinical outcomes and identify active components and factors associated with successful implementation

Methodology to design district heating systems with respect to local energy potentials, CO2-emission restrictions, and federal subsidies using oemof

To combine a variety of different heat generating technologies, static design methods will not be sufficient to design future heat supply systems. New energy system design approaches are being developed with consideration of fluctuating renewable energy sources, different subsidy measures, as well as CO2-emission reduction targets. The motive of this study is to develop a new methodology to design and optimise an energy system considering these constraints. The methodology is developed based on the Open Energy Modelling Framework (oemof) and applied on a sub-urban region in northern Germany. Local specifics of energy source potentials are taken into account. It adapts the boundary conditions of a German federal funding program for innovative heat supply networks “Heating Network Systems 4.0.” Federal funding restrictions of combined heat and power systems and self-consumption are also considered. An economic optimisation was conducted considering a variety of energy sources. Cost optimal energy system design was computed regarding investments costs, energy prices and annual CO2-emission restrictions. The integration of combined heat and power (CHP), photovoltaic (PV) and heat pump (HP) systems in combination with storage size optimisation can reduce CO2-emission of heat production by approx. 69% compared to the current state of heat production

Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome:a prospective registry study

Objective: This study aims to study the prognostic impact of LV function on mortality and examine the effect of age on the prognostic value of left ventricular function.  Methods: We examined the Myocardial Ischaemia National Audit Project (MINAP) registry (2006-2010) data with a mean follow up of 2.1 years. LV function was categorized into good (ejection fraction (EF) ≥50%), moderate (EF 30-49%) and poor (EF <30%) categories. Cox-proportional hazards models were constructed to examine the prognostic significance of LV function in different age groups (<65, 65-74, 75-84 and ≥85 years) on all-cause mortality adjusting for baseline variables.  Results: Of 424,848 patients, LV function data available for 123,609. Multiple imputations were used to impute missing values of LV function and the final sample for analyses were drawn from 414,305. After controlling for confounders, 339,887 participants were included in the regression models. For any age group, mortality was higher with worsening degree of LV impairment. Increased age reduced the adverse prognosis associated with reduced LV function (hazard ratios (HRs) of death comparing poor LV function to good LV function were 2.11 95%CI 1.88-2.37 for age <65 years and 1.28 95%CI 1.20-1.36 for age ≥85 years. Older patients had a high mortality risk even in those with good LV function. HRs of mortality for ≥85 compared to <65 years (HR=1.00) within good, moderate and poor ejection fractions groups were 5.89, 4.86 and 3.43, respectively.  Conclusions: In patients with ACS, clinicians should interpret the prognostic value of LV function taking into account patient’s age

Prevalence and health effects of communicable and non-communicable disease comorbidity in rural KwaZulu-Natal, South Africa

Objectives: To describe changes in prevalence of hypertension, diabetes, HIV and tuberculosis, and prevalence of comorbidity, and to investigate associations between each condition, and combinations of conditions, with self-reported general health and hospital admission. Methods: This study used data from a longitudinal population-based HIV and health surveillance cohort, conducted by the Africa Health Research Institute in Umkhanyakude district of rural KwaZulu-Natal, South Africa. Results: Prevalence of hypertension, HIV and diabetes increased from 2009 to 2015, and prevalence of tuberculosis decreased. 81% of the 47 334 participants were female; hypertension and diabetes were the commonest conditions in people over age 50, whereas HIV was most common in those younger than 50 years. Comorbidity of communicable and non-communicable conditions was commonest in 40- to 60-year-olds. The adjusted odd ratios (OR) for better self-reported general health with multimorbidity were 0.53 (95% CI 0.51–0.56), 0.29 (95% CI 0.27–0.29), 0.25 (95% CI 0.21–0.37) and 0.21 (95% CI 0.12–0.37) for one, two, three and four conditions, respectively, vs. no conditions. Tuberculosis was most strongly and inversely associated with better general health (OR 0.34 (0.31–0.37) and most strongly associated with hospital admission (OR 3.26 (2.32–2.99)). Conclusion: The high prevalence of communicable and non-communicable conditions in this rural South African population is giving rise to a burden of multimorbidity, as increased access to antiretroviral treatment has reduced mortality in people with HIV. Healthcare systems must adapt by working towards integrated primary care for HIV/AIDS and non-communicable diseases

What are children's trusts? Early findings from a national survey

&lt;i&gt;Background:&lt;/i&gt; The Children Act 2004 and National Service Framework for Children, Young People and Maternity Services require fuller integration of health, education and social services for children and young people in England and Wales. The UK government supported the establishment of 35 experimental children's trust pathfinders (henceforth called children's trusts) in England. &lt;i&gt;Methods:&lt;/i&gt; A questionnaire was completed by managers in all 35 children's trusts a year after their start. Children's trust documents were examined. Census and performance indicators were compared between children's trust areas and the rest of England. &lt;i&gt;Results&lt;/i&gt; Children's trust areas had demographic and social characteristics typical of England. All children's trusts aimed to improve health, education and social services by greater managerial and service integration. All had boards representing the three sectors; other agencies’ representation varied. Two-thirds of children's trusts had moved towards pooling budgets in at least some service areas. At this stage in their development, some had prioritized joint procurement or provision of services, with formal managerial structures, while others favoured an informal strategic planning, co-ordination and information sharing approach. The commonest priorities for services development were for disabled children (16 children's trusts), followed by early intervention (11) and mental health services (8). &lt;i&gt;Conclusions:&lt;/i&gt; The diverse strategies adopted by these 35 children's trusts during their first year is due to their own characteristics and to the way government strategy developed during this period. Whilst some prioritized organizational development, joint financing and commissioning, and information sharing, others laid more emphasis on mechanisms for bringing front-line professionals closer together. Their experiences are of value to others deciding how best to integrate children's services

Vaccination against COVID-19 and societys return to normality in England: a modelling study of impacts of different types of naturally acquired and vaccine-induced immunity

Objectives:  To project impacts of mass vaccination against COVID-19, and investigate possible impacts of different types of naturally acquired and vaccine-induced immunity on future dynamics of SARS-CoV-2 transmission from 2021 to 2024 in England. Design:  Deterministic, compartmental, discrete-time Susceptible-Exposed-Infectious-Recovered (SEIR) modelling. Participants:  Population in England. Interventions:  Mass vaccination programmes. Outcome measures:  Daily and cumulative number of deaths from COVID-19. Results:  If vaccine efficacy remains high (85%), the vaccine-induced sterilising immunity lasts ≥182 days, and the reinfectivity is greatly reduced (by ≥60%), annual mass vaccination programmes can prevent further COVID-19 outbreaks in England. Under optimistic scenarios, with annual revaccination programmes, the cumulative number of COVID-19 deaths is estimated to be from 130 000 to 150 000 by the end of 2024. However, the total number of COVID-19 deaths may be up to 431 000 by the end of 2024, under scenarios with compromised vaccine efficacy (62.5%), short duration of natural and vaccine immunity (365/182 days) and small reduction in reinfectivity (30%). Under the assumed scenarios, more frequent revaccinations are associated with smaller total numbers and lower peaks of daily deaths from COVID-19. Conclusions:  Under optimistic scenarios, mass immunisation using efficacious vaccines may enable society safely to return to normality. However, under plausible scenarios with low vaccine efficacy and short durability of immunity, COVID-19 could continue to cause recurrent waves of severe morbidity and mortality despite frequent vaccinations. It is crucial to monitor the vaccination effects in the real world, and to better understand characteristics of naturally acquired and vaccine-induced immunity against SARS-CoV-2