The Expenditures for Academic Inpatient Care of Inflammatory Bowel Disease Patients Are Almost Double Compared with Average Academic Gastroenterology and Hepatology Cases and Not Fully Recovered by Diagnosis-Related Group (DRG) Proceeds

Background Crohn’s disease (CD) and ulcerative colitis (UC) challenge economies worldwide. Detailed health economic data of DRG based academic inpatient care for inflammatory bowel disease (IBD) patients in Europe is unavailable. Methods IBD was identified through ICD-10 K50 and K51 code groups. We took an actual costing approach, compared expenditures to G-DRG and non-DRG proceeds and performed detailed cost center and type accounting to identify coverage determinants. Results Of all 3093 hospitalized cases at our department, 164 were CD and 157 UC inpatients in 2012. On average, they were 44.1 (CD 44.9 UC 43.3 all 58) years old, stayed 10.1 (CD 11.8 UC 8.4 vs. all 8) days, carried 5.8 (CD 6.4 UC 5.2 vs. all 6.8) secondary diagnoses, received 7.4 (CD 7.7 UC 7 vs. all 6.2) procedures, had a higher cost weight (CD 2.8 UC 2.4 vs. all 1.6) and required more intense nursing. Their care was more costly (means: total cost IBD 8477€ CD 9051€ UC 7903€ vs. all 5078€). However, expenditures were not fully recovered by DRG proceeds (means: IBD 7413€, CD 8441€, UC 6384€ vs all 4758€). We discovered substantial disease specific mismatches in cost centers and types and identified the medical ward personnel and materials budgets to be most imbalanced. Non-DRG proceeds were almost double (IBD 16.1% vs. all 8.2%), but did not balance deficits at total coverage analysis, that found medications (antimicrobials, biologics and blood products), medical materials (mostly endoscopy items) to contribute most to the deficit. Conclusions DRGs challenge sophisticated IBD care

Μέτρα ασφαλείας κατά τη διαδικασία προσέγγισης,φορτοεκφότωσης και αναχώρησης πλοίων μεταφοράς καυσίμων υδρογονανθράκων

Le Lagadec, MD ORCiD: 0000-0003-0114-8552'Abnormal vertical growth' (AVG) was recognised in Australia as a dysfunction of macadamia (Macadamia spp.) in the mid-1990s. Affected trees displayed unusually erect branching, and poor flowering and yield. Since 2002, the commercial significance of AVG, its cause, and strategies to alleviate its affects, has been studied. The cause is still unknown, and AVG remains a serious threat to orchard viability. AVG affects both commercial and urban macadamia. It occurs predominantly in the warmer-drier production regions of Queensland and New South Wales. An estimated 100,000 orchard trees are affected, equating to an annual loss of $ 10.5 M. In orchards, AVG occurs as aggregations of affected trees, affected tree number can increase by 4.5% per year, and yield reduction can exceed 30%. The more upright cultivars 'HAES 344' and '741' are highly susceptible, while the more spreading cultivars 'A4', 'A16' and 'A268' show tolerance. Incidence is higher (p<0.05) in soils of high permeability and good drainage. No soil chemical anomaly has been found. Fine root dry weight of AVG trees (0-15 cm depth) was found lower (p<0.05) than non-AVG. Next generation sequencing has led to the discovery of a new Bacillus sp. and a bipartite Geminivirus, which may have a role in the disease. Trunk cinctures will increase (p<0.05) yield of moderately affected trees. Further research is needed to clarify whether a pathogen is the cause, the role of soil moisture in AVG, and develop a varietal solution

On the effect of low oxygen concentrations on bacterial degradation of sinking particles

In marine oxygen (O2) minimum zones (OMZs), the transfer of particulate organic carbon (POC) to depth via the biological carbon pump might be enhanced as a result of slower remineralisation under lower dissolved O2 concentrations (DO). In parallel, nitrogen (N) loss to the atmosphere through microbial processes, such as denitrification and anammox, is directly linked to particulate nitrogen (PN) export. However it is unclear (1) whether DO is the only factor that potentially enhances POC transfer in OMZs, and (2) if particle fluxes are sufficient to support observed N loss rates. We performed a degradation experiment on sinking particles collected from the Baltic Sea, where anoxic zones are observed. Sinking material was harvested using surface-tethered sediment traps and subsequently incubated in darkness at different DO levels, including severe suboxia (<0.5 mg l−1 DO). Our results show that DO plays a role in regulating POC and PN degradation rates. POC(PN) degradation was reduced by approximately 100% from the high to low DO to the lowest DO. The amount of NH4+ produced from the pool of remineralising organic N matched estimations of NH4+ anammox requirements during our experiment. This anammox was likely fueled by DON degradation rather than PON degradation

Mycoplasma genitalium : a brief review

Mycoplasma genitalium belongs to the class Mollicutes and is the smallest prokaryote capable of independent replication. It was originally isolated from the urethras of two men with non-gonococcal urethritis (NGU). It has a number of characteristics which are similar to its genetically close relative, Mycoplasma pneumoniae, which is an established pathogen of the respiratory tract. M. genitalium lacks a cell wall and has a characteristic pear/flask shape with a terminal tip organelle. This organelle enables M. genitalium to glide along and adhere to moist/mucous surfaces, including host cells. M. genitalium has minimal metabolism, and when compared to the other genital mycoplasmas, has the ability to metabolise glucose. The organism is the smallest self-replicating prokaryote with a genome of only 580 kb pairs and was the second bacterium to have its genome fully sequenced. Its DNA falls under the low G+C category and thus has a lower melting temperature during denaturation in polymerase chain reaction (PCR) assays. The target genes for PCR assays include MgPa, rRNA and gap. M. genitalium has several virulence factors that are responsible for its pathogenicity. These include the ability to adhere to host epithelial cells using the terminal tip organelle with its adhesins, the release of enzymes and the ability to evade the host immune response by antigenic variation.Financial support for this study was obtained from the National Research Foundation of South Africa

An Introduction to Glaciated Margins::The Sedimentary and Geophysical Archive

A glaciated margin is a continental margin that has been occupied by a large ice mass, such that glacial processes and slope processes conspire to produce a thick sedimentary record. Ice masses take an active role in sculpting, redistributing and reorganizing the sediment that they erode on the continental shelf, and act as a supply route to large fan systems (e.g. trough mouth fans, submarine fans) on the continental slope and continental rise. To many researchers, the term ‘glaciated margin’ is synonymous with modern day areas fringing Antarctica and the Arctic shelf systems, yet the geological record contains ancient examples ranging in age from Precambrian to Cenozoic. In the pre-Pleistocene record, there is a tendency for the configuration of the tectonic plates to become increasingly obscure with age. For instance, in the Neoproterozoic record, not everyone agrees on the location of rift margins and some fundamental continental boundaries remain unclear. Given these issues, this introductory paper has two simple aims: (1) to provide a brief commentary of relevant Geological Society publications on glaciated margins, with the landmark papers highlighted and (2) to explain the contents of this volume