Reformoption Vertragswettbewerb in der gesetzlichen Krankenversicherung

Bisher stand bei den Reformen der gesetzlichen Krankenversicherung die Finanzierungsseite im Vordergrund, nun will sich die Bundesregierung auf die Leistungsseite konzentrieren. Wie kann mehr Wettbewerb im Gesundheitswesen etabliert werden? Welche Erfahrungen wurden damit im Ausland gemacht? Welche Rolle sollen zukünftig die Kassenärztlichen Vereinigungen spielen? Was bedeutet mehr Wettbewerb im Gesundheitswesen für die gesetzlichen Krankenkassen? --

Comments on article ”First report of Ixodes frontalis (Acari: Ixodidae) in Finland, an example of foreign tick species transported by a migratory bird” (Memoranda Soc. Fauna Flora Fennica 85:16–19. 2009)

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The relevance of private actors in the transnational sphere for just peace governance

"Vor dem Hintergrund der Bedeutungszunahme privater Akteure in den internationalen Beziehungen (wird im) Arbeitspapier systematisch (aufgezeigt), welche Rolle diese nicht-staatlichen Akteure in Konflikten um Anerkennung, um prozedurale oder distributive Gerechtigkeit spielen. Rebellengruppen, kriminelle Organisationen, transnationale Unternehmen, zivilgesellschaftliche Organisationen oder ethnische Diasporas - sie tragen einerseits zur Multiplikation von Gerechtigkeitsansprüchen im transnationalen Raum bei; andererseits beteiligen sie sich an neuen, innovativen Governance-Formen, um Gerechtigkeitskonflikte beizulegen. Im Working Paper wird die Frage gestellt, unter welchen Bedingungen die Einbeziehung der Gerechtigkeitsansprüche privater Akteure einer friedlichen Konfliktlösung zuträglich ist oder sie behindert. Diese Ambivalenz nichtstaatlicher Akteure wird im Hinblick auf die Begriffstrias Frieden, Governance und Gerechtigkeit konzeptionalisiert." (Autorenreferat

Reform des Riskostrukturausgleichs in der GKV

Das Bundesministerium für Gesundheit hat Ende März Eckpunkte zur Reform des Risikostrukturausgleichs in der Gesetzlichen Krankenversicherung vorgelegt. Welchen Anforderungen sollte eine solche Reform genügen? --

Collagen fibers mediate MRI-detected water diffusion and anisotropy in breast cancers

AbstractCollagen 1 (Col1) fibers play an important role in tumor interstitial macromolecular transport and cancer cell dissemination. Our goal was to understand the influence of Col1 fibers on water diffusion, and to examine the potential of using noninvasive diffusion tensor imaging (DTI) to indirectly detect Col1 fibers in breast lesions. We previously observed, in human MDA-MB-231 breast cancer xenografts engineered to fluoresce under hypoxia, relatively low amounts of Col1 fibers in fluorescent hypoxic regions. These xenograft tumors together with human breast cancer samples were used here to investigate the relationship between Col1 fibers, water diffusion and anisotropy, and hypoxia. Hypoxic low Col1 fiber containing regions showed decreased apparent diffusion coefficient (ADC) and fractional anisotropy (FA) compared to normoxic high Col1 fiber containing regions. Necrotic high Col1 fiber containing regions showed increased ADC with decreased FA values compared to normoxic viable high Col1 fiber regions that had increased ADC with increased FA values. A good agreement of ADC and FA patterns was observed between in vivo and ex vivo images. In human breast cancer specimens, ADC and FA decreased in low Col1 containing regions. Our data suggest that a decrease in ADC and FA values observed within a lesion could predict hypoxia, and a pattern of high ADC with low FA values could predict necrosis. Collectively the data identify the role of Col1 fibers in directed water movement and support expanding the evaluation of DTI parameters as surrogates for Col1 fiber patterns associated with specific tumor microenvironments as companion diagnostics and for staging

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Geert Van der Linden Een sierlijke kromme op een kruispunt van wegen: de beschermde populier op de Vollanderkouter in Strijpen. [A graceful curve on a crossroad: the protected poplar on the Vollanderkouter in Strijpen.]Een sierlijke kromme op een kruispunt van wegen. Wie associeert spontaan deze prozaïsche omschrijving met de S-curve die de stam van een populier op een kouter in het Zottegemse ommeland beschrijft? Geert Van der Linden doet het relaas van een vereenzaamde, bijna honderdjarige katoenpopulier uit Maryland op de Vollanderkouter in Strijpen. Met eiken als voorgangers brengen lokale heemkundigen de als monument beschermde boom in verband met de vierschaar die er in een ver verleden zou gestaan hebben.Marjan Buyle met medewerking van Els Jacobs en Philippe Schurmans Mission impossible? De restauratie van een gipsreliëf van Pieter Braecke. [Mission impossible? The restoration of a plaster relief by Pieter Braecke.]Gipsen objecten zijn uitermate kwetsbaar als ze niet in goede condities bewaard worden, en gipscollecties krijgen niet altijd de waardering die ze verdienen. Een omgevallen gipsen reliëf van Pieter Braecke uit de verzameling van de stad Nieuwpoort bood de gelegenheid aan het conservatieteam van het agentschap om de jarenlang opgebouwde expertise terzake tot een hoog niveau op te tillen. Philippe Schurmans en Els Jacobs gingen de uitdaging aan en Marjan Buyle vertelt het verhaal van deze haast onmogelijke reddingsoperatie.Maarten Van Dijck De IJslandvisser O.129 Amandine. [The Icelandic fishing vessel O.129 Amandine.]Gebouwd in Oostende werd de Amandine in september 1961 te water gelaten. Jarenlang zou dit - door diesel aangedreven - stalen schip ingezet worden op IJslandvaart, de meest tot de verbeelding sprekende tak van onze Belgische visserijgeschiedenis. In 1995 werd de Amandine als laatste schip van de Europese IJslandvloot uit de vaart genomen en na enige omzwervingen uiteindelijk gerestaureerd en ingericht als museumschip. Maarten Van Dijck is gespecialiseerd in varend erfgoed en neemt ons mee op sleeptouw doorheen de geschiedenis van s lands laatste IJslandvisser.Dieter Nuytten Monumentale ingenieurskunsten. De eigenheid van historische constructies in hun gevecht met de zwaartekracht. [Monumental art of engineering.The particularities of historical monuments in their struggle with gravity.]Dat monumenten blijven rechtstaan is uiteraard de eerste bekommernis van elke monumentenzorger, want stabiliteitsproblemen kunnen het duurzaam behoud van gebouwen in gevaar brengen. Dieter Nuytten specialiseerde zich in de belangrijke materie van de standzekerheid en hoopt aldus dit essentieel element in het beheer van monumenten naar voren te schuiven op de agenda´s van ontwerpers en erfgoedverantwoordelijken, waarbij de kennis van historische constructietechnieken minstens even belangrijk is als het uitwerken van hedendaagse technologische oplossingen.Summar

Flow and retreat of the Late Quaternary Pine Island-Thwaites palaeo-ice stream, West Antarctica

Multibeam swath bathymetry and sub-bottom profiler data are used to establish constraints on the flow and retreat history of a major palaeo-ice stream that carried the combined discharge from the parts of the West Antarctic Ice Sheet now occupied by the Pine Island and Thwaites glacier basins. Sets of highly elongated bedforms show that, at the last glacial maximum, the route of the Pine Island-Thwaites palaeo-ice stream arced north-northeast following a prominent cross-shelf trough. In this area, the grounding line advanced to within similar to 68 km of, and probably reached, the shelf edge. Minimum ice thickness is estimated at 715 m on the outer shelf, and we estimate a minimum ice discharge of similar to 108 km(3) yr(-1) assuming velocities similar to today's Pine Island glacier (similar to 2.5 km yr(-1)). Additional bed forms observed in a trough northwest of Pine Island Bay likely formed via diachronous ice flows across the outer shelf and demonstrate switching ice stream behavior. The "style" of ice retreat is also evident in five grounding zone wedges, which suggest episodic deglaciation characterized by halts in grounding line migration up-trough. Stillstands occurred in association with changes in ice bed gradient, and phases of inferred rapid retreat correlate to higher bed slopes, supporting theoretical studies that show bed geometry as a control on ice margin recession. However, estimates that individual wedges could have formed within several centuries still imply a relatively rapid overall retreat. Our findings show that the ice stream channeled a substantial fraction of West Antarctica's discharge in the past, just as the Pine Island and Thwaites glaciers do today

An integrated MR/PET system: prospective applications

Radiology is strongly depending on medical imaging technology and consequently directing technological progress. A novel technology can only be established, however, if improved diagnostic accuracy influence on therapeutic management and/or overall reduced cost can be evidenced. It has been demonstrated recently that Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) can technologically be integrated into one single hybrid system. Some scientific arguments on the benefits are obvious, e.g., that simultaneous imaging of morphological and functional information will improve tissue characterization. However, crossfire of questions still remains: What unmet radiological needs are addressed by the novel system? What level of hardware integration is reasonable, or would software-based image co-registration be sufficient? Will MR/PET achieve higher diagnostic accuracy compared to separate imaging? What is the added value compared to other hybrid imaging modalities like PET/CT? And finally, is the system economically reasonable and has the potential to reduce overall costs for therapy planning and monitoring? This article tries to highlight some perspectives of applying an integrated MR/PET system for simultaneous morphologic and functional imaging

Systematic reviews of complementary therapies - an annotated bibliography. Part 1: Acupuncture

Background Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with acupuncture. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of acupuncture; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. Results From a total of 48 potentially relevant reviews preselected in a screeening process 39 met the inclusion criteria. 22 were on various pain syndromes or rheumatic diseases. Other topics addressed by more than one review were addiction, nausea, asthma and tinnitus. Almost unanimously the reviews state that acupuncture trials include too few patients. Often included trials are heterogeneous regarding patients, interventions and outcome measures, are considered to have insufficient quality and contradictory results. Convincing evidence is available only for postoperative nausea, for which acupuncture appears to be of benefit, and smoking cessation, where acupuncture is no more effective than sham acupuncture. Conclusions A large number of systematic reviews on acupuncture exists. What is most obvious from these reviews is the need for (the funding of) well-designed, larger clinical trials

[11C]-l-Methionine positron emission tomography in the management of children and young adults with brain tumors

Only a few Methyl-[11C]-l-methionine (MET) positron emission tomography (PET) studies have focused on children and young adults with brain neoplasm. Due to radiation exposure, long scan acquisition time, and the need for sedation in young children MET-PET studies should be restricted to this group of patients when a decision for further therapy is not possible from routine diagnostic procedures alone, e.g., structural imaging. We investigated the diagnostic accuracy of MET-PET for the differentiation between tumorous and non-tumorous lesions in this group of patients. Forty eight MET-PET scans from 39 patients aged from 2 to 21 years (mean 15 ± 5.0 years) were analyzed. The MET tumor-uptake relative to a corresponding control region was calculated. A receiver operating characteristic (ROC) was performed to determine the MET-uptake value that best distinguishes tumorous from non-tumorous brain lesions. A differentiation between tumorous (n = 39) and non-tumorous brain lesions (n = 9) was possible at a threshold of 1.48 of relative MET-uptake with a sensitivity of 83% and a specificity of 92%, respectively. A differentiation between high grade malignant lesions (mean MET-uptake = 2.00 ± 0.46) and low grade tumors (mean MET-uptake = 1.84 ± 0.31) was not possible. There was a significant difference in MET-uptake between the histologically homogeneous subgroups of astrocytoma WHO grade II and anaplastic astrocytoma WHO grade III (P = 0.02). MET-PET might be a useful tool to differentiate tumorous from non-tumorous lesions in children and young adults when a decision for further therapy is difficult or impossible from routine structural imaging procedures alone