Planning medical care for actual need

Aim: When it came into force on 1 January 1993, the Health Structure Act brought about far-reaching changes in the German health system by completely reorganising needs-related planning for office-based medical care. The experience to date suggests that needs-related planning is having an effect. Since the law came into effect, the increase in the number of doctors has clearly levelled off, and in certain fields the trend can even be said to have been reversed. Indeed, needs-related planning will in future have to address a completely new issue, one that only a few years ago was considered inconceivable: a looming lack of doctors. It is precisely in this context that needs-related planning, an arrangement conceived when the number of doctors was rising, can be seen to have strategic flaws. It has now become clear that the data (population, number of doctors) and information on structures (geographical planning units) drawn on in needs-related planning to indicate the degree of provision are unsuitable for ascertaining the need for, and controlling the supply of, office-based medical care. Indeed, the current needs-related planning hardly justifies its name. Subjects and methods: There is a need for genuinely strategic planning that, rather than measuring the status quo in isolation, takes due heed of likely future trends in such factors as population and the number of doctors. Results and conclusion: The reversal of the trend from over- to undersupply of medical care has brought about an increasing scarcity of points of access. If the Associations of Statutory Health Insurance Physicians are to meet their legal commitment to provide universal medical coverage, it is essential that an analysis of the relationships within the care supply network be carried out. A potential solution to this problem is offered by “regional studies interaction models”, which model the physical accessibility and convenience for patients of supplier locations (here: office-based physicians) and the response of the demand side (here: the patients) to the existing geographical constellations

Immunosenescence and Cytomegalovirus: where do we stand after a decade?

AbstractSince Looney at al. published their seminal paper a decade ago it has become clear that many of the differences in T cell immunological parameters observed between young and old people are related to the age-associated increasing prevalence of infection with the persistent beta-herpesvirus HHV-5 (Cytomegalovirus). Ten years later, studies suggest that hallmark age-associated changes in peripheral blood T cell subset distribution may not occur at all in people who are not infected with this virus. Whether the observed changes are actually caused by CMV is an open question, but very similar, rapid changes observed in uninfected patients receiving CMV-infected kidney grafts are consistent with a causative role. This meeting intensively discussed these and other questions related to the impact of CMV on human immune status and its relevance for immune function in later life.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

A Fast and Simple Contact Printing Approach to Generate 2D Protein Nanopatterns

Protein micropatterning has become an important tool for many biomedical applications as well as in academic research. Current techniques that allow to reduce the feature size of patterns below 1 μm are, however, often costly and require sophisticated equipment. We present here a straightforward and convenient method to generate highly condensed nanopatterns of proteins without the need for clean room facilities or expensive equipment. Our approach is based on nanocontact printing and allows for the fabrication of protein patterns with feature sizes of 80 nm and periodicities down to 140 nm. This was made possible by the use of the material X-poly(dimethylsiloxane) (X-PDMS) in a two-layer stamp layout for protein printing. In a proof of principle, different proteins at various scales were printed and the pattern quality was evaluated by atomic force microscopy (AFM) and super-resolution fluorescence microscopy

Catchment areas of medical practices and the role played by geographical distance in the patient’s choice of doctor

R19,

Determination of the Membrane Environment of CD59 in Living Cells

The organization and dynamics of proteins and lipids in the plasma membrane, and their role in membrane functionality, have been subject of a long-lasting debate. Specifically, it is unclear to what extent membrane proteins are affected by their immediate lipid environment and vice versa. Studies on model membranes and plasma membrane vesicles indicated preferences of proteins for lipid phases characterized by different acyl chain order; however, whether such phases do indeed exist in live cells is still not known. Here, we refine a previously developed micropatterning approach combined with single molecule tracking to quantify the influence of the glycosylphosphatidylinositol-anchored (GPI-anchored) protein CD59 on its molecular environment directly in the live cell plasma membrane. We find that locally enriched and immobilized CD59 presents obstacles to the diffusion of fluorescently labeled lipids with a different phase-partitioning behavior independent of cell cholesterol levels and type of lipid. Our results give no evidence for either specific binding of the lipids to CD59 or the existence of nanoscopic ordered membrane regions associated with CD59