Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered

Detection and attribution of aerosol-cloud interactions in large-domain large-eddy simulations with the ICOsahedral Non-hydrostatic model

Clouds and aerosols contribute the largest uncertainty to current estimates and interpretations of the Earth’s changing energy budget. Here we use a new-generation large-domain large-eddy model, ICON-LEM (ICOsahedral Non-hydrostatic Large Eddy Model), to simulate the response of clouds to realistic anthropogenic perturbations in aerosols serving as cloud condensation nuclei (CCN). The novelty compared to previous studies is that (i) the LEM is run in weather prediction mode and with fully interactive land surface over a large domain and (ii) a large range of data from various sources are used for the detection and attribution. The aerosol perturbation was chosen as peak-aerosol conditions over Europe in 1985, with more than fivefold more sulfate than in 2013. Observational data from various satellite and ground-based remote sensing instruments are used, aiming at the detection and attribution of this response. The simulation was run for a selected day (2 May 2013) in which a large variety of cloud regimes was present over the selected domain of central Europe. It is first demonstrated that the aerosol fields used in the model are consistent with corresponding satellite aerosol optical depth retrievals for both 1985 (perturbed) and 2013 (reference) conditions. In comparison to retrievals from ground-based lidar for 2013, CCN profiles for the reference conditions were consistent with the observations, while the ones for the 1985 conditions were not. Similarly, the detection and attribution process was successful for droplet number concentrations: the ones simulated for the 2013 conditions were consistent with satellite as well as new ground-based lidar retrievals, while the ones for the 1985 conditions were outside the observational range. For other cloud quantities, including cloud fraction, liquid water path, cloud base altitude and cloud lifetime, the aerosol response was small compared to their natural variability. Also, large uncertainties in satellite and ground-based observations make the detection and attribution difficult for these quantities. An exception to this is the fact that at a large liquid water path value (LWP > 200 g m−2), the control simulation matches the observations, while the perturbed one shows an LWP which is too large. The model simulations allowed for quantifying the radiative forcing due to aerosol–cloud interactions, as well as the adjustments to this forcing. The latter were small compared to the variability and showed overall a small positive radiative effect. The overall effective radiative forcing (ERF) due to aerosol–cloud interactions (ERFaci) in the simulation was dominated thus by the Twomey effect and yielded for this day, region and aerosol perturbation −2.6 W m$^{-2}$. Using general circulation models to scale this to a global-mean present-day vs. pre-industrial ERFaci yields a global ERFaci of −0.8 W m$^{-2}$

Ovarian cancer risk in Polish BRCA1 mutation carriers is not associated with the prohibitin 3' untranslated region polymorphism

<p>Abstract</p> <p>Background</p> <p>The variable penetrance of ovarian cancer in <it>BRCA1 </it>mutation carriers suggests that other genetic or environmental factors modify disease risk. The C to T transition in the 3' untranslated region of the prohibitin (<it>PHB</it>) gene alters mRNA function and has recently been shown to be associated with hereditary breast cancer risk in Polish women harbouring <it>BRCA1 </it>mutations.</p> <p>Methods</p> <p>To investigate whether the <it>PHB </it>3'UTR polymorphism also modifies hereditary ovarian cancer risk, we performed a case-control study among Polish women carrying one of the three common founder mutations (5382insC, 300 T > G, 4154delA) including 127 ovarian cases and 127 unaffected controls who had both breasts and ovaries intact. Controls were matched to cases by year of birth and <it>BRCA1 </it>mutation. Genotyping analysis was performed using PCR-based restriction fragment length polymorphism analysis. Odds ratios (OR) were calculated using conditional and penalized univariable and multivariable logistic regression.</p> <p>Results</p> <p>A comparison of the genotype frequencies between cases and controls revealed no association of the <it>PHB </it>3'UTR _CT+TT genotypes with ovarian cancer risk (OR_adj1.34; 95% CI, 0.59–3.11).</p> <p>Conclusion</p> <p>Our data suggest that the <it>PHB </it>3'UTR polymorphism does not modify ovarian cancer risk in women carrying one of the three Polish <it>BRCA1 </it>founder mutations.</p

Public health component in building information modeling

A building information modelling (BIM) conception has established itself as an effective and practical approach to plan, design, construct, and manage buildings and infrastructure. Analysis of the governance literature has shown that the BIM-developed tools do not take fully into account the growing demands from ecology and health fields. In this connection, it is possible to offer an optimal way of adapting such tools to the necessary consideration of the sanitary and hygienic specifications of materials used in construction industry. It is proposed to do it through the introduction of assessments that meet the requirements of national sanitary standards. This approach was demonstrated in the case study of Revit® program

The Added Value of Large-Eddy and Storm-Resolving Models for Simulating Clouds and Precipitation

More than one hundred days were simulated over very large domains with fine (0.156 km to 2.5 km) grid spacing for realistic conditions to test the hypothesis that storm (kilometer) and large-eddy (hectometer) resolving simulations would provide an improved representation of clouds and precipitation in atmospheric simulations. At scales that resolve convective storms (storm-resolving for short), the vertical velocity variance becomes resolved and a better physical basis is achieved for representing clouds and precipitation. Similarly to past studies we found an improved representation of precipitation at kilometer scales, as compared to models with parameterized convection. The main precipitation features (location, diurnal cycle and spatial propagation) are well captured already at kilometer scales, and refining resolution to hectometer scales does not substantially change the simulations in these respects. It does, however, lead to a reduction in the precipitation on the time-scales considered – most notably over the ocean in the tropics. Changes in the distribution of precipitation, with less frequent extremes are also found in simulations incorporating hectometer scales. Hectometer scales appear to be more important for the representation of clouds, and make it possible to capture many important aspects of the cloud field, from the vertical distribution of cloud cover, to the distribution of cloud sizes, and to the diel (daily) cycle. Qualitative improvements, particularly in the ability to differentiate cumulus from stratiform clouds, are seen when one reduces the grid spacing from kilometer to hectometer scales. At the hectometer scale new challenges arise, but the similarity of observed and simulated scales, and the more direct connection between the circulation and the unconstrained degrees of freedom make these challenges less daunting. This quality, combined with already improved simulation as compared to more parameterized models, underpins our conviction that the use and further development of storm-resolving models offers exciting opportunities for advancing understanding of climate and climate change

Cluster Headache Genomewide Association Study and Meta-Analysis Identifies Eight Loci and Implicates Smoking as Causal Risk Factor

Objective: The objective of this study was to aggregate data for the first genomewide association study meta-analysis of cluster headache, to identify genetic risk variants, and gain biological insights. Methods: A total of 4,777 cases (3,348 men and 1,429 women) with clinically diagnosed cluster headache were recruited from 10 European and 1 East Asian cohorts. We first performed an inverse-variance genomewide association meta-analysis of 4,043 cases and 21,729 controls of European ancestry. In a secondary trans-ancestry meta-analysis, we included 734 cases and 9,846 controls of East Asian ancestry. Candidate causal genes were prioritized by 5 complementary methods: expression quantitative trait loci, transcriptome-wide association, fine-mapping of causal gene sets, genetically driven DNA methylation, and effects on protein structure. Gene set and tissue enrichment analyses, genetic correlation, genetic risk score analysis, and Mendelian randomization were part of the downstream analyses. Results: The estimated single nucleotide polymorphism (SNP)-based heritability of cluster headache was 14.5%. We identified 9 independent signals in 7 genomewide significant loci in the primary meta-analysis, and one additional locus in the trans-ethnic meta-analysis. Five of the loci were previously known. The 20 genes prioritized as potentially causal for cluster headache showed enrichment to artery and brain tissue. Cluster headache was genetically correlated with cigarette smoking, risk-taking behavior, attention deficit hyperactivity disorder (ADHD), depression, and musculoskeletal pain. Mendelian randomization analysis indicated a causal effect of cigarette smoking intensity on cluster headache. Three of the identified loci were shared with migraine. Interpretation: This first genomewide association study meta-analysis gives clues to the biological basis of cluster headache and indicates that smoking is a causal risk factor

Revised criteria system for a national assessment of threatened habitats in Germany

The Red List of threatened habitat types in Germany was first published in 1994 and it is updated approximately every ten years. In 2017 the third version was published by the German Federal Agency for Nature Conservation. In the course of the revision, the criteria system was also extended. In doing so, an attempt was made to find a compromise between the consideration of international developments that had taken place and existing national requirements. In particular, short-term developments should become visible through the German Red List status. In addition to ‘National long-term Threat’, the valuation now also includes ‘Current Trend’ and ‘Rarity’. Following the IUCN’s approach, the collapse risk is now represented on the basis of several criteria. However, in contrast to the IUCN procedure, where the worst evaluated criterion is determinative for Red List status, in our procedure all criteria are included in the evaluation. To counteract misleading signal-effects for management decisions, all significant criteria have an influence on the resulting German Red List status (RLG). They are combined in an assessment scheme. In order to map the overall risk of loss, both the long-term threat as a historical reference value and furthermore the current trend must have an influence on RLG. As a result, 65% of habitat types have differing risk of loss

Imaging Sensory Effects of Occipital Nerve Stimulation: A New Computer-based Method in Neuromodulation

Background: Within the last years, occipital nerve stimulation (ONS) has proven to be an important method in the treatment of severe therapy-resistant neurological pain disorders. The correspondence between lead placement as well as possible stimulation parameters and the resulting stimulation effects remains unclear. Objective: The method aims to directly relate the neuromodulatory mechanisms with the clinical treatment results, to achieve insight in the mode of action of neuromodulation, to identify the most effective stimulation sets and to optimize individual treatment effects. Methods: We describe a new computer-based imaging method for mapping the spatial, cognitive and affective sensory effects of ONS. The procedure allows a quantitative and qualitative analysis of the relationship between lead positioning, the stimulation settings as well as the sensory and clinical stimulation effects. Conclusion: A regular mapping of stimulation and sensory parameters allows a coordinated monitoring. The stimulation results can be reviewed and compared with regards to clinical effectiveness. (C) 2015 Elsevier Inc. All rights reserved

Zum Erfordernis der Bestandsorientierung in der integrierten Raum- und Verkehrspolitik

Integrierte Raum- und Verkehrspolitik ist der Nachhaltigkeit verpflichtet. Eine besondere Rolle kommt dabei dem öffentlichen Personenverkehr zu, da er innerhalb des Umweltverbunds gerade auf regionaler Ebene die Funktion eines konzeptionellen Rückgrates übernimmt und wegen seiner begrenzten Flexibilität erhöhte Anforderungen an die Ausgestaltung des Siedlungssystems stellt. In diesem Beitrag wird anhand eines regionalen Beispieles dargestellt, dass trotz räumlicher Veränderungsprozesse (hier: Suburbanisierung) die dauerhafte Beschaffenheit (Persistenz) des Raum- und Verkehrssystems so groß ist, dass nur bei Verzicht auf Investitionen in die Straßeninfrastruktur das System nachhaltiger werden kann, dass die Aufgabenzuweisung innerhalb des Umweltverbundes räumlich differenziert erfolgen muss und dass letztlich die im regionalen Kontext gesteuerte Siedlungsentwicklung zur Gewährleistung der Aufgabenwahrnehmung von erheblicher Bedeutung ist. Letzten Endes läuft dies angesichts begrenzter staatlicher Handlungsspielräume auf eine stärkere Bestandsorientierung in der integrierten Raum- und Verkehrspolitik hinaus. Abstract Integrated spatial and transport policies are bound to sustainability. A special role is given to public transport, as it—among the modes of ecomobility—serves as a conceptional back-bone at the regional level, and as it—due to its limited flexibility—is particularly dependent on the design of the settlement system. This paper shows with a regional case study that even under the condition of spatial change (here: urban sprawl) the composition of the spatial and transport system is so permanent (persistent) that without renunciation of road investments the system will not become more sustainable, that each mode of ecomobility serves a spatially different role, and that regionally efficient settlement control is indispensable to support this. As public scope of action remains to be limited, integrated spatial and transport policies will tend to asset orientation. JEL Classifications: R42, R5