spotlight europe no. 5 2019. Overuse of medical services. Unnecessary medical services can be harmful to patients

How is the overuse of medical services defined? The German Advisory Council on the Assessment of Developments in the Healthcare System (SVR) defines the overuse of medical services as treatment that goes beyond the coverage of needs. This refers to medical services that a patient does not need or want, or which entail a possibility of harm that outweighs the possible benefits. In its most recent report (2018), the SVR concludes that medical services are still frequently overused or incorrectly used in Germany, and that significant management deficits persist

SYSTOMONAS — an integrated database for systems biology analysis of Pseudomonas

To provide an integrated bioinformatics platform for a systems biology approach to the biology of pseudomonads in infection and biotechnology the database SYSTOMONAS (SYSTems biology of pseudOMONAS) was established. Besides our own experimental metabolome, proteome and transcriptome data, various additional predictions of cellular processes, such as gene-regulatory networks were stored. Reconstruction of metabolic networks in SYSTOMONAS was achieved via comparative genomics. Broad data integration is realized using SOAP interfaces for the well established databases BRENDA, KEGG and PRODORIC. Several tools for the analysis of stored data and for the visualization of the corresponding results are provided, enabling a quick understanding of metabolic pathways, genomic arrangements or promoter structures of interest. The focus of SYSTOMONAS is on pseudomonads and in particular Pseudomonas aeruginosa, an opportunistic human pathogen. With this database we would like to encourage the Pseudomonas community to elucidate cellular processes of interest using an integrated systems biology strategy. The database is accessible at

The role of the alternative coreceptor GPR15 in SIV tropism for human cells

AbstractMany SIV isolates can employ the orphan receptor GPR15 as coreceptor for efficient entry into transfected cell lines, but the role of endogenously expressed GPR15 in SIV cell tropism is largely unclear. Here, we show that several human B and T cell lines express GPR15 on the cell surface, including the T/B cell hybrid cell line CEMx174, and that GPR15 expression is essential for SIV infection of CEMx174 cells. In addition, GPR15 expression was detected on subsets of primary human CD4+, CD8+ and CD19+ peripheral blood mononuclear cells (PBMCs), respectively. However, GPR15+ PBMCs were not efficiently infected by HIV and SIV, including cells from individuals homozygous for the defective Δ32 ccr5 allele. These results suggest that GPR15 is coexpressed with CD4 on PBMCs but that infection of CD4+, GPR15+ cells is not responsible for the well documented ability of SIV to infect CCR5− blood cells

Reported benefits of CRC screening in general and for colonoscopy and the FOBT in particular in the identified leaflets (n = 28) and booklets (n = 13).

<p>FOBT: faecal occult blood test, guaiac-based.</p><p>CRC: colorectal cancer.</p><p>Reported benefits of CRC screening in general and for colonoscopy and the FOBT in particular in the identified leaflets (n = 28) and booklets (n = 13).</p

Aggregated results for reported benefits and harms, stratified by leaflets and booklets.

<p>The figure indicates whether a leaflet contains <u>any</u> information on the benefits of CRC screening a) in general or specifically for b) colonoscopy or c) the FOBT, and whether it contains any information on the d) general and e) specific harms of colonoscopy. To be rated positive for harms, it was not sufficient if the only information about possible harms referred to pain, stating incorrectly that there is no pain involved.</p

Reported harms of screening colonoscopy due to colonoscopy preparation, sedation and/or the procedure itself in the identified leaflets (n = 28) and booklets (n = 13).

<p>Reported harms of screening colonoscopy due to colonoscopy preparation, sedation and/or the procedure itself in the identified leaflets (n = 28) and booklets (n = 13).</p

Information on baseline risks.

<p>Information on baseline risks.</p

Reported accuracy of CRC screening tests in leaflets (n = 28) and booklets (n = 13).

<p>Reported accuracy of CRC screening tests in leaflets (n = 28) and booklets (n = 13).</p

From point to area: Upscaling approaches for Late Quaternary archaeological and environmental data

The study of past socio-environmental systems integrates a variety of terrestrial archives. To understand regional or continental socio-environmental interactions proxy data from local archives need to be transferred to larger spatial scales. System properties like spatial heterogeneity, historical and spatial contingency, nonlinearity, scale dependency or emergence make generalizations from local observations to larger scales difficult. As these are common properties of natural and social systems, the development of an interdisciplinary upscaling framework for socio-environmental systems remains a challenge. For example, the integration of social and environmental data is often hindered by divergent methodological, i.e. qualitative and quantitative, approaches and discipline-specific perceptions of spatial scales. Additionally, joint approaches can be hampered by differences in the predictability of natural systems, which are subject to physical laws, and social systems, which depend on humans' decisions and communication. Here we present results from an interdisciplinary discussion of upscaling approaches in socio-environmental research with a special focus on the migration of modern humans in Central Europe during the last 30,000 years. Based on case studies from different disciplines, we develop a classification system for upscaling approaches used in past socio-environmental research. Finally, we present an initial upscaling framework that fosters the development of an interdisciplinary concept of scales and allows for a consideration of system properties like scale dependency, nonlinearity and contingency. The upscaling framework includes the following steps: i) the identification of relevant spatial and temporal scales at which socio-environmental interactions operate; ii) the definition of appropriate parameters to describe scale-specific interactions; iii) a comparison of process and observation scales to evaluate the potential of local archive data for larger scale generalization and for reconstructing scale-specific past socio-environmental interactions; iv) the identification and adaption of appropriate upscaling approaches for the relevant scales; v) the development of scale-specific models of socio-environmental interactions, and vi) the connection of models in a nested hierarchy. Our intention is not to present final results, but rather to stimulate future discussions and to provide a basic reference on scale issues in the emerging field of integrated socio-environmental research