197 research outputs found

    PCN5 PROSPECTIVE HEALTH ECONOMIC EVALUATION OF MEDICAL CARE FOR PATIENTS WITH MALIGNANT LYMPHOMAS IN GERMANY: FIRST RESULTS

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    Symmetry breaking in dynamical systems

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    Symmetry breaking bifurcations and dynamical systems have obtained a lot of attention over the last years. This has several reasons: real world applications give rise to systems with symmetry, steady state solutions and periodic orbits may have interesting patterns, symmetry changes the notion of structural stability and introduces degeneracies into the systems as well as geometric simplifications. Therefore symmetric systems are attractive to those who study specific applications as well as to those who are interested in a the abstract theory of dynamical systems. Dynamical systems fall into two classes, those with continuous time and those with discrete time. In this paper we study only the continuous case, although the discrete case is as interesting as the continuous one. Many global results were obtained for the discrete case. Our emphasis are heteroclinic cycles and some mechanisms to create them. We do not pursue the question of stability. Of course many studies have been made to give conditions which imply the existence and stability of such cycles. In contrast to systems without symmetry heteroclinic cycles can be structurally stable in the symmetric case. Sometimes the various solutions on the cycle get mapped onto each other by group elements. Then this cycle will reduce to a homoclinic orbit if we project the equation onto the orbit space. Therefore techniques to study homoclinic bifurcations become available. In recent years some efforts have been made to understand the behaviour of dynamical systems near points where the symmetry of the system was perturbed by outside influences. This can lead to very complicated dynamical behaviour, as was pointed out by several authors. We will discuss some of the technical difficulties which arise in these problems. Then we will review some recent results on a geometric approach to this problem near steady state bifurcation points

    A comparative thematic review of vocational leadership literature from the USA, Great Britain and Australia

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    Vocational education and its leadership is an important sphere of economic activity worldwide and is being impacted by several trends including: the increasing significance and centrality of skills development in today’s economies; economic trends associated with globalisation (internationalisation of education and emergence of global labour markets); and demographic trends resulting in ageing populations and workforces. Leadership in vocational education contexts is crucial to the economic success of this sector. The aim of this paper is to provide a comparative thematic review of the research and literature on leadership in vocational education between the USA, Great Britain and Australia posed by the research question, ‘What are the key leadership issues facing vocational education and training sectors in the USA, Great Britain and Australia?’ This study contributes to the research and literature by identifying key impact factors for vocational education leadership in these nations over the last 13 years. Results from the comparative review established the following three key issues: a concern over equity and diversity; the importance of change management; and leadership skills and their development. Although leadership competencies are the subject of some debate there appears to be a broad consensus that leaders are developed not only by formal courses, but more importantly by on-the-job experiential learning. The future development of leaders within vocational education is discussed in relation to the implications for policy and practice, and suggestions for future research are provided

    Preclinical Evidence Supporting Early Initiation of Citalopram Treatment in Machado-Joseph Disease

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    Spinocerebellar ataxias are dominantly inherited neurodegenerative disorders with no disease-modifying treatment. We previously identified the selective serotonin reuptake inhibitor citalopram as a safe and effective drug to be repurposed for Machado-Joseph disease. Pre-symptomatic treatment of transgenic (CMVMJD135) mice strikingly ameliorated mutant ataxin-3 (ATXN3) pathogenesis. Here, we asked whether citalopram treatment initiated at a post-symptomatic age would still show efficacy. We used a cohort of CMVMJD135 mice that shows increased phenotypic severity and faster disease progression (CMVMJD135hi) compared to the mice used in the first trial. Groups of hemizygous CMVMJD135hi mice were orally treated with citalopram. Behavior, protein analysis, and pathology assessment were performed blindly to treatment. Our results show that even when initiated after symptom onset, treatment of CMVMJD135hi mice with citalopram ameliorated motor coordination and balance, attenuating disease progression, albeit to a lesser extent than that seen with pre-symptomatic treatment initiation. There was no impact on ATXN3 aggregation, which contrasts with the robust reduction in ATXN3-positive inclusions observed in CMVMJD135 mice, when treated pre-symptomatically. Post-symptomatic treatment of CMVMJD135hi mice revealed, however, a limited neuroprotective effect by showing a tendency to repair cerebellar calbindin staining, and to increase the number of motor neurons and of NeuN-positive cells in certain brain regions. While supporting that early initiation of treatment with citalopram leads to a marked increase in efficacy, these results strengthen our previous observation that modulation of serotonergic signaling by citalopram is a promising therapeutic approach for Machado-Joseph disease even after symptom onset.European Regional Development Funds (FEDER), through the Competitiveness Factors Operational Programme (COMPETE), and by National funds, through the Foundation for Science and Technology (FCT), under the scope of the project POCI-01-0145-FEDER-007038. This article has been developed under the scope of the project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the FEDER. This work was also supported by FCT and COMPETE through the projects [PTDC/SAU-GMG/112617/2009] (to PM) and [EXPL/BIM-MEC/0239/2012] (to AT-C), by FCT through the project [POCI-01-0145-FEDER-016818 (PTDC/NEU-NMC/3648/2014)] (to PM), by National Ataxia foundation (to PM and to AT-C), and by Ataxia UK (to PM). SE, SD-S, SO, and AT-C were supported by the FCT individual fellowships, SFRH/BD/78554/2011, SFRH/BD/78388/2011, PD/BD/127818/2016, and SFRH/BPD/102317/2014, respectively. FCT fellowships are co-financed by POPH, QREN, Governo da República Portuguesa, and EU/FSEinfo:eu-repo/semantics/publishedVersio

    Does type of hospital ownership influence physicians' daily work schedules? An observational real-time study in German hospital departments

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    Background: During the last two decades the German hospital sector has been engaged in a constant process of transformation. One obvious sign of this is the growing amount of hospital privatization. To date, most research studies have focused on the effects of privatization regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Yet little attention has been devoted to the effects of privatization on physicians' working routines. The aim of this observational real-time study is to deliver exact data about physicians' work at hospitals of different ownership. By analysing working hours, further impacts of hospital privatization can be assessed and areas of improvement identified. Methods: Observations were made by shadowing 100 physicians working in private, for-profit or non-profit as well as public hospital departments individually during whole weekday shifts in urban German settings. A total of 300 days of observations were conducted. All working activities were recorded, accurate to the second, by using a mobile personal computer. Results: Results have shown significant differences in physicians' working activities, depending on hospital ownership, concerning working hours and time spent on direct and indirect patient care. Conclusion: This is the first real-time analysis on differences in work activities depending on hospital ownership. The study provides an objective insight into physicians' daily work routines at hospitals of different ownership, with additional information on effects of hospital privatization

    The Impact of Social Support Networks on Maternal Employment: A Comparison of West German, East German and Migrant Mothers of Pre-School Children

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    Given shortages in public child care in Germany, this paper asks whether social support with child care and domestic work by spouses, kin and friends can facilitate mothers' return to full-time or part-time positions within the first six years after birth. Using SOEP data from 1993-2009 and event history analyses for competing risks, the author compares the employment transitions of West German, East German and migrant mothers of pre-school children. The results indicate that West German and migrant mothers return to work sooner if they have access to kin, and that kinship support is particularly important when public child care is unavailable. Furthermore, West German and migrant mothers are more likely to work full-time if their spouses partipate in domestic work. In contrast, social support does not affect employment transitions in East Germany where public child care is more easily accessible and continuous female employment is a prevalent social norm

    Is there a role for melatonin in fibromyalgia?

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    Fibromyalgia, characterised by persistent pain, fatigue, sleep disturbance and cognitive dysfunction, is a central sensitivity syndrome that also involves abnormality in peripheral generators and in the hypothalamic pituitary adrenal axis. Heterogeneity of clinical expression of fibromyalgia with a multifactorial aetiology has made the development of effective therapeutic strategies challenging. Physiological properties of the neurohormone melatonin appear related to the symptom profile exhibited by patients with fibromyalgia and thus disturbance of it’s production would be compatible with the pathophysiology. Altered levels of melatonin have been observed in patients with fibromyalgia which are associated with lower secretion during dark hours and higher secretion during daytime. However, inconsistencies of available clinical evidence limit conclusion of a relationship between levels of melatonin and symptom profiles in patients with fibromyalgia. Administration of melatonin to patients with fibromyalgia has demonstrated suppression of many symptoms and an improved quality of life consistent with benefit as a therapy for the management of this condition. Further studies with larger samples, however, are required to explore the potential role of melatonin in the pathophysiology of fibromyalgia and determine the optimal dosing regimen of melatonin for the management of fibromyalgia
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