Health Universities - Konzept, Relevanz und Best Practice : Mit regionaler Versorgung und interprofessioneller Bildung zu bedarfsgerechten Gesundheitsfachleuten

Das Konzept der Health Universities entstand als eine Antwort auf die Herausforderungen des Gesundheitswesens in den 1960er und 1970er Jahren. Es vereint bildungs- und versorgungspolitische Ansprüche, die schwierig unter einen Hut zu bringen sind. Wie hat sich dieses Konzept in Europa weiter entwickelt? Welche Bedeutung hat es für die Herausforderungen von heute? Dieser Bericht zeigt das Potential der Health Universities für eine bedarfsgerechte Ausbildung von Gesundheitsfachleuten zu Beginn des 21. Jahrhunderts, indem Konzept, Relevanz und Best Practice beschrieben werden

Swiss Industrial Biocatalysis Consortium (SIBC)

Taking up the common challenges in biocatalysis, a group of industrialists decided to react with a bottom-up solution, and created the Swiss Industrial Biocatalysis Consortium (SIBC). The Swiss Industrial Biocatalysis Consortium is a pre-competitive working group to better implement and utilize existing know-how and resources in biocatalysis, and to influence and shape the economic and educational political environment.Recent examples of activities are outlined

Low triiodothyronine syndrome: a prognostic marker for outcome in sepsis?

There is ongoing controversy as to whether hormonal changes of the euthyroid sick syndrome are predictors of poor outcome in sepsis and critical illness. In this prospective study, the prognostic accuracy of thyroid hormone levels in 103 critically ill adult patients on admission and during follow up in a medical intensive care unit (ICU) was assessed and was compared to clinical risk scores, namely, the acute physiology and chronic health evaluation and the simplified acute physiology score. Median T3 levels on admission to the ICU were lower in the 53 septic cases [0.9nmol/l (IQR 0.6-1.1)] as compared with the 50 patients with a systemic inflammatory response syndrome [1.2nmol/l (IQR 0.8-1.4), P<0.001]. The lowest T3 levels were found in patients with severe sepsis [0.8nmol/l (IQR 0.55-0.95)] and septic shock [0.8nmol/l (IQR 0.6-1.0)]. There was no difference in T3 and free thyroxin (fT4) levels on admission in non-survivors compared with survivors overall and in subgroups of patients with SIRS and sepsis. During the follow up, fT4 levels decreased significantly in non-survivors, while they increased in survivors [fT4 difference −1.3 (IQR −2.5 to 0.2) vs. 0.8 (IQR −0.85 to 4.1), P=0.003]. In addition, on the day of death, non-survivors had lower T3 and fT4 levels as compared with survivors (P=0.04 and P=0.02). T3 and fT4 levels on admission were not prognostic in this cohort of critically ill patients. A decrease in fT4 levels in the course of disease, however, may point to adverse outcom

Long-term mitigation of drought changes the functional potential and life-strategies of the forest soil microbiome involved in organic matter decomposition

Climate change can alter the flow of nutrients and energy through terrestrial ecosystems. Using an inverse climate change field experiment in the central European Alps, we explored how long-term irrigation of a naturally drought-stressed pine forest altered the metabolic potential of the soil microbiome and its ability to decompose lignocellulolytic compounds as a critical ecosystem function. Drought mitigation by a decade of irrigation stimulated profound changes in the functional capacity encoded in the soil microbiome, revealing alterations in carbon and nitrogen metabolism as well as regulatory processes protecting microorganisms from starvation and desiccation. Despite the structural and functional shifts from oligotrophic to copiotrophic microbial lifestyles under irrigation and the observation that different microbial taxa were involved in the degradation of cellulose and lignin as determined by a time-series stable-isotope probing incubation experiment with 13C-labeled substrates, degradation rates of these compounds were not affected by different water availabilities. These findings provide new insights into the impact of precipitation changes on the soil microbiome and associated ecosystem functioning in a drought-prone pine forest and will help to improve our understanding of alterations in biogeochemical cycling under a changing climate

Nachhaltigkeit in der Kreditfinanzierung

Für den Einbezug von Nachhaltigkeitsaspekten in den Bereichen Anlegen und Finanzieren hat sich Sustainable Finance (nachhaltige Finanzen) als übergeordneter Begriff etabliert. Auch wenn Sustainable Finance immer schon nachhaltige Aktivitäten in den verschiedensten Finanzbereichen mit einbezogen hat, lag der Fokus der Finanzinstitute wie auch der akademischen Forschung bisher auf dem Anlagegeschäft (Sustainable Investing). Ein eher weniger beleuchtetes Themenfeld ist die nachhaltige Finanzierung (Sustainable Financing), speziell die nachhaltige Kreditfinanzierung (Sustainable Lending). Da die Kreditfinanzierung eine der wichtigsten Finanzierungsquellen des Privatsektors darstellt (vgl. Box 1), ist sie auch für die aktuelle und zukünftige Nachhaltigkeitsdiskussion von zentraler Bedeutung und soll im Rahmen der vorliegenden Publikation vertieft diskutiert werden. Ziel ist es, einen möglichst umfassenden Überblick zu Theorie, Praxis und zukünftigen Handlungsfeldern im Bereich der nachhaltigen Kreditfinanzierung zu schaffen. Praxisbeispiele zeigen begleitend auf, wie einzelne Teilaspekte bereits konkret umgesetzt werden. Der Fokus liegt auf den zwei wichtigsten Teilgebieten der Kreditfinanzierung, dem Hypothekargeschäft und dem Unternehmenskreditgeschäft. Als Grundlage werden in Kapitel 1.2 zunächst die relevanten Perspektiven zur Nachhaltigkeit im Kreditwesen und in Kapitel 1.3 die relevanten Handlungsfelder der nachhaltigen Kreditfinanzierung erarbeitet. Diese Grundlagen sind notwendig, um darauf aufbauend die Nachhaltigkeitsbestrebungen im Bereich der Unternehmenskredite (Kapitel 2) sowie im Hypothekarbereich (Kapitel 3) zu diskutieren und die Notwendigkeit der in Kapitel 4 besprochenen weitergehenden Finanzierungsformen im Kreditbereich zu verdeutlichen (spezifische Finanzierung von Nachhaltigkeitslösungen). Ergänzend finden sich in den verschiedenen Kapiteln zahlreiche Boxen, welche weiterführende Hintergrundinformationen, Fallstudien sowie Praxisbeispiele enthalten

Evaluation of a structured treatment discontinuation in patients with inoperable alveolar echinococcosis on long-term benzimidazole therapy: A retrospective cohort study.

OBJECTIVES Alveolar echinococcosis (AE) is an orphan zoonosis of increasing concern in endemic areas, including Europe. It frequently presents in an advanced, inoperable stage, that requires life-long parasitostatic benzimidazole therapy. In some patients, long-term therapy leads to negative anti-Em18 antibody ELISA and PET. It is disputed, whether these patients are truly cured and treatment can be safely discontinued. Our aim was to retrospectively assess long-term outcome of 34 patients with inoperable AE who participated in a previous study to determine feasibility of benzimidazole treatment cessation. METHODS Retrospective analysis of medical charts was undertaken in all 34 AE patients who participated in our previous study. Of particular interest were AE recurrence or other reasons for re-treatment in patients who stopped benzimidazole therapy and whether baseline clinical and laboratory parameters help identify of patients that might qualifiy for treatment cessation. Additionally, volumetric measurement of AE lesions on contrast-enhanced cross-sectional imaging was performed at baseline and last follow-up in order to quantify treatment response. RESULTS 12 of 34 patients stopped benzimidazole therapy for a median of 131 months. 11 of these patients showed stable or regressive AE lesions as determined by volumetric measurement. One patient developed progressive lesions with persistently negative anti-Em18 antibody ELISA but slight FDG-uptake in repeated PET imaging. At baseline, patients who met criteria for treatment cessation demonstrated higher lymphocyte count and lower total IgE. CONCLUSION Treatment cessation is feasible in inoperable AE patients, who demonstrate negative anti-Em18 antibody ELISA and PET on follow-up. Close monitoring including sectional imaging is strongly advised

Pathology of Echinococcosis

Infection of humans by the larval stage of the tapeworms Echinococcus granulosus sensu lato or Echinococcus multilocularis causes the life-threatening zoonoses cystic echinococcosis (CE) and alveolar echinococcosis (AE). Although cystic liver lesions are a hallmark of both diseases, course, prognosis, and patients' management decisively differ between the two. The wide and overlapping spectrum of morphologies and the limited availability of ancillary tools are challenges for pathologists to reliably diagnose and subtype echinococcosis. Here, we systematically and quantitatively recorded the pathologic spectrum in a clinically and molecularly defined echinococcosis cohort (138 specimens from 112 patients). Immunohistochemistry using a novel monoclonal antibody (mAbEmG3) was implemented, including its combined application with the mAbEm2G11. Six morphologic criteria sufficiently discriminated between CE and AE: size of smallest (CE/AE: >2/≤2 mm) and largest cyst (CE/AE: >25/≤25 mm), thickness of laminated layer (CE/AE: >0.15/≤0.15 mm) and pericystic fibrosis (CE/AE: >0.6/≤0.6 mm), striation of laminated layer (CE/AE: moderate-strong/weak), and number of cysts (CE/AE: ≤9/>9). Combined immunohistochemistry with mAbEm2G11 (E. multilocularis specific) and mAbEmG3 (reactive in AE and CE) was equally specific as and occasionally more sensitive than polymerase chain reaction. On the basis of these findings, we developed a diagnostic algorithm for the differential diagnosis of echinococcosis. In summary, we have not only identified the means to diagnose echinococcosis with greater certainty, but also defined morphologic criteria, which robustly discriminate between CE and AE. We expect our findings to improve echinococcosis diagnostics, especially of challenging cases, beneficially impacting the management of echinococcosis patients

Pathology of Echinococcosis: A Morphologic and Immunohistochemical Study on 138 Specimens With Focus on the Differential Diagnosis Between Cystic and Alveolar Echinococcosis.

Infection of humans by the larval stage of the tapeworms Echinococcus granulosus sensu lato or Echinococcus multilocularis causes the life-threatening zoonoses cystic echinococcosis (CE) and alveolar echinococcosis (AE). Although cystic liver lesions are a hallmark of both diseases, course, prognosis, and patients' management decisively differ between the two. The wide and overlapping spectrum of morphologies and the limited availability of ancillary tools are challenges for pathologists to reliably diagnose and subtype echinococcosis. Here, we systematically and quantitatively recorded the pathologic spectrum in a clinically and molecularly defined echinococcosis cohort (138 specimens from 112 patients). Immunohistochemistry using a novel monoclonal antibody (mAbEmG3) was implemented, including its combined application with the mAbEm2G11. Six morphologic criteria sufficiently discriminated between CE and AE: size of smallest (CE/AE: >2/≤2 mm) and largest cyst (CE/AE: >25/≤25 mm), thickness of laminated layer (CE/AE: >0.15/≤0.15 mm) and pericystic fibrosis (CE/AE: >0.6/≤0.6 mm), striation of laminated layer (CE/AE: moderate-strong/weak), and number of cysts (CE/AE: ≤9/>9). Combined immunohistochemistry with mAbEm2G11 (E. multilocularis specific) and mAbEmG3 (reactive in AE and CE) was equally specific as and occasionally more sensitive than polymerase chain reaction. On the basis of these findings, we developed a diagnostic algorithm for the differential diagnosis of echinococcosis. In summary, we have not only identified the means to diagnose echinococcosis with greater certainty, but also defined morphologic criteria, which robustly discriminate between CE and AE. We expect our findings to improve echinococcosis diagnostics, especially of challenging cases, beneficially impacting the management of echinococcosis patients

libCreme: An optimization library for evaluating convex-roof entanglement measures

We present the software library libCreme which we have previously used to successfully calculate convex-roof entanglement measures of mixed quantum states appearing in realistic physical systems. Evaluating the amount of entanglement in such states is in general a non-trivial task requiring to solve a highly non-linear complex optimization problem. The algorithms provided here are able to achieve to do this for a large and important class of entanglement measures. The library is mostly written in the Matlab programming language, but is fully compatible to the free and open-source Octave platform. Some inefficient subroutines are written in C/C++ for better performance. This manuscript discusses the most important theoretical concepts and workings of the algorithms, focussing on the actual implementation and usage within the library. Detailed examples in the end should make it easy for the user to apply libCreme to specific problems.Comment: 13 pages, 1 figure. The program code can be downloaded either from the CPC Library (http://cpc.cs.qub.ac.uk) or directly at http://quantumtheory.physik.unibas.ch/people/roethlisberger/libCreme.zi