Wie viel Verfassung braucht Europa?

Dem „Konvent zur Zukunft Europas“ ist unter anderem die Aufgabe zugewiesen worden, eine neue Abgrenzung der wirtschafts- und finanzpolitischen Verantwortlichkeiten zwischen der europäischen und der nationalstaatlichen Ebene vorzunehmen. Brauchen wir eine europäische Wirtschaftsverfassung? Sollte die Finanzverfassung der EU erneuert werden

Empirical analysis shows reduced cost data collection may be an efficient method in economic clinical trials

BACKGROUND: Data collection for economic evaluation alongside clinical trials is burdensome and cost-intensive. Limiting both the frequency of data collection and recall periods can solve the problem. As a consequence, gaps in survey periods arise and must be filled appropriately. The aims of our study are to assess the validity of incomplete cost data collection and define suitable resource categories. METHODS: In the randomised KORINNA study, cost data from 234 elderly patients were collected quarterly over a 1-year period. Different strategies for incomplete data collection were compared with complete data collection. The sample size calculation was modified in response to elasticity of variance. RESULTS: Resource categories suitable for incomplete data collection were physiotherapy, ambulatory clinic in hospital, medication, consultations, outpatient nursing service and paid household help. Cost estimation from complete and incomplete data collection showed no difference when omitting information from one quarter. When omitting information from two quarters, costs were underestimated by 3.9% to 4.6%. With respect to the observed increased standard deviation, a larger sample size would be required, increased by 3%. Nevertheless, more time was saved than extra time would be required for additional patients. CONCLUSION: Cost data can be collected efficiently by reducing the frequency of data collection. This can be achieved by incomplete data collection for shortened periods or complete data collection by extending recall windows. In our analysis, cost estimates per year for ambulatory healthcare and non-healthcare services in terms of three data collections was as valid and accurate as a four complete data collections. In contrast, data on hospitalisation, rehabilitation stays and care insurance benefits should be collected for the entire target period, using extended recall windows. When applying the method of incomplete data collection, sample size calculation has to be modified because of the increased standard deviation. This approach is suitable to enable economic evaluation with lower costs to both study participants and investigators. TRIAL REGISTRATION: The trial registration number is ISRCTN0289374

Genome Sequence of AvianEscherichia coliStrain IHIT25637, an Extraintestinal PathogenicE. coliStrain of ST131 Encoding Colistin Resistance Determinant MCR-1

Sequence type 131 (ST131) is one of the predominant Escherichia coli lineages among extraintestinal pathogenic E. coli (ExPEC) that causes a variety of diseases in humans and animals and frequently shows multidrug resistance. Here, we report the first genome sequence of an ST131-ExPEC strain from poultry carrying the plasmid-encoded colistin resistance gene mcr-1

Meiotic cohesin REC8 marks the axial elements of rat synaptonemal complexes before cohesins SMC1β and SMC3

In meiotic prophase, the sister chromatids of each chromosome develop a common axial element (AE) that is integrated into the synaptonemal complex (SC). We analyzed the incorporation of sister chromatid cohesion proteins (cohesins) and other AE components into AEs. Meiotic cohesin REC8 appeared shortly before premeiotic S phase in the nucleus and formed AE-like structures (REC8-AEs) from premeiotic S phase on. Subsequently, meiotic cohesin SMC1β, cohesin SMC3, and AE proteins SCP2 and SCP3 formed dots along REC8-AEs, which extended and fused until they lined REC8-AEs along their length. In metaphase I, SMC1β, SMC3, SCP2, and SCP3 disappeared from the chromosome arms and accumulated around the centromeres, where they stayed until anaphase II. In striking contrast, REC8 persisted along the chromosome arms until anaphase I and near the centromeres until anaphase II. We propose that REC8 provides a basis for AE formation and that the first steps in AE assembly do not require SMC1β, SMC3, SCP2, and SCP3. Furthermore, SMC1β, SMC3, SCP2, and SCP3 cannot provide arm cohesion during metaphase I. We propose that REC8 then provides cohesion. RAD51 and/or DMC1 coimmunoprecipitates with REC8, suggesting that REC8 may also provide a basis for assembly of recombination complexes

Wären Sie vielleicht bereit, sich gegebenenfalls noch einmal befragen zu lassen? Oder: Gründe für die Teilnahme an Panelbefragungen

Ausgangspunkt für die vorliegende Untersuchung war die Tatsache, daß die Teilnehmer an Panelbefragungen bisher nie nach den Motiven für ihre Beteiligung gefragt worden sind. Dieses Versäumnis wurde im ZUMA-Methodenpanel ausgeglichen. Am Ende einer fünfwelligen Telefonbefragung von Januar bis Mai 1991 in der Stadt Ludwigshafen am Rhein wurden die Befragungspersonen direkt und offen nach den Gründen für ihre Teilnahme am Panel gefragt. Es handelte sich dabei um 140 Probanden und damit 54,7 Prozent der Panelbereiten der ersten Befragungswelle. Aus den Antworten auf die Frage nach den Teilnahmegründen konnten insgesamt 201 Informationen abgeleitet werden. Die Zuordnung zu einem Klassifikationsschema ergab, daß sich die Antworten relativ gleichmäßig, nämlich zu je einem Drittel, auf die drei inhaltlichen Hauptdimensionen 'Altruistische Gründe', 'Befragungsbezogene Gründe' und 'Persönliche Gründe' verteilen. Die meisten Einzelnennungen entfielen auf 'Interesse/Neugier' und die Wichtigkeit der Umfrage. 'Man nimmt also an Panelbefragungen bis zum Ende teil, weil man sie aus irgendwelchen Gründen für wichtig hält und interessant findet.' (psz

Nurse-based case management for aged patients with myocardial infarction: study protocol of a randomized controlled trial

BACKGROUND: Aged patients with coronary heart disease (CHD) have a high prevalence of co-morbidity associated with poor quality of life, high health care costs, and increased risk for adverse outcomes. These patients are often lacking an optimal home care which may result in subsequent readmissions. However, a specific case management programme for elderly patients with myocardial infarction (MI) is not yet available. The objective of this trial is to examine the effectiveness of a nurse-based case management in patients aged 65 years and older discharged after treatment of an acute MI in hospital. The programme is expected to influence patient readmission, mortality and quality of life, and thus to reduce health care costs compared with usual care. In this paper the study protocol is described. METHODS/DESIGN: The KORINNA (Koronarinfarkt Nachbehandlung im Alter) study is designed as a single-center randomized two-armed parallel group trial. KORINNA is conducted in the framework of KORA (Cooperative Health Research in the Region of Augsburg). Patients assigned to the intervention group receive a nurse-based follow-up for one year including home visits and telephone calls. Key elements of the intervention are to detect problems or risks, to give advice regarding a broad range of aspects of disease management and to refer to the general practitioner, if necessary. The control group receives usual care. Twelve months after the index hospitalization all patients are re-assessed. The study has started in September 2008. According to sample size estimation a total number of 338 patients will be recruited. The primary endpoint of the study is time to first readmission to hospital or out of hospital death. Secondary endpoints are functional status, participation, quality of life, compliance, and cost-effectiveness of the intervention. For the economic evaluation cost data is retrospectively assessed by the patients. The incremental cost-effectiveness ratio (ICER) will be calculated. DISCUSSION: The KORINNA study will contribute to the evidence regarding the effectiveness of case management programmes in aged people with MI. The results can be an important basis for clinicians, administrators and health policy makers to decide on the provision of high-quality care to older patients with CHD. TRIAL REGISTRATION: ISRCTN0289374

Occurrence of mcr-1 and mcr-2 colistin resistance genes in porcine Escherichia coli isolates (2010–2020) and genomic characterization of mcr-2-positive E. coli

Introduction: The global emergence of plasmid-mediated colistin resistance is threatening the efficacy of colistin as one of the last treatment options against multi-drug resistant Gram-negative bacteria. To date, ten mcr-genes (mcr-1 to mcr-10) were reported. While mcr-1 has disseminated globally, the occurrence of mcr-2 was reported scarcely. Methods and results: We determined the occurrence of mcr-1 and mcr-2 genes among Escherichia coli isolates from swine and performed detailed genomic characterization of mcr-2-positive strains. In the years 2010-2017, 7,614 porcine E. coli isolates were obtained from fecal swine samples in Europe and isolates carrying at least one of the virulence associated genes predicting Shiga toxin producing E. coli (STEC), enterotoxigenic E. coli (ETEC) or enteropathogenic E. coli (EPEC) were stored. 793 (10.4%) of these isolates carried the mcr-1 gene. Of 1,477 additional E. coli isolates obtained from sheep blood agar containing 4 mg/L colistin between 2018 and 2020, 36 (2.4%) isolates were mcr-1-positive. In contrast to mcr-1, the mcr-2 gene occurred at a very low frequency (0.13%) among the overall 9,091 isolates. Most mcr-2-positive isolates originated from Belgium (n = 9), one from Spain and two from Germany. They were obtained from six different farms and revealed multilocus sequence types ST10, ST29, ST93, ST100, ST3057 and ST5786. While the originally described mcr-2.1 was predominant, we also detected a new mcr-2 variant in two isolates from Belgium, which was termed mcr-2.8. MCR-2 isolates were mostly classified as ETEC or ETEC-like, while one isolate from Spain represented an atypical enteropathogenic E. coli (aEPEC; eae+). The ST29-aEPEC isolate carried mcr-2 on the chromosome. Another eight isolates carried their mcr-2 gene on IncX4 plasmids that resembled the pKP37-BE MCR-2 plasmid originally described in Belgium in 2015. Three ST100 E. coli isolates from a single farm in Belgium carried the mcr-2.1 gene on a 47-kb self-transmissible IncP type plasmid of a new IncP-1 clade. Discussion: This is the first report of mcr-2 genes in E. coli isolates from Germany. The detection of a new mcr-2 allele and a novel plasmid backbone suggests the presence of so far undetected mcr-2 variants and mobilizable vehicles.Peer Reviewe

Regionale Innovations- und Qualifizierungsstrategien in der Medizintechnik: Ergebnisse des Forschungsprojektes

'Innovations- und Qualifizierungsstrategien sind zum entscheidenden Wettbewerbsfaktor der stark exportorientierten Medizintechnikbranche in Deutschland geworden, um auf globalen Märkten mit innovativen Produkten weiterhin eine führende Position einzunehmen. Die komplexen und hochtechnologischen Produkte und Produktionssysteme sowie deren Anwendung, verknüpft mit relevanten Dienstleistungen, erfordern eine immer bessere und größtenteils fachübergreifende Qualifizierung der Beschäftigten auf allen einschlägigen Qualifikationsebenen: von Fachangestellten und -arbeitern über Meister bzw. Techniker bis hin zum akademischen Personal. Die zentralen Gestaltungsherausforderungen, denen sich die Unternehmen und die Anwender, aber auch die Berufsbildungsforschung, die Politik, die Interessensvertretungen etc. zuwenden müssen, um eine Zukunftsfähigkeit der Qualifizierung im Bereich Medizintechnik zu erlangen, sind nach vorliegender Studie: die Reformierung und die Modernisierung der dualen und schulischen Berufsausbildungen durch Aktualisierung der Ausbildungsinhalte und Bestimmung regelmäßiger Innovationszyklen zur Aktualisierung der Curricula; die Neugestaltung der fachschulischen Ausbildung durch die Verbindung der theoretischen und praktischen Ausbildung sowie die Etablierung der Praxis als eigenständiger Lernort; die Anpassung der Fort- und Weiterbildung an betriebliche Bedarfe, beispielsweise durch Aufgreifen aktueller Forschungsergebnisse; das Aufgreifen branchenspezifischer Qualifikationsinhalte (z.B. Kombination von medizinischen und technischen/ technologischen Fachkenntnissen); die Verbesserung der außerfachlichen Fähigkeiten (Team-, Kommunikations- und Problemlösefähigkeit, selbstverantwortliches Arbeiten), um neue Formen der Arbeitsorganisation effektiver umzusetzen (z.B. Team- und Projektarbeit, abteilungsübergreifende Zusammenarbeit, stärkere Kundenorientierung); das Aufgreifen der Akademisierungstendenzen durch Verbindung von dualer/ schulischer Ausbildung mit Bachelor-Studiengängen für bestimmte Aufgabenbereiche; die Implementation von betrieblichen Wissensmanagementsystemen, um verschiedene Wissensressourcen miteinander zu verbinden und für eine strukturierte 10 Weitergabe und Vermittlung der wesentlichen Wissenselemente/ -bestandteile zu sorgen (Stärkung des Unternehmens als innovative Organisation); die Vernetzung zwischen Wissenschaft und Praxis um stetigen Wissenstransfer zu gewährleisten (Ausbau von Netzwerkstrukturen). Den zukünftigen Qualifizierungsanforderungen kann in erster Linie über die Neugestaltung und Weiterentwicklung der bestehenden Berufe sowie über die Etablierung eines bedarfsgerechten Weiterbildungssystems begegnet werden. Transparenz und Vergleichbarkeit sind dabei wichtige Parameter der Qualitätssicherung. Erweiterte Aufgabenspektren charakterisieren die Jobs von morgen. Die Entwicklung neuer Berufsbilder wird derzeit aber nicht als probates Mittel bewertet, um den Anforderungen der Branche wirkungsvoll und nachhaltig zu begegnen. Im Gegenteil: neue Berufe würden den ohnehin unübersichtlichen 'Dschungel' an Qualifikationen weiter verstärken und eher zu einer Ab- als zu einer Aufwertung insbesondere der dualen und fachschulischen Ausbildungen führen. Zusammenfassend ist festzuhalten, dass die zukünftigen Qualifizierungsstrategien in der Medizintechnikbranche nicht in erster Linie mit der Entwicklung neuer Berufbilder, sondern mit der Reformierung und Weiterentwicklung bestehender Berufsbilder bewerkstelligt werden können. Neben der Sicherstellung einer breit gefächerten Grundausbildung kristallisieren sich ein bedarfsgerechtes, branchenspezifisches Fort- und Weiterbildungssystem sowie die Weiterentwicklung von regionalen Netzwerken als Handlungsfelder heraus, um den zukünftigen Herausforderungen der Branche im Bereich Qualifizierung konstruktiv zu begegnen.' [Autorenreferat

Correlating microbial community profiles with geochemical data in highly stratified sediments from the Arctic Mid-Ocean Ridge

Microbial communities and their associated metabolic activity in marine sediments have a profound impact on global biogeochemical cycles. Their composition and structure are attributed to geochemical and physical factors, but finding direct correlations has remained a challenge. Here we show a significant statistical relationship between variation in geochemical composition and prokaryotic community structure within deep-sea sediments. We obtained comprehensive geochemical data from two gravity cores near the hydrothermal vent field Loki’s Castle at the Arctic Mid-Ocean Ridge, in the Norwegian- Greenland Sea. Geochemical properties in the rift valley sediments exhibited strong centimeter-scale stratigraphic variability. Microbial populations were profiled by pyrosequencing from 15 sediment horizons (59,364 16S rRNA gene tags), quantitatively assessed by qPCR, and phylogenetically analyzed. Although the same taxa were generally present in all samples, their relative abundances varied substantially among horizons and fluctuated between Bacteria- and Archaea-dominated communities. By independently summarizing covariance structures of the relative abundance data and geochemical data, using principal components analysis, we found a significant correlation between changes in geochemical composition and changes in community structure. Differences in organic carbon and mineralogy shaped the relative abundance of microbial taxa. We used correlations to build hypotheses about energy metabolisms, particularly of the Deep Sea Archaeal Group, specific Deltaproteobacteria, and sediment lineages of potentially anaerobic Marine Group I Archaea. We demonstrate that total prokaryotic community structure can be directly correlated to geochemistry within these sediments, thus enhancing our understanding of biogeochemical cycling and our ability to predict metabolisms of uncultured microbes in deep-sea sediments

Impact of Financial Pyramids on Well-being of the Russian Society

The article considers the impact of financial pyramids on a man’s well-being in terms of the key domains: financial situation, social environment, education, employment, and health. The authors determinate the financial pyramid as a scheme of interaction of the organizer and participants. In a financial pyramid participants' contributions are not a source of investments and it is redistributed between them. It is important to understand that the participants of a financial pyramid are able to lose contributions. The major negative effects of financial pyramids on socio-economical and psychological wellbeing of a man and society in Russia were revealed. We detected their effect on: 1) a financial situation, i.e. financial losses of participants of financial pyramids; 2) man’s psycho-emotional state; 3) decision-making of various social groups, i.e. intensification of their cognitive distortions. An instrument of social and economic policies of Russia aimed at mitigating negative effects of financial pyramids was suggested and described. The instrument will enable to enhance confidence of population in financial institutions and their services