Exploration potenzieller Barrieren für die Akzeptanz eines interdisziplinären sektorenübergreifenden Versorgungsnetzwerkes für Patient*innen mit Morbus Parkinson

Hintergrund Mit dem ParkinsonNetzwerk Ostsachsen (PANOS) soll ein intersektorales, pfadbasiertes und plattformunterstütztes Versorgungskonzept etabliert werden, um trotz steigender Behandlungszahlen eine flächendeckende Parkinson-Versorgung mit adäquaten Therapien zu unterstützen. Fragestellung Welche Barrieren könnten die Akzeptanz und eine erfolgreiche Verstetigung des PANOS-Behandlungspfades gefährden? Methode Implementierungsbarrieren wurden über eine selektive Literaturrecherche identifiziert und in einer Onlinebefragung von 36 projektassoziierten Neurolog*innen und Hausärzt*innen priorisiert. Die Auswertung der Ergebnisse erfolgte anonymisiert und deskriptiv. Ergebnisse Dreizehn mögliche Implementierungsbarrieren wurden identifiziert. Es nahmen 11 Neurolog*innen und 7 Hausärzt*innen an der Onlineumfrage teil. Die befragten Neurolog*innen sahen in Doppeldokumentationen sowie in unzureichender Kommunikation und Kooperation zwischen den Leistungserbringenden die größten Hindernisse für eine Akzeptanz von PANOS. Hausärzt*innen beurteilten u. a. die restriktiven Verordnungs- und Budgetgrenzen und den möglicherweise zu hohen Zeitaufwand für Netzwerkprozesse als hinderlich. Diskussion Doppeldokumentationen von Patienten- und Behandlungsdaten sind zeitintensiv und fehleranfällig. Die Akzeptanz kann durch adäquate finanzielle Kompensation der Leistungserbringenden erhöht werden. Das hausärztliche Verordnungsverhalten könnte durch die Verwendung interventionsbezogener Abrechnungsziffern positiv beeinflusst werden. Die Ergebnisse zeigen u. a. einen Bedarf an integrativen technischen Systemlösungen und sektorenübergreifenden Dokumentationsstrukturen, um den Mehraufwand für Leistungserbringende zu reduzieren. Schlussfolgerung Eine Vorabanalyse der Einflussfaktoren von PANOS sowie die Sensibilisierung aller mitwirkenden Akteure für potenzielle Barrieren sind entscheidend für die Akzeptanz des Versorgungsnetzwerkes. Gezielte Maßnahmen zur Reduzierung und Vermeidung identifizierter Barrieren können die anwenderseitige Akzeptanz erhöhen und die Behandlungsergebnisse optimieren.Introduction The ParkinsonNetwork Eastern Saxony (PANOS) aims to establish an intersectoral, path-based and platform-supported care concept in order to support comprehensive care with adequate therapies despite the increasing number of patients to be treated. Objective Which barriers may limit the acceptance and successful implementation of PANOS? Methods Implementation barriers were identified through a selective literature review and prioritized in an online survey of 36 project-associated neurologists and general practitioners. The results were analyzed anonymously and descriptively. Results Thirteen potential implementation barriers were identified. Eleven neurologists and seven general practitioners participated in the online survey. The surveyed neurologists assessed double documentation and inadequate communication and cooperation between the service providers as the biggest obstacles to the acceptance of PANOS. General practitioners rated the restrictions for prescription and budget and the potentially high time expenditure required for network activities as barriers. Discussion Double documentation of patient and treatment data is time consuming and prone to errors. Adequate financial compensation could increase service providers’ willingness to participate in such measures. In addition, the prescribing behavior of general practitioners may be influenced positively by the use of intervention-related accounting numbers. The results indicate a need for integrative technical system solutions and intersectoral documentation structures in order to reduce the additional effort for service providers. Conclusion Analyzing the influencing factors of the PANOS network, and raising the awareness of all participating service providers to potential barriers, are decisive measures for the acceptance of the care network. Targeted measures to reduce and avoid identified barriers can increase user acceptance and optimize treatment results

A novel combined experimental and multiscale theoretical approach to unravel the structure of SiC/SiOx core/shell nanowires for their optimal design

In this work we propose a realistic model of nanometer-thick SiC/SiOxcore/shell nanowires (NWs) using a combined first-principles and experimental approach. SiC/SiOxcore/shell NWs were first synthesised by a low-cost carbothermal method and their chemical-physical experimental analysis was accomplished by recording X-ray absorption near-edge spectra. In particular, the K-edge absorption lineshapes of C, O, and Si are used to validate our computational model of the SiC/SiOxcore/shell NW architectures, obtained by a multiscale approach, including molecular dynamics, tight-binding and density functional simulations. Moreover, we present ab initio calculations of the electronic structure of hydrogenated SiC and SiC/SiOxcore/shell NWs, studying the modification induced by several different substitutional defects and impurities into both the surface and the interfacial region between the SiC core and the SiOxshell. We find that on the one hand the electron quantum confinement results in a broadening of the band gap, while hydroxyl surface terminations decrease it. This computational investigation shows that our model of SiC/SiOxcore/shell NWs is capable to deliver an accurate interpretation of the recorded X-ray absorption near-edge spectra and proves to be a valuable tool towards the optimal design and application of these nanosystems in actual devices

Collective Molecular Switching in Hybrid Superlattices for Light-Modulated Two-Dimensional Electronics

peer reviewe

Identification of O-mannosylated Virulence Factors in Ustilago maydis

The O-mannosyltransferase Pmt4 has emerged as crucial for fungal virulence in the animal pathogens Candida albicans or Cryptococcus neoformans as well as in the phytopathogenic fungus Ustilago maydis. Pmt4 O-mannosylates specific target proteins at the Endoplasmic Reticulum. Therefore a deficient O-mannosylation of these target proteins must be responsible for the loss of pathogenicity in pmt4 mutants. Taking advantage of the characteristics described for Pmt4 substrates in Saccharomyces cerevisiae, we performed a proteome-wide bioinformatic approach to identify putative Pmt4 targets in the corn smut fungus U. maydis and validated Pmt4-mediated glycosylation of candidate proteins by electrophoretic mobility shift assays. We found that the signalling mucin Msb2, which regulates appressorium differentiation upstream of the pathogenicity-related MAP kinase cascade, is O-mannosylated by Pmt4. The epistatic relationship of pmt4 and msb2 showed that both are likely to act in the same pathway. Furthermore, constitutive activation of the MAP kinase cascade restored appressorium development in pmt4 mutants, suggesting that during the initial phase of infection the failure to O-mannosylate Msb2 is responsible for the virulence defect of pmt4 mutants. On the other hand we demonstrate that during later stages of pathogenic development Pmt4 affects virulence independently of Msb2, probably by modifying secreted effector proteins. Pit1, a protein required for fungal spreading inside the infected leaf, was also identified as a Pmt4 target. Thus, O-mannosylation of different target proteins affects various stages of pathogenic development in U. maydis

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases

Proteomic Analysis of Rta2p-Dependent Raft-Association of Detergent-Resistant Membranes in Candida albicans

In Candida albicans, lipid rafts (also called detergent-resistant membranes, DRMs) are involved in many cellular processes and contain many important proteins. In our previous study, we demonstrated that Rta2p was required for calcineurin-mediated azole resistance and sphingoid long-chain base release in C. albicans. Here, we found that Rta2p was co-localized with raft-constituted ergosterol on the plasma membrane of C. albicans. Furthermore, this membrane expression pattern was totally disturbed by inhibitors of either ergosterol or sphingolipid synthesis. Biochemical fractionation of DRMs together with immunoblot uncovered that Rta2p, along with well-known DRM-associated proteins (Pma1p and Gas1p homologue), was associated with DRMs and their associations were blocked by inhibitors of either ergosterol or sphingolipid synthesis. Finally, we used the proteomic analysis together with immunoblot and identified that Rta2p was required for the association of 10 proteins with DRMs. These 5 proteins (Pma1p, Gas1p homologue, Erg11p, Pmt2p and Ali1p) have been reported to be DRM-associated and also that Erg11p is a well-known target of azoles in C. albicans. In conclusion, our results showed that Rta2p was predominantly localized in lipid rafts and was required for the association of certain membrane proteins with lipid rafts in C. albicans

Feel4Diabetes healthy diet score: Development and evaluation of clinical validity

Background: The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. Methods: Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson''s correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson''s correlations were studied between baseline and 1 year score, within the control group only. Results: The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants. Conclusion: The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner