Impfungen gegen Pneumokokken und Influenza: Wie groß ist die Evidenz?

Zusammenfassung: Durch Pneumokokken verursachte Infektionen und die Influenza können bei Kindern und älteren Personen sowie bei chronisch Kranken und Immunosupprimierten zu schweren, komplizierten Verläufen führen. Bei der alternden Bevölkerung in westlichen Ländern sind sie wichtige Ursachen für erhöhte Morbidität und Letalität. Weltweit unterstreicht die Antibiotikaresistenzentwicklung die Notwendigkeit der effektiven Impfung. Der 23-valente Polysaccharidimpfstoff gegen Pneumokokken wird kontrovers diskutiert. Neue Metaanalysen zeigten keine/wenig Wirksamkeit der Impfung in Bezug auf invasive Pneumokokkenerkrankungen oder Gesamtletalität. Jedoch dokumentierte eine neue Studie bei Pflegeheimbewohnern eine signifikante Reduktion von Pneumonie und Tod durch Pneumokokkenerkrankungen nach Impfungen. Der 7-valente Konjugatimpfstoff ist bei Kindern und bei Immunosupprimierten deutlich immunogener und effizienter und ist im schweizerischen Impfplan für Kinder integriert. In Deutschland wurde er bereits durch den 13-valenten Konjugatimpfstoff ersetzt. Influenzaimpfungen sind gut immunogen. Dies wird durch Adjuvanzien bei einer älteren Bevölkerung erhöht. Aufgrund der pandemischen Influenza H1N1 2009 wurden die Impfempfehlungen und die Zusammensetzung der Impfstoffe durch die WHO für den Herbst/Winter 2010/2011 entsprechend angepasst. Die Influenzaimpfung bietet zwar keinen guten Schutz gegen die Ansteckung, jedoch einen guten Schutz gegen Komplikationen der Influenz

Finite-Volume Energy Spectrum, Fractionalized Strings, and Low-Energy Effective Field Theory for the Quantum Dimer Model on the Square Lattice

We present detailed analytic calculations of finite-volume energy spectra, mean field theory, as well as a systematic low-energy effective field theory for the square lattice quantum dimer model. The analytic considerations explain why a string connecting two external static charges in the confining columnar phase fractionalizes into eight distinct strands with electric flux $\frac{1}{4}$. An emergent approximate spontaneously broken $SO(2)$ symmetry gives rise to a pseudo-Goldstone boson. Remarkably, this soft phonon-like excitation, which is massless at the Rokhsar-Kivelson (RK) point, exists far beyond this point. The Goldstone physics is captured by a systematic low-energy effective field theory. We determine its low-energy parameters by matching the analytic effective field theory with exact diagonalization results and Monte Carlo data. This confirms that the model exists in the columnar (and not in a plaquette or mixed) phase all the way to the RK point.Comment: 35 pages, 16 figure

Importance of Different Regions of H-2 for MLC Stimulation 1

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65829/1/j.1399-0039.1973.tb01008.x.pd

Exciton diffusion length and charge extraction yield in organic bilayer solar cells

A method for resolving the diffusion length of excitons and the extraction yield of charge carriers is presented based on the performance of organic bilayer solar cells and careful modeling. The technique uses a simultaneous variation of the absorber thickness and the excitation wavelength. Rigorously differing solar cell structures as well as independent photoluminescence quenching measurements give consistent results

Evaluation of range of motion restriction within the hip joint

In Total Hip Arthroplasty, determining the impingement free range of motion requirement is a complex task. This is because in the native hip, motion is restricted by both impingement as well as soft tissue restraint. The aim of this study is to determine a range of motion benchmark which can identify motions which are at risk from impingement and those which are constrained due to soft tissue. Two experimental methodologies were used to determine motions which were limited by impingement and those motions which were limited by both impingement and soft tissue restraint. By comparing these two experimental results, motions which were limited by impingement were able to be separated from those motions which were limited by soft tissue restraint. The results show motions in extension as well as flexion combined with adduction are limited by soft tissue restraint. Motions in flexion, flexion combined with abduction and adduction are at risk from osseous impingement. Consequently, these motions represent where the maximum likely damage will occur in femoroacetabular impingement or at most risk of prosthetic impingement in Total Hip Arthroplasty

Poor accuracy of freehand cup positioning during total hip arthroplasty

Several studies have demonstrated a correlation between the acetabular cup position and the risk of dislocation, wear and range of motion after total hip arthroplasty. The present study was designed to evaluate the accuracy of the surgeon’s estimated position of the cup after freehand placement in total hip replacement. Peroperative estimated abduction and anteversion of 200 acetabular components (placed by three orthopaedic surgeons and nine residents) were compared with measured outcomes (according to Pradhan) on postoperative radiographs. Cups were placed in 49.7° (SD 6.7) of abduction and 16.0° (SD 8.1) of anteversion. Estimation of placement was 46.3° (SD 4.3) of abduction and 14.6° (SD 5.9) of anteversion. Of more interest is the fact that for the orthopaedic surgeons the mean inaccuracy of estimation was 4.1° (SD 3.9) for abduction and 5.2° (SD 4.5) for anteversion and for their residents this was respectively, 6.3° (SD 4.6) and 5.7° (SD 5.0). Significant differences were found between orthopaedic surgeons and residents for inaccuracy of estimation for abduction, not for anteversion. Body mass index, sex, (un)cemented fixation and surgical approach (anterolateral or posterolateral) were not significant factors. Based upon the inaccuracy of estimation, the group’s chance on future cup placement within Lewinnek’s safe zone (5–25° anteversion and 30–50° abduction) is 82.7 and 85.2% for anteversion and abduction separately. When both parameters are combined, the chance of accurate placement is only 70.5%. The chance of placement of the acetabular component within 5° of an intended position, for both abduction and anteversion is 21.5% this percentage decreases to just 2.9% when the tolerated error is 1°. There is a tendency to underestimate both abduction and anteversion. Orthopaedic surgeons are superior to their residents in estimating abduction of the acetabular component. The results of this study indicate that freehand placement of the acetabular component is not a reliable method