Konzeptionelle und empirische Fragen der Krankheitsauswahl im Kontext der Einführung des morbiditätsorientierten Risikostrukturausgleichs in der GKV

Gemäß § 31 Abs. 1 Risikostrukturausgleichs-Verordnung (RSAV) soll sich das Versichertenklassifikationsmodell für den morbiditätsorientierten RSA an 50-80 Krankheiten orientieren. Dabei sollen insbesondere Krankheiten mit schwerwiegendem Verlauf und kostenintensive chronische Krankheiten berücksichtigt werden, bei denen die Leistungsausgaben der Versicherten im Mittel 50 % über den durchschnittlichen Ausgaben in der gesetzlichen Krankenversicherung (GKV) liegen. Die Krankheiten sollen eng abgrenzbar sein. Der Alfried Krupp von Bohlen und Halbach-Stiftungslehrstuhl für Medizinmanagement (Direktor: Prof. Dr. Jürgen Wasem) hat in Kooperation mit der CAREM GmbH ein Forschungsvorhaben durchgeführt, mit dem eine Liste von 50-80 Krankheiten für den morbiditätsorientierten Risikostrukturausgleich in der GKV entwickelt wurde. Für das Forschungsprojekt stand eine repräsentativer Individualdatensatz von rd. 3,2 Mio. Versicherten bei einer überregional tätigen Krankenkasse zur Verfügung. Die Begriffe der chronischen und schwerwiegenden Erkrankung wurden mittels systematischer Literaturrecherchen, der Definition in anderen Bereichen der GKV sowie einem Expertenworkshop operationalisiert. Es gibt keine einheitlichen Definitionen. Insgesamt erscheint es sachgerecht, chronischen Erkrankungen die folgenden Merkmale zuzuschreiben: ... --

Strabismus measurements with novel video goggles

PURPOSE: To assess the validity of a novel, simplified, noninvasive test for strabismus using video goggles. DESIGN: Cross-sectional method comparison study in which the new test, the strabismus video goggles, is compared with the existing reference standard, the Hess screen test. PARTICIPANTS: We studied 41 adult and child patients aged ≥6 years with ocular misalignment owing to congenital or acquired paralytic or comitant strabismus and 17 healthy volunteers. METHODS: All participants were tested with binocular infrared video goggles with built-in laser target projection and liquid crystal display shutters for alternate occlusion of the eyes and the conventional Hess screen test. In both tests, ocular deviations were measured on a 9-point target grid located at 0±15° horizontal and vertical eccentricity. MAIN OUTCOME MEASURES: Horizontal and vertical ocular deviations at 9 different gaze positions of each eye were measured by the strabismus video goggles and the Hess screen test. Agreement was quantified as the intraclass correlation coefficient. Secondary outcomes were the utility of the goggles in patients with visual suppression and in children. RESULTS: There was good agreement between the strabismus video goggles and the Hess screen test in the measurements of horizontal and vertical deviation (intraclass correlation coefficient horizontal 0.83, 95% confidence interval [0.77, 0.88], vertical 0.76, 95% confidence interval [0.68, 0.82]). Both methods reproduced the characteristic strabismus patterns in the 9-point grid. In contrast to Hess screen testing, strabismus video goggle measurements were even possible in patients with comitant strabismus and visual suppression. CONCLUSIONS The new device is simple and is fast and accurate in measuring ocular deviations, and the results are closely correlated with those obtained using the conventional Hess screen test. It can even be used in patients with visual suppression who are not suitable for the Hess screen test. The device can be applied in children as young as 6 years of age

Melanoregulin (MREG) Modulates Lysosome Function in Pigment Epithelial Cells

Melanoregulin (MREG), the product of the Mregdsu gene, is a small highly charged protein, hypothesized to play a role in organelle biogenesis due to its effect on pigmentation in dilute, ashen, and leaden mutant mice. Here we provide evidence that MREG is required in lysosome-dependent phagosome degradation. In the Mreg-/- mouse, we show that loss of MREG function results in phagosome accumulation due to delayed degradation of engulfed material. Over time, the Mreg-/- mouse retinal pigment epithelial cells accumulate the lipofuscin component, A2E. MREG-deficient human and mouse retinal pigment epithelial cells exhibit diminished activity of the lysosomal hydrolase, cathepsin D, due to defective processing. Moreover, MREG localizes to small intracellular vesicles and associates with the endosomal phosphoinositide, phosphatidylinositol 3,5-biphosphate. Collectively, these studies suggest that MREG is required for lysosome maturation and support a role for MREG in intracellular trafficking

Instances and connectors : issues for a second generation process language

This work is supported by UK EPSRC grants GR/L34433 and GR/L32699Over the past decade a variety of process languages have been defined, used and evaluated. It is now possible to consider second generation languages based on this experience. Rather than develop a second generation wish list this position paper explores two issues: instances and connectors. Instances relate to the relationship between a process model as a description and the, possibly multiple, enacting instances which are created from it. Connectors refers to the issue of concurrency control and achieving a higher level of abstraction in how parts of a model interact. We believe that these issues are key to developing systems which can effectively support business processes, and that they have not received sufficient attention within the process modelling community. Through exploring these issues we also illustrate our approach to designing a second generation process language.Postprin

Prikazi

1) Senka Božić-Vrbančić, Jelena Kupsjak: Feral Atlas. The More-Than-Human Anthropocene, Anna Tsing, Jannifer Deger, Alder Keleman Saxena i Feifei Zhou, ur., Stanford University Press, Stanford, 2020. 2) Maja Flajsig: Ekofeminizam. Između ženskih i zelenih studija, Goran Đurđević i Suzana Marjanić, ur., Durieux, Zagreb, 2020., 479 str. 3) Tanja Petrović: Transformacija rada. Narativi, prakse, režimi, Ozren Biti i Reana Senjković, ur., Institut za etnologiju i folkloristiku, Zagreb, 2021, 388 str. 4) Velna Rončević: Anne Allison, Precarious Japan, Duke University Press, Durham, 2013., 256 str. 5) Andrea Matošević: Priče iz konzerve. Povijest prerade i konzerviranja riba na sjeveroistočnom Jadranu, Iva Kosmos, Tanja Petrović i Martin Pogačar, ur., Srednja Europa, Zagreb, 2020., 301 str. 6) Iva Grubiša: Jasna Čapo, Dva doma. Hrvatska radna migracija u Njemačku kao transnacionalni fenomen, Durieux, Zagreb, 2019., 392. str. 7) Ljiljana Marks: Olga Supek, Ljeto u Detroitu. Studija jedne lokalne četvrti iz perspektive ekonomske antropologije, Hrvatsko etnološko društvo, Zagreb, 2020., 179 str. 8) Iris Biškupić Bašić: Katarina Bušić, Zbirka narodnih nošnji hrvatske dijaspore (The Croatian Diaspora Folk Clothing Collection), Etnografski muzej, Zagreb, 2019., 192 str. 9) Andrea Klobučar: Kapa dolje! Priča o (ne)pokrivanju glave, Mareta Kurtin, ur. Etnografski muzej, Zagreb, 2019., 344 str. 10) Tea Škokić: Liber Monstrorum Balcanorum. Čudovišni svijet europske margine, Miranda Levanat-Peričić i Tomislav Oroz, ur., Jesenski i Turk i Institut za etnologiju i folkloristiku, Zagreb, 2019., 371 str. 11) Olga Orlić: Devedesete. Kratki rezovi, Orlanda Obad i Petar Bagarić, ur., Institut za etnologiju i folkloristiku, Jesenski i Turk, Zagreb, 2020., 427 str. 12) Marijana Belaj: Antropologija izvan akademije – osvrt na Godišnji skup HED-a 2020: Etnografska istraživanja na tržišt

Prikazi

1) Senka Božić-Vrbančić, Jelena Kupsjak: Feral Atlas. The More-Than-Human Anthropocene, Anna Tsing, Jannifer Deger, Alder Keleman Saxena i Feifei Zhou, ur., Stanford University Press, Stanford, 2020. 2) Maja Flajsig: Ekofeminizam. Između ženskih i zelenih studija, Goran Đurđević i Suzana Marjanić, ur., Durieux, Zagreb, 2020., 479 str. 3) Tanja Petrović: Transformacija rada. Narativi, prakse, režimi, Ozren Biti i Reana Senjković, ur., Institut za etnologiju i folkloristiku, Zagreb, 2021, 388 str. 4) Velna Rončević: Anne Allison, Precarious Japan, Duke University Press, Durham, 2013., 256 str. 5) Andrea Matošević: Priče iz konzerve. Povijest prerade i konzerviranja riba na sjeveroistočnom Jadranu, Iva Kosmos, Tanja Petrović i Martin Pogačar, ur., Srednja Europa, Zagreb, 2020., 301 str. 6) Iva Grubiša: Jasna Čapo, Dva doma. Hrvatska radna migracija u Njemačku kao transnacionalni fenomen, Durieux, Zagreb, 2019., 392. str. 7) Ljiljana Marks: Olga Supek, Ljeto u Detroitu. Studija jedne lokalne četvrti iz perspektive ekonomske antropologije, Hrvatsko etnološko društvo, Zagreb, 2020., 179 str. 8) Iris Biškupić Bašić: Katarina Bušić, Zbirka narodnih nošnji hrvatske dijaspore (The Croatian Diaspora Folk Clothing Collection), Etnografski muzej, Zagreb, 2019., 192 str. 9) Andrea Klobučar: Kapa dolje! Priča o (ne)pokrivanju glave, Mareta Kurtin, ur. Etnografski muzej, Zagreb, 2019., 344 str. 10) Tea Škokić: Liber Monstrorum Balcanorum. Čudovišni svijet europske margine, Miranda Levanat-Peričić i Tomislav Oroz, ur., Jesenski i Turk i Institut za etnologiju i folkloristiku, Zagreb, 2019., 371 str. 11) Olga Orlić: Devedesete. Kratki rezovi, Orlanda Obad i Petar Bagarić, ur., Institut za etnologiju i folkloristiku, Jesenski i Turk, Zagreb, 2020., 427 str. 12) Marijana Belaj: Antropologija izvan akademije – osvrt na Godišnji skup HED-a 2020: Etnografska istraživanja na tržišt

Common variants at theCHEK2gene locus and risk of epithelial ovarian cancer

Genome-wide association studies have identified 20 genomic regions associated with risk of epithelial ovarian cancer (EOC), but many additional risk variants may exist. Here, we evaluated associations between common genetic variants [single nucleotide polymorphisms (SNPs) and indels] in DNA repair genes and EOC risk. We genotyped 2896 common variants at 143 gene loci in DNA samples from 15 397 patients with invasive EOC and controls. We found evidence of associations with EOC risk for variants at FANCA, EXO1, E2F4, E2F2, CREB5 and CHEK2 genes (P ≤ 0.001). The strongest risk association was for CHEK2 SNP rs17507066 with serous EOC (P = 4.74 x 10(-7)). Additional genotyping and imputation of genotypes from the 1000 genomes project identified a slightly more significant association for CHEK2 SNP rs6005807 (r (2) with rs17507066 = 0.84, odds ratio (OR) 1.17, 95% CI 1.11-1.24, P = 1.1×10(-7)). We identified 293 variants in the region with likelihood ratios of less than 1:100 for representing the causal variant. Functional annotation identified 25 candidate SNPs that alter transcription factor binding sites within regulatory elements active in EOC precursor tissues. In The Cancer Genome Atlas dataset, CHEK2 gene expression was significantly higher in primary EOCs compared to normal fallopian tube tissues (P = 3.72×10(-8)). We also identified an association between genotypes of the candidate causal SNP rs12166475 (r (2) = 0.99 with rs6005807) and CHEK2 expression (P = 2.70×10(-8)). These data suggest that common variants at 22q12.1 are associated with risk of serous EOC and CHEK2 as a plausible target susceptibility gene.Other Research Uni

Troponin T-release associates with cardiac radiation doses during adjuvant left-sided breast cancer radiotherapy

Background Adjuvant radiotherapy (RT) for left-sided breast cancer increases cardiac morbidity and mortality. For the heart, no safe radiation threshold has been established. Troponin T is a sensitive marker of myocardial damage. Our aim was to evaluate the effect of left-sided breast cancer RT on serum high sensitivity troponin T (hscTnT) levels and its association with cardiac radiation doses and echocardiographic parameters. Methods A total of 58 patients with an early stage, left-sided breast cancer or ductal carcinoma in situ (DCIS) who received adjuvant breast RT without prior chemotherapy were included in this prospective, non-randomized study. Serum samples were taken before, during and after RT. An increase of hscTnT >30 % was predefined as significant. A comprehensive 2D echocardiograph and electrocardiogram (ECG) were performed before and after RT. Dose-volume histograms (DVHs) were generated for different cardiac structures. Results The hscTnT increased during RT from baseline in 12/58 patients (21 %). Patients with increased hscTnT values (group A, N = 12) had significantly higher radiation doses for the whole heart (p = 0.02) and left ventricle (p = 0.03) than patients without hscTnT increase (group B, N = 46). For the left anterior descending artery (LAD), differences between groups A and B were found in volumes receiving 15 Gy (p = 0.03) and 20 Gy (p = 0.03) Furthermore, after RT, the interventricular septum thickened (p = 0.01), and the deceleration time was prolonged (p = 0.008) more in group A than in group B. Conclusions The increase in hscTnT level during adjuvant RT was positively associated with the cardiac radiation doses for the whole heart and LV in chemotherapy-naive breast cancer patients. Whether these acute subclinical changes increase the risk of excessive long-term cardiovascular morbidity or mortality, will be addressed in the follow-up of our patients.BioMed Central open acces