[Do gatekeeping programs increase equality of health care in Germany? A comparison of the health care situation of participants and nonparticipants]

This article compares the health care situation of participants in programs of general practitioner-centered health care (gatekeeping) in Germany (participants) with that of statutory health insurance holders who are not participating in such programs (nonparticipants). Because a key objective of the general practitioner model is to reduce the number of visits to specialists, the article also examines factors influencing frequent utilization of specialists in both groups. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2010) based on a sample representative of the German population. In this context, 5,232 holders of statutory health insurance aged between 18 and 79 years were interviewed on health care policy issues. The results show that regulating the utilization of specialists through the gatekeeping function of general practitioners succeeds in facilitating similar utilization rates across educational levels, between cities and towns, and between men and women. Thus, gatekeeping programs contribute to the reduction of health care inequalities.

A hybrid approach to multi-scale modelling of cancer

In this paper, we review multi-scale models of solid tumour growth and discuss a middle-out framework that tracks individual cells. By focusing on the cellular dynamics of a healthy colorectal crypt and its invasion by mutant, cancerous cells, we compare a cell-centre, a cell-vertex and a continuum model of cell proliferation and movement. All models reproduce the basic features of a healthy crypt: cells proliferate near the crypt base, they migrate upwards and are sloughed off near the top. The models are used to establish conditions under which mutant cells are able to colonize the crypt either by top-down or by bottom-up invasion. While the continuum model is quicker and easier to implement, it can be difficult to relate system parameters to measurable biophysical quantities. Conversely, the greater detail inherent in the multi-scale models means that experimentally derived parameters can be incorporated and, therefore, these models offer greater scope for understanding normal and diseased crypts, for testing and identifying new therapeutic targets and for predicting their impacts.

Intermediate structures in the cholate-phosphatidylcholine vesicle-micelle transition

The vesicle-micelle transition of egg phosphatidylcholine (PC) and sodium cholate was described by comparing cryo-transmission electron microscopic (cryo-TEM) images of the structures formed to the associated turbidity changes. These experiments were designed to identify the morphology of the intermediates between vesicles and small spheroidal mixed micelles. With increasing cholate concentration, the vesicular structures changed size and more multilamellar vesicles were seen. Between the apparent upper and lower phase boundaries, three structures were observed: open vesicles, large bilayer sheets (twenty to several hundred nanometers in diameter), and long (150-300 nm) flexible cylindrical micelles. The cylindrical micelles evolved from the edges of the bilayer sheets. At higher relative cholate concentration, the phase boundary was sharply defined by optical clarification of the egg PC-cholate mixtures. Cryo-TEM revealed only small spheroidal mixed micelles at this transition. These results provide the first direct evidence of the structural pathway or of molecular intermediates between a lamellar and a micellar state. Understanding these specific intermediates and the transitions between them is essential to developing reconstitution protocols and properly analyzing either activity or structural data obtained from cholate-dispersed membrane proteins.

THE FURTHER SEPARATION OF TYPES AMONG THE PNEUMOCOCCI HITHERTO INCLUDED IN GROUP IV AND THE DEVELOPMENT OF THERAPEUTIC ANTISERA FOR THESE TYPES

The unclassified strains known as Group IV have been separated into twenty-nine types which are designated by the Roman numerals IV and XXXII. Only a small percentage of the pneumococcus strains isolated in New York City for this study were left unclassified. The majority of the types gave very slight cross-reactions, the exceptions being Types II and V, III and VIII, VII and XVIII and XV and XXX. In the series of cases studied, Types IV, V, VII and VIII were found more prevalent in the lobar pneumonia of adults and Types V, VI a and XIV in children. The majority of the types were also found in normal individuals and in persons having respiratory infections other than pneumonia. Types VI a and XIX were most prevalent in the limited number of strains studied by us. Fourteen of the types were found in pneumococcus meningitis; Type XVIII was found most often. Antisera suitable for clinical trial have been prepared for fourteen types. From the majority of the horses inoculated for more than a year, antisera having 500 to 1000 units per cc. were obtained. Antisera of lower potency were concentrated and preparations obtained equal to or stronger than high grade unconcentrated serum. Potent bivalent antisera have been prepared for types which were found to give marked cross-agglutination reactions. The results with each type as to prevalence, severity of cases, presence in normal individuals, and in spinal meningitis, potency of antisera produced for therapeutic trial and virulence of strains for mice have been considered under the different type headings.

Novel detection system for plant protein production of pharmaceuticals and impact on conformational diseases

tate-of-the-art biochemistry methods in combination with an automated phenotyping method demonstrate the high potential of transgenic tobacco plants in producing properly-folded therapeutic proteins for the treatment of protein-misfolding diseases (e.g., Alzheimer's disease). This molecular farming approach led to highest protein production of hydroponically-grown tobacco compared to other growth substrates generally used in plant cultivation.

[Consensus statement "Dementia 2010" of the Austrian Alzheimer Society]

The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.

An integrative computational model for intestinal tissue renewal

OBJECTIVES

The luminal surface of the gut is lined with a monolayer of epithelial cells that acts as a nutrient absorptive engine and protective barrier. To maintain its integrity and functionality, the epithelium is renewed every few days. Theoretical models are powerful tools that can be used to test hypotheses concerning the regulation of this renewal process, to investigate how its dysfunction can lead to loss of homeostasis and neoplasia, and to identify potential therapeutic interventions. Here we propose a new multiscale model for crypt dynamics that links phenomena occurring at the subcellular, cellular and tissue levels of organisation.

METHODS

At the subcellular level, deterministic models characterise molecular networks, such as cell-cycle control and Wnt signalling. The output of these models determines the behaviour of each epithelial cell in response to intra-, inter- and extracellular cues. The modular nature of the model enables us to easily modify individual assumptions and analyse their effects on the system as a whole.

RESULTS

We perform virtual microdissection and labelling-index experiments, evaluate the impact of various model extensions, obtain new insight into clonal expansion in the crypt, and compare our predictions with recent mitochondrial DNA mutation data.

CONCLUSIONS

We demonstrate that relaxing the assumption that stem-cell positions are fixed enables clonal expansion and niche succession to occur. We also predict that the presence of extracellular factors near the base of the crypt alone suffices to explain the observed spatial variation in nuclear beta-catenin levels along the crypt axis.

Epidemiological analysis of the influenza A(H1N1)v outbreak in Bolivia, May-August 2009

The outbreak of pandemic influenza (H1N1) began in Bolivia on 25 May 2009. Between May and August, the National Center of Tropical Disease (CENETROP) analysed by RT-PCR 7,060 samples of which 12.7% were positive. A preliminary analysis of the 895 confirmed cases identified between May and August 2009 describes epidemiological and clinical characteristics. After the first imported cases from the United States and Peru, the locally acquired infections predominated (90%). The number of cases was highest in the age group of 10 to 29 year-olds, and 89.6% of cases were observed in people under the age of 40 years. Fever, cough, nasal discharge and headache remained the main symptoms.

Epidemiological analysis of the influenza A(H1N1)v outbreak in Bolivia, May-August 2009

The outbreak of pandemic influenza (H1N1) began in Bolivia on 25 May 2009. Between May and August, the National Center of Tropical Disease (CENETROP) analysed by RT-PCR 7,060 samples of which 12.7% were positive. A preliminary analysis of the 895 confirmed cases identified between May and August 2009 describes epidemiological and clinical characteristics. After the first imported cases from the United States and Peru, the locally acquired infections predominated (90%). The number of cases was highest in the age group of 10 to 29 year-olds, and 89.6% of cases were observed in people under the age of 40 years. Fever, cough, nasal discharge and headache remained the main symptoms.

[Measurement set-up for estimation of colour discrimination thresholds of colour vision deficiencies and while wearing coloured filters]

BACKGROUND

In clinical practice, several techniques for the evaluation of colour vision deficiencies are well established. Most of them are designed for the detection of congenital or pathological changes. Due to the narrow-banded light sources, used in monitors or anomaloscopes, the human gamut can be addressed only in part. With these set-ups, the impact of coloured filters on colour vision such as blue light filtering intraocular lenses cannot be investigated precisely.

MATERIAL AND METHODS

The technique is based on the visual matching of colour differences between two halves of a test field. The colours are generated by mixing seven types of LEDs. A transparent, vertically divided circular test field is retro-illuminated with this light using optical fibres and projection optics. An ocular optic assures the unaccommodated sight of the subject on the test field (size 2 degrees).

RESULTS

The developed set-up presents freely adjustable colours in the form of continuous light spectra to examine the influence of filter materials on colour discrimination. A colour space can be generated which corresponds to that of human perception. The saturation and brightness of the light is adjustable. The subject has to decide if he can discriminate between the colours in the test field halves or not. Before the next colours are shown the subject is neutrally adapted by a neutral hue to provide different adaptation levels. The luminescence of the test field can be varied up to 1500 cd/m(2). The adaptive algorithm of the sequence is based on the SIAM method described by Kaernbach. Based on reference measurements, including 4 subjects with a congenital deficiency, it was shown that the discrimination thresholds at the characteristic confusing axes are significantly different than those with normal colour vision. Also, the impact of green laser goggles on the colour perception was determined. Due to the filter the thresholds in the vicinity of yellow (x = 0.4664; y = 0.4525) are reduced in the yellow-orange and cyan range and increased in the green-yellow and magenta range.

CONCLUSION

With this set-up an objective instrument is available for clinical research in the field of individual human colour perception. It enables an accurate and detailed analysis of the impact of coloured filters as well as a quantitative detection of congenital anomalies. The adaptive algorithm allows short sequences and precise determination of colour discrimination thresholds.

New perspectives for population genetics of Chagas'disease vectors in the Northeastern Brazil: isolation of polymorphic microsatellite markers in Triatoma brasiliensis

Triatoma brasiliensis is the most important Chagas disease vector in semiarid areas of Northeastern Brazil. Although generally found in natural environment, it regularly colonizes or reinvades domiciliary ecotopes. In order to analyse gene flow between habitats, we identified and characterized six microsatellite loci using a microsatellite-enriched genomic library. To assess the usefulness of these microsatellites for genetic studies, we investigated their variability in two natural populations of the T. brasiliensis complex sampled in two Brazilian districts (Corone Jose Dia, South of Piaui state; Curaça, North of Bahia state). The taxonomic status of the samples was checked using cytb sequences. Phylogenetic analyses confirmed that the individuals from Bahia belonged to the T. juazeirensis species. Moreover, primers cross-amplification was tested in 5 Triatoma species and 4 loci successfully amplified in T. infestans and T. guasayana.