Sustainable Development Goals and livestock systems.

Within the framework of the Sustainable Development Goals (SDGs) of the United Nations, particularly those that livestock impact most significantly (SDGs 1, 2, 3, 5, 8, 12, 13, 15 and 17), this paper provides an overview of the livestock sector's impact on food system sustainability and opportunities for building solutions through sustainable livestock options that are supported by robust animal health services. The discourse is shaped by the experiences of the Global Agenda for Sustainable Livestock, a multi-stakeholder partnership which facilitates policy dialogue and action among diverse stakeholders to make livestock systems more sustainable. The Global Agenda for Sustainable Livestock adopted the aforementioned SDGs as the reference framework for its actions, which are organised under four domains (food and nutrition security, animal health and welfare, livelihoods and economic growth, and climate and natural resources). These domains are used to highlight the complexity and diversity of the livestock sector, its positive and negative relationships to development, the integral roles of animal health systems and the opportunities for livestock sector contributions towards a sustainable future.

Se plaçant dans la perspective des objectifs de développement durable (ODD) des Nations unies et plus particulièrement ceux sur lesquels l'élevage exerce le plus grand impact (ODD 1, 2, 3, 5, 8, 12, 13, 15 et 17), les auteurs font un tour d'horizon de l'impact du secteur de l'élevage sur la durabilité des systèmes d'approvisionnement alimentaire et font ressortir les solutions qui peuvent être envisagées en mettant en place des pratiques d'élevage durables soutenues par des services de santé animale robustes. L'exposé est structuré par les expériences acquises dans le cadre du Programme mondial pour un élevage durable, un partenariat multipartite qui facilite le dialogue politique entre diverses parties prenantes ainsi que les mesures visant à rendre les systèmes d'élevage plus durables. Le Programme mondial a intégré les ODD susmentionnés en tant que cadre de référence de ses interventions, qui se répartissent en quatre domaines (alimentation et sécurité nutritionnelle, santé et bien-être des animaux, moyens de subsistance et croissance économique, climat et ressources naturelles). Ces domaines permettent de souligner la complexité et la diversité du secteur de l'élevage, ses liens positifs et négatifs au regard du développement, le rôle prépondérant des systèmes de santé animale et les perspectives offertes au secteur de l'élevage pour contribuer à un futur durable.

Situándose en el perspectiva de los Objetivos de Desarrollo Sostenible (ODS) de las Naciones Unidas, en especial de aquellos en los que más influye la ganadería (ODS 1, 2, 3, 5, 8, 12, 13, 15 y 17), los autores exponen a grandes líneas el impacto del sector ganadero en la sostenibilidad del sistema alimentario y las oportunidades que existen para elaborar soluciones que pasen por actuar sobre el sector ganadero con el apoyo de robustos servicios zoosanitarios. La reflexión se fundamenta en la experiencia del Programa mundial para una ganadería sostenible, alianza multipartita que facilita la acción conjunta y el diálogo sobre políticas de diversas partes interesadas con objeto de hacer más sostenibles los sistemas ganaderos. El Programa mundial adoptó los mencionados ODS como marco de referencia de sus actividades, que están organizadas en cuatro ámbitos: seguridad alimentaria y de la nutrición; sanidad y bienestar animales; medios de sustento y crecimiento económico; y clima y recursos naturales. Estos ámbitos sirven para poner de relieve la complejidad y diversidad del sector ganadero, sus nexos positivos y negativos con el desarrollo, las funciones integrales que cumplen los sistemas de sanidad animal y las posibilidades existentes para que el sector ganadero contribuya a forjar un futuro sostenible.

Emergency department presentation of opioid use disorder and alcohol use disorder.

Mixing alcohol and opioid prescription medications can have serious health consequences. This study examines demographic and geographic differences in opioid use disorders (OUD) and alcohol use disorders (AUD) in emergency department (ED) presentations in the state of Texas. Using all diagnosis codes, the study examined discharge records for ED visits related to AUD and OUD in Texas for 2017. The study classified visits into three mutually exclusive groups (AUD-only, OUD-only, and AUD/OUD) and reported the number of visits, fatalities, total charges, proportions, and rates per 100,000 population by patient demographic characteristics. Chi square statistics assessed the association between patient characteristics and ED visit type, and the study used analysis of variance to compare ED visit rates by patient demographics. The study also fitted a multinomial logistic regression w to predict ED visit type by patient demographic and geographic characteristics. There were 221,363 OUD and AUD ED visits from Texans in 2017. Among them, 3863 had both AUD and OUD. There were 2443 fatalities related to AUD-only ED visits, whereas this rate was 292 for OUD-only ED visits. The majority of these patients had Medicare and Medicaid. AUD-only ED visits were more prevalent (680.7 vs 112.5 per 100,000 population) and resulted in higher overall charges than OUD-only ED visits ($6.1 billion vs $1 billion in total charges). However, AUD/OUD ED visits resulted in higher total charges on average than either OUD-only or AUD-only ED visits. Compared to patients with outpatient discharge, patients with inpatient admissions were more likely to belong to the OUD-only visit group (OR = 1.20, 95% CI: 1.17-1.23) or the AUD/OUD visit group (OR = 2.44, 95% CI: 2.28-2.61) than to the AUD-only visit group. Compared to urban patients, rural patients were less likely to belong to OUD-related visit groups than the AUD-only visit group. In conclusions, AUD was more prevalent than OUD among ED visits and resulted in a higher number of fatalities and higher medical charges. Current health policy regarding substance use that is heavily tilted toward curbing the opioid crisis remains woefully tolerant to AUDs. While efforts to curb opioid misuse should continue, future efforts should raise awareness among ED providers of the disease burden of and social harms caused by alcoholism and alcohol addiction.

[Quality Assessment of Bovine and Equine Colostrum - An Overview]. / Qualitätsbeurteilung von bovinen und equinen Kolostrum ­ Eine Übersicht.

INTRODUCTION: Good quality colostrum intake is essential for passive immunity in neonatal calf and foals. The quality of colostrum depends on its IgG content. Since in practice the possibilities for a direct determination of these parameter are limited, an estimation of colostrum quality is often based on its biophysical properties. The simple methodology allows to perform measurements directly on site and immediately after birth. The biophysical properties included in the current review are density, refractive index, relative density, viscosity, pH, and color. The determination of the density of bovine colostrum is a common method for the evaluation of the IgG content in practice since it correlates with IgG. Density of bovine colostrum should be 1047 g/l. Different colostrometers are available for the measurement. This method is also used in the horses. Density of equine colostrum should be 1060 g/l. Refractive index or the relative density by refractometer has been proven to correlate with the IgG and is an established method in cattle and horses. Good bovine colostrum should have an index of 22% brix and equine colostrum 23% brix. Although not yet established in practice an additional methodology would be the determination viscosity of bovine colostrum. Viscosity could be measured with an outlet cup. A relationship between viscosity and IgG has demonstrated. Sufficient data for this method is missing for equine colostrum. Color and pH are not suitable for estimating the IgG content.

INTRODUCTION: La prise de colostrum de bonne qualité est essentielle pour la construction d'une immunité passive chez le veau et le poulain nouveau-nés. La qualité du colostrum dépend de sa teneur en IgG. Comme dans la pratique les possibilités de détermination directe de ce paramètre sont limitées, une estimation de la qualité du colostrum est souvent basée sur ses propriétés biophysiques. Grâce à une méthodologie simple, la mesure peut généralement être effectuée directement sur place et immédiatement après la naissance. Les propriétés biophysiques incluses dans cette revue sont la densité, l'indice de réfraction, la densité relative, la viscosité, le pH et la couleur. La détermination de la densité du colostrum bovin est en pratique une méthode courante pour évaluer la teneur en IgG, car la densité est en corrélation avec la teneur en IgG. La densité du colostrum doit être d'au moins 1047 g/l. Différents colostromètres sont disponibles pour cette mesure. Cette méthode est également utilisée chez le cheval. La densité du colostrum équin doit être d'au moins 1060 g/l. La détermination de l'indice de réfraction ou de la densité relative au moyen d'un réfractomètre est une procédure établie chez les bovins et les chevaux, car une corrélation claire avec la teneur en IgG est prouvée. Pour être considéré comme bon, le colostrum bovin doit atteindre une valeur de 22% et le colostrum équin une valeur de 23% sur l'échelle de Brix. L'évaluation du colostrum bovin par viscosité est une autre approche qui doit encore être mise en pratique. Là encore, une relation entre la viscosité et la teneur en IgG pourrait être prouvée. La mesure de la viscosité peut être effectuée à l'aide d'une coupe d'écoulement. Chez le cheval, on ne dispose pas encore de données suffisantes sur cette méthode. La valeur du pH et la couleur ne conviennent pas pour estimer la teneur en IgG.

Disability Benefits and Change in Prescription Opioid Dose.

Among chronic low back pain (CLBP) patients, workers' compensation is associated with longer term prescription opioid analgesic use (OAU). The aim was to study the association between receiving Social Security Disability Insurance (SSDI) benefits and course of OAU. This prospective cohort study utilized data from primary care patients diagnosed with non-cancer CLBP. The outcomes were morphine equivalent dose (MED) - categorized as no OAU, 1-50mg MED, or >50mg MED - and change in MED over time using mixed multinomial logistic regression models. Covariates included sociodemographics, pain severity, pain management characteristics, continuity of care with their physician, health-related quality of life, number of comorbid health conditions, obesity, depression, and anxiety. In adjusted analysis, SSDI vs. non-SSDI patients were more likely to be receiving >50mg MED vs. no OAU at baseline (OR = 10.19; 95% CI:1.51-68.83). Differences in OAU trajectory between SSDI groups were nonsignificant (P = 0.204). Collection of SSDI benefits was an independent predictor of higher MED at baseline and persistently higher MED during 2 years of follow-up. Providers should consider the risk of persistent, high-dose opioid use in patients receiving SSDI benefits.

Do Patient-Centered Medical Homes Improve Health Behaviors, Outcomes, and Experiences of Low-Income Patients? A Systematic Review and Meta-Analysis.

OBJECTIVES: To examine: (1) what elements of patient-centered medical homes (PCMHs) are typically provided to low-income populations, (2) whether PCMHs improve health behaviors, experiences, and outcomes for low-income groups. DATA SOURCES/STUDY SETTING: Existing literature on PCMH utilization among health care organizations serving low-income populations. STUDY DESIGN: Systematic review and meta-analysis. DATA COLLECTION/EXTRACTION METHODS: We obtained papers through existing systematic and literature reviews and via PubMed, Web of Science, and the TRIP databases, which examined PCMHs serving low-income populations. A total of 434 studies were reviewed. Thirty-three articles met eligibility criteria. PRINCIPAL FINDINGS: Patient-centered medical home interventions usually were composed of five of the six recommended components. Overall positive effect of PCMH interventions was d = 0.247 (range -0.965 to 1.42). PCMH patients had better clinical outcomes (d = 0.395), higher adherence (0.392), and lower utilization of emergency rooms (d = -0.248), but there were apparent limitations in study quality. CONCLUSIONS: Evidence shows that the PCMH model can increase health outcomes among low-income populations. However, limitations to quality include no assessment for confounding variables. Implications are discussed.

[Psychosocial care of refugees in Germany : Insights from the emergency relief and development aid]. / Psychosoziale Versorgung von Flüchtlingen in Deutschland : Erkenntnisse aus der Not- und Entwicklungshilfe.

Approximately 1.2 million refugees have arrived in Germany since autumn 2014. They are often appraised as being a challenge for the German healthcare system because the acute need for healthcare support was large and appeared suddenly while at the same time resources were limited. This situation was previously unknown for a western European healthcare system, whereas it constitutes a typical challenge for nongovernmental organizations that are active in the field of emergency relief and development aid and that have developed a large number of successful intervention concepts. Of central importance in this context are the basic principles of equal rights, participation of those affected, the principle of nonmaleficence, the resource orientation instead of a deficit orientation as well as the need for integrated and stepped care models. These can serve as general principles not only in the setting of development aid in crisis areas worldwide but also in the health services provided to refugees in the current situation in Germany.

[Mental treatment of refugees in Germany : Model for a stepped approach]. / Psychische Versorgung von Flüchtlingen in Deutschland : Modell für ein gestuftes Vorgehen.

The recent influx of refugees and asylum seekers into Germany poses a challenge for the national healthcare system. In compliance with the present Asylum Seekers Benefits Act, the national healthcare system can be expected to have 1.5 million new members by early 2017. Providing adequate care particularly for people with mental illnesses or disorders will represent an immense challenge for all actors in the system. The circumstances of the flight combined with the foreign linguistic and socio-cultural background increase the severity of the cases and the difficulties of treatment. No procedures or guidelines for treatment have yet been established to ensure a standardized, cost-efficient and therapeutically effective treatment of patients with this background. This article describes the components of a stepped treatment procedure and proposes a stepped and collaborative care model (SCCM) that could be evaluated in nationwide studies. This approach is based on national and international treatment guidelines and aims to provide target-group specific, culturally sensitive methods of diagnosis and treatment. The various steps of the model build on each other, with the first steps relying on technological aids (e.g. online or smartphone options) and support from lay helpers and the more expensive specialist psychiatric and psychotherapeutic therapy only being initiated in cases of more severe mental disorders.

Linear and non-linear heart rate metrics for the assessment of anaesthetists' workload during general anaesthesia.

BACKGROUND: Excessive workload may impact the anaesthetists' ability to adequately process information during clinical practice in the operation room and may result in inaccurate situational awareness and performance. This exploratory study investigated heart rate (HR), linear and non-linear heart rate variability (HRV) metrics and subjective ratings scales for the assessment of workload associated with the anaesthesia stages induction, maintenance and emergence. METHODS: HR and HRV metrics were calculated based on five min segments from each of the three anaesthesia stages. The area under the receiver operating characteristics curve (AUC) of the investigated metrics was calculated to assess their ability to discriminate between the stages of anaesthesia. Additionally, a multiparametric approach based on logistic regression models was performed to further evaluate whether linear or non-linear heart rate metrics are suitable for the assessment of workload. RESULTS: Mean HR and several linear and non-linear HRV metrics including subjective workload ratings differed significantly between stages of anaesthesia. Permutation Entropy (PeEn, AUC=0.828) and mean HR (AUC=0.826) discriminated best between the anaesthesia stages induction and maintenance. In the multiparametric approach using logistic regression models, the model based on non-linear heart rate metrics provided a higher AUC compared with the models based on linear metrics. CONCLUSIONS: In this exploratory study based on short ECG segment analysis, PeEn and HR seem to be promising to separate workload levels between different stages of anaesthesia. The multiparametric analysis of the regression models favours non-linear heart rate metrics over linear metrics.

Patient Portal Use and Blood Pressure Control in Newly Diagnosed Hypertension.

BACKGROUND: Current evidence that patient portal use improves disease management is inconclusive. Randomized controlled trials have found no benefit of Web-based patient-provider communication for blood pressure (BP) control, but patients from these studies were not selected for uncontrolled hypertension, nor did measures of portal use occur in a real-world setting, as captured in the electronic medical record. This study determined whether patient portal use by patients with treated, incident hypertension was associated with achieving BP control. METHODS: Between 2008 to 2010, 1571 patients with an incident hypertension diagnosis, ages 21 to >89 years, were identified from an academic medical center primary care patient data registry. Cox proportional hazard models were computed to estimate the association between portal use and incident BP control during follow-up (2011-2015), before and after adjusting for covariates. Covariates included sociodemographics, smoking, obesity and other physical and mental health comorbidities, and volume of health care utilization. RESULTS: After adjusting for age, portal users were more likely than nonusers to achieve BP control (hazard ratio, 1.24; 95% confidence interval, 1.06-1.45). After adjustment for sociodemographics, portal use was no longer associated with BP control (hazard ratio, 0.98; 95% confidence interval, 0.83-1.16). CONCLUSIONS: Patient sociodemographic factors, including race, sex, and socioeconomic status, account for the observation that portal use leads to BP control among persons with newly diagnosed hypertension. Further research is warranted to determine whether there are benefits of portal use for other chronic conditions.

Higher Referrals for Diabetes Education in a Medical Home Model of Care.

BACKGROUND: The medical home model has been gaining attention from the health care community as a strategy for improved outcomes for management of chronic disease, including diabetes. The purpose of this study was to compare referrals for diabetes education among patients receiving care from a medical home model versus a traditional practice. METHODS: Data were obtained from a large, university-affiliated primary care patient data registry. All patients (age 18-96 years) with a diagnosis of prediabetes or diabetes and seen by a physician at least twice during 2011 to 2013 were selected for inclusion. Multivariate regression models measuring the association between medical home status and referral to diabetes education were computed before and after adjusting for covariates. RESULTS: A significantly (P < .001) higher percentage of patients in a medical home than without a medical home (23.9% vs 13.5%) received a referral for diabetes education. After adjusting for covariates, medical home patients were 2.7 times more likely to receive a referral for diabetes education (odds ratio, 2.70; 95% confidence interval, 1.69-4.35). CONCLUSION: Patients in a medical home model were more likely to receive referrals for diabetes education than patients in a standard university-affiliated family medicine practice. Future longitudinal designs that match characteristics of patients with a medical home with those of patients without one will provide strong evidence to determine whether referral to diabetes education is a result of the medical home model of care independent of confounding factors.

Comparison of Medical Diagnoses among Same-Sex and Opposite-Sex-Partnered Patients.

BACKGROUND: Health disparities for gay and lesbian individuals are well documented in survey research. However, a limitation throughout the existing literature is the reliance on self-reported health conditions. This study used medical record diagnoses for gay and lesbian patients seen in primary care clinics. METHODS: This study used medical records of primary care patients (n = 31,569) seen at Midwestern, university-affiliated primary care clinics. First, all records with information about the sexual partnering of the patient were identified (n = 13,509). Then, opposite-sex-partnered and same-sex-partnered (SSP) patients were compared for prevalence of common chronic conditions and clinic utilization. RESULTS: Only 44.20% of medical records included information about patients' sexual partners. Both male and female SSP patients were more likely to be lower socioeconomic status, be a current or former smoker, and be diagnosed with substance abuse/dependence and depression. CONCLUSIONS: The findings suggest the need for more consistent screening of the sexual partnering of patients for identifying patients who are at greater risk of poorer health outcomes. However, identifying the sexual partnering of patients may not occur systematically in primary care, and there may be a lack of disclosure by SSP patients to their physicians given the social stigma about same-sex relationships.

Presurgical Assessment of the Sensorimotor Cortex Using Resting-State fMRI.

BACKGROUND AND PURPOSE: The functional characterization of the motor cortex is an important issue in the presurgical evaluation of brain lesions. fMRI noninvasively identifies motor areas while patients are asked to move different body parts. This task-based approach has some drawbacks in clinical settings: long scanning times and exclusion of patients with severe functional or neurologic disabilities and children. Resting-state fMRI can avoid these difficulties because patients do not perform any goal-directed tasks. MATERIALS AND METHODS: Nineteen patients with diverse brain pathologies were prospectively evaluated by using task-based and resting-state fMRI to localize sensorimotor function. Independent component analyses were performed to generate spatial independent components reflecting functional brain networks or noise. Three radiologists identified the motor components and 3 portions of the motor cortex corresponding to the hand, foot, and face representations. Selected motor independent components were compared with task-based fMRI activation maps resulting from movements of the corresponding body parts. RESULTS: The motor cortex was successfully and consistently identified by using resting-state fMRI by the 3 radiologists for all patients. When they subdivided the motor cortex into 3 segments, the sensitivities of resting-state and task-based fMRI were comparable. Moreover, we report a good spatial correspondence with the task-based fMRI activity estimates. CONCLUSIONS: Resting-state fMRI can reliably image sensorimotor function in a clinical preoperative routine. It is a promising opportunity for presurgical localization of sensorimotor function and has the potential to benefit a large number of patients affected by a wide range of pathologies.

Racial differences in the association between nonmedical prescription opioid use, abuse/dependence, and major depression.

BACKGROUND: African Americans (AAs) have lower rates of depressive disorders and are less likely to receive opioid analgesics for chronic pain than whites. Given the evidence that prescription opioid use is associated with depression, we hypothesized that the opioid abuse/dependence and depression comorbidity would be less common among AAs compared with whites. METHODS: A cross-sectional secondary analysis of the public use files for the 2012 (n = 55,268) and 2013 (n = 55,160) National Survey on Drug Use and Health (NSDUH) was used to obtain past-year, DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria diagnoses of nonmedical prescription opioid use (NMPOU), abuse/dependence, and major depressive episode (MDE). Covariates included anxiety disorder, alcohol and illicit drug abuse/dependence, smoking, age, gender, education, marital status, health insurance, county urbanicity, and income. Logistic regression models estimating the association between opioid use and MDE were computed before and after adjusting for covariates and separately for AAs and whites. RESULTS: AAs and whites had similar past-year prevalence of NMPOU (3.5% vs. 3.7%) and abuse/dependence (0.7% vs. 0.9%). MDE was significantly more prevalent among whites (7.4% vs. 5.5%; P < .0001). Among whites, NMPOU and abuse/dependence were associated with MDE (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.12-1.64 and OR = 2.22, 95% CI = 1.67-2.94, respectively). Among AAs, there were no significant associations between NMPOU, abuse/dependence, and MDE (OR range: 0.80-0.95). CONCLUSIONS: In a nationally representative sample, co-occurrence of past-year depression, NMPOU, and abuse/dependence was determined in whites but not AAs. Additional research is needed to establish the contribution of pain and temporal relationships.

Disability and disability benefit seeking in chronic low back pain.

BACKGROUND: Numerous studies suggest psychosocial factors contribute to functional disability in patients with chronic low back pain (CLBP). However, less is known about the association of psychosocial factors, such as depression, with seeking medical disability benefits and their prevalence in benefit seekers compared with patients already receiving such payments. AIMS: To determine if characteristics of disability benefit seekers differ from patients receiving disability benefits and if both differ from patients not dependent on such payments. METHODS: Questionnaire data on pain, health-related quality of life, depression, social support, substance abuse, adverse childhood experiences and disability seeking were obtained from CLBP respondents recruited at 10 primary care clinics throughout Texas. A multinomial logistic regression model was computed using variables significantly associated with disability status and pain severity in univariate models. RESULTS: There were 213 participants. In full models, compared with those not on disability benefits, only depression symptoms were significantly associated with seeking disability benefits (odds ratio [OR] = 1.13; 95% confidence interval [CI] 1.01-1.26) and only duration of pain was significantly associated with being on such benefits (OR = 1.05; 95% CI 1.01-1.09). CONCLUSIONS: Patient characteristics differ between disability benefit seekers and those established on disability benefit payments. Depression may be a modifiable correlate of disability benefit seeking that if treated may reduce the number of patients who eventually come to depend on disability benefits. Additional data collection involving other pain syndromes is warranted to determine if these results are unique to CLBP or apply to other painful conditions.

[Assessment of legal capacity and testamentary capacity]. / Begutachtung der Geschäfts- und Testierfähigkeit.

The assessment of legal capacity and testamentary capacity require thorough knowledge of the legal framework and the relevant case law. This paper explains the concept of the legal capacity to contract and the concept of testamentary capacity with respect to German civil law. The relevance of major mental disorders for the assessment of legal capacity and testamentary capacity is discussed.

A virtual source model of a kilo-voltage radiotherapy device.

The purpose of this work is to develop a virtual source model (VSM) for the 50 kV INTRABEAM® device for Monte Carlo (MC) dose calculation. The geometry of the device was modelled in Geant4. A phase space file (PSF) was computed by simulating the interactions of monoenergetic primary electrons with the target. The PSF was approximated by computing the energy spectrum of the photons in the PSF. The variation of photon intensity, mean direction cosine and standard deviation along the axis of the source was thereafter computed. The isotropy of the source was used to approximate the properties of the source on the transverse plane. These functional approximations thereafter defined the VSM of the device. A sub-source was used to account for two kinds of photons, which were suppressed by the PSF approximation method. The intensity (relative to the main source) and emission directions of the sub-source required optimization. Optimization was achieved by the iterative adjustment of either or both parameters following MC simulation with the VSM and comparison of the calculated results to experimental data. The optimized source model was validated by comparing the calculated dose to water under several experimental setups, with reference data from the manufacturer, independent dosimetric check, and to literature results. The calculated photon energy spectra at other operating potentials (30 and 40 kV) of the device were also compared to literature data. The calculated energy spectra at all operating voltages are consistent with literature reports. The optimized sub-source has a relative intensity of 5% and an emission direction that is favoured along the axis of the source. The calculated depth dose curve for the bare probe agreed with the reference data, and the isodose lines are similar to published experimental results. Validation of the source model under a more complex experimental setup by film dosimetry agreed to within 2%/1 mm (98% pixel pass rate) of the values calculated with the VSM. We derived a VSM of the 50 kVp INTRABEAM source from a PSF. The dose predicted by the model agreed with reports in literature, reference data from the device manufacturer, and with an independent validation check. The algorithm could be used for treatment planning.

Mild cognitive impairment: advantages of a comprehensive neuropsychological assessment.

Mild cognitive impairment (MCI) could be an auspicious candidate for an early marker of a beginning dementia. However, although MCI is accepted as a heterogeneous condition by now, performance testing or diagnosis is often based on a limited number of cognitive tests. Furthermore, there is still disagreement about the necessity to include subjective cognitive complaints as a diagnostic criterion. The current study intends to examine the character of MCI when diagnosis is based upon multiple cognitive domains and does not require the presence of subjective complaints. 130 subjects from the HelMA (Helmholtz Alliance for Mental Health in an Ageing Society) longitudinal study completed a comprehensive neuropsychological test-battery and were diagnosed as either normally-ageing controls or patients with MCI. The prevalence rate of MCI was as high as 46.2%, hereby exceeding most estimates of other studies. Patients with MCI performed worse than controls in each of the 29 administered tests with memory being the predominant impaired cognitive domain. Surprisingly, there was no single patient with a purely non-amnestic impairment, considerably contradicting hitherto existing studies. The rather different distribution of impairment and prevalence rate emphasizes the demand of testbatteries including all cognitive domains so that inferences about MCI are as all-encompassing as possible.

[Positions for medical doctors in German hospitals for psychiatry and psychotherapy]. / Besetzung ärztlicher Stellen in deutschen Kliniken für Psychiatrie und Psychotherapie.

As in other medical specialties, there is currently an imbalance between the number of open positions and the number of applicants in the field of psychiatry and psychotherapy, despite an overall growing number of physicians. To assess the magnitude of this deficit, the German Association for Psychiatry and Psychotherapy (DGPPN) conducted a survey among heads of clinics for psychiatry and psychotherapy in Germany. There were several characteristic trends: there is high variability in the lack of applicants depending on the contextual conditions of the specific clinic. It increased significantly from 2008 to 2009, is more pronounced in the east rather than in the west, in smaller rather than in larger clinics, and for assistant doctors rather than for specialists. The lack of applicants is most likely also masked by compensatory measures such as the hiring of psychologists for the position of a physician. It is assumed that in addition to the general lack of physicians there is a specialty-specific component that plays a role: the disproportionate increase in the demand for psychiatric-psychotherapeutic services.

Laboratory-based assessment of influenza in German ambulant patients from 1998 to 2008.

BACKGROUND: In Germany, the cost for PCR diagnosis of influenza in ambulant patients was not covered by the national statutory health insurance system until 2008. Therefore, cell culture was the standard method applied for routine diagnosis. We have prospectively compared a 1-day rapid cell culture assay (RCA) with conventional cell culture (CCC) during the influenza seasons from 1997/1998 to 2007/2008 and with real-time PCR analysis during the influenza seasons 2003/2004 and 2006/2007. PATIENTS AND METHODS: This study is based on 4,262 respiratory samples obtained from ambulant patients between January 1998 and May 2008. The RCA was performed in microtiter plates that were stained with monoclonal antibodies to influenza virus A and B 16 h after inoculation. RESULTS: A total of 1,221 specimens were found to be positive by the cell culture methods - 1,143 (93.6%) by the RCA and 1,012 (82.9%) by the CCC. The sensitivity of the RCA and CCC versus PCR was 75.4% (221/293) and 58% (170/293), respectively. The specificity of both cell culture assays versus PCR was 100%. Influenza A represented 79.3% of the cases diagnosed. An increased activity of influenza was observed between January and March, with the rate of influenza-positive cases being highest for kindergarten and school-aged children. CONCLUSION: While PCR is the most sensitive assay for the diagnosis of influenza, the RCA can still be used for diagnosis and surveillance of this disease. Based on our findings and given the known fact that influenza antibodies reach a plateau 2-4 weeks after immunization, the optimal time for vaccination in Germany is from October through November. Kindergarten and school-aged children represent an important reservoir of infection. Consequently, routine immunization should be considered for this age group to prevent the spread of influenza.