Distinct Cortical-Thalamic-Striatal Circuits through the Parafascicular Nucleus.

The thalamic parafascicular nucleus (PF), an excitatory input to the basal ganglia, is targeted with deep-brain stimulation to alleviate a range of neuropsychiatric symptoms. Furthermore, PF lesions disrupt the execution of correct motor actions in uncertain environments. Nevertheless, the circuitry of the PF and its contribution to action selection are poorly understood. We find that, in mice, PF has the highest density of striatum-projecting neurons among all sub-cortical structures. This projection arises from transcriptionally and physiologically distinct classes of PF neurons that are also reciprocally connected with functionally distinct cortical regions, differentially innervate striatal neurons, and are not synaptically connected in PF. Thus, mouse PF contains heterogeneous neurons that are organized into parallel and independent associative, limbic, and somatosensory circuits. Furthermore, these subcircuits share motifs of cortical-PF-cortical and cortical-PF-striatum organization that allow each PF subregion, via its precise connectivity with cortex, to coordinate diverse inputs to striatum.

[Medical centers--from a Statutory Health Insurance Company's perspective]. / Medizinische Zentren--Anforderungen aus Sicht der GKV.

In the course of recent activities involving the bundling of healthcare institutions into so-called "Centers", many kinds of Healthcare Centers, Breast Centers, Comprehensive Cancer Centers etc. have been established. The term "Center" suggests expertise and superiority, and, without doubt, centers take medical care closer to higher quality and cost efficiency at the same time. However, there are preconditions which need to be fulfilled, such as the compliance with certain structural and process-oriented criteria in patient care. From the perspective of the compulsory health insurance funds, this raises questions regarding the type of centers that should be supported, the requirements that must be met, and the role that centers are assigned within the complex of our healthcare system. For health insurance purposes, Medical Centers provide innovative structural conditions for group-balanced concepts. Since the Statutory Health Insurance System Modernization Act (GKV-Modernisierungsgesetz and 140 a ff. SGB V) has provided individual contract options and inpatient oriented institutions have opened up to offer highly specialized ambulatory treatment (and 116b SGB V), centers have become attractive contractual partners for health insurance companies. The present article describes expectations and requirements in relation to the formation of Medical Centers from the perspective of a compulsory health insurance company, focusing on oncological centers.

[Disease management programs from a health insurer's point of view]. / Disease Management Programme aus Sicht einer Krankenkasse.

Disease Management Programmes represent a great challenge to the German statutory health insurance system. According to politicians, disease management programmes are an appropriate tool for increasing the level of care for chronically ill patients significantly, while at the same time they can slow down the cost explosion in health care. The statutory health insurers' point of view yields a more refined picture of the chances and risks involved. The chances are that a medical guideline-based, evidence-based, co-operative care of the chronically ill could be established. But also, there are the risks of misuse of disease management programmes and of misallocation of funds due to the ill-advised linkage with the so-called risk compensation scheme (RSA) balancing the sickness funds' structural deficits through redistribution. The nation-wide introduction of disease management programmes appears to be a gigantic experiment whose aim is to change the care of chronically ill patients and whose outcome is unpredictable.