[Constellations of findings and derived treatment interventions in telemedical monitoring of patients with heart failure, cardiac arrhythmia or increased risk for sudden cardiac death : Recommendations of the working group 33 telemonitoring of the German Cardiac Society]. / Befundkonstellation und abgeleitete Behandlungsinterventionen bei telemedizinisch überwachten Patienten mit Herzinsuffizienz, Herzrhythmusstörungen oder erhöhtem Risiko für den plötzlichen Herztod : Empfehlungen der Arbeitsgruppe 33 Telemonitoring der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung e. V.

The specification of standard operating procedures (SOPs) is a basic requirement for a successful implementation of telemonitoring with implanted cardiac devices and with external measuring devices in patients with heart failure, cardiac arrhytmia or increased risk of sudden cardiac death. The following article summarizes the possibilities of telemonitoring from a technical and organizational point of view and descibes basic requirements on SOPs. these basic requirements should be further specified and anchored in the organizational structure of the individual telemonitoring concept. Moreover, they should de understood as a basic guideline fpr the actions of telemonitoring center (TMC) employees.

[Position paper telemonitoring : From the Nucleus Members of the AG33 Telemonitoring of the DGK and associated members]. / Positionspapier Telemonitoring : Von den Nukleusmitgliedern der AG33 Telemonitoring in der DGK und assoziierten Mitgliedern.

The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e. V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and potentials of telemonitoring in the treatment of patients with cardiac diseases. In addition to telemonitoring of acute ischaemic diseases, acute coronary syndrome and acute cardiac arrhythmias, telemonitoring of chronic cardiac diseases is discussed. Chronic diseases, such as chronic heart failure, are age-associated and present society with the great challenge of providing high-quality, yet cost-efficient care to an increasing number of patients in the future. Telemonitoring offers an opportunity to meet this challenge. However, the introduction of telemonitoring and the associated changes for patients, doctors and other service providers must be accompanied by measures to ensure the acceptance of telemonitoring and the secure handling of sensitive data as well as the quality of telemonitoring services.

Phylogeography of the Rufous Vanga and the role of bioclimatic transition zones in promoting speciation within Madagascar.

Madagascar is known as a biodiversity hotspot, providing an ideal natural laboratory for investigating the processes of avian diversification. Yet, the phylogeography of Madagascar's avifauna is still largely unexamined. In this study, we evaluated phylogeographic patterns and species limits within the Rufous Vanga, Schetba rufa, a monotypic genus of forest-dwelling birds endemic to the island. Using an integrative taxonomic approach, we synthesized data from over 4000 ultra-conserved element (UCE) loci, mitochondrial DNA, multivariate morphometrics, and ecological niche modeling to uncover two reciprocally monophyletic, geographically circumscribed, and morphologically distinct clades of Schetba. The two lineages are restricted to eastern and western Madagascar, respectively, with distributions broadly consistent with previously described subspecies. Based on their genetic and morphological distinctiveness, the two subspecies merit recognition as separate species. The bioclimatic transition between the humid east and dry west of Madagascar likely promoted population subdivision and drove speciation in Schetba during the Pleistocene. Our study is the first evidence that an East-West bioclimatic transition zone played a role in the speciation of birds within Madagascar.

[Basic structural features of a cardiac telemedicine center for patients with heart failure and implanted devices, cardiac arrhythmias, and increased risk of sudden cardiac death : Recommendations of the working group 33 Telemonitoring of the German Cardiac Society]. / Grundlegende Strukturmerkmale eines kardiologischen Telemedizinzentrums für Patienten mit Herzinsuffizienz und implantierten Devices, Herzrhythmusstörungen und erhöhtem Risiko für den plötzlichen Herztod : Empfehlungen der Arbeitsgruppe 33 Telemonitoring in der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung e. V.

Heart failure is one of the most common diseases. It is associated with high morbidity and mortality. Since heart failure is age-associated, the number of patients with heart failure is constantly increasing. At the same time, the imbalance between the need for treatment and the provision of care is growing. Telemonitoring/telemedicine offers patients in rural or remote areas access to high-quality health care and enables fast access to specialists. The working group 33 Telemonitoring of the German Cardiac Society describes the characteristics and possible applications of telemonitoring/telemedicine in the treatment of patients with heart failure. Furthermore, quality criteria for cardiological telemedicine centres are defined. In addition to the personnel structure of a telemedicine centre and the competencies of employees, requirements for the technical infrastructure and the management of incoming data and alarms are described.

Reproducible and flexible simulation experiments with ML-Rules and SESSL.

Summary: The modeling language ML-Rules allows specifying and simulating complex systems biology models at multiple levels of organization. The development of such simulation models involves a wide variety of simulation experiments and the replicability of generated simulation results requires suitable means for documenting simulation experiments. Embedded domain-specific languages, such as SESSL, cater both requirements. With SESSL, the user can integrate diverse simulation experimentation methods and third-party software components into an executable, readable simulation experiment specification. A newly developed SESSL binding for ML-Rules exploits these features of SESSL, opening up new possibilities for executing and documenting simulation experiments with ML-Rules models. Availability and Implementation: ML-Rules is implemented in Java, SESSL and its bindings are implemented in Scala. The source code is available under open-source licenses: ML-Rulesgit.informatik.uni-rostock.de/mosi/mlrules2ML-Rules Quickstart (Graphical Editor)git.informatik.uni-rostock.de/mosi/mlrules2-quickstartSESSLgit.informatik.uni-rostock.de/mosi/sessl and sessl.orgSESSL Quickstart (Experiment Template)git.informatik.uni-rostock.de/mosi/sessl-quickstart Furthermore, Maven-compatible compiled packages of ML-Rules, SESSL, and the SESSL bindings are available from the Maven Central Repository at maven.org (org.sessl:* and org.jamesii:mlrules). Supplementary Material: The supplementary material contains a more complex case study that exemplifies the usage of the SESSL binding for ML-Rules. Contact: tom.warnke@uni-rostock.de.

[The telemedical service centre as an essential element of the conceptual approach for telemonitoring of cardiac patients : Requirements on the service, quality, and technical realization of telemonitoring]. / Das Telemedizinische Zentrum als essenzieller Baustein konzeptioneller Ansätze zum Telemonitoring kardialer Patienten : Anforderungen an Leistungen, Qualität und technische Umsetzung von Telemonitoring.

Telemonitoring as part of a treatment strategy supports and facilitates the monitoring, disease management and education of patients with heart failure and cardiac arrhythmias. Therefore, telemonitoring affects quality and success of the therapy. Thus, meeting the needs of the patients and of the involved health care professionals is important for the success of the telemonitoring service. Moreover, a high quality of the service has to be ensured. The following article describes several configuration options for telemonitoring services considering technical as well as quality- and service-related aspects.

[Differentiated antiplatelet therapy for acute coronary syndromes]. / Differenzierte antithrombozytäre Therapie bei akutem Koronarsyndrom.

Dual antiplatelet therapy is the cornerstone of maintenance medication following invasive treatment of patients with acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina). Over the last decade, P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated. The debate was enriched by the results of the large phase III clinical trials for prasugrel (TRITON) and ticagrelor (PLATO) compared to clopidogrel in patients with acute coronary syndromes. This article summarizes the critical details und subanalyses of both study programmes and highlights on clinical decision making when using the three P2Y12 blockers in acute coronary syndromes. A special focus is on higher risk patients such as those with ST elevation myocardial infarction and those with coexisting diabetes, but also on minimizing relevant bleedings, which are common during more intense platelet inhibition.

[Challenges of interdisciplinary collaboration in the management of rare diseases]. / Herausforderungen in der interdisziplinären Zusammenarbeit bei der Versorgung seltener Erkrankungen.

The care of patients with rare diseases is associated with many challenges, in particular those associated with high coordination complexity. In an explorative case study in a health-care network for patients with respiratory insufficiency, we have investigated the types and causes of coordination problems.We conducted semi-structured, qualitative interviews with 3 patients and their health-care providers. The evaluation of the views expressed in these interviews was worked up by applying qualitative content analysis.The network examined exhibits parallel structures. While the patient-centred interactions are ensuring patient care, learning processes among the health-care professionals take place and ideas for improved treatment are developed. Depending on the purpose, context-specific interaction patterns are evolving. Causes for coordination problems have been identified at the micro-, meso-, macro- and the indication-based levels, e. g., the low prevalence of the diseases and the lacking qualifications of the health-care professionals.Our results demonstrate the need for creating innovative health-care structures. Potential solutions range from the initiation of interdisciplinary working groups and cross-sectoral disease management guidelines tjhrough to the implementation of qualification measures.

[Health economic impact of heart failure: An analysis of the nationwide German database]. / Gesundheitsökonomische Bedeutung der Herzinsuffizienz: Analyse bundesweiter Daten.

BACKGROUND AND AIMS: Patients with congestive heart failure represent a significant amount of the total annual cost of the health care system. Because of a lack of studies on the economic health cost of the related health care, including all cost generating factors, we analysed in detail characteristics of these patients and the costs created by their care. METHOD: Data were retrieved from the German Bureau of Health Statistics for the year 2002 relating to congestive heart failure (Code I50) including other factors (e. g. co-morbidities, ambulatory and hospital care and choice of the doctor). The data were from more than 2 million patients, from 350 insurance companies, the Federal Employees Insurance and the German Institute for Medical Informatics and Documentation. A total of 86 193 patients with congestive heart failure had been recorded. RESULTS: More women than men were recorded as having congestive heart failure (66 vs. 34 %). The various health insurance companies paid 2.3 times more for patients with than without congestive heart failure. Nearly three quarters of the cost for these patients (72 %) resulted from in-patient care. Moreover, costs for drugs were three times higher (1073 Euro vs. 366 Euro). CONCLUSIONS: This analysis clearly demonstrates the increased costs incurred for patients with congestive heart failure. It should serve as a reference base for better assessing future innovations, such as telemedicine, for their effects in different sectors of health care.

[Pacemaker and implantable defibrillators with telemedical support]. / Schrittmacher und interne Defibrillatoren mit kardiotelemedizinischer Unterstützung.

Recent developments in pacemaker and ICD therapy can be characterized by a rising number of implantations (especially in the field of ICD and CRT systems) and an increasing complexity of the units involved. Problems evolving from this trend are the soaring numbers of necessary follow-up examinations, issues of patient safety and the necessity of device management by specialized physicians. Telemonitoring offers various possibilities of improvement in these areas. The manufacturers of the devices have developed applicable solutions for concepts of care including telemedical monitoring of patients with pacemakers, ICD and CRT systems. The systems commonly include an implant capable of either automatic or manual data transmission, a device for transmitting the implant's data (mobile communication or fixed line network), a server managing the information and a front-end (internet-based) platform for the physician. Multiple clinical trials have verified the stability and the security of this method of data transmission. Telemedical monitoring can be used in order to improve the monitoring of the patients' state of health (e. g., patients with CRT systems because of their CHF) and the management of arrhythmias (e. g., patients suffering from paroxysmal atrial fibrillation). Telemonitoring allows the intervals between follow-up check-ups to be individualized, thus, leading to financial savings. The telemedical monitoring of patients with ICD and CRT systems facilitates new opportunities for networked follow-up care and comprehensive medical treatment.

[Telemonitoring in chronic heart failure patients. Which diagnostic finding prevents hospital readmission?]. / Telemedizinisches Monitoring bei herzinsuffizienten Patienten Welche. Befundkonstellation verhindert die stationäre Wiedereinweisung?

Heart failure exhibits a significant clinical and health economic problem. The implementation of new therapeutic strategies favorably affecting the course of disease is still insufficient in day-to-day practice. Thus, the usage of telemedicine offers a central instrument for service and information, so that an optimized therapy can be achieved by consequent surveillance of the patient with chronic heart disease. Predefined vital parameters are automatically transmitted to the telemedicine center; if individually predefined limits are exceeded, therapeutic means are immediately initiated. For the patient, the center is attainable 24 h throughout the year in case he experiences cardio-pulmonary symptoms. This patient-oriented usage of technology should not replace the physician-patient relationship, but improves and supports the participation and self-management of patients. Furthermore, the results show that this technology can significantly reduce the amount of emergency physician services, hospital admissions and primary care physician visits, and displays for health economics purposes a clearly more cost-effective treatment strategy, while allowing for additional costs inherent to the system. The usage of telemonitoring in chronic heart failure patients may be a trendsetting form of care, which can be used to drastically optimize the information and data flow between patient, hospital and primary care physician individually and at any time.

Greenhouse Evaluation of Binucleate Rhizoctonia for Control of R. solani in Soybean.

Nine isolates of binucleate Rhizoctonia (BNR) from soybean were screened in the greenhouse for control of Rhizoctonia solani anastomosis groups AG-4 and AG-2-2. Eight of nine BNR isolates, when combined with AG-4 or AG-2-2, significantly increased emergence and survival of soybean (cv. Ozzie) and reduced disease severity compared with AG-4 or AG-2-2 alone. The interaction of soybean cultivar and BNR isolates in the presence of AG-4 and AG-2-2 was also studied using three isolates of BNR, BNR-4, BNR-8-2, and BNR-8-3, and seven soybean cultivars. There was no BNR × cultivar interaction. With AG-4, BNRs significantly increased emergence and survival of cultivars and reduced disease severity, whereas with AG-2-2, BNRs reduced disease severity. Control of R. solani by BNRs was achieved in both a potting soil mix and natural soil. In the initial screening experiments, two BNR isolates reduced emergence, but in all subsequent experiments using three BNR isolates alone, there were no negative effects on germination, survival, or height of soybean plants, and there was no evidence of pathogenicity. In several experiments, BNRs alone significantly increased height of plants compared with the noninoculated controls. BNRs were consistently isolated from hypocotyls and roots, indicating colonization of tissues was associated with control. These BNR isolates may have potential use in management of R. solani in soybean, but will require rigorous testing under field conditions and more extensive studies of their biology.

Effect of Sclerotinia Stem Rot on Yield of Soybean Inoculated at Different Growth Stages.

The effects of Sclerotinia stem rot, caused by Sclerotinia sclerotiorum, on yield of soybean were evaluated in the field with two cultivars in maturity group 0. Plants were inoculated at two growth stages, R3 and R5, using two inoculation methods. Seed weight, seed and pod numbers, seed protein, and oil content were measured. The effects of disease on yield were variable. Disease resulted in significant seed weight loss, with reductions per diseased plant ranging from 18.8 to 38.6%. The estimated yield loss per 10% disease incidence ranged from 83.2 to 229.0 kg/ha, with an average loss of 136.6 kg/ha for four field experiments. A reduction in the number of seeds and pods per plant and seed oil content occurred in some, but not all, experiments. Seed protein was not affected. When disease reduced seed weight, seed and pod numbers, or oil content, there was no growth stage × treatment interaction in the experiments, indicating that inoculation at R5 compared with R3 had a similar effect on yield.

Selected Soybean Plant Introductions with Partial Resistance to Sclerotinia sclerotiorum.

Sclerotinia stem rot, caused by Sclerotinia sclerotiorum, is a major soybean (Glycine max) disease in north-central regions of the United States and throughout the world. Current sources of resistance to Sclerotinia stem rot express partial resistance, and are limited in number within soybean germ plasm. A total of 6,520 maturity group (MG) 0 to IV plant introductions (PIs) were evaluated for Sclerotinia stem rot resistance in the United States and Canada in small plots or in the greenhouse from 1995 to 1997. Selected PIs with the most resistance were evaluated for resistance in the United States and Canada in replicated large plots from 1998 to 2000. The PIs in the MG I to III tests in Urbana, IL were evaluated for agronomic traits from 1998 to 2000. The selected PIs also were evaluated with an excised leaf inoculation and petiole inoculation technique. After the 1995 to 1997 evaluations, all but 68 PIs were eliminated because of their susceptibility to Sclerotinia stem rot. In field tests in Urbana, higher disease severity in selected MG I to III PIs was significantly (P< 0.05) associated with taller plant heights and greater canopy closure. All other agronomic traits evaluated were not associated or were inconsistently associated with disease severity. MG I to III PIs 153.282, 189.931, 196.157, 398.637, 417.201, 423.818, and 561.331 had high levels of resistance and had canopies similar to the resistant checks. The resistance ratings from the petiole inoculation technique had a high and significant (P< 0.01) correlation with disease severity in the MG I and II field tests. The partially resistant PIs identified in this study can be valuable in incorporating Sclerotinia stem rot resistance into elite germ plasm.

Granzyme B ELISPOT assay for ex vivo measurements of T cell immunity.

A major goal in immunodiagnostics has been the development of assay systems that can measure CD8(+) T cell immunity in humans, directly ex vivo, at high resolution, and with high throughput. We established granzyme B (grB) enzyme-linked immunospot assay (ELISPOT) in conjunction with image analysis to this end. Using grB transfected and untransfected Chinese hamster ovary (CHO) cells and T cell lines, we show that the antibody pair utilized was grB-specific and that only activated T cells secrete grB. GrB release began within 4 h after antigen stimulation and stopped within 40 h. Side-by-side comparison showed grB ELISPOT assays to have a higher resolution than classic chromium-release assays in terms of signal-to-noise ratio. The linearity of the relation of the number of CD8(+) effector T cells plated to grB spots detected suggests that grB ELISPOT assays measure the frequencies of grB-secreting cells directly. Reactivity to HIV peptides was seen in grB ELISPOT assays of freshly isolated PBMC from HIV patients, consistent with the detection of peptide-specific memory cells. The higher resolution and lower labor and material investment should make grB ELISPOT assays an attractive alternative to chromium-release assays in monitoring the clonal sizes of specific CD8 memory cells in vivo.

Direct visualization of cytokine-producing recall antigen-specific CD4 memory T cells in healthy individuals and HIV patients.

We have used computer-assisted cytokine ELISA spot analysis to measure the frequencies, the type of cytokine, and the amount of cytokine produced by individual recall Ag-specific CD4 memory cells in freshly isolated blood. We studied the memory cells specific for tetanus toxoid and purified protein derivative in 18 healthy individuals and in 22 HIV-infected patients on highly active antiretroviral therapy (HAART). In healthy individuals, the frequency, cytokine signature, and cytokine production per cell of these memory cells were stable over time. Although it is presently unclear whether the maintenance of the memory T cell pool depends upon Ag persistence, cross-reactive Ag stimulation, or cytokine-driven bystander stimulations and expansions, our data strongly argue for a stable memory cell pool in healthy individuals. In HIV patients, however, the frequency of these memory cells was a function of the viral load. The decreased numbers of functional memory cells in patients with high viral loads might provide one mechanism behind the immunodeficient state. Although the cytokine output per cell was unaffected in most patients (20 of 24), in some patients (4 of 24) it was >100-fold reduced, which might provide an additional mechanism to account for the reduced immunocompetence of these patients. The ability to visualize directly and quantify the cytokine produced by the low frequency memory cells in freshly isolated blood that have been physiologically stimulated by Ag should aid comprehensive studies of the Ag-specific memory cell pool in vivo, in health and disease.

Genetic variance, coefficient of parentage, and genetic distance of six soybean populations.

Plant breeders would like to predict which biparental populations will have the largest genetic variance. If the population genetic variance could be predicted using coefficient of parentage or genetic distance estimates based on molecular marker data, breeders could choose parents that produced segregating populations with a large genetic variance. Three biparental soybean Glycine max (L.) Merr. populations were developed by crossing parents that were closely related, based on pedigree relationships. Three additional biparental populations were developed by crossing parents that were assumed to be unrelated. The genetic variance of each population was estimated for yield, lodging, physiological maturity, and plant height. Coefficient of parentage was calculated for each pair of parents used to develop the segregating populations. Genetic distance was determined, based on the number of random amplified polymorphic markers (RAPD) that were polymorphic for each pair of parents. Genetic distance was not associated with the coefficient of parentage or the magnitude of the genetic variance. The genetic variance pooled across the three closely related populations was smaller than the genetic variance pooled across the three populations derived from crossing unrelated parents for all four traits that were evaluated.