[Effects of a One-Week Inpatient Health Programme for Family Caregivers and Persons in Need of Care (SVLFG Care Tandem) - A Quasi-Experimental Study]. / Effekte eines einwöchig-stationären Gesundheitsprogramms für pflegende Angehörige gemeinsam mit ihrer pflegebedürftigen Person (Pflege-Tandem der SVLFG) ­ eine quasiexperimentelle Studie.

AIM: The aim of this study was to assess the effect of a one-week inpatient health programme for family carers together with the persons in need of care (care tandem) on the well-being of family carers. Acceptance and subjective benefits were also assessed. The intervention was funded by the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG). METHODOLOGY: Central to the intervention are (1) the home care counselling before the seminar, (2) the one-week seminar in the setting of a rehabilitation clinic at a health resort, in particular with a care course, exercise and relaxation units and the use of local remedies, (3) the substitute care of the person in need of care in close proximity to the seminar location and (4) the low-threshold telephone aftercare by SVLFG specialists. In a controlled prospective panel study (IG n=35, VG n=67, allocation not randomised), well-being (WHO-5, range 0-100) was measured at several points in time (IG: 0, 1, 9, 17, 28 and 43 weeks after the start of the seminar; VG 0, 17, 28 and 43 weeks). Statistical analyses were performed using fixed-effects panel regression, controlling for time-varying covariates (period effects, external stress). RESULTS: In the IG (80% women, mean age 66.5 years), 69% of family carers showed evidence of clinically relevant depression at baseline. All care levels were represented among the people in need of care, predominantly 2 and 3, with medically diagnosed dementia in 37% of the cases. The VG was similarly structured. Under the condition of stable external stress, the initial effect was very clear (delta=+19 points). The effect then flattened out, but remained fairly stable at around 10 points above the initial level. Although the last measurement (43 weeks) was no longer statistically significantly higher, it was independent of the development of external stress. Acceptance and subjective benefit were very high. CONCLUSIONS: The strength of the intervention is the dyadic approach. The intervention promotes well-being and is highly accepted. The design allows at least cautious causal conclusions. For the remaining limitations, larger case numbers and a randomised controlled trial would be necessary.

[More free time for me? Effects of a group intervention for informal caregivers based on routine data from the SVLFG long-term care insurance]. / Mehr Freiraum für mich? Effekte einer Gruppenintervention für pflegende Angehörige anhand von Routinedaten der SVLFG-Pflegekasse.

BACKGROUND: The intervention is a multiday health program of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) for informal caregivers. AIM OF THE WORK: Does the intervention increase the use of outside help to gain free time for self-care? MATERIAL AND METHODS: Using a quasi-experimental within-design, we analyze annual benefit data from the SVLFG long-term care insurance for the cluster sample Bavaria from 2017 to 2020 with intervention in 2018/2019. Using fixed effects panel regressions, we determine the effect heterogeneity for care relationship, duration of care and degree of care, adjusting for period effects (intervention and comparison group: 88 and 6045 persons with 207 and 16,091 observations, respectively). RESULT: After the intervention, the use of services for outside help tends to be higher than before. The effect is significantly more pronounced with increasing care level, care within the partnership and shorter care duration. With care within the partnership, start of care before 1 year and care level 4/5, more outside help is used afterwards for 1160 € (p < 0.001) than before. DISCUSSION: Design and statistical method would allow a causal conclusion; however, in view of the limitations, in particular the small number of cases in the intervention group and the only limited characteristics available to control for time-dynamic heterogeneity, caution is advisable.

Japanese acupuncture and moxibustion in 16-18th-century Europe / 全日本鍼灸学会雑誌

Despite China's cultural impact, Japanese physicians used the medical knowledge they adopted from their great neighbor with surprising independence. Being more open to interactions with Westerners, even after the adoption of a semiseclusion policy in 1639, Japan played a significant role in the early knowledge transmission of acupuncture and moxibustion to Europe.<BR>The first reports on traditional Far Eastern medicine by Europeans came from 16th-century Japan, where Jesuit missionaries accumulated considerable knowledge of acupuncture, moxibustion, pulse feeling, and materia medica. However, their observations were dispersed among a variety of letters, 'historias', and dictionaries, and there was no significant impact among European readers.<BR>Medical interactions in Japan changed significantly in 1641 with the relocation of the Dutch trading post from Hirado to Dejima (Nagasaki). Establishing a permanent position for a surgeon/physician laid the foundations for continuous exchange between Japanese physicians and their Western colleagues.<BR>European scholarly interest in moxibustion began with a booklet by Hermann Buschoff, a Dutch clergyman in Batavia, about a remedy against Podagra that he called Moxa (in Japanese, mogusa). Buschoff found it difficult to understand the physiological principles underlying his miracle cure. After serious debate in the German Academy of Natural Science, Andreas Cleyer, a licensed physician and trading post chief in Japan, clarified the botanical background and the production methods of Moxa. However, unable to understand Eastern pathology, Western physicians inevitably looked for similarities with their own tradition and in Egyptian medicine. Although Engelbert Kaempfer demonstrated its broad range of applications in Japan, Moxa was assimilated as a remedy against gout following the old Western principle of 'revulsion'.<BR>After many earlier remarks by Portuguese Jesuits, Willem ten Rhijne's article on acupuncture marks the beginning of scholarly discussions on the art of needling. He and his eminent successor at Dejima, Kaempfer, presented recent Japanese inventions such as the 'tube needle'and the 'hammer needle', which were unknown in China. While the tube needle was a simple technical improvement, the hammer needle was used as part of a new therapeutic concept that ignored the Chinese 'meridians'. Both highly educated physicians were unable to overcome the language barrier and depended on Japanese interpreters with limited knowledge of Dutch. Thus 'meridians'were considered to be blood vessels, ki became 'wind'(flatus), and the accumulation of ki in the abdominal area seemed to be a kind of 'colic'. As Kaempfer described, the use of needles in such cases inevitably led to rejection by Western medical authorities.

[On early red-head-style external medicine and the Confucian physician Mukai Gensho].

In 1656, at the request of the imperial commissioner Inoue Masashige Chikugo-no-kami, the neo-Confucian physician Mukai Gensho compiled medical instructions given to him by the Dejima trading-post surgeon Hans Juriaen Hancke. This was the first text on Western surgery by a trained Japanese specialist. Based on an extensive analysis of related Japanese source material, it is shown that the manuscript Komoryu geka hiyo ("Secret compendium of red-head-style external medicine"), previously considered to represent Mukai's original report, is a rather corrupted version. Other manuscripts, such as Oranda-den geka ruiho ("Arranged formulas of Dutch external medicine"), Oranda geka iho ("Medical formulas of Dutch external medicine"), or Shoji shinan ("Compass of diagnosis and treatment"), are much more coherent in their contents and fit well with Dutch sources. Furthermore, it is shown how Mukai "identified" and "translated" the Latin names of ulcers, tumours, inflammations, etc., by comparing Hancke's teachings with the most comprehensive Eastern source on surgical matters, the Waìke zhèngzong (Jap. Geka seiso, "Orthodox manual of external medicine"). His eclectic approach resulted in a combination of Sino-Japanese pathology with Western treatment methods. Mukai had set an example that would dominate the reception of Western medicine in Japan for more than a century. It became widely known as early as 1670, when Yamawaki Doen included many parts of Mukai's report in his Oranda geka ryoho ("Good formulas of Dutch external medicine"), the first Japanese book on red-head-style external surgery.

Stability of a surface-bound oligonucleotide duplex inferred from molecular dynamics: a study of single nucleotide defects using DNA microarrays.

Microarray technology uses the sequence dependent hybridization (binding) affinity of surface-bound oligonucleotide strands for the quantification of complex nucleic acid mixtures. In spite of its huge potential in life science and medicine, microarray oligonucleotide hybridization remains far from being understood. Taking advantage of microarray combinatorial possibilities we show that, although surface bound, the hybridization affinities of single-base mismatched oligonucleotides can be derived from first principles using parameters from bulk.

Position dependent mismatch discrimination on DNA microarrays - experiments and model.

BACKGROUND: The propensity of oligonucleotide strands to form stable duplexes with complementary sequences is fundamental to a variety of biological and biotechnological processes as various as microRNA signalling, microarray hybridization and PCR. Yet our understanding of oligonucleotide hybridization, in particular in presence of surfaces, is rather limited. Here we use oligonucleotide microarrays made in-house by optically controlled DNA synthesis to produce probe sets comprising all possible single base mismatches and base bulges for each of 20 sequence motifs under study. RESULTS: We observe that mismatch discrimination is mostly determined by the defect position (relative to the duplex ends) as well as by the sequence context. We investigate the thermodynamics of the oligonucleotide duplexes on the basis of double-ended molecular zipper. Theoretical predictions of defect positional influence as well as long range sequence influence agree well with the experimental results. CONCLUSION: Molecular zipping at thermodynamic equilibrium explains the binding affinity of mismatched DNA duplexes on microarrays well. The position dependent nearest neighbor model (PDNN) can be inferred from it. Quantitative understanding of microarray experiments from first principles is in reach.

Impact of point-mutations on the hybridization affinity of surface-bound DNA/DNA and RNA/DNA oligonucleotide-duplexes: comparison of single base mismatches and base bulges.

BACKGROUND: The high binding specificity of short 10 to 30 mer oligonucleotide probes enables single base mismatch (MM) discrimination and thus provides the basis for genotyping and resequencing microarray applications. Recent experiments indicate that the underlying principles governing DNA microarray hybridization - and in particular MM discrimination - are not completely understood. Microarrays usually address complex mixtures of DNA targets. In order to reduce the level of complexity and to study the problem of surface-based hybridization with point defects in more detail, we performed array based hybridization experiments in well controlled and simple situations. RESULTS: We performed microarray hybridization experiments with short 16 to 40 mer target and probe lengths (in situations without competitive hybridization) in order to systematically investigate the impact of point-mutations - varying defect type and position - on the oligonucleotide duplex binding affinity. The influence of single base bulges and single base MMs depends predominantly on position - it is largest in the middle of the strand. The position-dependent influence of base bulges is very similar to that of single base MMs, however certain bulges give rise to an unexpectedly high binding affinity. Besides the defect (MM or bulge) type, which is the second contribution in importance to hybridization affinity, there is also a sequence dependence, which extends beyond the defect next-neighbor and which is difficult to quantify. Direct comparison between binding affinities of DNA/DNA and RNA/DNA duplexes shows, that RNA/DNA purine-purine MMs are more discriminating than corresponding DNA/DNA MMs. In DNA/DNA MM discrimination the affected base pair (C.G vs. A.T) is the pertinent parameter. We attribute these differences to the different structures of the duplexes (A vs. B form). CONCLUSION: We have shown that DNA microarrays can resolve even subtle changes in hybridization affinity for simple target mixtures. We have further shown that the impact of point defects on oligonucleotide stability can be broken down to a hierarchy of effects. In order to explain our observations we propose DNA molecular dynamics - in form of zipping of the oligonucleotide duplex - to play an important role.

Optical study of DNA surface hybridization reveals DNA surface density as a key parameter for microarray hybridization kinetics.

We investigate the kinetics of DNA hybridization reactions on glass substrates, where one 22 mer strand (bound-DNA) is immobilized via phenylene-diisothiocyanate linker molecule on the substrate, the dye-labeled (Cy3) complementary strand (free-DNA) is in solution in a reaction chamber. We use total internal reflection fluorescence for surface detection of hybridization. As a new feature we perform a simultaneous real-time measurement of the change of free-DNA concentration in bulk parallel to the total internal reflection fluorescence measurement. We observe that the free-DNA concentration decreases considerably during hybridization. We show how the standard Langmuir kinetics needs to be extended to take into account the change in bulk concentration and explain our experimental results. Connecting both measurements we can estimate the surface density of accessible, immobilized bound-DNA. We discuss the implications with respect to DNA microarray detection.

[The surgical license of Otaguro Gentan and its background].

After the birth of Caspar-style surgery (kasuparu-ryu geka) during the 1650s, for about three decades, certificates issued by surgeons of the Dutch East India Company proved useful to those pursuing a career as a 'Western-style physician'. Five of these 'diploma' have survived the ravages of time. Four of the five beneficiaries are well known. An investigation in Northern Kyushu and Shikoku brought to light historical records that clarify the hitherto unknown background of the fifth one, Otaguro Gentan. Gentan was the second son of Otaguro Shozaemon, a village headman in the province of Chikugo. With no prospects of succeeding his father, he went to serve in the residence of Kuze Hiroyuki in Edo. This powerful imperial councillor suggested an education in Western surgery at the Dutch trading post in Nagasaki. The instruction given by Arnold Dircksz ceased in October 1668 when he issued a certificate. After his 'graduation', Otaguro went to Edo again where he was employed by Hachisuga Tsunamichi, the young ruler of Awa. He changed his name to Mizogami, and for generations the sons of his family served as physicians to the Hachisuga family. Gentan was treaed with great generosity by Tsunamichi and his successor Tsunanori. In 1694, he was even granted use of Tsunamori's personal ship to travel to Nagasaki for further medical studies. But Gentan soon fell ill and after a brief visit to the village of his ancestors, he died at the end of the same year.