Suchergebnisse

Abstract: Glauben Sie, dass Sie sich eine umfassende Gesundheitsversorgung im Jahr 2020 noch leisten können? Gesundheit ist unser höchstes Gut – es darf keine Zeit vergeudet werden, weil die gesellschaftlichen Herausforderungen drängen und zugleich unsere Ressourcen begrenzt sind.Ohne zu dramatisieren, zeigen die Autoren Schwachstellen und künftige Herausforderungen unseres Gesundheitswesens auf. Aus verschiedenen Perspektiven werden nach gründlicher Analyse des Status quo mögliche Lösungswege beschrieben. Das Besondere dabei ist, dass sowohl ethische, rechtliche, versorgungspolitische, gesundheitsökonomische und auch machtpolitische Zusammenhänge dargestellt und erklärt werden.Das Buch wendet sich an alle, die sich beruflich oder aus eigenem Interesse um die Zukunft unseres Gesundheitswesens Gedanken machen. Die Herausgeber fordern im Hinblick auf die anstehende Bundestagswahl 2013 eine gesamtgesellschaftliche Kraftanstrengung. Die Zeit ist reif für einen Masterplan Gesundheitswesen 2020

Education-business partnership in the United Kingdom has a long history. The promotion of links between the partners at all levels and in all sectors of the economy has become a service industry in its own right. In 1991, the UK government established a regional network of Education-Business Partnerships (EBPs) in an attempt to coordinate these activities. Education-business links embrace curriculum enrichment for students at all levels of education; professional development for teachers, lecturers, and business employees; and institutional development and mutual benefits arising from collaboration between educational institutions, business, and the wider community. The authors review the development of education-business links in the United Kingdom and raise a number of issues about definition and purpose. They discuss the difficulties of establishing an educational framework for industrial, commercial, and business enterprises and the economic and technological processes which operate within them.

Recent legislation in the state of Ohio now allows chiropractic physicians who possess certain credentials to both diagnose and clear young patients who have sustained concussions. Unfortunately, little if any existing research examines the knowledge and abilities of chiropractic physicians regarding the management of this condition. Therefore, the purpose of this study was to provide a general overview of chiropractic physicians' knowledge regarding the diagnosis and management of pediatric concussions. A survey was emailed to 1,344 chiropractors in the state of Ohio. Of those who were contacted, 71 completed the survey. The survey included questions regarding demographics, patient scenarios, and concussion management. Although 66.7% of chiropractors qualified to care for concussions reported the utilization of guidelines, the rate dropped to 35.2% when all respondents were included. There were statistically significant differences concerning familiarity with the Graded Symptom Checklist (p=0.001) and the Post-Concussion Symptom Scale (p=0.007). In addition, the results of a question regarding the implementation of graduated return-to-play protocols were found to be borderline significant (p=0.06).The results of the study indicated that chiropractors who possess the credentials required by law are more knowledgeable regarding concussion diagnosis and management than those who do not.

The German health system is undergoing structural changes. Discussion often focuses on financial matters & the distribution of the 130 million Euro budget for the obligatory health insurance companies (excluding the private insurance organizations, which are only open to high-income groups). The authors call for a broader reform process that takes into account current deficiencies, ie, organization & quality of information flow, care quality, & transparency. Further participation of patients & insured could help to reach the goals of better efficiency, quality, & economic viability, while maintaining the principle of solidarity. The obligatory health insurance companies should not limit their political position on established corporatism but engage in reform & thereby gain legitimacy in the eyes of the 88% of the German population who are insured in the statutory system. The insurance companies therefore should define themselves as speakers of citizen interests as well as interests of patients, insured, & consumers. 11 References. Adapted from the source document.

Abstract
There is a significant silicosis risk for workers fabricating engineered stone (ES) products containing crystalline silica. The aims of this study by SafeWork NSW were to: (i) assess current worker exposure to respirable dust (RD) and respirable crystalline silica (RCS) following a 5-y awareness and compliance program of inspections in ES workshops and (ii) to identify improvements in work practices from the available evidence base to further reduce exposures. One hundred and twenty-three personal full shift samples taken on as many workers and 34 static samples across 27 workshops fabricating ES were included in the final assessment.
The exposure assessment was conducted using Casella Higgins–Dewell cyclones (Casella TSI) placed in the breathing zone of workers attached to SKC Air Check XR 5000 or SKC Chek TOUCH sampling pumps. Sample filters were sent to an ISO (2017) 17025:2017 accredited laboratory for gravimetric analysis for RD and X-Ray Diffraction (XRD) analysis to determine the amount of deposited RCS i.e. alpha-quartz and cristobalite.
All workshops used wet methods of fabrication. The geometric mean (GM) of the pooled result for respirable dust (RD) was 0.09 mg/m3 TWA-8 h and 0.034 mg/m3 TWA-8 h for RCS. The highest exposed workers with a GM RCS of 0.062 mg/m3 TWA-8 h were those using pneumatic hand tools for cutting or grinding combined with polishing tasks. Workers operating semiautomated routers and edge polishers had the lowest GM RCS exposures of 0.022 mg/m3 TWA-8 h and 0.018 mg/m3 TWA-8 h respectively. Although ES workers remain exposed to RCS above the workplace exposure limit (WEL) of 0.05 mg/m 3 TWA-8 h, these results point to a very substantial reduction in exposures compared to poorly controlled dry methods of fabrication. Therefore, the wearing of respiratory protection by workers remains necessary until further control measures are more widely adopted across the entire industry e.g. reduction in the crystalline silica content of ES.

Glioblastoma is an intrinsic brain tumour thought to arise from neuroglial progenitor cells. Its incidence increases steadily with age. Males are moderately more often affected. Genetic predisposition and exposure to irradiation in childhood are the only established risk factors which, however, account only for a very small proportion of glioblastomas. Surgery as safely feasible not only to allow for tissue diagnosis but also to reduce tumour volume is usually the first therapeutic measure. Radiotherapy delivered to the tumour region with a safety margin has been demonstrated to roughly double survival four decades ago. Temozolomide given during radiotherapy followed by six cycles of maintenance chemotherapy was the first and so far only pharmacological treatment shown to prolong survival. Adding tumour-treating fields during maintenance, temozolomide chemotherapy has been reported to prolong survival. There is little evidence that any intervention at relapse improves outcome, but nitrosourea-based chemotherapy, commonly lomustine, is probably the most agreed on standard of care. Bevacizumab prolongs progression-free survival and probably quality of life in the first line or recurrent setting, but not overall survival, and is therefore not approved in the European Union. Immunotherapy remains experimental. Drugs in advanced clinical development include the programmed death 1 antibody, nivolumab, the antibody drug conjugate depatuxizumab directed to the epidermal growth factor receptor and the proteasome inhibitor marizomib.

Glioblastoma is an intrinsic brain tumour thought to arise from neuroglial progenitor cells. Its incidence increases steadily with age. Males are moderately more often affected. Genetic predisposition and exposure to irradiation in childhood are the only established risk factors which, however, account only for a very small proportion of glioblastomas. Surgery as safely feasible not only to allow for tissue diagnosis but also to reduce tumour volume is usually the first therapeutic measure. Radiotherapy delivered to the tumour region with a safety margin has been demonstrated to roughly double survival four decades ago. Temozolomide given during radiotherapy followed by six cycles of maintenance chemotherapy was the first and so far only pharmacological treatment shown to prolong survival. Adding tumour-treating fields during maintenance, temozolomide chemotherapy has been reported to prolong survival. There is little evidence that any intervention at relapse improves outcome, but nitrosourea-based chemotherapy, commonly lomustine, is probably the most agreed on standard of care. Bevacizumab prolongs progression-free survival and probably quality of life in the first line or recurrent setting, but not overall survival, and is therefore not approved in the European Union. Immunotherapy remains experimental. Drugs in advanced clinical development include the programmed death 1 antibody, nivolumab, the antibody drug conjugate depatuxizumab directed to the epidermal growth factor receptor and the proteasome inhibitor marizomib.

Abstract
Internationally, respirable crystalline silica (RCS) occupational exposure limits (OELs) are being reassessed and, in some jurisdictions, lowered, putting pressure on the capabilities of the analytical techniques used to achieve robust analyses and reliable detection limits. In preparation of a lower OEL, options for lowering the limit of detection (LoD) for RCS analysis have been assessed. Using a Direct-on-Filter X-Ray Diffraction (XRD) analysis under reduced scan speeds in combination with low-noise RCS sampling filters, an LoD of 0.25 µg/filter and a limit of quantification (LoQ) of 0.82 µg/filter can be achieved. Both limits would translate in an LoD of 0.24 µg/m3 and LoQ of 0.78 µg/m3 when sampling respirable dust for 8 h at 2.2 L/min, providing a technical solution to monitor exposures at the proposed OEL of 0.025 mg/m3 (25 µg /m3) and below, with general sampling conditions as typically applied in Australia. This is the first report showing that the OEL of 0.025 mg/m3 (25 µg /m3) is measurable by one of the standardized, direct-on-filter XRD methods.

Brain disorders pose major challenges to medicine and treatment innovation. This is because their spectrum spans inflammatory, degenerative, traumatic/ischaemic, and neoplastic disease processes with a complex and often ill- understood aetiology. An improved genetic and genomic understanding of specific disease pathways offers new approaches to these challenges, but at present it is in its infancy. Here, we review different aspects of the challenges facing neuromedicine, give examples of where there are advances, and highlight challenges to be overcome. We see that some disorders such as Huntington's disease are the product of single gene mutations, whose discovery has been leading to the development of new targeted interventions. In the field of neurosurgery, the identification of a number of mutations allows an elaborated genetic analysis of brain tumours and opens the door to individualised therapies. Psychiatric disorders remain the area where progress is slow. Genetic analyses show that for major common disorders such as schizophrenia and depression there are no single gene alterations which offer options for targeted therapy development. However, new approaches are being developed to leverage genetic information to predict patients' responses to treatment. These recent developments hold promise for early diagnosis, follow-up with personalised treatments with adjusted therapeutic doses, predictable responses, reduced adverse drug reactions, and personal health planning. The scenario is promising but calls for increased support for curiosity-driven research into the mechanisms of normal brain functioning as well as challenging adaptations of health care and research infrastructures, encompassing legal frameworks for analysing large amounts of personal data, a flexible regulatory framework for correlating big data analyses in cooperative networks between academia and the drug development industry, and finally new strategies for brain banking in order to increase access to brain tissue samples. To make personalised medicine for brain disorders a reality, a joint effort between all relevant stakeholders - among which patients and patient organisations should play an important role - is required.

Funding: We thank Sabine Baxter for assistance with hybridoma and cell culture at the University of Pennsylvania Perelman School of Medicine Cell Center Services Facility. We acknowledge the use of cryo-EM instruments at Pfizer Inc. The cryo-EM work was supported by a grant from the National Institute of Health (R01GM103899 and R01GM129357 to V.Y.M.-B.). The TRPV2-flag-RFP construct cloned into the pEGFP-N2 vector was kindly provided by Prof. Kojima (Gunma University, Japan). The Developmental Therapeutics Program is acknowledged for screening PL against the NCI-60 cancer cell line panel. We are grateful to Carlos Custódia, Eunice Paisana, and Dr. Joao Barata for their assistance with cell-line modulation ̃ and the GBM tumor model, and to Dr. Vikki Cantrill for her assistance with the editing of this manuscript. Figure design by Claudia Flandoli (draw.science). The Histology and Comparative Pathology Laboratory of the Instituto de Medicina Molecular is acknowledged for technical support. We also thank FCT Portugal (FCT Investigator IF/00624/2015 to G.J.L.B., IF/01693/2014 to V.A.M. and IF/00595/2014 to N.L.B.-M., CEECIND/00436/2018 to N.L.B.-M., PhD studentship SFRH/BD/143583/2019 to B.B.S., PhD studentship PD/BD/128289/2017 to E.P.L., Postdoctoral fellowship SFRH/BPD/1187731/2016 to M.C.M.), Agencia Estatal Investigación of Spain (AEI, RTI-2018-099592-B-C21 to F.C.), EMBO (Installation Grant 3057 to N.L.B.-M.), and the Medical Research Council (MR/N010051/1 to P.F.). This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement 630731, 675007, 807281, and 743640. G.J.L.B. is a Royal Society University Research Fellow (URF\R\180019). ; The use of computational tools to identify biological targets of natural products with anticancer properties and unknown modes of action is gaining momentum. We employed self-organizing maps to deconvolute the phenotypic effects of piperlongumine (PL) and establish a link to modulation of the human transient receptor potential vanilloid 2 (hTRPV2) channel. The structure of the PL-bound full-length rat TRPV2 channel was determined by cryo-EM. PL binds to a transient allosteric pocket responsible for a new mode of anticancer activity against glioblastoma (GBM) in which hTRPV2 is overexpressed. Calcium imaging experiments revealed the importance of Arg539 and Thr522 residues on the antagonistic effect of PL and calcium influx modulation of the TRPV2 channel. Downregulation of hTRPV2 reduces sensitivity to PL and decreases ROS production. Analysis of GBM patient samples associates hTRPV2 overexpression with tumor grade, disease progression, and poor prognosis. Extensive tumor abrogation and long term survival was achieved in two murine models of orthotopic GBM by formulating PL in an implantable scaffold/hydrogel for sustained local therapy. Furthermore, in primary tumor samples derived from GBM patients, we observed a selective reduction of malignant cells in response to PL ex vivo. Our results establish a broadly applicable strategy, leveraging data-motivated research hypotheses for the discovery of novel means tackling cancer. ; publishersversion ; published