FUNGAL SYMBIONTS. Global assessment of arbuscular mycorrhizal fungus diversity reveals very low endemism.

The global biogeography of microorganisms remains largely unknown, in contrast to the well-studied diversity patterns of macroorganisms. We used arbuscular mycorrhizal (AM) fungus DNA from 1014 plant-root samples collected worldwide to determine the global distribution of these plant symbionts. We found that AM fungal communities reflected local environmental conditions and the spatial distance between sites. However, despite AM fungi apparently possessing limited dispersal ability, we found 93% of taxa on multiple continents and 34% on all six continents surveyed. This contrasts with the high spatial turnover of other fungal taxa and with the endemism displayed by plants at the global scale. We suggest that the biogeography of AM fungi is driven by unexpectedly efficient dispersal, probably via both abiotic and biotic vectors, including humans.

[From pay-for-effort to pay-for-performance--an analysis of the Swiss health care system with focus on the inpatient sector]. / Von der Kostenerstattung zur leistungs- und ergebnisorientierten Vergütung--Eine Analyse des schweizerischen Gesundheitswesens mit Fokus auf dem stationären Bereich.

INTRODUCTION: The Swiss health care system is facing the implementation of lump compensation in the form of diagnosis related groups from 2010 on. In addition there is an increasing discussion about the quality of health care in the media. We have analyzed current remuneration in Swiss health care and their steering effects on providers in order to deduct future developments in Swiss health care remuneration. METHODS: Based on the remuneration contracts and tariff regularities at the Basel University Hospital we conducted an internet and literature search. The identified Swiss remuneration systems were classified after remuneration scales and remuneration item using a typology of performance-related remuneration systems. The steering effects of the remuneration systems on the providers were deducted. RESULTS: Remuneration scales can be classified in <>, <> or <>. Remuneration items can be classified in <>, <> or <>. Remuneration systems can lead to increased or decreased services or to patient selection. In the Swiss health care system we find a trend away from traditional <> to <> remuneration systems. In that context diagnosis related groups are identified as an intermediate step in the development of remuneration systems. CONCLUSIONS: Future developments of medical remuneration in terms of a consideration of quality of medical performance and negotiated costs seem likely in Switzerland in the long term. Both, economics and quality should be considered adequately in a health care remuneration system.

[Organization of clinical emergency units. Mission and environmental factors determine the organizational concept]. / Organisation der Notfallstation. Umfeld und Leistungsauftrag bestimmen das Organisationskonzept.

AIM: Mission and organization of emergency units were analysed to understand the underlying principles and concepts. METHODS: The recent literature (2000-2007) on organizational structures and functional concepts of clinical emergency units was reviewed. An organizational portfolio based on the criteria specialization (presence of medical specialists on the emergency unit) and integration (integration of the emergency unit into the hospital structure) was established. The resulting organizational archetypes were comparatively assessed based on established efficiency criteria (efficiency of resource utilization, process efficiency, market efficiency). RESULTS: Clinical emergency units differ with regard to autonomy (within the hospital structure), range of services and service depth (horizontal and vertical integration). The "specialization"-"integration"-portfolio enabled the definition of typical organizational patterns (so-called archetypes): profit centres primarily driven by economic objectives, service centres operating on the basis of agreements with the hospital board, functional clinical units integrated into medical specialty units (e.g., surgery, gynaecology) and modular organizations characterized by small emergency teams that would call specialists immediately after triage and initial diagnostic. CONCLUSIONS: There is no "one fits all" concept for the organization of clinical emergency units. Instead, a number of well characterized organizational concepts are available enabling a rational choice based on a hospital's mission and demand.

[Synovial osteochondromatosis]. / L'osteocondromatosi sinoviale.

The Authors have examined the clinical history, roentgenograms, differential diagnosis and treatment of synovial osteochondromatosis.

[Review of 41 cases of surgically treated acromioclavicular dislocations]. / Revisione di 41 casi di lussazione acromio-claveare di 3 tipo trattati chirurgicamente.

The authors have examined the follow-up of 41 cases of acromio- clavicular dislocation, treated by internal fixation. Statistics show a very good end result.

[Evaluation of the aftermath of trimalleolar fractures of the tibio-tarsal joint]. / Valutazione dei postumi delle fratture trimalleolari della tibio-tarsica.

The authors have examined the follow-up of 57 cases of trimalleolar fractures treated by internal fixation. Statistics show a good end result. The Authors, moreover, report the frequent presence of synostosis tibio-fibulare distale. This condition, however, has no influence on ankle motion.