Rapid chiral assembly of rigid DNA building blocks for molecular nanofabrication.

Practical components for three-dimensional molecular nanofabrication must be simple to produce, stereopure, rigid, and adaptable. We report a family of DNA tetrahedra, less than 10 nanometers on a side, that can self-assemble in seconds with near-quantitative yield of one diastereomer. They can be connected by programmable DNA linkers. Their triangulated architecture confers structural stability; by compressing a DNA tetrahedron with an atomic force microscope, we have measured the axial compressibility of DNA and observed the buckling of the double helix under high loads.

[The use of methylphenidate in children: analysis of prescription usage based in routine data of the statutory health insurance bodies concerning drug prescriptions]. / Der Einsatz von Methylphenidat im Kindesalter: Analyse des Verordnungsverhaltens auf der Basis von Routinedaten der gesetzlichen Krankenkassen zu Arzneimittelverordungen.

UNLABELLED: In Germany only few data is available on the use of stimulants in the treatment of Attention Deficit/Hyperactivity Disorder. For the first time a full survey of health insurance data was carried out on methylphenidate prescriptions from 2000 to 2001 in an East German District. 783 patients of the total cohort received at least one prescription for methylphenidate. In our sample, the treatment prevalence more than doubled in the observation period from 0.6 % to 1.4 % in children aged between 5 and 15 years, this age group representing the largest treatment group. Younger children, adolescents and adults were only rarely treated. The treatment was undertaken predominantly by paediatricians, general practitioners and neurologists/psychiatrists/child psychiatrists. Prescriptions were issued by one, or by not more than two doctors. CONCLUSION: In Mecklenburg-Vorpommern the prevalence of stimulant treatment has clearly increased. Since diagnosis-related data is not available it is not possible to assess the indications for treatment. Further studies should serve to evaluate the correspondence between diagnosis and therapy in relation to stimulant medication.

[Factors for ambulant care--first results of a small area comparison of assessment data in the Federal States of Schleswig-Holstein and Mecklenburg-Vorpommern]. / Einflussfaktoren auf die ambulante Pflege--Erste Ergebnisse eines kleinräumigen Vergleichs der Begutachtungsdaten in den Bundesländern Mecklenburg-Vorpommern und Schleswig-Holstein.

This paper shows possible opportunities and analysis potentials to contrast between Federal States--in this case Schleswig-Holstein and Mecklenburg-Vorpommern--with regard to application for and demands on benefits granted by statutory long-term care insurance. It is a further development of an early study. Under the assumption of an equal behaviour as to application for, demands on and distinction of ADL (activities of daily life) variances for defined areas of a Federal State are pointed out. Within a Federal State, definite differences between rural and urban areas are exemplified. Applications for and demands on benefits follow the same trend, but there are differences in profile. Self-assessment of each of the the States concerned, differs surprisingly and is in itself often contradictory. On comparing these States, it was possible to verify individual factors of influence such as infrastructure, housing property conditions and individual self-assessment. Moreover the paper shows the influence of the process of transition taking place in East Germany, e. g. by selective migration and fast suburbanization.

Medical biomodelling in surgical applications: results of a multicentric European validation of 466 cases.

The study started in September 1999 and ended in April 2002. It is based on a questionnaire [www.phidias.org] assessing case-related questions due to the application of stereolithographic models. Each questionnaire contains over 50 items. These variables take into account diagnosis, indications and benefits of stereolithographic models with view on different steps of the surgical procedures: preoperative planning, intraoperative application and overall outcome after surgical intervervention. These questionnaires were completed by the surgeons who performed operation. Over the time course of our multicentric study (30 months), we evaluated 466 cases. The study population consists of n=231 male and n= 235 female patients. 54 surgeons from 9 European countries were involved. There are main groups of diagnosis that related to the use of a model. Most models were used in maxillofacial surgery. The operative planning may help to determine the resection line of tumor and optimize reconstructive procedures. Correction of large calvarian defects can be simulated and implants can be produced preoperatively. Overall in 58 % of all cases a time- saving effect was reported. The study strongly suggests, that medical modeling has utility in surgical specialities, especially in the craniofacial and maxillofacial area, however increasingly in the orthopedic field. Due to our results, medical modeling optimizes the preoperative surgical planning. Surgeons are enabeled to perform realistic and interactive simulations. The fabrication of implants, its design and fit on the model, allow to reduce operation time and in consequence risk and cost of operation. In addition, the understanging of volumetric data is improved, especially if medical models are combined with standart imaging modalities. Finally, surgeons are able to improve communication between their patientents and colleagues.

[Application behavior and disability in ambulatory care according to SGB XI. A structural regional approach]. / Antragsverhalten und Pflegbedürftigkeit in der ambulanten Pflege nach dem SGB XI. Ein siedlungsstruktureller Ansatz.

A REGIONAL ANALYSIS: The target of this task undertaken by a geographer was an analysis according to limited regional areas, of application for and demands on benefits granted by the statutory social long-term care insurance body, and hence an interdisciplinary estimate. Definite differences between individual areas in Schleswig-Holstein were seen, and it was partly possible to explain why such differences exist. The infrastructure, the housing space ownership conditions and individual self-assessment are essential factors when applying for benefits. Identification of the geography of the relevant residential location was effected by the individual zip code. In 79.8% of the cases included in a random test the locations were clearly defined. The combination of geography and epidemiology enables a clear allocation of medical phenomena also for further research concerning differences between well-defined areas.

[Expert assessment of work disability--do we realize the effects?]. / AU-Begutachtung--Wissen wir eigentlich, was wir bewirken?

Three inquiries on the results of medical expertises concerning incapacitation for work in cases where employers had doubted this fact, seem to establish that the Medical Service of the Social Health Insurance (MDK) is quite capable of keeping improper use of the epithet "unfit for work" in check. If the design of the studies is critically analysed, it becomes evident that most problems are still unsolved. More clarity regarding the sense or nonsense of this work-intensive topic may result from a carefully and completely planned randomised trial. Such a study appears mandatory, the more so since the economic benefit of the expertises does not seem to be very bright, taking several hypotheses into consideration.

[Results of expert assessment of disability with reference to selected diagnostic groups by the Medical Service of Hospital Insurance]. / Begutachtungsergebnisse der Pflegebedürftigkeit unter Berücksichtigung ausgewählter Diagnosegruppen durch den Medizinischen Dienst der Krankenversicherung (MDK).

A topical survey is given by the documentation of the examination for the statutory nursing care insurance. The first part of the report contains the complete tabulated results of the Federal Republic of Germany. Furthermore a graphical comparison of selected groups of diagnoses like psychiatric disorders has been statistically evaluated and is commented upon.

[Documentation in expert evaluation of disability status by the medical service of hospital insurance]. / Berichterstattung zur Begutachtung der Pflegebedürftigkeit durch den Medizinischen Dienst der Krankenversicherung (MDK).

A first survey is given by the documentation of the examination for the statutory nursing care insurance. The first part of the report contains the complete tabulated results of the Federal Republic of Germany. Furthermore a graphical comparison of elected federal states has been statistically evaluated and is commented upon.

[Does budgeting modify quality and efficiency of ambulatory drug therapy? Use of indicators exemplified by the prescribing behavior of established physicians of a North German region with predetermined quality deficits before introduction of the Health Structural Law]. / Beeinflusst eine Budgetierung Qualität und Wirtschaftlichkeit der ambulanten Arzneimitteltherapie? Anwendung von Indikatoren am Beispiel des Verorrdnungsverhaitens niedergelassener Arzte einer norddeutschen Region mit festgestellten Qualitätsdefiziten vor der Einführung des GSG.

Application of indicators exemplified by the prescribing conduct of physicians in a specific region of northern Germany showing deficits before implementation of the new GSG (Health Structure Law). The prescriptions of physicians in a specific region of northern Germany were examined to see whether the quality of drug therapy in this region, which showed deficits before the implementation of the GSG, had been influenced by this law. After encoding the prescription data the 100 most often prescribed drugs were identified as physician-related the resulting costs determined and arranged in order of precedence ("medicine charts"). The indicators were defined as to which "medicine-chart" drug they related, to facilitate a qualitative analysis of the prescriptions. The indicators were: Drugs, whose therapeutic advantage is not proven Drugs based on obsolete therapeutic concepts Drugs with lower-priced and/or therapeutic equal alternatives Standard-Therapeutics.

[Implementation of the psychiatric personnel regulation--an intermediate-term evaluation]. / Die Umsetzung der Psychiatrie-Personalverordnung--eine Zwischenbilanz.

The new German Psychiatry Personnel Regulations were enforced in 1991. The aim was to set a standard for performance-adapted optimised personnel calculation for all professions taking part in stationary care and to initiate structural changes in psychiatric institutions. In general psychiatry, geronto-psychiatry, and addiction diseases, patients are classified in different categories according to the degree of disease and resulting therapeutic effort by the team taking part in therapy. In this manner personnel requirements are calculated prospectively in terms of working minutes. Realisation in Schleswig-Holstein is based on general agreements that allow evaluation, testing, and quality assurance by a graduated instrumentarium basing on valid data. A differentiated interventional management has been agreed upon. It will act in case of conflicts caused by the clinical classifications. Categorisation shows a clear trend towards classifying patients in the mandatory intensive care groups A2, S2 and G2. Correspondingly fewer patients are classified as requiring "standard treatment" and "treatment for severe and multiple sickness". This development is mainly supported by large specialised clinics and institutions with less than 50 beds. The acute-case departments of houses for central care show largely stable categorisation data during the 1 1/2 years of the survey. To evaluate the changes and trends a catalogue of structural points of view serves to verify the structural changes. Thus, criteria of quality are defined that contribute to an evaluation of the realisation of the new Personnel Regulations and support quality planning and management of the clinics.(ABSTRACT TRUNCATED AT 250 WORDS)

[The development of drug utilization with special reference to demographic factors]. / Die Entwicklung des Arzneimittelverbrauchs unter besonderer Berücksichtigung demographischer Faktoren.

Possible influences of demographic changes in the Federal Republic of Germany on future expenditures for medication have been investigated using population models from the Federal Statistical Office and data concerning the structure of current drug expenditures of the health insurance system. In addition the former contribution of demographic changes to the development of drug expenditures has been estimated using retrospective analysis. The study demonstrates that a constant supply with medicines would require an increase of expenses of 0.6% per year until 2,000 AD due to demographic changes, assuming other conditions remain constant. Development since 1957, however, shows that demographic influences are of relatively low importance for the development of total drug expenditures. During the last decade the total growth of costs for medicines was 6 times higher than that which would have been expected due to demographic changes alone. Further comparisons with the growth rate of the gross national product (GNP) demonstrate that since 1975 growth of drug expenditures parallels growth of GNP. The price indices for pharmaceutical products and for cost of living developed in a parallel way during the same period of time.

[Effect of demographic changes on the case rate and days of care for hospitalized internal medicine patients]. / Einfluss demographischer Anderungen auf Fallzahlen und Pflegetage hospitalisierter internistischer Patienten.

Using case categories at the Center for Internal Medicine of the Medical University at Lübeck and predictions of future population trends by the German Federal Statistical Office, likely future numbers of inpatients and days of hospital stay were calculated. Assuming other conditions remaining constant, an annual rise of 0.9% of medical cases is to be expected until the year 2005. An increase above this average is expected for cases of cardiovascular and respiratory disease and of malignant neoplasms, while it will be below average for renal or gastrointestinal diseases. These data are similar to comparable projections made, on the basis of Federal statistics, of hospital cases registered with local health insurance schemes. In addition they indicate an increase of 3% for all non-paediatric admissions up to 2005.