Comparing the quality of care in physician networks to usual care for elderly patients in three German regions: a quasi-experimental cohort study.

OBJECTIVES: Patients in Germany have free choice of physicians in the ambulatory care sector and can consult them as often as they wish without a referral. This can lead to inefficiencies in treatment pathways. In response, some physicians have formed networks to improve the coordination and quality of care. This study aims to investigate whether the care provided by these networks results in better health and process outcomes than usual care. STUDY DESIGN: This was a quasi-experimental cohort study. METHODS: We analysed claims data from 2017 to 2018 in Bavaria, Brandenburg, and Westphalia-Lippe. Our study population includes patients aged 65 years or older with heart failure (n = 267,256), back pain (n = 931,672), or depression (n = 483,068). We compared condition-specific and generic quality indicators between patients treated in physician networks and usual care. Ambulatory care-sensitive emergency department cases were used as a primary outcome measure. Imbalances between the groups were minimized using propensity score matching. RESULTS: Rates of ambulatory care-sensitive emergency department cases yielded insignificant differences between networks and usual care in the depression and heart failure subgroups. For back pain patients, rates were 0.17 percentage points higher (P < 0.01) in network patients compared with usual care. Among network patients, generic indicators for prevention and coordination showed significantly better performance. For instance, the rate of completed vaccination against influenza is 3.03 percentage points higher (P < 0.01), and the rate of specialist visits after referral is 1.6 percentage points higher (P < 0.01) in heart failure patients, who are treated in physician networks. This is accompanied by higher rates of polypharmacy. Furthermore, the results for condition-specific indicators suggest that for most indicators, a greater proportion of the care provided by physician networks adhered to national treatment guidelines. CONCLUSIONS: Our findings suggest that physician networks in Germany do not reduce rates of ambulatory care-sensitive emergency department cases but perform better than usual care in terms of care coordination and prevention. Further research is needed to confirm our findings and explore the implications of the potentially higher rates of polypharmacy seen in physician networks.

An investigation of secondary electron emission from ZnO based nanomaterials for future applications in radiation detectors.

This paper discusses the use of nanomaterials for the improved performance of time-of-flight particle detectors based on secondary electron emission (SEE). The purpose of the research presented in this paper is to find a nanomaterial that has a higher SEE than gold. In this article, we present a measurement of the SEE properties from 1D (one-dimensional) nanostructures of ZnO and ZnO/GaN (ZnO with GaN coating) composed of a mostly regular pattern of nanotubes grown on a thin Si3N4 substrate. The study was performed with 4.77 meV/u Au beam. We observed an average increase of 2.5 in the SEE properties from the 1D ZnO nanotubes compared to gold.

Influence of surface states and size effects on the Seebeck coefficient and electrical resistance of Bi1-xSbx nanowire arrays.

The Seebeck coefficient and electrical resistance of Bi1-xSbx nanowire arrays electrodeposited in etched ion-track membranes have been investigated as a function of wire diameter (40-750 nm) and composition (0 ≤ x ≤ 1). The experimental data reveal a non-monotonic dependence between thermopower and wire diameter for three different compositions. Thus, the thermopower values decrease with decreasing wire diameter, exhibiting a minimum around ∼60 nm. This non-monotonic dependence of the Seebeck coefficient is attributed to the interplay of surface and bulk states. On the one hand, the metallic properties of the surface states can contribute to decreasing the thermopower of the nanostructure with increasing surface-to-volume ratio. On the other hand, for wires thinner than ∼60 nm, the relative increase of the thermopower can be tentatively attributed to the presence of quantum-size effects on both surface and bulk states. These measurements contribute to a better understanding of the interplay between bulk and surface states in nanostructures, and indicate that the decrease of Seebeck coefficient with decreasing diameter caused by the presence of surfaces states can possibly be overcome for even thinner nanowires.

[Arthroderma benhamiae strains in Germany : Morphological and physiological characteristics of the anamorphs]. / Arthroderma-benhamiae-Stämme aus Deutschland : Morphologische und physiologische Merkmale der anamorphen Formen.

BACKGROUND: Anamorphs of Arthroderma (A.) benhamiae, which can cause inflammatory tinea lesions in humans, have been progressively spreading in Germany. OBJECTIVES: Identification of A. benhamiae anamorphs by conventional methods. MATERIALS AND METHODS: Evaluation of our own results obtained with A. benhamiae anamorphs and from the relevant literature. RESULTS: Infections with A. benhamiae anamorphs are usually transferred by guinea pigs or other animals. A. benhamiae anamorphs can be cultured on growth media used for dermatophytes and can be characterized morphologically and physiologically. In Germany the yellow variant is seen most often but a white variant that equals Trichophyton (T.) interdigitale has also been observed. On Sabouraud agar the yellow variant develops markedly yellow thalli, whereas the white variant produces white aerial mycelium. Microconidia are formed by the yellow variant-if at all-only scarcely and delayed; they are small, roundish, and arranged in a grape-like order. The white variant produces peg-shaped microconidia alongside hyphae as well as roundish ones in grape-like clusters, and subsequently some macroconidia, chlamydospores, and spiral hyphae. In microcultures with both variants circuit-like hyphal structures can consistently be demonstrated. On Trichophyton agars only the yellow variant is clearly dependent on thiamine. The urease test is negative with the yellow variant and positive with the white variant. Most strains of both variants are negative in the hair perforation test. CONCLUSIONS: The characteristics described allow reliable identification of the yellow variant of the A. benhamiae anamorph by conventional methods; a distinction between the white variant and T. interdigitale can be more difficult. Dermatologists should be able to identify this agent in clinical routine.

Organic matter breakdown in streams in a region of contrasting anthropogenic land use.

Streams provide ecosystem services to humans that depend on ecosystem functions, such as organic matter breakdown (OMB). OMB can be affected by land use-related disturbance. We measured OMB in 29 low-order streams in a region of contrasting land use in south-west Germany to quantify land use effects on OMB. We deployed fine and coarse mesh leaf bags in streams of forest, agricultural, vinicultural and urban catchments to determine the microbial and invertebrate-mediated OMB, respectively. Furthermore, we monitored physicochemical, geographical and habitat parameters to explain potential differences in OMB among land use types and sites. Only microbial OMB differed between land use types. Microbial OMB was negatively correlated with pH and invertebrate-mediated OMB was positively correlated with tree cover. Generally, OMB responded to stressor gradients rather than directly to land use. Therefore, the monitoring of specific stressors may be more relevant than land use to detect effects on ecosystem functions, and to extrapolate effects on functions, e.g. in the context of assessing ecosystem services.

Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: an ex vivo canine study.

OBJECTIVES: To evaluate the degree of lateralization achievable and strength of tibial tuberosity transposition and advancement (TTTA) relative to pin and tension band wiring (PTBW) for lateral tibial tuberosity transposition. METHODS: Six pairs of cadaveric tibiae were used. Tibial tuberosity position was determined with computed tomography (CT); bones were then randomly assigned into TTTA and PTBW groups. The PTBW group had a tibial tuberosity osteotomy and fixation with pin and tension band wiring. The TTTA group had a tibial tuberosity advancement performed with lateralization of the tibial tuberosity by 50% of cage depth, using spacers on the cranial cage screw. Postoperative CT images showed lateralization and craniocaudal deviation. Single axial distractive loading was applied to the patella at 90˚ to the tibial plateau, and peak load, energy, and stiffness were calculated. RESULTS: There were significant differences in lateralization (PTBW: 67.92 ± 5.1 %; TTTA: 88.51 ± 5.5 %) (p = 0.0173) and craniocaudal deviation (PTBW: -8.30 ± 1.4 %; TTTA: 6.83 ± 0.6) (p = 0.0001). There were no significant differences in peak load to failure (N) (PTBW: 1448 ± 121; TTTA: 1597 ± 43) (p = 0.4541), energy to failure (N/mm) (PTBW: 15013 ± 2719; TTTA: 17314 ± 887) (p = 0.646), or stiffness (N/mm)(PTBW: 102.8 ± 4.7; TTTA: 92.9 ± 4.8) (p = 0.2716). CLINICAL SIGNIFICANCE: The TTTA was more effective at lateralization of the tibial tuberosity, and of comparable strength to PTBW. Greater support of the osteotomized fragment with TTTA may resist cyclic loading, and requires evaluation.

Alkaline cooking (nixtamalisation) and the reduction in the in vivo toxicity of fumonisin-contaminated corn in a rat feeding bioassay.

Nixtamalisation is a widely used food processing method in which whole kernel corn is cooked and steeped in alkaline water. It reduces the amount of fumonisin B1 (FB1) that can be detected after cooking. However, the fate of FB1 during nixtamalisation is not fully understood and potentially toxic reaction products, including matrix-associated "masked" FB1 forms that are not detected by routine analytical methods might remain in nixtamalised corn. To assess how nixtamalisation of whole kernel corn affects fumonisin toxicity, male rats were fed diets containing low, mid or high levels of uncooked (LU, MU, HU) or alkaline cooked (LC, MC, HC) FB1-contaminated corn for 3 weeks. The control diet contained uncontaminated corn only. Apoptotic kidney lesions of the type caused by FB1 were not found in the LC or MC groups. Lesions in the group fed HC were minimal and less severe than those found in the rats fed LU, MU or HU. Furthermore, significantly increased sphinganine and sphingosine concentrations indicative of FB1 exposure were found in the kidneys of the rats given LU, MU or HU. Concentrations were also elevated, but to a lesser extent, in rats fed HC, whereas sphinganine and sphingosine concentrations in rats given LC or MC did not differ from the control group. FB1 concentrations in the LC (0.08 mg kg(-1)), MC (0.13 mg kg(-1)) and HC (0.37 mg kg(-1)) diets were markedly reduced compared with their LU (1.8 mg kg(-1)), MU (3.5 mg kg(-1)) and HU (4.2 mg kg(-1)) counterparts as determined by HPLC (n = 1 analysis/diet). Taken together, the findings show that nixtamalisation is an effective cooking method for reducing the potential toxicity of FB1 contaminated corn.

The fate of a normal human cell traversed by a single charged particle.

The long-term "fate" of normal human cells after single hits of charged particles is one of the oldest unsolved issues in radiation protection and cellular radiobiology. Using a high-precision heavy-ion microbeam we could target normal human fibroblasts with exactly one or five carbon ions and measured the early cytogenetic damage and the late behaviour using single-cell cloning. Around 70% of the first cycle cells presented visible aberrations in mFISH after a single ion traversal, and about 5% of the cells were still able to form colonies. In one third of selected high-proliferative colonies we observed clonal (radiation-induced) aberrations. Terminal differentiation and markers of senescence (PCNA, p16) in the descendants of cells traversed by one carbon ion occurred earlier than in controls, but no evidence of radiation-induced chromosomal instability was found. We conclude that cells surviving single-ion traversal, often carrying clonal chromosome aberrations, undergo accelerated senescence but maintain chromosomal stability.

[Generalized metastatic intestinal and cutaneous calcinosis in a Hovawart puppy with leptospirosis]. / Generalisierte metastatische intestinale und kutane Kalzinosis bei einem Hovawart-Welpen mit Leptospirose.

A 10-week old male Hovawart presented with acute renal failure. Based on clinical symptoms, blood analysis results and serology, a diagnosis of leptospirosis was made. Besides being acotemic, the puppy was initially also severely hypercalcemic. The dog was treated successfully, but developed widespread cutaneous and visceral calcifications. Severe pyloric calcification resulted in functional pyloric obstruction, which was successfully treated by pyloromyotomy. All skin lesions were cured with topical therapy within a few weeks. To the authors' knowledge, this is the first report of generalized intestinal and cutaneous calcification associated with acute renal failure due to Leptospirosis.

Effect of dog breed and body conformation on vertical ground reaction forces, impulses, and stance times.

OBJECTIVES: To assess whether fully normalised vertical ground reaction forces and stance times obtained at a trot depend on dog breed or body conformations. METHODS: Peak vertical forces (PVF), vertical impulses (VI), stance times (ST), and ratio of forelimb impulse to total impulse (RVI) of 54 dogs of seven different breeds were normalised to body weight and body size according to the theory of dynamic similarity, and were tested for differences between breeds. Breeds were Borzoi, Bernese Mountain dog, Great Dane, Labrador Retriever, Landseer, Rhodesian Ridgeback, and Rottweiler. Body length ratio (BLR) and body mass index (BMI) were also compared between breeds. RESULTS: Significant differences between breeds were found for the normalised forelimb PVF, VI and ST, and hindlimb PVF. Looking at individual breeds, it was most evident that Borzois had a lower forelimb VI, and a higher hindlimb PVF than the other breeds. This resulted in Borzois having a lower RVI compared to other dogs, indicating a more caudally located centre of gravity. Only a few differences in gait parameters were found between other dog breeds. The BMI was significantly lower in Borzois than in other breeds, but was otherwise not associated with gait parameters. CLINICAL SIGNIFICANCE: Force plate data of dogs of different breeds are not necessarily comparable, even after full normalisation to body weight and body size. Group comparisons should only be made when the groups consist of breeds with similar body conformations.

Stability of the mycotoxin deoxynivalenol (DON) during the production of flour-based foods and wheat flake cereal.

Deoxynivalenol (DON) is a mycotoxin found in cereal grains and cereal-based foods. DON concentrations in finished products are reduced under some processing conditions, but not others. DON concentrations in flour, wheat and selected foods made from them under commercially relevant conditions were compared by GC with electron capture detection. Average concentrations (n = 9/item) in cookies, crackers and pretzels ranged from 61% (cookies) to 111% (pretzels) compared with flour (100% = 0.46 µg g⁻¹). Lesser amounts were found in donuts and bread: their respective DON concentrations were 44% and 30% that of flour. Mass balance estimates for DON (µg g⁻¹ flour equivalents) ranged from 50% (bread = 0.23 µg g⁻¹ flour equivalents) to 120% (donuts), indicating that dilution by recipe ingredients contributed to DON reductions in bread and accounted for all of the apparent reduction in donuts. Mass balance estimates averaged 76% (crackers) to 107% (pretzels) for the other flour products. DON concentrations were higher in cereal flakes (0.55 µg g⁻¹ in the finished product and 0.58 µmg g⁻¹ on a mass balance basis) than in wheat (0.40 µg g⁻¹), suggesting that DON concentrations might increase during processing of wheat cereals under some conditions. In summary, DON concentrations of finished food products were reduced ≥ 50% only in bread and donuts. Reduction in bread resulted from a combination of DON 'loss' and dilution by recipe ingredients whereas the reduction in donuts was due entirely to dilution. These results are further evidence of DON stability during the preparation of popular flour or wheat-based products.

Ground reaction force profiles after partial and pancarpal arthrodesis in dogs.

OBJECTIVES: To evaluate and compare long-term functional outcome after partial carpal arthrodesis and pancarpal arthrodesis in dogs using kinetic gait analysis. METHODS: Fourteen dogs with 19 partial carpal or pancarpal arthrodeses were retrospectively examined and underwent force-plate gait analysis. Mean times since surgery were 29.4 and 24.4 months for pancarpal and partial carpal arthrodesis respectively. Vertical and braking-propulsive ground reaction force profiles were compared between treatment groups, and to those of normal dogs (control group) using Kruskal-Wallis one-way analysis of variance. RESULTS: With the exception of time to vertical peak that occurred earlier in dogs with pancarpal than in dogs with partial carpal arthrodesis (p <0.01), there was no difference between the two treatment groups. Several parameters differed significantly between operated and healthy dogs (p <0.01): vertical impulses were significantly lower in both treatment groups, braking forces and impulses were also reduced after both techniques. Propulsive forces and impulses were only reduced in dogs with pancarpal arthrodesis. When comparing gait parameters of sound limbs of unilateral operated dogs to those of control dogs, braking forces and impulses (p <0.01; p <0.05) were significantly higher in the sound legs of unilateral operated dogs. CLINICAL SIGNIFICANCE: Long-term outcome after partial carpal and pancarpal arthrodesis is good and comparable to each other. Propulsive action may be altered more in dogs with pancarpal arthrodesis.

Repair of long-bone fractures in cats and small dogs with the Unilock mandible locking plate system.

OBJECTIVES: To retrospectively evaluate stabilisation of long-bone fractures in cats and small dogs using the Unilock system. METHODS: Medical histories and radiographs of consecutive patients with long-bone fractures stabilised with the Unilock system were reviewed. Cases with follow-up radiographs taken at least four weeks postoperatively were included. Signalment of the patient, fracture localisation and type, primary fracture repair or revision surgery, single or double plating, and complications for each patient were noted. Additionally, implant size, number of screws, number of cortices engaged with screws, and number of empty holes across the fracture were evaluated in fractures where a single plate had been applied. RESULTS: Eighteen humeral, 18 radial, 20 femoral, and 10 tibial fractures were treated. The Unilock system was used for primary repair in 44 fractures and for revision surgery in 22 fractures. Two plates were applied in 17 fractures, and a single plate was applied in 49 fractures. Follow-up radiographs were taken four to 109 weeks postoperatively. Complications were seen in 12 animals and 13 fractures (19.7%). Fixation failure occurred in seven fractures (10.6%). Cases with a single plate that suffered fixation failure had thinner screws in relation to bone diameter than cases with double plates, and more screws in a main fragment than those without fixation failure. CLINICAL SIGNIFICANCE: The Unilock system is a suitable implant for fracture fixation of long bones in cats and small dogs.

No evidence for DNA and early cytogenetic damage in bystander cells after heavy-ion microirradiation at two facilities.

The occurrence of bystander effects has challenged the evaluation of risk for heavy ions, mainly in the context of space exploration and the increasing application of carbon ions in radiotherapy. In the present study, we addressed whether heavy-ion-induced DNA and cytogenetic damage is detectable in bystander cells. The formation of gamma-H2AX foci, sister chromatid exchanges and micronuclei were used as markers of damage to DNA. Normal human fibroblasts were exposed to low fluences of carbon and uranium ions, and alternatively single cells were targeted with heavy ions using the GSI microbeam. We did not observe a significant increase in the bystander formation of gamma-H2AX foci, sister chromatid exchanges or micronuclei. In addition, we performed for the first time parallel experiments at two microbeam facilities (GSI, JAEA) using the same cell line, culture conditions and irradiation protocols. No significant enhancement of the micronucleus frequencies in bystander cells was detected after targeted carbon-ion irradiation, confirming the results. Details regarding the history, culture conditions or support of the cells might be affecting the detection of bystander effects. On the other hand, the potential X-ray- and heavy-ion-induced bystander effects investigated herein clearly do not exceed the experimental error and thus are either lacking or are less pronounced than the effects reported in the literature for similar end points after alpha-particle and X-ray exposure.

Maternal fumonisin exposure as a risk factor for neural tube defects.

Fumonisins are mycotoxins produced by the fungus F. verticillioides, a common contaminant of maize (corn) worldwide. Maternal consumption of fumonisin B(1)-contaminated maize during early pregnancy has recently been associated with increased risk for neural tube defects (NTDs) in human populations that rely heavily on maize as a dietary staple. Experimental administration of purified fumonisin to mice early in gestation also results in an increased incidence of NTDs in exposed offspring. Fumonisin inhibits the enzyme ceramide synthase in de novo sphingolipid biosynthesis, resulting in an elevation of free sphingoid bases and depletion of downstream glycosphingolipids. Increased sphingoid base metabolites (i.e., sphinganine-1-phosphate) may perturb signaling cascades involved in embryonic morphogenesis by functioning as ligands for sphingosine-1-P (S1P) receptors, a family of G-protein-coupled receptors that regulate key biological processes such as cell survival/proliferation, differentiation and migration. Fumonisin-induced depletion of glycosphingolipids impairs expression and function of the GPI-anchored folate receptor (Folr1), which may also contribute to adverse pregnancy outcomes. NTDs appear to be multifactorial in origin, involving complex gene-nutrient-environment interactions. Vitamin supplements containing folic acid have been shown to reduce the occurrence of NTDs, and may help protect the developing fetus from environmental teratogens. Fumonisins appear to be an environmental risk factor for birth defects, although other aspects of maternal nutrition and genetics play interactive roles in determining pregnancy outcome. Minimizing exposures to mycotoxins through enhanced agricultural practices, identifying biomarkers of exposure, characterizing mechanisms of toxicity, and improving maternal nutrition are all important strategies for reducing the NTD burden in susceptible human populations.

Joint mice migration into the deep digital flexor tendon sheath in dogs. Clinical cases and anatomical study.

This study describes the appearance of 'joint mice' in the sheath of the deep digital flexor muscle tendon (DDFT) due to osteochondritis dissecans (OCD) lesions in the talocrural joint of 12 dogs. Surgical excision of all free fragments in the DDFT sheath was performed in five dogs, and their clinical progression was documented. The excision of free fragments from the DDFT sheath, but not arthro-tomy, proved clinically beneficial despite the presence of degenerative joint disease. The anatomical communication between the talocrural joint and the DDFT sheath and its dimensions are further illustrated with the use of contrast media and dissection of cadaver limbs.

Traumatic dislocation of the lumbosacral joint in two cats.

The clinical and radiological features, surgical treatment, and outcome of two cats with traumatically induced dislocation of the lumbosacral joint are described in this report. The dislocation of the lumbosacral joint was concurrent with dorsal luxation of the articular facets in both cases. Open reduction, followed by stabilization with a dorsal suture sling, resulted in a good clinical outcome.

Fumonisin concentrations and in vivo toxicity of nixtamalized Fusarium verticillioides culture material: evidence for fumonisin-matrix interactions.

The toxic potential of nixtamalized foods can be underestimated if, during cooking, reversible fumonisin-food matrix interactions reduce the amount of mycotoxin that is detected but not the amount that is bioavailable. Fusarium verticillioides culture material (CM) was nixtamalized as is (NCM) or after mixing with ground corn (NCMC). Additional portions were sham nixtamalized without (SCM) or with corn (SCMC). Nixtamalization and sham nixtamalization reduced FB(1); CM, NCM, and SCM diets contained 9.08, 2.08, and 1.19 ppm, respectively. FB(1) was further reduced in the NCMC (0.49 ppm) but not the SCMC (1.01 ppm) diets compared to their NCM and SCM counterparts. Equivalent weights of the cooked products, uncooked CM, corn (UC) or nixtamalized UC (NUC) were fed to rats for up to three weeks. Kidney lesions in the NCM-fed group were less severe than in the CM-fed, positive control group and no lesions were found in the NCMC and other groups. Group kidney sphinganine (biomarker of fumonisin exposure) concentrations decreased in the order: CM (absolute concentration (nmol/g)=600-800)>NCM (400-600)>SCM and SCMC (30-90)>NCMC, UC and NUC (<8). Together, these results suggest that mycotoxin-corn matrix interactions during nixtamalization reduce the bioavailability and toxicity of FB(1).

Temporary transarticular stabilization with a locking plate for medial shoulder luxation in a dog.

This report describes the temporary fixation of a traumatic shoulder luxation in a large-breed dog using a 3.5-mm Locking Round-Hole Reconstruction Plate (LRHRP) to provide stable internal splinting, allowing healing of the injured ligaments, joint capsule, glenohumeral ligaments, tendons, and muscles for restoration of joint stability. The use of a temporary plate with a locking system should be considered as an option in the treatment of canine shoulder joint luxations with severe tissue damage.