[Heterogeneity of costs and performance for penetrating eye injuries and suturing amniotic membranes under DRG conditions : Analysis of case constellations of the G-DRG C01B of the Regensburg University eye clinic]

Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions.

Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta

The study aims to identify risk constellations for symptomatic spinal cord malperfusion in patients undergoing extensive stent-graft coverage of the thoracic aorta.

Health risk appraisal in older people 1: are older people living alone an "at-risk" group?

BACKGROUND: In the UK, population screening for unmet need has failed to improve the health of older people. Attention is turning to interventions targeted at 'at-risk' groups. Living alone in later life is seen as a potential health risk, and older people living alone are thought to be an at-risk group worthy of further intervention. AIM: To explore the clinical significance of living alone and the epidemiology of lone status as an at-risk category, by investigating associations between lone status and health behaviours, health status, and service use, in non-disabled older people. Design of study: Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal in older people. SETTING: Four group practices in suburban London. METHOD: Sixty per cent of 2641 community-dwelling non-disabled people aged 65 years and over registered at a practice agreed to participate in the study; 84% of these returned completed questionnaires. A third of this group, (n = 860, 33.1%) lived alone and two-thirds (n = 1741, 66.9%) lived with someone else. RESULTS: Those living alone were more likely to report fair or poor health, poor vision, difficulties in instrumental and basic activities of daily living, worse memory and mood, lower physical activity, poorer diet, worsening function, risk of social isolation, hazardous alcohol use, having no emergency carer, and multiple falls in the previous 12 months. After adjustment for age, sex, income, and educational attainment, living alone remained associated with multiple falls, functional impairment, poor diet, smoking status, risk of social isolation, and three self-reported chronic conditions: arthritis and/or rheumatism, glaucoma, and cataracts. CONCLUSION: Clinicians working with independently-living older people living alone should anticipate higher levels of disease and disability in these patients, and higher health and social risks, much of which will be due to older age, lower educational status, and female sex. Living alone itself appears to be associated with higher risks of falling, and constellations of pathologies, including visual loss and joint disorders. Targeted population screening using lone status may be useful in identifying older individuals at high risk of falling.

Folliculo-stellate cells of "true dendritic" type are involved in the inflammatory microenvironment of tumor immunosurveillance of pituitary adenomas

Folliculo-stellate cells are a nonendocrine, sustentacular-like complementary population of the anterior pituitary. They currently are considered as functionally and phenotypically heterogeneous, with one subpopulation of folliculo-stellate cells possibly representing resident adenohypophyseal macrophages. We took advantage of a limited T-cell mediated inflammatory reaction selectively involving tumor tissue in three cases of pituitary adenoma (2 prolactin cell adenomas, and 1 null cell adenoma) to test the hypothesis whether some folliculo-stellate cells within inflammatory foci would also assume monocytic/dendritic properties. Immunohistochemical double labeling for S-100 protein and the class II major histocompatibility antigen HLA-DR indeed showed several arborized cells to coexpress both epitopes. These were distributed both amidst adenomatous acini and along intratumoral vessels, and were morphologically undistinguishable from conventional folliculo-stellate cells. On the other hand, markers of follicular dendritic cells (CD21) and Langerhans' cells (CD1a) tested negative. Furthermore, no S-100/HLA-DR coexpressing folliculo-stellate cells were seen in either peritumoral parenchyma of the cases in point nor in control pituitary adenomas lacking inflammatory reaction. These findings suggest that a subset of folliculo-stellate cells may be induced by an appropriate local inflammatory microenvironment to assume a dendritic cell-like immunophenotype recognizable by their coexpression of S-100 protein and HLA-DR. By analogy with HLA-DR expressing cells in well-established extrapituitary inflammatory constellations, we speculate that folliculo-stellate cells with such immunophenotype may actually perform professional antigen presentation. A distinctly uncommon finding in pituitary adenomas, lymphocytic infiltrates may therefore be read as a manifestation of tumoral immunosurveillance.

Histo-blood group antigens as allo- and autoantigens

The science of blood groups has made giant steps forward during the last decade. Blood-group typing of red blood cells (RBCs) is performed on more than 15 million samples per year in Europe, today much less often for forensic reasons than for clinical purposes such as transfusion and organ transplantation. Specific monoclonal antibodies are used with interpretation on the basis of RBC agglutination patterns, and mass genotyping may well be on its way to becoming a routine procedure. The discovery that most blood group systems, whose antigens are by definition found on RBCs, are also expressed in multiple other tissues has sparked the interest of transplantation medicine in immunohematology beyond the HLA system. The one and only "histo-blood group" (HBG) system that is routinely considered in transplantation medicine is ABO, because ABO antigen-incompatible donor/recipient constellations are preferably avoided. However, other HBG systems may also play a role, thus far underestimated. This paper is an up-to-date analysis of the importance of HBG systems in the alloimmunity of transplantation and autoimmune events, such as hemolytic anemia.

An Optical Survey for Space Debris on Highly Eccentric MEO Orbits

Optical surveys for space debris in high-altitude orbits have been conducted since more than ten years. Originally these efforts concentrated mainly on the geostationary ring (GEO). Corresponding observation strategies, processing techniques and cataloguing approaches have been developed and successfully applied. The ESA GEO surveys, e.g., resulted in the detection of a significant population of small-size debris and later in the discovery of high area-to-mass ratio objects in GEO-like orbits. The observation scenarios were successively adapted to survey the geostationary transfer orbit (GTO) region; and recently surveys to search for debris in the medium Earth orbit (MEO) region of the global navigation satellite constellations were successfully conducted. Comparably less experience (both, in terms of practical observation and strategy definition) is available for eccentric orbits that (at least partly) are in the MEO region, in particular for the Molniya-type orbits. Several breakup events and deliberate fragmentations are known to have taken place in such orbits. Different survey and follow-up strategies for searching space debris objects in highly-eccentric MEO orbits, and to acquire orbits which are sufficiently accurate to catalogue such objects and to maintain their orbits over longer time spans were developed. Simulations were performed to compare the performance of different survey and cataloguing strategies. Eventually, optical observations were conducted in the framework of an ESA study using ESA’s Space Debris Telescope (ESASDT) the 1-m Zeiss telescope located at the Optical Ground Station (OGS) at the Teide Observatory at Tenerife, Spain. A first series of surveys of Molnjya-type orbits was performed between January and April 2013. During these four months survey observations were performed during nine nights. A basic survey consisted of observing a single geocentric field for 10 minutes. If a faint object was found, follow-up observations were performed during the same night to ensure a save rediscovery of the object during the next nights. Additional follow-up observations to maintain the orbits of these newly discovered faint objects were also acquired with AIUB ́s 1m ZIMLAT telescope in Zimmerwald, Switzerland. Eventually 195 basic surveys were performed during these nine nights corresponding to about 32.5 hours of observations. In total 24 uncorrelated faint objects were discovered and all known catalogue objects in the survey fields were detected. On average one uncorrelated object was found every 80 minutes. Some of these objects show a considerable brightness variation and have a high area-to-mass ratio as determined in the orbit estimation process.

Getting Old Here and There: Opportunities and Pitfalls of Transnational Care Arrangements

This article focuses on challenges of transnational aging and family care among „guest-workers‟ from Italy and Spain. It is based on two qualitative studies on aging in migration and experiences of family care. These migrants‟ situations tend to be socioeconomically underprivileged, yet they have the option to either stay in Switzerland or return to Italy or Spain. Our results show that an additional option is available by combining elements of both national systems of reference. However, these options are often costly and have short-comings which are particularly relevant when ill health conditions demand intensified care. By then, decisions taken within the context of transnational ways of living have far-reaching consequences that affect not only the elderly migrants but also their adult children. The empirical data presented in this article illustrate how specific constellations of caring options emerge from the Swiss „guest-worker‟ migration regime and from transnational practices and choices made in earlier years.

Making business in the open: coping with economic and institutional risk and insecurity in the Kafue flats, Zambia

This paper deals with the difference between risk and insecurity from an anthropological perspective using a critical New Institutionalist approach. Risk refers to the ability to reduce undesirable outcomes, based on a range of information actors have on possible outcomes; insecurity refers to the lack of this information. With regard to the neo-liberal setting of a resource rich area in Zambia, Central Africa, local actors – men and women – face risk and insecurity in market constellations between rural and urban areas. They attempt to cope with risk using technical means and diversification of livelihood strategies. But as common-pool resources have been transformed from common property institutions to open access, also leading to unpredictability of competitors and partners in “free” markets, actors rely on magic options to reduce insecurity and transform it into risk-assessing strategies as an adaptation to modern times. Keywords: Risk, insecurity, institutional change, neo-liberal market, common pool resources, livelihood strategies, magic, Zambia.

Educational Systems and Gender Segregation in Education: A Three-Country Comparison of Germany, Norway and Canada

How do institutional settings and their embedded policy principles affect gender-typed enrolment in educational programmes? Based on gender-sensitive theories on career choice, we hypothesised that gender segregation in education is higher with a wider range of offers of vocational programmes. By analysing youth survey and panel data, we tested this assumption for Germany, Norway and Canada, three countries whose educational systems represent a different mix of academic, vocational and universalistic education principles. We found that vocational programmes are considerably more gender-segregated than are academic (e.g. university) programmes. Men, more so than women, can avoid gender-typed programmes by passing on to a university education. This in turn means that as long as their secondary school achievement does not allow for a higher education career, they have a higher likelihood of being allocated to male-typed programmes in the vocational education and training (VET) system. In addition, social background and the age at which students have to choose educational offers impact on the transition to gendered educational programmes. Overall, gender segregation in education is highest in Germany and the lowest in Canada. We interpret the differences between these countries with respect to the constellations of educational principles and policies in the respective countries.

Cooperative VET in Training Networks: Analysing the Free-Rider Problem in a Sociology-of-Conventions Perspective

In training networks, particularly small and medium-sized enterprises pool their resources to train apprentices within the framework of the dual VET system, while an intermediary organisation is tasked with managing operations. Over the course of their apprenticeship, the apprentices switch from one training company to another on a (half-) yearly basis. Drawing on a case study of four training networks in Switzerland and the theoretical framework of the sociology of conventions, this paper aims to understand the reasons for the slow dissemination and reluctant adoption of this promising form of organising VET in Switzerland. The results of the study show that the system of moving from one company to another creates a variety of free-rider constellations in the distribution of the collectively generated corporative benefits. This explains why companies are reluctant to participate in this model. For the network to be sustainable, the intermediary organisation has to address discontent arising from free-rider problems while taking into account that the solutions found are always tentative and will often result in new free-rider problems.

The Principle of Proportionality in International Law

Whilst the principle of proportionality indisputably plays a crucial role in the protection of fundamental rights, it is still unclear to what extent it applies to other fields in international law. The paper therefore explores the role it plays in selected fields of public international law, beyond human rights. The examination begins in the classical domain of reprisals and in maritime boundary delimitation and continues to analyse the role played in the law of multilateral trade regulation of the World Trade Organization and in bilateral investment protection. In an attempt to explain differences in recourse to proportionality in the various fields, we develop in our conclusions a distinction between horizontal and vertical constellations of legal protection.