Die neue Gibbon-Anlage im NaturZoo Rheine

A new enclosure for White-handed Gibbons was opened at NaturZoo Rheine, Germany, on 6. May 2007. The exhibit design follows the island enclosure type. The enclosure is remarkable by its size of 1.200 m². The room above this surface is richly structured by poles, stems and ropes up to 8 m high. Additionally there is a lush vegetation of bamboo, bushes, vines and also some living trees. The islands are connected to a house with two indoor-rooms and an off-exhibit outdoor cage. The whole enclosure and the surrounding landscape fit in very well in the natural layout of the zoo-landscape.Some observations on use of the enclosure by the gibbons as well as maintenance experiences are given. Also the responses of the visitors to the new exhibit are commented.A summary on the maintenance of gibbons in zoos in general and in NaturZoo Rheine is added.     

Kurzinterventionen bei Alkoholproblemen im Allgemeinkrankenhaus

Background: One of the main causes for hospital admissions is problematic alcohol consumption. The aim of this review was to provide a summary of different types of brief alcohol interventions (BAI) in general hospitals and to report their effectiveness. Method: The selection of the studies was based on a systematic literature search using PubMed. Articles published in English or German were considered. Studies conducted at specialized hospitals, emergency departments or outpatient clinics were excluded. Ten controlled clinical trials investigating BAI among general hospital inpatients were identified. The studies investigated various outcomes: drinking reduction or abstinence, biological markers, morbidity, motivation and alcohol related problems. Results: Altogether, four intervention types were tested: counseling, skill-based training, education and advice. At follow-up, six studies reported a significant drinking reduction among the treated and non-treated study groups. Seven studies showed positive intervention effects regarding any of the outcomes. Three of four studies with a 6 months follow-up reported intervention effects regarding drinking reduction, whereas all studies with follow-up at month 12 or later did not find a significantly greater drinking reduction among the treated compared to the non-treated patients. However, most of these studies reported intervention effects regarding biological markers, morbidity, motivation, alcohol related problems or other outcomes. Differences in effectiveness for various interventions were not found. Conclusions: The implementation of BAI in general hospitals is recommended. BAI quicken the process of drinking reduction, and with it the reduction of alcohol related problems or morbidity. As only short-term effects were found for drinking reduction, after care seems to be an important factor when providing BAI.     

General Anesthetics Effects on Circadian Temporal Structure: An Update

Disruptions of circadian and biological rhythms as well as general anesthesia can induce sleep disorders, resulting in an increase in sleepiness and drowsiness and a decrease in vigilance. It has been previously shown that circadian time can influence the pharmacologic sensitivity and the duration of action of general anesthetics. Studies on interactions between general anesthesia and circadian rhythms are few, but all of them suggest an important role of general anesthetics on circadian rhythms. General anesthesia is a particular wake‐sleep state that could potentially alter circadian rhythms on the days following anesthesia. The aim of this review is to discuss the various effects of general anesthesia on animal and human circadian time structure. This topic is highly relevant to clinicians, especially those involved in that field of ambulatory practice responsible for post‐operative patient care, including patient recovery and fatigue.     

Psychosoziale Belastungen, familiäre Konflikte und Therapieverantwortung bei Diabetes im Kindes- und Jugendalter

Children and youth with type 1 diabetes show an enhanced prevalence of psychiatric disorders, especially depression and eating disorders. Their parents suffer from constant vigilance, fear of hypoglycaemia and worries about their child’s future. Children’s quality of life corresponds largely to the quality of life of healthy peers, but is influenced by glycemic control and family conflicts. Illness related family conflicts increase in adolescence, when parental supervision of diabetes therapy run contrary to adolescents’ needs of autonomy. A stepwise transfer of treatment responsibility, which is adjusted to the child’s developmental status, should begin in adolescence at the earliest. The psychosocial care of patient families from diagnosis on should be an integral part of treatment and include patient education programs as well as psychological single case and group intervention.     

Case finding in the elderly: does the primary care team already know enough?

The needs of an elderly population in one general practice were assessed by the primary health care team. A simple questionnaire was filled in as far as possible by members of the team on known social and functional criteria for each patient aged over 75. The questionnaire was complete for 100 of 118 elderly patients. The information was accurate for over 95% of the criteria as verified by information held by the health authority. This information will now be used for yearly reviews of each patient based on opportunistic contacts. This is a simple method of collating information that is already known. If such information was available to health authorities it would give them an idea of the type and extent of the support services needed for elderly people.     

A Psychiatric Home Care Program: A Report on Three Years' Experience (1962-1964)

The activities covering a three-year period of a psychiatric home care treatment program attached to a psychiatric unit of a general hospital are described. A detailed account of its operation and the roles played by each member of the team is given. This service frequently provides a substitute for hospitalization in the management of both acute and chronic psychiatric states and thereby constitutes an important preventive measure in the field of public health. Even if the initial attitude of the patient is negative it is possible to gain the co-operation of the family who become a useful ally in the treatment. The co-operation of the patient is not as essential as has been thought. The traditional role of the psychiatrist is reversed by virtue of his attending the patient at home. The active participation of social agencies is an integral part of the treatment.     

Audit of surgical practice in a community hospital.

The results of a prospective analysis of one year''s surgery on inpatients in a busy community hospital showed that a high quality of surgery may be achieved with safety and low rates of complications. The results of a retrospective analysis of certain aspects of surgery was just as encouraging. Surgery that is performed in a community hospital is convenient for the patient, provides continuity of care by the general practitioner, and waiting list times are short. Surgical facilities can form an integral part of the comprehensive service provided by a community hospital and can lighten the caseload for minor surgery at the district general hospital. Close liaison between the two hospitals is essential.     

General practitioners' responsibilities to their patients.

The views of general practitioners about their responsibilities for patient care have not been canvassed. A survey of general practitioners was therefore carried out to determine their views. A postal questionnaire, in which general practitioners were asked what they saw as their responsibilities, was sent to 525 principals in Avon and completed by 424, giving a response rate of 81%. The doctors generally agreed that their responsibilities for patient care included problems related to internal medicine, such as managing diabetes and hypertension. Less consensus was found in the replies to questions about technical procedures, such as resection of ingrowing toenails, and gynaecological, orthopaedic, or psychosocial problems. The results supported the view that general practitioners are gradually abandoning technical aspects of medicine to specialists without a compensating role having been defined. In the light of this trend the responsibilities of general practitioners should be clearly defined by the profession.     

Recovery of the motor function of the arm with the aid of a hand exoskeleton controlled by a brain–computer interface in a patient with an extensive brain lesion

The dynamics of motor function recovery in a patient with an extensive brain lesion has been investigated during a course of neurorehabilitation assisted by a hand exoskeleton controlled by a brain–computer interface. Biomechanical analysis of the movements of the paretic arm recorded during the rehabilitation course was used for an unbiased assessment of motor function. Fifteen procedures involving hand exoskeleton control (one procedure per week) yielded the following results: (a) the velocity profile for targeted movements of the paretic hand became nearly bell-shaped; (b) the patient began to extend and abduct the hand, which was flexed and adducted at the beginning of the course; and (c) the patient started supinating the forearm, which was pronated at the beginning of the rehabilitation course. The first result is interpreted as improvement of the general level of control over the paretic hand, and the two other results are interpreted as a decrease in spasticity of the paretic hand.     

Cystic fibrosis carrier testing in early pregnancy by general practitioners.

OBJECTIVE--To assess the feasibility of genetic counselling in general practice by using cystic fibrosis carrier screening at the booking appointment as an integral part of routine antenatal care and as a paradigm for the wider participation of general practitioners in medical genetics. DESIGN--Maternal testing (male partner tested only if woman screens positive) and couple testing for cystic fibrosis carrier status in the antenatal population attending one general practice and, later, in a further six (outreach) practices also. SETTING--Two partner urban training practice (pilot practice) in south Manchester, and six north west practices (two inner city, three urban, one rural dispensing). SUBJECTS--Total practice population of 50,000 (pilot practice plus six outreach practices) with an estimated 500-800 pregnancies per year. MAIN OUTCOME MEASURES--(a) Proportion of carriers of cystic fibrosis identified, counselled, and appropriately managed within the first trimester of pregnancy; (b) questionnaire and interview measures of patient satisfaction and stress. RESULTS--Eleven carriers of cystic fibrosis were detected including one carrier couple. This carrier couple, after extensive counselling, elected to have prenatal diagnosis by chorionic villus biopsy. The fetus was homozygous normal. CONCLUSIONS--General practitioners can successfully integrate genetic counselling and cystic fibrosis carrier screening into the first antenatal booking appointment. When a carrier couple is identified clinical geneticists can help with the discussion of reproductive options, and prenatal diagnosis by chorionic villus biopsy can be completed within the first trimester. The results suggest that general practitioners will have an increasingly important role in medical genetics, subject to continuing evaluation of patient acceptability and stress.     

Der Phosphatstoffwechsel des Facettenauges im Dunkeln und im Licht

Zusammenfassung 1. Bei Belichtung des Facettenauges vonCalliphora finden sich keine Veränderungen in den Mengen der phosphathaltigen Substanzgruppen, die zu den sogenannten Baustoffen gehören.2. Unter den zum energiebildenden Stoffwechsel gehörenden Metaboliten erfolgen bei Belichtung Veränderungen, die auf einen hohen Energiebedarf in den Augen hinweisen, insbesondere eine Verringerung des ATP und eine Zunahme des ADP und des freien anorganischen Phosphates.3. Die Belichtung verursacht eine Erhöhung der Umsatzraten aller phosphathaltigen Verbindungen; diese ist auffallend stark in der Gruppe der Phosphatide.4. Da dieser besonders erhöhte Umsatz der Phosphatide einen spezifischen Effekt darstellt, wird auf eine spezielle Bedeutung der Phosphatide für die Funktion der Lichtsinneszellen geschlossen.

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The phosphate metabolism of the compound eye in darkness and in light

The phosphate metabolism of the compound eye of the blow-fly (males of wild-type and mutantchalky [Langer 1962b] ofCalliphora erythrocephala Meigen) was investigated in connection with its function as a sensory organ. Microchemical analyses were made to determine changes in the amounts of phosphorus compounds. After having kept flies in darkness or under illumination with ultraviolet light for six hours, the substances of the isolated eyes were separated according toSchneider (1945). In no fraction did the phosphate content vary between dark-adapted and illuminated eyes. On the other hand, the amount of free inorganic phosphate increased with illumination, whereas the phosphate liberated from acid-instable compounds during 7 minutes hydrolysis (N HCl; 100° C) decreased correspondingly. This effect was more pronounced in mutantchalky than in wild-type eyes. Specific enzymatic analyses of the adenine nucleotides showed — already after two hours — significantly less ATP in illuminated than in dark-adapted eyes of mutantchalky. In order to check the influence of adequate stimulation on the turnover of phosphate compounds, the extent of incorporation of radioactive phosphorus in the eyes was measured after feeding carrier free³²P-orthophosphate to starved flies (1 µC per fly). One to four hours after feeding, the over-all incorporation was found to be 35 % higher in light than in darkness (P<0.01). Within the fractions phosphatides showed an increase nearly three times that of the acid soluble compounds. This means that independently of the general rise in metabolic rate, there is a specific effect of illumination. Phosphatides are assumed to have special importance for the processes of excitation in the light sensitive cells of the compound eye.

     

Das Miteinander im Tumor

Interactions in the tumor Cancer has long been regarded as a mass of cells growing aberrantly due to mutations leading to constant cell proliferation and inhibition of cell death. Meanwhile, it has been acknowledged that not only tumor cells but also stroma plays an important role in tumorigenesis and progression. Although infiltrating immune cells are found in many tumors, an effective response to the tumor often seems to fail. One of the reasons discussed in this context is the modulation and suppression of immune cells by the tumor environment. Tumor cells show an altered metabolism leading to the secretion of metabolites that have been shown to act on stromal cells such as immune cells. Therefore, tumor metabolism is a promising therapeutic target to inhibit tumor growth and reactivate an effective anti‐tumor immune response.     

Regulation of inflammatory arthritis by the upstream kinase mitogen activated protein kinase kinase 7 in the c-Jun N-Terminal kinase pathway

Musculoskeletal pain is common across all populations and costly in terms of impact on the individual and, more generally, on society. In most health-care systems, the first person to see the patient with a musculoskeletal problem such as back pain is the general practitioner, and access to other professionals such as physiotherapists, chiropractors, or osteopaths is still either largely controlled by a traditional medical model of referral or left to self-referral by the patient. In this paper, we examine the arguments for the general practitioner-led model and consider the arguments, and underpinning evidence, for reconsidering who should take responsibility for the early assessment and treatment of patients with musculoskeletal problems.     

Taking responsibility for the early assessment and treatment of patients with musculoskeletal pain: a review and critical analysis

Musculoskeletal pain is common across all populations and costly in terms of impact on the individual and, more generally, on society. In most health-care systems, the first person to see the patient with a musculoskeletal problem such as back pain is the general practitioner, and access to other professionals such as physiotherapists, chiropractors, or osteopaths is still either largely controlled by a traditional medical model of referral or left to self-referral by the patient. In this paper, we examine the arguments for the general practitioner-led model and consider the arguments, and underpinning evidence, for reconsidering who should take responsibility for the early assessment and treatment of patients with musculoskeletal problems.     

Taxonomie im Wandel

Taxonomy in change Taxonomy is currently experiencing profound changes. Molecular methods as DNA barcoding have become inherent parts of modern taxonomic research. The uprising application of high‐throughput technologies will help us to assess species diversity faster and to understand the characteristics of an organism more in detail. As consequence, a modern taxonomic science with integrative character is emerging. Furthermore, the beginning digitalization and cross‐linking of taxonomic data will pave the way of an upcoming dynamic cybertaxonomy.     

Missed opportunities for prevention in general internal medicine

BACKGROUND: According to the Canadian Society of Internal Medicine, the Canadian general internist is in the ideal position to promote patient health through disease prevention. To explore the general internist''s contribution to disease prevention, the authors quantified the extent to which opportunities for prevention were addressed by the general internal medicine (GIM) service in an acute care teaching hospital in Calgary. METHODS: The authors interviewed 100 adult patients before discharge from the hospital''s GIM service between May 14, 1997, and Dec. 2, 1997. The number of potential opportunities for preventive intervention were identified for each patient from 10 possible interventions recommended by the Canadian Task Force on the Periodic Health Examination (now the Canadian Task Force on Preventive Health Care): breast cancer screening, Papanicolaou smear for cervical cancer, counselling on menopausal hormone replacement therapy, digital rectal examination for prostate cancer, smoking cessation counselling, cholesterol measurement, therapy or monitoring for hypertension, influenza vaccination, pneumococcal vaccination and colorectal cancer screening. The authors determined which interventions the patient had undergone before the current admission to hospital and, using patient recall and postdischarge medical chart review, which opportunities for intervention were addressed by the GIM service during the current admission. An opportunity for preventive intervention was considered as addressed by the GIM service if it was performed during the current admission or if the general internist informed the patient or the patient''s family physician of the need for such intervention in the near future. RESULTS: Among the 10 preventive interventions considered, a mean of 3.8 potential opportunities for prevention were identified for each patient. Of these, 46.5% had been addressed before the current admission, and 8.7% were addressed by the GIM service during the admission. Therefore, at the time of discharge, a mean of 55.2% of opportunities had been addressed. Among the opportunities not previously addressed, the GIM service most frequently addressed digital rectal examination for prostate cancer and cholesterol measurement. INTERPRETATION: General internists are discharging patients without sufficiently addressing opportunities for disease prevention. Preventive care protocols may be needed to limit the frequency of missed opportunities for prevention in patients admitted to tertiary care GIM services.     

Study of "discharge communications" from hospital.

All hospital discharge communications concerned with acute admission from one general practice over a three month period were analysed. There was an appreciable delay between the time that the patient was discharged and the information was received by the general practitioner. Just over half of the patients had contacted their general practitioner after discharge before the general practitioner had received any information. The content of the communications was variable, and important subjects were frequently omitted. No communication was received for 11% of the discharged patients. There is a need for more efficient communication between secondary and primary care.