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Hintergrund: Die Erfassung der gesundheitsbezogenen Lebensqualität ist als relevanter Gesundheitsindikator in der Medizin, so auch in der Dermatologie, akzeptiert und hat dort eine große Bedeutung erzielt. Chronische Wunden mit entsprechenden körperlichen und psychischen Auswirkungen [zum vollständigen Text gelangen Sie über die oben angegebene URL], 16. Deutscher Kongress für Versorgungsforschung (DKVF)

SummaryBackground: Patient-reported outcomes (PROs) are essential components of wound and vascular diagnostics and management. Aim: To provide an overview of PROs as diagnostic tools in the management of chronic wounds.Methods: Review of different concepts on inclusion of PROs in wound practice from literature.Results: PROs are indispensable sources of information for the understanding of the biopsycho- social context of wound diseases. Essential dimensions to be recorded are pain, health-related quality of life and patient benefit. Psychological parameters, adherence, treatment goals and treatment benefits are often needed. Further fields of interest include cumulative life course impairment, coping with disease, stigmatisation specifically applied according to clinical questions.Conclusion: Patient-reported outcomes are mandatory for the diagnostic work-up of chronic wounds. They also provide essential information in the course of a disease, can be diagnostic clues for non-adherence and treatment failures. Measurement of many PRO parameters in wound disease, such as health-related quality of life and pain, is facilitated by validated instruments, which are recommended for practice.

Hintergrund und Ziel der Studie: Die Evaluation patientenrelevanter Therapieziele sowie des Therapienutzens ist fur verschiedene medizinische Entscheidungstrager vom Arzt bis zu den Zulassungsbehorden von zunehmender Bedeutung. Die vorliegende Studie analysiert die Patientenbedurfnisse im Sinne von Therapiezielen und den Therapienutzen dermatologischer Patienten. Methodik: Daten von 500 Patienten, welche aufgrund zehn verschiedener dermatologischer Erkrankungen in einer deutschen Universitatshautklinik behandelt wurden, wurden mittels deskriptiver Statistik und Varianzanalysen mit Post-Hoc-Tests ausgewertet. Die Patienten litten an Akne vulgaris, Atopischer Dermatitis, Autoimmunerkrankungen der Haut, Hand- und Fusekzem, Haarerkrankungen, Herpes zoster, Hyperhidrose, Psoriasis vulgaris, Ulcus cruris und Urtikaria (je n = 50 Patienten). Die Relevanz von 23 verschiedenen Therapiezielen im Sinne von Patientenbedurfnissen und deren Zielerreichung durch die aktuelle dermatologische Therapie wurde auf einer Funf-Punkt-Likertskala von 0 bis 4 anhand des validierten Patient-Benefit-Index-Fragebogens (PBI) gemessen. Ergebnisse: Der mittlere Bedurfnislevel lag bei 2,66 ± 0,91 Punkten. Die Therapieziele der Bedurfniskategorie „Zuversicht auf Heilung“ waren wichtiger als diejenigen der Kategorie „Verminderung sozialer Beeintrachtigung“. Patienten mit Hand- und Fusekzemen, Autoimmunerkrankungen und Psoriasis prasentierten eine signifikant hohere mittlere Bedurfnislage als andere dermatologische Patienten. Der mittlere Therapienutzen lag bei 1,69 ± 1,29 Punkten. Dies bedeutet, dass die Erreichung der verschiedenen Ziele auch fur die Patienten ein relevantes Ausmas erreichte (PBI ≥ 1). Die beiden aus Patientensicht wichtigsten Therapieziele „Vertrauen in die Therapie zu haben“ und „eine klare Diagnose und Therapie zu finden“ erzielten die hochsten Nutzenwerte. Patienten mit Herpes zoster, Ulcus cruris und Autoimmunerkrankungen hatten einen signifikant hoheren Therapienutzen als Patienten mit anderen Erkrankungen. Schlussfolgerung: Eine Vielzahl an Therapiezielen zeigt eine hohe Wichtigkeit fur dermatologische Patienten, wobei signifikante Unterschiede zwischen den einzelnen Diagnosen vorliegen. Der durch die aktuelle Therapie erzielte Nutzen erreichte ein fur die Patienten relevantes Ausmas, war allerdings fur die einzelnen dermatologischen Krankheitsbilder ebenfalls signifikant unterschiedlich.

Health-related quality of life has not only been established as an important patient-reported outcome measure in patient care but has been defined as an evaluation criterion for therapies in the German Code of Social Law as well as in the guidelines of the American Food and Drug Administration and of the European Medicines Agency (EMA). Quality of life can be measured in a standardised manner. Validated questionnaires are available for recording specific problems of patients with, for example, skin diseases. Measuring quality of life has not yet been implemented into daily dermatological routine, although (1) studies have confirmed that the measurement of quality of life offers major benefits for the treatment of skin diseases, and (2) first experiences in implementing quality of life measurement into practice have been positive. The further implementation of systemically measuring quality of life requires advancements in automated measurement and the assumption of cost by social health insurances.

Ziel der Studie: Betulin ist ein Triterpen aus dem Korkgewebe der Birke. Die antipruritischen Eigenschaften einer Betulin-haltigen Creme wurden bislang nicht dokumentiert. Ziel dieser Anwendungsbeobachtung war die Erfassung sensorischer Parameter im Verlauf einer topischen Therapie mit Betulin bei trockener, chronisch juckender Haut. Da die patientenseitigen Ziele bei chronischem Pruritus bislang nicht im Kontext einer topischen Therapie erhoben wurden, war ein weiteres Ziel die Erhebung des Patientennutzens anhand des Patient Benefit Index fur Pruritus (PBI-P). Methodik: In einer offenen Anwendungsbeobachtung wurden 64 Patienten (n = 33 weiblich, n = 31 mannlich, Altersmedian: 61,5 Jahre) mit trockener Haut und Pruritus auf entzundlicher Haut (n = 20; Gruppe 1), Pruritus auf nichtentzundlicher Haut (n = 23; Gruppe 2) und Pruritus mit chronischen Kratzlasionen (n = 21; Gruppe 3) mit einer Betulin-haltigen Creme uber 14 Tage behandelt. Ergebnisse: 52,7 % der Patienten (n = 29) gaben eine signifikante Abnahme (p Schlussfolgerung: Die topische Anwendung einer Betulin-haltigen Creme scheint eine effektive adjuvante Therapiemoglichkeit bei juckender trockener Haut zu sein; eine Bestatigung durch vehikelkontrollierte Studien steht aus.

Hintergrund In der fruhen Nutzenbewertung nach dem Arzneimittelmarkt-Neuordnungsgesetz (AMNOG) ist die gesundheitsbezogene Lebensqualitat als ein Kriterium zur Quantifizierung des Zusatznutzens eines Arzneimittels verankert. Trotz dieser Vorgabe ist noch unklar, welche Rolle die Lebensqualitat in dieser Bewertung tatsachlich spielt.

Die Erhebung des Nutzens aus Patientensicht spielt eine immer grosere Rolle in Forschung und klinischer Praxis. Der Patientennutzen kann prospektiv (vor und nach einer Behandlung) anhand der gesundheitsbezogenen Lebensqualitat gemessen werden – oder retrospektiv als Nutzeneinschatzung nach der Behandlung. Fur beide Ansatze der Nutzenerfassung liegen validierte Fragebogen fur den Einsatz in der Dermatologie vor, die in diesem Artikel beispielhaft vorgestellt werden.

Ever since Wilhelm Conrad Roentgen discovered X-rays more than a hundred years ago, ‘Roentgen-Strahlung’ has played a very important role in science. One of the greatest achievements of modern science, our extensive knowledge of the atomic structure of matter, has been made possible to a large extent through the use of X-rays. During the last few years an exciting new perspective has come forth in the X-ray field: the possibility of performing X-ray measurements with femtosecond time resolution. New types of radiation sources are being developed that provide X-rays pulses of unprecedented short width, roughly speaking 10−13 to 10−14 s. As far as X-ray structural analysis is concerned, until recently one could only retrieve, in essence, a time-averaged static picture of the structure. In the near future, femtosecond X-ray pulses will enable the observation of the

Relatively small-scale laser-driven sources of short wavelength radiation covering a range from the extreme ultraviolet to the hard X-ray regime are now available. Because the duration of the X-ray pulses is comparable to, or shorter than the laser pulse width, it is possible to carry out X-ray measurements with picosecond or femtosecond time resolution.

The motion of atoms on interatomic potential energy surfaces is fundamental to the dynamics of liquids and solids. An accelerator-based source of femtosecond x-ray pulses allowed us to follow directly atomic displacements on an optically modified energy landscape, leading eventually to the transition from crystalline solid to disordered liquid. We show that, to first order in time, the dynamics are inertial, and we place constraints on the shape and curvature of the transition-state potential energy surface. Our measurements point toward analogies between this nonequilibrium phase transition and the short-time dynamics intrinsic to equilibrium liquids.

For a long time the capability to perform measurements with femtosecond time-resolution belonged exclusively to the domain of optics. However, in the last few years laser-driven X-ray sources have been developed which enable femtosecond time-resolution to be extended to the X-ray regime.

BACKGROUND: The improvement in quality of life and the generation of patient benefits are major objectives in acne therapy. OBJECTIVES: Benefit assessment and tolerance-assessment of topical clindamycin + benzoyl peroxide in acne therapy in a random inspection in Germany. METHODS: Benefit assessment was raised from an open observational study with n = 906 patients being treated by 205 dermatologists. Assessment was performed at baseline, after 3 to 5 weeks (medium:4) and 10 to 12 weeks. The main endpoints where the lesion count of all acne lesions as well as the main global assessment of the patient and the physician. Quality of life was measured by the „acne disability index” and the patient-defined benefit was assessed with the „patient benefit index (PBI)”. To evaluate the tolerance, standardised questions where adressed to the physician and the patient. According to GCP/ICH-guidelines all AE and SAE were recorded and evaluated. RESULTS: All clinical outcome parameters showed a significant improvement after a treatment with topical clindamycin + benzoyl peroxide for 4 and 10 - 12 weeks (p 1) was 90.2 % after 4 weeks and 93,0 % after 10 - 12 weeks. CONCLUSION: The topical preparation of clindamycin + benzoyl peroxide is a safe and effective treatment option for patients with mild to moderate acne vulgaris. The treatment showed in a big proportion of patients a relevant improvement of patient defined benefit.

To cite this article: Franzke N, Schafer I, Jost K, Blome C, Rustenbach SJ, Reich K, Reusch M, Maurer M, Augustin M. A new instrument for the assessment of patient-defined benefit in the treatment of allergic rhinitis. Allergy 2011; 66: 665–670. Abstract Background: Allergic rhinitis (AR) is a common disease that affects health-related quality of life (HRQoL). Current and future health policy demands the assessment of patient-relevant treatment benefit for evaluation of treatments. Methods: We developed, validated and tested a standardized instrument for the assessment of patient-relevant needs and benefits in AR. In an open survey of patients with AR, 100 need and benefit items were generated. The items were condensed to a 25-item list by an expert panel. On this list, patient rates the personal importance of 25 treatment needs on a scale ranging from ‘not at all’ to ‘very’ before treatment (Patient Needs Questionnaire, PNQ). At the end of the treatment, patient rates the extent, to which these needs were achieved by treatment from ‘did not help at all’ to ‘helped a lot’ (Patient Benefit Questionnaire). The patient benefit index (PBI) is computed to provide a global weighted benefit parameter. This disease-specific instrument was validated in n = 104 patients with AR. Results: The PBI-AR showed good acceptability and feasibility in clinical routine. Reduction in nose and eye symptoms was rated most important. The PBI amounted to 2.2 (PBI ranges from 0 = ‘no benefit’ to 4 = ‘maximum benefit’). Reliability of the PNQ was high (Cronbach’s alpha = 0.9).The PBI was significantly correlated with relevant external validation criteria, such as patient satisfaction (R = 0.54) and HRQoL (R = 0.26). Conclusion: The PBI-AR is a feasible, reliable and valid instrument for the standardized assessment of patient-relevant benefits in the treatment of AR.

As the potential for bioterrorism has appeared to increase, the need for simple systems for identifying potential inhibitors of the binding of such agents to cell membranes has increased. In this work, surface plasmon resonance (SPR) was used to monitor binding of ricin, a ribosome inactivating protein, to the plasma membranes of NIH 3T3 cells. Once conditions were established, efficacy of the system for monitoring effectiveness of compounds at inhibiting ricin binding was ascertained by determining the IC50s for asialofetuin and for bovine serum albumin derivatized with an average of 34 lactosyl moieties (BSA-Lac34). Results indicated that SPR is an efficient method for measuring adherence of a toxin to isolated cell plasma membranes. SPR can also indicate whether a compound that is an effective inhibitor of binding when a single ligand such as ASF is used will be as effective when used in studies with cells that may express multiple cell surface ligands for ricin and/or the inhibitor.

Summary Background The assessment of patient-relevant benefit is gaining importance in evaluating treatments. The ‘Patient Benefit Index, standard version’ questionnaire (PBI-S) is a validated instrument to assess patients’ treatment needs and benefits in skin diseases. Before therapy, the patient rates the importance of predefined treatment goals; after therapy, he rates the extent to which these goals have been achieved. Thus far, no such instrument has been developed specifically for pruritus. Objectives Development and validation of a patient-relevant benefit questionnaire in the treatment of pruritus. Methods Fifty patients with pruritus were questioned on impairments due to pruritus and treatment needs. Four treatment objectives not already covered by the PBI-S were added to obtain a disease-specific instrument. This was tested for feasibility by 36 patients with pruritus and validated in a sample of 100 patients with pruritus. Results The instrument was feasible in clinical practice. There were

Item does not contain fulltext BACKGROUND: Chronic pruritus is a frequently occurring symptom of various dermatoses that causes a high burden and impaired quality of life. An effective anti pruritic therapy is important for the patient, but its effectiveness is difficult to evaluate. Diverse methods and interpretations of pruritic metrics are utilized in clinical trials and the daily clinical practice in different countries, resulting in difficulties comparing collected data. METHODS: We founded a European Network on Assessment of Severity and Burden of Pruritus (PruNet) that is supported by the EADV. PruNet consists of 28 experts from 15 EU countries (21 dermatologists, 5 medical informaticists, 2 psychologists) and aims to unify the assessment of itch in routine dermatological care. Following a preliminary survey, a consensus conference was held in order to agree upon the prioritization of patient-reported outcome tools. RESULTS: Through utilizing the Delphi method, it was agreed that tools for measuring itch intensity (ex. the visual analogue scale) and quality of life (ex. ItchyQoL) are of primary importance and should urgently be foremost validated. CONCLUSION: The validation and harmonization of standards are needed for the improvement of quality care for patients suffering from pruritic dermatoses. This summer, the first validation studies in several EADV member countries already began.

Health-related quality of life has not only been established as an important patient-reported outcome measure in patient care but has been defined as an evaluation criterion for therapies in the German Code of Social Law as well as in the guidelines of the American Food and Drug Administration and of the European Medicines Agency (EMA). Quality of life can be measured in a standardised manner. Validated questionnaires are available for recording specific problems of patients with, for example, skin diseases. Measuring quality of life has not yet been implemented into daily dermatological routine, although (1) studies have confirmed that the measurement of quality of life offers major benefits for the treatment of skin diseases, and (2) first experiences in implementing quality of life measurement into practice have been positive. The further implementation of systemically measuring quality of life requires advancements in automated measurement and the assumption of cost by social health insurances.

In the next decade the scientific community expects a strong impact in physics, chemistry, biology, material research and life sciences by the availability of high-brilliance X-ray radiation from free-electron laser (FEL) sources. In particular, in the field of ultrafast science these new sources will allow new types of experiments, enabling new phenomena to be discovered. Whereas today ultrafast X-ray diffraction experiments are strongly restricted by the limited X-ray flux of current sources of sub-picosecond X-ray pulses, FELs will provide short pulses of typically 10{sup 12} photons with a duration of the order of 100 fs and monochromaticity of 10{sup -3}. Here, the feasibility of time-resolved single-shot powder diffraction experiments using these intense pulses, and the requirements of these experiments, are discussed. The detector count rates are estimated for diffraction from a model compound in a wide q-regime under the special consideration of high resolving power. In the case of LCLS radiation parameters, single-shot experiments will be feasible although high-resolution powder diffraction will require a reduction of the intrinsic FEL radiation bandwidth.

According to German law, health-related quality of life is a relevant criterion in the early assessment of the benefits of drug treatment. In spite of its regulatory importance, the role of quality of life assessment in quantifying the additional benefits of novel vs standard treatments is not yet clear.The paper is aimed at analyzing the theoretical foundation, the methodological foundation, and the empirical evaluation of the criterion "quality of life" in recent benefit dossiers, as published by the Federal Joint Committee (G-BA) and the German Institute for Quality and Efficiency in Health Care (IQWiG).Benefit dossiers assessed by the end of 2013 were quantitatively analyzed regarding the choice, frequency of use, and consequences of quality of life assessment.In 59 of the 66 dossiers quality of life assessment was performed, frequently using the EQ-5D (n = 16 procedures) and the SF-36 (n = 8 procedures). Of the 107 evaluations of the subpopulation within these 59 dossiers, in only 2 cases was an additional benefit due to the quality of life declared by the IQWiG and G-BA.In spite of the acceptance of quality of life measures and their inclusion in the dossiers, they have rarely been the basis for the declaration of additional benefits. This reluctance does not stem from the availability of instruments, but results from problems in their selection, the design and conduct of the study, data interpretation, together with shortcomings regarding the statistical and clinical significance of quality of life data.

A short-pulse 4.51 keV Ti K o femtosecond laser-plasma driven hard x-ray source has been built and characterized. This source is incorporated into a set-up for ultrafast time-resolved x-ray diffraction experiments, to study ultrafast lattice dynamics in laser-excited materials.

Summary form only given. Time-resolved x-ray diffraction using multi-keV x-ray pulses reveals nonthermal changes of the lattice structure in less than 300 fs in a semiconductor and, for the first time, in a metal.

Generation of 3/2 harmonic on solid targets with high intensity femtosecond pulses is investigated. Well collimated high efficient 3/2 harmonic emission is reached at the plasma scale length of the order of the laser wavelength.

Hintergrund: Die Behandlung chronischer Lip- und Lymphodeme ist aus soziookonomischer Sicht von groser Bedeutung, da das Krankheitsbild mit hohen Kosten, starker Patientenbelastung sowie einem stetigen Bedarf an medizinischer Versorgung verbunden ist. Komplikationen wie Erysipele und chronische Wunden konnen okonomische und soziale Situation der Patienten ebenfalls stark beeinflussen. Studienziel war die Erhebung der Krankheitskosten von Patienten mit Lymph- und Lipodemen in der Metropolregion Hamburg. Methoden: Eine Beobachtungs- und Querschnittsstudie wurde an Patienten mit einem mindestens 3 Monaten bestehenden, primaren oder sekundaren Lymph- oder Lipodemen der oberen oder unteren Gliedmasen realisiert. Strukturierte Patienteninterviews sowie standardisierte klinische Untersuchungen wurden durchgefuhrt und Befunde auf digitalen Fotos archiviert. Verbrauche wurden aus gesamtgesellschaftlicher Perspektive kalkuliert, direkte medizinische und nicht medizinische Produkte ermittelt. Zusatzlich erfolgte die Berechnung der indirekten Kosten. Ergebnisse: Insgesamt wurden 348 Patienten (90,8% weiblich, durchschnittliches Alter 57,3±14,5 Jahre) in die Studie eingeschlossen. Durchschnittliche jahrliche Kosten pro Lymphodempatient lagen bei € 8.121, die sich aus € 4.708 (58%) direkten und € 3.413 (42%) indirekten Kosten zusammensetzten. Der Kostenanteil der GKV betrug € 5.552 und die Patienten hatten einen Eigenanteil in Hohe von € 494 (out-of-pocket-Kosten). Subgruppen-Analysen von a) Arm- vs. Beinodem und b) primares vs. sekundares Odem zeigten keine signifikanten Unterschiede in den einzelnen Gruppen. Medizinischen Kosten und Arbeitsunfahigkeitskosten waren Hauptkostentreiber sowohl in der Gesamtgruppen- als auch in den Subgruppen-Analysen. Schlussfolgerung: Chronische Lip- und Lymphodeme sind mit hohen direkten und indirekten Kosten verbunden. Notwendig ist eine fruhe Erkennung und Behandlung dieser Lymphodeme sowie der Aufbau effizienter Disease Management Programme.

With a prevalence of 20%, chronic pruritus is a symptom of many diseases with major impact on healthcare costs. The lack of specific therapeutic measures makes the development of new drugs and their testing in clinical trials urgent. It is not possible to measure pruritus in an objective way. For these reasons, it is necessary to have a series of standardized measures to characterize pruritus in a reliable way. Intensity scales such as the visual analog scale (VAS) are most frequently used to document the course of the symptoms. However, for assessing pruritus intensity, VAS is not an optimal instrument, although it cannot be dispensed with. The VAS should be combined with other scales in clinical studies in order to internally test the consistency of data. Other instruments for assessing intensity and course of pruritus are in the process of development. Presently scratch activity and scratch-associated lesions can be documented in a descriptive fashion. There are some studies that have employed devices to document scratch activity; however, methodological studies are not yet available. The patient-benefit index is an indispensable tool in clinical trials. A questionnaire for gathering data on the history and some pruritus-specific parameters has been developed and published. Questionnaires on patient quality of life, anxiety and depression are helpful in obtaining data on other cost-relevant parameters. A questionnaire on the quality of life, for instance, can provide important help in the assessment of the burden of the disease. The results of these questionnaires can be correlated with data on pruritus intensity scales. The relevant questionnaires have been partially digitalized so that they are available immediately as part of patient care. Additional methodological developments and studies are required in order to define a robust set of instruments for measuring pruritus in daily practice and in clinical studies.

Treatment of lymphoedema is complex and needs specific skills. There are no standards for the evaluation of quality of care.Development and application of indicators for the measurement of quality of care in lymphoedema.In a three-step process including a national Delphi expert consensus, quality indicators were derived from national and international guidelines. In a cross-sectional study involving a large spectrum of care providers, the quality of lymphoedema care in the community was assessed by transforming the indicators to one unweighted quality index (QI).A total of 12 quality indicators were identified and applied to n = 348 patients with lymphoedema and lipolymphoedema of any origin in the metropolitan area of Hamburg (90.8% female, mean age 57, SD 14.5 years). On average, 55% of the quality indicators were met, and 64.8% of the patients were satisfied with lymphoedema care. There was a significant correlation between QI and satisfaction.The quality indicators and the QI are feasible and valid for the evaluation of quality of care. They can support optimizing lymphoedema care.

Although nail psoriasis affects a marked proportion of patients with psoriasis and causes significant psychological stress, only few epidemiological data characterizing patients with nail involvement are available.To gain robust data on the epidemiology and disease burden of nail psoriasis in Germany.Two nationwide, noninterventional, cross-sectional studies on psoriasis health care were conducted in 2005 and 2007, involving 48 (2005) and 130 (2007) German office-based and clinic-based dermatological centres. Data of n=3531 patients with psoriasis were collected using standardized questionnaires and physical examinations by trained dermatologists. Patients with nail psoriasis were compared with patients without any nail involvement concerning sex, age, disease duration, family history, disease severity, presence of psoriatic arthritis (PsA), health-related quality of life (HRQoL), number of inpatient therapies, and days off work.Nail psoriasis was diagnosed in 40·9% of the patients; prevalence was 11·2 percentage points higher in men than in women. Patients with nail involvement had a longer disease duration (21·9 vs. 18·1 years), higher disease severity (mean Psoriasis Area and Severity Index 12·7 vs. 9·3), higher frequency of PsA (26·0% vs. 12·7%), stronger impairment of HRQoL (mean Dermatology Life Quality Index 8·9 vs. 7·3), and a 2·5-fold higher rate of inpatient treatments.Nail involvement is a relevant manifestation of psoriasis and is associated with a higher disease severity and quality of life impairment. Accordingly, management of psoriasis should include a special focus on nail involvement.

Summary Background: Two national surveys conducted in 2005 and 2007 indicated deficits in psoriasis care in Germany, although there has been a notable nationwide improvement within this period. It remained unclear whether regional differences in psoriasis health care have an influence on patient outcomes in Germany. Aim: Assessment of regional differences in the health care situation of patient with psoriasis in Germany. Patients and Methods: Nation-wide cross-sectional study in 130 dermatological practices and clinics. Regional classification was based on the affiliation to the Associations of Statutory Health Insurance Physicians. A panel of experts developed eight criteria as indicators of quality of care, among them clinical characteristics and severity of psoriasis (PASI), previous treatments, quality of life and patient-relevant therapeutic benefits. Results: Care indicators showed marked regional differences. The proportion of patients with preceding systemic or biologic treatment varied between regions. Those regions with high proportions had better results in patient-reported outcomes. Conclusions: Differences in economic and regulatory conditions of health care might account for the observed regional variations. Thus, further analyses of these factors are of great importance to assure consistent psoriasis health care in Germany.

Melanoma depends on, interacts with and reacts to the stroma in which it is embedded, including fibroblasts, extracellular matrix, endothelial cells and immune cells. However, the impact of melanoma on the epidermal tumor microenvironment-the multilayered epithelium of the skin-is poorly understood. Gap junctions are essential for intercellular communication and involved in proliferation, differentiation and homeostasis of keratinocytes. We have shown previously that the gap junction proteins connexin 26 and 30 (Cx26 and Cx30) are induced in the epidermal tumor microenvironment of skin cancers including melanoma. This study compares the extent of Cx26, Cx30 and Cx43 expression in the epidermal microenvironment of melanocytic nevi and melanomas and its association with melanoma thickness, proliferative index of the tumor and its microenvironment, and with 5-year metastasis and survival. We found that induction of Cx26 and Cx30 cell-cell border expression in the epidermal tumor microenvironment correlates to malignancy. Importantly, there was a significant correlation of tumor thickness with the vertical epidermal Cx26 and Cx30 expression pattern and the horizontal Cx26 dissemination. Furthermore, horizontal Cx26 expression correlated with metastasis. Vertical epidermal expression patterns of Cx26 and Cx30 significantly correlated with the proliferative index in the epidermal tumor microenvironment but not with the proliferative index in the tumor. In contrast, Cx43 did not correlate with malignancy, thickness or proliferative index. In summary, here we show for the first time a significant association between the progression of melanoma and alterations in its epithelial tumor microenvironment.

To date, no standardised indicators for quality of care in psoriasis have been published.Development and testing of evidence-based indicators of quality of care and guideline compliance in the treatment of psoriasis.Indicators of process and outcome quality were extracted and evaluated in a Delphi process according to international standards. The primary reference was the S3 German guideline for psoriasis treatment. The indicators were validated with data from two nationwide studies on psoriasis care involving 1,511 and 2,009 patients.Eight quality indicators were defined: mean PASI, mean quality of life (Dermatology Life Quality Index; DLQI), proportion of patients with PASI20, with DLQI10, with previous systemic treatment, with PASI20 and systemic treatment, with inpatient treatment, and number of work days lost. All indicators proved suitable for application, and were sensitive to change.Guideline-based indicators of quality of care are useful in the analysis of health care and the implementation of treatment guidelines in psoriasis.

Femtosecond time-resolved small and wide angle x-ray diffuse scattering techniques are applied to investigate the ultrafast nucleation processes that occur during the ablation process in semiconducting materials. Following intense optical excitation, a transient liquid state of high compressibility characterized by large-amplitude density fluctuations is observed and the buildup of these fluctuations is measured in real time. Small-angle scattering measurements reveal snapshots of the spontaneous nucleation of nanoscale voids within a metastable liquid and support theoretical predictions of the ablation process.

Ricin, a ribosome-inactivating protein from the plant Ricinus communis , is a heterodimeric protein. The A chain is a N -glycosidase and the B chain (RTB) is a lectin with two carbohydrate binding sites. RTB has been shown to bind asialofetuin with much greater affinity than it does galactose, supporting the hypothesis that it may exhibit multivalency. To test this, neoglycoconjugates were prepared and tested for their ability to function as ligands for ricin binding. Because the two carbohydrate binding sites on RTB are ∼70 A apart, bovine serum albumin (BSA) was used as the carbohydrate carrier. It was derivatized with either the oligosaccharide portion of asialo-GM1 or with lactose. These sugars were used because ricin was found to adhere more effectively to asialo-GM1 and LacCer immobilized on plastic than to the other glycosphingolipids tested. Results of binding studies done using surface plasmon resonance indicated that the RTB subunit of ricin exhibited a multivalent effect when it bound to the neoglycoconjugates.

Powder Diffraction offers the possibility to collect entire structural information from single profiles. This feature fits well with the possibility and requirement of x‐ray free‐electron laser sources to collect data on a single shot basis. The requirements for powder diffraction experiments using hard x‐ray free‐electron laser radiation are discussed in terms of bandwidth, x‐ray spot size and detector resolution. Time‐resolved measurements are proposed using ultrashort optical laser pulses to excite sample transformation on the 100 femtosecond time scale. Preliminary thoughts on energy absorption in the sample due to optical laser and x‐ray beam are discussed.

Intense femtosecond laser excitation can produce transient states of matter that would otherwise be inaccessible to laboratory investigation. At high excitation densities, the interatomic forces that bind solids and determine many of their properties can be substantially altered. Here, we present the detailed mapping of the carrier density–dependent interatomic potential of bismuth approaching a solid-solid phase transition. Our experiments combine stroboscopic techniques that use a high-brightness linear electron accelerator–based x-ray source with pulse-by-pulse timing reconstruction for femtosecond resolution, allowing quantitative characterization of the interatomic potential energy surface of the highly excited solid.

The melting dynamics of laser excited InSb have been studied with femtosecond x-ray diffraction. These measurements observe the delayed onset of diffusive atomic motion, signaling the appearance of liquidlike dynamics. They also demonstrate that the root-mean-squared displacement in the [111] direction increases faster than in the [110] direction after the first 500 fs. This structural anisotropy indicates that the initially generated fluid differs significantly from the equilibrium liquid.

The melting dynamics of laser excited InSb have been studied with femtosecond x-ray diffraction. These measurements demonstrate that the initial stage of crystal disordering results from inertial motion on a laser softened potential energy surface. These inertial dynamics dominate for the first half picosecond following laser excitation, indicating that interatomic forces minimally influence atomic excursions from the equilibrium lattice positions, even for motions in excess of an {angstrom}. This also indicates that the atoms disorder initially without losing memory of their lattice reference.

Linear-accelerator-based sources will revolutionize ultrafast x-ray science due to their unprecedented brightness and short pulse duration. However, time-resolved studies at the resolution of the x-ray pulse duration are hampered by the inability to precisely synchronize an external laser to the accelerator. At the Sub-Picosecond Pulse Source at the Stanford Linear-Accelerator Center we solved this problem by measuring the arrival time of each high energy electron bunch with electro-optic sampling. This indirectly determined the arrival time of each x-ray pulse relative to an external pump laser pulse with a time resolution of better than 60 fs rms.

The Sub‐Picosecond Photon Source (SPPS), in operation since May 2003, makes x‐ray pulses of 100 fs. Spontaneous radiation originates from a short pulsed electron beam that passes through an undulator at the Stanford Linear Accelerator Center. New techniques characterize the x‐rays, the electrons, and the timing jitter in real time. These results provide a framework for discussion of possible strong field experiments at SPPS and at future fourth‐generation photon sources like the recently funded Linac Coherent Light Source.

This study presents recent developments and applications of ultrafast X-ray diffraction. These include optical pump/X-ray probe experiments for performing ultrafast X-ray spectroscopy, time-resolved X-ray diffraction for the investigation of electronically induced solid-liquid phase transformations in semiconductors, and time-resolved X-ray diffraction for monitoring the rapid changes of the atomic configuration associated with the lattice waves.