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Fragestellung: Der Grad von AC-Gelenksprengungen wird anhand von Panoramaaufnahmen festgestellt. Das Ausmaß der Dislokation bildet die Grundlage für die Einteilung nach Rockwood und in weiterer Folge für die Therapiefindung. Ziel der Studie war es, die Auswirkung von Verkippungen der [zum vollständigen Text gelangen Sie über die oben angegebene URL]

BackgroundThe rheumatoid arthritis impact of disease score (RAID) is a patient-reported outcome measure to evaluate the impact of rheumatoid arthritis (RA) on patients’ quality of life (1). While an adapted instrument has been developed for psoriatic arthritis (2), there are no comparable instruments for other inflammatory rheumatic diseases. Since the RAID includes generic questions on pain, functional capacity, fatigue, physical and emotional well-being, sleep disturbances and coping, it could be an informative instrument beyond RA.ObjectivesTo analyse the performance of the RAID in ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), polymyalgia rheumatica (PMR), primary Sjögren’s syndrome (pSS), idiopathic inflammatory myositis (IIM), and systemic sclerosis (SSc) compared to RA.MethodsFrom 2015 to 2019, a total of 12,398 patients reported the RAID in the National Database of the German Collaborative Arthritis Centres. We calculated the age- and sex-adjusted partial correlation (0.3-0.5 weak, 0.5-0.7 moderate, > 0.7 strong correlation) between the RAID score and five other patient- or physician-reported outcomes, namely patient global (PtGl) health status, PtGl disease activity, physician global (PhGl) disease activity, the World Health Organisation Well-Being Index (WHO-5) and the EuroQoL-5 Dimensions (EQ-5D). Furthermore, for each of the diagnoses the mean difference between the RAID and the other outcomes was compared with the respective differences for RA. The EQ-5D and WHO-5 were rescaled to match the scale of the RAID (range 0-10). General linear regression was used to assess the age- and sex-adjusted effect of each diagnosis on the difference between the RAID and the five other scores with RA as the referent diagnosis. We defined the effect of a diagnosis as clinically relevant if the mean change of difference was at least one unit.ResultsThe mean RAID score in RA (3.6) was lower than in AS (4.0) and SSc (3.8) and higher than in SLE, PMR, pSS or IIM (Table 1). Across all diagnoses, the RAID correlated strongly with PtGl health status (0.72 to 0.83), moderately to strongly with PtGl disease activity (0.55 to 0.78) and WHO-5 (0.67 to 0.83), moderately with the EQ-5D (0.61 to 0.68), and weakly with PhGl disease activity (0.25 to 0.41). Small mean differences were found between the RAID and either PtGl disease activity (0 to -0.6), PtGl health status (-0.4 to -0.9) or WHO-5 (-0.7 to -1.3). A higher deviation was observed for EQ-5D (1.1 to 1.7) and PhGl disease activity (1.4 to 2.2). However, the discrepancies between the five outcomes and the RAID turned out to be similar across all diagnoses and, more importantly, comparable to RA. Linear regression revealed no clinically relevant effect of any of the diagnoses on the difference between RAID and the other outcomes (Figure 1).Table 1.Characteristics and patient- and physician-reported outcomes in patients with inflammatory rheumatic diseases.RAASSLEPMRpSSIIMSScNumber of cases7826153211421105301106386Female (%)74428964895876Age, in years (mean±SD)63±1451±1447±1573±853±1658±1458±14Disease duration, in years (mean±SD)13±1118±1315±105±612±911±812±10RAID (mean±SD)3.6±2.34.0±2.33.0±2.43.2±2.33.4±2.43.5±2.53.8±2.3PtGl health status (mean±SD)4.2±2.34.4±2.23.6±2.44.1±2.34.1±2.34.2±2.54.6±2.1PtGl disease activity (mean±SD)3.7±2.44.0±2.42.7±2.53.8±2.73.5±2.63.7±2.54.1±2.3PhGl disease activity (mean±SD)1.8±1.92.2±1.91.6±1.31.0±1.41.8±1.31.8±1.62.2±1.6EQ-5D (mean±SD)0.8±0.20.8±0.20.8±0.20.8±0.20.8±0.20.8±0.20.8±0.2WHO-5 (mean±SD)57±2553±2358±2556±2657±2560±2653±24SD, Standard Deviation; PtGl, Patient Global; PhGl, Physician Global; EuroQoL-5 Dimensions (EQ-5D); World Health Organisation Well-Being Index (WHO-5)Figure 1.ConclusionThe RAID score performed comparably well across all diagnoses investigated. These findings support the use of the RAID for measuring the impact of disease not only in RA, but also in AS, SLE, PMR, pSS, IIM and SSc.References[1]PMID: 21540201[2]PMID: 24790067AcknowledgementsWe thank all participating rheumatologists and patients for their valuable contributions.The National Database of the German Collaborative Arthritis centers is supported by the Association of Regional Cooperative Rheumatology Centres, the German Society for Rheumatology and joint contributions to the Rheumatological Training Academy and the German Rheumatism Research Centre by the following members of the Working Group of Corporate Members of the German Society for Rheumatology: AbbVie, AstraZeneca, BMS, GALAPAGOS, GSK, Lilly, Medac, MSD, Pfizer, Sanofi-Aventis and UCB.Disclosure of InterestsKatja Thiele: None declared, Katinka Albrecht: None declared, Angela Zink: None declared, Martin Aringer: None declared, Kirsten Karberg: None declared, Susanna Spaethling-Mestekemper Speakers bureau: BMS, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Sanofi, UCB, Consultant of: Abbvie, Gilead, GSK, UCB, Novartis, Ulrich von Hinueber: None declared, Johanna Callhoff Paid instructor for: Rheumatologische Fortbildungsakademie GmbH, Grant/research support from: Abbvie, AstraZeneca, BMS, GALAPAGOS, GSK, Lilly, Medac, MSD, Pfizer, Sanofi, UCB

Background The vast majority of patients with rheumatoid arthritis (RA) included in the national database of the German Collaborative Arthritis Centers are treated with disease-modifying antirheumatic drugs (DMARD). The clinical and patient-related characteristics of patients who did not have DMARD treatment in the longer term were investigated. Methodology Between 2012 and 2016 a total of 10,289 patients with RA were documented. Patient characteristics, disease activity and severity, comorbidities and concomitant treatment were descriptively evaluated. Patients who were without DMARDs for more than 1 year and not in remission (disease activity score 28, simple disease activity index or Boolean remission) were analyzed separately. Logistic regression was used to investigate which variables were associated with DMARD treatment. Results A total of 426 patients were ≤1 year without DMARDs, 1090 > 1 year without DMARDs and 8773 (85%) currently had DMARD treatment. Of the patients who were without DMARDs for more than 1 year, 51% were in remission. Even if no remission criteria were met, the rheumatologists nevertheless found the strived for RA situation in the majority of patients. Of the patients who were without DMARDs for more than 1 year, 13% received glucocorticoid treatment >5 mg/day. In patients with a high degree of severity (odds ratio, OR severe vs. asymptomatic/mild 2.33, 95% confidence interval, CI 1.80;3.02) or positive rheumatoid factor (OR 2.24, CI 1.96;2.56) the chance of receiving DMARD treatment was twice as high. Existing comorbidities did not reduce the chance of receiving DMARD treatment. Conclusion The RA patients in the national database who had no DMARDs for more than 1 year were mostly in remission or with low disease activity. Signs of inadequate disease control were found in only 11% of all patients without DMARD treatment.

To quantify vitamin D status among pregnant women in the Pacific Northwest (Portland, OR, and Seattle, WA) and examine pregnancy and newborn outcomes in relationship to maternal serum blood samples obtained during pregnancy.A retrospective cohort design.Data from 2009 to 2013 were abstracted from the health records of two out-of-hospital midwifery practices in the Pacific Northwest.Women with recorded serum blood samples for vitamin D during pregnancy were included. We reviewed health records of 663 women, and 357 met criteria.We extracted demographic, biometric, and pregnancy outcome data from participants' records and analyzed them using regression models.Mean serum 25-hydroxy vitamin D (25[OH]D) was 29.96 ± 10.9 ng/ml; 45.5% of participants were sufficient (≥30 ng/ml), and 55.5% were insufficient or deficient (29 ng/ml). Lower vitamin D levels were predicted by Seattle location, greater prepregnancy body mass index, and blood samples drawn during the winter. Vitamin D status was not a predictor of spontaneous abortion, glucose tolerance test result, cesarean birth, infant birth weight, or any other outcome investigated.Although there is a high prevalence of vitamin D insufficiency and deficiency in pregnant women in the Pacific Northwest, adverse health effects were not observed. This may be attributable to the overall healthy profile of the women in our sample. Further research on maternal vitamin D status should focus on identification of optimal vitamin D levels in pregnancy and long-term outcomes among offspring of women who are vitamin D deficient, particularly those from high-risk, vulnerable populations.

Ruptures of the pectoralis major (PM) tendon are rare but have increased in recent years, especially during fitness exercising, such as bench pressing. The pathomechanism is an eccentric load under pretension of the PM (falling onto the outstretched arm, injuries during ground combat, boxing and during downward movement when bench pressing). The rupture sequence starts from superior to inferior at the insertion site with initial rupture of the most inferior muscle parts, followed by the sternal part and the clavicular part. Most classifications are based on rupture location, extent and time of injury. In addition to clinical presentation and sonography, magnetic resonance imaging is now established as the gold standard in diagnosing PM pathologies. Surgical management is indicated for all lateral PM ruptures with relevant strength deficits. Treatment in the acute interval (3 weeks) is the primary goal; however, even in chronic cases or after failed conservative management a secondary operative approach enables notable clinical improvement. Conservative therapy mostly affects patients who have muscular injuries close to the anatomic origin and smaller partial tears. Surgical management aims for anatomic reconstruction of the PM unit with restoration of the original tension to enable optimal strength transmission. Surgical refixation or reconstruction (with autograft/allograft) of acute and chronic PM ruptures shows excellent clinical results with high patient satisfaction. Latissimus dorsi (LD) and teres major (TM) tendon ruptures are rare injuries but can lead to significant impairments in high-performance athletes. In contrast to PM ruptures, LD and TM injuries are primarily treated conservatively with very satisfactory results.Rupturen der M.-pectoralis-major(PM)-Sehne sind seltene Verletzungen, jedoch hat ihre Zahl v. a. bei der Ausübung von Kraftsport in den letzten Jahren zugenommen. Als Pathomechanismus gilt eine exzentrische Belastung unter PM-Anspannung (Sturz auf den ausgestreckten Arm, Verletzung während des Bodenkampfes oder Boxens, aber v. a. während Abwärtsbewegungen beim Bankdrücken). Die Ruptursequenz startet am Ansatz, ausgehend von superior nach inferior, beginnend mit den inferiorsten Muskelsegmenten, gefolgt von Pars sternocostalis (PS) und Pars clavicularis. Die meisten Klassifikationen bauen auf Rupturlokalisation, -ausdehnung und Verletzungszeitpunkt auf. Neben klinischen Zeichen und Sonographie hat sich die MRT als diagnostischer Goldstandard etabliert. Die Indikation zur operativen Versorgung besteht bei fast allen lateralen PM-Sehnen-Rupturen mit relevantem Kraftdefizit. Eine Versorgung3 Wochen ist primär anzustreben, jedoch ist eine operative Behandlung in chronischen Fällen möglich. Die konservative Therapie betrifft ausschließlich Patienten, die ursprungsnahe, muskuläre Verletzungen aufweisen, sowie kleinere Teilrisse. Ziel der operativen Therapie ist die anatomische Rekonstruktion der PM-Einheit mit Wiederherstellung der ursprünglichen Spannungsverhältnisse, um die optimale Kraftübertragung zu ermöglichen. Die operative Refixation bzw. Rekonstruktion (mit Auto‑/Allograft) von akuten und chronischen PM-Sehnen-Rupturen zeigt gute klinische Ergebnisse mit sehr hoher Patientenzufriedenheit. Latissimus-dorsi(LD)- und Teres-major(TM)-Sehnenrupturen sind selten, können aber bei Hochleistungssportlern zu deutlichen Beeinträchtigungen führen. Entgegen den PM-Sehnen-Rupturen werden LD- und TM-Verletzungen mit sehr zufriedenstellenden Ergebnissen primär konservativ behandelt.

Introduction: Mothers and infants are at high risk for inadequate vitamin D status. Mechanisms by which vitamin D may affect maternal and infant DNA methylation are poorly understood. Objective: This study quantified the effects of vitamin D(3) supplementation on DNA methylation in pregnant and lactating women and their breastfed infants. Materials and Methods: In this randomized controlled pilot study, pregnant women received vitamin D(3) 400 international units (IU) (n = 6; control) or 3,800 IU (n = 7; intervention) daily from late second trimester through 4–6 weeks postpartum. Epigenome-wide DNA methylation was quantified in leukocytes collected from mothers at birth and mother–infant dyads at 4–6 weeks postpartum. Results: At birth, intervention group mothers showed DNA methylation gain and loss at 76 and 89 cytosine–guanine (CpG) dinucleotides, respectively, compared to controls. Postpartum, methylation gain was noted at 200 and loss at 102 CpGs. Associated gene clusters showed strongest biologic relevance for cell migration/motility and cellular membrane function at birth and cadherin signaling and immune function at postpartum. Breastfed 4–6-week-old infants of intervention mothers showed DNA methylation gain and loss in 217 and 213 CpGs, respectively, compared to controls. Genes showing differential methylation mapped most strongly to collagen metabolic processes and regulation of apoptosis. Conclusions: Maternal vitamin D supplementation during pregnancy and lactation alters DNA methylation in mothers and breastfed infants. Additional work is needed to fully elucidate the short- and long-term biologic effects of vitamin D supplementation at varying doses, which could hold important implications for establishing clinical recommendations for prenatal and offspring health promotion.

In recent years, a growing number of wealthy families entering the equity market have been seeking direct investments. But how do these actively investing families (family investors, henceforth) behave compared to non-family investors such as private equity (PE) firms? Answering this is particularly interesting from the investee firms’ perspective of family businesses, as the mindset of family investors might be more similar to their own. However, studies so far have neglected to distinguish between different investors in family firms. Thus, this conceptual paper aims to improve the understanding of family and PE investors and to consider the conditions and decision criteria under which family firms seek an external investor. To fulfil this goal, the two investor types are systematically compared, and based on multiple theoretical perspectives, a model of which investor type would best fit with family firms and their specific challenges is proposed. Thereby, we argue that the two investor types might be suitable partners for the investee firms depending on the challenges they face. In recent years, a growing number of wealthy families entering the equitymarket have been seeking direct investments. But how do these actively investingfamilies (family investors, henceforth) behave compared to non-family investorssuch as private equity (PE) firms? Answering this is particularly interesting from theinvestee firms’ perspective of family businesses, as the mindset of family investorsmight be more similar to their own. However, studies so far have neglected todistinguish between different investors in family firms. Thus, this conceptual paperaims to improve the understanding of family and PE investors and to consider theconditions and decision criteria under which family firms seek an external investor.To fulfil this goal, the two investor types are systematically compared, and based onmultiple theoretical perspectives, a model of which investor type would best fit withfamily firms and their specific challenges is proposed. Thereby, we argue that thetwo investor types might be suitable partners for the investee firms depending on thechallenges they face.

Prognostisch ungunstige Faktoren sollen in Therapieentscheidungen bei rheumatoider Arthritis (RA) einbezogen werden. Es gibt kaum Daten uber die Haufigkeit der einzelnen Faktoren bei Patienten in der Routineversorgung. Krankheitsaktivitat (Disease Activity Score DAS28), Erosionen, Antikorper gegen citrullinierte Peptide oder Rheumafaktoren (ACPA/RF), vorheriges Therapieversagen, Entzundungsmarker sowie Funktionseinschrankungen (FFbH 5,1, 64 % waren ACPA/RF+, 13 % hatten Erosionen und 37 % einen FFbH 5,1 von 33 % auf 52 % und FFbH von 41 % auf 66 %. In der Kerndokumentation waren zwischen 47 % (DMARD naiv) und 82 % (≥2 vorherige DMARD-Therapien) ACPA/RF+. 5 bis 11 % hatten unter Therapie einen DAS28 > 5,1. Der Anteil von Patienten mit FFbH < 70 stieg mit der Zahl der Vortherapien von 26 % auf 50 %. Der mit zunehmender Zahl abgesetzter DMARD-Therapien steigende Anteil von Patienten mit ungunstigen Prognosefaktoren unterstreicht deren Bedeutung im Hinblick auf einen schwer zu kontrollierenden Krankheitsverlauf.

The vast majority of patients with rheumatoid arthritis (RA) included in the national database of the German Collaborative Arthritis Centers are treated with disease-modifying antirheumatic drugs (DMARD). The clinical and patient-related characteristics of patients who did not have DMARD treatment in the longer term were investigated.Between 2012 and 2016 a total of 10,289 patients with RA were documented. Patient characteristics, disease activity and severity, comorbidities and concomitant treatment were descriptively evaluated. Patients who were without DMARDs for more than 1 year and not in remission (disease activity score 28, simple disease activity index or Boolean remission) were analyzed separately. Logistic regression was used to investigate which variables were associated with DMARD treatment.A total of 426 patients were ≤1 year without DMARDs, 1090 1 year without DMARDs and 8773 (85%) currently had DMARD treatment. Of the patients who were without DMARDs for more than 1 year, 51% were in remission. Even if no remission criteria were met, the rheumatologists nevertheless found the strived for RA situation in the majority of patients. Of the patients who were without DMARDs for more than 1 year, 13% received glucocorticoid treatment5 mg/day. In patients with a high degree of severity (odds ratio, OR severe vs. asymptomatic/mild 2.33, 95% confidence interval, CI 1.80;3.02) or positive rheumatoid factor (OR 2.24, CI 1.96;2.56) the chance of receiving DMARD treatment was twice as high. Existing comorbidities did not reduce the chance of receiving DMARD treatment.The RA patients in the national database who had no DMARDs for more than 1 year were mostly in remission or with low disease activity. Signs of inadequate disease control were found in only 11% of all patients without DMARD treatment.HINTERGRUND: Die große Mehrheit der in der Kerndokumentation erfassten Patienten mit rheumatoider Arthritis (RA) wird mit krankheitsmodifizierenden Antirheumatika (DMARDs) behandelt. Wir haben klinische und patientenbezogene Merkmale der Patienten untersucht, die längerfristig keine DMARD-Therapie haben.Zwischen 2012 und 2016 wurden 10.289 Patienten mit RA dokumentiert. Patientencharakteristika, Krankheitsaktivität und -schweregrad, Komorbidität und Begleittherapie wurden deskriptiv ausgewertet. Patienten, die über 1 Jahr ohne DMARDs und nicht in Remission (nach disease activity score 28, simple disease activity index oder Boolean Remission) waren, wurden gesondert analysiert. Mit logistischer Regression wurde untersucht, welche Variablen mit einer DMARD-Therapie assoziiert sind.Es waren 426 Patienten ≤1 Jahr ohne DMARD, 1090 1 Jahr ohne DMARDs, und 8773 (85 %) hatten aktuell eine DMARD-Therapie. Patienten, die über 1 Jahr ohne DMARDs waren, befanden sich zu 51 % in Remission. Wurde kein Remissionskriterium erfüllt, so befanden die Rheumatologen trotzdem mehrheitlich einen angestrebten Zustand der RA. Es erhielten 13 % aller Patienten, die über 1 Jahr ohne DMARDs waren, eine Glukokortikoidtherapie5 mg/Tag. Eine doppelt so hohe Chance, eine DMARD-Therapie zu bekommen, hatten Patienten mit einem hohen Schweregrad (Odds Ratio [OR] [sehr] schwer vs. asymptomatisch/leicht 2,33 [95 %-KI: 1,80;3,02]) bzw. positivem Rheumafaktor (OR 2,24 [1,96;2,56]). Vorhandene Komorbiditäten verringerten nicht die Chance, ein DMARD zu erhalten.RA-Patienten der Kerndokumentation, die über 1 Jahr kein DMARD haben, sind mehrheitlich in Remission oder befinden sich in niedriger Krankheitsaktivität. Anzeichen für eine unzureichende Krankheitskontrolle finden sich nur bei 11 % aller Patienten ohne DMARD-Therapie.

Eine wichtige Aufgabe der forensischen Anthropologie liegt in der Identifizierung von unbekannten Verstorbenen. Hierfur kommen etablierte Identifizierungsverfahren, wie Daktyloskopie, Odontostomatologie und genetischer Fingerabdruck zum Einsatz, die das Vorhandensein von Vergleichsmaterial der vermissten Person voraussetzen. Gibt es jedoch keine Hinweise auf die Person, verbleibt oftmals nur die Moglichkeit einer forensischen Gesichtsweichteilrekonstruktion. Die Methode basiert auf dem hohen Widererkennungsgrad des Gesichts auf Grundlage der knochernen Strukturen des Schadels und deren anatomischer Merkmale. Es sollte der Anwendungsversuch eines neuartigen, kostengunstigen und flexiblen Prozesses zur computergestutzten 3D-Gesichtsweichteilrekonstruktion mithilfe digitaler Fotoaufnahmen eines Schadels erfolgen. Die Rekonstruktion wurde an einem ausgewahlten forensischen Fall und unter Einsatz einer Open-Source-Software durchgefuhrt. Fur die vollstandige Gesichtsweichteilrekonstruktion einer verstorbenen Person wurden 76 digitale Fotoaufnahmen des Schadels aus unterschiedlichen Perspektiven angefertigt (Nikon D7100 SLR-Digitalkamera und Drehteller). Hierbei konnten antemortalen Vergleichsfotos ahnliche Rekonstruktionsergebnisse erzielt werden. Zudem wurde eine Modellbibliothek fur Gesichtsmerkmale entwickelt. Der vorgestellte Prozess der computergestutzten 3D-Gesichtsweichteilrekonstruktion, basierend auf Open-Source-Software, stellt eine kostengunstige und flexible Alternative zu bisherigen Rekonstruktionsverfahren dar. Ob das Rekonstruktionsergebnis tatsachlich zum Wiedererkennen der Person fuhrt, hangt von zahlreichen weiteren Faktoren ab.

Prevention of disease is a cornerstone of nursing care. Through our endeavors in research, teaching, and clinical care, nurses consistently seek to change the trajectory of disease development. The theoretical framework known as the Developmental Origins of Health and Disease (DOHaD) offers a new lens that shifts the current disease prevention paradigm upstream, encouraging intensified care of pregnant girls/women, neonates, and infants. This new focus parallels other emerging ecobiodevelopmental, life-course theories, which identify the long-term impact of early environments and stressors on the later risk of chronic adult diseases. Nurses have the potential to influence the health of multiple generations by incorporating DOHaD perspectives and interventions into their research and patient care.

This study examined how corporate governance codes specific to private family firms encourage the bright side and restrict the dark side of family influence. Moreover, it investigated whether these codes foster agency or stewardship tendencies of the family’s involvement in the business. The results of this qualitative research study revealed that the eight analyzed codes are not consistent in their recommendations and focus on different aspects of family influence. Nevertheless, some common recommendations could be identified-for instance, the relevance of family governance mechanisms to avoid conflicts.

This study examines private equity minority investors’ exit from family firms and its consequences for owner families. The authors theoretically discuss potential conflicts that might influence the exit decision, alternative exit routes, and the intentions of the family owners to exit the business along with the private equity investors. Subsequently, the theoretical insights were tested empirically using a case-based research approach. Four private equity firms provided data on 14 cases of completed minority private equity investments from Germany. Semi-structured interviews with investment managers offered further information regarding the analysed cases. Empirical findings reveal that conflicts of interest over the exit of private equity minority investors only rarely arise. Moreover, differences between planned and applied exit routes are mainly caused by changes in the economic situation of the company and/or in the conditions of financial markets and are related to changes in family owners’ exit intentions

Hintergrund Ein Skelettkollektiv aus dem 4./5. Jh. wurde molekulargenetisch analysiert. Erste Aussagen zur Geschlechterverteilung innerhalb des Grabungsfunds waren zuvor durch morphognostische Analysen am Knochenmaterial der Einzelindividuen getroffen worden. Jedoch konnte nicht bei allen Einzelindividuen das Geschlecht eindeutig morphognostisch bestimmt werden. Dies war z.T. durch den Zustand des Materials bedingt.

Background The successful post-mortem identification of highly degraded corpses and mass disaster victims using forensic molecular genetic analyses is a challenging task and particularly influenced by the efficacy and evaluation of standard examinations in the laboratory workflow. In many cases only highly degraded soft tissue is present, so that only bones, teeth or nails are available for DNA analysis. A lack of expertise in bone preparation for DNA typing in conjunction with the choice of time-consuming methods often leads to large delays during victim identification.

Die Totung von Neugeborenen gehort zur Seltenheit im rechtsmedizinischen Obduktionsgut, stellt aber dennoch ein relevantes Thema dar. Die Haufigkeit von Neonatiziden, die Feststellung regionaler Unterschiede oder Besonderheiten, ein Vergleich vor und nach der politischen Wende sowie die Erfassung morphologischer Veranderungen an getoteten Neugeborenen sollen dargestellt werden. In der retrospektiven Studie wurden die Daten von 71 Neonatiziden der Regionen Leipzig und Chemnitz uber einen Zeitraum von 30 Jahren ausgewertet. Die Fallanalyse erfolgte anhand der Obduktionsunterlagen des Instituts fur Rechtsmedizin der Universitat Leipzig und des Rechtsmedizinischen Instituts Chemnitz – jetzt Prosektur des Instituts fur Rechtsmedizin Leipzig – der Jahre 1981–2010. Pro Jahr fanden sich zwischen 0 und 6 Neonatizide. Das hausliche Milieu war sowohl der haufigste Fund- als auch Geburtsort; die typischste Auffindesituation war das in Handtucher und/oder Bekleidungsstucke der Kindesmutter eingewickelte und in eine Plastiktute verpackte Neugeborene. Als haufigste Todesursache wurde Ersticken gefunden. Es gab keine signifikanten Unterschiede in der Haufigkeit der Neonatizide zwischen den groseren Stadten Leipzig und Chemnitz sowie den ubrigen kleinstadtischen und landlichen Gebieten. Innerhalb der kleinstadtischen und landlichen Regionen wurde im Vogtlandkreis ein signifikant haufigeres Auftreten von Neonatiziden festgestellt. Die Haufigkeit der Neonatizide blieb im untersuchten Territorium unabhangig von der Gesellschaftsordnung konstant.

Trotz beunruhigender Zahlen fehlt dem Thema „Suizid im hohen Lebensalter“ noch immer die notige Aufmerksamkeit. In den Fokus der Offentlichkeit gelangen Suizide von Alteren haufig nur, wenn es sich um prominente Falle handelt. Mit der vorliegenden Arbeit sollen die Charakteristika der Suizide in Zwickau mit dem Fokus auf die uber 65-Jahrigen herausgearbeitet werden. Es soll gezeigt werden, dass die Zwickauer Suiziddaten mit nationalen und internationalen vergleichbar sind. Es erfolgte eine statistisch-retrospektive Untersuchung aller Todesfalle durch vorsatzliche Selbstbeschadigung der Jahre 1994–2013 im Stadtgebiet Zwickau. Einbezogen wurden Todesbescheinigungen sowie Ermittlungs- und Sektionsakten. Die Todesfalle wurden u. a. hinsichtlich demografischer Faktoren, Methoden, Motiv und Vorankundigungen untersucht. Deutschlandweit und international sind die hochsten Suizidraten in den Altersgruppen der uber 65-Jahrigen zu verzeichnen. Die Untersuchung von Todesfallen durch vorsatzliche Selbstbeschadigung in der Stadt Zwickau in Westsachsen im Zeitraum 1994–2013 ergab eine statistisch hochsignifikant hohe Suizidrate in der Altersgruppe der uber 80-Jahrigen. Angesichts der demografischen Entwicklung in der Bundesrepublik, der zunehmenden Multimorbiditat und der sozialen Isolation alterer Menschen ist von einem weiteren Anstieg der Suizidalitat im Alter auszugehen. Dieses Phanomen sollte in den nachsten Jahren entsprechend weiter thematisiert werden. Es ist notwendig, Praventionen zu erweitern und altere Menschen uber bestehende Hilfsangebote aufzuklaren.

Purpose – The purpose of this paper is to grasp the effect of familiness on capital structure decisions in family firms, as family firm identity may be an important source of competitive advantage due to its potential to moderate relationships with stakeholders such as banks.Design/methodology/approach – The paper uses panel data from 2010 to 2014, which combine financial and structural data on 691 large private German companies. The econometric approach is a random-effect and tobit panel regression using different dependent variables relating to debt.Findings – The study reveals that family firms have significantly higher overall and long-term debt levels compared to their non-family counterparts. Contrary to the extant literature, tangibility is not significantly related to debt in the context of family firms and the hypothesized higher usage of trade credits by family-owned businesses could not be supported.Research limitations/implications – Future research can improve the measurement of familiness by changing from a dichotomous to a continuous variable, acknowledging that family businesses are not homogenous. This would also enable a different econometric approach.Practical implications – A practical implication for family firms is to actively capitalize on their identity and thus, improving the way they present themselves towards different groups of stakeholders to mitigate information asymmetries and enhance trust.Originality/value – The paper investigates large private family-owned businesses, applies multiple dependent variables, and uses a family firm specific theoretical framework, namely familiness, to explain the family’s influence on the business. PurposeThe purpose of this paper is to grasp the effect of familiness on capital structure decisions in family firms, as family firm identity may be an important source of competitive advantage due to its potential to moderate relationships with stakeholders such as banks.Design/methodology/approachThe paper uses panel data from 2010 to 2014, which combine financial and structural data on 691 large private German companies. The econometric approach is a random-effect and tobit panel regression using different dependent variables relating to debt.FindingsThe study reveals that family firms have significantly higher overall and long-term debt levels compared to their non-family counterparts. Contrary to the extant literature, tangibility is not significantly related to debt in the context of family firms and the hypothesized higher usage of trade credits by family-owned businesses could not be supported.Research limitations/implicationsFuture research can improve the measurement of familiness by changing from a dichotomous to a continuous variable, acknowledging that family businesses are not homogenous. This would also enable a different econometric approach.Practical implicationsA practical implication for family firms is to actively capitalize on their identity and thus, improving the way they present themselves towards different groups of stakeholders to mitigate information asymmetries and enhance trust.Originality/valueThe paper investigates large private family-owned businesses, applies multiple dependent variables, and uses a family firm specific theoretical framework, namely familiness, to explain the family’s influence on the business.

Unfavorable prognostic factors-high disease activity, early erosions, and autoantibodies-should be considered when making treatment decisions in rheumatoid arthritis (RA). There are little data on the frequency of individual poor prognostic factors among RA patients in daily care.Disease activity (Disease Activity Score, DAS28), erosions, antibodies against citrullinated peptides or rheumatoid factor (ACPA/RF+), previous treatment failure, inflammation markers, and functional disability (FFbH 70) were defined as prognostic factors. Different treatment decision making situations were evaluated in disease-modifying antirheumatic drug (DMARD)-naïve patients from the early RA CAPEA cohort (n = 1059), and in patients from the biologics register RABBIT after failure of one (n = 2217) or more (n = 3280) conventional synthetic (cs)DMARDs or one (n = 1134) or more (n = 795) biologic (b)DMARDs. With the national database of German arthritis centers (NDB), the frequency of these factors was analyzed according to treatment strata (no/1In DMARD-naïve patients (CAPEA), 50% presented with DAS28 5.1, 64% were ACPA/RF+, 13% had erosions, and 37% functional disability (FFbH 70). In RABBIT, 63 (1With growing numbers of previous DMARD therapies, increasing proportions of patients have poor prognostic factors. This underlines the importance of these factors for a difficult-to-treat disease course.

Family firms commonly prefer internal funding and retention of control. Under certain circumstances, however, equity investments from outside the family can be a relevant alternative source of capital. To facilitate further knowledge about the interaction of family-owned businesses and external equity investors, the present work reviews 42 studies and suggests possible directions for future research. Results reveal that extant studies focus mainly on five key areas—corporate finance, contract design and collaboration, succession and exit route, strategy and performance, and corporate governance. Moreover, the paper discusses various gaps in the extant work and presents three opportunities for future research in a detailed manner. These include a comparison of different types of investors in the context of family-owned businesses, an investigation of minority investor exits from family firms, and an analysis of the impact of investors on family firm boards. All in all, the findings can guide the future development of this emerging field of research and have implications for theory and practice.

In aktuellen Leitlinien der Deutschen Gesellschaft fur Rheumatologie (DGRh) wird eine koordinierte multiprofessionelle Behandlung und Rehabilitation von Patienten mit entzundlich-rheumatischen Krankheiten gefordert. In der Realitat sind Rehabilitationsleistungen der Deutschen Rentenversicherung (DRV) bei diesen Patienten von 2000 bis 2012 bundesweit zuruckgegangen, am deutlichsten bei Mannern mit ankylosierender Spondylitis (AS) um fast ein Drittel. Daruber hinaus zeigen sich fur stationare Rehabilitationsleistungen der DRV wegen rheumatoider Arthritis (RA) zwischen den Bundeslandern Unterschiede um den Faktor 2,6. Rehabilitationsleistungen wegen RA oder AS werden von der DRV bis zu 14-mal haufiger durchgefuhrt als von einer der grosten Krankenkassen, die gesetzlich fur die Rehabilitation jenseits des Erwerbslebens zustandig sind. Die Struktur- und Prozessqualitat sind in Rehabilitationseinrichtungen mit hohen Zahlen von Patienten mit entzundlich-rheumatischen Krankheiten deutlich erhoht. Unter den RA-Patienten in deutschen Rheumazentren sind im Jahr 2011 noch 40 % von mittelgradigen bis erheblichen Alltagseinschrankungen (Funktionsfragebogen Hannover [FFBH] ≤ 70) betroffen. Dennoch halbierten sich nach den Daten der Kerndokumentation von 1995 bis 2011 die stationaren Rehabilitationsleistungen fur RA-Patienten mit FFBH ≤ 70 um etwa die Halfte. In ambulanter rheumatologischer Versorgung erhielten nach eigenen Angaben innerhalb der letzten 12 Monate 38 % der RA-Kranken mit FFBH

Positive therapeutic effects on the work force participation derived from international clinical trials may not be directly transferable to the community based care in Germany. Therefore recent changes of data regarding sick leave (SL), work disability pension (WDP) and employment from the social insurance and from the national database of the German collaborative arthritis centers were analyzed covering a time period of at least 10 years. Health insurance data showed a steeper decline in the average duration of SL caused by rheumatoid arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) compared with all other diseases. In RA patients from the collaborative arthritis centers the mean duration of SL was much more reduced than the average duration of SL for members of the compulsory health insurance. The proportion of gainfully employed RA patients in collaborative arthritis centers has particularly increased in women. According to data from the pension insurance fund less incident cases of WDP due to RA, AS, and SLE have been observed than WDP caused by all other diseases. Thus different nationwide data show positive changes of the work force participation of individuals suffering from inflammatory rheumatic diseases in Germany.

Mainly males in their 40s and 50s suffer from distal biceps tendon rupture. The diagnosis is made by clinical evaluation and is usually confirmed by magnetic resonance imaging. Different approaches and reconstruction techniques have been described in the past, and the clinical results are mostly good and excellent. Thereby the decision regarding which technique to use lies with the surgeon. However, specific complications have been described and should be considered.

Dislocation of a hip arthroplasty is one of the main complications after primary or revision surgery. Definition of specific risk factors concerning patient, indication and surgery makes it possible to determine risk patients for dislocation.The aim of this study is to identify patient-specific risk factors, such as body mass index (BMI), age and gender, in order to evaluate primary dislocation and to correlate with secondary dislocation. It is investigated whether high BMI, advanced age or female gender are able to promote secondary dislocation.In order to identify risk factors for dislocation after primary and revision hip arthroplasty, a retrospective analysis for dislocation was performed of all hip arthroplasties treated in our hospital between 2007 and 2011. 106 patients without an indication for surgical revision were included and treated conservatively. The patient cohort was divided into two groups, depending on the success of the therapy and were analysed for BMI, age and gender. Group I (n = 32) included patients without a re-dislocation event, in contrast to group II (n = 74), which included patients with re-dislocation of the hip arthroplasty.The mean age at the time of primary dislocation was 68 ± 14 years (32 % male and 68 % female). Re-dislocation was presented in 74 cases (70 %). Group II showed a significantly higher BMI (27.11 ± 6.24 kg/m(2)) than group I (24.49 ± 4.86 kg/m(2); p = 0.02). There was no significant effect of age (p = 0.70). The mean age in group I was 71 ± 16 years and in group II of 70 ± 13 years. The incidence of hip dislocation was 2.33-fold higher in women than in men. There was no significant difference between the genders with respect to the risk of re-dislocation.A higher BMI correlates significantly with a greater risk of re-dislocation of a hip arthroplasty. On the other hand, age and gender do not influence the risk. However, the dislocation of a hip arthroplasty is a multifactorial event, which can be influenced by patient-specific factors as well as specific factors for indication and operation technique.

Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient's general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.

Objective To identify the combined effect of prenatal and postnatal vitamin D3 supplementation on the vitamin D status of pregnant and lactating women and their exclusively breastfed infants. Design Double-blind, randomized controlled trial. Setting Upper Midwestern U.S., hospital-based obstetric practice. Participants Pregnant women (N = 13) planning to exclusively breastfeed were randomized at 24 to 28 weeks gestation to receive vitamin D3 at a dosage of 400 IU (control group, n = 6) or 3,800 IU (intervention group, n = 7) daily through 4 to 6 weeks postpartum. Vitamin D status was determined at enrollment and in mother–infant dyads at 24 to 72 hours after birth and 4 to 6 weeks postpartum. Methods Serum 25-hydroxyvitamin D levels were measured to determine the effect of vitamin D3 supplementation on the vitamin D status of mothers and infants. Analysis of covariance was used to compare differences in 25-hydroxyvitamin D levels between the control and intervention groups. Results The mothers' vitamin D levels were significantly higher in the intervention group than in the control group at birth (p = .044) and at 4 to 6 weeks postpartum (p = .002). Infants in the intervention group had significantly higher vitamin D levels at birth (p = .021) and nonsignificant, clinically relevant increases at 4 to 6 weeks of age (p = .256). No differences were found between maternal groups in serum calcium or parathyroid hormone levels. Conclusion Prenatal to postpartum vitamin D3 supplementation is an effective intervention to increase a mother's vitamin D status and to promote optimal vitamin D status in newborns and exclusively breastfed infants.

Glucocorticoide (GC) sind unverzichtbarer Bestandteil einer zeitgemasen Behandlung in der Rheumatologie. Aufgrund des schnellen Wirkungseintritts und des hohen antiinflammatorischen Potentials sind sie in vielen Fallen unverzichtbar. Dies gilt trotz des bekannten Spektrums an unerwunschten Wirkungen und trotz einer eher bescheidenen Evidenz aus kontrollierten klinischen Studien. Umso bedeutsamer sind in dieser Situation Ergebnisse aus Beobachtungsdaten, die sowohl Auskunft geben uber typische Therapieentscheidungen von Rheumatologen im Hinblick auf die Verordnung von GC und die Kombination mit anderen Medikamenten als auch im Hinblick auf die Vermeidung der wichtigsten unerwunschten Wirkung, der GCinduzierten Osteoporose. Diese Daten liefert die Kerndokumentation der Rheumazentren. Sie zeigt als Querschnitt durch die rheumatologische Versorgung, dass 60% der Patienten mit rheumatoider Arthritis unter einer Therapie mit GC stehen, 85% davon mit einer Dosierung bis zu 7,5 mg/d. GC ersetzen nicht die Therapie mit DMARDs sondern sie werden verstarkt in Kombination mit neueren oder als besonders wirksam geltenden DMARDs eingesetzt, was die Orientierung der Therapie am Schweregrad der Krankheit unterstreicht. Die Variationsbreite zwischen den rheumatologischen Einrichtungen hinsichtlich des Einsatzes von GC ist gros und verdeutlicht die insgesamt ungesicherte empirische Evidenz. Hinsichtlich der GC-induzierten Osteoporose wird unter Rheumatologen eine umfangreiche, risikoadaptierte Therapie vorgenommen. Zwei Drittel der Patienten unter GC-Therapie erhalten eine Osteoporoseprophylaxe, Hochrisikogruppen deutlich mehr. Die Daten unterstreichen den hohen Stellenwert der GC in der modernen Rheumatherapie.

Degradation-related poor quality of ancient DNA from long-time stored biological material (e.g. historical skeletal remains) often leads to a loss of information in molecular genetic characterisation. A new generation of DNA quantification and STR technologies consider mentioned issue by an optimised primer design combined with active master mix components. In this respect, the efficiency of the new PowerQuant™ (Promega) quantification kit and the Investigator ® ESSplex SE QS STR kit (QIAGEN) was tested and analysed. Both analyses tools were evaluated by their applicability to monitor the presence of possible PCR inhibitors and DNA degradation that influences downstream STR analyses and further result interpretation. Characteristic features that reflect mentioned phenomena of both systems where correlated with respect to a combined use in aDNA analyses. Here, especially the Investigator ® ESSplex SE QS kit, which features an intelligent system design comprising both DNA typing and quality control, has shown to be valuable. Some given result interpretation thresholds were adapted with regard to aDNA applicability in forensic case work and anthropological interest.

Positive therapeutic effects on the work force participation derived from international clinical trials may not be directly transferable to the community based care in Germany. Therefore recent changes of data regarding sick leave (SL), work disability pension (WDP) and employment from the social insurance and from the national database of the German collaborative arthritis centers were analyzed covering a time period of at least 10 years. Health insurance data showed a steeper decline in the average duration of SL caused by rheumatoid arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) compared with all other diseases. In RA patients from the collaborative arthritis centers the mean duration of SL was much more reduced than the average duration of SL for members of the compulsory health insurance. The proportion of gainfully employed RA patients in collaborative arthritis centers has particularly increased in women. According to data from the pension insurance fund less incident cases of WDP due to RA, AS, and SLE have been observed than WDP caused by all other diseases. Thus different nationwide data show positive changes of the work force participation of individuals suffering from inflammatory rheumatic diseases in Germany.

In this survey of the industry, it is shown that despite the partial dissatisfaction with antimony-based polycondensation catalysts these catalysts are expected to remain the mainstay of industrial PET polycondensation catalysis. This is despite the intensive efforts invested in the search of other, stable and inexpensive non-antimony catalysts, such as those based on titanium, aluminium, and several traodtion metals such as molybdenum, cobalt and zirconium.

Die Pseudodynamik ist eine moderne und effiziente Versuchstechnik zur Ermittlung der Antwort einer Struktur unter starker dynamischer, insbesondere unter Erdbebeneinwirkung. Sie erlaubt, mit einem statischen Experiment das Verhalten eines Tragwerkes unter Erdbebeneinwirkung im Zeitverlauf realistisch zu simulieren. Obwohl weltweit schon viele pseudodynamische Versuche durchgefuhrt wurden, gibt es bisher kaum Anleitungen, welche die Pseudodynamik fur eine breite Anwendung aufbereiten. Im Rahmen der Erdbeben-Tragwerksforschung am Institut fur Baustatik und Konstruktion der Eidgenossischen Technischen Hochschule Zurich wurde eine solche Anleitung fur pseudodynamische Versuche an Tragwerken mit grosen Steifigkeitsanderungen und mehreren Freiheitsgraden entwickelt, die auf eigenen systematischen Versuchen basiert.

Unlike in women, where instruments are available to measure the severity of symptoms, cross-culturally validated instruments are lacking for aging males. This study set out to conduct a translation and cultural validation of the 'Aging Males' Symptoms' (AMS) scale, originally developed in German, into English for use in North America and the UK. Following international methodological recommendations, the AMS scale was translated in a standardized way consisting of forward translation, quality control, backward translation and a pretest. Five experienced bilingual translators and reviewers were involved. Many difficulties of compatibility between the cultural backgrounds of Germany, the UK and North America were identified and resolved by consensus. This resulted in one version for British and American English. A pretest in volunteers demonstrated clarity and understandability across social classes, but also suggested minor changes in the instrument. A preliminary test-retest comparison of the final scale ...