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Cereal phytases originating from wheat and rye or in combination with supplemented microbial phytase (Natuphos®) each were added to phytase-inactivated cereal-based diets to determine whether phytases of different origin exhibit additivity in their response on coefficient of apparent phosphorus (P) absorption in growing pigs. Thirty castrates with an initial body weight of 16.5 kg were kept in stainless steel metabolism crates during a 20 days experimental period. The animals were allocated to six dietary treatments. The basal diets (Diets 1, 3 and 5) were devoid of phytase from wheat and/or rye due to complete inactivation of plant phytase in these grains by microwave treatment. Total phytase activity in the experimental diets was calculated to amount in total to 150 U/kg originating in equal parts from wheat and microbial phytases (Diet 2) or rye and microbial phytases (Diet 4) or wheat and rye phytases (Diet 6). The diets were fed twice daily at a rate of 375 g per meal. An adaptation period of 10 days to the diets and experimental conditions was followed by a quantitative collection of faeces and urine during 10 days. The supplementation of phytase-inactivated basal diets with combinations of microbial and wheat phytases (Diet 2), microbial and rye phytases (Diet 4) as well as with wheat and rye phytases (Diet 6) increased (P<0.05) coefficient of apparent P absorption by 0.179, 0.150 and 0.058 in the wheat-, rye- and wheat–rye-based diets, respectively. The linear regression model was used for predicting the additivity of the effect of each of the intrinsic (cereal) and extrinsic (microbial) phytases on apparent P absorption in growing pigs. It was concluded that different sources of phytases exhibit linear additivity in their response on apparent P absorption in growing pigs, provided that existing differences in equivalency values between cereal and microbial phytases, obtained under similar experimental conditions, are taken into consideration. [Copyright &y& Elsevier]

Summary In contrast to supplemented microbial phytases, considerably lower cereal phytase activities were found after application of an enzyme solution extracted in citrate/NaOH buffer (pH 5.5) for 1 h as compared with the direct incubation of the plant material. Differences between both methods obtained were 70% for wheat and spelt and 50% for barley and rye. The determination of phytase activity of a wheat sample by direct incubation was affected by the sample size and amount of substrate (Na-phytate) added. Optimal conditions are a maximal level of phytase activity of ≤ 0.05 U incubated for 60 min in a buffered solution (citrate/NaOH, pH 5.5) with 10 ml of 32.6 mmol/l Na-phytate at 37 ∘ C. Possible reasons for the differences between both methods and for the factors affecting phytase activity by direct incubation are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Animal Physiology & Animal Nutrition is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Animal Physiology & Animal Nutrition is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Animal Physiology & Animal Nutrition is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Segmenting the population into homogenous groups according to their healthcare needs may help to understand the population's demand for healthcare services and thus support health systems to properly allocate healthcare resources and plan interventions. It may also help to reduce the fragmented provision of healthcare services. The aim of this study was to apply a data-driven utilisation-based cluster analysis to segment a defined population in the south of Germany., Methods: Based on claims data of one big German health insurance a two-stage clustering approach was applied to group the population into segments. A hierarchical method (Ward's linkage) was performed to determine the optimal number of clusters, followed by a k-means cluster analysis using age and healthcare utilisation data in 2019. The resulting segments were described in terms of their morbidity, costs and demographic characteristics., Results: The 126,046 patients were divided into six distinct population segments. Healthcare utilisation, morbidity and demographic characteristics differed significantly across the segments. The segment "High overall care use" comprised the smallest share of patients (2.03%) but accounted for 24.04% of total cost. The overall utilisation of services was higher than the population average. In contrast, the segment "Low overall care use" included 42.89% of the study population, accounting for 9.94% of total cost. Utilisation of services by patients in this segment was lower than population average., Conclusion: Population segmentation offers the opportunity to identify patient groups with similar healthcare utilisation patterns, patient demographics and morbidity. Thereby, healthcare services could be tailored for groups of patients with similar healthcare needs., (© 2023. The Author(s).)

Objectives: Evidence-based decision-making is the sine qua non for safe and effective patient care and the long-term functioning of health systems. Since 2020 Digital Health Applications (DiHA) in Germany have been undergoing a systematic pathway to be reimbursed by statutory health insurance (SHI) which is attracting attention in other European countries. We therefore investigate coverage decisions on DiHA and the underlying evidence on health care effects, which legally include both medical outcomes and patient-centred structural and procedural outcomes., Methods: Based on publicly available data of the Institute for Medicines and Medical Devices searched between 08/2021 and 02/2022, all DiHA listed in the corresponding registry and thus reimbursable by the SHI were systematically investigated and presented descriptively on the basis of predefined criteria, such as clinical condition, and costs. The clinical trials on DiHA permanently included in the registry were reviewed with regard to their study design, endpoints investigated, the survey instruments used, and whether an intention-to-treat analysis was performed. Risk of bias was assessed using the ROB II tool., Results: By February 2022, 30 DiHA had been included in the DiHA registry, one third of them permanently and two thirds conditionally. Most DiHA were therapeutic applications for mental illness based on cognitive behavioural therapy. For all permanently included DiHA, randomised controlled trials were conducted to demonstrate the impact on health care effects. While medical outcomes were investigated for all of these DiHA, patient-centred structural and procedural outcomes were rarely investigated. The majority of clinical trials showed a high risk of bias, mainly due to insufficient reporting quality. Overall, the prices for DiHA covered by SHI are on average around € 150 per month (min. € 40; max. € 248)., Conclusions: Evidence-based decision-making on coverage of DiHA leaves room for improvements both in terms of reporting-quality and the use of patient-centred structural and procedural outcomes in addition to medical outcomes. With appropriate evidence, DiHA can offer an opportunity as an adjunct to existing therapy while currently the high risk of bias of the trials raises doubts about the justification of its high costs., (© 2022. The Author(s).)

In Germany, some digital health applications (DiHA) became reimbursable through the statutory health insurance system with the adoption of the Digital Healthcare Act in 2019. Approaches and concepts for the German care context were developed in an iterative process, based on existing concepts from international experience. A DiHA categorization was developed that could be used as a basis to enable the creation of a reimbursed DiHA repository, and to derive evidence requirements for coverage and reimbursement for each DiHA. The results provide an overview of a possible classification of DiHA as well as approaches to assessment and evaluation. The structure of remuneration and pricing in connection with the formation of groups is demonstrated., Competing Interests: VS was employed by HelloBetter—GET.ON Institut für Online Gesundheitstrainings GmbH. DS and KK were employed by fbeta GmbH. CP was employed by D+B Rechtsanwälte. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lantzsch, Panteli, Martino, Stephani, Seißler, Püschel, Knöppler and Busse.)

Background: Innovative medical technologies are commonly associated with positive expectations. At the time of their introduction into care, there is often little evidence available regarding their benefits and harms. Accordingly, some innovative medical technologies with a lack of evidence are used widely until or even though findings of adverse events emerge, while others with study results supporting their safety and effectiveness remain underused. This study aims at examining the diffusion patterns of innovative medical technologies in German inpatient care between 2005 and 2017 while simultaneously considering evidence development., Methods: Based on a qualitatively derived typology and a quantitative clustering of the adoption curves, a representative sample of 21 technologies was selected for further evaluation. Published scientific evidence on efficacy/effectiveness and safety of the technologies was identified and extracted in a systematic approach. Derived from a two-dimensional classification according to the degree of utilization and availability of supportive evidence, the diffusion patterns were then assigned to the categories "Success" (widespread/positive), "Hazard" (widespread/negative), "Overadoption" (widespread/limited or none), "Underadoption" (cautious/positive), "Vigilance" (cautious/negative), and "Prudence" (cautious/limited or none)., Results: Overall, we found limited evidence on the examined technologies regarding both the quantity and quality of published randomized controlled trials. Thus, the categories "Prudence" and "Overadoption" together account for nearly three-quarters of the years evaluated, followed by "Success" with 17%. Even when evidence is available, the transfer of knowledge into practice appears to be inhibited., Conclusions: The successful implementation of safe and effective innovative medical technologies into practice requires substantial further efforts by policymakers to strengthen systematic knowledge generation and translation. Creating an environment that encourages the conduct of rigorous studies, promotes knowledge translation, and rewards innovative medical technologies according to their added value is a prerequisite for the diffusion of valuable health care., (© 2021. The Author(s).)

Dermal paraneoplastic syndromes are non-malignant disorders, caused indirectly by the increase in growth factors or as immunological reactions, which lead to a variety of inflammatory, hyperkeratotic or proliferative skin reactions. They can occur as facultative or obligate paraneoplastic dermatoses, which are associated with oncological processes (solid tumours or hematologic diseases). The recognition of paraneoplastic skin disorders can accelerate proper diagnosis and determine better prognosis for the patient and is also important to clinicians because it is often the first symptom of life-threatening malignancies. Many of them may also cause ocular changes that can lead to serious complications including perforation of the eye bulb, vascular changes in the retina resulting in vision loss and demand multidisciplinary co-operation with an ophthalmologist. This manuscript is a review of the literature about eye disorders in association with dermal paraneoplastic syndromes., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Termedia Sp. z o. o.)

Background: Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users., Objective: The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine., Methods: An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies., Results: Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models., Conclusions: The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group's social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development., (©Lorenz Harst, Hendrikje Lantzsch, Madlen Scheibe. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.05.2019.)

A total of 72 barrows (initial body weight 16.7 kg) was used, to evaluate the influence of microbial phytase supplementation alone or in combination with calcium to barley soybean meal diets on the accumulation of cadmium (Cd) in kidney, liver, muscle, brain and bone. The control group received the basal diet with 6 g Ca and a low native Cd concentration of 0.03 mg/kg dry matter (DM). In the experimental groups 2, 3, 4 and 5 dietary cadmium concentration was elevated to 0.78 mg/kg DM. The diet of group 3 was supplemented with 800 U microbial phytase/kg, the diet of group 4 with 6 g Ca/kg. The diet of group 5 contained both supplements. The addition of microbial phytase caused an increase of Cd retention in kidney and liver at 30 and 50 kg body weight. This effect was counteracted by the contemporary addition of calcium. A supplementation of Ca alone showed no effect on the Cd accumulation in kidney and liver. In muscle, brain and bone no effects of phytase and calcium on the accumuLation of Cd could be found.