Krankenhausfinanzierung 2013 Fiori, W.; Lakomek, H.-J.; Buscham, K. ...
Zeitschrift für Rheumatologie,
04/2013, Letnik:
72, Številka:
3
Journal Article
Recenzirano
Zusammenfassung
Auch für 2013 ergibt sich wieder eine Vielzahl von Neuerungen in der Krankenhausfinanzierung, die auch für die internistische Rheumatologie von Relevanz sein können. Zunehmend spielen ...neben Änderungen im G-DRG-System 2013 und für die Kodierung auch die sich verändernden gesetzlichen Rahmenbedingungen sowie die Rechtsprechung eine Rolle für die wirtschaftliche Lage und strategische Positionierung eines Krankenhauses. Der Beitrag stellt die wesentlichen Änderungen vor und diskutiert die sich daraus ergebenden Konsequenzen für Rheumakliniken.
We report on the functionalization of nanocrystalline nc-Si/SiO
2
semiconductor quantum dots (QDs) by short d(20G, 20T) oligonucleotides. The obtained complexes have been studied by Raman ...spectroscopy techniques with high spectral and spatial resolution. A new phenomenon of multiband resonant light scattering on single oligonucleotide molecules has been discovered, and peculiarities of this effect related to the nonradiative transfer of photoexcitation from nc-Si/SiO
2
quantum dots to d(20G, 20T) oligonucleotide molecules have been revealed.
If a peripheral target follows an ipsilateral cue with a stimulus-onset-asynchrony (SOA) of 300 ms or more, its detection is delayed compared to a contralateral-cue condition. This phenomena, known ...as inhibition-of-return (IOR), affects responses to visual, auditory, and tactile stimuli, and is thought to provide an index of exogenous shifts of spatial attention. The present study investigated whether tactile IOR occurs in a somatotopic vs an allocentric frame of reference. In experiment 1, tactile cue and target stimuli were presented to the index and middle fingers of either hand, with the hands positioned in an uncrossed posture (SOA 500 or 1,000 ms). Speeded target detection responses were slowest for targets presented from the cued finger, and were also slower for targets presented to the adjacent finger on the cued hand than to either finger on the uncued hand. The same pattern of results was also reported when the index and middle fingers of the two hands were interleaved on the midline (experiment 2), suggesting that the gradient of tactile IOR surrounding a cued body site is modulated by the somatotopic rather than by the allocentric distance between cue and target.
In this paper we present a review of what we know about the evolution and energization of energetic electrons in the inner magnetosphere. We emphasize what we have learned since the review by Friedel ...et al. 17 that discussed in detail the possible acceleration mechanisms for these electrons. The primary result has been a greater focus on local acceleration processes with significant new evidence that points to processes that are acting in the region between GPS and geosynchronous altitudes. In addition to reviewing the most recent results we also use as an example the magnetosphere’s energetic electron responses to a series of storms that occurred in the July 16–25, 2004 period. The storms had gradually increasing magnitude, in terms of their minimum DST of − 80, − 101, − 148, and − 197 nT. We followed the penetration and enhancements of the electrons as a function of L value using the HEO3 observations. We found that the two smallest storms did not cause relativistic electron enhancements for L < 6. 5 but did cause enhancements in the electron “source” populations at > 130 and > 230 keV down to L ∼3. 0. The two largest events cause electron enhancements at all energies from > 130 keV to > 3 MeV down to L ∼2. 5. We found that the Cluster IES observations of the source populations in the pre midnight plasma sheet were quite intense with strong field aligned distributions during the early main phase of the storm on July 24. The combined results indicate that these early main phase electron fluxes at Cluster may be directly linked to the rapid response of electrons at low L observed by HEO3 and could have been the source for the < 1 MeV fluxes observed there.
Observation at the room temperature the spectra of the resonant inelastic light scattering by the spatially confined optical phonons as well as the excitonic luminescence caused by confinement ...effects in the ensemble of isolated quantum dots (QDs) nc-Si/SiO{sub 2} is reported. It is shown that the samples investigated are high purity and high crystalline perfection quality nc-Si/SiO{sub 2} QDs without amorphous phase {alpha}-Si and contaminants. Comparison between the experimental data obtained and phenomenological model of the strong space confinement of optical phonons revealed the need of the more accurate form of the weighted function for the confinement of optical phonons. It is shown that simultaneous detection of the inelastic light scattering by the confinement of phonons and the excitonic luminescence spectra by the confined electron-hole pairs in the nc-Si/SiO{sub 2} QDs allows selfconsistently to determine more accurate values of the diameter of the nc-Si/SiO{sub 2} QDs.
The objective of this experiment was to determine the relative digestive capabilities and N retention between goats and llamas fed three forages. Four llamas (2 yrs; 125
±
7.3
kg BW) and four ...Boer-cross goats (2 yrs; 53
±
8.4
kg BW) were housed in metabolism crates and fed alfalfa (
Medicago sativa; ALF), temperate C
3 grass (
Festuca arundinacea; C3G) and tropical C
4 grass (
Cynodon dactylon; C4G) hays. Each forage was fed for 21 d during which time the animals were adapted to the forage, followed by a 5 d period of urine and feces sample collection. Dry matter intake species differences, when adjusted to metabolic body weight (kg BW
0.75; MW), were noted for ALF and C3G (
P
<
0.01), while the goats showed a difference between all three forages (
P
<
0.05; 61.6, 31.0 and 46.2
g/(d
kg
0.75) for ALF, C3G and C4G, respectively), the llamas showed a difference between the grasses (40.4, 52.1 and 38.5
g/(d
kg
0.75) for ALF, C3G and C4G, respectively). Digestible DM relative to MW (DDM/MW) was higher for ALF and C4G for the goats versus the llamas (
P
<
0.03; 42.5 and 29.0
g/(d
kg
0.75) for goat ALF and C4G and 27.9 and 23.2
g/(d
kg
0.75) for the llama ALF and C4G, respectively). Llamas had a higher DDM/MW for the C3G, 19.6 and 28.9
g/(d
kg
0.75) than goats. Both animal species were in positive N balance for all three forages; llamas and goats retained more N on the high-protein ALF, 0.60 and 0.22
g/(d
kg
0.75), respectively, than they did on either of the grasses (
P
<
0.05; 0.15 and 0.04
g/(d
kg
0.75) for C3G and 0.35 and 0.14
g/(d
kg
0.75) for C4G). Unexpectedly, however, both species retained more N on C4G than on C3G. These results demonstrate that, under these circumstances, llamas do not have a higher digestive efficiency than goats, and goats retained more DM and N than llamas. Thus the goats appear to be more efficient on these forages than the llamas. Feeding strategy and morphology difference may account for these findings.
Zusammenfassung
Der folgende Beitrag stellt die wesentlichen allgemeinen und Rheumatologie-spezifischen Änderungen im G-DRG-System, in den Diagnose- und Prozedurenklassifikationssystemen sowie bei ...der Abrechnung für 2010 vor. Da das G-DRG-System vorrangig als Geldumverteilungsinstrument genutzt wird, muss jedes Krankenhaus mit Hilfe eines Übergangs-Groupers anhand der eigenen Daten analysieren, welche ökonomischen Auswirkungen die Veränderungen haben. Rheumatologische Fachabteilungen können je nach individuellem Leistungsspektrum zu den Gewinnern oder Verlierern der Systemanpassung gehören. Zusätzlich werden relevante Aspekte der aktuellen Rechtsprechung thematisiert.
Zusammenfassung
Der folgende Beitrag stellt die wesentlichen allgemeinen und fachspezifischen Änderungen in der Finanzierung von Leistungen der Rheumatologie in Deutschland für das Jahr 2012 dar. ...Neben den relevanten Änderungen im G-DRG-System 2012 und für die Kodierung wird auch auf die neuen gesetzlichen Rahmenbedingungen sowie auf die Anreize des Vergütungssystems eingegangen. Die sich aus den Veränderungen ergebenden Konsequenzen für Rheumakliniken werden diskutiert.
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