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Ein Disease-Management-Programm (abgekürzt DMP) ist ein zentral organisiertes Behandlungsprogramm für chronisch kranke Menschen. Es stützt sich auf die Erkenntnisse der evidenzbasierten Medizin. Im Bereich der gesetzlichen Krankenversicherung (GKV) werden diese Programme auch als strukturierte Behandlungsprogramme oder Chronikerprogramme bezeichnet. Das Konzept stammt ursprünglich aus den USA.

Disease-Management-Programme existieren im deutschen Gesundheitswesen seit etwa 2002. Sie gelten als Bausteine für andere neuartige Konzepte wie integrierte Versorgung und Fall-Management.

Definition

Es gibt für den Begriff Disease Management keine einheitliche Definition. Exemplarisch sei hier die Definition der Disease Management Association of America (DMAA) in der Übersetzung der Bundesärztekammer wiedergegeben:

"Disease-Management besteht aus einem System koordinierter Gesundheitsversorgungsmaßnahmen und Informationen für Patientenpopulationen mit Krankheitsbildern, bei denen eine aktive Beteiligung der Patienten an der Behandlung zu substanziellen Effekten führen kann. Disease-Management

 unterstützt die Arzt-Patientenbeziehung und das Behandlungsschema
 zielt auf die Prävention von Krankheitsverschlechterungen und Komplikationen durch die Verwendung Evidenz-basierter Behandlungsleitlinien und Patienten-Empowerment-Strategien
 prüft fortlaufend die klinischen, humanitären und ökonomischen Behandlungsergebnisse mit dem Ziel, die Gesundheitslage zu verbessern"

Ziele
Etwa zwanzig Prozent der Bundesbürger leiden an chronischen Erkrankungen mit einer Krankheitsdauer von mehr als vier Wochen und brauchen eine kontinuierliche ärztliche Behandlung, die Überwachung und medikamentöse Therapie umfasst. Die Organisation des deutschen Gesundheitswesens ist aber primär auf die Therapie von akuten Krankheiten ausgerichtet, so dass ein chronisch kranker Patient mehrere Anlaufstellen für verschiedene Aspekte seiner Krankheit haben kann. Der erste Ansprechpartner ist normalerweise der Hausarzt, der in der Regel auch die Langzeitbetreuung übernimmt. Sind Spezialkenntnisse oder spezielle Geräte erforderlich, wird der Patient zu einem Facharzt oder sogar zu mehreren Fachärzten überwiesen oder in ein Krankenhaus eingewiesen. Patienten können aber einen Facharzt auch direkt konsultieren oder sich in Notfällen im Krankenhaus behandeln lassen. Dort wird dann zwar der Akutfall therapiert, es findet aber keine präventive Langzeitbetreuung statt. Auch können die Patienten den Hausarzt oder die Fachärzte beliebig oft wechseln und verschiedene Krankenhäuser aufsuchen. Mitunter stockt der Informationsfluss zwischen den Behandlern, so dass es an der Koordination der Behandlung mangelt. Durch diese unsystematische, punktuelle Behandlung besteht die Gefahr einer Unter-, Über- oder gar Fehlversorgung des Patienten. Diese Entwicklung soll durch Disease-Management-Programme korrigiert werden, indem eine langfristige, präventive Begleitung des Chronikers erfolgt.

Mit Hilfe von Disease-Management-Programmen sollen
 Patienten, die unter chronischen Krankheiten leiden, durch eine gut abgestimmte, kontinuierliche Betreuung und Behandlung vor Folgeerkrankungen bewahrt werden;
 Haus- und Fachärzte sowie Krankenhäuser, Apotheken und Reha-Einrichtungen koordiniert zusammenarbeiten;
 die Therapieschritte nach wissenschaftlich gesichertem medizinischen Wissensstand aufeinander abgestimmt sein;
 mittel- bis langfristig die Leistungsausgaben der Krankenkasse gesenkt werden.

Indikationen des Disease-Management-Programme sind insbesondere so genannte Zivilisationskrankheiten – beispielsweise Koronare Herzkrankheit, Asthma, Chronisch obstruktive Lungenerkrankung oder Diabetes mellitus Typ II. Diese Krankheiten treten aufgrund der modernen Lebensumstände – schlechte Ernährung, Bewegungsarmut, Stress, Umweltgifte – häufig auf und verursachen einen wesentlichen Anteil der medizinischen Versorgungskosten. Allein der Anteil der Diabetiker an der Erwachsenenbevölkerung in Deutschland und Europa wird auf 7 % bis 8 % geschätzt. Entsprechend zielen die begleitenden Maßnahmen der Disease-Management-Programme auf Verhaltensänderungen bei den Patienten ab – gesündere Ernährung, mehr Bewegung, Raucherentwöhnung etc.

Disease Management kann auch bei anderen, nicht zivilisationsbedingten chronischen Krankheiten eingesetzt werden. In Deutschland gibt es zurzeit (2019) Programme für Brustkrebs, Diabetes mellitus Typ I, Diabetes mellitus Typ II, Asthma, Chronisch obstruktive Lungenerkrankung (COPD) sowie Koronare Herzkrankheit (KHK) mit einem Modul Chronische Herzinsuffizienz.

Instrumente
Disease-Management-Programme stellen keinen Ersatz für die Therapie durch einen Arzt dar, sondern sind als unterstützende und koordinierende Maßnahme vorgesehen. In erster Linie haben sie informativen Charakter, d. h., der Patient wird über seine Krankheit, deren Symptome und Bedeutung, Behandlungsmöglichkeiten, Medikamente und Spezialärzte umfassend aufgeklärt. Dazu werden fast alle Möglichkeiten der modernen Kommunikation verwendet:
 Informationsbroschüren;
 Telefonische Beratungsgespräche;
 Erinnerungen (z. B. an notwendige Arztbesuche) per Telefon, Brief, E-Mail oder SMS;
 Beratung und Betreuung der Arzneimitteltherapie in der Apotheke vor Ort;
 Statistische Auswertungen über den Gesundheitszustand;
 Schulungen;
 Unterstützung durch telemedizinische Geräte.

Varianten
Im deutschen Gesundheitswesen werden zwei Spielarten von DMPn unterschieden:
 Disease-Management-Programme nach RSAV (DMP nach RSAV bzw. RSA-DMP);
 Freie Disease-Management-Programme.

DMP nach RSAV/DMP-Richtlinie
Die Disease-Management-Programme nach RSAV (Risikostrukturausgleich-Verordnung) wurden mit dem Gesetz zur Reform des Risikostrukturausgleichs in der gesetzlichen Krankenversicherung vom 10. Dezember 2001 eingeführt. Dies entsprach einem Vorschlag aus einem Gutachten von Karl Lauterbach und Eberhard Wille für die Verbände der Gesetzlichen Krankenversicherung. Sie sind den gesetzlichen Krankenkassen (GKV) vorbehalten, da die Anzahl der am DMP teilnehmenden Patienten sich auf die Berechnung des Risikostrukturausgleichs auswirkte. Für eingeschriebene (d. h. teilnehmende) Versicherte wurden von 2003 bis 2008 neben den übrigen Versicherten eigene Profile gebildet, auf deren Basis ein gesonderter Ausgleich unter Berücksichtigung von durchschnittlichen Leistungsausgaben dieser Versichertengruppe stattfindet. Dies führte dazu, dass die Krankenkassen für solche eingeschriebenen Versicherten die Durchschnittsausgaben dieser Versichertengruppen aus dem RSA zugerechnet bekamen und nicht nur die wesentlich geringeren Zuweisungen, die sich aufgrund von Alter und Geschlecht ergaben. Seit Inkrafttreten des GKV-Versorgungsstrukturgesetz (GKV-VStG) zum 1. Januar 2012 ist der G-BA beauftragt, zu den DMP eigene Richtlinien zu erlassen.

Die Indikationen, für die DMP nach RSAV durchgeführt werden können, werden vom Gesetzgeber festgelegt. Im Einzelnen sind dies zurzeit:
 Brustkrebs,
 Diabetes mellitus Typ II,
 Koronare Herzkrankheit (KHK) inkl. Modul zu chronischer Herzinsuffizienz,
 Diabetes mellitus Typ I,
 Chronisch obstruktive Atemwegserkrankungen (COPD),
 Asthma bronchiale.

Weitere Indikationen (wie chronischer Rückenschmerz, Osteoporose, rheumatoide Arthritis, Depressionen, Herzinsuffizienz) sind in Vorbereitung; ob sie tatsächlich umgesetzt werden, ist allerdings noch nicht klar.

Möchte eine gesetzliche Krankenversicherung ein DMP nach RSAV durchführen, so entwickelt sie zunächst ein Programmkonzept und schließt dazu Verträge mit den Kassenärztlichen Vereinigungen (KV), Ärztenetzen, Krankenhäusern oder einzelnen Ärzten zu dessen Durchführung ab. Da es in Deutschland derzeit 17 KV-Bereiche gibt, muss eine bundesweit operierende Kasse somit mindestens 17 Verträge abschließen, um eine flächendeckende Versorgung zu gewährleisten. Diese Verträge werden dann beim Bundesamt für Soziale Sicherung (BAS) zur Prüfung eingereicht. Entsprechen die Verträge den gesetzlichen Anforderungen, werden sie vom BAS akkreditiert, d. h., die Berücksichtigung im Risikostrukturausgleich wird genehmigt.

Um die Qualität der Behandlungsprogramme sicherzustellen und die Versorgungsziele für einen Patienten festzulegen, ist im Laufe des Programms von Arzt und Versicherten regelmäßig gemeinsam ein Dokumentationsbogen auszufüllen. Dieser Dokumentationsbogen enthält einen Datensatz mit wichtigen Parametern, die zur Evaluation des Programms dienen. Auf dem Dokumentationsbogen werden – abhängig von der Indikation – folgende Werte festgehalten:
 Wichtige Laborparameter bzw. deren Veränderung;
 Untersuchungen;
 Begleit- und Folgeerkrankungen;
 Relevante Medikamente;
 Empfohlene und durchgeführte Schulungen;
 Administrative Daten (behandelnder Arzt, Erstellungsdatum etc.).

Anhand dieser Dokumentationsbögen kann die Krankenkasse den Verlauf des Programms unterstützen und die Wirkung kann ausgewertet werden.

Teilnahme der Versicherten
Die Teilnahme eines Patienten ist freiwillig, wird jedoch häufig mit Bonusmaßnahmen unterstützt. Möchte ein Patient an einem DMP teilnehmen, so muss er sich zunächst einen am Programm teilnehmenden Arzt auswählen. Der Arzt erklärt dabei seine Teilnahme gegenüber der Kassenärztlichen Vereinigung, die ihm nach Prüfung der Strukturvoraussetzungen die Teilnahme bestätigt. Zusammen mit dem Arzt füllt der Patient dann eine Teilnahmeerklärung und die Erstdokumentation (elektronisch) aus.
Die ausgefüllten Unterlagen werden in Papierform und elektronisch (per Datenträger oder Datenfernübertragung) an eine Datenstelle weitergeleitet. Die Datenstelle muss den Datensatz anhand definierter Kriterien auf Plausibilität, Vollständigkeit und fristgerechte Übermittlung überprüfen. Soweit Daten zu ergänzen oder zu korrigieren sind, fordert sie diese beim Arzt nach.

Die erhobenen Daten werden mit pseudonymisierten Versichertendaten zur Gemeinsamen Einrichtung der das DMP durchführenden Krankenkassen und der KV übermittelt. Die Daten werden auch vollständig an die Krankenkasse weitergegeben. Dabei ist von der Krankenkasse sicherzustellen, dass nicht jeder Mitarbeiter Zugriff auf die Daten der Dokumentationen erhält. Die Dokumentationen stehen unter einem besonderen Datenschutz und dürfen nur für die Zwecke der DMP eingesehen und verarbeitet werden.

Qualitätssicherung
Bestandteil der DMP-Verträge sind Ziele, die mit den Disease-Management-Programmen erreicht werden sollen, sowie konkrete Auslösealgorithmen auf Basis der auf den Dokumentationsbögen dokumentierten Parameter. Dabei wird festgelegt, ob der Arzt durch die gemeinsame Einrichtung der Krankenkassen und KV oder der Versicherte von seiner Krankenkasse Informationen erhalten soll. Dies bedeutet z. B., dass für am DMP Diabetes mellitus Typ 2 teilnehmende Versicherte, die nicht jährlich zur Untersuchung ihrer Augen eine Überweisung zum Augenarzt bekommen haben, von der Krankenkasse über die Wichtigkeit dieser Untersuchung informiert werden sollen.

"Reminding"
Unter "Reminding" werden Erinnerungssysteme sowohl für den Arzt als auch für den Patienten verstanden. Der Arzt wird auf noch im Quartal zu erstellende Dokumentationen hingewiesen. Die Krankenkassen informieren ihre Versicherten bei fehlenden Dokumentationen, nicht wahrgenommenen Schulungen oder anderen diagnose-spezifischen Anlässen.

Beendigung der Teilnahme
Des Weiteren übernimmt die Krankenkasse das so genannte "Fallclearing". Das bedeutet, dass die Kasse anhand festgelegter Regelwerke die Erfüllung des Programms kontrolliert und den Patienten gegebenenfalls ausschreibt, d. h. die Programmteilnahme beendet. Bei der Indikation Brustkrebs muss beispielsweise die Ausschreibung vorgenommen werden, wenn die Erstmanifestation – also das erste Auftreten – der Krankheit mehr als zehn Jahre zurückliegt und der Patient rezidivfrei ist. Weitere Ausschreibegründe sind unzureichende Programmteilnahme – in der Regel fehlende oder zu spät eingehende Dokumentationsbögen oder nicht wahrgenommene Schulungen – sowie Tod oder Kassenwechsel.

Konzeptionelle Kritikpunkte
 Die Definition der medizinischen Leitlinien für den Gesundheitszustand und die Methoden der Therapie sind in der medizinischen Fachwelt nicht unumstritten, bilden aber die Mehrheitsmeinung ab.
 Einige Ärzte fühlen sich in der Behandlungsfreiheit eingeschränkt, da sie sich bei ihrer Behandlung an der Leitlinie orientieren sollen. Der anfangs starke Widerstand der Ärzte hat sich allerdings mittlerweile gelegt. Die meisten Kassenärzte in Deutschland nehmen an den RSA-DMP teil.
 Die Verbindung mit dem Risikostrukturausgleich der Krankenkassen hat in der Vergangenheit dazu geführt, dass möglichst viele Patienten in ein Programm eingeschrieben wurden, um nicht finanziell benachteiligt zu werden. Durch die Koppelung an den Risikostrukturausgleich stand eher die Quantität der eingeschriebenen Versicherten als die Qualität der Versorgung von Hochrisikopatienten im Vordergrund. Derzeit gibt es nur noch eine Erstattung der Durchschnittsausgaben, die teilweise nicht zur Kostendeckung der Programme reicht.
 Die Dokumentationen waren zu bürokratisch und zu kompliziert und wurden während des laufenden Verfahrens zum Teil drastisch geändert (Datenversionen 1 und 2 gemäß RSAV 7. Fassung und RSAV 9. Fassung).
 DMP-Verfahren mussten auf Grund der föderalen Struktur der Ärztevertretungen für jeden KV-Bezirk einzeln verhandelt werden. Hierbei wurden Verträge mit unterschiedlichen Inhalten abgeschlossen.
 Durch Einschaltung des Bundesversicherungsamtes als Genehmigungs- und Prüfungsinstitution wurde der Prozess maßgeblich bürokratisiert und führt zu hohen Verwaltungskosten bei den Krankenkassen. So sind einige Punkte nicht klar geregelt bzw. wurden bei der Definition der Programme nicht berücksichtigt und lassen daher Interpretationsspielraum. Erst im Jahr 2006 lag ein verbindlicher Prüfkatalog vor, der zwischen den Landesprüfdiensten und dem Bundesversicherungsamt geeint wurde. Zuvor gab es jahrelang Unstimmigkeiten bzgl. einzelner Auslegungsfragen. Für die Krankenkassen ist der Prüfkatalog ein maßgebliches Instrument für ihre DMP-Organisation.
 Durch Interpretation des Gesetzes durch das BVA wurde die Konzeption von DMP-Programmen nach RSAV ausschließlich den öffentlich-rechtlichen Institutionen im Gesundheitswesen zugesprochen. Private Anbieter von DMP-Programmen konnten daher nur als Dienstleister der Kasse die Programme mitgestalten und umsetzen.
 Durch den i. d. R. regional einheitlichen Abschluss der DMP wurde verhindert, dass die Krankenkassen unterschiedliche Programme (z. B. stärker patientenorientiert) anbieten können. Somit ist es nicht möglich, unterschiedliche Ansätze und Konzepte umzusetzen und deren Wirksamkeit und Effizienz zu erproben.

Praktische Schwierigkeiten bei den DMP-Daten
 Insbesondere bei der Einführung der DMP nach RSAV traten in den Jahren 2003–2005 in der Praxis große Schwierigkeiten auf.
 Die permanenten Anpassungen des Prozessdesigns und der Dokumentationsbögen führen zu einem erheblichen Mehraufwand in der Administration für alle Beteiligten: Patienten, Ärzte aber auch Krankenkassen u. a.
 Die DMP-Verträge mit den einzelnen KV-Bezirken gestalten sich unterschiedlich, so dass der Programmteilnehmer einem KV-Bezirk zugeordnet werden muss. Maßgeblich für die Zuordnung ist allerdings nicht der Wohnort des Versicherten, sondern die Praxisniederlassung des behandelnden Arztes, was zu Schwierigkeiten führen kann.
 Aufgrund der föderalen Gliederung der Kassenärzte in 17 KV-Bezirke gibt es keine bundesweit einheitliche Liste mit akkreditierten Ärzten. DMP-Anbieter müssen daher Akkreditierungslisten in unterschiedlichsten Formaten zusammenführen.

eDMP – elektronisches DMP
Beginnend im Jahr 2005 wurde in allen KV-Regionen das eDMP eingeführt, d. h. die elektronische Übermittlung von Dokumentationen zwischen Arztpraxis und Datenstelle. Dabei werden die Daten der bisherigen Dokumentationsbögen auf einer Diskette, einer CD oder über ein gesichertes Online-Verfahren übertragen. Parallel ist die Unterschrift des Arztes auf einem "Begleitschein" oder einer "Versandliste" notwendig, da es noch keine zugelassene elektronische Arztunterschrift gibt. Spätestens zum 1. Juli 2008 (je nach Bundesland) ist eDMP für alle Vertragsärzte verpflichtend. Für Brustkrebs konnte in Ausnahmefällen bis zum 1. Juli 2009 per Bogen dokumentiert werden.

Umfang der über DMP im RSA verteilten Beträge
Im RSA-Jahresausgleich 2005 entfielen von den 70,1 Mio. Versichertenjahren rd. 1,7 Mio. auf Versichertenjahre mit Einschreibung in ein DMP, also nur rd. 2,4 von Hundert. Da die Eingeschriebenen in der Regel überdurchschnittlich kostenintensive Erkrankungen aufweisen, beträgt der Anteil der DMP-Ausgaben an allen im RSA berücksichtigten Ausgaben allerdings mit 7,9 Mrd. Euro Ausgaben von 129,2 Mrd. Euro Ausgaben rd. 6,1 vom Hundert. (Daten aus dem Internet beim Bundesversicherungsamt herunterladbar: www.bundesversicherungsamt.de, dort bei "Fachinformationen, Risikostrukturausgleich, Jahresausgleiche".)

Neuere Entwicklungen und Ausblick
Im Jahr 2008 entfiel das Erfordernis der Arztunterschrift auf den Folgedokumentationen durch das GKV-Wettbewerbsstärkungsgesetz (GKV-WSG 2007). Ferner wurde zum 1. April 2008 die elektronische Dokumentation Pflicht.

Zum 1. Januar 2009 wurde der bisherige Risikostrukturausgleich durch einen morbiditätsorientierten RSA (Morbi-RSA) abgelöst. Innerhalb des neuen Morbi-RSA entfällt die gesonderte Erstattung der erhöhten Krankheitskosten von DMP-Teilnehmern an die Krankenkassen – sie wird jetzt für 80 ausgewählte Krankheitsgruppen durchgeführt. Allerdings erhalten die Krankenkassen weiterhin für jeden in ein DMP eingeschriebenen Versicherten eine Programmkostenpauschale pro Monat (2009: 15 Euro/Monat, 2012: 12,76 Euro/Monat). Die Attraktivität der DMPs für die Krankenkassen hat sich durch die RSA-Änderung deutlich verringert.

Mit dem GKV-VStG wurde zum 1. Januar 2012 auch das Erfordernis der Arztunterschrift auf Erstdokumentationen abgeschafft. Mit der Unterschrift hatte der Arzt bis dahin die Richtigkeit der Angaben auf der Dokumentation bestätigt.

Im Jahr 2013 treten zum 1. Juli 2013 Überarbeitungen in den DMP Brustkrebs, Asthma und COPD in Kraft. Alle DMP-Teilnehmer werden über die Änderungen von den Krankenkassen und den Ärzten informiert. Änderungen ergeben sich insbesondere durch den medizinischen Fortschritt im DMP Brustkrebs.

Freie DMP
Ein freies Disease-Management-Programm ist jedes DMP, welches ohne RSA-Koppelung und BVA-Aufsicht entwickelt und durchgeführt wird. In erster Linie sind das die DMP der privaten Krankenversicherungen (PKV), es gibt jedoch auch gesetzliche Kassen, die solche freien DMP durchführen, dann i. d. R. als Modellvorhaben oder Projekt der Integrierten Versorgung.
Die Gestaltung der freien DMP ist patientenzentriert und zum Teil umfangreicher als die der RSA-DMP. Auch hier finden regelmäßige Beratungsgespräche statt, bei denen relevante Daten erhoben werden. Auch Info-Broschüren und statistische Auswertungen des Gesundheitszustandes sind Bestandteil der medizinischen DMP. Weiterhin unterstützen selbst zusammengestellte Befundbögen und telemetrische Geräte das Betreuungsprogramm. Oft werden die Patienten abhängig von ihrem Gesundheitszustand auch verschieden intensiv betreut.
Die Indikationen sind ähnlich den RSA-DMP hauptsächlich Zivilisationskrankheiten wie Diabetes, Osteoporose, Herzkrankheiten, Asthma, Hypertonie usw. Auch Präventionsprogramme z. B. zur Ernährung werden im Rahmen von freien DMP angeboten.
Der prinzipielle Ablauf gliedert sich ähnlich den RSA-DMP in drei Phasen: Selektion, Gewinnung und Betreuung.
Der Schwerpunkt liegt hier weniger auf der Quantität, sondern auf der Qualität der Betreuung, da die DMP zunächst erhöhten Verwaltungsaufwand für die Krankenkasse bedeuten und die Kosteneinsparungen nicht pauschal durch die Quantität der eingeschriebenen Patienten entstehen, sondern durch die gezielte Betreuung von Hochrisikopatienten und Schwerkranken.
Bei der Umsetzung der freien DMP haben sich ebenfalls einige praktische Schwierigkeiten ergeben:
 Mangelnde Mitwirkungsbereitschaft der Versicherten. Besonders bei Herzkrankheiten und Diabetes sind die Patienten meist schon in einem hohen Lebensalter und haben eine lange Leidensgeschichte hinter sich. Diese Gruppe zu Verhaltensänderungen zu motivieren oder ihnen eine positive Einstellung zum Programm abzuringen, gestaltet sich recht schwierig. Besonders die PKV-Kunden sind zudem oft Gutverdiener bzw. in der sozialen Rangordnung recht hoch stehende Personen, die in ihrem Leben bereits viel erreicht haben und viel Verantwortung tragen. Diese Gruppe lässt sich nicht gern in ihre Lebensgestaltung hineinreden, da sich ihr beruflicher Erfolg psychologisch kaum mit "mangelhaftem" Privatleben in Übereinstimmung bringen lässt.
 Die Ärzteschaft steht den freien DMP meist noch skeptischer gegenüber als den RSA-DMP, da weder ihre eigenen Vertretungen (z. B. Kassenärztliche Vereinigungen) noch übergeordnete Institutionen wie der Gesetzgeber mit einbezogen sind. Dadurch entsteht noch mehr das Gefühl, ihnen würde die Verantwortung für den Patienten entzogen.

Evaluation
Seit der Einführung der Disease Management Programme in Deutschland 2003 bestand die gesetzliche Verpflichtung nach §137 Sozialgesetzbuch V, den Erfolg der Maßnahme zu belegen (Evaluation). Diese Verpflichtung nahm ursprünglich das Bundesministerium für Gesundheit war, hat diese Aufgabe 2011 jedoch an den Gemeinsamen Bundesausschuss (G-BA) übertragen. Das Bundesamt für Soziale Sicherung lässt neue strukturierte Behandlungsprogramme (Disease Management Programme – DMP) zu. Seit 2016 werden die Evaluationberichte von den Gesetzlichen Krankenkassen erstellt, die dafür externe Dienstleister beauftragen. Der G-BA erlässt nur noch die Richtlinien für die Anforderungen der Evaluation. Die Firma Medical Netcare GmbH ist deutschlandweit für alle BKKen, IKKen und Ersatzkassen als Evaluator tätig. Sie stellt aktuelle Evaluationsberichte online zur Verfügung. Die Berichte für die AOK und die Knappschaft werden vom Institut für angewandte Sozialwissenschaft GmbH (infas) sowie der Prognos AG erstellt. Von der ärztlichen Seite werden ebenfalls Evaluationsberichte zur Verfügung gestellt.

Der wissenschaftlich wünschenswerte Vergleich einer Anwendergruppe mit einer Kontrollgruppe, die nicht am DMP teilnimmt scheitert am Datenschutz der Nichtanwender. Eine Nutzung der Routinedaten von Nichtteilnehmern ist rechtlich unzulässig. Die Evaluation besteht daher in der Protokollierung und Verlaufsdokumentation der Messwerte der Teilnehmer.

Beispiele für Studien zu Disease-Management-Programmen:
 Jaan Sidorov, Robert Shull, Janet Tomcavage, Sabrina Girolami, Nadine Lawton, Ronald Harris: Does diabetes disease management save money and improve outcomes? In: Diabetes Care. 25(4), April 2002, S. 684–689.
 D. P. Holst, D. Kaye, M. Richardson, H. Krum, D. Prior, A. Aggarwal, R. Wolfe, P. Bergin: Improved outcomes from a comprehensive management system for heart failure. In: Eur J Heart Fail. 3(5), Oktober 2001, S. 619–625.
 G. C. Fonarow, L. W. Stevenson, J. A. Walden, N. A. Livingston, A. E. Steimle, M. A. Hamilton, J. Moriguchi, J. H. Tillisch, M. A. Woo: Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. In: J Am Coll Cardiol. 30(3), Sep 1997, S. 725–732.

Literatur

 Kerstin Raczek, Jens Bölscher, Johann-Matthias Graf v.d. Schulenburg: Disease Management bei Diabetes mellitus. Cuvillier Verlag, Göttingen 2000, ISBN 3-89712-846-2.
 Viviane Scherenberg: Patientenorientierung – Compliance und Disease Management Programme. Verlag für Wissenschaft und Kultur, Stuttgart 2003, ISBN 3-936749-43-4.

Weblinks
 Bundesversicherungsamt (BVA) – Informationen zu den DMP und der Kopplung an den RSA (abgerufen am 10. Oktober 2011 um 15:40)

Einzelnachweise

Gesundheitswesen (Deutschland)


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Five Questions With Melissa Parker, Founder And CEO Of Reed's Remedies
Melissa Parker
Courtney Belmontes
Five Questions with Melissa Parker, founder and CEO of Reed's Remedies, a new line of CBD sprays that include Focus, Sleep, Calm, Detox, Desire, Relief, and introducing Soothe — a new pain mitigating lotion. Offering an exact 7 mg dose every time, Reed's Remedies sprays combine the power of steam-distilled CBD in its absolute purest form with a dynamic blend of plant-based compounds (called terpenes) that, when combined, produce effects far more powerful than what any element could achieve alone. But there's more to this line of CBD products found throughout Southern California's Erewhon Market locations, which is why it's a NEXTY Award finalist for "Best New Hemp/CBD Product" at the 2020 Natural Products West Expo, the nation's largest annual gathering of health and wellness brands and retailers.
Warren Bobrow=WB: Please tell me about yourself? Where are you from? What was your path to healing? Tell me about your company?
Melissa Parker=MP: I am a Los Angeles native, a wife, mother of three girls, and founder of Reed's Remedies. For as long as I could remember, I've had a passion for nature and, more specifically, a fascination with medicinal plants, pharmacology and human biology. I get it from my father, Bill Reed, who passed away from a brain aneurysm when I was 17, and I suppose he got it from his father, Ernest "Dale" Reed, who was a chemist. Like them, my happy place is being neck deep in science and research… but always with a focus on the natural world and an aim to heal. In 2015, I discovered CBD, and the more research I consumed, the more I became utterly convinced that this cannabinoid would revolutionize health, wellness and medicine as we know it.
Since 2015, I've been working with one of the industry's leading scientists on a new technology that combines advanced molecular steam-distilled cannabinoids (CBD) and powerful terpenes to create formulas that are highly concentrated, designed for quick absorption, pure and targeted. Alone, each ingredient has a level of therapeutic value, but the "magic" happens when each of our formulation ingredients are brought together. Their medicinal properties are strengthened, and they work together to produce powerful, fast-acting results in the form of an oral spray.
Our sprays deliver a precise dose of 7mg of CBD-rich hemp oil in each pump. The closed container maintains its purity and strength by keeping it safe from exposure to air and contaminants.
Reeds_Remedies_Bottle_Desire
Photo credit: Edition Design Company
Three years of R&D work has gone into Reed's Remedies, which launched in 2018. Other than my three daughters, these products are my proudest accomplishments. Seeing Reed's Remedies featured throughout Erewhon Market stores is a beautiful reward too, as Southern Californians know that Erewhon is synonymous with cutting-edge innovation, sustainability, and the highest quality health and wellness products.
WB: I wrote a book, actually my first book- on Apothecary Cocktails. How much is the current craze surrounding CBD different from the pharmacists working in pharmacy science in the 1800's? What do you think about the term Snake Oil? How does this affect your work?
MP: Because of my reliance on apothecary sciences and botany, I've always felt like a pharmacist from the 1800s, especially back in 2008 at the height of my herbal medicine practice. A hundred years ago, essential oils and herbal tinctures (including cannabis and hemp oil!) were available at pharmacies throughout the U.S. and used as a primary source of medicine.
Reed's Remedies Terpene Chart 02.05.20
Snake oil in today's marketplace is rampant and very real; study after study confirms that the majority of products online that claim to be CBD are in fact oils low in CBD and high in dangerous toxins. It falls upon companies like mine to combat the poor reputation they have created. To that end, each bottle of Reed's Remedies bears a QR code that allows easy access to independent, third party lab test results on the exact formulation scanned. I don't want consumers to take my word for it; I want them to see for themselves and feel assured that Reed's Remedies are free of solvents, heavy metals, toxins, pesticides, chemicals and additives. Our formulations are pure by nature and design so that my customers are only ingesting what they need, and nothing more. We also source from one of just 13 hemp farms to bear the U.S. Hemp Authority seal, a stamp given to a select few that follow the strictest, cleanest and safest growing practices.
WB: Please tell me about how you deal with stigmas? How do you tell people about what you do? What is their most common reaction?
MP: In California, there isn't too much stigma or resistance, though I was initially hesitant to tell acquaintances in my outer circles about what I do. I'm comfortable with it now and those same people who I once worried wouldn't understand CBD now come to me for advice and direction on how they can use it to achieve relief for themselves or a loved ones. The question I hear the most from first time users is, "How is CBD going to make me feel?" Some people are anxious about the possibility of feeling out of control or high. The beauty of CBD is that it makes you feel like the best version of yourself, which is why we say at Reed's Remedies that "You are within reach." We also take the guesswork out of it by offering formulas for specific needs. Consumers are looking for more sleep, more focus, more relief, more calm, and more desire in their lives. It's about being empowered to take your health and wellness into your own hands so that you can finally feel more you, naturally.
WB: Do you cook? Have you ever prepared foods that your grandma made when you were young? (If you were lucky enough to have a grandma who cooked for you?) What is your favorite restaurant? What kind of food? Where is it?
MP: I don't have many chefs in my family, but I am blessed to have grown up in Los Angeles, where there is so much diversity in cuisine. When I want comfort food, I drive to a little hole-in-the wall place in the heart of the San Fernando Valley called Mandarin Deli which serves authentic Mandarin food which makes my soul smile. I always order the same thing: scallion pancakes and beef noodle soup. The best! Makes me drool just thinking about it. I've been going for 24 years now.
WB: What is your passion?
MP: Helping people who are suffering. Life is full of suffering, and none of us are immune to it. From losing my father in my youth to experiencing a car accident as an adult that left me dealing with chronic pain and a host of long-term medical problems, I know first-hand how painful life can be. Helping people in any way I can, by providing relief that is within reach, is what has and continues to drive me. Sharing my knowledge of plant medicine and giving people a renewed sense of hope and excitement in life is beyond fulfilling.
Friday's Best Deals: Aukey USB-C Hub, Cyberpunk 2077 Pre-Order Sale, Pokemon Sword, and More Charlottes Web Hldgs Inc. (CWBHF) Q4 2019 Earnings Call Transcript

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Write output of bash script to file with date I'm trying to create a log file of a bash script that is run with the data. I currently have this:
bash script.sh > /var/log/%Y-%m-%d_%H:%M.log

The problem is the log file actual writes %Y-%m-%d_%H:%M and not the date. Is there way to get the date to actually write out the date by only running it in the console?

A: Pass that string to date:
bash script.sh > "/var/log/$(date +%Y-%m-%d_%H:%M).log"

redpajama_set_name: RedPajamaStackExchange


text:
Duncan Bannatyne
Dragons' Den advice on patents
A recent episode of Dragons' Den contained a heated discussion on the subject of patents – and a very important lesson for anybody with an invention.
The stars of the BBC's Dragons' Den television show
By Duncan Bannatyne
The Dragons were asked to invest in a product called Shopbox, which is a secure, temperature-controlled container for groceries that are ordered online. Those pitching the idea, Stuart Archbold and Andrew Leslie, claimed that their storage system was key to the future of grocery delivery as it would allow goods to be dropped off and left for many hours before a customer returned home. The pair had already spent almost £1m on their idea.
However, a row quickly erupted about the validity of the patent they had secured. I argued that there was nothing to stop other people from copying the idea to put a chip in the box to control the temperature. Later in the show it turned out the pair did have a patent for the product – but this was lost in the pitch and was a key reason why I pulled out of the investment.
But there are some crucial lessons that anyone with an invention can learn from this. Firstly, I've checked with a patent lawyer and the vital thing to remember is that it's impossible to patent a concept or an idea only. A patentable invention must have technical features which together with the application are new and innovative.
You don't need to have the finished article, though that always helps, but at least be able to supply sufficient technical information to prove that it can be made or used, or if it's a method carried out. Crucially, there must be some previously unseen, 'inventive step' that marks the product out as unique.
If all these things are in place, the patent will play a vital role in preventing other people from creating something identical that carries out the same function and takes away from your business.
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The process of applying for a patent should force entrepreneurs to consider their unique selling points and understand their place in the market before protecting their product.
That's why I was so surprised when the owners of Shopbox said they had a patent for their concept and fellow dragon Peter Jones even appeared to agree. Peter knows as well as I do that you can't acquire a patent for a concept alone.
Despite it becoming apparent that the duo did, in fact, hold a patent, I am afraid I would still question its value, however, and ask whether it covers that vital 'inventive step'.
Business owners must get a patent that covers their product's unique selling point but is not so narrow in its definition that a competitor could enter the market with a slight variation. In the case of Shopbox, for example, a patent claim broadly defined in terms of a 'container for groceries' would be vulnerable to challenge. A claim protecting a technical feature of the container, such as the mechanism used to maintain a constant temperature inside, would be far more robust.
Inventors need to know that they can't get a patent simply for a concept, and only a robust patent will offer any protection against competitors. I know of a dozen operators who claim to have a patent for a treadmill – and all of them compete in the same market and fight for the same business. If you do apply for a patent, make sure it does the product justice and protects your unique selling point.
Duncan Bannatyne is the founder and chairman of Bannatyne Fitness and author of How to Be Smart with Your Time, is out now. Follow him on Twitter @duncanbannatyne
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text:
Q: Do notable applications use cocos2d? I'm French so excuse my poor English.
I'd like to know is if Tiny Wings, Angry Birds, and other great applications like that use cocos2D, for some or all of their game. I want to use the particle designer and we must use  it with cocos2d, but I don't like the fact that the image of cocos2d appears on my application on the App Store.

A: Tiny Wings, Angry Birds, Mega Jump, Trainyard... to name a few, use cocos2d, box2d, or both.
Source: A description of a cocos2d book that I'm waiting to be released.
Also... you can change the default loading image of the application... easily.
-- EDIT --
To remove the frame rate from your application, remove the following line of code from your app delegate file:
[[Director sharedDirector] setDisplayFPS:YES];

Or, you can leave the line there but set it to NO.


text:
Idaho Administrative Code 2003 Archive
Alphabetical Index of the State Agencies and IDAPA Designations. The agency rules are in Adobe Portable Document Format (PDF). Please see our page about PDFs for links to reader software download sites and trouble shooting tips.
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Administrative Code Archives


text:
Cohort profile: why do people keep hurting their back?
David M. Klyne ORCID: orcid.org/0000-0002-4993-51011,
Wolbert van den Hoorn ORCID: orcid.org/0000-0002-9658-23881,
Mary F. Barbe ORCID: orcid.org/0000-0002-5235-98032,
Jacek Cholewicki ORCID: orcid.org/0000-0003-3682-64483,
Leanne M. Hall ORCID: orcid.org/0000-0001-9641-92171,
Asaduzzaman Khan ORCID: orcid.org/0000-0003-4188-20654,
Roberto Meroni ORCID: orcid.org/0000-0002-5717-11485,
G. Lorimer Moseley ORCID: orcid.org/0000-0002-3750-49456,
Michael Nicholas ORCID: orcid.org/0000-0002-4947-398X7,
Lee O'Sullivan ORCID: orcid.org/0000-0002-3225-30401,
Rachel Park ORCID: orcid.org/0000-0001-9970-948X1,
Glen Russell ORCID: orcid.org/0000-0002-7631-29701,
Michele Sterling ORCID: orcid.org/0000-0003-1772-22488,9 &
Paul W. Hodges ORCID: orcid.org/0000-0002-1206-91071
Low back pain (LBP) is one of the most disabling and costly conditions worldwide. It remains unclear why many individuals experience persistent and recurrent symptoms after an acute episode whereas others do not. A longitudinal cohort study was established to address this problem. We aimed to; (1) evaluate whether promising and potentially modifiable biological, psychological, social and behavioural factors, along with their possible interactions, predict LBP outcome after an acute episode; (2) compare these factors between individuals with and without acute LBP; and (3) evaluate the time-course of changes in these factors from LBP onset. This paper outlines the methodology and compares baseline characteristics between acute LBP and control, and LBP participants with and without follow-up.
133 individuals with acute LBP and 74 pain-free individuals participated. Bio-psycho-social and behavioural measures were collected at baseline and 3-monthly for 12 months (LBP) or 3 months (control). Pain and disability were recorded fortnightly. Baseline characteristics were mostly similar between those who did and did not return for follow-up. Initial analyses of this cohort have revealed important insights into the pathways involved in acute-to-chronic LBP. These and future findings will provide new targets for treatment and prevention of persistent and recurrent LBP.
Low back pain (LBP) is the world's leading cause of disability [1] and is associated with enormous and escalating costs to society [2]. Most of this burden is attributed to the condition when LBP becomes persistent or recurrent. Why some individuals with acute LBP recover, whereas others do not [3, 4], is largely unknown.
Although psychosocial factors have generally been considered stronger predictors of long-term outcome than diagnostic or injury-related factors [5, 6], they only explain a small proportion of the variance in outcome [6, 7]. Biological factors have largely been dismissed and the few that have been comprehensively addressed (e.g., muscle strength/endurance [8]) have little relation to outcome [9]. With this incomplete understanding of factors related to LBP outcome, it is not surprising that most treatments have modest effects at best [10] and are generally unable to prevent recurrence/persistence of pain [11].
We argue that three issues underlie a fresh approach to this problem. First, novel biological factors that could plausibly contribute to LBP outcome have been identified in cross-sectional studies, e.g., systemic inflammation, trunk muscle morphology/function, and processing of pain. Up until now, these potentially modifiable factors had not been tested longitudinally from the initial onset of symptoms, and analyses of the early time-points from the cohort presented in this paper are providing promising results [12,13,14]. Second, although interaction between biological, psychological and social factors is implied in the biopsychosocial model of pain, this interaction has received little attention in past longitudinal studies of LBP outcome. Again, early analyses from the present cohort have revealed interaction between features such as depression, cytokines and poor LBP outcome [12,13,14,15,16]. Third, there is growing evidence that behavioural factors such as sleep interact with the "biopsychosocial" components of LBP, but their contribution to outcome is unknown. This too has been supported by early observations [12, 14]. Further, little is known of the time course of changes in each of the biopsychosocial domains over 12 months following an acute LBP episode. There is strong foundation to evaluate whether candidate biological factors, along with their possible interaction with psychosocial factors, contribute to the transition from acute LBP to that of persistent/recurrent symptoms.
The purpose of this paper is to provide a profile of a cohort study that aims to; (1) evaluate whether outcome after an acute episode of LBP can be predicted by the most promising bio-psycho-social factors and/or the interactions between them; (2) compare these factors between individuals with and without acute LBP; and (3) evaluate the time course of changes in these factors following LBP onset. This paper outlines the participants, measures and data collection schedule, and compares baseline characteristics between acute LBP and control, and follow-up and non-follow-up LBP participants.
This longitudinal cohort study involved measures of variables within the biological, psychological and social domains (Table 1) at multiple time-points for 12 months (Additional file 1: Table S1). Measures of sleep, physical activity, alcohol consumption and smoking were grouped separately in a "behavioural" domain as they cross between classical domains. Eligible participants completed a series of detailed online questionnaires related to their pain and disability level, health, demographics, behaviour, and psychosocial status within 24 h of undertaking a laboratory-based session (~ 4 h) at the University of Queensland to assess biological variables. Measures (laboratory-based biological measures and online questionnaires) were repeated at 3, 6 and 9 months for LBP participants, and at 3 months for control participants. At 12 months, questionnaires were completed by all participants in the LBP group in addition to a separate 12-month recall questionnaire relating to the trajectory of their LBP since initial assessment for the study. Participants were also instructed (and reminded) via email to report their pain and disability level every fortnight for 3 (controls) or 12 months (LBP) via an online survey. For some analyses that have been conducted to date, these pain and disability data have been used to classify LBP participants as either "unrecovered", "partially recovered" or "recovered" at follow-up (for details see Additional file 1: Table S2).
Table 1 Detailed description of measures
A total of 1849 individuals from Brisbane (and surrounds), Australia, were screened between April 2012 and September 2017 (Fig. 1). Participants were recruited through advertisements around the University campus and local community, social media, three nearby hospitals and via a professional recruitment agency (Trialfacts).
Cohort flow diagram
Screening was conducted using two different methods. Initially, eligibility was determined via email and/or phone, and when this method was used the reason(s) for exclusion at this initial screening were not recorded. This was replaced with an automated online screening questionnaire from April 2014, with reasons for exclusion recorded. The inclusion and exclusion criteria for LBP participants are outlined in Additional file 1: Table S3. Participants did not need to be experiencing their first ever LBP episode. Previous LBP was recorded for inclusion as a covariate. Control participants were included if they had not experienced LBP within the last month in addition to meeting the exclusion criteria in Additional file 1: Table S3.
At the first laboratory testing session (after initial screening), eligibility for inclusion were confirmed using data from the baseline questionnaire (completed within 24 h of the first laboratory-based session), to ensure that the participant's average level of pain and LBP-related disability in the past week exceeded the inclusion threshold (≥ 1/10 for pain; ≥ 1/24 for disability). Potential control participants who reported a score > 0 on a 0 ("no pain") to 10 ("worst pain imaginable") numerical rating scale (NRS) and/or the Roland Morris Disability Questionnaire (RMDQ [35], [for definition of measures see Table 1]), or provided no scores were excluded from the study (N = 14). Potential LBP participants who reported < 1 on the pain NRS and/or the RMDQ, or provided no scores in the past week were excluded from the study (N = 8). After data collection, criteria for exclusion were identified for two participants with LBP (multiple sclerosis [N = 1], duration of LBP > 14 days [N = 1]) and two control participants (no pain/disability data [N = 1], pain/injury in another body region [N = 1]). These participants were excluded from the dataset. The final cohort included 133 and 74 participants in the LBP and control groups, respectively, for analyses.
Details of the measures and at what time-point(s) they were implemented are presented in Table 1 and Additional file 1: Table S1. All variables were measured in a standardised order for each participant. Biological measures were those we considered to be the most promising candidate factors for predicting LBP recurrence/persistence based on previous research and plausible rationales founded on clinical, epidemiological and fundamental research. For psychological measures, we considered three key domains of relevance in LBP: cognitive (expectations, beliefs, and perceptions concerning pain) [6, 36,37,38], emotional (distress, anxiety, and depression) [5], and behavioural (coping, pain behaviour, and activity/activity avoidance) [6, 36, 37]. Social measures were selected based on the Multinational Musculoskeletal Inception Cohort Study (MMICS) guidelines [39]. These guidelines were developed by an international expert team with review of the best available evidence from systematic/narrative reviews and expert consensus. As it was not our intention to withhold treatment over the study period, we collected information regarding health care and medication use so that treatment variables can be included as covariates. The total number of variables was restricted to limit the required participant sample size, minimise the potential for over-fitting, and for cost–benefit.
A sample size of 217 was calculated based on power to detect predictor variables using complex multiple regression models (i.e., 28 predictor variables, 5 a priori selected interactions) and growth curve modelling methods, while allowing for loss to follow-up. The planned sample size was not achieved due to feasibility issues as outlined in the "limitations" section. Although the achieved sample size (N = 133) limits the ability to examine numerous interactions simultaneously, reduced model sizes and alternative methods (e.g., cluster analysis) have been applied successfully on data from this cohort [12,13,14,15,16].
All questionnaire-based measures (that could be quantitatively analysed) at baseline were compared between: (1) LBP and control participants, and (2) LBP participants who did and did not follow-up at 3, 6, 9 and 12 months.
Participant characteristics at baseline
The characteristics of the study participants are described in Additional file 1: Table S4. Compared to controls, LBP participants were/had: taller and heavier, a higher BMI, a higher prevalence of comorbidities, a higher incidence of previous LBP, higher depressive and pain catastrophizing symptoms, higher self-reported job demands, more sick days (over the last 12 months), poorer sleep quality, more likely to have a history of cigarette smoking, and more likely to have performed vigorous physical activity on less days in the previous week.
Participant attrition
Of the 133 eligible acute LBP participants who were enrolled in the study and provided baseline data, 35 (26%) were lost to follow-up for their laboratory-based measures (i.e., did not attempt/complete any biological measures) at 3 months, a further 9 at 6 months (total lost to follow-up = 44, 33%), and a further 5 at 9 months (total lost to follow-up = 49, 37%). As biological measures were not performed at 12 months, all participants were invited to complete the standard 3-montly questionnaire in addition to a separate recall questionnaire at 12 months, irrespective of whether or not they had continued or dropped out earlier. One or both of these were fully/partly completed by all but 41 of the 133 LBP participants who started the study (follow-up at 12 months: N = 92). For participants that did follow-up, Additional file 1: Table S5 shows the number of those that provided valid data for each of the 3-monthly questionnaire-based measures at each respective time-point. Ten control participants did not return for follow-up at 3 months. With respect to the completion rate of fortnightly pain (NRS) and disability (RMDQ) questionnaires, 85% (1505 of 1770) were completed by LBP participants who were retained for follow-up (i.e., up to 3, 6, 9 or 12 months) within 7 days of each questionnaire being issued, and 91% (282 of 310) were completed by control participants (i.e., up to 3 months).
Comparison of follow-up and non-follow-up participants
Comparison of baseline characteristics between LBP participants who did and did not follow-up for laboratory-based measures at 3, 6 and 9 months, and questionnaire measures at 12 months, revealed some differences, as shown in Table 2.
Table 2 Comparison of baseline characteristics between participants with LBP who did (FU) and did not (NFU) follow-up at 3, 6, 9 and 12 months
This paper profiles the only acute LBP cohort in which detailed biological, psychological, social and behavioural factors have been longitudinally and frequently collected, to date. The cohort has great potential to provide unique insight into the features that may predict and/or mediate long-term outcome [40].
The findings of baseline (acute LBP) characteristics presented here provide a foundation for future longitudinal analyses. Whether the findings can be generalised to a larger or clinical sample of individuals with early-acute LBP requires further and detailed studies of the condition during the early-acute phase. Despite the rate of loss to follow-up, most occurred after the first session, and baseline characteristics were generally similar between those who did and not return for follow-up.
Initial analyses of this cohort have revealed specific immune and nervous system features associated with the transition to persistent/recurrent LBP, and that various psychological and behavioural factors shape these relationships [12,13,14,15,16]. Ongoing analyses focus on elucidating the role of trunk neuromuscular, kinematic, mechanical and morphological properties, along with their possible interactions with psychosocial/behavioural features, in predicting LBP outcome.
The strict "acute LBP" inclusion criteria (i.e., within 2 weeks of onset of a LBP episode following 1 month without pain) rendered recruitment challenging – > 50% of screened individuals did not meet these criteria.
Study measures and follow-up procedures imposed substantial burden and explains the reported attrition.
Missing data due to attrition was high as is usual in longitudinal cohorts, and statistical approaches (e.g., mixed effects models) have been, and will continue to be, used to minimise bias.
The smaller than expected sample size limits the types of analyses to investigate interactions, and their interpretation; however, approaches such as cluster analyses have so far provided valuable insights.
It was not possible to collect blood samples at a standardised time during the day for each participant at each time-point. To account for the diurnal variations in cytokines [41], time of blood collection was recorded for inclusion as a potential confounder when interpreting cytokine levels.
All data are held at The University of Queensland, Brisbane, Australia, and handled confidentially in a de-identified format. Currently, only the research team has access to the data. Proposals for collaborative analyses are invited to contact the lead author (Dr David Klyne: d.klyne@uq.edu.au) or principal investigator (Professor Paul Hodges: p.hodges@uq.edu.au).
AUDIT:
Alcohol Use Disorders Identification Test
BMI:
CES-D:
Centre for Epidemiological Studies of Depression Scale
Centre of pressure
Conditioned pain modulation
CPT:
Cold pain threshold
CS:
Conditioning stimulus
ELISA:
Enzyme-linked immunosorbent assays
EMG:
FABQ:
Fear-Avoidance Beliefs Questionnaire
FU:
Follow-up participants
HPT:
Heat pain threshold
IPAQ:
International Physical Activity Questionnaire
IQR:
Interquartile range
JCQ:
Job Content Questionnaire
LBOS:
Low-Back Outcome Scale
LBP:
NFU:
Non-follow-up participants
NRS:
Numerical rating scale
PCS:
Pain Catastrophizing Scale
PPT:
Pressure pain threshold
PSEQ:
Pain Self-Efficacy Questionnaire
PSQI:
Pittsburgh Sleep Quality Index
RMDQ:
Roland Morris Disability Questionnaire
TNF:
Tumor necrosis factor
Test stimulus
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Hamberg-van Reenen HH, Ariens GAM, Blatter BM, van Mechelen W, Bongers PM. A systematic review of the relation between physical capacity and future low back and neck/shoulder pain. Pain. 2007;130(1–2):93–107. https://doi.org/10.1016/j.pain.2006.11.004.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):192–300. https://doi.org/10.1007/s00586-006-1072-1.
Deyo RA, Phillips WR. Low back pain A primary care challenge. Spine. 1996;21(24):2826–32. https://doi.org/10.1097/00007632-199612150-00003.
Klyne DM, Moseley GL, Sterling M, Barbe MF, Hodges PW. Are Signs of central sensitization in acute low back pain a precursor to poor outcome? J Pain. 2019. https://doi.org/10.1016/j.jpain.2019.03.001.
Klyne DM, Hodges PW. Circulating adipokines in predicting the transition from acute to persistent low back pain. Pain Med. 2020. https://doi.org/10.1093/pm/pnaa052.
Klyne DM, Barbe MF, van den Hoorn W, Hodges PW. ISSLS PRIZE IN CLINICAL SCIENCE 2018: longitudinal analysis of inflammatory, psychological, and sleep-related factors following an acute low back pain episode-the good, the bad, and the ugly. Eur Spine J. 2018;27(4):763–77. https://doi.org/10.1007/s00586-018-5490-7.
Klyne DM, Moseley GL, Sterling M, Barbe MF, Hodges PW. Individual Variation in Pain Sensitivity and Conditioned Pain Modulation in Acute Low Back Pain: Effect of Stimulus Type, Sleep, and Psychological and Lifestyle Factors. J Pain. 2018;19(8):942e-1-e-18. https://doi.org/10.1016/j.jpain.2018.02.017.
Klyne DM, Barbe MF, Hodges PW. Systemic inflammatory profiles and their relationships with demographic, behavioural and clinical features in acute low back pain. Brain Behav Immun. 2017;60:84–92. https://doi.org/10.1016/j.bbi.2016.10.003.
Greenough CG, Fraser RD. Assessment of outcome in patients with low-back pain. Spine. 1992;17(1):36–41.
Radloff LS. The CES-D Scale: a new self-report depression scale for research in the general population. ApplPsycholMeas. 1977;1:385–401.
Osman A, Barrios FX, Kopper BA, Hauptmann W, Jones J, O'Neill E. Factor structure, reliability, and validity of the pain catastrophizing scale. J Behav Med. 1997;20(6):589–605. https://doi.org/10.1023/A:1025570508954.
Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.
Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11(2):153–63. https://doi.org/10.1016/j.ejpain.2005.12.008.
Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol. 1998;3(4):322–55.
Klyne DM, Schmid AB, Moseley GL, Sterling M, Hodges PW. Effect of types and anatomic arrangement of painful stimuli on conditioned pain modulation. J Pain. 2015;16(2):176–85. https://doi.org/10.1016/j.jpain.2014.11.005.
Stokes M, Hides J, Elliott J, Kiesel K, Hodges P. Rehabilitative ultrasound imaging of the posterior paraspinal muscles. J Orthop Sports Phys Ther. 2007;37(10):581–95. https://doi.org/10.2519/jospt.2007.2599.
Cholewicki J, Silfies SP, Shah RA, Greene HS, Reeves NP, Alvi K, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 2005;30(23):2614–20.
Hodges P, van den Hoorn W, Dawson A, Cholewicki J. Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. J Biomech. 2009;42(1):61–6. https://doi.org/10.1016/j.jbiomech.2008.10.001.
van Dieen JH, Koppes LL, Twisk JW. Low back pain history and postural sway in unstable sitting. Spine. 2010;35(7):812–7. https://doi.org/10.1097/BRS.0b013e3181bb81a8.
Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S. The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine. 2000;25(8):989–94. https://doi.org/10.1097/00007632-200004150-00015.
Scholtes SA, Gombatto SP, Van Dillen LR. Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests. ClinBiomech. 2009;24(1):7–12. https://doi.org/10.1016/j.clinbiomech.2008.09.008.
Bruijn SM, Meijer OG, van Dieen JH, Kingma I, Lamoth CJ. Coordination of leg swing, thorax rotations, and pelvis rotations during gait: the organisation of total body angular momentum. Gait Posture. 2008;27(3):455–62. https://doi.org/10.1016/j.gaitpost.2007.05.017.
Lamoth CJ, Meijer OG, Wuisman PI, van Dieen JH, Levin MF, Beek PJ. Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain. Spine. 2002;27(4):E92-9. https://doi.org/10.1097/00007632-200202150-00016.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiat Res. 1989;28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4.
Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. Int J BehavNutr Phys Act. 2011;8:115. https://doi.org/10.1186/1479-5868-8-115.
Babor TF, Higgins-Biddle J, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary care. Geneva: World Health Organization; 2001.
Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8(2):141–4.
Mallen CD, Peat G, Thomas E, Dunn KM, Croft PR. Prognostic factors for musculoskeletal pain in primary care: a systematic review. Brit J Gen Pract. 2007;57(541):655–61.
Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008b;337:a171. https://doi.org/10.1136/bmj.a171.
Boersma K, Linton SJ. How does persistent pain develop? An analysis of the relationship between psychological variables, pain and function across stages of chronicity. Behav Res Ther. 2005;43(11):1495–507. https://doi.org/10.1016/j.brat.2004.11.006.
Pincus T, Santos R, Breen A, Burton AK, Underwood M, Multinational Musculoskeletal Inception Cohort Study C. A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Arthritis Rheum. 2008;59(1):14–24. https://doi.org/10.1002/art.23251.
Klyne DM, Hodges PW. Letter to the editor concerning "Multiple confounders influence the association between low-grade systemic inflammation and musculoskeletal pain. A call for a prudent interpretation of the literature" by Schipholt et al. Spine J. 2019;19(11):1899–900. https://doi.org/10.1016/j.spinee.2019.06.011.
Petrovsky N, McNair P, Harrison LC. Diurnal rhythms of pro-inflammatory cytokines: regulation by plasma cortisol and therapeutic implications. Cytokine. 1998;10(4):307–12. https://doi.org/10.1006/cyto.1997.0289.
This research was funded by the National Health and Medical Research Council (NHMRC) of Australia (Project Grant: ID631369; Program Grant: APP1091302). PWH supported by NHMRC Fellowship APP1102905. GLM supported by NHMRC Fellowship ID1061279. MS supported by NHMRC Fellowship APP1002489. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
David M. Klyne, Wolbert van den Hoorn, Leanne M. Hall, Lee O'Sullivan, Rachel Park, Glen Russell & Paul W. Hodges
Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, USA
Mary F. Barbe
MSU Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI, USA
Jacek Cholewicki
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
Asaduzzaman Khan
Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
Roberto Meroni
IIMPACT, University of South Australia, Adelaide, Australia
G. Lorimer Moseley
Pain Management Research Institute, Royal North Shore Hospital, The University of Sydney, Sydney, Australia
Michael Nicholas
NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
Michele Sterling
Recover Injury Research Centre, The University of Queensland, Brisbane, Australia
David M. Klyne
Wolbert van den Hoorn
Leanne M. Hall
Lee O'Sullivan
Rachel Park
Glen Russell
Paul W. Hodges
Conceived and designed the study: DK, PH, WVDH, MB, JC, AK, LM, MN and MS. Recruitment of participants: DK, LO, RP and GR. Analysed the data: DK, PH, WVDH and RM. Wrote the manuscript: DK and PH. All authors revised the manuscript. All authors read and approved the final manuscript.
Correspondence to Paul W. Hodges.
The study was approved by The University of Queensland's Human Research Ethics Committee (ID: 2010000045), Royal Brisbane & Women's Hospital Human Research Ethics Committee (ID: HREC/13/QRBW/268), and the Uniting Care Health Human Research Ethics Committee (ID: 1404). All participants provided written informed consent, were informed of their right to withdraw from the study at any time without penalty, and were informed of the study purpose.
Additional Tables.
Klyne, D.M., van den Hoorn, W., Barbe, M.F. et al. Cohort profile: why do people keep hurting their back?. BMC Res Notes 13, 538 (2020). https://doi.org/10.1186/s13104-020-05356-z
DOI: https://doi.org/10.1186/s13104-020-05356-z
Low back pain (LBP)
Acute to chronic
Biological factors
Behavioural factors


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2-year-old at center of FL AMBER Alert found safe, alleged triple homicide suspect in stand-off with police
King Crockett, the 2-year-old at the center of a statewide AMBER Alert in Florida and Georgia, has been recovered safely.
However, authorities say the child's alleged abductee and father, Caesar Crockett, is in a stand-off situation with the Florida Highway Patrol and the Tampa Police Department.
According to a news release, Crockett, the suspect involved in the Amber Alert issued from Georgia earlier Wednesday, was spotted near I-75 and Fowler Avenue.
A chase soon ensued that led to I-4. While exiting eastbound I-4 at I-75, the Crockett crashed on the exit ramp.
Authorities say the child was recovered safely. However, Crockett is still inside the vehicle, armed with a gun in a standoff with troopers and police.
The Bibb County Sheriff's Office says officials are looking for 29-year-old Caesar Crockett Jr. after he was accused of getting into a fight with his child's mother Tuesday night in Macon.
During the fight, the sheriff's office says he pulled out a gun and fatally shot the woman's mother, stepfather and sister. He then left with his 2-year-old son, King Crockett.
This is a developing story. Stay with us for updates.


Mold testing: Culturable air samples collected using BioCassette, Andersen, SAS, RCS, etc.
Mold testing: Spore trap (or non-viable) samples such as Air-O-Cell, BioAire, and Micro5 cassettes, Allergenco, Burkard and BioSIS slides.
For more information on our air quality testing laboratory or for a complete list of microbiological tests performed at Mold & Bacteria Consulting Laboratories, please call our Ontario, Mississauga Office at 905-290-9101 or the British Columbia, Burnaby Office at 604-435-6555.
MBL, your indoor air quality testing laboratory.
Sampling for airborne fungal spores may be conducted for a number of reasons including assessing the air quality, detection of pathogenic organisms, epidemiological surveys and predictions, detection of mycotoxin producing fungi, or detection and measurement of exposure to allergenic fungi and actinomycetes. Before sampling for airborne fungal spores it's important to have a clear objective and the data that would meet that objective. Some of these objectives require counting and identification of the airborne fungal particulates. A well calibrated pump is therefore required. The method of sampling, the equipment and the media are determined by the data required. For example if one is interested in species identification, then they would collect culturable air samples using an Andersen or RCS sampler.
If the air was sampled by impaction onto a growth media, then the samples are first incubated at suitable temperature followed by counting and identification of resulting colonies (if any). A number of factors may affect the reliability of the colony counts data. These include the suitability of the agar media used for sampling, colony density, and presence of fast growing isolates. Some agar media are highly selective and therefore would not suitable when the objective was to determine the diversity of fungal species in the air. If the colony density is very high, then counting becomes difficult. In the presence of fast growing isolates, slow growing isolates are masked and hence difficult to count.
The second method of air sampling is where the air is impacted on inert medium, usually a filter membrane or adhesive-coated slide. The collection medium is then analyzed by transmitted light microscopy (popularly known as direct microscopic examination), typically at 600–1000 × magnification. A number of different collection devices may be used for spore trap sampling of which the most common are slit or circular impactors such as the Air-O-Cell®, Allergenco D, Micro 5, Cyclex D and other similar cassettes. Mixed cellulose ester membrane (MCEM) filters are also occasionally used.
Identification of airborne fungal spores to species can only be accomplished by an experienced mycologist. Similarly, spore trap analysis requires considerable skill and experience on the part of the analyst to identify spores accurately, and to differentiate them from other airborne particulate. In most cases identification of airborne fungal spores by direct microscopic examination is limited to genus. In some cases identification of spores to specific genus is difficult. A good spore trap analyst requires several years of experience. A recent multi-laboratory comparative study of spore trap analyses found that only 75% of commercial accredited labs could consistently identify correctly Cladosporium spores and only 50% could identify Aspergillus/Penicillium-like spores consistently. The level of experience required for species identification or spore trap analysis cannot be attained in a short time, and it cannot easily be acquired by individuals lacking advanced training in mycology or plant pathology.
Mold & Bacteria Consulting Laboratories is accredited by CALA to the Internationally recognized ISO/IEC 17025:2005. For a full scope of accredited tests click Scope of Accreditation.
Mold test kits are meant to help a homeowner or property manager to perform preliminary tests for mold. Mold test kits are not meant to replace professional advice. There are many test kits out there. While some are worth paying for a majority of the so called "Mold Test Kits" are useless. For example, settle agar plates are frequently sold to homeowners as "mold test kits". While these may give useful information when used by a professional their results can be very misleading.
The mold test kits that we recommended are kits that utilize the same equipment that professionals use. For example, a homeowner can comfortably perform air sampling in their homes using the same equipment that is used by the professionals. This initial sampling can help the homeowner determine whether they require professional help or not. A professional is supposed to perform extensive investigation and not just air sampling.
If you would like more information on mold testing kits click Homeowner Mold Testing Kits.
We have compiled a short flash video demo on how to sample air for airborne fungal total spore counts. To see the video, please click Air Sampling For Total Fungal Spore Counts.
After seeing the video, please be kind enough to suggest how we could improve the video.
Is Air Sampling For Mold Necessary?
Is air sampling of mold necessary? Any type of mold sampling whether air or surface sampling should be based on a well defined objective. For example, if the objective is to determine whether occupants were exposed to airborne mold spores, then air sampling would be recommended. Air sampling may also help to detect hidden mold growth.
Before sampling for mold, it is important to have a well defined objective.


Claris Life Sciences CRID Pharma Dechra Pharmaceuticals Mnfg.
Dr. Reddy's Laboratories SAS Dragenopharm DSA Consultants DSM Pharmaceutical Products Florida Biologix hameln Pharmaceuticals Hetero USA Inc.
IDT Biologika GmbH Indoco Remedies Ltd.
InSymbiosis Kemwell Biopharma KP Pharmaceutical Technology Lab. PiSA Mefar Ilac Sanayi Micro Test Laboratories, Inc.
Par Sterile Products, LLC PharmaSystems, Inc.
Procaps Reig Jofre Group Sandoz GmbH Scientech Laboratries, Inc.
ShilpaMedicare Sigma- Tau PharmaSource Inc.
AirClean Systems Baker BASi Bioquell, Inc.
Buchi AG Buchi Pilot Plant & Reactors Buchiglas-USA C. W. Brabender Instruments Delta Trak Inc.
Donaldson Company, Inc. Freund-Vector Corporation HIT Archive Corporation Horiba Instruments, Inc.
KP Pharmaceutical Technology Miele Professional Overlook Industries, Inc.
Rees Scientific Scientech Laboratries, Inc.
Manufacturing, Liquids AB Bio Technologies, Inc.


Home » Posts Tagged "hosting"
Some of our students seem to struggle with concepts of hosting a website, how to set it up with your registrar and by tweaking the DNS settings.
We found that video super helpful and wanted to share it with the community.
Feel free to comment under the post should you have any questions!
Welcome to Mungi Online Training Platform !
Today we are proud to announce that our website is finally live after being bombarded by requests over the last year.
Many of our students and trainee requested an online platform to share the Mungi Love! We did our best to get this platform ready as soon as we could and would like to hear your recommendations and critics as the website is far from being finish.
We will announce some major new features soon!


Most items have free shipping. Because of the cost of shipping/postage they will go standard post.
We will review this request and if approved and all ok then simply login to your account, view the order using the "Complete Orders" link under the My Account menu and click the Return Item(s) button. We'll notify you via e-mail of your refund once we've received and processed the returned item.


A short decade ago you couldn't have a sustainable footwear retail store if the business wasn't built on the back of major footwear brands.
It suited everyone – consumers wanted known brands which had built value, reliability and quality based on a platform of consistency and trust. Most of the brands sold were and still are manufactured from one of Australia's largest trading partner, namely China.
Well apart from the obvious economic factors, footwear which is exported from China maintained a certain quality and consistency that wholesalers, retailers and consumers could live with, appreciate and grow from.
With the increase of labour costs in China, certain factories have now also raised wholesale order minimums to countries like Australia quite possibly to deal with increases of their own.
With these changes afoot, Chinese exporters and manufacturers main attraction, (quality, low minimums and keen prices) compared to European rivals have slowly been eroding. This erosion is what's playing into the hands of European brands – in particular the price, quality, consistency and styling hailing from Spain and Portugal.
As the Australian dollar fluctuates season on season, price rises and falls in footwear in particular from China had an adverse affect on production costs in comparison to similar price fluctuations from Europe and the Euro. Labour costs in China are still better than Europe, but the gap between European and Chinese manufactured footwear is closing, fast.
This is the one area which Australian consumers still debate on – the comparison in quality, craftsmanship and price when compared to not so expensive but tangibly higher quality leathers and styling of European product. This has changed the landscape for wholesale suppliers in Australia which for the past decade, have solely relied and were interdependent on footwear produced in China. Independent footwear stores in Australia are leading this charge for quality and Euro driven product in mainstream sales. For them, it becomes increasingly difficult to compete with a plethora of volume and price driven, predominantly Chinese retail footwear brands which are discounted at department stores 6 out of 7 days a week.
Is this really happening and who's leading the change?
In short, end consumers seem to be embracing a different mindset. Australian's are travelling more and with their love affair and infatuation with European cars, architecture, food and fashion, it is only heading north.
The changing consumer who were once bent on buying long term known brand names are now looking for quality, difference and uniqueness with regard to footwear. It appears on the surface that country of origin is playing a large role as brand names. This opens the game up to anyone with a European label and quality service.
Ask any retailer who scoffed yet ordered the Spanish manufactured Carousel sandal from TAOS in its first year or the Willow ankle boot from EOS and they'll tell you the consumer repeated a very important lesson – in the presence of quality and styling, price is almost a secondary consideration.
Motivational speaker and Founder and Director of www.barrynicolaou.com & ShoeCircle, Barry Nicolaou is a regular Exposed Online Contributor.
Tags: AGHA, Australian business, Australian fashion exhibition, australian footwear designer, brands, fashion exposed trade event, fashion exposed trade fair, fashion retail, footwear, retail, ShoeCircle, shoes, style, wholesale, womenswear. Bookmark the permalink.


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How much does a website cost in Puerto Rico?
Calculating real website cost can be tricky and it depends on who do you ask and how much work are you ready to do yourself. In Puerto Rico the development of a professional business website can cost anywhere from US$3,045.60 to US$21,807.00.


The objective of the AUD103m Civil Society Water, Sanitation and Hygiene Fund (CS WASH Fund) was to enhance the health and quality of life of the poor and vulnerable by improving sustainable access to safe water, sanitation and hygiene. Expected outcomes of the Fund were: (i) improved performance of actors in the WASH enabling environment, (ii) improved gender equality, (iii) improved WASH evidence and knowledge base, (iv) improved hygiene behaviour, (v) increased use of improved and equitable sanitation services and (vi) increased use of improved and equitable water supply services.
The Fund was supported 13 Australian and International Civil Society Organisations (CSO) to deliver 29 WASH projects in 19 countries over the years 2013 to 2018. The Fund was expected to provide direct benefits to 3.5 million people in target populations as well as indirect benefits to over 10 million people.
Watch a short video about the Fund.
Download the Overview of the Fund Achievements.
The Fund included an Innovation and Impact Fund (I&I Fund), which further supported innovation by grantees. To see the I&I Fund projects click here.


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Team Germany
Team Poland
Wolfgang Schindler
Welfare standards in the aquaculture industry
International cooperation with other organizations
Ending the use of battery cages
Ending beak searing
European Chicken Commitment
Pig Mobile Tour
Vegan Taste Week
Vegan projects with companies
Using legal leverage
Corporate outreach
Lobbying and networking
Knowledge and quality management
Home | About Us | Statute
© AnthiaCumming – iStock
Statute of the Albert Schweitzer Foundation
Version: Aug 21st, 2018
Albert Schweitzer taught and practiced reverence for all living things. The organization is dedicated to his maxim, and will in particular promote and demand law and justice for our fellow creatures as a part of our shared world.
§ 1 Name, Designation, and Location
The Foundation bears the name "Albert Schweitzer Foundation". It is an incorporated foundation under civil law, headquartered in Berlin.
§ 2 Foundation Objectives
(1) The purposes of the foundation are the promotion of animal welfare, animal rights, and the moral education of the general public. The foundation thereby aims to reduce the legal inequality and actual harm to which fellow beings are exposed due to their specific identity and/or religion, their race, their gender, their nationality and/or certain physical or psychological peculiarities. The beliefs and norms of the public in terms of ethical progress should be influenced and developed to this end; in particular, it should be the case that citizens increasingly support charitable purposes, and that through this, respect and consideration toward non-human life becomes self-evident.
(2) The purposes of the Foundation are realized for example through educational and training events and brochures, and through the acquisition and dissemination of knowledge (letters, press releases, online articles, public appearances in the media).
(3) The Foundation shall also achieve its aims in accordance with Section 58 (1) of the Fiscal Code by acquiring donations and other funds and forwarding these funds to other domestic or foreign bodies for the purpose of promoting animal welfare and education. The acquisition of funds for a body under private law subject to unlimited taxation presupposes that this is itself tax-privileged.
(4) The Foundation pursues exclusively and directly charitable purposes within the meaning of §§ 51 et seq. of the Tax Code. This does not affect the fact that the foundation naturally cannot always pursue these objectives with equal intensity. The Board of Directors selects the means that are available for each objective.
§ 3 Non-profit Status
(1) The Foundation is a non-profit. It does not pursue its own economic purposes. The Foundation should not benefit any persons or legal entities by expenditures which are alien to the purpose of the Foundation or from disproportionately high subsidies, benefits, or remuneration.
(2) Legal rights to statutory benefits of the foundation are justified neither by these Articles nor by other means.
§ 4 Basic Assets of the Foundation
(1) The basic assets as of 30.06.2013 amounted to EUR 81,129.19.
(2) The basic assets can be increased by donations. Contributions without a determined purpose due to disposition of property upon death may be given to the basic assets.
(3) The basic assets of the Foundation are to be invested profitably and safely and to be lasting and undiminished in value.
(4) In order to maintain and strengthen the Foundation's performance, the basic assets can be redeployed. Gains from the redeployment of non-basic assets may be supplied to the redeployment reserve, which is supplied to the basic assets of the equalizer of redeployment losses.
§ 5 Foundation Funds
(1) The Foundation fulfills its tasks
From the proceeds of the endowment,
From grants, insofar as the grantors do not determine that they go toward strengthening the basic assets. § 4 (2) remains unaffected.
(2) All funds shall only be used economically, efficiently, and according to the Statute.
(3) The fiscally allowable reserves in particular should be formed, in order to maintain the basic assets undiminished in their value and to meet the tax-deferred statutory purposes permanently and sustainably.
§ 6 Foundation Board
(1) The sole organ of the foundation is the Foundation Board, which consists of at least three and at most five members, including a Chairperson. The Chairperson can use the title "President." The presiding member of the board should preferably be experienced in business/economics and/or have a business/economics education.
(2) New Board Members are appointed by co-optation.
The Executive Board may elect its chairman by co-optation or, provided at least three members of the Executive Board participate in the voting, from among its members.
(3) The term of office of Mahi Klosterhalfen is not limited. The term of office of other members and Chairperson is three years. Re-election is permitted. Those members whose office is ended are not entitled to vote in this case. Once their term of office has elapsed, and if the number of members falls below three upon departure of a member, the member of the Executive Board of the Foundation shall remain in office until a successor has been appointed.
(4) The Foundation is managed and represented by the Foundation Board. Mahi Klosterhalfen can represent the Foundation alone, but in all other cases at least two Board members must represent the Foundation. Internally, the members may only act if the Chairperson is prevented from doing so.
(5) The members of the Management Board are committed to a conscientious and economical administration of the foundation. The activity of the board members is an honorary capacity and provided free of charge. This does not preclude their compensation for necessary expenses. The Board may decide that activities of members of the Board be remunerated in a manner appropriate to the task performed and the earnings and other means of the Foundation.
§ 7 Responsibilities of the Foundation Board
(1) The Chairperson of the Foundation Board is responsible for the administration and management of the foundation, including portfolio management.
(2) Tasks of the Management Board in particular
Decision-making regarding the use of proceeds of the basic assets and the consumption of certain benefits,
Election of the members of the Management Board according to § 6 (2),
Decision-making on the discharge of the Chairperson, taking into consideration all documents required by management,
Amendments to the Foundation Statute and applications for transformation or dissolution of the Foundation, see. § 10.
(3) The Board must have the Foundation from January 2014 on audited by an auditor or auditing company. The audit engagement letter and the results of the audit must also extend to the preservation of the basic assets and the statutory use of proceeds and any donations.
(4) In order to clarify scientific, ethical, and other issues that arise with regard to the Foundation activity, the Foundation Board may establish a scientific advisory board to provide advice.
§ 8 The Workings of the Foundation Board
(1) The Board of Directors will be convened by the Chairperson whenever necessary but at least once a year, and allowing three weeks before the meeting. Sessions may be convened if a member so requests. The convocation is made in writing and given by fax, e-mail, or by other documentable transmission in electronic form.
(2) The Foundation Board is permitted to reach decisions when assembled appropriately and if at least two members are present. Failure to do so holds as long as all members are present and no objection is raised.
(3) The Board of Directors takes its decisions, unless there is a case of the present § 10, by a simple majority of the votes cast. In a tie vote, the Chairperson shall be the decidor.
(4) If no member objects, resolutions may be passed by circular letter. This does not take decisions under § 10 hereof. Decision-making capacity is considered sufficient when at least two members are included in the circulation procedure.
(5) Minutes of the meetings are to be produced as transcripts and signed by the members present, and thus can be delivered to absent members.
(6) The Board should adopt a rules of procedure.
§ 9 Financial Year and Management
(1) The financial year is the calendar year.
(2) The revenue and expenditure of the Foundation shall be recorded and relevant documents collected. At the end of each financial year, a balance sheet, a profit and loss account and a report on the fulfilment of the foundation's purpose must be prepared. The Executive Board shall adopt the report on the fulfillment of the Foundation's mission and the audit report recognised by it in accordance with Section 7 (3) as an annual report. The annual report shall be submitted to the supervisory authority no later than eight months after the end of the financial year.
§ 10 Amendments, Transformation, and Dissolution of the Foundation
(1) Amendments are allowed, as long as they are considered necessary to adapt to changing conditions. They should not impair or abolish the tax privileges of the Foundation. If they may affect the tax privileges of the Foundation, they are submitted to the competent tax authority to comment.
(2) Changes in the Foundation's objectives are admissible only if its fulfillment is impossible or if circumstances change such that the fulfillment of the Foundation's purpose no longer seems sensible. Transformation and dissolution of the Foundation shall be governed by the statutory provisions.
(3) Any decision under paragraphs 1 and 2 requires the approval of all members of the Board. The decisions become effective only after approval by the Foundation Supervisory Authority (§ 12).
§ 11 Asset Seizure
Upon termination or dissolution of the Foundation or loss of tax-privileged purposes, the remaining funds go to the non-profit organization People for Animal Rights, Aachen. This organization must use the funds in compliance with the Foundation's purpose directly, and exclusively for charitable purposes.
§ 12 Foundation Supervisory
The Foundation is subject to Berlin state supervision in line with the provisions of the Berlin Foundation Act. The Foundation supervisory authority shall be notified promptly of changes of address, the power of representation, and the composition of the Foundation Board.
§ 13 Entry into force
The recasting of the Foundation Statute will enter into force with the approval of the Government of Upper Bavaria. Simultaneously, the Foundation Statute from 09.11.2000 (approved by the Government of Upper Bavaria with government letter dated 29.12.2000 and amended by the Government of Upper Bavaria with Government on 24.09.2009, 22.12.2009 and from 27.06.2011) is repealed.
Help to bring about positive change for the animals.
Albert Schweitzer Foundation
Dircksenstr. 47
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Game On Camps request to renovate basketball courts
Official Press Release - Jan. 17, 2020
[Glenwood Springs, Colorado] Game On Camps is excited to announce that the Glenwood City Council voted unanimously last night to pass the motion to renovate Sayre Park's basketball courts. Game On Camps presented the initiative in partnership with the Parks and Recreation Department, Hoop d'Ville and other community stakeholders.
The renovation will not cost taxpayers as funding for the project was raised solely by Game On Camps, Hoop d'Ville and Grand River Construction and is being matched by the City's Park Impact Fees. An application for a $25,000 FMLD Mini Grant is also being submitted.
Gregg Rippy of Grand River Construction meets with Pedro Campos of Zeher Landscape and Jim Yellico, Game On Camps Board member to discuss the renovation plan Dec. 2019.
All members of council went on record with high praise for Game On Camps and its partnering stakeholders for the way they achieved the approval for the renovation, and said they hope it inspires other community groups to approach their requests of the City with, as Gregg Rippy stated, "not a hand out but a hand in."
"This first phase of Sayre Park's regeneration has been a community-led initiative from the beginning. It's been a pleasure to work with Cassandra (Irving), Jim (Yellico), Mike (Picore), and Gregg (Rippy) and all those with passion and vision who have stepped forward to help lead this effort," said Parks and Rec Director Brian Smith. "They've been a perfect example of how businesses, service groups and citizen committees can work in partnership with City leaders to build improvements that increase the quality of life of our residents and, in this case, even benefits kids around the world through Game On Camps global programs."
The Mayor agreed to write a letter of endorsement for Game On Camps application for the Enterprise Zoning Contribution, which will give donors up to 25% more of a tax incentive on their contributions to the project.
Gregg and Merilee Rippy of Grand River Construction bring the lion's share of donations to the project with a commitment of up to $100k of in-kind services. Gregg has also volunteered to manage the project. Hoop d'Ville contributed $5,000, and Game On Camps offered the initial $1,500 donation, which included a donation from India's top-ranked semi-professional women's basketball team, as a show of good faith and is the non-profit brokering community donations.
Rhonda Mosier, head coach of GSHS Varsity Basketball Team, was in attendance with several of her players who spoke in favor of the initiative. The team has now decided to raise $1,000 to contribute to the project.
Construction is set to begin on the courts in April and will feature a special ribbon-cutting ceremony with the Parks and Recreation Department and community stakeholders.
Local businesses and community members who would like to donate to the project and benefit from the EZ contribution tax incentives can go to GameOnCamps.com/sayrepark or contact Cassandra Irving directly at cassandra@gameoncamps.com. Game On Camps has set aside a special account at Alpine Bank for the donations.
Game On Camps is a 501c3 sports non-profit based in Glenwood that gives local players a global impact. All funds raised through its sports camps at Sayre Park support its global sports camps for underprivileged youth in India and Ukraine. For more information, visit GameOnCamps.com.


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Minnesota State Highway 81 was a state highway in the U.S. state of Minnesota. It ran north from what is now TH 200 to Crookston. It was eliminated when US 75 was realigned to this road in the mid-1950s.

The highway was  in length.

Route description
Highway 81 served as a north-south route between Halstad, Shelly, Nielsville, Climax, Eldred, and Crookston.

Legally, the highway was defined as Legislative Route 175 in the Minnesota Statutes § 161.115(106).

History
State Highway 81 was authorized in 1934.

The number was removed in the mid-1950s when U.S. Route 75 was realigned to this road.

Major intersections

References

081 1934
Crookston, Minnesota
U.S. Route 75