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oviding primary healthcare in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

Social enterprise has been demonstrated as a feasible model for providing primary health care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. Selleck N-Formyl-Met-Leu-Phe More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

Assessing the quality of healthcare data is a complex task including the selection of suitable measurement methods (MM) and adequately assessing their results.

To present an interoperable data quality (DQ) assessment method that formalizes MMs based on standardized data definitions and intends to support collaborative governance of DQ-assessment knowledge, e.g. which MMs to apply and how to assess their results in different situations.

We describe and explain central concepts of our method using the example of its first real world application in a study on predictive biomarkers for rejection and other injuries of kidney transplants. We applied our open source tool-openCQA-that implements our method utilizing the openEHR specifications. Means to support collaborative governance of DQ-assessment knowledge are the version-control system git and openEHR clinical information models.

Applying the method on the study's dataset showed satisfactory practicability of the described concepts and produced useful results for DQ-assessment.

The main contribution of our work is to provide applicable concepts and a tested exemplary open source implementation for interoperable and knowledge-based DQ-assessment in healthcare that considers the need for flexible task and domain specific requirements.

The main contribution of our work is to provide applicable concepts and a tested exemplary open source implementation for interoperable and knowledge-based DQ-assessment in healthcare that considers the need for flexible task and domain specific requirements.

Tongue squamous cell carcinoma (TSCC) is a common type of oral cancer, with a relatively poor prognosis and low post-treatment survival rate. Various strategies and novel drugs to treat TSCC are emerging and under investigation. Trichosanthin (TCS), extracted from the root tubers of Tian-Hua-Fen, has been found to have multiple biological and pharmacological functions, including inhibiting the growth of cancer cells. Granzyme B (GrzB) is a common toxic protein secreted by natural killer cells and cytotoxic T cells. Our group has reported that TCS combined with GrzB might be a superior approach to inhibit liver tumor progression, but data relating to the use of this combination to treat TSCC remain limited. The aim of this study was to examine the effectiveness of TCS on TSCC processes and underlying mechanisms.

First, we screened the potential antitumor activity of TCS using two types of SCC cell lines. Subsequently, a subcutaneous squamous cell carcinoma xenograft model in nude mice was established. Thes the TCS/GrzB combination could represent an effective immunotherapy for TSCC.

These results suggest that the TCS/GrzB combination could represent an effective immunotherapy for TSCC.

The causality between the use of alcohol and cigarettes and atrial fibrillation (AF) remains controversial. We conducted a Mendelian randomization (MR) study to evaluate the association of genetic variants related to tobacco and alcohol use with AF.

Single nucleotide polymorphisms (SNPs) related to smoking initiation (N = 374), age at initiation of regular smoking (N = 10), cigarettes per day (N = 55), and smoking cessation (N = 24) were derived from a genome-wide association studies (GWAS) of tobacco use (N = 1.2 million individuals). SNPs related to heavy alcohol use (N = 6) were derived from a GWAS of UK biobank (N = 125,249 individuals). The genetically matching instrumented variables were obtained from the GWAS of AF (N = 588,190 individuals). The estimates between tobacco and alcohol use and AF were combined by inverse-variance weighted (IVW), simple median, weighted median, MR-robust adjusted profile score method, MR-PRESSO, and multivariable MR.

A total of 65,446 AF patients and 522,744 referents were included. In the IVW analysis, the odds ratio per one-unit increase of smoking initiation was 1.11 (95% CI, 1.06-1.16; P = 3.35 × 10

) for AF. Genetically predicted age at initiation of regular smoking, cigarettes per day and smoking cessation were not associated with AF. The IVW estimate showed that heavy alcohol consumption increased AF risk (OR, 1.11; 95% CI, 1.04-1.18; P = 0.001). The results were consistent in complementary analyses and multivariable MR.

Our MR study indicated that regular smoking was associated with increased risk of AF, no matter the age at initiation of regular smoking, or the number of cigarettes smoked per day. Genetically predicted heavy alcohol consumption increased the risk of AF.

Our MR study indicated that regular smoking was associated with increased risk of AF, no matter the age at initiation of regular smoking, or the number of cigarettes smoked per day. Genetically predicted heavy alcohol consumption increased the risk of AF.

Second medical opinions can give patients confidence when choosing among treatment options and help them understand their diagnosis. Health insurers in several countries, including Germany, offer formal second opinion programs (SecOPs). We systematically collected and analyzed information on German health insurers' approach to SecOPs, how the SecOPs are structured, and to what extent they are evaluated.

In April 2019, we sent a questionnaire by post to all German statutory (n= 109) and private health insurers (n= 52). In September 2019, we contacted the nonresponders by email. The results were analyzed descriptively. They are presented overall and grouped by type of insurance (statutory/private health insurer).

Thirty one of One hundred sixty one health insurers (response rate 19%) agreed to participate. The participating insurers covered approximately 40% of the statutory and 34% of the private health insured people. A total of 44 SecOPs were identified with a median of 1 SecOP (interquartile range (IQR) 1-2) offered by a health insurer.