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Purpose
This study aims to determine the intention to use hospital report cards (HRCs) for hospital referral purposes in the presence or absence of patient-reported outcomes (PROs) as well as to explore the relevance of publicly available hospital performance information from the perspective of referring physicians.
Methods
We identified the most relevant information for hospital referral purposes based on a literature review and qualitative research. Primary survey data were collected (May–June 2021) on a sample of 591 referring orthopedists in Germany and analyzed using structural equation modeling. Participating orthopedists were recruited using a sequential mixed-mode strategy and randomly allocated to work with HRCs in the presence (intervention) or absence (control) of PROs.
Results
Overall, 420 orthopedists (mean age 53.48, SD 8.04) were included in the analysis. The presence of PROs on HRCs was not associated with an increased intention to use HRCs (p = 0.316). Performance expectancy was shown to be the most important determinant for using HRCs (path coefficient: 0.387, p < .001). However, referring physicians have doubts as to whether HRCs can help them. We identified “complication rate” and “the number of cases treated” as most important for the hospital referral decision making; PROs were rated slightly less important.
Conclusions
This study underpins the purpose of HRCs, namely to support referring physicians in searching for a hospital. Nevertheless, only a minority would support the use of HRCs for the next hospital search in its current form. We showed that presenting relevant information on HRCs did not increase their use intention.
Background: Physician-rating websites (PRWs) may lead to quality improvements in case they enable and establish a peer-to-peer communication between patients and physicians. Yet, we know little about whether and how physicians respond on the Web to patient ratings.
Objective: The objective of this study was to describe trends in physicians’ Web-based responses to patient ratings over time, to identify what physician characteristics influence Web-based responses, and to examine the topics physicians are likely to respond to.
Methods: We analyzed physician responses to more than 1 million patient ratings displayed on the German PRW, jameda, from 2010 to 2015. Quantitative analysis contained chi-square analyses and the Mann-Whitney U test. Quantitative content techniques were applied to determine the topics physicians respond to based on a randomly selected sample of 600 Web-based ratings and corresponding physician responses.
Results: Overall, physicians responded to 1.58% (16,640/1,052,347) of all Web-based ratings, with an increasing trend over time from 0.70% (157/22,355) in 2010 to 1.88% (6377/339,919) in 2015. Web-based ratings that were responded to had significantly worse rating results than ratings that were not responded to (2.15 vs 1.74, P<.001). Physicians who respond on the Web to patient ratings differ significantly from nonresponders regarding several characteristics such as gender and patient recommendation results (P<.001 each). Regarding scaled-survey rating elements, physicians were most likely to respond to the waiting time within the practice (19.4%, 99/509) and the time spent with the patient (18.3%, 110/600). Almost one-third of topics in narrative comments were answered by the physicians (30.66%, 382/1246).
Conclusions: So far, only a minority of physicians have taken the chance to respond on the Web to patient ratings. This is likely because of (1) the low awareness of PRWs among physicians, (2) the fact that only a few PRWs enable physicians to respond on the Web to patient ratings, and (3) the lack of an active moderator to establish peer-to-peer communication. PRW providers should foster more frequent communication between the patient and the physician and encourage physicians to respond on the Web to patient ratings. Further research is needed to learn more about the motivation of physicians to respond or not respond to Web-based patient ratings.
Background: Physician-rating websites are currently gaining in popularity because they increase transparency in the health care system. However, research on the characteristics and content of these portals remains limited.
Objective: To identify and synthesize published evidence in peer-reviewed journals regarding frequently discussed issues about physician-rating websites.
Methods: Peer-reviewed English and German language literature was searched in seven databases (Medline (via PubMed), the Cochrane Library, Business Source Complete, ABI/Inform Complete, PsycInfo, Scopus, and ISI web of knowledge) without any time constraints. Additionally, reference lists of included studies were screened to assure completeness. The following eight previously defined questions were addressed: 1) What percentage of physicians has been rated? 2) What is the average number of ratings on physician-rating websites? 3) Are there any differences among rated physicians related to socioeconomic status? 4) Are ratings more likely to be positive or negative? 5) What significance do patient narratives have? 6) How should physicians deal with physician-rating websites? 7) What major shortcomings do physician-rating websites have? 8) What recommendations can be made for further improvement of physician-rating websites?
Results: Twenty-four articles published in peer-reviewed journals met our inclusion criteria. Most studies were published by US (n=13) and German (n=8) researchers; however, the focus differed considerably. The current usage of physician-rating websites is still low but is increasing. International data show that 1 out of 6 physicians has been rated, and approximately 90% of all ratings on physician-rating websites were positive. Although often a concern, we could not find any evidence of "doctor-bashing". Physicians should not ignore these websites, but rather, monitor the information available and use it for internal and ex-ternal purpose. Several shortcomings limit the significance of the results published on physician-rating websites; some recommendations to address these limitations are presented.
Conclusions: Although the number of publications is still low, physician-rating websites are gaining more attention in research. But the current condition of physician-rating websites is lacking. This is the case both in the United States and in Germany. Further research is necessary to increase the quality of the websites, especially from the patients’ perspective.
Purpose: The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences of both patients as well as referring physicians regarding publicly available hospital quality information.
Methods: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients’ and referring physicians’ preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models.
Results: Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (p < 0.001 each). Among patients, “Postoperative complication rate” (20.6%; level range of 1.164) was rated highest, followed by “Mobility at hospital discharge” (19.9%; level range of 1.127), and ‘‘The number of cases treated” (18.5%; level range of 1.045). In contrast, referring physicians valued most the ‘‘One-year revision surgery rate’’ (30.4%; level range of 1.989), followed by “The number of cases treated” (21.0%; level range of 1.372), and “Postoperative complication rate” (17.2%; level range of 1.123).
Conclusion: We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting.
Background: Physician-rating websites have become a popular tool to create more transparency about the quality of health care providers. So far, it remains unknown whether online-based rating websites have the potential to contribute to a better standard of care. Objective: Our goal was to examine which health care providers use online rating websites and for what purposes, and whether health care providers use online patient ratings to improve patient care. Methods: We conducted an online-based cross-sectional study by surveying 2360 physicians and other health care providers (September 2015). In addition to descriptive statistics, we performed multilevel logistic regression models to ascertain the effects of providers' demographics as well as report card-related variables on the likelihood that providers implement measures to improve patient care. Results: Overall, more than half of the responding providers surveyed (54.66%, 1290/2360) used online ratings to derive measures to improve patient care (implemented measures: mean 3.06, SD 2.29). Ophthalmologists (68%, 40/59) and gynecologists (65.4%, 123/188) were most likely to implement any measures. The most widely implemented quality measures were related to communication with patients (28.77%, 679/2360), the appointment scheduling process (23.60%, 557/2360), and office workflow (21.23%, 501/2360). Scaled-survey results had a greater impact on deriving measures than narrative comments. Multilevel logistic regression models revealed medical specialty, the frequency of report card use, and the appraisal of the trustworthiness of scaled-survey ratings to be significantly associated predictors for implementing measures to improve patient care because of online ratings. Conclusions: Our results suggest that online ratings displayed on physician-rating websites have an impact on patient care. Despite the limitations of our study and unintended consequences of physician-rating websites, they still may have the potential to improve patient care.
Objective: To evaluate the impact of different dissemination channels on the awareness and usage of hospital performance reports among referring physicians, as well as the usefulness of such reports from the referring physicians’ perspective.
Data sources/Study setting: Primary data collected from a survey with 277 referring physicians (response rate = 26.2%) in Nuremberg, Germany (03–06/2016).
Study design: Cluster-randomised controlled trial at the practice level. Physician practices were randomly assigned to one of two conditions: (1) physicians in the control arm could become aware of the performance reports via mass media channels (Mass Media, npr MM=132, nph MM=147); (2) physicians in the intervention arm also received a printed version of the report via mail (Mass and Special Media, npr MSM=117; nph MSM=130). <br> Principal findings: Overall, 68% of respondents recalled hospital performance reports and 21% used them for referral decisions. Physicians from the Mass and Special Media group were more likely to be aware of the performance reports (OR 4.16; 95% CI 2.16–8.00, p < .001) but not more likely to be influenced when referring patients into hospitals (OR 1.73; 95% CI 0.72–4.12, p > .05). On a 1 (very good) to 6 (insufficient) scale, the usefulness of the performance reports was rated 3.67 (±1.40). Aggregated presentation formats were rated more helpful than detailed hospital quality information.
Conclusions: Hospital quality reports have limited impact on referral practices. To increase the latter, concerns raised by referring physicians must be given more weight. Those principally refer to the underlying data, the design of the reports, and the lack of important information.
BACKGROUND: Over the past decade, physician-rating websites have been gaining attention in scientific literature and in the media. However, little knowledge is available about the awareness and the impact of using such sites on health care professionals. It also remains unclear what key predictors are associated with the knowledge and the use of physician-rating websites. OBJECTIVE: To estimate the current level of awareness and use of physician-rating websites in Germany and to determine their impact on physician choice making and the key predictors which are associated with the knowledge and the use of physician-rating websites. METHODS: This study was designed as a cross-sectional survey. An online panel was consulted in January 2013. A questionnaire was developed containing 28 questions; a pretest was carried out to assess the comprehension of the questionnaire. Several sociodemographic (eg, age, gender, health insurance status, Internet use) and 2 health-related independent variables (ie, health status and health care utilization) were included. Data were analyzed using descriptive statistics, chi-square tests, and t tests. Binary multivariate logistic regression models were performed for elaborating the characteristics of physician-rating website users. Results from the logistic regression are presented for both the observed and weighted sample. RESULTS: In total, 1505 respondents (mean age 43.73 years, SD 14.39; 857/1505, 57.25% female) completed our survey. Of all respondents, 32.09% (483/1505) heard of physician-rating websites and 25.32% (381/1505) already had used a website when searching for a physician. Furthermore, 11.03% (166/1505) had already posted a rating on a physician-rating website. Approximately 65.35% (249/381) consulted a particular physician based on the ratings shown on the websites; in contrast, 52.23% (199/381) had not consulted a particular physician because of the publicly reported ratings. Significantly higher likelihoods for being aware of the websites could be demonstrated for female participants (P<.001), those who were widowed (P=.01), covered by statutory health insurance (P=.02), and with higher health care utilization (P<.001). Health care utilization was significantly associated with all dependent variables in our multivariate logistic regression models (P<.001). Furthermore, significantly higher scores could be shown for health insurance status in the unweighted and Internet use in the weighted models. CONCLUSIONS: Neither health policy makers nor physicians should underestimate the influence of physician-rating websites. They already play an important role in providing information to help patients decide on an appropriate physician. Assuming there will be a rising level of public awareness, the influence of their use will increase well into the future. Future studies should assess the impact of physician-rating websites under experimental conditions and investigate whether physician-rating websites have the potential to reflect the quality of care offered by health care providers.
BACKGROUND: Even though physician rating websites (PRWs) have been gaining in importance in both practice and research, little evidence is available on the association of patients' online ratings with the quality of care of physicians. It thus remains unclear whether patients should rely on these ratings when selecting a physician. The objective of this study was to measure the association between online ratings and structural and quality of care measures for 65 physician practices from the German Integrated Health Care Network "Quality and Efficiency" (QuE). METHODS: Online reviews from two German PRWs were included which covered a three-year period (2011 to 2013) and included 1179 and 991 ratings, respectively. Information for 65 QuE practices was obtained for the year 2012 and included 21 measures related to structural information (N = 6), process quality (N = 10), intermediate outcomes (N = 2), patient satisfaction (N = 1), and costs (N = 2). The Spearman rank coefficient of correlation was applied to measure the association between ratings and practice-related information. RESULTS: Patient satisfaction results from offline surveys and the patients per doctor ratio in a practice were shown to be significantly associated with online ratings on both PRWs. For one PRW, additional significant associations could be shown between online ratings and cost-related measures for medication, preventative examinations, and one diabetes type 2-related intermediate outcome measure. There again, results from the second PRW showed significant associations with the age of the physicians and the number of patients per practice, four process-related quality measures for diabetes type 2 and asthma, and one cost-related measure for medication. CONCLUSIONS: Several significant associations were found which varied between the PRWs. Patients interested in the satisfaction of other patients with a physician might select a physician on the basis of online ratings. Even though our results indicate associations with some diabetes and asthma measures, but not with coronary heart disease measures, there is still insufficient evidence to draw strong conclusions. The limited number of practices in our study may have weakened our findings.
Die Bachelorarbeit befasst sich mit dem Generieren kurzer fröhlicher und harmonischer Musikstücke mittels des Einsatzes genetischer Algorithmen. Dabei werden die Evolutionsprozesse der Biologie nachgeahmt. In der Programmiersprache Java, unter der Verwendung der Open-Source-Programmierbibliothek JFugue, sind dafür die einzelnen Zyklusphasen entworfen und implementiert worden.
Die Vereinigung der Biologie, der Kunst und der Informatik wird damit erreicht, um etwas ästhetisch Wirksames zu schaffen und stellt den besonderen Reiz der Arbeit dar.
Appropriate data models are essential for the systematic collection, aggregation, and integration of health data and for subsequent analysis. However, recommendations for modeling health data are often not publicly available within specific projects. Therefore, the project Zukunftslabor Gesundheit investigates recommendations for modeling. Expert interviews with five experts were conducted and analyzed using qualitative content analysis. Based on the condensed categories “governance”, “modeling” and “standards”, the project team generated eight hypotheses for recommendations on health data modeling. In addition, relevant framework conditions such as different roles, international cooperation, education/training and political influence were identified. Although emerging from interviewing a small convenience sample of experts, the results help to plan more extensive data collections and to create recommendations for health data modeling.
Soziale Medien ermöglichen es ihren Nutzern besondere Beziehungen untereinander aufzubauen und zu vertiefen. Manche User bauen dabei eine weitreichende Followerschaft auf, die sogenannten Influencer. Die vorliegende Arbeit untersucht die Beziehung von Followern zu Influencer, indem der aktuelle Forschungsstand zu (trans-)parasozialen Beziehungen sowie gefühlter Interkonnektivität herangezogen wird. Mithilfe einer Online-Befragung werden die Auswirkungen einer intensiven parasozialen Beziehung zu Influencern auf verschiedene Erwartungsdimensionen untersucht. Die Ergebnisse werden vor dem Hintergrund der Theorie diskutiert und mögliche Forschungslücken herausgestellt.
Einführung einer institutionellen Forschungsdateninfrastruktur an der Helmut-Schmidt-Universität
(2016)
Die vorliegende Bachelorarbeit untersucht den zur Einführung einer institutionellen Forschungsdateninfrastruktur zu berücksichtigenden Handlungsrahmen an der Helmut-Schmidt-Universität/ Universität der Bundeswehr Hamburg (HSU/ UniBw H) und gibt unter besonderer Berücksichtigung möglicher Aufgabenfelder der Universitätsbibliothek allgemeine Handlungsempfehlungen für deren Implementierung. Da sich die Arbeit sowohl an die Verantwortlichen zur Einführung einer Forschungsdateninfrastruktur an der HSU/ UniBw H als auch an Interessierte der akademischen Gemeinschaft richtet, werden die zum besseren Verständnis besonders relevanten Begriffe zunächst herausgestellt. Auf der Grundlage aktueller Forschungsliteratur und verfügbarer Praxiserfahrung anderer Universitäten wurde mittels Webseitenanalyse und der Auswertung von Fragebögen eine gesamtheitliche Beschreibung für die Implementierung einer institutionellen Forschungsdateninfrastruktur zum Abgleich mit der Ausgangssituation an der HSU/ UniBw H erstellt. Die Arbeit verdeutlicht in den daraus abgeleiteten Handlungsempfehlungen den zu berücksichtigenden allgemeinen Handlungsrahmen in seiner Komplexität und zeigt vor allem diesbezügliche Aufgabenfelder der Universitätsbibliothek von der Initiierung bis zum Abschluss der Implementierung auf. Im Wesentlichen wird hierbei herausgestellt, dass die Universitätsbibliothek als klassische Gedächtnisorganisation und zentraler Informationsdienstleister ihre Kompetenzen besonders bei der Entwicklung und Verwirklichung des Forschungsdatenmanagements sinnvoll einbringen und zukunftsorientiert erweitern kann und sollte. Auslegungsbestimmend ist die von der Universitätsleitung festzulegende Ziel- und Zweckbestimmung der institutionellen Forschungsdateninfrastruktur. Diese dient dem Forschungsdatenmanagement zur Skalierung und Bestimmung von Umfang, Komplexität und Anforderungen an die potentiellen Aufgabenbereiche insbesondere der Universitätsbibliothek. Somit leistet diese Bachelorarbeit einen grundlegenden Beitrag zur weiteren Strukturierung und Konkretisierung der initiatorischen Überlegungen der Universitätsbibliotheksleitung zu den Möglichkeiten der Einführung einer institutionellen Forschungsdateninfrastruktur an der HSU/ UniBw H.
Dass die Stadt- und Staatstheater nicht in der Lage seien, sich auf die neuen Realitäten einer pluralisierten Stadtgesellschaft einzustellen und ihre Rolle neu zu definieren, sie stattdessen in Traditionen verharrten und „von allem zu viel und immer das gleiche“ spielten, ist ein im Rahmen der Stadttheaterdebatte häufig geäußerter Vorwurf. Ein sehr viel komplexeres und widersprüchlicheres Bild ergibt sich unter anderem aus der Analyse der Werkstatistiken des Deutschen Bühnenvereines wie auch der Theaterstatistiken. Sie legen nahe, dass sich seit Beginn der 1990er Jahre bedeutende Veränderungen in den Repertoires und Spielplänen der Stadt- und Staatstheater vollzogen haben, die sich als Versuch der Theater interpretieren lassen, sich neu in der Stadtgesellschaft der Gegenwart zu verorten. Der Aufsatz arbeitet die Bemühungen der Theater um eine größere Repertoirevielfalt und Neuverortung heraus, um anschließend die Frage zu diskutieren, welche Schlüsse sich hieraus sowohl für die Kulturpolitik wie auch die Theater ziehen lassen.
In diesem Kapitel steht die frühe Kindheit (ab der Geburt bis etwa zum dritten Geburtstag) im Fokus. In dieser ganz frühen Phase der Kindheit - die damit ja auch die Phase der nun erst entstehenden neuen Familie ist - sind es oft weniger die Kinder, welche außergewöhnliche Schwierigkeiten und Herausforderungen stemmen müssen und deswegen Gast in den Beratungseinrichtungen sind, sondern eher die Eltern bzw. das gesamte neue familiäre System. Diesem Umstand sollte in der Beratungssituation natürlich Rechnung getragen werden und daher stehen hier auch insbesondere die neu gewordenen Eltern und ihr Erleben der Situation im Mittelpunkt.
Automatisierte Steuerung von virtuellen Biogas-Kraftwerksverbünden für den netzorientierten Betrieb
(2019)
Das Steuerungssystem VKV Netz ermöglicht den auf die Erbringung regionaler Systemdienstleistungen ausgerichteten Betrieb virtueller Biogas-Kraftwerksverbünde. Damit leistet es sowohl einen Beitrag zum zukünftig gesteigerten Bedarf an Regelenergie durch regenerative Kraftwerke als es auch alternative, zukunftsfähige Erlöspotenziale für die zumeist landwirtschaftlichen bzw. landwirtschaftsnahen Biogas-Anlagenbetreiber abseits des EEG aufzeigt. Das Steuerungssystem wurde im Rahmen des BMWi-Verbundforschungsvorhabens VKV Netz (Förderkennzeichen 0325943A) durch die Hochschule Hannover, die SLT-Technologies GmbH & Co. KG sowie die Überlandwerk Leinetal GmbH in Kooperation mit assoziierten Biogasanlagen im Zeitraum 01.01.2016 bis 31.12.2018 entwickelt und pilotiert.
Der zunehmende Anteil erneuerbarer Energien an der Stromproduktion Deutschlands erfordert einen ebenso steigenden Anteil der erneuerbaren Energien an der Bereitstellung von Regelenergie zur Stabilisierung der Stromnetze. Durch die Möglichkeit der zeitlichen Entkopplung von Gas- und Stromproduktion ist insbesondere die Biogastechnologie für die Bereitstellung von Regelenergie geeignet. Der vorliegende Beitrag skizziert ein Steuerungssystem für virtuelle Biogas-Verbundkraftwerke, dessen Oberziel die Stabilisierung des Stromnetzes ist. Die Entwicklung des Systems erfolgt im Zuge des Forschungsprojekts VKV Netz und wird durch das Bundesministerium für Wirtschaft und Energie gefördert.
Fragen gehören zu den wirkungsvollsten Mitteln, um Lernprozesse anzustoßen. Sie regen Studierende an, sich mit Inhalten auseinanderzusetzen, diese zu verstehen und ihr Wissen und Können zu zeigen. Fragen ermöglichen Lernenden genauso wie Lehrenden Feedback zum Lernstand zu erhalten. Eine „gute“ Frage zu erstellen, ist eine Herausforderung für alle Dozierenden, die ihnen in verschiedenen Lehrzusammenhängen begegnet:
• Klausurfragen (summatives Prüfen)
• Test- und Übungsaufgaben zur Selbsteinschätzung Studierender
• Test- und Übungsaufgaben als Lernfortschrittskontrolle
• Semesterbegleitende Übungsaufgaben zum kontinuierlichen Lernen
• Fragen für den Einsatz von Abstimmungssystemen (Audience-Response-Systeme)
Die vorliegende Handreichung bietet eine praktische Anleitung zur Erstellung guter Fragen im Antwort-Wahl-Verfahren (AWV). Unter guten Fragen verstehen wir Fragen hoher Qualität hinsichtlich der Gütekriterien Reliabilität, Validität und Objektivität. Den Schwerpunkt der Arbeit bilden allgemeine Hinweise zur Formulierung guter Fragen, wobei auch die fachdisziplinäre Sicht berücksichtigt wird.
Im Rahmen der aktuellen Bildungsdebatte profilieren sich in zunehmendem Maße Museen und Bibliotheken als Akteure der kulturellen Bildung. Durch ihre ausdifferenzierten Angebote agieren sie dabei sowohl auf den formellen und außerschulischen Bildungs- wie auch unterhaltenden Freizeitmärkten, jeweils sowohl auf politischer sowie wirtschaftlicher und gesellschaftlicher Makro-, Meso- und Mikroebene. Dabei bietet sich insbesondere den vielen Museen, die über eine eigene Museumsbibliothek verfügen, eine signifikant potenzierte Möglichkeit, im Rahmen einer professionellen Öffentlichkeitsarbeit durch die Konzeptionierung ihrer Bibliothek zu einem Informations- und Kommunikationszentrum und deren Positionierung in der Produkt- und Kommunikationspolitik der Marketingstrategie des Museums, ihren (potentiellen) heterogenen Zielgruppen erweiterte und additive Angebote und dadurch neuartige Zugänge zu offerieren sowie die Einrichtung dadurch im Stadtraum öffentlichkeitswirksam neu zu verorten, indem eine derart strukturell und programmatisch revisionierte und professionell geführte Museumsbibliothek der Gesellschaft weitere Lern- wie auch Kommunikationsräume im Sinne eines Kulturzentrums eröffnet. Eine solch autonome und allseits anerkannte Museumsbibliothek, die als zentrale Abteilung des Museums eng mit den anderen Handlungsbereichen der Einrichtung, insbesondere jedoch der Museumspädagogik und der Kommunikationsabteilung zusammenarbeitet, bietet dem Museum des Weiteren durch ihre hybride Scharnierfunktion als museale wie auch bibliothekarische Einrichtung eine ideale Möglichkeit, sich als Ort der kulturellen Bildung innerhalb der (kulturellen) Bildungslandschaft der Region mit weiteren Anbietern dieser Ressorts, vor allem jedoch Bibliotheken und Schulen, kooperativ und öffentlichkeitswirksam zu vernetzen.
Background: Maintenance of metal homeostasis is crucial in bacterial pathogenicity as metal starvation is the most important mechanism in the nutritional immunity strategy of host cells. Thus, pathogenic bacteria have evolved sensitive metal scavenging systems to overcome this particular host defence mechanism. The ruminant pathogen Mycobacterium avium ssp. paratuberculosis (MAP) displays a unique gut tropism and causes a chronic progressive intestinal inflammation. MAP possesses eight conserved lineage specific large sequence polymorphisms (LSP), which distinguish MAP from its ancestral M. avium ssp. hominissuis or other M. avium subspecies. LSP14 and LSP15 harbour many genes proposed to be involved in metal homeostasis and have been suggested to substitute for a MAP specific, impaired mycobactin synthesis.
Results: In the present study, we found that a LSP14 located putative IrtAB-like iron transporter encoded by mptABC was induced by zinc but not by iron starvation. Heterologous reporter gene assays with the lacZ gene under control of the mptABC promoter in M. smegmatis (MSMEG) and in a MSMEGΔfurB deletion mutant revealed a zinc dependent, metalloregulator FurB mediated expression of mptABC via a conserved mycobacterial FurB recognition site. Deep sequencing of RNA from MAP cultures treated with the zinc chelator TPEN revealed that 70 genes responded to zinc limitation. Remarkably, 45 of these genes were located on a large genomic island of approximately 90 kb which harboured LSP14 and LSP15. Thirty-five of these genes were predicted to be controlled by FurB, due to the presence of putative binding sites. This clustering of zinc responsive genes was exclusively found in MAP and not in other mycobacteria.
Conclusions: Our data revealed a particular genomic signature for MAP given by a unique zinc specific locus, thereby suggesting an exceptional relevance of zinc for the metabolism of MAP. MAP seems to be well adapted to maintain zinc homeostasis which might contribute to the peculiarity of MAP pathogenicity.
Im Rahmen der vorliegenden Bachelorarbeit ging es um die Forschungsfrage, ob eine landmarkenbasierte Registrierung hinreichende Ergebnisse für die Anpassung eines Formmodells an eine segmentierte Cochlea liefert. Dazu wurden zwölf Landmarken auf die Oberfläche einer segmentierten Cochlea sowie auf die eines ausgewählten Formmodells gesetzt. Im Anschluss wurden die Abstände zwischen korrespondieren Landmarken des Formmodells und der segmentierten Cochlea mithilfe von drei verschiedenen Optimierungsverfahren minimiert. Bei dem quantitativen Vergleich zwischen den Ergebnissen der vorgestellten Optimierungsverfahren konnten keine signifikanten Unterschiede festgestellt werden. In der Evaluation wurde demonstriert, dass das Formmodell an der segmentierten Cochlea insgesamt hinreichend angenähert werden konnte. Lediglich in der Basalregion und am Apex der Cochlea ist die Anpassung noch verbesserungsbedürftig.