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The aim of this cross-sectional study was to investigate associated factors of the severity of clinical mastitis (CM). Milk samples of 249 cases of CM were microbiologically examined, of which 27.2% were mild, 38.5% moderate, and 34.3% severe mastitis. The samples were incubated aerobically and anaerobically to investigate the role of aerobic and anaerobic microorganisms. In addition, the pathogen shedding was quantitatively examined, and animal individual data, outside temperature and relative humidity, were collected to determine associated factors for the severity of CM. The pathogen isolated the most was Escherichia coli (35.2%), followed by Streptococcus spp. (16.4%). Non-aureus staphylococci (NaS) (15.4%) and other pathogens (e.g., Staphylococcus aureus, coryneforms) (15.4%) were the pathogens that were isolated the most for mild mastitis. Moderate mastitis was mostly caused by E. coli (38%). E. coli was also the most common pathogen in severe mastitis (50.6%), followed by Streptococcus spp. (16.4%), and Klebsiella spp. (10.3%). Obligate anaerobes (Clostridium spp.) were isolated in one case (0.4%) of moderate mastitis. The mortality rate (deceased or culled due to the mastitis in the following two weeks) was 34.5% for severe mastitis, 21.7% for moderate mastitis, and 4.4% for mild mastitis. The overall mortality rate of CM was 21.1%. The pathogen shedding (back logarithmized) was highest for severe mastitis (55,000 cfu/mL) and E. coli (91,200 cfu/mL). High pathogen shedding, low previous somatic cell count (SCC) before mastitis, high outside temperature, and high humidity were associated with severe courses of mastitis.
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.
Die verpflichtende Nachhaltigkeitsberichterstattung ist auf dem Weg das Nachhaltigkeitsreporting von Unternehmen zu verändern. Eine wachsende Zahl an Unternehmen muss immer häufiger Informationen offenlegen, die sie vormals bewusst nicht publizierten. Einige Unternehmen könnten dies als ein Hindernis sehen, andere erkennen darin womöglich eine Chance für die Unternehmenskommunikation. Indem sie über gesetzlichen Mindestanforderungen hinaus publizieren und sich damit für eine umfassendere und transparentere Berichterstattung entscheiden, könnten Unternehmen von Profilierungsmöglichkeiten und Wettbewerbsvorteile profitieren. Das Ziel dieser Arbeit ist die Frage zu beantworten, welche Determinanten die freiwillige Offenlegung von Informationen, die über die gesetzlichen Mindestanforderungen der nichtfinanziellen Erklärung (NfE) hinausgehen, beeinflussen. Um die Forschungsfrage zu beantworten, wurde eine quantitative Inhaltsanalyse von 200 nach dem § 289b Handelsgesetzbuch (HGB) berichtspflichtigen Unternehmen durchgeführt. Hierzu wurden die nichtfinanziellen Erklärungen und weitere nachhaltigkeitsbezogene Informationen auf ihrer Unternehmenswebsite analysiert. Zudem wurde ein Offenlegungsscore konzipiert, um den Grad der zusätzlichen freiwilligen Offenlegung zu messen. Anschließend wurde untersucht, inwieweit Einflussfaktoren eine über die gesetzlichen Mindestanforderungen hinausgehende Offenlegung erklären können. Die Ergebnisse zeigen einen signifikanten Zusammenhang zwischen den Determinanten Unternehmensgröße, Berichtshistorie, Vorstandsgröße sowie dem Anteil ausländischer Vorstandsmitglieder und dem Offenlegungsgrad von freiwilligen zusätzlichen nichtfinanziellen Informationen. Hingegen konnte kein signifikanter Zusammenhang zwischen dem Offenlegungsgrad und den Determinanten Branchenzugehörigkeit, Kapitalmarktorientierung und Frauenanteil im Vorstand beobachtet werden.
Kleine und mittlere Unternehmen (KMU), die dem Bereich der Automatisierungstechnik zuliefern, stehen vor der wachsenden Herausforderung, dass Kundinnen und Kunden vermehrt Produkte fordern, die im Sinne der IT-Sicherheit „sicher“ entwickelt werden. Die Norm IEC 62443-4-1 beschreibt einen solchen sichereren Produkt-Entwicklungslebenszyklus. Derartige Standards stellen hohe Anforderungen an die Organisation der Prozesse. Um die Umsetzung dieses Prozesses auch KMU zu ermöglichen, werden im folgenden Dokument Musterprozesse beschrieben, die Unternehmen befähigen die Anforderungen zu verstehen und im eigenen Unternehmen ein-, bzw. fortzuführen.
Social Scoring in China
(2023)
In den zurückliegenden Jahren hat eine Nachricht Schlagzeilen gemacht, die besonders in der westlichen Welt für Aufruhr gesorgt hat: Die Regierung der Volkrepublik China implementiere ein Sozialkreditsystem, das die Menschen in ihrem alltäglichen Verhalten bewerte und zu „Wohlverhalten" zwingen solle.
Diese Arbeit beschäftigt sich mit den Hintergründen des „Sozialkreditsystem", seiner Entstehung, Umsetzung und der Rezeption durch die chinesische Bevölkerung. Abschließend wird ein Vergleich mit ähnlichen Systemen in Deutschland versucht.
Economic and political/governmental infrastructural factors are major contributors to the economic development/growth of all sectors of a country, such as in the area of healthcare systems and clinical research, including the pharmaceutical industry. But what is the interaction between economic, and political/governmental infrastructural factors and the development of healthcare systems, especially, the performance of the pharmaceutical industry? Information from selected articles of a literature search of PubMed and by using Google Advanced Search led to the generation of five categories of infrastructural factors, and were filled with data from 41 African Countries using the World Health Organization data repository. Median changes over time were given and tested by Wilcoxon signed-rank test and Friedman test, respectively. Analysis of factors related to availability of healthcare facilities showed that physicians and pharmacies were significant increased, with insignificantly decreased number of hospital beds. Healthcare Financing by the Government showed notable differences. Private health spending decreased significantly unlike Gross National Income. Analysis of infrastructural factors showed that stable supply of electricity and the associated use of the Internet improved significantly. The low level of data on the expansion of paved road networks suggests less developed medical services in remote rural areas. Healthcare systems in African countries improved over the last two decades, but differences between the individual countries still prevail and some of the countries cannot yet offer an attractive sales market for the products of pharmaceutical companies.
In der Sozialen Arbeit und Gesundheitsfürsorge fokussieren frühe Präventions- und Hilfsangebote nach wie vor die sogenannte primäre Dyade, also die Beziehung zwischen Mutter und Kind. Väter werden oft außer Acht gelassen, obwohl sie das Familienleben und die Entwicklung des Kindes positiv wie negativ beeinflussen können und in der Erziehung heute präsenter sind als es in früheren Generationen der Fall war. Aus unterschiedlichen Perspektiven geht dieses Buch der Frage nach, mit welchen Angeboten, Erfolgsaussichten, Risiken und Nebenwirkungen (belastete) Väter unterstützt und angesprochen werden können.
Einfluss politischer Social-Media-Kommunikation auf journalistische Zeitungsberichterstattung
(2023)
Auswirkungen strategischer Social-Media-Kommunikation politischer Akteure auf Zeitungsartikel: Inwiefern Themenframes auf sozialen Netzwerken die deutsche Presse beeinflussen.
Wahlkämpfe sind ein ständiges Ringen um die Deutungshoheit über Themen in den Massenmedien zwischen politischen Parteien und Akteuren. Dabei wirkt sich die Art der Medienberichterstattung über den Wahlkampf auf die Meinungsbildung der Rezipient*innen aus und beeinflusst ihr Wahlverhalten. Diese Forschungsarbeit setzt einen anderen Blickwinkel auf die Wahlkampfberichterstattung und untersucht, wie politische Parteien im Wahlkampf Themen in sozialen Netzwerken darstellen (framen) und inwieweit diese Themenframes von Journalist*innen in Zeitungsartikel übernommen werden. Der SPD-Landesverband Niedersachsen veröffentlichte im gesamten Landtagswahlkampf eine sehr geringe Anzahl an Pressemitteilungen. Im Untersuchungszeitraum (08.09-06.10.2022), den letzten vier Wochen des Wahlkampfes, waren es drei Stück. Demnach liegt die Schlussfolgerung nahe, dass Pressemitteilungen kein relevantes Kommunikationsmittel im Wahlkampf (mehr) sind und Inhalte stattdessen über soziale Netzwerke kommuniziert werden.
Methodik
Das Forschungsthema wurde mithilfe einer Input-Output-Analyse bearbeitet. Im ersten Schritt wurde eine qualitative Input-Inhaltsanalyse der Social-Media-Kommunikation durchgeführt. Es wurden 52 Beiträge auf Twitter und Instagram auf ihre inhaltliche Gestaltung analysiert. Auf Grundlage dieser Ergebnisse wurde eine quantitative Output-Inhaltsanalyse durchgeführt. Darin wurden 427 Zeitungsartikel aus elf Tageszeitungen untersucht. Das Codebuch zur Output-Analyse zielte darauf ab, verwendeten Themen, Themenframes sowie Übernahmen von Originaltönen der Social-Media-Beiträge in Zeitungsartikeln zu ermitteln.
Ergebnisse
Journalist*innen übernehmen Inhalte aus Social-Media-Beiträgen (noch) zu einem geringen Anteil in Zeitungsartikel. Die Themenauswahl zwischen Social-Media-Beiträgen und Zeitungsartikeln war sehr ähnlich, die Frame-Übernahme fiel hingegen gering aus. Wenn Frames übernommen wurden, wurden sie überwiegend ohne Einordnung oder Kritik vermittelt. Inhalte und Originaltöne aus Social-Media Beiträgen des SPD-Landesverbands Niedersachsen übernahmen Journalist*innen im Großteil der Stichprobenartikel nicht. Insgesamt fiel auf, dass regionale Tageszeitungen häufiger SPD-Frames und Originaltöne aus Social-Media-Inhalten in ihre Berichterstattung übernahmen als überregionale Tageszeitungen. Im Hinblick auf Quellen in Zeitungsartikeln fiel auf, dass die SPD und dessen Akteure im Vergleich zu anderen Parteien und Parteiakteuren häufiger als Quelle verwendet wurden. Die Untersuchungsergebnisse lassen auf eine journalistisch unabhängige Arbeit und Artikelaufbereitung schließen. Für das Kommunikationsmanagement ist das jedoch möglicherweise eine Zeit des Umbruchs, weil eine Tendenz, zumindest in der politischen Kommunikation, zu beobachten ist: weg von klassischer Pressearbeit, hin zu sozialer Netzwerkkommunikation.
PROFINET Security: A Look on Selected Concepts for Secure Communication in the Automation Domain
(2023)
We provide a brief overview of the cryptographic security extensions for PROFINET, as defined and specified by PROFIBUS & PROFINET International (PI). These come in three hierarchically defined Security Classes, called Security Class 1, 2 and 3. Security Class 1 provides basic security improvements with moderate implementation impact on PROFINET components. Security Classes 2 and 3, in contrast, introduce an integrated cryptographic protection of PROFINET communication. We first highlight and discuss the security features that the PROFINET specification offers for future PROFINET products. Then, as our main focus, we take a closer look at some of the technical challenges that were faced during the conceptualization and design of Security Class 2 and 3 features. In particular, we elaborate on how secure application relations between PROFINET components are established and how a disruption-free availability of a secure communication channel is guaranteed despite the need to refresh cryptographic keys regularly. The authors are members of the PI Working Group CB/PG10 Security.
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.
Context: Higher education is changing at an accelerating pace due to the widespread use of digital teaching and emerging technologies. In particular, AI assistants such as ChatGPT pose significant challenges for higher education institutions because they bring change to several areas, such as learning assessments or learning experiences.
Objective: Our objective is to discuss the impact of AI assistants in the context of higher education, outline possible changes to the context, and present recommendations for adapting to change.
Method: We review related work and develop a conceptual structure that visualizes the role of AI assistants in higher education.
Results: The conceptual structure distinguishes between humans, learning, organization, and disruptor, which guides our discussion regarding the implications of AI assistant usage in higher education. The discussion is based on evidence from related literature.
Conclusion: AI assistants will change the context of higher education in a disruptive manner, and the tipping point for this transformation has already been reached. It is in our hands to shape this transformation.
The aim of this cross-sectional study was to investigate the occurrence of bacteremia in severe mastitis cases of dairy cows. Milk and corresponding blood samples of 77 cases of severe mastitis were bacteriologically examined. All samples (milk and blood) were incubated aerobically and anaerobically to also investigate the role of obligate anaerobic microorganisms in addition to aerobic microorganisms in severe mastitis. Bacteremia occurred if identical bacterial strains were isolated from milk and blood samples of the same case. In addition, pathogen shedding was examined, and the data of animals and weather were collected to determine associated factors for the occurrence of bacteremia in severe mastitis. If Gram-negative bacteria were detected in milk samples, a Limulus test (detection of endotoxins) was also performed for corresponding blood samples without the growth of Gram-negative bacteria. In 74 cases (96.1%), microbial growth was detected in aerobically incubated milk samples. The most-frequently isolated bacteria in milk samples were Escherichia (E.) coli (48.9%), Streptococcus (S.) spp. (18.1%), and Klebsiella (K.) spp. (16%). Obligatory anaerobic microorganisms were not isolated. In 72 cases (93.5%) of the aerobically examined blood samples, microbial growth was detected. The most-frequently isolated pathogens in blood samples were non-aureus Staphylococci (NaS) (40.6%) and Bacillus spp. (12.3%). The Limulus test was positive for 60.5% of cases, which means a detection of endotoxins in most blood samples without the growth of Gram-negative bacteria. Bacteremia was confirmed in 12 cases (15.5%) for K. pneumoniae (5/12), E. coli (4/12), S. dysgalactiae (2/12), and S. uberis (1/12). The mortality rate (deceased or culled) was 66.6% for cases with bacteremia and 34.1% for cases without bacteremia. High pathogen shedding and high humidity were associated with the occurrence of bacteremia in severe mastitis.
Das Metavorhaben „Partizipation, Praxisbezug, Ethik und Monitoring in der Förderlinie ‚sexualisierte Gewalt in pädagogischen Kontexten‘ (ParPEM)“, zielt auf die inhaltliche Begleitung der vom BMBF am 7.11.2016 ausgeschriebenen Anschlussförderlinie ab, durch die fünf Einzelvorhaben und elf Verbundvorhaben gefördert werden. Dieser Schlussbericht fasst die Forschungsergebisse des Teilprojekts „Münster“ zusammen.
Der Artikel befasst sich mit der Zusammensetzung multiprofessioneller Teams in Beratungsstellen - bezogen auf die Grundprofessionen. Er zeigt auf, dass die Psychologie in der Geschichte der Beratungsstellen eine dominante Rolle im multiprofessionellen Gefüge übernommen hat, mit der Folge, dass bis heute um professionsspezifische Handlungsansätze der Sozialen Arbeit in der Beratung, sowie um ein gutes Verhältnis von Psychologie und Sozialer Arbeit gerungen werden muss. Es wird aufgedeckt, dass dieses Ringen auch im Umgang mit der empirisch nachgewiesenen, neuen quantitativen Dominanz der Sozialen Arbeit im multiprofessionellen Gefüge sichtbar wird und ein nur defizitorientierter, dominant psychologischer Blick darauf vermieden werden sollte.
Der Bericht über die Mitgliederversammlung gliedert sich in vier Teile: Einen kurzen Bericht über die formalen Anteile der Versammlung (1), die kurze Vorstellung der mit dem Cora-Baltussen-Förderpreis ausgezeichneten Abschlussarbeiten (2), eine Paraphrase des Vortrags von Armin Nassehi (3) sowie eine kritisch-kommentierende Diskussion des Fishbowls über Führungskräfte in der klinischen Pflege (4).
Zu den Phänomenen digitalisierter Kommunikation ist inzwischen auch die Chatberatung zu zählen. Vor diesem Hintergrund zeigt sich die Notwendigkeit, Kommunikation via Chat phänomenologisch zu durchdringen, sozialtheoretisch einzuordnen und beratungsethisch kritisch zu reflektieren. Dies geschieht am Beispiel der Chatseelsorge, die zugleich von Beratung unterschieden wird.
Das vom Bundesministerium für Bildung und Forschung geförderte Forschungsprojekt "Stärken oder schützen? Über Inhalte, Methoden und kollektive Orientierungen sexualpädagogischer und gewaltpräventiver Praxis – ein Professionalisierungsbeitrag (SoS)" erforschte pädagogischen Praxen mit Schwerpunkt auf der Sexualpädagogik und der Prävention sexualisierter Gewalt. Dieses Memorandum fasst die Ergebnisse des Verbundvorhabens zusammen.
Monitoring of clinical trials is a fundamental process required by regulatory agencies. It assures the compliance of a center to the required regulations and the trial protocol. Traditionally, monitoring teams relied on extensive on-site visits and source data verification. However, this is costly, and the outcome is limited. Thus, central statistical monitoring (CSM) is an additional approach recently embraced by the International Council for Harmonisation (ICH) to detect problematic or erroneous data by using visualizations and statistical control measures. Existing implementations have been primarily focused on detecting inlier and outlier data. Other approaches include principal component analysis and distribution of the data. Here we focus on the utilization of comparisons of centers to the Grand mean for different model types and assumptions for common data types, such as binomial, ordinal, and continuous response variables. We implement the usage of multiple comparisons of single centers to the Grand mean of all centers. This approach is also available for various non-normal data types that are abundant in clinical trials. Further, using confidence intervals, an assessment of equivalence to the Grand mean can be applied. In a Monte Carlo simulation study, the applied statistical approaches have been investigated for their ability to control type I error and the assessment of their respective power for balanced and unbalanced designs which are common in registry data and clinical trials. Data from the German Multiple Sclerosis Registry (GMSR) including proportions of missing data, adverse events and disease severity scores were used to verify the results on Real-World-Data (RWD).
The digital transformation with its new technologies and customer expectation has a significant effect on the customer channels in the insurance industry. The objective of this study is the identification of enabling and hindering factors for the adoption of online claim notification services that are an important part of the customer experience in insurance. For this purpose, we conducted a quantitative cross-sectional survey based on the exemplary scenario of car insurance in Germany and analyzed the data via structural equation modeling (SEM). The findings show that, besides classical technology acceptance factors such as perceived usefulness and ease of use, digital mindset and status quo behavior play a role: acceptance of digital innovations, lacking endurance as well as lacking frustration tolerance with the status quo lead to a higher intention for use. Moreover, the results are strongly moderated by the severity of the damage event—an insurance-specific factor that is sparsely considered so far. The latter discovery implies that customers prefer a communication channel choice based on the individual circumstances of the claim.
Introduction
Atopic dermatitis (AD) is a common inflammatory skin disease. Many patients are initiating a systemic therapy, if the disease is not adequately controlled with topical treatment only. Currently, there is little real-world evidence on the AD-related medical care situation in Germany. This study analyzed patient characteristics, treatment patterns, healthcare resource utilization and costs associated with systemically treated AD for the German healthcare system.
Methods
In this descriptive, retrospective cohort study, aggregated anonymized German health claims data from the InGef research database were used. Within a representative sample of four million insured individuals, patients with AD and systemic drug therapy initiation (SDTI) in the index year 2017 were identified and included into the study cohort. Systemic drug therapy included dupilumab, systemic corticosteroids (SCS) and systemic immunosuppressants (SIS). Patients were observed for one year starting from the date of SDTI in 2017.
Results
9975 patients were included (57.8% female, mean age 39.6 years [SD 25.5]). In the one-year observation period, the most common systemic drug therapy was SCS (> 99.0%). Administrations of dupilumab (0.3%) or dispensations of SIS were rare (cyclosporine: 0.5%, azathioprine: 0.6%, methotrexate: 0.1%). Median treatment duration of SCS, cyclosporine and azathioprine was 27 days, 102 days, and 109 days, respectively. 2.8% of the patients received phototherapy; 41.6% used topical corticosteroids and/or topical calcineurin inhibitor. Average annual costs for medications amounted to € 1237 per patient. Outpatient services were used by 99.6% with associated mean annual costs of € 943; 25.4% had at least one hospitalization (mean annual costs: € 5836). 5.3% of adult patients received sickness benefits with associated mean annual costs of € 5026.
Conclusions
Despite unfavorable risk–benefit profile, this study demonstrated a common treatment with SCS, whereas other systemic drug therapy options were rarely used. Furthermore, the results suggest a substantial economic burden for patients with AD and SDTI.
In der detaillierten Beschäftigung mit Quellen der Sozialen Arbeit zur Entstehung der Supervision in den 1960er Jahren legt dieser Beitrag den Fokus auf die auch in der sozialpädagogischen Geschichtsschreibung weithin unterdrückten religiösen Hintergründe. In der Beschäftigung mit den Rahmenbedingungen der Supervisionsausbildung an der katholischen Akademie für Jugendfragen in Münster kann gezeigt werden, wie eng katholische Milieus und Ethiken mit der Entstehung von Supervision im nordwestdeutschen Raum verbunden waren und was das für das frühe Verständnis von Supervision und ihre weitere Entwicklung bedeutete.
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.
Hospizarbeit und ihre Öffentlichkeitsarbeit im Blick auf junge Menschen. Ein Forschungsprojekt
(2023)
Den Hospizgedanken in die Mitte der Gesellschaft zu tragen ist eine der Kernaufgaben der Hospizarbeit. Dafür ist eine aktive, engagierte und lebendige Öffentlichkeitsarbeit notwendig, die ihren Inhalt genauso aktiv im Blick hat, wie ihre Zielgruppe. Wie kann diese gestaltet werden und wie kann es gelingen, Menschen und insbesondere auch jüngere Menschen für das Ehrenamt in der Hospizarbeit zu gewinnen? Wie können junge Menschen die Hospizarbeit mitgestalten, unterstützen und verändern?
Ziel der Online-Umfrage war es, zunächst einen Überblick über die (Alters-) Strukturen des Haupt- sowie Ehrenamts zu gewinnen. Des Weiteren wurde untersucht, ob das Engagement junger Menschen im hospizlichen Ehrenamt gewünscht ist, wie dieses bisher wahrgenommen wird und welche Hoffnungen, aber auch Bedenken gegenüber jungem Ehrenamt geäußert werden.
Darüber hinaus diente die Umfrage dazu, einen Überblick über bereits bestehende Maßnahmen zur Öffentlichkeitsarbeit im Allgemeinen sowie speziell bezogen auf die Zielgruppe zu erlangen. Zusätzlich ließen sich dadurch (neue) Ansatzpunkte für eine erfolgreiche Öffentlichkeitsarbeit in und für die (niedersächsische) Hospizlandschaft zusammentragen.
The shift towards RES introduces challenges related to power system stability due to the characteristics of inverter-based resources (IBRs) and the intermittent nature of renewable resources. This paper addresses these challenges by conducting comprehensive time and frequency simulations on the IEEE two-area benchmark power system with detailed type 4 wind turbine generators (WTGs), including turbines, generators, converters, filters, and controllers. The simulations analyse small-signal and transient stability, considering variations in active and reactive power, short-circuit events, and wind variations. Metrics such as rate of change of frequency (RoCoF), frequency nadir, percentage of frequency variation, and probability density function (PDF) are used to evaluate the system performance. The findings emphasise the importance of including detailed models of RES in stability analyses and demonstrate the impact of RES penetration on power system dynamics. This study contributes to a deeper understanding of RES integration challenges and provides insights for ensuring the reliable and secure operation of power systems in the presence of high levels of RES penetration.
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.
Der Nachhaltigkeitsbericht der Hochschule Hannover erscheint jährlich und wird vom Green Office (Strategische Hochschulentwicklung) erstellt. Er bildet aktuelle Nachhaltigkeitsaktivitäten der HsH in den Handlungsfeldern Energie, Gebäude, Beschaffung, Begrünung, Mobilität sowie Lehre und Forschung ab und gibt einen Überblick über alle geplanten Entwicklungen in diesen Bereichen.
In this paper a new rotor position observer for permanent magnet synchronous machines (PMSM) based on an Extended-Kalman-Filter (EKF) is presented. With this method, just one single EKF is sufficent to evaluate the position information from electromotive force (EMF) and anisotropy. Thus, the PMSM can be controlled for the entire speed range without a position sensor and without the need to switch or synchronize between different observers. The approach covers online estimation of permanent magnetic field and mechanical load. The resulting EKF-based rotor position estimator is embedded in the existing cascaded control concept of the PMSM without need of additional angle trackers or signal filters. The experimental validation for the position sensorless control shows optimized dynamic behaviour.
Im Rahmen des Projektes ist eine Plattform für Komponenten intelligenter Gebäudeautomationssysteme entwickelt worden und deren Brauchbarkeit wurde an zwei Demonstratoren aufgezeigt. Die entwickelten Komponenten werden gleichzeitig sowohl die Wirtschaftlichkeit als auch die Umweltverträglichkeit zukünftiger Produkte, beispielsweise intelligenter Raumbediengeräte oder intelligenter Türschlösser, wesentlich steigern.
Charakteristisches Merkmal der Plattform ist der geringe Energiebedarf. Die Kombination dieser Merkmale ermöglicht einen längeren drahtlosen Betrieb mit weniger Batteriezellen im Vergleich zu bestehenden Systemen. Die Steigerung der Wirtschaftlichkeit ergibt sich bereits durch die Ausdehnung der Wartungsintervalle für den Batteriewechsel und die Steigerung der Umweltverträglichkeit folgt aus der verringerten Menge anfallender Altbatterien. Darüber hinaus konnten unterschiedliche Energy-Harvesting-Technologien umgesetzt werden die einen geringeren Energieverbrauch der Applikation voraussetzen. Der Einsatz des Multi-Energy-Harvesting bietet das Potenzial zur weiteren Steigerung der Wirtschaftlichkeit und Umweltverträglichkeit der Plattform. Bei ausreichend verfügbarer Energie kann EnergyHarvesting die gesamte Energieversorgung einer Komponente gewährleisten und es kann auf Batterien vollständig verzichtet werden.
Der Bericht geht auf die Umsetzung des Konzepts und die Resultate ein. Dabei basieren die Kapitel des Berichts auf den Arbeitspaketen des Projekts. In den einzelnen Arbeitspaketen wird auf die Ergebnisse der Projektpartner bzw. gemeinsame Ergebnisse eingegangen. Am Berichtsende folgt eine Zusammenfassung und ein Ausblick auf die Verwendung der Ergebnisse durch die Projektpartner.
During the Corona-Pandemic, information (e.g. from the analysis of balance sheets and payment behavior) traditionally used for corporate credit risk analysis became less valuable because it represents only past circumstances. Therefore, the use of currently published data from social media platforms, which have shown to contain valuable information regarding the financial stability of companies, should be evaluated. In this data e. g. additional information from disappointed employees or customers can be present. In order to analyze in how far this data can improve the information base for corporate credit risk assessment, Twitter data regarding the ten greatest insolvencies of German companies in 2020 and solvent counterparts is analyzed in this paper. The results from t-tests show, that sentiment before the insolvencies is significantly worse than in the comparison group which is in alignment with previously conducted research endeavors. Furthermore, companies can be classified as prospectively solvent or insolvent with up to 70% accuracy by applying the k-nearest-neighbor algorithm to monthly aggregated sentiment scores. No significant differences in the number of Tweets for both groups can be proven, which is in contrast to findings from studies which were conducted before the Corona-Pandemic. The results can be utilized by practitioners and scientists in order to improve decision support systems in the domain of corporate credit risk analysis. From a scientific point of view, the results show, that the information asymmetry between lenders and borrowers in credit relationships, which are principals and agents according to the principal-agent-theory, can be reduced based on user generated content from social media platforms. In future studies, it should be evaluated in how far the data can be integrated in established processes for credit decision making. Furthermore, additional social media platforms as well as samples of companies should be analyzed. Lastly, the authenticity of user generated contend should be taken into account in order to ensure, that credit decisions rely on truthful information only.
Unverständliche Texte sind ein täglicher Alptraum vieler Millionen Erwachsener in deutschsprachigen Ländern. Ob Behördenbrief, Beipackzettel oder Betriebsanleitung: Man mag das Kauderwelsch nicht lesen. Dabei ist es gar nicht so kompliziert, diesen Ärger aus der Welt zu schaffen. Dieses Buch berichtet von Hintergründen und zeigt, wie man es macht.
The trend towards the use of Ethernet in automation networks is ongoing. Due to its high flexibility, speed, and bandwidth, Ethernet nowadays is not only widely used in homes and offices worldwide but finding its way into industrial applications. Especially in automation processes, where many field devices send data in relative short time spans, the requirements for a safe and fast data transfer are high. This makes the use of industrial Ethernet essential. A new hardware-layer, specifically tailored for industrial applications, has been introduced in the form of Ethernet-APL (‘Advanced Physical Layer’). Ethernet-APL is based on the Ethernet standard and implements a two-wire Ethernet-based communication for field devices and provides data and power over a two-wire cable. The operation in areas with potentially explosive atmosphere is also possible. This enables a modular, fast, and transparent Ethernet network structure throughout the entire plant. However, by integrating Ethernet-APL into the field, industrial networks in the future will face the challenge of operating at varying datarates at different locations in the network, resulting in a ‘mixed link speed’ network. This can lead to limitations in packet-throughput and consequently to potential packet loss of system relevant data, which must be avoided. Therefore, the purpose of this thesis is to investigate the potential of packet loss in ‘mixed link speed’ networks.
Unternehmen, die sich ernsthaft mit Nachhaltigkeit beschäftigen, müssen den Nachweis erbringen, dass sie positive Effekte für die Gesellschaft erzielen. Damit ist eine ganzheitliche Wirkungsmessung unabdingbar. Sozialunternehmen sollten als Vorbild für eine solche Wirkungsmessung dienen. Eine wissenschaftliche Studie auf Basis der sog. „Ergebnispyramide“ kommt jedoch zu dem Schluss, dass selbst diese ihre Wirkung bisher kaum ganzheitlich messen.
Schattenbibliotheken sind Lösungen, die sich aus einem Literaturmangel in der Forschung ergeben haben. Urheberrechtlich geschützte Inhalte werden hier online jedem frei zur Verfügung gestellt. In der vorliegenden Arbeit wird versucht, das Wirken dieser Dokumentsammlungen einzuordnen. So wird die Entstehung von Schattenbibliotheken aufgezeigt, auf den rechtlichen Umgang mit diesen Plattform eingegangen, zwei Schattenbibliotheken beispielhaft näher betrachtet und deren Auswirkungen abgebildet, bevor die Arbeit mit einem persönlichen Fazit abschließt.
Background
To perform a systematic review about the effect of using clinical pathways on length of stay (LOS), hospital costs and patient outcomes. To provide a framework for local healthcare organisations considering the effectiveness of clinical pathways as a patient management strategy.
Methods
As participants, we considered hospitalized children and adults of every age and indication whose treatment involved the management strategy "clinical pathways". We include only randomised controlled trials (RCT) and controlled clinical trials (CCT), not restricted by language or country of publication. Single measures of continuous and dichotomous study outcomes were extracted from each study. Separate analyses were done in order to compare effects of clinical pathways on length of stay (LOS), hospital costs and patient outcomes. A random effects meta-analysis was performed with untransformed and log transformed outcomes.
Results
In total 17 trials met inclusion criteria, representing 4,070 patients. The quality of the included studies was moderate and studies reporting economic data can be described by a very limited scope of evaluation. In general, the majority of studies reporting economic data (LOS and hospital costs) showed a positive impact. Out of 16 reporting effects on LOS, 12 found significant shortening. Furthermore, in a subgroup-analysis, clinical pathways for invasive procedures showed a stronger LOS reduction (weighted mean difference (WMD) -2.5 days versus -0.8 days)).
There was no evidence of differences in readmission to hospitals or in-hospital complications. The overall Odds Ratio (OR) for re-admission was 1.1 (95% CI: 0.57 to 2.08) and for in-hospital complications, the overall OR was 0.7 (95% CI: 0.49 to 1.0). Six studies examined costs, and four showed significantly lower costs for the pathway group. However, heterogeneity between studies reporting on LOS and cost effects was substantial.
Conclusion
As a result of the relatively small number of studies meeting inclusion criteria, this evidence base is not conclusive enough to provide a replicable framework for all pathway strategies. Considering the clinical areas for implementation, clinical pathways seem to be effective especially for invasive care. When implementing clinical pathways, the decision makers need to consider the benefits and costs under different circumstances (e.g. market forces).
Rassismus, Antisemitismus und Rechtsextremismus führen zu schweren Menschenrechtsverletzungen. Denn diese Formen von Diskriminierung und Ausgrenzung sind Motivation für Hass und Gewalt, machen Menschen zu „Anderen“, grenzen sie aus der Gesellschaft aus und sprechen ihnen so die gleichen Grund- und Menschenrechte und damit die Menschenwürde ab. Sie greifen damit auch das Fundament unserer Verfassung an. Strafverfolgungsbehörden und Gerichte müssen in der Lage sein, rassistische, antisemitische und rechte Taten zu erkennen und wirksam zu verfolgen. Sie müssen dabei zugleich sicherstellen, dass die Tatopfer effektiven und diskriminierungsfreien Zugang zum Recht bekommen. Nur so können die Betroffenen Gerechtigkeit erfahren, angemessene Anerkennung ihres erlittenen Unrechts erhalten und Vertrauen in den Rechtsstaat und insbesondere die Strafjustiz (wieder-)gewinnen.
Welche große Gefahr von Rassismus, Antisemitismus und Rechtsextremismus ausgeht, wurde vielfach auf erschreckende Weise öffentlich sichtbar: Beispielhaft genannt seien die Ermordung des Kasseler Regierungspräsidenten Walter Lübcke und die zahlreichen Morde bei den Anschlägen in Halle und Hanau. Für viele Menschen, die alltäglich von rassistischer und antisemitischer Gewalt und Diskriminierung betroffen sind, lösten diese Ereignisse und das Verhalten der Sicherheits- und Strafverfolgungsbehörden Zweifel daran aus, ob der deutsche Staat sie wirksam schützen kann oder will. Deshalb war es ein wichtiger Schritt, dass die Bundesregierung 2021 ein Maßnahmepaket zur Bekämpfung von Rassismus und Rechtsextremismus verabschiedete und deren Umsetzung auf den Weg brachte, und dass die neue Bundesregierung diese fortsetzen und weiterentwickeln will.
Rassismus und Antisemitismus bauen auf ein gesellschaftlich und historisch tief verwurzeltes ungleiches Machtverhältnis auf. Sie sind deshalb mehr als ein Diskriminierungsverhältnis zwischen Einzelpersonen, sondern haben sich in Strukturen, Verfahren und (gesellschaftlichen wie staatlichen) Institutionen niedergeschlagen. Wirksamer Schutz vor rassistischen, antisemitischen und rechtsextremen Gewalttaten und deren effektive Strafverfolgung setzen daher voraus, dass die alltägliche Praxis von Sicherheitsbehörden und Strafverfolgung nachhaltig verändert wird. Hierfür müssen bestehende Routinen und Denkmuster kritisch überprüft und verändert werden.
Der vorliegende Reader soll bei der insofern gebotenen (selbst-)kritischen Auseinandersetzung unterstützen. Er enthält zudem, aufbauend auf Einsichten und Einschätzungen aus der Praxis, Empfehlungen für wirkungsvolle Maßnahmen und gebotene Veränderungsprozesse. Diese brauchen engagierte Träger*innen eines solchen Wandels, aber auch und insbesondere Leitungskräfte in den Institutionen, die es als ihre Verpflichtung verstehen, die notwendigen Veränderungsprozesse anzustoßen, sie zu finanzieren und ihre Durchführung und Wirkungen zu monitoren.
In this paper we describe the selection of a modern build automation tool for an industry research partner of ours, namely an insurance company. Build automation has become increasingly important over the years. Today, build automation became one of the central concepts in topics such as cloud native development based on microservices and DevOps. Since more and more products for build automation have entered the market and existing tools have changed their functional scope, there is nowadays a large number of tools on the market that differ greatly in their functional scope. Based on requirements from our partner company, a build server analysis was conducted. This paper presents our analysis requirements, a detailed look at one of the examined tools and a summarizes our comparison of all three tools from our final comparison round.
Einfluss von Industrie 4.0 auf die Anwendbarkeit von Lastmanagement in der industriellen Produktion
(2018)
Technische Energiemanagementsysteme (kurz und im Folgenden tEnMS) in der produzierenden Industrie dienen heute meinst dem Messen, Speichern und Auswerten von Energieverbrauchsdaten. Allerdings besteht auch die Möglichkeit der Vorhersage und aktiven Einflussnahme auf die Energieaufnahme von Produktionsumgebungen durch das tEnMS. Derartige Funktionen werden als Prognose- und Lastmanagementfunktionen bezeichnet. Industrielle Produktionsumgebungen erfahren im Rahmen von Industrie 4.0 einen Wandel. Dieser Beitrag soll aufzeigen, wie tEnMS durch den beschriebenen Wandel beeinflusst werden und welche Chancen sich daraus für zukünftige tEnMS ergeben.
Background:
The increase in food intolerances poses a burgeoning problem in our society. Food intolerances not only lead to physical impairment of the individual patient but also result in a high socio-economic burden due to factors such as the treatment required as well as absenteeism. The present study aimed to explore whether lactose intolerant (LI) patients exhibit more frequent comorbidities than non-LI patients.
Methods:
The study was conducted on a case-control basis and the results were determined using routine data analysis. Routine data from the IMS Disease Analyzer database were used for this purpose. A total of 6,758 data records were processed and analyzed.
Results:
There were significant correlations between LI and the incidence of osteoporosis, changes in mental status, and the presence of additional food intolerances. Comparing 3,379 LI vs. 3,379 non-LI patients, 34.5% vs. 17.7% (P<0.0001) suffered from abdominal pain; 30.6% vs. 17.2% (P<0.0001) from gastrointestinal infections; and 20.9% vs. 16.0% (P=0.0053) from depression. Adjusted odds ratios (OR) were the highest for fructose intolerance (n=229 LI vs. n=7 non-LI; OR 31.06; P<0.0001), irritable bowel syndrome (n=247 LI vs. n=44 non-LI; OR 5.23; P<0.0001), and bloating (n=351 LI vs. n=68 non-LI; OR 4.94; P<0.0001).
Conclusion:
The study confirms that LI should not be regarded as an isolated illness but considered a possible trigger for further diseases. Additional research is necessary to assert more precise statements.
Background:
Hereditary angioedema (HAE) is a rare genetic disease and characterized by clinical features such as paroxysmal, recurrent angioedema of the skin, the gastrointestinal tract, and the upper airways. Swelling of the skin occurs primarily in the face, extremities and genitals. Gastrointestinal attacks are accompanied by painful abdominal cramps, vomiting and diarrhea. Due to the low prevalence and the fact that HAE patients often present with rather unspecific symptoms such as abdominal cramps, the final diagnosis is often made after a long delay. The aim of this German-wide survey was to characterize the period between occurrence of first symptoms and final diagnosis regarding self-perceived health, symptom burden and false diagnoses for patients with HAE.
Results:
Overall, 81 patients with HAE were included and participated in the telephone-based survey. Of those, the majority reported their current health status as “good” (47.5%) or “very good” (13.8%), which was observed to be a clear improvement compared to the year before final diagnosis (“good” (16.3%), “very good” (11.3%)). Edema in the extremities (85.2%) and in the gastrointestinal tract (81.5%) were the most currently reported symptoms and occurred earlier than other reported symptoms (mean age at onset 18.1 and 17.8 years, respectively). Misdiagnoses were observed in 50.6% of participating HAE patients with appendicitis and allergy being the most frequently reported misdiagnoses (40.0 and 30.0% of those with misdiagnosis, respectively). Patients with misdiagnosis often received mistreatment (80.0%) with pharmaceuticals and surgical interventions as the most frequently carried out mistreatments (65.6 and 56.3% of those with mistreatment, respectively). The mean observed diagnostic delay was 18.1 years (median 15.0 years). The diagnostic delay was higher in older patients and index patients.
Conclusions:
This study showed that self-perceived status of health for patients is much better once the final correct diagnosis has been made and specific treatment was available. Further challenge in the future will still be to increase awareness for HAE especially in settings which are normally approached by patients at occurrence of first symptoms to assure early referral to specialists and therefore increase the likelihood of receiving an early diagnosis.
Aim:
To characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.
Subject and methods:
The study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.
Results:
The incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).
Conclusions:
In Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.
Influence on persistence and adherence with oral bisphosphonates on fracture rates in osteoporosis
(2009)
Background and Aim:
Oral bisphosphonates have been shown to reduce the risk of fractures in patients with osteoporosis. It can be assumed that the clinical effectiveness of oral bisphosphonates depends on persistence with therapy.
Methods:
The influence of persistence with and adherence to oral bisphosphonates on fracture risk in a real-life setting was investigated. Data from 4451 patients with a defi ned index prescription of bisphosphonates were included. Fracture rates within 180, 360, and 720 days after index prescription were compared between persistent and non-persistent patients. In an extended Cox regression model applying multiple event analysis, the influence of adherence was analyzed. Persistence was defined as the duration of continuous therapy; adherence was measured in terms of the medication possession ratio (MPR).
Results:
In patients with a fracture before index prescription, fracture rates were reduced by 29% (p = 0.025) comparing persistent and non-persistent patients within 180 days after the index prescription and by 45% (p < 0.001) within 360 days. The extended Cox regression model showed that good adherence (MPR ≥ 0.8) reduced fracture risk by about 39% (HR 0.61, 95% CI 0.47–0.78; p < 0.01).
Conclusions:
In patients with osteoporosis-related fractures, good persistence and adherence to oral bisphosphonates reduced fracture risk significantly.
To effectively prevent and control bovine mastitis, farmers and their advisors need to take infection pathways and durations into account. Still, studies exploring both aspects through molecular epidemiology with sampling of entire dairy cow herds over longer periods are scarce. Therefore, quarter foremilk samples were collected at 14-d intervals from all lactating dairy cows (n = 263) over 18 wk in one commercial dairy herd. Quarters were considered infected with Staphylococcus aureus, Streptococcus uberis, or Streptococcus dysgalactiae when ≥100 cfu/mL of the respective pathogen was detected, or with Staphylococcus epidermidis or Staphylococcus haemolyticus when ≥500 cfu/mL of the respective pathogen was detected. All isolates of the mentioned species underwent randomly amplified polymorphic DNA (RAPD)-PCR to explore strain diversity and to distinguish ongoing from new infections. Survival analysis was used to estimate infection durations. Five different strains of Staph. aureus were isolated, and the most prevalent strain caused more than 80% of all Staph. aureus infections (n = 46). In contrast, 46 Staph. epidermidis and 69 Staph. haemolyticus strains were isolated, and none of these caused infections in more than 2 different quarters. The 3 most dominant strains of Strep. dysgalactiae (7 strains) and Strep. uberis (18 strains) caused 81% of 33 and 49% of 37 infections in total, respectively. The estimated median infection duration for Staph. aureus was 80 d, and that for Staph. epidermidis and Staph. haemolyticus was 28 and 22 d, respectively. The probability of remaining infected with Strep. dysgalactiae or Strep. uberis for more than 84 and 70 d was 58.7 and 53.5%, respectively. Staphylococcus epidermidis and Staph. haemolyticus were not transmitted contagiously and the average infection durations were short, which brings into question whether antimicrobial treatment of intramammary infections with these organisms is justified. In contrast, infections with the other 3 pathogens lasted longer and largely originated from contagious transmission.
Background:
Huntington’s disease (HD) is a rare, genetic, neurodegenerative and ultimately fatal disease with no cure or progression-delaying treatment currently available. HD is characterized by a triad of cognitive, behavioural and motor symptoms. Evidence on epidemiology and management of HD is limited, especially for Germany. This study aims to estimate the incidence and prevalence of HD and analyze the current routine care based on German claims data.
Methods:
The source of data was a sample of the Institute for Applied Health Research Berlin (InGef) Research Database, comprising data of approximately four million insured persons from approximately 70 German statutory health insurances. The study was conducted in a retrospective cross-sectional design using 2015 and 2016 as a two-year observation period. At least two outpatient or inpatient ICD-10 codes for HD (ICD-10: G10) during the study period were required for case identification. Patients were considered incident if no HD diagnoses in the 4 years prior to the year of case identification were documented. Information on outpatient drug dispensations, medical aids and remedies were considered to describe the current treatment situation of HD patients.
Results:
A 2-year incidence of 1.8 per 100,000 persons (95%-Confidence interval (CI): 1.4–2.4) and a 2-year period prevalence of 9.3 per 100,000 persons (95%-CI: 8.3–10.4) was observed. The prevalence of HD increased with advancing age, peaking at 60–69 years (16.8 per 100,000 persons; 95%-CI: 13.4–21.0) and decreasing afterwards.
The most frequently observed comorbidities and disease-associated symptoms in HD patients were depression (42.9%), dementia (37.7%), urinary incontinence (32.5%), extrapyramidal and movement disorders (30.5%), dysphagia (28.6%) and disorders of the lipoprotein metabolism (28.2%).
The most common medications in HD patients were antipsychotics (66.9%), followed by antidepressants (45.1%). Anticonvulsants (16.6%), opioids (14.6%) and hypnotics (9.7%) were observed less frequently.
Physical therapy was the most often used medical aid in HD patients (46.4%). Nursing services and speech therapy were used by 27.9 and 22.7% of HD patients, respectively, whereas use of psychotherapy was rare (3.2%).
Conclusions:
Based on a representative sample, this study provides new insights into the epidemiology and routine care of HD patients in Germany, and thus, may serve as a starting point for further research.
Incorporation and Deposition of Spin Crossover Materials into and onto Electrospun Nanofibers
(2023)
We synthesized iron(II)-triazole spin crossover compounds of the type [Fe(atrz)3]X2 and incorporated and deposited them on electrospun polymer nanofibers. For this, we used two separate electrospinning methods with the goal of obtaining polymer complex composites with intact switching properties. In view of possible applications, we chose iron(II)-triazole-complexes that are known to exhibit spin crossover close to ambient temperature. Therefore, we used the complexes [Fe(atrz)3]Cl2 and [Fe(atrz)3](2ns)2 (2ns = 2-Naphthalenesulfonate) and deposited those on fibers of polymethylmethacrylate (PMMA) and incorporated them into core–shell-like PMMA fiber structures. These core–shell structures showed to be inert to outer environmental influences, such as droplets of water, which we purposely cast on the fiber structure, and it did not rinse away the used complex. We analyzed both the complexes and the composites with IR-, UV/Vis, Mössbauer spectroscopy, SQUID magnetometry, as well as SEM and EDX imaging. The analysis via UV/Vis spectroscopy, Mössbauer spectroscopy, and temperature-dependent magnetic measurements with the SQUID magnetometer showed that the spin crossover properties were maintained and were not changed after the electrospinning processes.
Background:
Multiple Sclerosis (MS) is a chronic inflammatory, immune mediated disease of the central nervous system, with Relapsing Remitting MS (RRMS) being the most common type. Within the last years, the status of high disease activity (HDA) has become increasingly important for clinical decisions. Nevertheless, little is known about the incidence, the characteristics, and the current treatment of patients with RRMS and HDA in Germany. Therefore, this study aims to estimate the incidence of HDA in a German RRMS patient population, to characterize this population and to describe current drug treatment routines and further healthcare utilization of these patients.
Methods:
A claims data analyses has been conducted, using a sample of the InGef Research Database that comprises data of approximately four million insured persons from around 70 German statutory health insurances (SHI). The study was conducted in a retrospective cohort design, including the years 2012–2016. Identification of RRMS population based on ICD-10 code (ICD-10-GM: G35.1). For identification of HDA, criteria from other studies as well as expert opinions have been used. Information on incidence, characteristics and current treatment of patients with RRMS and HDA was considered.
Results:
The overall HDA incidence within the RRMS population was 8.5% for 2016. It was highest for the age group of 0–19 years (29.4% women, 33.3% men) and lowest for the age group of ≥ 50 years (4.3% women, 5.6% men). Mean age of patients with RRMS and incident HDA was 38.4 years (SD: 11.8) and women accounted for 67.8%.
Analyses of drug utilization showed that 82.4% received at least one disease-modifying drug (DMD) in 2016. A percentage of 49.8% of patients received drugs for relapse therapy. A share of 55% of RRMS patients with HDA had at least one hospitalization with a mean length of stay of 13.9 days (SD: 18.3 days) in 2016. The average number of outpatient physician contacts was 28.1 (SD: 14.0).
Conclusions:
This study based on representative Germany-wide claims data from the SHI showed a high incidence of HDA especially within the young RRMS population. Future research should consider HDA as an important criterion for the quality of care for MS patients.
