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Consumer Acceptance of Alternative Proteins: Exploring Determinants of the Consumer Willingness to Buy in Germany
Get PDFIn Western countries, a shift to a diet rich in proteins from diverse sources could aid the transition to more sustainable patterns of protein consumption and production, contributing to meet the future demand for protein from the growing population. The successful integration of alternative proteins into diets hinges, however, on consumer acceptance. Despite a plethora of acceptance studies on alternative proteins, comparative insights remain limited. To improve the fragmented understanding of the drivers and barriers of alternative protein acceptance, this study examines consumer willingness in Germany to buy food products containing proteins from three sources—algae, crickets and jellyfish—using the same methodological approach. The findings indicate that environmental consciousness strengthens the willingness to buy products based on all three protein sources while neophobia weakens it. In contrast, past meat consumption habits contribute positively to the acceptance of animal-origin alternative proteins, like crickets and jellyfish, but negatively to the acceptance of algae. The acceptance is also influenced by demographic factors. It is argued that strategies targeting these factors can enhance the acceptance of alternative protein sources such as algae, crickets and jellyfish. However, it is important to tailor the strategies to the determinants that influence the willingness to buy products from a particular protein source
Impact of the Channel Length in Nanoporous Electric Double-Layer Capacitors on the Charge Transport Explored by Metal–Organic Framework Films
Get PDFFor enhancing the performance of electric double-layer capacitors, the porous electrodes must be further optimized. While many studies on electrolyte and electrode structures enable detailed insights, the length of the pore channels of the electrode has been overlooked. Here, we use films of two-dimensional conductive metal–organic frameworks, where the film thickness (and thus the pore channel length) is rationally tuned over a wide range. Cyclic voltammetry experiments with two different electrolytes were conducted, revealing the charge transport kinetics in the porous electrodes. For the highly mobile electrolyte, the kinetics is not limited by ion transport (i.e., diffusion) even for thick films, exhibiting mainly surface-controlled kinetic behavior. In contrast, for the less mobile electrolyte, the kinetics is primarily limited by ion diffusion, and the pore channel length has a severe impact, where long channels result in strongly decreased capacitances, highlighting the importance of adjusting the channel length
Discrete JT gravity as an Ising model
Get PDFInspired by the program of discrete holography, we show that Jackiw-Teitelboim (JT) gravity on a hyperbolic tiling of Euclidean AdS2 gives rise to an Ising model on the dual lattice, subject to a topological constraint. The Ising model involves an asymptotic boundary condition with spins pointing opposite to the magnetic field. The topological constraint enforces a single domain wall between the spins of opposite direction, with the topology of a circle. The resolvent of JT gravity is related to the free energy of this Ising model, and the classical limit of JT gravity corresponds to the Ising low-temperature limit. We study this Ising model through a Monte Carlo approach and a mean-field approximation. For finite truncations of the infinite hyperbolic lattice, the map between both theories is only valid in a regime in which the domain wall has a finite size. For the extremal cases of large positive or negative coupling, the domain wall either shrinks to zero or touches the boundary of the lattice. This behavior is confirmed by the mean-field analysis. We expect that our results may be used as a starting point for establishing a holographic matrix model duality for discretized gravity
Uranium(VI) retention by calcium (alumino)silicate hydrates – Impact of temperature and ionic strength
Get PDFCalcium aluminosilicate hydrates (C-A-S-H) are the main hydration products of cement formulations with Al-rich additives such as blast furnace slags, fly ashes or calcined clays. We studied systematically the effect of Al substitution on both the structure of C-A-S-H phases and their U(VI) retention properties in comparison to C-S-H phases. To represent the different stages of cement degradation, three series of samples were synthesized, which included samples with Ca/Si molar ratios of 0.8, 1.2 and 1.6 and different Al/Si molar ratios of 0, 0.06 and 0.18 for each series. Furthermore, the impact of synthesis temperature (room temperature, 100 °C, 200 °C) on the C-(A-)S-H structure was studied. The U(VI) retention, studied either by sorption experiments or by direct synthesis of U(VI)-containing C-(A-)S-H phases, was found to be strong with log Rd between 4.9 and 5.6. Structural characteristics of the cementitious phases were obtained from powder X-ray diffraction (XRD) as well as 29Si and 27Al solid-state magic angle spinning nuclear magnetic resonance (SS MAS NMR) spectroscopy. AlO4 tetrahedra were identified to occupy bridging positions of the silicate chains, thereby increasing the mean chain length and providing additional sorption sites for U(VI) at room temperature. Elevated temperatures during solid phase formation, however, lead to a stronger cross-linking of the silicate chains with the appearance of neoformed crystalline phases. Luminescence spectroscopy was applied to characterize the U(VI) binding. Various U(VI) species (interlayer or surface sorbed) are formed in different proportions, depending on the composition and structure of the C-(A-)S-H phases, which are partly affected by elevated temperatures. To simulate salinity changes of the pore water, the effect of enhanced ionic strengths and the presence of carbonate on the stability of the U(VI) retention by the C-(A-)S-H phases was studied by sorption and leaching experiments over extended timescales of up to 6 months. For C-(A-)S-H phases previously exposed to temperatures of up to 100 °C, the effect of medium ionic strengths (up to 2.6 M) on U(VI) retention was insignificant
Anwendung von “machine learning“ Algorithmen für die Vorhersage der funktionellen Erholung nach subarachnoidaler Blutung - eine monozentrische retrospektive Studie
Get PDFBackground: There is a controversy about the superiority of the performance of prognostic tools based on advanced machine learning (ML) algorithms for patients with aneurysmal subarachnoid hemorrhage (aSAH). Unfortunately, evaluation of the performance of current ML-based tools is not comprehensive enough, often using a single model and exclusively the area under the receiver operating characteristic curve (AUROC) to quantify the performance. Therefore, it remains unclear whether these would be reliable and benefit patients. My goal was to develop and evaluate ML models for predicting unfavorable functional outcome in aSAH patients and identify the model with the best performance.
Methods: A retrospective dataset comprising 955 patients with aSAH was randomly split into training and internal test sets, with 670 (70%) and 285 (30%) patients respectively. Clinical scores, along with clinical and radiological features at admission, as well as secondary complications from the training set were used to construct models based on five machine learning (ML) algorithms (logistic regression [LR], K-nearest neighbor [KNN], extreme gradient boosting [XGB], random forest [RF] and artificial neural network [ANN]). For comparison and evaluation among models, AUROC, the area under the precision-recall curve (AUPR), calibration curve, and decision curve analysis (DCA) were utilized on the internal test set.
Results: Composite models (based on LR, XGB, RF and ANN algorithms) had significantly higher AUROC than simple models in predicting unfavorable functional outcomes. Compared to other composite models (RF and XGB algorithms) with good calibration, LR had the highest value of AUPR and showed the greatest benefit in DCA.
Conclusion: A prediction model employing LR algorithm has shown superior performance in identifying patients with aSAH who are at high risk for adverse functional outcomes. Thus, this model could be a useful tool to assisting healthcare professionals in their decision-making processes.Hintergrund: Die Bewertung von prognostischen Instrumenten auf der Basis von „advanced machine learning“-Algorithmen für Patienten mit subarachnoidalen Blutungen bei Aneurysmen (aSAH) ist bisher kaum möglich. Der Grund dafür ist eine noch unzureichende Datenlage. Das Ziel der Studie ist die Entwicklung und der Vergleich verschiedener Verfahren des „machine learning“ für die Prognose ungünstigen klinischen Verlaufs bei aSAH-Patienten.
Methoden: Ein retrospektiv erhobener Datensatz von 955 Patienten mit aSAH wurde nach dem Zufallsprinzip in einen Trainingsdatensatz mit 670 (70%) Patienten sowie in einen internen Testdatensatz mit 285 (30%) geteilt. Die Modellgestaltung erfolgte unter Verwendung des klinischen Scores bei Aufnahme des Patienten, weiterer klinischer und radiologischer Merkmale sowie unter Beachtung sekundärer Komplikationen. Folgende fünf “machine learning” Algorithmen wurden einbezogen: “logistic regression” [LR], “K-nearest neighbor” [KNN], “extreme gradient boosting” [XGB], “random forest” [RF] und “artificial neural network“ [ANN]. Die Modellbewertung am Testdatensatz erfolgte mit Hilfe der Fläche unter der „receiver operating characteristic curve“ (AUROC), der „precision-recall curve“ (AUPR), der „calibration curve“, und der „decision curve analysis“ (DCA).
Ergebnisse: Komplexere Modelle basierend auf LR, XGB, RF und ANN Algorithmen zeigten höhere AUROCs als die einfachen Modelle und sie waren prädiktiver hinsichtlich eines ungünstigen funktionellen Verlaufes der Patienten. Im Vergleich mit anderen komplexen Modellen (RF und XGB), die eine gute „calibration curve“ zeigten, hatte LR die größte AUPR und war bei DCA überlegen.
Schlussfolgerungen: Das Vorhersagemodell auf Basis des LR-Algorithmus zeigte die beste Ergebnisse bei der Erkennung von aSAH-Patienten mit einer ungünstigen klinischen Entwicklung. Es kann ein sinnvolles Hilfsmittel zur Unterstützung ärztlichen Handeln bei der klinischen Betreuung von aSAH-Patienten sein
Untersuchung eines neuartigen Konzepts für die Zukunft der Mitralklappenreparatur: Bildgestützte Vorhersage der Annuloplastie-Ringgröße
Get PDFObjectives: Annuloplasty rings are used in surgical mitral valve repair (MVr), to stabilize and reshape the MV annulus. Precise selection of the ring size is crucial in MVr to achieve a positive outcome. If the ring is selected too large or too small, it may cause unfavorable repair results. Moreover, the conventional sizing strategies highly depend on the surgeons´ experience. Considering the aforementioned information, our study examined the efficacy of 3D transesophageal echocardiography (3D-TEE) coupled with post-processing utilizing a specialized software package. The investigation specifically focuses on its feasibility in predicting annuloplasty ring sizes for MVr.
Methods: In this study, patients who underwent minimally invasive mitral valve repair (MI-MVr) using Physio-II (Edwards Lifesciences, Irvine, CA, USA) as ring annuloplasty between August 2018 and August 2021 were analyzed. Inclusion criteria for the study were limited to patients presenting Carpentier type II pathology and those who were discharged with either no residual mitral regurgitation (MR) or only trace amounts. A total of 150 patients who met these criteria were considered for the 3D-MV reconstruction analysis using a semi-automated software package to quantify MV geometry. The feasibility of 3D-MV reconstruction values in predicting ring size was examined using univariable and multivariable linear regression analyses.
Results: Our findings revealed correlations between the implanted ring size and 3D-MV reconstruction values. The highest correlation coefficients were observed for the CW with a coefficient of 0.839 (p<0.001), followed closely by the ITD (r=0.796; p<0.001), the annulus area (r=0.782 ;p<0.001), and the AML area (r=0.767; p<0.001). Within the context of the multivariable regression analysis, only CW and ITD emerged as independent predictors for ring size in MVr surgery. The highest level of agreement between predicted and implanted ring size was obtained with the model including CW and ITD (76.6%).
Conclusions: The study demonstrates that the use of the 4D-MV Assessment Tool may play a pivotal role in assisting surgeons during the decision-making process for ring sizing, especially in minimally invasive settings. This advancement is a crucial initial step towards achieving ring size predictions, potentially paving the way for future developments including multimodal machine learning decision support.Einleitung: Annuloplastieringe werden in der chirurgischen Mitralklappenrekonstruktion (MVr) verwendet, um den Mitralklappenring zu stabilisieren und neu zu formen. Die präzise Auswahl der Annuloplastieringgröße ist entscheidend für den Erfolg der MVr. Ein zu großer oder zu kleiner Annuloplastiering, kann zu einer Restundichtigkeit der Mitralklappe oder zu einem Einziehen des vorderen Segels in den Ausflusstrakt des linken Ventrikels in der Systole führen. Darüber hinaus sind herkömmliche Sizing-Strategien stark von der Erfahrung der Chirurgen und Chirurginnen abhängig. Vor diesem Hintergrund haben wir die Wertigkeit der 3D-TEE mit anschließender Verarbeitung mithilfe einer dezierten Software zur Vorhersage der Annuloplastieringgröße für die MVr untersucht.
Methodik: In dieser Studie wurden Patienten eingeschlossen, die zwischen August 2018 und August 2021 einer minimal-invasiven MVr mit einem CE Physio-II-Annuloplastiering (Edwards Lifesciences, Irvine, CA, USA) unterzogen wurden. Nur Patienten mit Carpentier-Typ-II-Pathologie, die ohne bzw. nur geringer Restinsuffizienz der Mitralklappe entlassen wurden, wurden in die Studie eingeschlossen. Insgesamt wurden 150 Patienten für die 3D-MV-Rekonstruktionsanalyse mithilfe einer halbautomatisierten Software zur Quantifizierung der MV-Geometrie untersucht. Zur Vorhersage der Ringgröße wurden univariable und multivariable lineare Regressionsanalysen durchgeführt.
Ergebnisse: Unsere Ergebnisse zeigten Korrelationen zwischen der implantierten Ringgröße und gewissen Werten der 3D-MV-Rekonstruktion. Die höchsten Korrelationskoeffizienten wurden für den interkommissuralen Abstand (CW) mit einem Koeffizienten von 0,839 (p<0,001) festgestellt, gefolgt von dem intertrigonalen Abstand (ITD) (r=0,796; p<0,001), der Fläche des Mitralklappenrings (r=0,782; p<0,001) und der Fläche des Mitralklappensegels (r=0,767; p<0,001). In der multivariablen Regressionsanalyse wurden nur die CW und die ITD als unabhängige Prädiktoren für die Ringgröße der Annuloplastie identifiziert. Das höchste Maß an Übereinstimmung zwischen vorhergesagter und implantierte Ringgröße wurde mit dem Modell erzielt, das die CW und ITD einschloss (76,6%).
Schlussfolgerung: Die vorliegende Studie zeigt einen eindeutigen Zusammenhang zwischen dem interkommissuralen und dem intertrigonalen Abstand, erhoben aus dem 4D-MV Assessment Tool, mit der Größe des Annuloplastieringes für Mitralklappenrekonstruktionen. Dieser Fortschritt stellt einen entscheidenden ersten Schritt zur präoperativen Vorhersage von Ringgrößen dar und ebnet potenziell den Weg für zukünftige Entwicklungen, einschließlich der Entscheidungsunterstützung durch multimodale maschinelle Lernverfahren
Mars Express: From the Launch Pad to a 20-Year Success Record at Mars
Get PDFMars Express was conceived and built by ESA as a successor of the unsuccessful Russian Mars-96 mission. It was planned from the onset as an orbiter and lander mission to be able to carry out long-term, remote sensing and in-situ scientific investigations of the planet Mars and its environment. As an exceptionally successful workhorse and a backbone of the Agency’s Science Programme in operation at Mars since end December 2003, Mars Express has proven to be a highly productive mission returning excellent scientific value for the investments made by ESA and its Member States. This paper is intended as the introduction to the series of papers that make this special collection. It briefly reviews the history of the mission, its science goals, its uniqueness while establishing its complementarity with other Mars missions in a collaborative context. It also lists the teams and operational aspects and innovations that made this mission a success. Then the paper highlights Mars Express’s scientific achievements throughout its 20-year lifetime. Mars Express results and discoveries continue playing an essential role in understanding the geological, atmospheric and climate evolution of the Red Planet and determining its potential past habitability. To conclude, a preview of the science and other topics covered by this collection is given. Mars Express, a pioneering mission for Europe at Mars, is currently continuing on its long scientific journey around the Red Planet
Utilization of Complementary and Integrative Medicine as exemplified by two different German cross-sectional studies
Get PDFHintergrund: Methoden aus dem Bereich Komplementäre und Integrative Medizin (KIM) werden in Deutschland von einem Großteil der Bevölkerung in Anspruch genommen. Diese Verfahren sind häufig zu wenig wissenschaftlich untersucht. Die Dissertation umfasst zwei Studien, die die Inanspruchnahme von KIM analysieren.
Methoden: Menschen mit einem Bezug zu KIM (Studie I) wurden in den Jahren 2020/21 zu gesundheitsfördernden Selbsthilfemaßnahmen aus dem KIM-Bereich und dem emotionalen Befinden während der COVID-19-Pandemie befragt. Im Jahr 2019 wurden Medizinstudierende (Studie II) zur Inanspruchnahme von und Einstellung zu KIM befragt. Die Daten der explorativen Querschnittserhebungen wurden deskriptiv ausgewertet und vergleichend dargestellt. Es wurden Fragebögen zur Inanspruchnahme und Wirksamkeit von KIM mit einer Auswahl von 17 (Studie I), beziehungsweise 16 (Studie II) KIM-Methoden entwickelt. In Studie I wurde das emotionale Befinden für neun Emotionen mittels numerischer Ratingskalen erfasst. In Studie II wurde eine deutsche Version des Complementary and Alternative Medicine Health Belief Questionnaire (CHBQ) für Medizinstudierende eingeführt (Range von 10 bis 70, höherer Wert ≙ positivere Einstellung zu KIM).
Ergebnisse: Insgesamt konnten über 2000 Teilnehmende (Studie I: n=1605; Studie II: n=349) eingeschlossen werden, mehrheitlich weibliche (Studie I: 80,6%; Studie II 69,0%). Die in Studie I am meisten genutzten KIM-Methoden zur Gesundheitsförderung waren Naturaufenthalte (85,6%), gesunde Ernährung (85,6%) sowie Bewegung (83,6%). Fast die Hälfte der Medizinstudierenden in Studie II hat bereits KIM angewandt, insbesondere pflanzliche Arzneimittel (34,3%), Yoga (27,4%) und Homöopathie (27,1%). Die Wirksamkeit wurde überwiegend als „stark“ oder „mittel“ (Studie I), beziehungsweise „gut“ oder „etwas“ (Studie II) eingeschätzt. Die Inanspruchnahme von acht Methoden wurde in den Studien ähnlich erfragt: Yoga, Nahrungsergänzungsmittel, Meditation, Anthroposophische Medizin, Heilpflanzen, Indische Medizin, Chinesische Medizin und Homöopathie. Bei Menschen mit KIM-Bezug sind negative Emotionen wie Angst geringer ausgeprägt als positive wie Wohlfühlen. Medizinstudierende befürworten mehr Forschung im Bereich KIM. Ihre Haltung zu KIM ist mit einem CHBQ-Score von 44,2±10,7 (Mittelwert±Standardabweichung) als eher neutral zu bewerten.
Fazit: Die Inanspruchnahme von KIM ist in den untersuchten Studienpopulationen relevant. Die mit Lebensstilmaßnahmen aus dem KIM-Bereich verbundenen Erwartungen hinsichtlich einer Gesundheitsförderung in Krisensituationen könnten einen Einfluss auf das emotionale Befinden haben. Das Interesse von Medizinstudierenden könnte durch die Randposition von KIM im Curriculum bedingt sein. Kausale Zusammenhänge lassen sich aufgrund des Querschnittsdesigns nicht zeigen. Künftige vergleichende Forschung im Bereich KIM benötigt klare Definitionen bei der Abfrage, um Vergleichbarkeit und Validität der Studienergebnisse zu gewährleisten.Background: Methods from the field of complementary and integrative medicine (CIM) are used by a large part of the population in Germany, but these procedures are often not or insufficiently scientifically studied. This thesis includes two studies that focus on the use of CIM in two different study populations.
Methods: People with a known connection to CIM (study I) were surveyed in 2020/21 about health-promoting self-help measures from the field of CIM and their emotional status during the COVID-19 pandemic. In 2019, medical students (study II) were surveyed about their use of CIM and attitudes toward CIM. Data from the exploratory cross-sectional surveys were analyzed descriptively and compared. The research group developed questionnaires on the use and estimated effectiveness of CIM with a selection of 17 (study I) or 16 (study II) CIM methods. In study I, the emotional status was assessed for nine emotions by using numerical rating scales. In study II, a German version of the Complementary and Alternative Medicine Health Belief Questionnaire (CHBQ) was introduced (range 10 to 70, higher score ≙ more positive attitude toward CIM).
Results: In total, more than 2000 participants were included (study I: n=1605; study II n=349) in both studies. The majority was female (study I: 80.6%; study II: 69.0%). In study I, frequently used CIM methods for health promotion were staying in nature (85.6%), healthy nutrition (85.6%) and physical activity (83.6%). In study II, almost half of the medical students have already used CIM, especially herbal remedies (34.3%), yoga (27.4%), and homeopathy (27.1%). Efficacy was predominantly rated as “strong” or “moderate” (study I), or “good” or “somewhat” (study II). The use of eight methods was surveyed similarly in both studies: yoga, nutritional supplements, meditation, Anthroposophic
Medicine, herbal medicine, Indian Medicine, Chinese Medicine, and homeopathy. In people with an affinity to CIM, negative emotions such as fear are less pronounced than positive emotions such as wellbeing. Medical students wish for more research on CIM. Their attitude towards CIM can be rated as rather neutral, with an average CHBQ score of 44.2±10.7 (mean±standard deviation).
Conclusion: The use of CIM is relevant in the study populations. Expectations associated with lifestyle measures from the CIM area regarding to health promotion in crisis situations could have an influence on the emotional wellbeing. The interest of medical students towards CIM could be influenced by the marginal position of CIM in the curriculum. Causality cannot be shown due to the cross-sectional design. Future comparative research in the field of CIM requires clear definitions in the survey to establish comparability and validity of the study results
Changes in Ruminal Fermentation and Growth Performance in Calves After Increasing Ruminal Undegradable Protein at Two Different Time Points Pre-Weaning
Get PDFThe cost-effective rearing of heifers depends on the provision of adequate nutrients at an appropriate age to meet nutrient requirements for growth and production. The objective of the present study was to investigate how the time of switching to a rumen-undegradable protein (RUP) source affects the ruminal fermentation and growth performance of Holstein dairy calves. A total of 36 Holstein female calves were randomly allocated to one of three dietary treatments on day 28 or 42 of life. In the first 28 days of life, they were on the same soybean meal (SBM)-based starter diet containing 22.2% crude protein with 37% RUP. The RUP content of the experimental diet was increased to 48% by a total replacement of the original SBM with xylose-treated soybean meal (XSBM). The following treatments were used: (1) starter diet containing SBM from d 28 (SBM28); (2) starter diet containing XSBM from d 28 (XSBM28); and (3) starter diet containing XSBM from d 42 (XSBM42). All the calves were fed a constant amount of milk (4 L/d), weaned on day 60, and then remained in the experiment until day 70 of life. The results showed that neither feed intake nor BW were influenced by the treatments in the pre-weaning period (days 28 to 60). The calves fed the XSBM28 and XSBM42 diets had greater daily gain and gain-to-feed ratio compared to those on the SBM28 diet post-weaning from day 61 to 70 (p < 0.05). The inclusion of XSBM in the starter diets from days 28 and 42 increased the calves’ height pre- and post-weaning (p < 0.05). The ruminal pH and concentrations of butyrate and iso-butyrate were higher at weaning when the calves were fed the XSBM diets. The calves fed the XSBM diets had less ammonia-N and total short-chain fatty acids at day 70 of life (p < 0.05) and a lower neutral detergent fiber digestibility in the post-weaning period (p < 0.05). The fecal scores and blood metabolites were not different among the treatments. The results showed that increasing the RUP content from 37% to 48% in the starter diets by a total replacement of SBM with XSBM during the pre-weaning period may improve the growth performance around weaning. A later replacement at 42 days of life appears equally effective compared to a replacement at 28 days of life
Specific Aspects of Day Clinic Psychiatric Care Using the Examples of Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT)
No full textThis habilitation thesis focuses on specific questions within psychiatric health services research, particularly regarding day clinic treatment offerings. It begins with the first survey conducted in the German-speaking world on disorder-specific, day clinic, and inpatient treatment options for individuals with borderline personality disorder (BPD). The findings reveal a significant undersupply of care, characterized by long waiting times and a very high patient-to-treatment-place ratio for DBT (Dialectical Behavior Therapy), clearly indicating that existing services do not meet actual demand.
Building on this, a specialized DBT day clinic in a Berlin psychiatric care region was evaluated. This clinic aimed to address the identified treatment gap. The evaluation showed, for the first time, statistically significant to highly significant improvements in BPD-specific symptoms. The study also systematically examined negative effects of the DBT treatment – a first for a day clinic setting – by identifying which negative effects patients subjectively experienced. Additionally, the research sought to identify patient-level predictors for poor treatment response, with the goal of informing future therapeutic developments for BPD.
Subsequent publications stemmed from this methodological evaluation approach, now applied to a different therapeutic concept: a transdiagnostic (i.e., not disorder-specific) treatment in a day clinic for a more heterogeneous psychiatric patient group. These studies also demonstrated high treatment effectiveness, not only in symptom reduction but also in improvements in patients’ subjective quality of life. Notably, the negative effects of the transdiagnostic ACT (Acceptance and Commitment Therapy) approach were found to be lower compared to other clinical populations.
The ACT day clinic study was conducted during the COVID-19 pandemic, thus reflecting the challenges of delivering mental health care during a particularly vulnerable period.
In summary, the thesis examines the real-world implementation of psychiatric care structures from a health services research perspective, with a focus on day clinics. It scientifically documents the benefits and possible downsides of selected therapeutic methods and their sometimes surprising treatment outcomes. The findings are based on real, unfiltered data from two Berlin psychiatric care regions and provide a representative snapshot of mental health service delivery at the time of study. These results may contribute to the ongoing development of day clinic models to improve mental health care delivery.
The two day clinics investigated serve as examples of different models within the evolving landscape of psychiatric care: one being a highly specialized, disorder-specific DBT program, the other a broad, transdiagnostic ACT approach. Both reflect recent trends toward more outpatient-oriented treatment structures in psychiatry