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Process over outcome quality in paediatrics? An analysis of outpatient healthcare quality indicators for seven common diseases
No full textPurpose: The purpose of this study was to examine the scope, quality dimensions and treatment aspects covered by existing quality indicators (QIs) for the somatic diseases bronchial asthma, atopic eczema, otitis media and tonsillitis as well as the psychiatric disorders attention deficit hyperactivity disorder (ADHD), depression and conduct disorder in paediatrics.
Methods: QIs were identified through an analysis of the guidelines and a systematic search of literature and indicator databases. Subsequently, two researchers independently assigned the QIs to the quality dimensions according to Donabedian and Organisation for Economic Cooperation and Development (OECD) and to the content categories covering the treatment process.
Results: We found 1268 QIs for bronchial asthma, 335 QIs for depression, 199 QIs for ADHD, 115 QIs for otitis media, 72 QIs for conduct disorder, 52 QIs for tonsillitis and 50 QIs for atopic eczema. Of these, 78% focused on process quality, 20% on outcome quality and 2% on structural quality. Using OECD criteria, 72% of the QIs were assigned to effectiveness, 17% to patient-centredness, 11% to patient safety and 1% to efficiency. The QIs covered the following categories: diagnostics (30%), therapy (38%), patient-reported outcome measures/ observer-reported outcome measures/patient-reported experience measures (in sum 11%), health monitoring (11%) and office management (11%).
Conclusion: Most QIs focused on the dimensions of effectiveness and process quality, and on the categories of diagnostics and therapy, with outcome-focused and patient-focused QIs being under-represented. Possible reasons for this striking imbalance could be the easier measurability and clearer assignment of accountability in comparison to the QIs of outcome quality, patient-centredness and patient safety. To produce a more balanced picture of the quality of healthcare, the future development of QIs should prioritise the currently under-represented dimensions.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
Exhaustion of Digital Goods: An Economic Perspective
No full textThe "UsedSoft" decision of the Court of Justice of the European Union (CJEU)
about the right of a buyer of a downloaded copy of a software to resell this copy triggered a controversial discussion about the applicability of the "exhaustion" rule (US: first-sale doctrine) to copyright-protected digital goods (as, e.g., also e-books). This paper offers, in a first step, a systematic analysis and assessment of economic reasonings that have been discussed in the literature about exhaustion, and applies this framework, in a second step, to downloaded digital creative works. An important result is that digitalisation, on one hand, changes considerably the benefits and costs of exhaustion, esp. in regard to the danger of jeopardizing the incentives for copyright owners. On the other hand, however, also the costs of imposing restrictions might be high and even increase in a digital economy. This leads to the conclusion that it is necessary to think seriously about the legal limits for the restrictions that copyright owners should be allowed to impose on their customers. However, these limits might be drawn also by other legal instruments than copyright exhaustion
The Visual Construction of Patrimony: Medieval Monuments in German-, Polish-, and Czech-speaking Volumes on Architectural History (1840-1940)
No full textDie Kunstgeschichte - und insbesondere die Architekturgeschichte - ist untrennbar mit Bildern, Reproduktionen und Repräsentationen der untersuchten Objekte verbunden. Kunsthistoriker:innen sind gezwungen, Visualisierungen, mediale Übersetzungen zu verwenden, wenn es um die Größe, den Raum und die Multiperspektivität von Kunstwerken geht, insbesondere wenn sie sich mit Architektur beschäftigt.
Die vorliegende Studie untersucht illustrierte kunsthistorische Bände, die zwischen 1840 und 1940 im polnischen, tschechischen und deutschen Sprachraum erschienen sind. Ab dem 19. Jahrhundert entwickelte sich die Architekturgeschichte zu einem wissenschaftlichen Feld, das eine wichtige Rolle in Prozessen der nationalen Identitätsbildung spielte. Je nach den komplexen Machtverhältnissen und den politischen Rahmenbedingungen innerhalb des gewählten Zeitraums repräsentieren die Bücher unterschiedliche kunsthistorische und nationale Kanones. Insbesondere die darin enthaltenen Bilder wurden als notwendiges Instrument zur Verbreitung des kunsthistorischen Wissens angesehen. Als "visuelle Archive" dienten sie als Sammlung wissenschaftlicher Arbeitsobjekte für die Kunstgeschichte. Darüber hinaus wurden sie zu visuellen Repräsentanten des Patrimoniums und konstruierten (nationale) Identitäten in Mitteleuropa.
Indem die untersuchten Objekte auf Diskursräume ausgedehnt werden, die in der deutschsprachigen Kunstgeschichtsschreibung bislang eher unsichtbar waren, und einzelne Aspekte dieses komplexen, verflochtenen gesamteuropäischen Kontextes analysiert werden, kann die Formierung von wissenschaftlichem, kulturellem und visuellem Wissen revidiert werden. Das Verständnis dieser Prozesse wird auch die heutigen Herausforderungen der (Re-)Formierung eines adäquaten und vertretbaren Kanons für die Kunstgeschichte im Hinblick auf postkoloniale Studien und transkulturelle, interkontinentale, globale Kunstgeschichten beleuchten. Darüber hinaus besteht eine der Hauptaufgaben der Kunstgeschichte darin, Kunst zu benennen, zu analysieren und somit zu bewahren. Die Suche nach angemessenen und zeitgemäßen Lösungen zur visuellen Vermittlung von Wissen über Kunst geht also weiter - nicht zuletzt in den digitalen Medien.
Die vorliegende Dissertation basiert auf einem Katalog ausgewählter Publikationen, die exemplarisch für die Visualisierungsstrategien der verschiedenen Akteure des kunsthistorischen Diskurses in dieser Zeit stehen. Den einzelnen Fallstudien ist eine allgemeinere Analyse des deutsch-, polnisch- und tschechischsprachigen Diskurses über Kunstgeschichte und Patrimonium sowie eine historische Einführung vorangestellt. Die Analyse bestätigt den Einfluss der Bilder von mittelalterlichen Denkmälern auf die Konstruktion von Patrimonium in Abhängigkeit vom jeweiligen kulturellen und politischen Umfeld und die nachhaltige Wirkung derselben im kunsthistorischen Diskurs.History of art – and history of architecture in particular – is inseparably connected with images, reproductions as well as representations of the analysed objects. The art historian is forced to use visualisations, medial translations, regarding the size, space and multiperspectivity of artworks, especially when focusing on architecture.
This research investigates illustrated art historical volumes, published in Polish-, Czech- and German-speaking territories between 1840 and 1940. From the 19th century onwards, history of architecture developed into a scientific field playing an important role in processes of national identity formation. According to the complex distributions of power and the political conditions within the chosen period, the volumes represent varying art historical and national canons. Especially the images within were considered a necessary instrument to spread the art-historical knowledge. As ‘visual archives’ they served as a collection of scholarly working objects for art history. Furthermore, they became the visual representatives of patrimony, constructing (national) identities in Central Europe.
In expanding the investigated objects to spaces of discourse that have so far been relatively invisible in the German-language art historiography and analysing individual aspects of this complex, entangled pan-European context, the formation of scientific, cultural and visual knowledge can be revised. Understanding these processes will also illuminate today’s challenges of (re)forming an adequate and justifiable canon for art history regarding post-colonial studies and transcultural, intercontinental, global art histories. Moreover, one of the main art historical tasks is to name, analyse and hence preserve art. Thus, the search for adequate and contemporary solutions to visually convey knowledge about art continues – not least in digital media.
This doctoral thesis is based on a catalogue of selected volumes, that serve as examples for the visualisation strategies pursued by the different participants of art historical discourse at the time. The individual case studies are preceded by a more general analysis of the German-, Polish- and Czech- speaking discourses on art history and patrimony, as well as a historical introduction. The analysis confirms the influence of the images of medieval monuments on the construction of patrimony depending on the respective cultural and political environment and the lasting effect of the same in the art historical discourse
Molecular architecture and electron transfer pathway of the Stn family transhydrogenase
No full textThe challenge of endergonic reduction of NADP+ using NADH is overcome by ferredoxin-dependent transhydrogenases that employ electron bifurcation for electron carrier adjustments in the ancient Wood-Ljungdahl pathway. Recently, an electron-bifurcating transhydrogenase with subunit compositions distinct from the well-characterized Nfn-type transhydrogenase was described: the Stn complex. Here, we present the single-particle cryo-EM structure of the Stn family transhydrogenase from the acetogenic bacterium Sporomusa ovata and functionally dissect its electron transfer pathway. Stn forms a tetramer consisting of functional heterotrimeric StnABC complexes. Our findings demonstrate that the StnAB subunits assume the structural and functional role of a bifurcating module, homologous to the HydBC core of the electron-bifurcating HydABC complex. Moreover, StnC contains a NuoG-like domain and a GltD-like NADPH binding domain that resembles the NfnB subunit of the NfnAB complex. However, in contrast to NfnB, StnC lost the ability to bifurcate electrons. Structural comparison allows us to describe how the same fold on one hand evolved bifurcation activity on its own while on the other hand combined with an associated bifurcating module, exemplifying modular evolution in anaerobic metabolism to produce activities critical for survival at the thermodynamic limit of life.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
Re-Thinking Knowledge in Community-Supported Agriculture to Achieve Transformational Change towards Sustainability
No full textCommunity-supported agriculture has gained a significant amount of prominence in recent
years by offering a more sustainable and morally acceptable alternative to conventional food systems.
Their organization offers a modern take on how to manage production by supporting the usage and
exchange of knowledge between all stakeholders involved. The leverage points concept argues that
re-thinking how knowledge is produced and used in systems is one of the key realms of leverage
in which transformation towards sustainability can be achieved. Current sustainability research
lacks a focus on deep leverage points that bear great potential for transformational change. This
concept, however, revolves around these deep realms of leverage and has not been applied to CSA
yet. Thus, a qualitative study with semi-structured interviews has been performed at 22 CSA farms
in Germany in order to gather detailed insights on the production and flow of knowledge and
analyze if and to what degree these CSAs have the potential to leverage transformational change
towards sustainability. This analysis helps to understand how certain mechanisms can influence
sustainability in a positive manner and promote the usage of these mechanisms in the agricultural
landscape. Ultimately, the data indicates that CSAs do bear great potential to leverage sustainability
transformation in regard to re-thinking agriculture. Characteristics that lead to this cognition are a
highly cooperative, participatory and transparent structure, characteristics that allow for the creation
and exchange of information to flourish.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
Should wealth transfers be taxed? Citizens’ view on a fundamental question
No full textIn a recent representative survey, German citizens are asked whether or not inherited wealth beyond a certain amount should be taxed. Almost 60 percent stated that it should not be taxed. We use this survey to identify the factors that drive this fundamental opposition against the taxation of inherited wealth. We find monetary self-interest and redistributive preferences to drive citizens’ attitude in this matter. We account for other intra-familial transfers, in particular long-term care. Being at the heart of intra-familial exchange relations, women are more likely to oppose wealth transfer taxation than men are. Citizens’ attitude towards inheritance taxation does not depend on their personal experience in giving long-term care. Expecting the typical German family to reward intra-familial caregiving through a higher inheritance reduces the opposition against the taxation of inherited wealth
Long-term Contracts for Network-supportive Flexibility in Local Flexibility Markets
No full textWith an ongoing energy transition, the electric network is increasingly challenged. Handling congestion is a major responsibility of network operators. In recent years, market-based approaches to utilize network-supportive flexibility, especially local flexibility markets (LFMs), have been discussed as possible future development of congestion management processes. LFMs are a promising opportunity for the efficient, transparent and non-discriminatory integration of new flexibility options, in particular demand-side flexibility. Despite a wide body of supporting literature and several pilot implementations, there is still no common commitment to the concept of LFMs in the European Union. Here we address decision makers in the European energy economy, especially network operators, and discuss a possible flexibility product design using a methodological approach with four steps. First, we review the theoretical background of LFMs, considering both network operators' views and the possibility of demand response as a flexibility provider. Based on this review, we formulate an interim conclusion regarding requirements for flexibility product design in general. Second, using an existing framework, we propose a concrete, capacity-based, long-term flexibility product specification. Third, we discuss compliance between the defined requirements and the proposed product design to highlight the relevance of key design parameters and identify further research needs. Finally, we derive policy implications for network operators' decision makers regarding the implementation of LFMs
Do negative headlines really undermine the credibility of a quality label? A quasi-natural experiment
No full textIn 2013, Stiftung Warentest tested hazelnut chocolate for their leading magazine, called Test. Stiftung Warentest is one of the most important consumer organizations in Germany. Ritter Sport is a high-quality producer of chocolate in Germany. Their hazelnut chocolate did not pass the test. It was given the grade of unsatisfactory. Stiftung Warentest accused Ritter Sport of labelling an artificial flavouring as a natural flavouring. Ritter Sport rejected the accusation. They went to court and won the trial. Stiftung Warentest had to withdraw the issue in question of Test magazine. This affair was all over the media in January of 2014. Using the Ritter Sport versus Stiftung Warentest case, we analyse whether negative headlines really undermine the credibility of a quality label by examining Stiftung Warentest and their quality label, also called Test. In addition, we examine what can be done to restore or, more generally, increase the credibility of a quality label. Based on a quasi-natural experiment, we find that the negative headlines on Stiftung Warentest have undermined the credibility of the Test label. We also find that the credibility of the Test label can be increased by providing reference values to the tests, strengthening the independence of Stiftung Warentest, and using laboratory methods in the tests. For the most part, the same holds true for any quality label
Hype or hope? High placebo response in major depression treatment with ketamine and esketamine: a systematic review and meta-analysis
No full textBackground: Ketamine and esketamine offer a novel approach in the
pharmacological treatment of major depressive disorder (MDD). This metaanalysis
aimed to investigate the placebo response in double-blind,
randomized controlled studies (RCTs) on patients with MDD receiving
ketamine or esketamine.
Methods: For this systematic review and meta-analysis Medline (PubMed),
Cochrane Central Register of Controlled Trials (CENTRAL), PsycInfo and
Embase databases were systematically searched for citations published up to
March 17, 2023. A total number of 5017 abstracts was identified. Quality of the
included trials was assessed with the Cochrane risk-of-bias tool. The metaanalysis
was performed using a restricted maximum likelihood model. This study
is registered with PROSPERO, number CRD42022377591.
Results: A total number of 14 studies and 1100 participants (593 in the
medication group and 507 in the placebo group) meeting the inclusion criteria
were selected. We estimated the pooled effect sizes of the overall placebo (dpl =
-1.85 [CI 95%: -2.9 to -0.79] and overall treatment (dtr = -2.57; [CI 95% -3.36 to
-1.78]) response. The overall placebo response accounts for up to 72% of the
overall treatment response. Furthermore, we performed subgroup analysis of 8
studies for the for the 7 days post-intervention timepoint. Seven days postintervention
the placebo response (dpl 7d = -1.98 [CI 95%: -3.26 to -0.69])
accounts for 66% of the treatment response (dtr 7d = - 3.01 [CI 95%, -4.28
to -1.74]).
Conclusion: Ketamine and esketamine show large antidepressant effects.
However, our findings suggest that the placebo response plays a significant role in the antidepressant response and should be used for the benefit of the
patients in clinical practice.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg
Screening for Peripheral Vascular Stiffness in Lipedema Patients by Automatic Electrocardiogram-Based Oscillometric Detection
No full textBody mass index (BMI) is seen as a predictor of cardiovascular disease (CVD) in lipedema
patients. A valid predictor of CVD is increased aortic stiffness (IAS), and previous research described
IAS in lipedema. However, it is not known if this applies to all patients. In this cross-sectional
single-center cohort study, peripheral pulse wave velocity (PWV) as a non-invasive indicator of aortic
stiffness was measured in 41 patients with lipedema, irrespective of stage and without pre-existing cardiovascular
conditions or a history of smoking and a maximum body mass index (BMI) of 35 kg/m2.
Automatically electrocardiogram-triggered oscillometric sensor technology by the Gesenius–Keller
method was used. Regardless of the stage of lipedema disease, there was no significant difference
in PWV compared to published standard values adjusted to age and blood pressure. BMI alone is
not a predictor of cardiovascular risk in lipedema patients. Measuring other anthropometric factors,
such as the waist–hip ratio or waist–height ratio, should be included, and the existing cardiovascular
risk factors, comorbidities, and adipose tissue distribution for accurate risk stratification should be
taken into account. Automated sensor technology recording the PWV represents a valid and reliable
method for health monitoring and early detection of cardiovascular risks.Gefördert durch den Open-Access-Publikationsfonds der UB Marburg