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Simple Avoidance of Lost Votes by Electoral Thresholds
No full textProzent-Hürden führen normalerweise dazu, dass Stimmen verfallen, was der Gleichheit der Wahl widerspricht und die Chancen kleinerer sowie neuer Parteien mindert. Es gibt mehrere mögliche Auswege, z. B. durch Präferenzwahl. Noch einfacher ist es, wenn jede Partei angibt, an welche andere Partei ihre Stimmen gehen sollen, falls sie selbst an der Prozent-Hürde scheitert.Electoral thresholds usually cause votes to lapse, which contradicts the equality of votes and reduces the chances of smaller and new parties. There are several possible ways out, e.g. by preferential voting. An even easier solution is that each party specifies which other party should get its votes if it fails to meet the electoral threshold
Factors Influencing Telemedicine Adoption Among Health Care Professionals: Qualitative Interview Study
No full textBackground: Telemedicine is transforming health care by enabling remote diagnosis, consultation, and treatment. Despite rapid adoption during the COVID-19 pandemic, telemedicine uptake among health care professionals (HCPs) remains inconsistent due to perceived risks and lack of tailored policies. Existing studies focus on patient perspectives or general adoption factors, neglecting the complex interplay of contextual variables and trust constructs influencing HCPs' telemedicine adoption. This gap highlights the need for a framework integrating risks, benefits, and trust in telemedicine adoption, while addressing health care’s unique dynamics.
Objective: This study aimed to adapt and extend the extended valence framework (EVF) to telemedicine, deconstructing factors driving adoption from an HCP perspective. Specifically, it investigated the nuanced roles of perceived risks, benefits, and trust referents (eg, technology, treatment, technology provider, and patient) in shaping behavioral intentions, while integrating contextual factors.
Methods: We used a qualitative research design involving semistructured interviews with 14 HCPs experienced in offering video consultations. The interview data were analyzed with deductive and inductive coding based on the EVF. Two coders conducted the coding process independently, achieving an intercoder reliability of 86.14%. The qualitative content analysis aimed to uncover the nuanced perspectives of HCPs, identifying key risk and benefit dimensions and trust referents relevant to telemedicine adoption.
Results: The study reveals the complex considerations HCPs have when adopting telemedicine. Perceived risks were multidimensional, including performance risks such as treatment limitations (mentioned by 7/14, 50% of the participants) and reliance on technical proficiency of patients (5/14, 36%), privacy risks related to data security (10/14, 71%), and time and financial risks associated with training (7/14, 50%) and equipment costs (4/14, 29%). Perceived benefits encompassed convenience through reduced travel time (5/14, 36%), improved care quality due to higher accessibility (8/14, 57%), and operational efficiency (7/14, 50%). Trust referents played a pivotal role; trust in technology was linked to functionality (6/14, 43%) and reliability (5/14, 36%), while trust in treatment depended on effective collaboration (9/14, 64%). Transparency emerged as a critical antecedent of trust across different referents, comprising disclosure, clarity, and accuracy. In addition, the study highlighted the importance of context-specific variables such as symptom characteristics (10/14, 71%) and prior professional experience with telemedicine (11/14, 79%).
Conclusions: This study expands the EVF for telemedicine, providing a framework integrating multidimensional risks, benefits, trust, and contextual factors. It advances theory by decomposing trust referents and transparency into actionable subdimensions and emphasizing context-specific variables. Practically, the findings guide stakeholders: policy makers should prioritize transparent regulations and data security, health care organizations should provide training and support for HCPs, and technology developers must design telemedicine solutions aligning with trust and usability needs. This understanding equips health care to address barriers, optimize adoption, and leverage telemedicine’s potential for sustainable clinical integration
Förster Resonance Energy Transfer Measurements in Living Bacteria for Interaction Studies of BamA with BamD and Inhibitor Identification
No full textThe β-barrel assembly machinery (BAM) is a multimeric protein complex responsible for the folding of outer membrane proteins in gram-negative bacteria. It is essential for cell survival and outer membrane integrity. Therefore, it is of impact in the context of antibiotic resistance and can serve as a target for the development of new antibiotics. The interaction between two of its subunits, BamA and BamD, is essential for its function. Here, a FRET-based assay to quantify the affinity between these two proteins in living bacterial cells is presented. The method was applied to identify two interaction hotspots at the binding interface. BamDY184 was identified to significantly contribute to the binding between both proteins through hydrophobic interactions and hydrogen bonding. Additionally, two salt bridges formed between BamDR94, BamDR97, and BamAE127 contributed substantially to the binding of BamA to BamD as well. Two peptides (RFIRLN and VAEYYTER) that mimic the amino acid sequence of BamD around the identified hotspots were shown to inhibit the interaction between BamA and BamD in a dose-dependent manner in the upper micromolar range. These two peptides can potentially act as antibiotic enhancers. This shows that the BamA–BamD interaction site can be addressed for the design of protein–protein interaction inhibitors. Additionally, the method, as presented in this study, can be used for further functional studies on interactions within the BAM complex
Improving the Care of Severe, Open Fractures and Postoperative Infections of the Lower Extremities: Protocol for an Interdisciplinary Treatment Approach
No full textBackground: Patients with open fractures often experience complications during their injury. The treatments incur high costs. Interdisciplinary cooperation between different medical disciplines may improve treatment outcomes. Such cooperation has not yet been envisaged in the German health care system. Objective: The aim of the study is to improve the treatment of fractures with open soft tissue damage or postoperative complications in terms of duration and sustainability in a region in northwest Germany. Largely standardized diagnostics and therapy are intended to optimize processes in hospitals. In addition, a reduction in the duration of treatment and treatment costs is to be achieved.
Methods: Using a digital platform, physicians from 31 hospitals present patient cases to an interdisciplinary group of experts from the fields of plastic surgery, infectiology, hygiene, and others. The group of experts from the environment of the University Hospital Münster promptly makes a joint treatment recommendation for the individual case. The plan is to examine 3300 patients with open fractures or surgical complications. As consortium partners, there are also 3 statutory health insurance companies. The extent to which the therapy recommendations are effective and contribute to cost reduction in the health care system will be empirically investigated in a stepped-wedge cluster-randomized design. In addition, medical and nonmedical professional groups involved in the project will be asked about their work in the project (in total, 248 clinic employees). The primary outcome is the complication rate of open fractures or the occurrence of postoperative complications. As secondary outcomes, the number of antibiotics administered, limb function, and quality of life will be assessed. The health economic evaluation refers to the costs of health services and absenteeism. For the work-related evaluation, workload, work engagement, work-related resources, readiness for technology, and ergonomic aspects of the new telemedical technology will be collected. In addition, clinic employees will give their assessments of the success of the project in a structured telephone interview based on scaled and open-ended questions. Results: The project started in June 2022; data collection started in April 2023. As of mid-June 2024, data from 425 patients had been included. In total, 146 members of staff had taken part in the questionnaire survey and 15 had taken part in the interviews. Conclusions: Standardized treatment pathways in the standard care of patients with open fractures and postoperative infections will be established to reduce complications, improve chances of recovery, and reduce costs. Unnecessary and redundant treatment steps will be avoided through standardized diagnostics and therapy. The interdisciplinary treatment perspective allows for a more individualized therapy. In the medium term, outpatient or inpatient treatment centers specialized in the patient group could be set up where the new diagnostic and therapeutic pathways could be competently applied
Spatiotemporal wavevector dynamics of transverse mode-locked beams
No full textThe phase-locking of transverse higher-order resonator modes results in a beam with rapidly oscillating spatial intensity profile. To complete the description of such transverse mode-locked (TML) beams, their spatiotemporal phase dynamics are explored in this work. The analysis of the phase terms of TML beams reveals oscillating wavevectors, which are experimentally verified by exploiting the mode-matching requirement of a single-mode fiber. The wavevector oscillation is further quantified by exploring its dependence on beam size. The findings have to be considered in potential future applications of TML beams in phase-sensitive processes
Spectral library and method for sparse unmixing of hyperspectral images in fluorescence guided resection of brain tumors
No full textThrough spectral unmixing, hyperspectral imaging (HSI) in fluorescence-guided brain tumor surgery has enabled the detection and classification of tumor regions invisible to the human eye. Prior unmixing work has focused on determining a minimal set of viable fluorophore spectra known to be present in the brain and effectively reconstructing human data without overfitting. With these endmembers, non-negative least squares regression (NNLS) was commonly used to compute the abundances. However, HSI images are heterogeneous, so one small set of endmember spectra may not fit all pixels well. Additionally, NNLS is the maximum likelihood estimator only if the measurement is normally distributed, and it does not enforce sparsity, which leads to overfitting and unphysical results. In this paper, we analyzed 555666 HSI fluorescence spectra from 891 ex vivo measurements of patients with various brain tumors to show that a Poisson distribution indeed models the measured data 82% better than a Gaussian in terms of the Kullback-Leibler divergence, and that the endmember abundance vectors are sparse. With this knowledge, we introduce (1) a library of 9 endmember spectra, including PpIX (620 nm and 634 nm photostates), NADH, FAD, flavins, lipofuscin, melanin, elastin, and collagen, (2) a sparse, non-negative Poisson regression algorithm to perform physics-informed unmixing with this library without overfitting, and (3) a highly realistic spectral measurement simulation with known endmember abundances. The new unmixing method was then tested on the human and simulated data and compared to four other candidate methods. It outperforms previous methods with 25% lower error in the computed abundances on the simulated data than NNLS, lower reconstruction error on human data, better sparsity, and 31 times faster runtime than state-of-the-art Poisson regression. This method and library of endmember spectra can enable more accurate spectral unmixing to aid the surgeon better during brain tumor resection
The ubiquitination landscape of the influenza A virus polymerase
No full textDuring influenza A virus (IAV) infections, viral proteins are targeted by cellular E3 ligases for modification with ubiquitin. Here, we decipher and functionally explore the ubiquitination landscape of the IAV polymerase proteins during infection of human alveolar epithelial cells by applying mass spectrometry analysis of immuno-purified K-ε-GG (di-glycyl)-remnant-bearing peptides. We have identified 59 modified lysines across the three subunits, PB2, PB1 and PA of the viral polymerase of which 17 distinctively affect mRNA transcription, vRNA replication and the generation of recombinant viruses via non-proteolytic mechanisms. Moreover, further functional and in silico analysis indicate that ubiquitination at K578 in the PB1 thumb domain is mechanistically linked to dynamic structural transitions of the viral polymerase that are required for vRNA replication. Mutations K578A and K578R differentially affect the generation of recombinant viruses by impeding cRNA and vRNA synthesis, NP binding as well as polymerase dimerization. Collectively, our results demonstrate that the ubiquitin-mediated charge neutralization at PB1-K578 disrupts the interaction to an unstructured loop in the PB2 N-terminus that is required to coordinate polymerase dimerization and facilitate vRNA replication. This provides evidence that IAV exploits the cellular ubiquitin system to modulate the activity of the viral polymerase for viral replication
Boek der beschawynge to gode:In dussem bocke hefft men wo ein iowelik christen minsche schal betrachten
No full textCaseload per Year in Robotic-Assisted Minimally Invasive Esophagectomy: A Narrative Review
No full textEsophageal surgery is deemed one of the most complex visceral operations. There is a well-documented correlation between higher caseload and better outcomes, with hospitals that perform more surgeries experiencing significantly lower mortality rates. The approach to caseload per year varies across different countries within Europe. Germany increased the minimum annual required caseload of complex esophageal surgeries from 10 to 26 starting in 2023. Furthermore, the new regulations present challenges for surgical training and staff recruitment, risking the further fragmentation of training programs. Enhanced regional cooperation is proposed as a solution to ensure comprehensive training. This review explores the benefits of robotic-assisted minimally invasive esophagectomy (RAMIE) in improving surgical precision and patient outcomes and aims to evaluate how the caseload per year influences the quality of patient care and the efficacy of surgical training, especially with the integration of advanced robotic techniques
Täuschen allein und in Teams
No full textThere is a reward for a project that can be increased through ability, effort, and cheating. This is analysed for one agent and a team of two. As an extension, a preference for honesty is added, which can prevent cheating but not without limit and not so easily in the team context.Es gibt für ein Projekt eine Belohnung, die durch Fähigkeit, Anstrengung und Betrug gesteigert werden kann. Dies wird für einen Agenten und ein Zweierteam analysiert. Als Erweiterung wird eine Präferenz für Ehrlichkeit hinzugefügt, die Betrug verhindern kann, aber nicht unbegrenzt und nicht so leicht im Teamkontext