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A Multi-Scale Assessment and Modeling of Water and Land Resources for Sustainability in the Lower Okavango River Basin: Integrating Climate Change, Land Use, and Hydrological Dynamics
No full textThis dissertation provides a multi-scale assessment and modeling of water and land resources within the Lower Okavango River Basin, aiming to foster sustainability by integrating the complex dynamics of climate change, land use changes, and hydrological responses. Water scarcity, climate change, and food insecurity are some of the challenges the world faces, which demand quick action and concerted efforts to achieve sustainable resource management, particularly in the arid and semi-arid environments of sub-Saharan Africa like the Okavango. The transboundary Okavango River basin located in the drylands of southern Angola, northeastern Namibia and northwestern Botswana, epitomizes the complex challenges of managing shared resources amongst pressures from climate extremes, rapid population growth, adverse land use practices.
The research addresses critical knowledge gaps by sequentially evaluating hydrological model performance, projecting future hydro-climatic scenarios, and assessing land suitability for climate-resilient agriculture. This study emanated from limited comprehensive assessments exploring this catchment (Mendelsohn et al., 2002; Strohbach, 2008), and its dynamic response to different variables.
Firstly, the Soil and Water Assessment Tool (SWAT) model's performance was evaluated for streamflow estimation in the semi-arid Okavango-Omatako catchment using high-resolution TanDEM-X DEM. The model was configured for a 31-year period from 1985 to 2015. Subsequently, calibration and validation processes followed using the SUFI-2 algorithm. SWAT demonstrated reasonable results in modelling semi-arid streamflow with high and low flows adequately captured, establishing its applicability for this data-scarce, flat terrain. The semi-arid characteristics together with relatively flat terrain features justified the need for the evaluation of model performance using discharge data in our study region.
Secondly, the SWAT+ model was employed to assess the projected streamflow response of the lower Okavango River Basin under combined climate and LULC change scenarios. Integrating CMIP6 GCMs and Shared Socioeconomic Pathways (SSPs), projections indicate a 5-20% decrease in precipitation, with a more substantial decline, reaching up to 60%, anticipated in streamflow by the year 2100. Projections indicate that dry season flows will nearly cease, thereby confirming the "dry gets drier" paradigm. Furthermore, it is projected that the water yield will be increasingly concentrated along river corridors, with the majority of the basin experiencing an annual water volume of less than 129 mm by the end of the century. Projections indicate that the expansion of cropland will exceed 65% of the basin area, replacing wetlands and natural vegetation.
Thirdly, to explore adaptation strategies, land suitability for drought-tolerant leguminous crops (sunn hemp and pigeon pea) was assessed in the Rundu sub-basins. This study proposed an innovative approach through the integration of subjective and objective analytical methods, which are independent of one another. The subjective component of the analysis employed a Multi-Criteria Decision Making-Analytic Hierarchy Process (MCDM-AHP), while the objective component used a data-driven multivariate approach supported by tree-based learning algorithms, including Random Forest and XGBoost. The MCDM-AHP method utilised expert evaluations to rank the importance of variables, identifying water sources, slope, and soil properties as key factors. A suitability mapping analysis revealed that 17.63% of the area was highly suitable and 62.77% moderately suitable for these legumes. Conversely, according to the data driven methodology, soil fertility and nitrogen content emerged as key determinants for land suitability.
This integrated research underscores the sensitivity of streamflow to both precipitation and land cover dynamics in semi-arid regions and highlights the urgent need for nature-based adaptation strategies and an improved regulatory framework for climate resilient water management in the Okavango Basin. The findings aim to provide reference materials for water and land resource managers, policymakers, and concerned professionals to make informed decision and improve resource management and planning contributing in development of future adaptation strategies. Ultimately, this work contributes to a deeper understanding of the Okavango's hydrological system and its vulnerabilities, offering scientific evidence to support sustainable development, transboundary cooperation through entities like OKACOM, and alignment with SDGs in this critical basin.2025-07-1
Social protection systems and decent jobs in the context of (in)formal labor markets
No full textThis dissertation explores the interplay between social protection systems, decent work, and labor market dynamics through four empirical chapters conducted in Brazil and Côte d'Ivoire. Chapter 1 examines exit dynamics from Brazil’s conditional cash transfer program Bolsa Familia using panel data analysis combined with a shift-share instrument approach. The results show that local employment growth modestly increases the likelihood of beneficiary exit, particularly in multi-adult households. Chapter 2 uses a discrete choice experiment with nearly 5,000 Brazilian workers to estimate their willingness to pay for formal employment. On average, workers are willing to forgo 15% of their wages for a formal job, though this valuation varies across subgroups and may fall short of the cost of formalization. Providing information increases valuation; however, the effect is especially strong among workers already inclined toward formality. Chapter 3 evaluates a light-touch consulting intervention for micro, small, and medium-sized enterprises (MSMEs) in Côte d'Ivoire using a randomized controlled trial. The program led to an increase in formalization, primarily through improved minimum wage compliance and the provision of written contracts without negatively affecting firm performance. The results suggest that low-cost, non-coercive approaches can promote employment formalization in MSMEs in Côte d'Ivoire. Chapter 4 shifts the focus to people already in formal employment, analyzing how racial peer composition affects worker retention in Brazil. Using unexpected coworker deaths as an exogenous shock to the racial composition of a peer group, the chapter shows that non-white workers are more likely to quit when they lose a same-race peer. This effect is more pronounced in firms with larger racial wage gaps and weaker in occupations with high levels of teamwork. These findings highlight the importance of peer effects in sustaining workplace diversity and the need for policies that promote inclusive work environments beyond hiring. Together, the chapters provide evidence on how labor market policies, social protection systems, and firm- and worker-level incentives interact.2025-07-1
Evaluation of the molecular tumor board and establishment of a suitable follow-up concept for MTB recommendations
No full textDie molekulargenetische Entwicklung der vergangenen Jahre ermöglicht die spezifische Analyse molekularer Alterationen des Tumorgenoms und trägt im Sinne einer personalisierten Medizin zur Entwicklung molekularer Zieloptionen in verschiedenen Tumorentitäten bei. Im Rahmen dieser Entwicklung entstanden molekulare Tumorboards (MTBs), welche eine interdisziplinäre und spezialisierte Plattform der molekularen Onkologie sind. Sie vereinen Studien- und Expertenwissen, in der Absicht für vorgestellte Patienten am Ende der zugelassenen Leitlinientherapie auf Grundlage molekularer Analysen die bestmögliche Therapieoption zu empfehlen. Dadurch sind MTBs ein wichtiges Instrument der Präzisionsonkologie. In der Struktur von MTBs ist ein System der Nachverfolgung zur Evaluation und Verbesserung unerlässlich, um einen geregelten und informierten Einsatz der Therapieversuche im Off-Label-Use und Erfahrungen daraus zu gewährleisten. Dadurch kann durch Erkenntnisse aus vorangegangenen MTB-Fällen die künftige Empfehlungserstellung im Rahmen eines selbstlernenden Systems verbessert werden. Ausgewertet wurden die ersten 70 MTB-Konferenzen. Zur Verfügung stehen Ergebnisse zu Entitäten, MTB-Empfehlungen, Evidenzen der Therapieempfehlungen, Kostenübernahmen durch die Krankenkassen und Adhärenz zu den Empfehlungen des MTB. Das MTB der UMG wies eine im nationalen Vergleich hohe Empfehlungsrate auf, mit einer Tendenz zum Aussprechen von Empfehlungen mit niedrigeren Evidenzen. Wichtig für die Patienten und die zukünftige informierte Entscheidungsfindung durch das System der wissensgenerierenden Patientenversorgung sowie Generierung von Evidenz sind erfolgreich umgesetzte Therapieversuche. Durch die Nachverfolgung der Empfehlungsumsetzung mit Hilfe des Patientenstatus-Systems konnte die Umsetzungsquote für Empfehlungen des MTB bestimmt werden. Die Einwilligung der Patienten in die Registerstudie des MTB bedeutet Empfehlungen des MTB nachverfolgen zu können und hat damit durch ein Erreichen höherer Datenqualität der Nachverfolgung erheblichen Wert bei der Verringerung fehlender Evidenz. Der Umsetzung von MTB-Empfehlungen standen am häufigsten die Verschlechterung des Zustands und das Versterben der Patienten entgegen. Ein weiterer Anteil der Non-Adhärenz ist durch Ablehnung der Kostenübernahme oder Umsetzung alternativer Therapien zu begründen. Aus den Ergebnissen lässt sich schließen, dass eine molekulare Analyse sowie Intervention häufig zu spät oder gar nicht im Krankheitsverlauf vieler Patienten ohne weitere Optionen durchgeführt werden. Die Auswertungsergebnisse sind kongruent mit Erfahrungen anderer deutscher MTBs, mit einem erkennbaren Harmonisierungs- und Optimierungsbestreben, welche die Etablierung von Evidenz in der molekularen Onkologie fördern. Für das MTB der UMG können die Erkenntnisse des Systems der wissensgenerierenden Patientenversorgung aus vorherigen, dokumentierten MTB-Fällen eine Verbesserung der Empfehlungserstellung sowie der Umsetzungsraten und Outcomes bedeuten. Hierbei ist das Ziel, eine höhere Einschlussrate in entsprechende Studien und effektive Umsetzungen von Off-Label-Therapien mit Evidenzgenerierung durch Publikationen von Therapieerfolgen zu erreichen. Das System und der Ablauf des MTB sowie dessen Ergebnisse sollen zum Beispiel durch automatisierte, einheitliche Dokumentation und die systematisierte Nachverfolgung einer kontinuierlich wachsenden Patientenzahl des MTB, die Vereinheitlichung der Prozesse der Kostenübernahme von Therapieempfehlungen sowie eine Implementierung von Datensätzen des Klinischen Krebsregisters Niedersachsens verbessert werden.The advances of molecular genetics in recent years have facilitated the analysis of specific molecular alterations in cancer genomes, thereby propelling the development of molecular target options for various tumor entities within the paradigm of personalized medicine. Following this development, molecular tumor boards (MTBs) were established as an interdisciplinary and specialized platform in the field of molecular oncology. The unification of study results and expert knowledge is pivotal in the recommendation of the most optimal therapeutic option for patients who have exhausted standard guideline therapies, as determined by molecular analyses. This highlights the significant role of MTBs in precision oncology. The establishment of a follow-up system is imperative to evaluate and optimize the MTB's structure, thereby facilitating a well-ordered and informed utilization of off-label therapy attempts and the experience gained from them. The objective is for the MTB’s future recommendations to be improved by insights gained from previous MTB cases, thereby establishing a self-learning system. To this end, an analysis of the initial 70 MTB conferences has been conducted. A range of results is available, including entities, types of MTB-recommendations, evidence of therapy recommendations, insurance coverage, and adherence to the MTB's recommendations. When considered in the context of national data, the MTB demonstrates a high rate of recommendations, with a tendency towards lower levels of evidence-based therapy recommendations. For patients and for the purpose of enabling informed decision-making, the knowledge-generating system of patient care is of key importance, as is the generation of evidence. The most significant aspect is therapy attempts that have successfully been implemented. The utilization of a patient status system to monitor the implementation of recommendations facilitates the determination of the rate at which MTB recommendations are being implemented. The agreement of patients to the MTB's register study enables the follow-up of the MTB's recommendations and has significant value in reducing missing evidence by means of achieving higher data quality. In many cases of non-adherence, the implementation of MTB recommendations was hindered by deterioration in the patient's condition or death. A secondary aspect contributing to non-implementation is the refusal of cost coverage by insurance companies or the implementation of an alternative therapy. As demonstrated by the results of this study, molecular analysis and intervention are frequently initiated after an optimal window of opportunity has passed, or not initiated at all, in cases where patients have exhausted all other treatment options. The analysis results are consistent with the experiences of other German MTBs, demonstrating a continuous effort towards harmonization and optimization that further establishes evidence in the field of molecular oncology. The knowledge gained from analyzing former patient cases can improve the recommendation process, implementation rates and eventual patient outcomes. An essential future objective is to achieve higher rates of inclusion into respective clinical trials and to ensure effective implementation of off-label therapies with the generation of evidence through the publication of successful therapy attempts. The MTB's system and procedures and their respective results may be improved in a number of ways. These include, for example, the automation and standardization of documentation and subsequent systematic follow-up of a continually growing number of MTB patients. Furthermore, the standardization of the cost coverage of therapy recommendations may be implemented, as well as the implementation of data sets of the KKN.2025-12-1
Prognostic value of venous lactate in normotensive patients with pulmonary embolism
No full textDie akute Lungenembolie (LE) ist nach Herzinfarkt und Schlaganfall die dritthäufigste Todesursache unter den kardiovaskulären Erkrankungen (Raskob et al. 2014; Jiménez et al. 2016). Der durch eine akute Rechtsherzbelastung (RHB) entstehende obstruktive Schock einhergehend mit einer Reduktion des Herzzeitvolumens und peripherer Minderperfusion ist die gefährlichste Komplikation der LE. Deswegen betont die Leitlinie der Europäischen Gesellschaft für Kardiologie (ESC) die Bedeutung einer zügigen Identifikation von Patienten mit Anzeichen für eine akute RHB (Konstantinides et al. 2020).
Laktat als prognostischer Marker wurde bereits in anderen Formen des Schocks untersucht: So ist arterielles Laktat ≥2,0 mmol/l ein Teil der Definition des septischem Schocks (Singer et al. 2016) und wird bei der Stadieneinteilung des kardiogenen Schocks verwendet (Baran et al. 2019). Vanni et al. zeigten in mehreren Arbeiten (2011, 2013, 2015 und 2017), dass arterielles Laktat bei nicht nach hämodynamischem Status selektierten und bei normotensiven Patienten mit akuter LE Komplikationen während des Krankenhausaufenthaltes und Krankenhausmortalität vorhersagt. Die breite Anwendbarkeit dieser Ergebnisse ist leider limitiert durch die Notwendigkeit einer arteriellen Blutentnahme. In der vorliegenden Arbeit wurde der prognostische Wert des Laktatspiegels aus dem deutlich einfacher zu gewinnenden venösen Blut bei normotensiven Patienten mit LE untersucht.
Durch die Analyse von 419 normotensiven Patienten, die zwischen August 2008 und März 2018 in das Pulmonary Embolism Registry Göttingen (PERGO) eingeschlossen wurden, konnte gezeigt werden, dass (I) venöses Laktat ≥2,3 mmol/l mit einem erhöhten Risiko für eine LE-bedingte Komplikation während des Krankenhausaufenthaltes assoziiert war, (II) venöses Laktat ≥3,3 mmol/l sowohl das Auftreten von LE bedingten Komplikationen als auch einen Tod jeglicher Ursache während der Krankenhausaufenthaltes vorhersagte, (III) venöses Laktat die Risikostratifizierung von Patienten mit einem intermediärem Risikoprofil verbessern könnte, (IV) der vorbeschriebene Grenzwert für arterielles Laktat von 2,0 mmol/l bei venösen Proben nur eine geringe Spezifität besaß und nicht verwendet werden sollte (Ebner et al. 2021).After myocardial infarction and stroke acute pulmonary embolism (PE) is the third leading cause of death among cardiovascular diseases (Raskob et al. 2014; Jiménez et al. 2016). Obstructive shock caused by acute right heart failure (RHF) resulting in a critical reduction of cardiac output and peripheral hypoperfusion is the severest complication of PE. Hence, the algorithm for risk stratification developed by the European Society for Cardiology (ESC) aims for the fast identification of patients at risk for RHF (Konstantinides et al. 2020).
Lactate has been investigated as a prognostic marker in various forms of shock, and arterial lactate with a cut off value of 2,0 mmol/l is part of the definition of septic shock (Singer et al 2016) and is used in the evaluation of shock severity in cardiogenic shock (Baran et al. 2019). In context of PE, arterial lactate has been investigated by Vanni et al. (2011, 2013, 2015 and 2017) in cohorts of unselected and normotensive patients with acute PE. Vanni et al. showed that arterial lactate predicted complications and mortality during hospital stay in either cohort. The clinical application of these findings is limited by the necessity for arterial blood sampling. This study aimed to investigate the prognostic value of venous lactate, that can be easily measured from samples obtained during a routine venous blood draw, in normotensive patients suffering acute PE.
Based on the data of 419 normotensive patients included in the Pulmonary Embolism Registry Göttingen (PERGO) between August 2008 and March 2018 the results of this study showed that (I) venous lactate ≥2,3 mmol/l was associated with an increased risk for PE related complications during the in-hospital stay, (II) venous lactate ≥3,3 mmol/l was associated with in-hospital PE related complications and all-cause mortality, (III) venous lactate improved risk stratification in patients at intermediate risk for early mortality, (IV) the previously described cut -off value of 2,0 mmol/l for arterial lactate lacked specificity in venous samples and should therefore not be used (Ebner et al. 2021).2025-09-0
Der Einfluss von Hypoxie auf das antigenvermittelte Stimulationsverhalten von B-Zellen
No full textThe influence of hypoxia on B lymphocytes is yet unknown. During their migration through the human body, B lymphocytes are faced with different tissues and varying oxygen levels. What is the impact of hypoxia on them? Based on this question human Burkitt lymphoma B cells were cultivated under hypoxia and their reaction after stimulation of the B-cell antigen receptor (BCR) was measured via flow cytometry.
It was shown that hypoxia decreases the intracellular mobilization of calcium after BCR stimulation. We had a special focus on the proteins CIN85 and CD2AP. The impact of CD2AP under hypoxia is yet to discover. The results were not clarifying the influence of that protein on B cells under hypoxia. However CIN85 causes a relevant adaptation to hypoxia in B cells by stabilizing the marker and manager of adaptation to hypoxia HIF-1α. It also steadies the mobilization of calcium after short time under hypoxia, while under longer terms of hypoxia the mobilization of calcium was decreasing.2025-10-2
Investigating the mechanistic impact of concurrently applying mindfulness meditation and transcranial direct current stimulation in patients with fibromyalgia on cortical excitability using transcranial magnet stimulation
No full textChronic pain, particularly in patients experiencing a high level of CS like in FM, poses an
immense challenge due to its emotional-cognitive, sensory, and neuroimmunology facets. To
add to our understanding of mechanisms of pain relief, this study embarked on the explora tion of ppTMS parameters before and after MM training and combined therapy of MM and
tDCS on M1 in FM patients.
The lack of significant changes in ppTMS parameters challenges the assumption of the ef fectiveness of treatments. Their different mechanisms did not work synergistically on SICI,
ICF, and LICI or may require longer or more intense interventions. It is suggested that MM
may mainly work on the burden of pain by affecting its emotional-cognitive qualities while
tDCS tries to dampen the actual quantitative input. Indeed, our investigation highlights the
need for additional research to elucidate the reliability and validity of ppTMS parameters as
biomarkers for pain perception in FM.
Other objective biomarkers such as cytokines, heart rate variability or CSP, and subjective
questionnaires such as the CS inventory may be more successful in unraveling the complex
mechanisms of MM and tDCS acting on CS in FM.2025-12-0
Monitoring of liver regeneration
No full textThe liver’s unique regenerative capacity has long been of major clinical and scientific interest, particularly in the context of extensive hepatic resections for the treatment of primary or secondary liver malignancies. In Germany, liver cancer remains among the leading causes of cancer-related mortality, with increasing incidence and poor prognosis at diagnosis. Besides primary liver tumors, hepatic metastases—especially from colorectal carcinoma, but also from gastric, pancreatic, breast, or skin cancers—are frequently observed and require surgical intervention.
Accurate preoperative assessment of the remaining liver volume (Future Liver Remnant, FLR) and its functional capacity is essential to avoid postoperative liver failure. While imaging techniques can estimate liver volume, they fail to capture functional integrity. Laboratory markers and liver biopsies provide functional insights but are either unspecific or invasive. As a result, there is an urgent need for reliable, non-invasive biomarkers to predict postoperative liver function and regenerative potential.
This dissertation investigates two non-invasive approaches to monitor and potentially predict liver regeneration after major hepatic resection: the LiMAx® test (Maximum Liver Function Capacity) and circulating microRNAs (miRNAs). The study confirmed the differential expression of specific miRNAs during the regenerative process, indicating their potential role as predictive biomarkers for hepatic regeneration. However, further validation, including tissue-specific analyses, is necessary to confirm their organ specificity and clinical applicability.
The LiMAx® test showed a plausible representation of liver regeneration in postoperative monitoring, with values gradually approaching preoperative levels. Nevertheless, its routine clinical implementation is limited by high cost, technical complexity, and the requirement for high patient compliance. Importantly, the application of the 0.5% rule based on FLR volume, supplemented by preoperative LiMAx® testing, did not lead to changes in treatment strategies nor prevent postoperative liver failure within the study cohort.
In conclusion, while both miRNA profiling and LiMAx® testing provide valuable insights into liver regeneration, further research is required to establish their predictive value and clinical utility. The identification of reliable, non-invasive biomarkers remains a key goal for improving perioperative management and patient outcomes in hepatic surgery.2025-10-2
Survey on guideline-based diagnosis and treatment of long-term patients with schizophrenia in acute inpatient settings
No full textDie Schizophrenie ist eine schwerwiegende psychiatrische Erkrankung. Sie mindert die Lebensqualität der Betroffenen enorm und stellt das behandelnde Fachpersonal vor große Herausforderungen. Durch ihr häufig frühes Manifestationsalter und ihren typischerweise chronischen Verlauf begleitet sie viele der Erkrankten ein Leben lang. Schizophrenie wird als maßgeblicher Risikofaktor für ausgedehnte, sowie wiederkehrende Klinikaufenthalte benannt. Das Auftreten eines therapieresistenten Verlaufs ist möglich. Bei diesem haben unter anderem die antipsychotische Pharmakotherapie mit Clozapin und die Elektrokonvulsionstherapie einen besonderen Stellenwert.
Das Ziel unserer Untersuchung war die Darstellung der bundesweiten Versorgungssituation von psychiatrischen Patient*innen, welche ohne aktuelle Behandlungsindikation einen stationären Aufenthalt von mindestens 90 Tagen aufwiesen. Die Datenerhebung fand im anonymisierten Design mittels Online-Fragenbogen statt. Dieser sollte von den behandelnden ärztlichen Kolleg*innen ausgefüllt werden. Es erfolgte eine Beschreibung der Strukturmerkmale der erfassten Einrichtungen, eine Abfrage nach Anwesenheit und Anzahl von Langzeitpatient*innen, sowie eine allgemeine Charakterisierung dieser nach demografischen Basisdaten. Der Fokus des Fragebogens lag in der Erfassung der erfolgten Diagnostik und Therapie von Langzeitpatient*innen mit Schizophrenie. Wir orientierten uns hierfür exemplarisch an den Empfehlungen der S3-Leitlinie Schizophrenie der DGPPN.
Unsere erfassten Daten stammten vor allem aus kleineren Fachkrankenhäusern und Universitätskliniken. Etwa 80 % der Einrichtungen hatten zum Erhebungszeitpunkt Langzeitpatient*innen in ihrer Betreuung. Die mediane Verweildauer lag mit 200 Tagen um mehr als den Faktor 2, die mittlere Verweildauer mit 313 Tagen um mehr als den Faktor 3 über dem Einschlusskriterium. Circa 60 % der erfassten Langzeitpatient*innen wiesen eine Hauptdiagnose aus dem Schizophrenie-Spektrum auf. Die Gründe für den Langlieger*innen-Status waren vielfältig. Am häufigsten wurde die fehlende Aufnahmekapazität eines Heims in circa 80 % der Fälle angegeben. Risikofaktoren für die Ausprägung einer Schizophrenie wie traumatische Ereignisse, das Vorhandensein eines Migrationshintergrunds und eine Flucht aus dem Heimatland lagen nur selten vor. Etwa 8 von 10 Betroffenen erhielten zum Erhebungszeitpunkt eine antipsychotische Pharmakotherapie. Allerdings wurde nur etwa die Hälfte der Langzeitpatient*innen mit Schizophrenie mittels Clozapin therapiert und nur etwa 40 % unter empfohlenen Parametern. Die EKT kam nur selten zum Einsatz. Die Gründe hierfür wurden, analog zur ausbleibenden Clozapingabe, vor allem in der fehlenden Einwillung gesehen. Eine Therapie gegen den natürlichen Willen erfolgte bei ungefähr einem Viertel der Patient*innen und ausschließlich in pharmakologischer Form mittels Antipsychotika.
Die Ergebnisse unserer Studie bestätigen den Großteil der Fragestellungen, welche wir bei der Projektkonzipierung hatten. Die Unterbringung von Langzeitpatient*innen ohne medizinische Indikation ist weder für die Erkrankten noch für die Einrichtungen optimal. Es besteht eine hohe Notwendigkeit der leitliniengerechten Behandlung von Schizophrenie-Patient*innen, da die Empfehlungen der Leitlinie sich nach den aktuellsten und relevantesten wissenschaftlichen Erkenntnissen richten. Es ist weiterhin erforderlich, individuelle Lösungen für die Betreuung und Unterbringung von psychiatrisch schwer Erkrankten außerhalb des stationären Settings zu finden, wenn diese hierfür nicht geeignet sind. Wenn eine Clozapin Gabe oder eine EKT an der fehlenden Einwilligung der Patient*innen oder der Betreuer*innen scheitert, ist eine umfassende Aufklärung über den Stellenwert dieser Behandlungsoptionen bei Therapieresistenz unerlässlich.Schizophrenia is a serious psychiatric disorder. It greatly reduces the quality of life of those affected and poses major challenges for the treating professionals. Due to its often early age of onset and typically chronic course, it accompanies many of those affected throughout their lives. Schizophrenia is identified as a significant risk factor for prolonged and recurrent hospitalizations. A treatment-resistant course is possible. In this case, antipsychotic pharmacotherapy with clozapine and electroconvulsive therapy, among other things, are particularly important.
The aim of our study was to describe the nationwide care situation of psychiatric patients who had been hospitalized for at least 90 days without a current treatment indication. Data collection was carried out anonymously using an online questionnaire. This was to be completed by the treating medical colleagues. A description of the structural characteristics of the institutions surveyed was provided, along with a query regarding the presence and number of long-term patients, as well as a general characterization of these patients based on basic demographic data. The questionnaire focused on recording the diagnosis and treatment of long-term patients with schizophrenia. We based our approach on the recommendations of the DGPPN's S3 guideline on schizophrenia.
The data we collected came primarily from smaller specialist hospitals and university clinics. At the time of the survey, approximately 80% of the facilities had long-term patients in their care. The median length of stay was 200 days, more than twice the inclusion criterion, and the mean length of stay was 313 days, more than three times the inclusion criterion. Approximately 60% of the long-term patients recorded had a primary diagnosis from the schizophrenia spectrum. The reasons for long-term patient status were varied. The most common reason given was a lack of capacity at a residential facility, accounting for approximately 80% of cases. Risk factors for the development of schizophrenia, such as traumatic events, a migrant background, and fleeing one's home country, were rarely present. At the time of the survey, about 8 out of 10 patients were receiving antipsychotic pharmacotherapy. However, only about half of the long-term patients with schizophrenia were treated with clozapine, and only about 40% were treated within the recommended parameters. ECT was rarely used. As with the lack of clozapine administration, the reasons for this were seen primarily in the lack of consent. Therapy against the patient's natural will was administered to about a quarter of the patients and exclusively in pharmacological form using antipsychotics.
The results of our study confirm most of the questions we had when designing the project. The accommodation of long-term patients without medical indication is not optimal for either the patients or the institutions. There is a great need for guideline-based treatment of schizophrenia patients, as the recommendations in the guideline are based on the latest and most relevant scientific findings. It is still necessary to find individual solutions for the care and accommodation of severely mentally ill patients outside of an inpatient setting if they are not suitable for this. If clozapine administration or ECT fails due to a lack of consent from patients or caregivers, comprehensive information about the importance of these treatment options in cases of treatment resistance is essential.2026-01-0
Comparison of Conventional versus Video-Based Patient Education for Diagnostic Gastroscopy – A Prospective Randomized Study
No full textBackground:
A survey conducted by the European Society of Gastrointestinal Endoscopy (ESGE) highlights significant variability in the provision of medical information across Europe. Furthermore, it has been demonstrated that patients frequently leave consultations feeling inadequately informed, with such dissatisfaction being cited as a contributing factor to subsequent treatment errors. Full information on gastroscopy could provide a remedy here.
This study aims to assess whether the incorporation of an additional educational video can reduce patient anxiety, enhance satisfaction, and minimize the required sedation.
Methods:
This is a duocentric prospective randomized study. Before and after receiving the self-created video, both groups completed a specially standardized questionnaire.
At the end, descriptive statistic was calculated, and the two groups were compared with each other.
Results:
A total of 311 participants were enrolled (intervention group (n=127, Group A) and the control group (n=124, Group B)). The educational video, viewed prior to the medical consultation, significantly alleviated subjective anxiety (p<0.001) to a degree comparable to the conventional consultation alone. Moreover, 88% of patients rated the video as a useful or highly beneficial addition to their education. There was no difference in the sedation between the two groups (p = 0.176, 95%KI [-13.5,37.6]).
Conclusion:
The educational video represents an effective adjunct to the standard educational interview, enhancing the clarity and comprehensibility of pre-procedural information. It similarly reduces anxiety to the same extent as a direct explanation by the physician, and as such, can be recommended as a valuable supplement in routine clinical practice. The dosage of propofol is not affected.2025-10-2
Spatial Random Graphs: Studying dependence structures in spatial data
No full textSpatial random graphs provide a powerful framework for analyzing the relations and interactions governed by an underlying spatial structure. Such graphs can be used not only to model and analyze observed networks, but also to represent complex data via synthetic networks, i.e. networks in which the edge structure is not observed but in which edges are introduced to provide a representation of additional information. In both cases, spatial graph models can be very useful for describing and highlighting the characteristics of the underlying dependence structures. A wide range of sophisticated spatial graph models is important for capturing some key structures of complicated real-world networks.
This thesis makes substantial contributions to the theoretical study of dependence structures in spatial (random) graphs. It is based on three research articles (currently available as preprints on arXiv) and one work in progress. The thesis summarizes the approaches and main results of these papers, which are included in full in the appendix. A fundamental ingredient for understanding and analyzing the graph structure is a metric that measures the (dis)similarity between spatial random graphs in a natural way. The first research article constructs such a spatial graph metric by building on an optimal assignment of the vertices with costs based on the dissimilarity of both, vertex and edge structures. The paper demonstrates that the new graph metric can be used as a statistical tool to infer important graph properties and further serves as a foundation for deriving a metric for spatial random graph distributions.
Due to the complexity of the underlying dependence structure, a direct analysis of spatial random graphs is often not feasible. Instead, the second paper studies the approximation of possibly more complicated spatial random graphs with simpler spatial random graphs. These simpler spatial random graphs are based on suitable independence assumptions and are a generalization of the random geometric graph consisting of vertices given by a Gibbs process and (conditionally) independent edges generated from a connection function. The results are derived by an application of Stein's method which allows to state explicit convergence rates with respect to the metric for spatial random graph distributions introduced in the first paper.
An application of these results yields interesting convergence statements, for example, in the context of thinnings and discretizations of spatial random graphs.
Another application is considered in the third paper, where synthetic networks are studied under a privacy constraint. In this context, a private synthetic graph generator is introduced that takes observed attributes as an input and jointly generates a network based on the true data and private data, respectively.
Finally, as part of ongoing research, it is outlined how kernel Stein discrepancies can be used to perform goodness-of-fit tests for point processes.2025-10-0