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Exploring the transformative impact of technology on school leadership. affordances, practices, implications
Get PDFIn the context of digital transformation processes in schools, the introduction of technology is often discussed in terms of the individualization and optimization of teaching, learning and school management. However, it is often neglected that technologies are preconfigured and provide socio-material offers that invite certain actions and thus subtly shift forms of practice. Since the everyday life and actions of school leaders are also significantly influenced by digitalization-related transformation processes, they also have to refer to technologies and the associated affordances in their everyday actions. However, what these affordances are and how they influence the actions of school leaders remains unclear in previous research. Against this background, the present paper focuses on the following question: How do school leaders integrate technology into their daily practice and how does technology influence the practices of school leaders? Based on the results of an empirical-qualitative study using expert interviews and shadowing, the article presents empirical examples of technology-related affordances in the everyday lives of school leaders. Associated actions of school leaders in dealing with technology as well as subtle shifts in the dynamics between school leaders and other actors are shown. The article concludes with a discussion of implications for school practice, future research, and the professionalization of school leaders
Traumatische Wirbelsäulenfrakturen bei Mehrfachverletzten: eine Vergleichsstudie zwischen alleiniger dorsaler Stabilisierung und kombinierter dorsoventraler Versorgung
Get PDFZiel:
Der optimale Ansatz für die chirurgische Behandlung schwerer traumatischer Wirbelsäulenfrakturen bei Patienten mit Polytrauma ist umstritten. Diese Studie vergleicht die alleinige dorsale Stabilisierung (Gruppe I) mit dem kombinierten dorsoventralen Ansatz (dorsale Stabilisierung + Wirbelkörperersatz Gruppe II). Analysiert wurden bildmorphologische Ergebnisse, einschließlich des sagittalen Index (SI) und des Loss of Vertebral Height (LVH), sowie klinischer Ergebnisse wie Schmerzen, neurologischer Status und postoperativen Komplikationen.
Methoden:
In dieser retrospektiven, monozentrischen Studie wurden alle Patienten mit Polytrauma und diagnostizierten Wirbelsäulenfrakturen (BW1 bis LW5), die sich zwischen dem 1. Januar 2015 und dem 30. September 2024 einer chirurgischen Stabilisierung unterzogen, einbezogen. Die Patientenakten und die Bildgebungen wurden analysiert, wobei Sagittal Index (SI), Loss of Vertebral Height (LVH), Schmerz gemäß Visuelle Analog Skala (VAS) und neurologischer Status zu Studienbeginn, nach jedem chirurgischen Eingriff und beim Follow-up erfasst wurden. Lineare gemischte Regressionsmodelle, angepasst an die Ausgangswerte, verglichen SI, LVH und Schmerzen, während ein Proportional Odds Ratio-Modell für den Vergleich des neurologischen Status zwischen den beiden Gruppen verwendet wurde.
Ergebnisse:
Insgesamt wurden 77 Patienten (47 Männer) eingeschlossen, davon 31 in Gruppe I und 46 in Gruppe II. Die demografischen Merkmale wie Alter, Geschlecht, Verletzungsursache, initiales Hämoglobin und Begleitverletzungen waren zwischen den Gruppen vergleichbar. Das mediane Follow-up betrug 16 Monaten in Gruppe I und 19 Monaten in Gruppe II. Die meisten Frakturen lagen im thorakolumbalen Übergangsbereich (BW12 und LW1), und laut AO-Klassifikation handelte es sich größtenteils um Kompressionsfrakturen (A3 oder 4, mit 12 und 10 in Gruppe I sowie 11 und 28 in Gruppe II). Das Regressionsmodell zeigte eine überlegene sagittale Ausrichtung in Gruppe II mit einer mittleren Differenz für den SI von -4,24 (95 % CI -7,13 bis -1,36; p-Wert = 0,004) und eine verbesserte Wiederherstellung der Wirbelkörperhöhe mit einer mittleren Differenz für LVH von 0,11 im kombinierten Ansatz (95 % CI 0,02 bis 0,20; p-Wert = 0,02). In Bezug auf die Schmerzreduktion beim Follow-up zeigte der kombinierte Ansatz bessere Ergebnisse mit einer mittleren Differenz von -1,55 (95 % CI -3,05 bis -0,05; p-Wert = 0,047). Das Proportional-Odds-Modell bezüglich des neurologischen Status zeigte in der kombinierten Gruppe bessere Ergebnisse mit einem Proportional-Odds-Ratio (POR) von 5,12 (95 % CI 1,51 bis 23,77; p-Wert = 0,022). Postoperative Komplikationen traten in beiden Gruppen bei jeweils sieben Patienten auf.
Schlussfolgerung:
Die kombinierte dorsoventrale Stabilisierung bei Wirbelsäulenfrakturen verbessert die Stellung der Wirbelsäule durch eine bessere sagittale Ausrichtung und eine erhöhte Wirbelkörperhöhe. Dies traf insbesondere auf das letzte follow-up zu, da nach initialer Versorgung ein deutlich geringerer Korrekturverlaust auftrat. Damit gingen im Vergleich zur alleinigen dorsalen Stabilisierung bessere klinische Ergebnisse einher, einschließlich Schmerzlinderung und neurologischem Status. Bezüglich Komplikationen gab es zwischen den beiden Gruppen keine signifikanten Unterschiede.43 Seiten ; Illustrationen, Diagramm
Development and performance evaluation of the wavelength-shifting optical module for the IceCube upgrade
Get PDFThe IceCube Neutrino Observatory excels at detecting high-energy neutrinos via Cherenkov light in glacial ice. At lower energies, however, the high dark noise of the optical sensors dominates the signal, severely limiting sensitivity to astrophysical events such as supernovae. The Wavelength-shifting Optical Module (WOM) provides an elegant solution by improving detection efficiency and extending sensitivity into the ultraviolet (UV) range, which is largely inaccessible to standard IceCube optical modules. The WOM features a cylindrical wavelength-shifting tube that absorbs UV-photons and re-emits them at longer wavelengths, which are then guided via total internal reflection to photomultiplier tubes (PMTs) located at both ends. This design enhances UV sensitivity and reduces noise by decoupling the photosensitive area from the PMTs. These features are particularly beneficial for the upcoming IceCube Upgrade, the next development to IceCube, with a denser instrumentation optimized to lower the energy threshold of detected neutrinos.
This thesis presents the complete development cycle of the WOM, from simulation-based design and material selection to laboratory characterization and in-situ integration studies. A comprehensive performance evaluation is included, covering PMT quantum efficiency, time resolution, angular response, and effective area. In addition, an optimized production process and extensive optical and environmental testing demonstrate the WOM’s suitability for deployment in the IceCube Upgrade. While its performance varies across different Upgrade use cases, it shows strong potential for broader applications, particularly in low-background or UV-sensitive detection environments.viii, 245 Seiten ; Illustrationen, Diagramm
Implementierung des da Vinci Single-Port Robotersystems in der Klinik für Allgemein-, Viszeral- und Transplantationschirurgie der Universitätsmedizin Mainz
Get PDF62 Seiten ; Diagramm
Islamophobia in Western Europe is unrelated to religiosity but highly correlated with far right attitudes
Get PDFThe far right’s relationship with religion has become a major focus of current research. Even in Western Europe, one of the most rapidly secularising areas of the world, far right actors claim to defend Christian values against the alleged threat of Islam and Muslim immigrants, a rhetorical strategy known as ‘Christianism’. Yet, little is known about how religiosity, Islamophobia, and populist far-right ideology are connected at the level of mass belief systems in Western Europe. Most of the literature is focused either on religiosity’s effect on voting or on the connection between religiosity and ethnic prejudice, without considering religiosity’s relationships with the wider spectrum of far-right ideology. The present article fills this gap by analysing survey data from Britain, France, Germany, and the Netherlands. It uses SEM to uncover the relationships between Christian religiosity on the one hand and Islamophobia and far-right attitudes on the other. The results are broadly similar across different contexts: religiosity is mostly unrelated to Islamophobia, nativism, right-wing authoritarianism, and populism. Conversely, Islamophobia overlaps considerably with both nativism and authoritarianism: people who perceive immigration as a threat and favour strict laws and harsh enforcement also tend to reject Islam, but not for religious reasons. This pattern is compatible with the strategy of Christianism, which is largely devoid of religiosity, yet facilitates the “othering” of Muslims as a cultural out-group. It also helps to explain why there is no genuine, electorally relevant religious far right in Western Europe
Einfluss unterschiedlicher Wirkmechanismen der oralen Antikoagulation auf das Rekanalisationsergebnis der mechanischen Thrombektomie bei zerebralem Großgefäßverschluss – Eine retrospektive Analyse des German Stroke Registry
No full textZusammenfassung
Hintergrund:
Die mechanische Thrombektomie (MT) ist eine wirksame Behandlungsmethode bei ischämischen Schlaganfällen mit Großgefäßverschluss. Gleichzeitig stellt die prästa-tionäre orale Antikoagulation (OAK) mit direkten oralen Antikoagulantien (DOAK), wie Thrombininhibitoren (Dabigatran) und Faktor-Xa-Inhibitoren, eine zentrale Strategie in der Sekundärprävention von Schlaganfällen bei Patienten mit Vorhofflimmern dar. Es bleibt jedoch unklar, wie sich eine bestehende OAK auf die Sicherheit und Effekti-vität der MT auswirkt.
Zielsetzung:
Ziel der Arbeit war es, den Einfluss einer antikoagulatorischen Vortherapie auf die Erfolgsrate der MT, das funktionelle Outcome, sowie die periprozeduralen Komplika-tionen zu untersuchen. Dabei wurde ein Vergleich zwischen Dabigatran und
Faktor-Xa-Inhibitoren durchgeführt.
Methodik:
Es wurden retrospektiv 1.906 Patient*innen aus dem „German Stroke Registry-Endovascular Treatment“ (GSR-ET) analysiert, die aufgrund eines ischämischen Schlaganfalls mit MT behandelt wurden. Die Kohorte umfasste 146 Patient*innen mit Dabigatran und 1.760 Patient*innen mit Faktor-Xa- Inhibitoren. Analysiert wurden die prozeduralen Erfolgsraten, funktionelle Outcomes (modifizierte Rankin-Skala, mRS), Sicherheitsparameter (z. B. symptomatische intrakranielle Blutungen, sICH) und Komplikationen.
Ergebnisse:
Die Erfolgsrate der MT, gemessen am mTICI-Score (≥2b), zeigte keine signifikanten Unterschiede zwischen Dabigatran und Faktor- Xa-Inhibitoren. Auch in Bezug auf periprozedurale Komplikationen, wie sICH und maligne Mediainfarkte, zeigten sich keine signifikanten Unterschiede. Das funktionelle Outcome (mRS ≤2 nach 90 Tagen) war zwischen den beiden Gruppen vergleichbar, wobei patientenspezifische Fakto-ren wie Alter und Komorbiditäten eine wesentliche Rolle spielten. Schlussfolgerung: Eine antikoagulatorische Vortherapie mit Dabigatran oder Faktor-Xa-Inhibitoren scheint die Sicherheit und Effektivität der MT nicht wesentlich zu beeinträchtigen. Aufgrund des fehlenden Vergleichs mit einer DOAK-freien Kontrollgruppe lassen sich jedoch keine
abschließenden Aussagen über den generellen Einfluss einer OAK auf die MT tref-fen. Die höhere Rate an begleitender Thrombolyse in der Dabigatran-Gruppe sollte bei der Interpretation der Ergebnisse berücksichtigt werden. Weitere Studien sind notwendig, um die optimale antikoagulatorische Strategie im Kontext der MT zu defi-niereVI, 80 Seiten ; Illustrationen, Diagramm
Type 1 diabetes and other autoimmune diseases : epidemiology, pathophysiology and screening
No full textIntroduction:
The interplay between type 1 diabetes (T1D) and concomitant autoimmune diseases (AID) is both clinically and scientifically relevant. In this review, we delineate the epidemiological, pathophysiological and practical aspects underlying polyautoimmunity with a focus on T1D.
Method:
A comprehensive review of literature on T1D and associated AID was conducted, with the aim of drawing informed conclusions relevant to clinical practice. It draws on a targeted PubMed search conducted March–May 2025, emphasising recent peer-reviewed articles in English.
Results:
Epidemiological data consistently indicate that individuals with T1D exhibit a significantly increased prevalence of additional AID. Familial aggregation of discordant AID and the concept of polyglandular autoimmune syndromes (PAS) or autoimmune polyendocrinopathy highlight that multiple AID can cluster and occur in a sequential and overlapping fashion, with T1D frequently acting as either an early or a subsequent manifestation. Thereby, genetic susceptibility, environmental triggers and epigenetic factors are pivotal in the initiation and progression of autoimmunity. Clinically, the coexistence of T1D with other AID poses significant challenges in disease management, often necessitating adjustments in therapeutic regimens and careful monitoring to mitigate complications. Early detection via stratified autoantibody testing is important for timely intervention and improved long-term outcomes.
Conclusions:
Accordingly, screening for T1D-associated autoantibodies in individuals with a personal or family history of AIDs, and vice versa, should be implemented in clinical practice
Inflammatory stromal and T cells mediate human bone marrow niche remodeling in clonal hematopoiesis and myelodysplasia
No full textSomatic mutations in hematopoietic stem/progenitor cells (HSPCs) can lead to clonal hematopoiesis of indeterminate potential (CHIP) and progression to myelodysplastic syndromes (MDS). Using single-cell and anatomical profiling of a large cohort of human bone marrow (BM), we show that the HSPC BM niche in CHIP and MDS is undergoing inflammatory remodeling. This includes loss of CXCL12⁺ adipogenic stromal cells and the emergence of a distinct population of inflammatory mesenchymal stromal cells (iMSCs), which arise in CHIP and become more prevalent in MDS. Functional studies in primary BM HSPC-MSC co-cultures reveals that healthy aged and CHIP HSPCs activate stromal support, while MDS HSPCs fail to do so. In contrast, MDS blasts further suppress HSPC support and trigger inflammation, indicating disease-stage-specific stromal disruption. In parallel, we show that iMSCs retain partial support and angiogenic potential in MDS, coinciding with expanded BM vasculature. Additionally, we identify IFN-responsive T cells that preferentially interact with iMSCs, potentially reinforcing local inflammation. These findings position iMSCs as central mediators of early BM niche dysfunction and potential therapeutic targets for intercepting pre-malignant hematopoiesis
Protocol for the differentiation of induced pluripotent stem cells into retinal pigment epithelial cells
No full textInduced pluripotent stem cells (iPSCs) are emerging as a valuable system for modeling tissues and organs. Here, we describe a highly scalable protocol for the differentiation of iPSCs into retinal pigment epithelium (RPE), including a new step that makes it easier for researchers to obtain a high-purity culture. We also describe a cryopreservation technique for RPE progenitor cells to enable their storage. The use of cryopreserved cells allows a subsequent reduction in differentiation time compared to the full protocol
Digital and AI-assisted multimodal supportive care, combining physical activity, nutrition, and pain management during chemotherapy for advanced pancreatic cancer patients : study protocol of the European multicenter randomized controlled trial of the RELEVIUM project
No full textBackground
Multimodal care, including nutritional support, physical exercise, and pain management, is essential to address complex therapeutic challenges in advanced pancreatic cancer. There is an increasing prevalence worldwide in pancreatic cancer and the disease is often diagnosed late leading to limited treatment options and poor prognosis. Advanced pancreatic cancer patients experience a wide range of adverse symptoms that affect their quality of life and require comprehensive and interdisciplinary patient care early in treatment. Integrating digital health, particularly through remote monitoring, plays a vital role in addressing the therapeutic challenges and improving data-driven clinical decision-making. Therefore, the European project RELEVIUM examines the effect of a personalized, digitally assisted multimodal supportive care intervention on health-related quality of life in patients with pancreatic cancer aiming to improve early access to multidisciplinary, cost-effective palliative care.
Methods
In cancer centers in Estonia, Israel, and Germany, 132 patients will be randomly assigned in the prospective randomized controlled trial RELEVIUM-RCT into two groups. Both groups receive standard chemotherapy. The control group follows usual care, while the intervention group receives personalized, digitally assisted multimodal support integrated into usual care. The intervention includes guidance and monitoring on pain, nutrition, fatigue, sarcopenia, and physical activity. Patients track their physical activities, nutritional behavior and rate pain and fatigue daily via a smartwatch and mobile app. The physician analyses these longitudinal data on a dashboard and counsels the patients every two weeks during clinical visits, assisted by an interdisciplinary team and digital support system. The primary endpoint of the study is health-related quality of life including factors such as time until a definitive deterioration in selected dimensions (physical functioning and/or appetite loss) assessed at 8 weeks. Secondary endpoints include longitudinal analyses of efficacy related to pain, physical function, nutrition, sarcopenia, and socioeconomic factors.
Discussion
The RELEVIUM-RCT investigates the efficacy of digital health support for individuals with advanced pancreatic cancer in conjunction with conventional treatments in three European countries. Longitudinal data on the interplay of chemotherapy toxicity, fatigue, pain, physical activity, and nutrition will provide valuable extended insights on multimodal pancreatic cancer care. Moreover, this data can help demonstrate the benefits of digital health in clinical decision-making, ultimately contributing to improved quality of care in Europe