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Enhancing mental health care: a problem, resources and goals oriented multidimensional framework (PRoGO)
No full textBackground
Lawrence Weed introduced the “Problem-Oriented Medical Records” (POMR) approach to medicine. Its core principle is that treatment should be organised around patients’ specific problems. This approach gained widespread adoption in the United States during the 1970s. However, few studies have compared POMR with the traditional “source-based” method, and evidence supporting its application in mental health remains particularly limited.
Methods
We carried out a narrative review to examine whether POMR is appropriate for mental health care and which modifications are necessary for this purpose.
Findings
Psychiatry and psychotherapy address brain-mediated disorders that lack clear biological markers. Diagnoses rely on the assessment of psychopathological symptoms, which are grouped into syndromes. These symptoms and syndromes can be effectively categorized as “problems”. Given that psychiatric treatment is often symptomatic in that it focuses on symptoms rather than diagnoses, POMR provides an ideal framework for organizing care.
Furthermore, mental health is inherently multidimensional, encompassing biological, psychological, social, and existential domains. This complexity necessitates interdisciplinary collaboration. However, under the conventional source-based approach, professional groups often operate in parallel rather than jointly together. POMR, by contrast, facilitates seamless collaboration by aligning teams around patient-centred problems. A special aspect of mental health care is the emphasis on considering patients’ individual goals and resources, rather than focusing only on their deficits.
Interpretation
By systematically applying POMR to psychiatric care—particularly through tightly coordinated interdisciplinary treatment—clinicians could enhance both clinical and functional outcomes, improve both patient and team satisfaction, and better align treatment with patients’ unique needs. To support this approach, we propose a practical grid which we refer to as the Problem–Resources–Goals Oriented framework (PRoGO), reflecting the necessary adaptations for mental health. Clinical trials are warranted to assess the effectiveness of POMR/PRoGO in psychiatric practice and its potential to advance the field
Managerial compensation, bonus banks, and long‐term orientation
No full textBonus banks are multiyear performance plans for deferring bonus payments and enhancing pay-for-performance by facilitating downward corrections of bonuses. These compensation schemes have become widely accepted among practitioners and regulators in recent years with the aim to reduce managerial short-termism. This paper examines the incentive properties of bonus bank schemes based on performance measures as proposed in the literature. To attain efficient investment decisions, such a scheme depends on managers' reports about value creation, but managers have incentives to misreport. We study how the bonus bank can be used to elicit truthful reporting and hence efficient investment in multiyear settings. For situations in which equity market values are not applicable, for example, when managers have private information, we find that an internal market for the bonus bank between the leaving manager and the successor can induce truthful reporting under restrictive conditions only. In particular, negotiations under asymmetric information require the successor to have significantly superior capabilities to compensate for the uncertainty inherent in valuing the bonus bank
"You wanna flirt?" – "Let's flirt": a corpus-based analysis of flirting
No full textFlirting is thus far linguistically under-researched. What makes it an intriguing phenomenon to investigate is that it seems to have no fixed form but a clear function. This article hence aims to fill the existing research gap by investigating flirting in the US dating show Love is Blind. The TV format is marked by the contestants not having visual contact in the early stages of the dating process and its focus on promoting marriage as an outcome of the show. In contrast to previous research, this corpus-driven study utilises a top-down approach and manual data coding in order to get an, if possible, all-encompassing picture of this practise. We furthermore present a comprehensive definition of flirting, highlighting playful transgression as a key feature. In our analysis we found that contestants make use of six vehicles to signal sexual and/or romantic interest, among these, sexual innuendo, self-praise and imagined future. While there are differences in the amount of the vehicles used by women and men, there seems to be no normative restriction in usage, meaning that both men and women use all six vehicles
Elektrophotographischer Pulverauftrag für das pulverbettbasierte Schmelzen von Metallen mittels Laserstrahl
No full textDie vorliegende Arbeit untersucht das Potenzial des elektrophotographischen Pulverauftrags zur Flexibilisierung des pulverbettbasierten Laserstrahlschmelzens von Metallen (PBF-LB/M). Ziel war es, das elektrophotographische Wirkprinzip systematisch auf den additiven Fertigungsprozess zu übertragen und hinsichtlich seiner Prozessschritte, Einflussgrößen und Einsatzmöglichkeiten zu qualifizieren.
Dazu wurden drei wesentliche Entwicklungsfelder eines flexiblen Pulverauftragssystems identifiziert: (1) selektiver und flächiger Pulverauftrag mit variablem Druckbild, (2) Mono- und Multimaterialfähigkeit sowie (3) ein kontaktloser Auftrag zur Entkopplung von der Pulverfließfähigkeit. Aufbauend auf einer Analyse der Rahmenbedingungen wurden relevante system- und prozessbezogene Einflussgrößen eingegrenzt und mittels physikalischer Modelle Mindestanforderungen an die elektrischen Feldkräfte abgeleitet.
Zur experimentellen Erprobung wurde eine Prinzipvorrichtung entwickelt, mit der die elektrophotographischen Prozessschritte erstmals für metallische Pulver reproduzierbar umgesetzt werden konnten. Die Untersuchungen zeigen, dass qualitativ hochwertige selektive und flächige Pulverablagen erzeugt werden können und dass nicht nur Einzelschichten, sondern auch stabile Pulverbetten – sowohl in Monomaterial als auch im Multimaterial – aufgebaut werden können. Abweichungen zwischen theoretischen Prognosen und experimentellen Resultaten verdeutlichen jedoch die Relevanz zusätzlicher Einflussfaktoren und die Notwendigkeit einer weiterführenden Prozessstabilisierung.
In einer Erweiterungsstudie wurde das verarbeitbare Pulverspektrum systematisch untersucht. Die Ergebnisse belegen, dass Werkstoffdichte, elektrische Leitfähigkeit, Partikelform und Partikelgrößenverteilung das Prozessfenster maßgeblich beeinflussen. Besonders hervorzuheben ist, dass auch nichtfließfähige metallische Pulver sowie nichtmetallische Pulver (Keramiken und Polymere) kontaktlos verarbeitet werden können, sofern das dielektrische Verhalten und die Ladungsübertragung – beispielsweise durch Additive wie SiO₂ – gezielt eingestellt werden.
Zur Integration des Pulverauftrags in die PBF-LB/M-Anlage wurde ein prototypisches System realisiert und unter realen Prozessbedingungen getestet. Die Ergebnisse zeigen, dass metallische Pulver sowohl auf losem Pulver als auch auf bereits verfestigtem Material zuverlässig abgelegt werden können. Gleichzeitig wurden verfahrensspezifische Herausforderungen identifiziert, insbesondere hinsichtlich Prozessführung, elektrischer Felder in unterschiedlichen Atmosphären und der erforderlichen Prozessüberwachung.
Insgesamt zeigt die Arbeit, dass der elektrophotographische Pulverauftrag prinzipiell auf das PBF-LB/M übertragbar ist und neue Perspektiven für flexible, materialübergreifende und kontaktlose Pulverauftragssysteme eröffnet. Die gewonnenen Erkenntnisse bilden die Grundlage für zukünftige Forschungsarbeiten zur Erweiterung des verarbeitbaren Pulverspektrums, zur Optimierung des Prozessfensters und zur Etablierung der Elektrophotographie als innovatives Pulverauftragsverfahren in der additiven Fertigung.This dissertation investigates the potential of electrophotographic powder deposition to enhance the flexibility of Laser Beam Powder Bed Fusion of metals (PBF-LB/M). The objective was to systematically transfer the electrophotographic working principle to the additive manufacturing process and to qualify its process steps, influencing factors, and application possibilities.
Three key areas of development for a flexible powder deposition system were identified: (1) selective and area-wide deposition with variable image patterns, (2) mono- and multimaterial capability, and (3) contactless deposition to decouple the process from powder flowability. Based on an analysis of the boundary conditions, relevant system- and process-related influencing factors were defined, and the minimum electric field strengths required for powder attraction and deposition were derived using physical models.
To experimentally evaluate the process, a prototype setup was developed that enabled the electrophotographic process steps for metallic powders to be carried out reproducibly for the first time. The results demonstrate that high-quality selective and area-wide powder layers can be generated and that the process can build not only single layers but also stable powder beds—in both mono- and multimaterial configurations. Deviations between theoretical predictions and experimental results highlight additional, previously unaccounted-for influences and underline the need for further work on process stabilization.
An extended study examined the range of processable powders. The results show that material density, electrical conductivity, particle morphology, and particle size distribution significantly affect the process window. Importantly, even non-flowable metallic powders as well as non-metallic powders (ceramics and polymers) can be deposited contactlessly, provided their dielectric behavior and charge transport—e.g., by adding charge control agents such as SiO₂—are properly adjusted.
For integration into a PBF-LB/M system, a prototypical electrophotographic deposition module was developed and tested under realistic machine conditions. The findings demonstrate that metallic powders can be deposited both onto loose powder and onto previously fused material, validating compatibility with the PBF-LB/M workflow. At the same time, process-specific challenges were identified, particularly concerning electric field behavior in different atmospheres and the need for improved process control and monitoring.
Overall, this work shows that electrophotographic powder deposition is fundamentally transferable to PBF-LB/M and opens new possibilities for flexible, material-independent, and contactless powder delivery. The insights gained provide a foundation for future research aimed at expanding the range of processable powders, refining the process window, and establishing electrophotography as an innovative powder deposition technique in additive manufacturing
Histological, ultrastructural, and single-cell profiling reveal immune-mediated remodeling in gallbladder inflammation
No full textGallbladder inflammation comprises distinct pathological entities, including acute, neutrophil-dominated injury and chronic, fibrotic remodeling. This study aimed to define the cellular and structural programs that characterize these two inflammatory states and link epithelial, immune, and stromal alterations. Tissue and blood samples from forty-one patients, including twelve with acute cholecystitis and twenty-nine with chronic cholelithiasis, were analyzed using histopathology, immunohistochemistry, transmission electron microscopy, targeted cytokine expression analysis, and single-cell RNA sequencing of immune-enriched suspensions. Acute cholecystitis showed epithelial disruption, edema, and dense infiltration by neutrophils and macrophages, including an increased density of CD163 + macrophages, accompanied by elevated systemic inflammation. Chronic cholelithiasis displayed preserved epithelial continuity, fibrosis, glandular remodeling, and reduced immune-cell density. Ultrastructural analysis revealed abundant mucin granules and intact junctions in acute inflammation, contrasting with mucin depletion and dense-body accumulation in chronic disease. Single-cell transcriptomic analysis identified twelve immune and stromal populations, showing contrasting immune–stromal configurations: pro-inflammatory myeloid and cytotoxic T cells dominated in acute inflammation, whereas macrophage–B-cell–fibroblast networks were enriched in chronic cholelithiasis, reflecting adaptive and fibrotic remodeling rather than a temporal transition. This study defines distinct but coordinated immune–stromal programs underlying human gallbladder inflammation and provides a cellular framework for understanding condition-specific mechanisms of acute and chronic disease
Jesus war tot – Jesus lebt (LK 24,13-55): Wortgottesdienst zur Emmauserzählung – erarbeitet auf ethnographischer Basis
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Religionsbezogene Bildung im Sonderpädagogischen Förderzentrum als Basis für eine inklusionsorientierte Lehrkräftebildung an der Universität: ethnografische Fallstudie – fachliche Grundlegung – perspektivische Ausblicke
No full text
Co-localized dermoscopy and LC-OCT for AI-assisted margin assessment of basal cell carcinoma: development of a "BCC-One-Stop-Shop" workflow
No full textBackground/Objectives: The surgical treatment of basal cell carcinoma (BCC) remains challenging due to the time-consuming, expensive and invasive nature of Mohs micrographic surgery. The objective is to develop a standardized protocol for managing diagnosis, surgery, and margin control within a single patient visit. Methods: Several protocols were tested to establish a “BCC-One-Stop-Shop”, combining in vivo and ex vivo margin mapping of BCC, pre- and postoperatively using Line-field confocal optical coherence tomography (LC-OCT). We introduce an algorithm enabling real-time localization of LC-OCT acquisitions on a previously acquired dermoscopy image. Additionally, an artificial intelligence model provides a BCC probability score based on LC-OCT images. Together, the co-localization algorithm and AI BCC model generate a color-coded visualization of the tumor within the dermoscopy image, allowing precise pre-operative in vivo margin assessment. Results: We found our protocol, the implementation of the co-localization tool and the AI model, to be quick to apply, easy to learn and helpful regarding the initial determination of BCC tumor margins. Patients responded positively to the recognizable visualization of the disease. Conclusions: Pre- and postoperative margin mapping using LC-OCT imaging appears to be effective and feasible and could reduce time, costs, resources, excision sizes and patient burden by sparing additional excision steps in micrographic surgery. The integration of real-time co-localization and the AI-calculated probability score represent meaningful and practical enhancements for routine clinical use. To further evaluate the efficacy and safety of the BCC-One-Stop-Shop-Method and the newly introduced device features, larger-scale studies are warranted and are currently being conducted