Current landscape of hospital information systems in gynecology and obstetrics in Germany: a survey of the commission Digital Medicine of the German Society for Gynecology and Obstetrics

Purpose Hospital information systems (HIS) play a critical role in modern healthcare by facilitating the management and delivery of patient care services. We aimed to evaluate the current landscape of HIS in the specialty of gynecology and obstetrics in Germany. Methods An anonymous questionnaire was distributed via the German Society of Gynecology and Obstetrics newsletter in December 2022. The questionnaire covered the domains baseline demographic information, satisfaction with daily use, satisfaction with implementation, and degree of digitization. Results Ninety-one participants completed the survey. Median age was 34 years; 67.4% (60 of 89) were female, and 32.6% (29 of 89) were male. Of the survey participants, 47.7% (42 of 88) were residents, 26.1% (23 of 91) senior physicians, and 9.1% (8 of 88) medical directors. The degree of digitization of clinical documentation is mainly mixed digital and paper-based (64.0%, 57 of 89) while 16.9% (15 of 89) operate mainly paper-based. The current HIS has been in use on average for 9 years. The median number of different software systems used in daily routine is 4. About 33.7% (30 of 89) would likely or very likely recommend their current HIS to a colleague. Conclusions The current landscape of HIS in gynecology and obstetrics in Germany is characterized by a high heterogeneity of systems with low interoperability and long service life; thus, many healthcare professionals are not satisfied. There is both a need to enhance and an interest in modernizing the technological infrastructure to meet today’s requirements for patient care.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Heidelberg (8914

Auto-operative designs and confluent subjectivation: On the educational significance of hybrid materialities using the example of music-making-things

Die kumulative Dissertation widmet sich der Frage nach der erziehungswissenschaftlichen Bedeutung von hybriden Materialitäten, die als digital-materielle Dinge und environments auf Basis von Informatisierung und autooperativen Designs in zunehmender Weise Alltagspraktiken präfigurieren sowie Selbst- und Weltverhältnisse mitstrukturieren. Exemplarisch untersucht wird dies mit guten Gründen am Beispiel von Musiktechnologien. Die eingereichten Aufsätze stellen Forschungsergebnisse aus dem Kontext des Verbundprojekts Musikalische Interface Designs: Augmentierte Kreativität und Konnektivität (BMBF 2017-2022) dar. Sie werden durch einen ausführlichen Rahmentext kultur- und grundlagentheoretisch eingebettet und forschungslogisch kontextualisiert. Die Arbeit knüpft im weitesten Sinn an den Diskurs zur erziehungswissenschaftlichen und pädagogischen Bedeutung der Dinge an, wobei in Anbetracht der untersuchten hybriden, digital-materiellen ›MusikmachDinge‹ und environments einige perspektivische Aktualisierungen mit allgemeinpädagogischer Relevanz eingeführt werden. Im Fokus der Arbeit steht insbesondere die Frage nach dem Mitwirken der interaktiven hybriden Ding-Designs an Subjektivierungsprozessen. Im Anschluss daran stellen sich zudem Fragen nach damit verbundenen Herausforderungen und Chancen für den Bildungsbereich. Die vier Aufsätze thematisieren unterschiedliche Aspekte des Spannungsverhältnisses zwischen den Designs und Affordanzen der interaktiven Dinge, den damit verbundenen Subjektivierungsprozessen, ihrem neuartigen sozio-technischen Charakter sowie ihrer bildungspolitischen Institutionalisierung. Der Rahmentext erläutert und begründet mit Bezugnahmen auf Diskurse im Feld sowie auf thematisch angrenzende Disziplinen das forschungslogische Vorgehen und die grundlegenden Perspektiven der Arbeit. Die kulturhistorische Kontextualisierung der hybriden MusikmachDinge und ihrer interaktiven Designs macht diese als Teil einer umfassenderen Entwicklung sichtbar, die auch die erziehungswissenschaftliche Theoriebildung selbst beeinflusst hat und sich unter dem Schlagwort einer polyvalenten gesellschaftlichen ›Kybernetisierung‹ subsumieren lässt. Im Rahmen dieser Entwicklung, der auch die Digitalisierung und der daran anschließende Postdigitalitätsdiskurs zuzuordnen sind, entstehen neue Bildungs- und Subjektverständnisse, die perspektivisch nicht mehr unbedingt auf Prozesse der (Selbst-)Reflexion abzielen und die in ihrem Kern posthumanistisch konfiguriert sind. In genealogischer Perspektive treten zwei Stränge innerhalb des ›kybernetischen Dispositivs‹ zutage – ein repräsentationaler und ein körperlich-performativer – die zwei Möglichkeiten darstellen, dieses Dispositiv zu deuten, sich ihm gegenüber zu verhalten und es zu gestalten. Die beiden Stränge eröffnen nicht nur unterschiedliche individuelle und kollektive Entwicklungsmöglichkeiten, sondern spannen auch unterschiedliche normative Horizonte auf. Da sich die Subjektivierungsprozesse bei der Auseinandersetzung mit den hybriden Materialitäten der interaktiven MusikmachDinge in hohem Maße körperlich vermitteln, wird eine Perspektive auf Prozesse verkörperter Interaktivität entwickelt, mit der sich diese vor dem Hintergrund der dargelegten Kybernetisierung als soziotechnische Grenzprozesse empirisch präzise in den Blick nehmen lassen. Um die damit verbundenen Subjektivierungsformen genauer zu bezeichnen, bietet sich der Begriff einer konfluenten Subjektivation an, in der Menschen und (rechnende) environments sich aus Kooperationsgründen möglichst eng aufeinander abstimmen, wobei die aus der Environmentalität ubiquitärer Medientechnologien resultierende ›ökologische Perspektive‹ sich nicht auf Einzelindividuen beschränkt, sondern auch auf überindividuelle und transsubjektive Ebenen verweist. Ein daran anschließendes Ergebnis der Arbeit ist die Entwicklung einer Methode zum Durchführen von bildungstheoretischen Strukturanalysen für hybride, digital-materielle Medientechnologien. Dabei wird an Ideen aus der strukturalen Medienbildung angeknüpft, die mit medien- und designtheoretischen Perspektiven ergänzt und zu einem eigenständigen Verfahren ausgebaut werden, das komplexere Analysen erlaubt als gängige Artefaktanalysen, sich aber auch sehr gut für den Einsatz in konkreten empirischen und (medien-)didaktischen Kontexten eignet. Basis dessen ist ein Subjektivierungsmodell, in dem verschiedene Relationierungs- ebenen von Mensch und Artefakt kontrastiv in den Blick genommen und Reduktionismen aller Art möglichst vermieden werden. Auf Grundlage der empirischen Daten aus dem Projekt wird zudem eine Typologie der Haltungen entwickelt, mit denen die am Projekt Teilnehmenden den ausgeliehenen Musiktechnologien begegnen. In Verbindung mit den Strukturanalysen können auf dieser Grundlage die Passungsverhältnisse zwischen Nutzer*innen und Mediendesigns in den Blick genommen und pädagogisch fruchtbar gemacht werden. In den Haltungen zeichnen sich unterschiedliche Erwartungs-, Vorgehens-, Aneignungs- und Akzeptanzmuster ab, bei denen musikalische und/oder technische Vorkenntnisse zwar eine Rolle spielen, aber persönliche Interessen und Anliegen, private Umfelder, individuelle Zukunftsvorstellungen usw. sich als mindestens ebenso bedeutsam herausstellen. In (medien-)didaktischer Hinsicht lässt sich die Verbindung von Haltungstypen und Strukturanalysen sehr gut operationalisieren, um passgenaue Bildungsangebote mit spezifischen pädagogischen Zielsetzungen für unterschiedliche Zielgruppen zu entwickeln. Weitere Ergebnisse der Arbeit sind zum einen das in Auseinandersetzung mit Jacques Rancière entwickelte Konzept ›medialer Sinnlichkeitsregimes‹ und einer damit verbundenen Körperpolitik, die auch mit spezifischen Historizitätstypen von Bildung und ihrer Vermittlung in und durch Bildungsinstitutionen korrespondieren. Exemplarisch erläutert wird dies anhand eines kurzen empirischen Beispiels aus dem Projekt, in dem die Entwicklung und die Adaption bzw. die Ablehnung von Gestenrepertoires thematisiert wird, die sich im Rahmen neuer Medien-Musizier- Praktiken entwickeln. Zum anderen lassen sich neben dem Plädoyer für das Gestalten passgenauerer Medienbildungsangebote auch einige bildungspolitische Empfehlungen aus den Forschungsergebnissen ableiten. So wird einerseits für das Fördern einer integrativen (statt einer zersplitterten) Kulturellen Bildung und für den Aufbau entsprechender Reflexionskompetenzen im Feld plädiert und andererseits vorgeschlagen, das Sonische als epistemisch relevanten relationalen Weltzugang als eigenen Bereich in musikalische Bildungsangebote einzuführen.The cumulative dissertation is dedicated to the question of the educational significance of hybrid materialities, which, as digital-material things and environments based on informatization and auto-operative designs, increasingly prefigure everyday practices and help to structure self and world relations. This is examined with good reason using the example of music technologies. The submitted essays present research results from the context of the joint research project Musical Interface Designs: Augmented Creativity and Connectivity (BMBF 2017-2022). They are embedded and contextualized in terms of research logic by a detailed framework text. In the broadest sense, the work ties in with the discourse on the educational and pedagogical significance of things, whereby, in view of the hybrid, digital-material things and environments examined, some perspective updates with general pedagogical relevance are introduced. The work focuses in particular on the question of how the interactive hybrid designs of ›music-making things‹ contribute to subjectivation processes. This is followed by questions about the associated challenges and opportunities for the education sector. The four essays address different aspects of the tense relationship between the designs and affordances of interactive things, the associated subjectivation processes, their novel socio-technical character and their institutionalization in educational policy. The framework text explains the research logic and the fundamental perspectives of the work with reference to discourses in the field and thematically related disciplines. The cultural-historical contextualization of hybrid music-making things and their interactive designs makes them visible as part of a broader development that has also influenced educational theory itself and can be subsumed under the buzzword of a polyvalent social ›cybernetization‹. As part of this development, which also includes digitalization and the subsequent discourse about the post-digital, new understandings of education and the self are emerging that are no longer necessarily aimed at processes of (self-)reflection but are rather post-humanist in their core configuration. From a genealogical perspective, two strands emerge within the ›cybernetic dispositive‹ – a representational and a corporeal-performative one – which represent two ways of interpreting this dispositive, relating to it and shaping it. The two strands not only open up different individual and collective development possibilities, but also span different normative horizons. Since the processes of subjectivation in the engagement with the hybrid materialities of interactive music-making things are to a large extent mediated physically, a perspective on processes of embodied interactivity is developed with which these can be examined empirically and precisely as socio-technical boundary processes against the background of the cybernetization described above. To designate these forms of subjectivation, in which people and (computational) environments coordinate as closely as possible with each other for reasons of cooperation, the term confluent subjectivation seems to be adequate, whereby the ecological perspective resulting from the environmentality of ubiquitous media technologies is not limited to individuals, but also refers to supra-individual and trans-subjective levels. A related result of the work is the development of a method for educational-theoretical analyses for hybrid media technologies. This is based on ideas from structural media education, which are supplemented with media and design theoretical perspectives and developed into a method that allows more complex analyses than conventional artifact analyses, but is also very well suited for use in concrete empirical and didactic contexts. This is based on a model of subjectivation in which different levels of relation between humans and artifacts are contrasted and forms of reductionism are avoided as far as possible. Moreover a typology of the attitudes with which the participants encounter the borrowed music technologies is developed. In conjunction with the educational- theoretical analyses, it’s possible to take a closer look at the fit between users and media designs and make it useful for educational purposes. In terms of attitudes, very different patterns of expectation, approach, appropriation and acceptance emerge, in which previous musical and/or technical knowledge play a role, but personal interests and concerns, private environments, individual visions of the future, etc. prove to be at least as important in relation to the results of the engagement with the music-making things. From a media didactic point of view, the combination of attitude types and structural analyses can be operationalized well in order to develop tailor-made educational offers with specific pedagogical objectives for different target groups. Further results of the work are, on the one hand, the concept of media sensuality regimes and an associated body politics developed with regard to Jacques Rancière. This also corresponds with specific types of historicity of education and its mediation as well as with the logics of educational institutions. This is exemplified by a short empirical example from the project, in which the development and adaptation or rejection of gesture repertoires that emerge in the context of new media-music-making practices is addressed. On the other hand some educational policy recommendations can be derived from the research results. First, the promotion of an integrative (rather than a ›fragmented‹) cultural education and the development of corresponding reflection skills in the field is advocated. And second it is suggested to introduce the sonic as an epistemically relevant approach to the world as a separate area in music education

Neutrophil-to-Lymphocyte Ratio and Prognostic Nutritional Index Are Predictors for Overall Survival after Primary Pancreatic Resection of Pancreatic Ductal Adenocarcinoma: A Single Centre Evaluation

Purpose: Prognostic inflammation-based parameters have been reported as useful tools in various oncologic diseases. Pancreatic ductal adenocarcinoma (PDAC) is characterized by a high mortality rate, making reliable prognostic markers highly desirable. However, there is still inconsistency in the literature regarding the efficacy of the different available scores. Methods: A total of 207 patients, who underwent primary resection of PDAC from January 2000 to December 2018 at the University Hospital of Erlangen, were included in this retrospective single-center study. Different biomarkers, including the preoperative neutrophil–lymphocyte ratio (NLR), the platelet–lymphocyte ratio (PLR), the c-reactive protein (CRP)–albumin ratio (CAR), the lymphocyte–CRP ratio (LCR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score (mGPS) were analyzed for their ability to predict overall survival (OS). Results: In our cohort, the median overall survival was 20.7 months. Among the investigated biomarkers, NLR and PNI were identified as independent prognostic markers (Hazard Ratio (HR) 1.6 (1.0–2.5), p = 0.048 and HR 0.6 (0.4–0.9), p = 0.018), whereas PLR, CAR, LCR and mGPS did not reach significance in the multivariate analysis. Subgroup analysis revealed that the prognostic value of NLR and PNI is particularly evident in locally advanced tumor stages (pT3/4 and pN+). Conclusions: The NLR and PNI could serve as valuable tools for estimating prognosis in patients with PDAC undergoing pancreatic resection in curative intention, especially in locally advanced tumor stages. However, conflicting results in the current literature highlight the need for further prospective studies to validate these findings.This research received no external funding

Clinical and patient‐reported outcomes and neurofilament response during tofersen treatment in SOD1‐related ALS—A multicenter observational study over 18 months

Introduction/Aims In amyotrophic lateral sclerosis (ALS) caused by SOD1 mutations (SOD1‐ALS), tofersen received accelerated approval in the United States and is available via expanded access programs (EAP) outside the United States. This multicenter study investigates clinical and patient‐reported outcomes (PRO) and serum neurofilament light chain (sNfL) during tofersen treatment in an EAP in Germany. Methods Sixteen SOD1‐ALS patients receiving tofersen for at least 6 months were analyzed. The ALS progression rate (ALS‐PR), as measured by the monthly change of the ALS functional rating scale—revised (ALSFRS‐R), slow vital capacity (SVC), and sNfL were investigated. PRO included the Measure Yourself Medical Outcome Profile (MYMOP2), Treatment Satisfaction Questionnaire for Medication (TSQM‐9), and Net Promoter Score (NPS). Results Mean tofersen treatment was 11 months (6–18 months). ALS‐PR showed a mean change of −0.2 (range 0 to −1.1) and relative reduction by 25%. Seven patients demonstrated increased ALSFRS‐R. SVC was stable (mean 88%, range −15% to +28%). sNfL decreased in all patients except one heterozygous D91A‐SOD1 mutation carrier (mean change of sNfL −58%, range −91 to +27%, p  < .01). MYMOP2 indicated improved symptom severity ( n  = 10) or yet perception of partial response ( n  = 6). TSQM‐9 showed high global treatment satisfaction (mean 83, SD 16) although the convenience of drug administration was modest (mean 50, SD 27). NPS revealed a very high recommendation rate for tofersen (NPS +80). Discussion Data from this EAP supported the clinical and sNfL response to tofersen in SOD1‐ALS. PRO suggested a favorable patient perception of tofersen treatment in clinical practice.Boris Canessa ALS Stiftung (Düsseldorf, Germany) and Martin Herrenknecht Fonds for ALS Researc

The Effectiveness of Physical Literacy Interventions: A Systematic Review with Meta-Analysis

Background The holistic concept of physical literacy assumes that individuals require adequate cognitive (knowledge and understanding), affective (motivation and confidence), and physical (physical competence) qualities to engage in lifelong physical activity behavior. In recent years, the research field has undergone rapid development and has also yielded an increasing number of interventions that aim to translate the theoretical-philosophical ideas into practical endeavors. Objective The goal of the present pre-registered systematic review was to (a) provide a general overview of evaluation studies on physical literacy interventions and (b) to quantitatively examine the effectiveness of physical literacy interventions. Methods Drawing on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched a total of 18 databases for physical literacy interventions. Inclusion criteria were English language, publication by November 2021, and interventions using physical literacy as a theoretical underpinning or evaluation outcome. Articles that met these criteria were analyzed with respect to their basic delivery characteristics, study quality, evaluation approach, and main findings. We additionally ran meta-analyses with all non-randomized and randomized controlled trials to examine and compare the effect of these interventions on five outcome categories: (i) physical competence, (ii) motivation and confidence, (iii) knowledge and understanding, (iv) physical activity behavior, and (v) total physical literacy. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess the effects on the different categories. Results The screening process with two independent raters yielded 48 eligible interventions reported in 51 eligible articles. Quantitative evaluations most frequently addressed physical competence (72.2%), followed by motivation and confidence (47.2%), physical activity behavior (41.7%), and knowledge and understanding (33.3%). The controlled intervention studies ( n  = 24) exerted significant effects on all five physical literacy categories. Despite meaningful heterogeneity across the subgroups, the strongest effects were found for physical competence (SMD 0.90; 95% CI 0.55–1.25), followed by physical literacy aggregate scores (SMD 0.61; 95% CI 0.20–1.01), knowledge and understanding (SMD 0.54; 95% CI 0.30–0.79), physical activity behavior (SMD 0.39; 95% CI 0.23–0.55), and motivation and confidence (SMD 0.30; 95% CI 0.17–0.44). Conclusions The present study empirically demonstrated the effectiveness of physical literacy interventions on several outcomes relevant for promoting physical activity and health. To better inform current practices, future studies are advised to identify those program characteristics that significantly influence the effectiveness of physical literacy interventions. Clinical Trial Registration PROSPERO CRD42020188926.Open Access funding enabled and organized by Projekt DEAL.Friedrich-Alexander-Universität Erlangen-Nürnberg (1041

Blood pressure and kidney function in neonates and young infants with intrauterine growth restriction

Background Intrauterine growth restriction (IUGR) has been associated with changes in kidney anatomy, nephrogenesis and the vascular system, resulting in secondary arterial hypertension and kidney damage in adulthood. Here, we compare routine clinical and metabolic parameters between IUGR and non-IUGR study participants in the neonatal and early infant period. Methods A total of 39 IUGR and 60 non-IUGR neonates were included during an 18-month study period. We compared blood pressure, serum creatinine (SCr), urea nitrogen (BUN), urinary albumin, α-1-microglobulin, transferrin, immunoglobulin G and total protein excretion in spontaneous urine normalized by urine creatinine level during the hospital stay. Results There were no significant differences in mean values of blood pressure and urinary protein excretion between cases and controls. SCr and BUN levels were lower in the IUGR group compared to the non-IUGR group. Conclusions The lower levels of SCr and BUN may be attributed to lower liver and muscle mass in IUGR neonates and young infants. Biomarkers currently used in routine clinical care do not allow early postnatal prediction of higher blood pressure or worse kidney function due to IUGR, so further studies are needed. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information .Open Access funding enabled and organized by Projekt DEAL.Else Kröner-Fresenius-Stiftung http://dx.doi.org/10.13039/501100003042Friedrich-Alexander-Universität Erlangen-Nürnberg (1041

Sitting Pressure Measurements in Wheelchair Users—Can the Effects of Daily Relief Activities Be Depicted?

Seat pressure measurements in wheelchair users have been available for some time; however, repeated measurements from a commercially available pressure mat over 90 min did not differ in the pressure-loaded measurement area or the coordinates of the center of pressure, even in participants who were able to reposition themselves in the wheelchair. The question therefore arises: to what extent are there other parameters that reflect the activity of wheelchair users with the pressure mat? To investigate this, a commercial pressure mat (BodiTrak ® ) was used to perform the measurements of pressure of 33 adult wheelchair-dependent people with spinal cord injury after 30 and 90 min sitting on the cushion. In addition to the standard output of the pressure mat, graph-based surface analyses (calculation of the area of maximum pressure, calculation of the pressure-loaded measurement area, and pressure–area ratio) was performed retrospectively using Python 3.7. The analysis of the measurements after 30 and 90 min was performed by distinguishing the participants between those who could actively change their position (N = 24) and those who could not (N = 9). The parameters of the pressure mat and the graph-based analyses remained unchanged for active participants. In participants who were unable to actively change their position, the area of maximum pressure and the pressure–area ratio (ratio of maximum pressure area and total pressure-loaded area) increased. Significant differences between minutes 30 and 90 are only found for the pressure–area ratio. Thus, when measuring the seat pressure of wheelchair users, the pressure–area ratio should be taken into account as it reflects the daily relief activities of wheelchair users.This research received no external funding

Charakterisierung prodromaler Parkinson-Symptome und Pathologie in Mäusen und Ratten transgen für das humane Alpha-synuclein-Protein

Parkinson’s disease (PD) is on the rise and causal therapeutic approaches do not exist. The lack of interventional treatments is probably linked to an oftentimes delayed diagnosis and a hampered understanding of non-specific prodromal symptoms. In fact, by the time of clinical diagnosis, which is usually based on cardinal motor symptoms, individuals are already affected by an advanced and irretrievable loss of dopaminergic neurons. Over the last decades, there was increasing evidence about early, PD-associated non-motor symptoms, such as impaired sleep, constipation and hyposmia. However, diagnosis of PD remains delayed, emphasizing the need for a better clinical and preclinical understanding of its prodromal phase. Moreover, the scientific community is challenged by an oftentimes low translational value of animal-based preclinical data. Thus, sex-related differences in PD have to be taken into consideration with emphasis of the design of (preclinical) studies. The present study addressed those issues by implementing a study design including two species (Rattus norvegicus and Mus musculus), both sexes, gene dosages (i.e., wild type, heterozygous and homozygous animals), behavioral longitudinal phenotyping (for motor- and non-motor functions) as well as pathophysiology (hematology, neuropathology) in human alpha-synuclein expressing transgenic BAC-SNCA rats and mice. In detail, wild type and homozygous human alpha-synuclein expressing rats (BAC-SNCA rats) between the age of 2- and 15 months were characterized including motor and non-motor symptoms, associated hematological changes and an investigation of alpha-synuclein phosphorylated at serine 129 in the brain of these animals. Likewise, behavioral characterization of wild type, heterozygous and homozygous males and females of the human alpha-synuclein expressing murine model (BAC-SNCA mice) was performed for animals at the age of 1-, 3- and 10-months, with a pathophysiological focus on differences in transgene expression, dopaminergic neurodegeneration and, the presence of alpha-synuclein phosphorylated at serine 129. For BAC-SNCA rats, this work revealed disrupted resting-periods (reminiscent of sleep disturbances), along with increased anxiety, constipation-like symptoms, an anhedonia-like phenotype, mild cognitive changes, reduced motor learning as well as an impaired gait even before the age of 6 months. Alike, an impaired gait and increased-anxiety (in the Light/Dark paradigm) were observed in BAC-SNCA mice indicating species independent influences of human alpha-synuclein. In addition, the transgene differentially affected metabolic parameters in males and females leading to e.g., an increased energy expenditure only in male animals. Transgene-independent sex-related differences became apparent for motor symptoms as well as metabolic processes of BAC-SNCA mice. By Western Blot, male but not female BAC-SNCA mice displayed a gene-dose dependent increase of the levels of human alpha synuclein as well as a decline of tyrosine hydroxylase at the age of 2 months. Interestingly, phosphorylation of alpha-synuclein in the central nervous system seems to play a pivotal role in both species. Insoluble pS129aSyn positive inclusions were already detectable in various brain areas of 4-month-old homozygous BAC-SNCA rats and neuropathological findings correlated with hematological changes in a timely manner. In summary, this thesis revealed behavioral as well as neuropathological homologs of PD in (young) BAC-SNCA mice and rats, indicating that both models can be used in future studies to promote a better understanding of the prodromal phase of the disorder. Thereby, phosphorylation of alpha-synuclein appears to play a pivotal role across species in these models, raising hope for its future use as a reliable biomarker for an early detection of the disease.Morbus Parkinson (PD) ist auf dem Vormarsch und bis heute existiert keine ursächliche Therapie. Vermutlich steht dieser Mangel an Therapiemöglichkeiten in engem Zusammenhang mit einer oft verspäteten Diagnosestellung sowie unserem eingeschränkten Wissen über unspezifische, prodromale Symptome. In der Tat liegt bei Patienten zum Zeitpunkt der Diagnose, welche normalerweise auf kardinalen motorischen Symptomen basiert, bereits ein fortgeschrittener und unumkehrbarer Verlust dopaminerger Neuronen vor. In den letzten Jahrzehnten stieg unser Wissen über frühe, mit PD assoziierten, nicht motorischen Symptome wie Schlafstörungen, Verstopfung und Geruchsverlust stetig. Dennoch erfolgt die Diagnosestellung von PD verzögert und ein besseres Verständnis der prodromalen Phase auf klinischer und vorklinischer Ebene ist dringend von Nöten. Darüber hinaus ist die wissenschaftliche Gemeinschaft mit einer oft unzureichenden translationalen Validität von vorklinischen Tierstudien konfrontiert. Deshalb müssen zukünftige Studien unser Wissen über Geschlechtsunterschiede in PD im Rahmen des (vorklinischen) Studiendesigns mit einbeziehen. Um diese Ziele zu erfüllen, integriert das Studiendesign dieser Arbeit zwei Spezies (rattus norvegicus und mus musculus), beide Geschlechter, Gendosis (wildtyp, heterozygot und homozygot), sowie eine longitudinale Verhaltenscharakterisierung (motorischer und nichtmotorischer Symptome) und Pathophysiologie (Hämatologie und Neuropathologie) in für humanes Alpha-Synuclein-Protein (aSyn) transgenen BAC-SNCA Ratten und Mäusen. Im Detail wurden wildtyp und homozygote humanes aSyn exprimierende Ratten (BAC-SNCA Ratten) im Alter von 2 bis 15 Monaten im Hinblick auf motorische und nicht-motorische Symptome, assoziierte hämatologische Unterschiede, sowie an serine 129 phosphoryliertes aSyn (pS129aSyn) in den Gehirnen dieser Tiere hin untersucht. In Anlehnung daran, wurden wildtyp, heterozygote und homozygote humanes aSyn exprimierende Mäuse im Alter von 1, 3 und 10 Monaten sowohl im Verhalten charakterisiert als auch pathophysiologisch hinsichtlich der Expression des Transgens, dopaminerger Neurodegeneration und der Phosphorylierung von aSyn an Serine 129 (pS129aSyn) hin untersucht. Im BAC-SNCA Rattenmodell konnten im Rahmen dieser Studie gestörte Ruhephasen (ein Hinweis auf Schlafstörungen), ein gesteigertes Angst-ähnliches Verhalten, Verstopfungs- und Anhedonie-ähnliche Symptome, leichte kognitive Veränderungen, reduziertes Lernen motorischer Fähigkeiten sowie Veränderungen im Gangbild bereits in Tieren jünger als 6 Monate festgestellt werden. Veränderungen im Gangbild sowie ein gesteigertes angstähnliches Verhalten (im Hell/Dunkel Experiment) konnte ebenso im BAC-SNCA Mausmodell gemessen werden, was auf speziesübergreifende Effekte des Transgens hindeutet. Darüber hinaus hatte das Transgen im BAC-SNCA Mausmodell einen geschlechtsspezifischen Einfluss auf den Metabolismus der Tiere, insofern als, dass nur männliche, transgene Tiere einen erhöhten Energieverbrauch aufwiesen. Transgenunabhängige Effekte des Geschlechts wurden sowohl für motorische Fähigkeiten, als auch metabolische Parameter der Tiere gemessen. Im Western Blot zeigten männliche, aber nicht weibliche BAC-SNCA Mäuse eine Gendosisabhängige Erhöhung der Level an humanem aSyn, sowie eine Reduktion der Tyrosinhydroxylase im Alter von 2 Monaten. Interessanterweise weist diese Studie auf eine besondere Rolle von phosphoryliertem aSyn im zentralen Nervensystem beider Spezies hin. Unlösliche, pS129aSyn positive Strukturen konnten bereits in zahlreichen Gehirnarealen von 4 Monate alten homozygoten BAC-Ratten detektiert werden und neuropathologische Veränderungen waren zeitlich mit hämatologischen Veränderungen assoziiert. Zusammenfassend zeigt diese Studie das Vorhandensein von verhaltensbezogenen und neuropathologischen Homologen von PD in (jungen) BAC-SNCA Mäusen und Ratten und empfiehlt somit beide Modelle für zukünftige Studien im Hinblick auf ein besseres Verständnis der prodromalen Phase der Erkrankung. Dabei scheint die Phosphorylierung von alphasynuclein eine entscheidende Rolle in beide Spezies zu spielen, was als Grundlage für zukünftigen Fortschritt in der Entwicklung zuverlässiger diagnostischer Biomarker dienen kann

Modernes Kundenrückgewinnungsmanagement. Profitabilität, Produktretouren und Kundengewinnung in einer Omni-Channel Umgebung

Summary This overview represents a summary of three individual studies conducted within a non-contractual setting in the fashion industry. The main connecting research topic across all pa-pers incorporates profitability (including product returns) and the research goal was to shed light on important business areas of modern consumer goods retailers, e.g., the profitability of new vs. regained customers or the profitability of owned vs. paid digital channels. The summary of paper 1 is as follows: Background: Research from contractual settings predominantly finds that regained custom-ers are more profitable than new customers due to recurring payments over longer periods of time. However, in non-contractual consumer goods industries like the fashion industry cus-tomers can leave at any time and return items they do not like. Thus, excluding product re-turns may omit important parts of the realistic picture of a customer’s actual profitability. Research Objective: The main research objective was to find out whether including product returns in the profitability analysis can challenge the well accepted finding of regained cus-tomers being more profitable than new customers. Setting: The dataset comes from a fashion retailer from the medium price segment and mainly targets middle-aged women in a large European country. It uses a 10-year dataset for over 125,000 customers incorporating product returns. Methods/Design: We use a Seemingly Unrelated Regression Tobit Model for revealing the differences in purchase and return values between customer groups. We run a random effects regression to display the differences in return values between online and offline channels and to illustrate a positive learning effect or bad habit effect. Central Results: In non-contractual settings, regained customers tend to be worth less, not more, than new customers. The return value of customers is higher in online channels than in offline channels. In offline channels there are positive learning effects in return value; in online channels we observe bad habit effects of the return value with increasing numbers of orders. Due to the bad habit effect, regained customers purchase higher amounts before re-turns, but lower amounts after returns in their second compared to their first lifecycle. Practical and Theoretical Implications The commonly accepted finding that regained cus-tomers are more profitable than new customers need not generalize to non-contractual set-tings, thus firms may attribute marketing resources on acquiring new customers. Regained customers tend to be more profitable in their second than in their first lifecycles in their pur-chase value before returns, however, the consideration of product returns reverses this effect. Thus, a failure to account for product returns in non-contractual settings may lead to errone-ous results and to the development of a flawed theory. Lastly, there is a substantial discrep-ancy in the return value of customers between online and offline channels, i.e., the presence of a channel effect. Whereas this result by itself is consistent with the theory, this differentia-tion between channels paves the road for a new phenomenon, the “bad habit effect”. The summary of paper 2 is as follows: Background: Modern retailers can choose between many different channels to acquire cus-tomers. Some channels may be better suited to encourage customers to make their first pur-chase, while other channels may be better suited for establishing long-term relationships. To test which channel is appropriate we analyze customer journeys and their purchase outcome. Research Objective: The main research objective was to analyze the effectiveness of pre-dominantly paid (e.g., display ads) and owned (e.g., internal emails) digital channels on the short- and long-term purchasing behaviors of customers. Setting: The dataset comes from the same fashion retailer as in Paper 1. It contains a total of 907,064 digital customer journeys. Methods/Design: We use a Heckman selection model to evaluate the impact of marketing channels on purchase incidence and purchase outcome. It assumes a probit model for the se-lection stage (purchase decision) and a regression model for the outcome stage (order value and purchase value). Central Results: Predominantly paid (cognitive) and owned (affective) digital channels both lead to customers’ first purchases (except for display ads), but only owned (affective) digital channels positively impact long-term purchase value. Predominantly social channels posi-tively impact the long-term purchase value only if they are owned channels. Customer jour-ney durations greater than 1 h lead to a higher long-term purchase value than shorter custom-er journey durations (less than 1 h). Practical and Theoretical Implications: We advise firms to utilize paid (cognitive) digital channels only for a short-term sales push. This push strategy may be effective for the first purchase decision due to the cognitive visibility effect that these channels have on a custom-er’s information search. Contrary, we explain the finding that only predominantly owned digital channels, lead to a higher long-term purchase value by a higher affective degree; that is, customers generate more positive thoughts and attitudes toward the brand and its products when interacting with the brand. Emotionalizing and involving customers in predominantly owned (affective) digital channels foster and build long-term relationships, leading to a “pull” strategy. Social channels are actively, selectively, and intentionally sought and con-tain less biased information due to social settings and the involvement of others. Thus, higher trust in owned social channels leads customers to a higher long-term purchase value. The summary of paper 3 is as follows: Background: Firms strive to invest in active regain management measures that lead to re-gaining valuable customers within the group of lost customers. However, the crucial question is whether these regaining measures will pay off, i.e., will they influence a customer’s sec-ond lifetime net purchase value positively? Firms would greatly benefit from knowing which customers are valuable in their second lifetime and are thus worth targeting and regaining. Research Objective: The main research objective was to find out if active regain manage-ment measures and a customer´s first lifetime characteristics can indicate second lifetime profitability. Setting: The dataset comes from the same fashion retailer as in Paper 1 and 2 and contains a customer’s full purchasing and return data for over 10 years including 125,000 customers. Methods/Design: A Seemingly Unrelated Regression Tobit Model is used for analyzing the effectiveness of active regain management measures and an OLS regression is used to pre-dict first lifetime characteristics on second lifetime profitability including the moderator age. Central Results: In non-contractual settings, active regain management measures do not change the second lifetime profitability of former lost customers. A customer’s first lifetime net purchase value and age of relationship positively in-fluences second lifetime profitabil-ity, while first lifetime number of orders and return value negatively affects second lifetime profitability. Age plays a significant moderating role in increasing the differences in second life-time net purchase value between younger and older customers with rising first lifetime return value, but decreases with first lifetime age of relationship and number of orders. Practical and Theoretical Implications: Financial resources of inefficient win-back offers should be used for investments in new customer acquisition. The implementation of continu-ous tracking and foreseeing relevant first lifetime characteristics adds to the theoretical re-gain management framework and even reveals opportunities to retain customers before they are lost. The sole focus on youth, reinforce the relevance of elder customers, and call for a deeper understanding of purchasing behavior across age groups. Conclusion The analysis of the profitability of customers and channels already represents a fundamental research topic across the customer literature; however, the presented results extend the scope of profitability analysis and highlights the uniqueness of non-contractual settings in a billion-dollar market like the fashion industry. For instance, we build on current theory by introduc-ing the “bad habit effect,” into marketing literature. For practitioners the presented results not only can directly impact a firm’s financial situation, but they may also help in the devel-opment of future business areas or strategies

Elterliche Medienerziehung in einer tiefgreifend mediatisierten Gesellschaft. Qualitative und quantitative Befunde zu Aushandlungsprozessen in der kommunikativen Figuration Familie.

Vor dem Hintergrund einer tiefgreifend mediatisierten Lebenswelt und dem damit verbundenen Wandel von Medienumgebungen, familialen Medienensembles und kindlichen Medienrepertoires widmet sich die vorliegende kumulative Dissertation der Fragestellung, wie sich elterliche Medienerziehung gestaltet. Hierbei wird das Ziel verfolgt, medienbezogene Erziehungsprozesse sowohl theoretisch, methodologisch als auch empirisch zu erfassen. Die Thematik wurde anhand von vier Artikeln bearbeitet. Ein Beitrag verdeutlicht unter Aufarbeitung des aktuellen Forschungsstandes und eigener empirischer Ergebnisse aus theoretischer und methodologischer Perspektive, wie der Ansatz der kommunikativen Figurationen eine umfassende Betrachtung elterlicher Medienerziehung, nicht nur als relationale, sondern auch als situative und über die Zeit hinweg dynamische Aushandlungsprozesse zwischen allen beteiligten Akteur*innen, ermöglicht. Dabei werden insbesondere Machtdynamiken und die Bindung zwischen Eltern und Kindern bzw. Jugendlichen, aber auch weiteren wichtigen Personen und sozialen Domänen berücksichtigt. In drei Artikeln wurden darüber hinaus empirische Erkenntnisse zu elterlicher Medienerziehung anhand von qualitativen und quantitativen Daten zweier Panelstudien eigenständig hervorgebracht. Die längsschnittlichen Daten lieferten dabei jeweils die Perspektiven der Erziehenden als auch der Zu-Erziehenden, die über mehrere Zeitpunkte hinweg erhoben und analysiert wurden. Unterschiedliche Kohorten mit gerade eingeschulten Kindern (ab sechs Jahren) bis hin zu Jugendlichen in der späten Adoleszenz (bis 17 Jahre) ermöglichen einen Einblick über eine große Zeitspanne des Aufwachsens. Zwei qualitative Ergebnisse darstellende Artikel geben einerseits Aufschluss darüber, wie elterliche Medienerziehung in den familialen Mediensozialisationsprozess eingebunden ist und welchen Stellenwert sie dort einnimmt. Andererseits verdeutlicht der zweite Beitrag, inwiefern Medienerziehung als dynamische Machtbalance zwischen Eltern, deren Kindern und weiteren familienexternen Akteur*innen verstanden werden kann. Ein Artikel, der quantitative Ergebnisse vorstellt, berücksichtigt dagegen, inwiefern sich Eltern in ihrer Medienerziehung konstant verhalten, ebenso wie Unterschiede in den Sichtweisen von Erziehenden und Zu-Erziehenden. Die Dissertation beleuchtet demnach nicht nur den aktuellen Stand der Forschung zu elterlicher Medienerziehung, sondern bringt eigene theoretische, methodologische und empirische Ergebnisse hervor.Against the backdrop of a deeply mediatized lifeworld and the associated changes in media environments, familial media ensembles, and children's media repertoires, this cumulative dissertation addresses the question of how parental media education is shaped. The aim here is to capture media-related educational processes theoretically, methodologically, and empirically. The topic was dealt with by means of four articles. One article, by reviewing the current state of research and own empirical results from a theoretical and methodological perspective, illustrates how the approach of communicative figurations enables a comprehensive view of parental media education, not only as relational, but also as situational and over time dynamic negotiation processes between all actors involved. In particular, power dynamics and the bond between parents and children or adolescents, but also other important persons and social domains are considered. In addition, three articles provided own empirical findings on parental media education based on qualitative and quantitative data from two panel studies. The longitudinal data provided the perspectives of both the educators and the educated, which were collected and analyzed over several points in time. Different cohorts of children just starting school (from age six) to later adolescents (up to age 17) provide insight into a large time span of growing up. Two articles presenting qualitative results, on the one hand, provide information about how parental media education is integrated into the familial media socialization process and what significance it has there. On the other hand, the second article illustrates how media education can be understood as a dynamic balance of power between parents, their children and other actors outside the family. An article presenting quantitative results, on the other hand, considers the extent to which parents behave in a constant manner in their media education, as well as differences in the views of educators and educated. Accordingly, the dissertation not only highlights the current state of research on parental media education, but also produces its own theoretical, methodological, and empirical results