Sozialberichterstattung durch Medieninhalte: ein Forschungsprojekt des Instituts für Soziologie der Universität Hamburg

In dem Beitrag werden theoretische und methodologische Vorüberlegungen zu dem Projekt Sozialberichterstattung durch Medieninhalte vorgelegt. Ziel der Sozialberichterstattung (SBE) ist die Messung der Lebensqualität. Die zur Lebensqualität-Messung gebräuchlichen Operationalisierungsansätze werden erweitert: gerade weil es bei der SBE um eine Verbesserung des gesamtgesellschaftlichen Informationssystems geht, wird das Massenkommunikationssystem mit in das Operationalisierungsverfahren einbezogen. Außerdem wird zu den bei der Konstruktion sozialer Indikatoren üblichen vier Analyseebenen eine fünfte eingeführt: aufmerksamkeitsorientierende Wissenskomplexe. Im Mittelpunkt des Interesses steht die Struktur dieser Wissenskomplexe, die von massenmedialen Organisationen vor dem Hintergrund ihrer genuinen Standards produziert werden. Es werden Leit-Dimensionen entwickelt, die im Zusammenspiel mit durchzuführenden Primärerhebungen die Grundlage bilden für Arbeiten zur Entwicklung von Textindikatoren. Abschließend wird der Untersuchungsplan für das Projekt vorgestellt, der sieben Schritte umfaßt: Rahmen, Struktur, Einzelkategorien, "Mapping", Konsistenz, Externkontrolle, Treffsicherheit. (RW

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Measuring the melt flow on the laser cut front

AbstractThe flow characteristics on the laser cut front for 10mm stainless steel AISI 304 (EN 1.4301) are studied in this paper using High Speed Imaging (HSI). The laser cut samples were produced with a 6kW fiber laser with nitrogen gas assist. Previous work in this field has used unusual cutting parameters to make the experimentation easier. This work presents, for the first time, HSI results from standard commercially viable cutting parameters. This was made possible by the development of a new experimental technique. The results presented here suggest that the cut front produced when cutting stainless steel with a fiber laser and a nitrogen assist gas is covered in bumps which themselves are covered in a thin layer of liquid. Under the conditions shown here the bumps move down the cut front at an average speed of approximately 0.4m/s. The liquid flows at an average speed of approximately 1.1m/s. The average melt depth at the bottom of the cut zone under these conditions is approximately 0.17mm