Comparison of 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine-enhanced MRI in 471 patients with known or suspected renal lesions: Results of a multicenter, single-blind, interindividual, randomized clinical phase III trial

The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers ('average reader') was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI

Implementierung von Smart Mobility in ländlichen Räumen : Innovative Lösungen und potenzielle Regionalwirkungen für den Kreis Heinsberg

Driven by the proliferating digitization of services, an increasing number of new mobility services evolved recently, bearing chances to improve living and working conditions especially in rural areas. Even though such “Smart mobility” (SMo) solutions are mainly introduced in urban areas so far, they also offer promising opportunities for organizing sustainable transport solutions in less densely populated areas, given the innovation adaption is tailor-made to rural needs. Up to now, diffusion research has particularly focused on the investigation of urban innovation phenomena, research on innovation implementation in rural areas is much rarer (Doloreux et al. 2007; Eder 2019). The same applies to research scope of transport geography that is mainly focussing on urban contexts. Rural areas are characterised by various disadvantages due to their slightly pronounced regional innovation systems (RIS) (Cooke 1992; Koschatzky 2001) and hence particularly dependent on alternative strategies for implementing SMo. The successful innovation implementation depends on their ”regional absorptive capacities” (RACAP, Cohen/Levinthal 1990; Niosi/Bellon 2002) and the constitution of the political actors at the meso-level as well as the individual preferences of the users at the micro-level. Due to their adoption or rejection decision, users have a pivotal influence on the innovations’ success (Rogers 2003; Antonelli 2006). However, previous studies only obtained independent analysis on one of these two levels, an integrated and joint consideration is still pending.With regards to the multi-level concept by Dopfer et al. (2004) this thesis hence investigates the requirements for implementing SMo in rural areas analysing both, the implications from the meso-level as well as the user preferences at the micro-level likewise. Following Creswell’s (2003) “mixed methods” approach, qualitative as well as quantitative methods are jointly applied. The focus of the different methodological steps lies on the qualitative expert interviews (n=30) for a multidimensional assessment of promoting and inhibiting factors of innovation implementation. In addition a standard user survey (n=294) in the case study region of Heinsberg (HS), Germany, investigates the user preference and attitudes towards the potential adoption of SMo, supplemented by an analysis of mobile network data (MND) and insights from a project study at RWTH Aachen University. Furthermore potential regional effects of SMo as a location factor will be investigated, that may evolve by implementing SMo in rural areas (Liefner/Schätzl 2017; Hahne/von Stackelberg 1994). The results show that user targeted communication and marketing concepts, regional cooperations in terms of regional PPP, collaboration with local key actors and the introduction of test opportunities promote the implementation of SMo the most in rural areas. Even though the outstanding car dependency promises a clear scaling potential for SMo in rural areas, it holds significant implementation barriers and hinders the adoption of SMo at the same time. According to the findings of this study, tight municipal budgets, risks of cannibalisation effects by external providers and a lack of pressure to act, are generally averting the transformation of the rural transport system. According to this thesis, autonomous shuttles, digitally connected on-demand Minibuses, cooperative car-sharing models (neighbourhood-based) and mobility stations have proven promising potential for the implementation in rural areas. Both their context-specific adaptation according to rural RACAP as well as their integration into a digital, community-operated mobility platform to increase visibility and user communication are thus essential prerequisites for a successful implementation. This also applies to the county of HS, where users have so far refrained from using SMo due to a lack of sufficient information, extensive car-using habits and high prices for SMo offers. Free test options, short booking times via online tools (i.e. platform), and local, neighbourhood-based services would, however, encourage users to abandon the car in favour of SMo-services. In case of the county of HS, hence the introduction of a joint (multi-use) mobility platform in line with a digital integration of the existing on-demand bus "MultiBus" is just as recommendable as offering a combined solution consisting of an e-bike subscription model and a public transport ticket. This can not only improve accessibility on the last mile, but also generate synergy effects with the underfunded public transportation system.With respect to their impact on the innovation-based regional development, SMo-services additionally create mostly qualitative effects for the regional (economic) development of rural areas: even if their introduction cannot generate direct economic effects due to the small rural domestic market, indirect effects can possibly occur due to subsidies for governmental projects (i.e. testing areas) and improved accessibility of business locations for workers. However noteworthy labour market effects are not expectable, even though the demands for IT-based professionals and improvements of the digital user skills require further education and training. SMo can, however, achieve clear improvements in the quality of life and lift the service level for the general public, it can however not compensate the slowdown of the migration effects due to the prevailing pull factors of the cities (i.e. job opportunities, institutional thickness, culture and social life).This work also develops a new definition of "smart": it does not always have to be something radically "new", but foremost digitalize existing services (1), enhance efficiency and ensure the systems’ connectivity (2), offer context-specific adaption of the product (3) and ensure demand oriented user integration (4). This work also reveals that social innovations in the mobility sector have hardly been implemented in rural areas so far, although the constitution of social capital offers a promising setting. Finally this work discloses strategic and operational deficits in the communication and coordination of mobility in rural areas between the political meso-level and the users at the micro-level. On the basis of the specific rural RACAP it hence develops a "Smart Mobility Strategy", which comprises both operative components of smart services as well as important strategic tasks for a successful mobility management in rural areas (i.e. communication campaigns, guideline development, user integration, network formation, activation of endogenous potentials and the coordination of regional co-innovation activities)