The performance of medical record review as an instrument for measuring and improving patient safety

The general aim of this thesis was to evaluate the performance of medical record review (MRR) as an instrument to measure and improve patient safety in clinical care. This method consisted of the Harvard Medical Practice Study (HMPS) trigger tool, although slightly adapted and only applied to patients who died during their stay in our hospital. We calculated the predictive value of the triggers and their reproducibility. Furthermore, we assessed the inter- and intrarater reproducibility for the decision on the presence of an adverse event (AE), the potential preventability and the contribution to death of a patient. After that, we assessed the external reproducibility of MRR regarding this second stage. Additionally, we investigated if an automatic trigger tool could be helpful in the selection of cases with a (potentially preventable) AE. Finally, we evaluated the potential improvement of the trigger system by adding lab values. This thesis investigated the current MRR process in our centre and possibilities for improvement. It would also be of interest to expand the research and evaluate if and how this process affects the improvement of care. In short, medical record review can be used to evaluate the trend of AEs in a hospital. Due to its low reproducibility it is less useful for the evaluation of individual cases. To improve the reproducibility of preventability, it is advisable to define a uniform definition for preventability. Also, an evaluation of the costs versus the effect is necessary

Natural enemy diversity reduces temporal variability in wasp but not bee parasitism

Biodiversity may enhance and stabilise ecosystem functioning, but little evidence exists for diversity–function relationships involving multitrophic interactions in real landscapes. In multitrophic communities diversity may vary at different trophic levels, with either synergistic or antagonistic effects on ecosystem functioning. Intensification of land-use systems is often found to reduce diversity, which in turn may lead to reduced associated ecological functions in natural food webs, such as host-parasite interactions. In this study we investigated the relationship between the number of natural enemy and host species and the mean rate and temporal variability of parasitism (inverse of stability), along an intensification gradient of coffee agroforests in Ecuador. We used standardised trap nests for bees and wasps and their natural enemies in 14 agroforests, and evaluated these monthly over a period of 17 months. We found that parasitism rates of wasps and bees increased with increasing number of enemy species and decreased with increasing number of host species. Temporal variability in parasitism rates decreased with increasing number of enemy species and increased with temporal variability in enemy species richness; however, these effects were restricted to wasp hosts. Intensification of agroforests did not significantly affect species richness of hosts or enemies or their relation to parasitism and its temporal variability. We conclude that high enemy diversity may enhance parasitism rates and that high host diversity may provide resistance against consumption. Furthermore, we show that a diverse and stable enemy community may also have a stabilizing effect on parasitism rates. However, these effects may be host-guild specific, as these relations were restricted to wasps

A late requirement for Wnt and FGF signaling during activin-induced formation of foregut endoderm from mouse embryonic stem cells

AbstractHere we examine how BMP, Wnt, and FGF signaling modulate activin-induced mesendodermal differentiation of mouse ES cells grown under defined conditions in adherent monoculture. We monitor ES cells containing reporter genes for markers of primitive streak (PS) and its progeny and extend previous findings on the ability of increasing concentrations of activin to progressively induce more ES cell progeny to anterior PS and endodermal fates. We find that the number of Sox17- and Gsc-expressing cells increases with increasing activin concentration while the highest number of T-expressing cells is found at the lowest activin concentration. The expression of Gsc and other anterior markers induced by activin is prevented by treatment with BMP4, which induces T expression and subsequent mesodermal development. We show that canonical Wnt signaling is required only during late stages of activin-induced development of Sox17-expressing endodermal cells. Furthermore, Dkk1 treatment is less effective in reducing development of Sox17+ endodermal cells in adherent culture than in aggregate culture and appears to inhibit nodal-mediated induction of Sox17+ cells more effectively than activin-mediated induction. Notably, activin induction of Gsc-GFP+ cells appears refractory to inhibition of canonical Wnt signaling but shows a dependence on early as well as late FGF signaling. Additionally, we find a late dependence on FGF signaling during induction of Sox17+ cells by activin while BMP4-induced T expression requires FGF signaling in adherent but not aggregate culture. Lastly, we demonstrate that activin-induced definitive endoderm derived from mouse ES cells can incorporate into the developing foregut endoderm in vivo and adopt a mostly anterior foregut character after further culture in vitro

Materialist and Post-Materialist Concerns and the Wish for a Strong Leader in 27 Countries

There is evidence that democracies are under threat around the world while the quest for strong leaders is increasing. Although the causes of these developments are complex and multifaceted, here we focus on one factor: the extent to which citizens express materialist and post-materialist concerns. We explore whether objective higher levels of democracy are differentially associated with materialist and post-materialist concerns and, in turn, whether this is related to the wish for a strong leader. Testing this hypothesis across 27 countries (N = 5,741) demonstrated a direct negative effect of democracies' development on the wish for a strong leader. Further, multi-level mediation analysis showed that the relation between the Democracy Index and the wish for a strong leader was mediated by materialist concerns. This pattern of results suggests that lower levels of democracy are associated with enhanced concerns about basic needs and this is linked to greater support for strong leaders.Peer reviewe

Materialist and Post-Materialist Concerns and the Wish for a Strong Leader in 27 Countries

There is evidence that democracies are under threat around the world while the quest for strong leaders is increasing. Although the causes of these developments are complex and multifaceted, here we focus on one factor: the extent to which citizens express materialist and post-materialist concerns. We explore whether objective higher levels of democracy are differentially associated with materialist and post-materialist concerns and, in turn, whether this is related to the wish for a strong leader. Testing this hypothesis across 27 countries (N = 5,741) demonstrated a direct negative effect of democracies' development on the wish for a strong leader. Further, multi-level mediation analysis showed that the relation between the Democracy Index and the wish for a strong leader was mediated by materialist concerns. This pattern of results suggests that lower levels of democracy are associated with enhanced concerns about basic needs and this is linked to greater support for strong leaders.Peer reviewe

Revisiting the Measurement of Anomie

Peer reviewe

Cultural Values Moderate the Impact of Relative Deprivation

Relative deprivation (RD) is the judgment that one or one’s ingroup is worse off compared with some relevant standard coupled with feelings of dissatisfaction, anger, and resentment. RD predicts a wide range of outcomes, but it is unclear whether this relationship is moderated by national cultural differences. Therefore, in the first study, we used national assessments of individual-collectivism and power distance to code 303 effect sizes from 31 different countries with 200,578 participants. RD predicted outcomes ranging from life satisfaction to collective action more strongly within individualistic nations. A second survey of 6,112 undergraduate university students from 28 different countries confirmed the predictive value of RD. Again, the relationship between individual RD and different outcomes was stronger for students who lived in more individualistic countries. Group-based RD also predicted political trust more strongly for students who lived in countries marked by lower power distance. RD effects, although consistent predictors, are culturally bounded. In particular, RD is more likely to motivate reactions within individualistic countries that emphasize individual agency and achievement as a source of self-worth

Identification of the Aldo-Keto Reductase Responsible for d-Galacturonic Acid Conversion to l-Galactonate in Saccharomyces cerevisiae

d-galacturonic acid (d-GalUA) is the main constituent of pectin, a complex polysaccharide abundant in several agro-industrial by-products such as sugar beet pulp or citrus peel. During several attempts to valorise d-GalUA by engineering the popular cell factory Saccharomyces cerevisiae, it became obvious that d-GalUA is, to a certain degree, converted to l-galactonate (l-GalA) by an endogenous enzymatic activity. The goal of the current work was to clarify the identity of the responsible enzyme(s). A protein homology search identified three NADPH-dependent unspecific aldo-keto reductases in baker’s yeast (encoded by GCY1, YPR1 and GRE3) that show sequence similarities to known d-GalUA reductases from filamentous fungi. Characterization of the respective deletion mutants and an in vitro enzyme assay with a Gcy1 overproducing strain verified that Gcy1 is mainly responsible for the detectable reduction of d-GalUA to l-GalA