Perioperatives Stressmanagement: Rolle des vegetativen Nervensystems beim postoperativen Delir

Aufgrund der deutlich ungünstigeren Prognose, die Patient:innen nach dem Erleiden eines Delirs haben, gewinnen Prävention und Therapie des Delirs in der klinischen Versorgung erhebliche Bedeutung. Patient:innen mit erhöhter Vulnerabilität können auf verschiedene Auslöser hin ein klinisches Bild eines Delirs entwickeln. Bei der Ätiologie des Delirs spielen sowohl das cholinerge als auch das adrenerge System sowie eine resultierende Neuroinflammation eine herausragende Rolle. Die vielfältigen Mechanismen, die zu einem Delir führen können, umfassen ein cholinerges Delir mit Acetylcholinmangel sowie ein adrenerges Delir, das durch Stress und Aktivierung des sympathischen Nervensystems verursacht wird. In der vorliegenden Habilitationsschrift wurden verschiedene Aspekte des postoperativen Delirs untersucht. Die CESARO-Studie beschrieb den perioperativen Verlauf der Cholinesteraseaktivitäten. Die Studie zur postoperativen Anämie zeigte, dass postoperative Anämie mit einem höheren Delirrisiko und längeren Krankenhausaufenthalten verbunden sein könnte. Die Untersuchung an Krebspatient:innen deutete darauf hin, dass die Belastung durch langfristige Medikamenteneinnahme von Wirkstoffen mit anticholinergen Eigenschaften ein unabhängiger Risikofaktor für postoperatives Delir sein könnte. Die Auswirkungen von Dexmedetomidin deuteten darauf hin, dass dadurch das Risiko für postoperatives Delir reduziert wird. Die sekundäre Analyse zur cholinergen Dysregulation durch Dexmedetomidin zeigte keine signifikanten Veränderungen der cholinergen Enzyme, legte jedoch nahe, dass Dexmedetomidin möglicherweise die cholinerge Dysregulation bei größeren chirurgischen Eingriffen blockiert. Es besteht die Notwendigkeit weiterer differenzierter Forschung, um die Mechanismen und Faktoren des postoperativen Delirs besser zu verstehen. Die Identifikation von Regulationsmechanismen könnte zu gezielten therapeutischen Ansätzen führen, um das Management des Delirs zu verbessern. Dazu sollten klinische Studien die Rolle des vegetativen Nervensystems im perioperativen Stressmanagement weiter untersuchen, um die Prävention und Behandlung des Delirs zu optimieren

Using New Camera-Based Technologies for Gait Analysis in Older Adults in Comparison to the Established GAITRite System

Various gait parameters can be used to assess the risk of falling in older adults. However, the state-of-the-art systems used to quantify gait parameters often come with high costs as well as training and space requirements. Gait analysis systems, which use mobile and commercially available cameras, can be an easily available, marker-free alternative. In a study with 44 participants (age ≥ 65 years), gait patterns were analyzed with three different systems: a pressure sensitive walkway system (GAITRite-System, GS) as gold standard, Motognosis Labs Software using a Microsoft Kinect Sensor (MKS), and a smartphone camera-based application (SCA). Intertrial repeatability showed moderate to excellent results for MKS (ICC(1,1) 0.574 to 0.962) for almost all measured gait parameters and moderate reliability in SCA measures for gait speed (ICC(1,1) 0.526 to 0.535). All gait parameters of MKS showed a high level of agreement with GS (ICC(2,k) 0.811 to 0.981). Gait parameters extracted with SCA showed poor reliability. The tested gait analysis systems based on different camera systems are currently only partially able to capture valid gait parameters. If the underlying algorithms are adapted and camera technology is advancing, it is conceivable that these comparatively simple methods could be used for gait analysis

Finanzregulierung und internationale Wettbewerbsfähigkeit: Der Fall Deutsche Bundesliga

“Financial Regulation and International Competitiveness: The Case of the German Bundesliga“: The paper discusses the intensively discussed problem of financial crisis, overburdening debts and insolvencies in professional European football. The academic literature identifies several special characteristics of professional football leagues that allegedly lead to a systematic over-investment as well as features of a rat race. As a consequence, there are systemic market failures that warrant a regulative intervention by the competent national and European football associations. However, from an economics perspective, most of these alleged market failures turn out to be normal features of business competition. A closer inspection merely leaves two problems to be solved: (i) the widespread rescue of insolvent clubs (that are “too prominent too fail”) causing moral hazard issues and (ii) negative externalities on the league competition when an insolvent club would leave the market in the middle of the season. Even though these remaining issues may be viewed to justify regulations on the financial behavior of clubs by the league organizations, a note of caution needs to be issued: intervention may lead to over-regulation that distorts competition and, in particular, serves to cement the status quo competitiveness relations (i.e. preventing the incumbent top clubs from new emerging competitors). Furthermore, existing anticompetitive arrangements in football leagues contribute to the alleged market failure problems, so that more competition and not less competition may be the appropriate answer. A review of the pioneer financial regulations of the German Bundesliga allows for the conclusion that most of the German rules do not yet cross the line to over-regulation. However, the 50+1-rule, restricting newcomers from taking ownership of clubs (while protecting existing investments of the same type) clearly restricts competition and protects anticompetitive rents of incumbents. In the face of the upcoming UEFA-wide financial regulations, a first-mover effect may help German clubs to increase their international competitiveness

Finanzregulierung und internationale Wettbewerbsfähigkeit: der Fall Deutsche Bundesliga

“Financial Regulation and International Competitiveness: The Case of the German Bundesliga“: The paper discusses the intensively discussed problem of financial crisis, overburdening debts and insolvencies in professional European football. The academic literature identifies several special characteristics of professional football leagues that allegedly lead to a systematic over-investment as well as features of a rat race. As a consequence, there are systemic market failures that warrant a regulative intervention by the competent national and European football associations. However, from an economics perspective, most of these alleged market failures turn out to be normal features of business competition. A closer inspection merely leaves two problems to be solved: (i) the widespread rescue of insolvent clubs (that are “too prominent too fail”) causing moral hazard issues and (ii) negative externalities on the league competition when an insolvent club would leave the market in the middle of the season. Even though these remaining issues may be viewed to justify regulations on the financial behavior of clubs by the league organizations, a note of caution needs to be issued: intervention may lead to over-regulation that distorts competition and, in particular, serves to cement the status quo competitiveness relations (i.e. preventing the incumbent top clubs from new emerging competitors). Furthermore, existing anticompetitive arrangements in football leagues contribute to the alleged market failure problems, so that more competition and not less competition may be the appropriate answer. A review of the pioneer financial regulations of the German Bundesliga allows for the conclusion that most of the German rules do not yet cross the line to over-regulation. However, the 50+1-rule, restricting newcomers from taking ownership of clubs (while protecting existing investments of the same type) clearly restricts competition and protects anticompetitive rents of incumbents. In the face of the upcoming UEFA-wide financial regulations, a first-mover effect may help German clubs to increase their international competitiveness

Market power and media revenue allocation in professonal sports: the case of formula one

Recent allegations from participants of the FIA Formula One World Championship (F1) suggest that the promoter of F1 (possibly together with the sports association) violates European competition law in two ways. First, it allegedly abuses its market power by deducting an inappropriate high share from the revenues of the collective sale of media rights in order to boost the profits of its private equity parent company (vertical allocation of media revenue). Second, it allegedly forms a cartel with selected top teams at the detriment of smaller teams by providing both unjustified extra payments to these teams and enforcing a heavily biased horizontal allocation of media revenues, benefitting the cartel teams. Professional sports championships typically receive common revenue, for instance, from trademark rights and marketing, but often also from the sale of broadcasting and other media rights. This common revenue needs to be allocated in two ways: (i) vertical allocation between the sports authority and the participants, and (ii) horizontal allocation among the participants. Different professional sports championships employ vastly differing schemes for both types of allocation. In this paper, we present an empirical assessment whether the current antitrust allegations against F1 may be valid. We employ concentration measures from empirical economics, like the Hirshman-Herfindahl-Index (HHI), the concentration ratio and the standard deviation in order to assess different allocation schemes from different commercial sports. With the help of these indices we show that the allocation scheme employed in F1 considerably differs from such used in other professional sports championships. We find the empirical picture to be consistent with an anticompetitive interpretation of F1 media revenue structures and policies. We conclude that there is merit in starting an in-depth antitrust investigation of Formula One motor racing, which would also represent an opportunity for the European Commission to correct earlier mistakes

Digital pen technology for conducting cognitive assessments: a cross-over study with older adults

Many digitalized cognitive assessments exist to increase reliability, standardization, and objectivity. Particularly in older adults, the performance of digitized cognitive assessments can lead to poorer test results if they are unfamiliar with the computer, mouse, keyboard, or touch screen. In a cross-over design study, 40 older adults (age M = 74.4 ± 4.1 years) conducted the Trail Making Test A and B with a digital pen (digital pen tests, DPT) and a regular pencil (pencil tests, PT) to identify differences in performance. Furthermore, the tests conducted with a digital pen were analyzed manually (manual results, MR) and electronically (electronic results, ER) by an automized system algorithm to determine the possibilities of digital pen evaluation. ICC(2,k) showed a good level of agreement for TMT A (ICC(2,k) = 0.668) and TMT B (ICC(2,k) = 0.734) between PT and DPT. When comparing MR and ER, ICC(2,k) showed an excellent level of agreement in TMT A (ICC(2,k) = 0.999) and TMT B (ICC(2,k) = 0.994). The frequency of pen lifting correlates significantly with the execution time in TMT A (r = 0.372, p = 0.030) and TMT B (r = 0.567, p < 0.001). A digital pen can be used to perform the Trail Making Test, as it has been shown that there is no difference in the results due to the type of pen used. With a digital pen, the advantages of digitized testing can be used without having to accept the disadvantages

App-Based Evaluation of Older People’s Fall Risk Using the mHealth App Lindera Mobility Analysis: Exploratory Study

Background: Falls and the risk of falling in older people pose a high risk for losing independence. As the risk of falling progresses over time, it is often not adequately diagnosed due to the long intervals between contacts with health care professionals. This leads to the risk of falling being not properly detected until the first fall. App-based software able to screen fall risks of older adults and to monitor the progress and presence of fall risk factors could detect a developing fall risk at an early stage prior to the first fall. As smartphones become more common in the elderly population, this approach is easily available and feasible. Objective: The aim of the study is to evaluate the app Lindera Mobility Analysis (LIN). The reference standards determined the risk of falling and validated functional assessments of mobility. Methods: The LIN app was utilized in home- and community-dwelling older adults aged 65 years or more. The Berg Balance Scale (BBS), the Tinetti Test (TIN), and the Timed Up & Go Test (TUG) were used as reference standards. In addition to descriptive statistics, data correlation and the comparison of the mean difference of analog measures (reference standards) and digital measures were tested. Spearman rank correlation analysis was performed and Bland-Altman (B-A) plots drawn. Results: Data of 42 participants could be obtained (n=25, 59.5%, women). There was a significant correlation between the LIN app and the BBS (r=-0.587, P<.001), TUG (r=0.474, P=.002), and TIN (r=-0.464, P=.002). B-A plots showed only few data points outside the predefined limits of agreement (LOA) when combining functional tests and results of LIN. Conclusions: The digital app LIN has the potential to detect the risk of falling in older people. Further steps in establishing the validity of the LIN app should include its clinical applicability

Barrieren und Chancen für Innovationen im Schienengüterverkehr

Der Vortrag zeigt die großen Linien der Barrieren für Innovationen im Schienengüterverkehr und die Chancen für Innovationen mit dem Ziel eines Nachhaltigen Güterverkehrs. Auf innovationstheoretischer Ebene sind die wesentlichen Barrieren 1) die path dependency, 2) das Inventor's Dilemma und 3) ein massives Technolgoisches Patt im Schienengüterverkehr. Als Chancen für Innovationen sind der Druck aus den Rahmenbedingungen und aus Nischenaktivitäten auf das bisherige Güterverkehrssystem (Multi-Level Perspetive) als auch das weitere Wachstum der Logistikbranche (Innovationen zur Überwindungen des Technologischen Patts) zu nennen

Codebook and documentation of the panel study 'Labour Market and Social Security' (PASS) : Volume I: Introduction and overview. Wave 2 (2007/2008)

"The panel study 'Labour Market and Social Security' (PASS), established by the Institute for Employment Research (IAB), is a new dataset for labour market, welfare state and poverty research in Germany, creating a new empirical basis for the scientific community and for policy advice. This Datenreport provides an overview of the second survey wave, for which 12,487 individuals were interviewed in 8,429 households between December 2007 and July 2008. 10,114 individuals and 7,342 households were interviewed for the second time in the context of PASS. The spectrum of questions and the design of PASS are intended to close gaps in the existing stock of data. PASS has three main characteristics that extend analysis potential beyond that of the Federal Employment Agency's administrative data: 1. The panel takes the household context into account - including the situation before and after receipt of Unemployment Benefit II. 2. The panel is complete in that it covers all groups of persons and all employment biographies, not only people in dependent employment, unemployed people and those in need of assistance. The dataset also provides information on the status during phases of economic inactivity, self-employment or employment as civil servants. 3. The panel collects additional or significantly more detailed data on relevant characteristics such as attitudes, employment potential or job-search behaviour." (Author's abstract, IAB-Doku) ((en)) Additional Information Questionnaires of the second wave. Here you can find the German version. Further information about the panel study "Labour Market and Social Security".IAB-Haushaltspanel, Datengewinnung, Erhebungsmethode, Stichprobe, Panel - Methode, Datenaufbereitung