Health effects of heating, ventilation and air conditioning on hospital patients: a scoping review

Background: In the face of climate change, the protection of vulnerable patients from extreme climatic conditions is of growing interest to the healthcare sector and governments. Inpatients are especially susceptible to heat due to acute illness and/or chronic diseases. Their condition can be aggravated by adverse environmental factors. Installing air conditioning can be seen as an element of public health adaptation because it was shown to improve mortality rates of hospital patients experiencing hot temperatures. Still, the mediating factors and resulting health effects are largely unknown. Method: The PRISMA-ScR guideline was followed for this scoping review. Available evidence on the health effects of Heating, Ventilation, Air Conditioning (HVAC) and fans was searched in Medline, Embase and the Cochrane Library. The focus of the search strategy was on inpatients of the hospital. Grey literature was screened on 14 relevant websites. English and German publications were eligible without restrictions on publication date. Results were charted according to the categories population, intervention, control and outcome together with a qualitative description. Results: The review process yielded eleven publications of which seven were issued after 2003. Seven were clinical trials, three cross-sectional studies and one was a case report. The publications described the installation of HVAC on general wards and in intensive care units. Main topics were heat stress protection and support of thermoregulation, but also the rewarming of hypothermic patients. HVAC use resulted in a recovery effect shown by improved vital signs, reduced cardiac stress, accelerated recuperation and greater physical activity. This protective effect was demonstrated by a shorter hospital stay for patients with respiratory disease and a reduction of mortality for heat illness patients. Conclusion: This scoping review summarises the fragmented evidence on health effects of HVAC and fan utilisation for inpatients. Installing HVAC has the potential to improve patients' outcomes and to make hospital treatment more efficient during heat waves. The application of HVAC could be a promising adaptation measure to mitigate the adverse effects of climate change on health and healthcare systems

Strategic Alliances - a differentiated view

The common literature about strategic alliances offers a very fragmented picture. This thesis gives a theoretical overview on strategic alliances and builds the basis for the following examination of the different dimensions most strategic alliances have. The examination of the different dimensions is the crucial point of this thesis. Here the reader gets a detailed insight into the different dimensions and the implications they have on the design of a particular strategic alliance. This examination leads in the end to a more differentiated view on strategic alliances and the insight that no simple models exist, which give a sufficient basis for decision-making and understanding strategic alliances, today. The thesis concludes with an outlook into the future and some prognoses what topics have to be examined more carefully

Demand and Welfare in Health Economics

In this dissertation I present three projects related to the topic demand and welfare in health economics by leveraging changes in technology, institutions and policies through quasi-experimental and experimental approaches. In the first essay "Television, Health, and Happiness", which is joint work with Adrian Chadi, we study the consequences of television consumption. Watching television is the most time-consuming human activity besides work but its role for individual well-being is unclear. Negative consequences portrayed in the literature raise the question whether this popular activity constitutes an economic good or whether it is an economic bad and hence serves as a prime example of irrational behavior reducing individual health and happiness. We are the first to comprehensively address this question by exploiting a large-scale natural experiment in West Germany, where households in a few geographically restricted areas received commercial television via terrestrial frequencies. Rich panel data allow us to determine how signal availability over time changes individual time-use and well-being. Contrary to previous research, we find no health impact when television consumption increases. For life satisfaction, we even find positive effects. Additional data support the notion that television is not an economic bad and that non-experimental evidence seems to be driven by negative selection. The second essay "Vaccines at Work", which is joint work with Roberto Mosquera and Adrian Chadi, is investigating the causes and consequences of vaccination. Influenza vaccination could be a cost-effective way to reduce costs in terms of human lives and productivity losses, but low take-up rates and vaccination unintentionally causing moral hazard may decrease its benefits. We ran a natural field experiment in cooperation with a bank in Ecuador, where we experimentally manipulated incentives to participate in a health intervention, which allows us to determine the personal consequences of being randomly encouraged to get vaccinated using administrative firm data. In a first stage, we find strong evidence that opportunity costs and peers matter to increase vaccination demand. In the second stage, contrary to the company’s expectation, vaccination did not reduce sickness absence during the flu season. Getting vaccinated was ineffective with no measurable health externalities from coworker vaccination. We rule out meaningful individual health effects when considering several thresholds of expected vaccine effectiveness. Using a dataset of administrative records on medical diagnoses and employee surveys, we find evidence consistent with vaccination causing moral hazard, which could decrease the effectiveness of vaccination. The third essay studies "The Unintended Consequences of Health Insurance" in a universal health care system. Universal healthcare is associated with desirable health and equity outcomes and often allows individuals to purchase supplementary private health insurance. While the purchase of private health insurance is clearly beneficial in the absence of public insurance, it is more difficult to evaluate individual costs and benefits when baseline coverage exists for everyone. The perceived benefits of insurance and the increase in health costs due to premium payments can lead to hidden costs and unintended consequences of supplementary health insurance. To study those costs, I use a regression kink design in conjunction with a policy implemented in Australia in 2000 to overcome selection. The policy punishes agents for delaying the purchase of private health until later in life. Following the policy-guided instrumentation of insurance purchase, it appears that private health insurance does not cause moral hazard. There is a zero effect on medical expenditures despite evidence of adverse selection. Supplementary insurance does not change mortality or work expenses but it changes the budget. We observe an increase in student debt which is consistent with premium payments crowding out debt repayments. There is a loss of gross income from private health insurance which is consistent with income under-reporting to reduce expenses from premium payments

The Role of Brownfields and Their Revitalisation for the Functional Connectivity of the Urban Tree System in a Regrowing City

The connectivity of green infrastructure facilitating the movement of organisms is the key to strengthening biodiversity in cities. Brownfields are a valuable land resource, with their revitalisation as a Nature Based Solution high on the policy agenda. In supporting cities which simultaneously aim for densification and the maintenance or further development of greenery, this paper develops a model for identifying and prioritising the role of revitalised and prevailing brownfields for the connectivity of green infrastructure using the example of Leipzig, Germany. Comparing metrics between land use categories, brownfields have a central role as stepping stones, with a value of 13%, while revitalised brownfields substantially contribute to global connectivity, with a value of 87% being equally important, for example, with Leipzig’s central parks. This paper’s spatial-explicit network approach provides a complementary planning tool for prioritising brownfields and the added value of their renaturing by identifying (a) strategic functional corridors formed by brownfields, (b) the connectivity relevance and exposure of individual brownfields, and (c) how renatured brownfields would strengthen existing corridors and form alternative paths. This paper presents an approach using freely available software tools and high-resolution canopy data as a proxy for functional connectivity which serves as a standardised and comparable ex-ante evaluation of NBS strategies being implemented in other cities.CLEARING HOUSE (Collaborative Learning in Research, Information-sharing, and Governance on How Urban Forest-based Solutions Support Sino-European Urban Futures) Horizon 2020 projectNaturaConnect (Designing a Resilient and Coherent Trans-European Network for Nature and People) Horizon 2020 projectPeer Reviewe

Synthesis and biological evaluation of a novel MUC1 glycopeptide conjugate vaccine candidate comprising a 4'-deoxy-4'-fluoro-Thomsen-Friedenreich epitope

The development of selective anticancer vaccines that provide enhanced protection against tumor recurrence and metastasis has been the subject of intense research in the scientific community. The tumor-associated glycoprotein MUC1 represents a well-established target for cancer immunotherapy and has been used for the construction of various synthetic vaccine candidates. However, many of these vaccine prototypes suffer from an inherent low immunogenicity and are susceptible to rapid in vivo degradation. To overcome these drawbacks, novel fluorinated MUC1 glycopeptide-BSA/TTox conjugate vaccines have been prepared. Immunization of mice with the 4' F-TF-MUC1-TTox conjugate resulted in strong immune responses overriding the natural tolerance against MUC1 and producing selective IgG antibodies that are cross-reactive with native MUC1 epitopes on MCF-7 human cancer cells