Möglichkeiten und Grenzen der partiellen Rangdatenanalyse in der sozialwissenschaftlichen Forschung: Untersuchungen zu sozialen Netzwerken und Hilfeleistungen

Demands for care are met not only by professional care services but as well by family members and friends, especially by partners and children. These personal resources are not equally available to everyone. Moreover, there may be differences in preferences when choosing between alternative care arrangements. In particular, the often intimate situations arising in nursing care will lead many to prefer close relatives or friends over professional care services. We consider preference orderings between potentially supporting persons or professional care services. The orderings were obtained by asking respondents to name the most preferred groups of persons they would ask for support in a hypothetical case of being in the need of care. This question is part of the standard panel questionnaire program of the Socio-Economic Panel Study (SOEP) and is thus regularly posed. Similar questions to state preferences among a given set of potential alternatives can be found in many social surveys. The analysis of such data requires suitable methods that take their special features into account. We present a method to visualize partial rankings. The method is then used to present rankings over partial preferences, where the set of alternatives depends on the availability of networks of relatives, partners and friends. The method visualizes rank data using the skeleton of polytopes, by which the complexity of given preferences can faithfully be represented . Using the method for responses to the question about nursing care clearly demonstrates a shortcoming of this type of questions in general survey questionnaires. Pflegebedürfnisse werden zum erheblichen Teil durch professionelle Dienste befriedigt. Ein wichtiger Eckpfeiler in der pflegerischen Versorgung stellen darüber hinausfamiliäre Beziehungen wie Partner und Kinder, sowie Freundes- und Nachbarschaftsnetzwerke dar. Diese Ressourcen stehen aber nicht allen Personen gleichermaßen zur Verfügung, sondern sind in der Bevölkerung ungleich verteilt. Wir beschäftigen uns mit der Reihenfolge von genannten Unterstützungspersonen, bei der Befragte Personengruppen - überwiegend aus dem Kreis informeller Beziehungen - im Hinblick auf die Versorgung im Rahmen einer hypothetischen Pflegebedürftigkeit nennen sollten. Es handelt sich um eine Frage, die u.a. den Befragten des Sozio-ökonomischen Panels regelmäßig gestellt wird. Die Besonderheit der Situation einer pflegerischen Bedürftigkeit aufgrund der Notlage und der Intimität des Ereignisses setzt eher vertrauensvolle Personen als Ansprechpartner voraus. Inhaltlich können somit durch diese Personenangaben Hinweise auf die Ausgestaltung individuell differenzierter Teilnetzwerke gefunden werden. Ähnliche Fragen nach Präferenzen finden sich aber auch in vielen anderen Bereichen der Sozialstatistik, in denen Befragte gebeten werden, ihre Präferenzen für bestimmte Alternativen zu äußern. Die besonderen Eigenschaften solcher Daten erfordern geeignete Methoden, die den Besonderheiten der erzeugten Daten Rechnung tragen. Die vorliegende Arbeit soll einen Beitrag zur Darstellung und Analyse solcher Rangdaten leisten. Dabei werden zwei Ziele verfolgt: Einerseits wird ein Verfahren zur Visualisierung von Rangdaten dargestellt, das bislang in der sozialwissenschaftlichen Forschung wenig Beachtung gefunden hat und hier im konkreten Fall für die Darstellung von Teilnetzwerken angewendet wird. Es handelt sich um die Darstellung von Rangdaten mit Hilfe von Polytopen, durch die sich die Komplexität in den Präferenzäußerungen explorativ grafisch veranschaulichen lässt. Andererseits soll anhand dieses Verfahrens die inhaltliche und methodische Problematik einer Fragebogenkonstruktion diskutiert werden, in der Personen gebeten werden, Aussagen über hypothetische Zustände oder Meinungen zu leisten, um ihren Präferenzen Ausdruck zu verleihen.social networks, rank data, polytope, social support

Vascular morphometric changes after radioactivestent implantation: a dose-response analysis

AbstractObjectivesThe goal of this study was to evaluate the dose-dependency of morphometric changes in the coronary arterial wall after radioactive stenting.BackgroundRadioactive stents have been found to reduce intrastent intimal hyperplasia (IIH) but lead to a characteristic type of restenosis occurring predominantly at the stent edges.MethodsFifteen patients underwent intravascular ultrasound (IVUS) examination after implantation of a P-32 radioactive stent and at the six-month follow-up. The post-stent IVUS measurements on seven predefined locations of each lesion were subjected to a computer algorithm for the development of dose-volume histograms (DVH). Thus, we derived the radiation doses delivered to at least 10% and 90% of the adventitia (DV10, DV90). The IIH and vascular remodeling at follow-up were correlated with the doses in each segment.ResultsThe IIH was most pronounced at the stent edges and lowest in the stent-body, whereas we detected a significant expansive remodeling within the stent body. The delivered doses correlated with a decreased IIH (r = 0.52, p < 0.001 for DV10 and r = 0.62, p < 0.001 for DV90) and with expansive remodeling (r = 0.48, p = 0.009 for DV10 and r = 0.50, p = 0.006 for DV90). A DV10 >90 Gy or a DV90 >15 Gy reduced IIH and induced expansive remodeling. Plaque growth was not reduced by radioactive stents.ConclusionsThe DVH analysis reveals a dose-dependent increase of external elastic lamina area behind radioactive stents, whereas plaque growth is not reduced but inverted into an outward direction from the stent. A DV10 >90 Gy or a DV90 >15 Gy results in a beneficial long-term outcome after radioactive stenting

Dopamine boosts intention and action awareness in Parkinson’s disease

Dopaminergic deficiency in Parkinson’s disease (PD) has been associated with underactivation of the supplementary motor area and a reduction of voluntary actions. In these patients, awareness of intention to act has been shown to be delayed. However, delayed awareness of intention to act has also been shown in patients with hyperdopaminergic states and an excess of unwilled movements, as in Tourette’s, and in patients with functional movement disorders. Hence, the role of dopamine in the awareness of intention and action remains unclear. 36 PD patients were tested ON and OFF dopaminergic medication and compared with 35 healthy age-matched controls. In addition, 17 PD patients with subthalamic deep brain stimulation (DBS) were tested ON medication and ON and OFF stimulation. Participants judged either the moment a self-generated action was performed, or the moment the urge to perform the action was felt, using the “Libet method”. Temporal judgments of intention and action awareness were comparable between unmedicated PD patients and controls. Dopaminergic medication boosted anticipatory awareness of both intentions and actions in PD patients, relative to an unmedicated condition. The difference between ON/OFF DBS was not statistically reliable. Functional improvement of motor ability in PD through dopaminergic supplementation leads to earlier awareness of both intention, and of voluntary action

Subthalamic and nigral neurons are differentially modulated during parkinsonian gait

The parkinsonian gait disorder and freezing of gait are therapeutically demanding symptoms with considerable impact on quality of life. The aim of this study was to assess the role of subthalamic and nigral neurons in the parkinsonian gait control using intraoperative microelectrode recordings of basal ganglia neurons during a supine stepping task. Twelve male patients (56 ± 7 years) suffering from moderate idiopathic Parkinson's disease (disease duration 10 ± 3 years, Hoehn and Yahr stage 2), undergoing awake neurosurgery for deep brain stimulation, participated in the study. After 10 s resting, stepping at self-paced speed for 35 s was followed by short intervals of stepping in response to random 'start' and 'stop' cues. Single- and multi-unit activity was analysed offline in relation to different aspects of the stepping task (attentional 'start' and 'stop' cues, heel strikes, stepping irregularities) in terms of firing frequency, firing pattern and oscillatory activity. Subthalamic nucleus and substantia nigra neurons responded to different aspects of the stepping task. Of the subthalamic nucleus neurons, 24% exhibited movement-related activity modulation as an increase of the firing rate, suggesting a predominant role of the subthalamic nucleus in motor aspects of the task, while 8% of subthalamic nucleus neurons showed a modulation in response to the attentional cues. In contrast, responsive substantia nigra neurons showed activity changes exclusively associated with attentional aspects of the stepping task (15%). The firing pattern of subthalamic nucleus neurons revealed gait-related firing regularization and a drop of beta oscillations during the stepping performance. During freezing episodes instead, there was a rise of beta oscillatory activity. This study shows for the first time specific, task-related subthalamic nucleus and substantia nigra single-unit activity changes during gait-like movements in humans with differential roles in motor and attentional control of gait. The emergence of perturbed firing patterns in the subthalamic nucleus indicates a disrupted information transfer within the gait network, resulting in freezing of gait

Comparison of subthalamic unilateral and bilateral theta burst deep brain stimulation in Parkinson’s disease

High-frequency, conventional deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson’s disease (PD) is usually applied bilaterally under the assumption of additive effects due to interhemispheric crosstalk. Theta burst stimulation (TBS-DBS) represents a new patterned stimulation mode with 5 Hz interburst and 200 Hz intraburst frequency, whose stimulation effects in a bilateral mode compared to unilateral are unknown. This single-center study evaluated acute motor effects of the most affected, contralateral body side in 17 PD patients with unilateral subthalamic TBS-DBS and 11 PD patients with bilateral TBS-DBS. Compared to therapy absence, both unilateral and bilateral TBS-DBS significantly improved (p &lt; 0.05) lateralized Movement Disorder Society-Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS III) scores. Bilateral TBS-DBS revealed only slight, but not significant additional effects in comparison to unilateral TBS-DBS on total lateralized motor scores, but on the subitem lower limb rigidity. These results indicate that bilateral TBS-DBS has limited additive beneficial effects compared to unilateral TBS-DBS in the short term

Genome sequence of the bioplastic-producing ‘‘Knallgas’’ bacterium Ralstonia eutropha H16

The H2-oxidizing lithoautotrophic bacterium Ralstonia eutropha H16 is a metabolically versatile organism capable of subsisting, in the absence of organic growth substrates, on H2 and CO2 as its sole sources of energy and carbon. R. eutropha H16 first attracted biotechnological interest nearly 50 years ago with the realization that the organism’s ability to produce and store large amounts of poly[R-(–)-3-hydroxybutyrate] and other polyesters could be harnessed to make biodegradable plastics. Here we report the complete genome sequence of the two chromosomes of R. eutropha H16. Together, chromosome 1 (4,052,032 base pairs (bp)) and chromosome 2 (2,912,490 bp) encode 6,116 putative genes. Analysis of the genome sequence offers the genetic basis for exploiting the biotechnological potential of this organism and provides insights into its remarkable metabolic versatility

EviGUIDE - a tool for evidence-based decision making in image-guided adaptive brachytherapy for cervical cancer

PURPOSE: To develop a novel decision-support system for radiation oncology that incorporates clinical, treatment and outcome data, as well as outcome models from a large clinical trial on magnetic resonance image-guided adaptive brachytherapy (MR-IGABT) for locally advanced cervical cancer (LACC). METHODS: A system, called EviGUIDE, was developed that combines dosimetric information from the treatment planning system, patient and treatment characteristics, and established tumor control probability (TCP), and normal tissue complication probability (NTCP) models, to predict clinical outcome of radiotherapy treatment of LACC. Six Cox Proportional Hazards models based on data from 1341 patients of the EMBRACE-I study have been integrated. One TCP model for local tumor control, and five NTCP models for OAR morbidities. RESULTS: EviGUIDE incorporates TCP-NTCP graphs to help users visualize the clinical impact of different treatment plans and provides feedback on achievable doses based on a large reference population. It enables holistic assessment of the interplay between multiple clinical endpoints and tumour and treatment variables. Retrospective analysis of 45 patients treated with MR-IGABT showed that there exists a sub-cohort of patients (20%) with increased risk factors, that could greatly benefit from the quantitative and visual feedback. CONCLUSION: A novel digital concept was developed that can enhance clinical decision- making and facilitate personalized treatment. It serves as a proof of concept for a new generation of decision support systems in radiation oncology, which incorporate outcome models and high-quality reference data, and aids the dissemination of evidence-based knowledge about optimal treatment and serve as a blueprint for other sites in radiation oncology

Tools for large-scale data analytics of an international multi-center study in radiation oncology for cervical cancer

PURPOSE: To develop and implement a software that enables centers, treating patients with state-of-the-art radiation oncology, to compare their patient, treatment, and outcome data to a reference cohort, and to assess the quality of their treatment approach. MATERIALS AND METHODS: A comprehensive data dashboard was designed, which al- lowed holistic assessment of institutional treatment approaches. The software was tested in the ongoing EMBRACE-II study for locally advanced cervical cancer. The tool created individualized dashboards and automatic analysis scripts, verified pro- tocol compliance and checked data for inconsistencies. Identified quality assurance (QA) events were analysed. A survey among users was conducted to assess usability. RESULTS: The survey indicated favourable feedback to the prototype and highlighted its value for internal monitoring. Overall, 2302 QA events were identified (0.4% of all collected data). 54% were due to missing or incomplete data, and 46% originated from other causes. At least one QA event was found in 519/1001 (52%) of patients. QA events related to primary study endpoints were found in 16% of patients. Sta- tistical methods demonstrated good performance in detecting anomalies, with precisions ranging from 71% to 100%. Most frequent QA event categories were Treatment Technique (27%), Patient Characteristics (22%), Dose Reporting (17%), Outcome 156 (15%), Outliers (12%), and RT Structures (8%). CONCLUSION: A software tool was developed and tested within a clinical trial in radia- tion oncology. It enabled the quantitative and qualitative comparison of institutional patient and treatment parameters with a large multi-center reference cohort. We demonstrated the value of using statistical methods to automatically detect implau- sible data points and highlighted common pitfalls and uncertainties in radiotherapy for cervical cancer

Who tries to get a Kita place and who actually uses it? A comparison between migrant and non-migrant families with children under the age of three

Die institutionelle Betreuung und Bildungsförderung von Kindern unter drei Jahren soll dazu beitragen, herkunftsbedingte Nachteile früh auszugleichen. Insbesondere Kinder aus Migrantenfamilien sollen vom Kindertagesstättenangebot profitieren. Allerdings nutzen Migrantenfamilien seltener eine institutionelle Betreuung für ihr Kind als autochthone Familien. Der Frage, ob es sich dabei um eine freiwillige oder unfreiwillige Nichtinanspruchnahme handelt, wird in diesem Beitrag nachgegangen. Mit Hilfe der Daten der ersten KiföG-Zusatzuntersuchung von AID:A kann gezeigt werden, dass sich Migranten genauso häufig um einen institutionellen Betreuungsplatz für ihr Kind bemühen wie autochthone Eltern. Dennoch ist die tatsächliche Inanspruchnahme eines Betreuungsplatzes durch Migranten deutlich geringer, wenn beide Elternteile im Ausland geboren sind. Die Sprachpraxis der Eltern spielt hingegen nur eine geringe Rolle bei der Inanspruchnahme. Die Ergebnisse weisen darauf hin, dass Auswahlprozesse und eine ungleiche Ressourcenverteilung eine wichtige Rolle bei der ungleichen Inanspruchnahme institutioneller Kinderbetreuung spielen. (DIPF/Orig.)Institutional childcare and education for children under three is thought to be instrumental in compensating for social disadvantages at an early stage. In particular, children from migrant families should benefit from an easily accessible supply of nursery schools. However, migrant families send their children to nursery school less often than non-migrant families. This article looks into the reasons for the reduced utilization. Using data from the first KiföG add-on of the AID:A survey conducted by the German Youth Institute, the authors show that parents from migrant backgrounds express a similar demand for day care as do non-migrant parents. At the same time, utilization rates are much lower for migrant families, especially when both parents were born abroad. Remarkably, the language skills of the parents only have a minor influence. These findings indicate that admission processes and an unequal allocation of resources may play a major role in the unequal utilization of nursery schools. (DIPF/Orig.