The analysis of collective mindsets: Introducing a New Method of Institutional Analysis in Comparative Research

This article presents a specific qualitative method – the Collective Mindset Analysis (CMA) – that is applicable within the frame of institutional analysis to map the cognitive and normative institutions at work. The purpose of this paper is to introduce and discuss the method and its methodology as well. The paper will elaborate on how the method is applied to international research and will provide concrete examples drawn from a bigger research project on economic elites in eleven countries. It will demonstrate the steps of interpretation of interview material from this project with the help of CMA, using concrete text sequences. The sequences have been extracted from interviews with Brazilian top managers that were conducted in the context of an international research project. The paper will show, how an institutional approach, that is relying on the sociology of knowledge, can be supported by a method, that helps to reconstruct the cognitive and normative rules in a given culture and to analyze, how these rules are translated in action orientations to solve culturally significant problems. Thus, the method can be a remedy for the shortcomings of institutional analysis in mapping and comparing the knowledge stocks in different cultures and a new tool in international comparative research

Autonomieverlust der Medizin? Zum Strukturwandel moderner Großkrankenhäuser in Deutschland, Österreich und der Schweiz

Der Beitrag untersucht im Ländervergleich zwischen Deutschland, Österreich und der Schweiz, inwiefern sich die Strukturen der großen Krankenhäuser in Richtung einer Ökonomisierung, verstanden als zunehmende Geltung von Wirtschaftlichkeitskriterien, verändern. Der mögliche Autonomieverlust der Medizin durch betriebswirtschaftliches Management und betriebswirtschaftliche Effizienzprinzipien infolge dieser institutionellen Weichenstellungen kann Folgen für die Konstellation in den Arbeitsbeziehungen im Krankenhaus zeitigen. Auf Basis von Struktur-, Lebensverlaufs- und Inhaltsanalysen lässt sich erkennen, dass die Veränderung der institutionellen Verfasstheit der Großkrankenhäuser und der Leitungs- und Qualifikationsstrukturen je nach länderspezifischem Kontext unterschiedlich stark dafür sorgen, dass der konservative Pfad durchbrochen wird und die institutionellen Weichenstellungen in Richtung zunehmender Ökonomisierung zeigen: in der Schweiz am weitreichendsten, in Österreich am geringsten.A comparative study of Germany, Austria and Switzerland, the article discusses the question of how far current changes in public hospitals have induced a shift towards commodification and managerialism. As a consequence of the increasing importance of management, business and efficiency principles, resulting in a decline in medicine's autonomy, labour relations in hospitals are likely to be effected. Based on structural analysis, life course analysis and content analysis the findings indicate how changes in the management and qualification structure of large hospitals have resulted in them abandoning their conservative path. To varying degrees commodification is modifying the institutional structures of large hospitals in all three countries. Whilst Switzerland can be shown to be setting the commodification pace, such a process has had the least impact in Austria

Expression of DC-SIGN and DC-SIGNR on human sinusoidal endothelium: a role for capturing hepatitis C virus particles.

Hepatic sinusoidal endothelial cells are unique among endothelial cells in their ability to internalize and process a diverse range of antigens. DC-SIGNR, a type 2 C-type lectin expressed on liver sinusoids, has been shown to bind with high affinity to hepatitis C virus (HCV) E2 glycoprotein. DC-SIGN is a closely related homologue reported to be expressed only on dendritic cells and a subset of macrophages and has similar binding affinity to HCV E2 glycoprotein. These receptors function as adhesion and antigen presentation molecules. We report distinct patterns of DC-SIGNR and DC-SIGN expression in human liver tissue and show for the first time that both C-type lectins are expressed on sinusoidal endothelial cells. We confirmed that these receptors are functional by demonstrating their ability to bind HCV E2 glycoproteins. Although these lectins on primary sinusoidal cells support HCV E2 binding, they are unable to support HCV entry. These data support a model where DC-SIGN and DC-SIGNR on sinusoidal endothelium provide a mechanism for high affinity binding of circulating HCV within the liver sinusoids allowing subsequent transfer of the virus to underlying hepatocytes, in a manner analogous to DC-SIGN presentation of human immunodeficiency virus on dendritic cells

PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

Background & Aims: Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (ADNo ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. Methods: The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. Results: Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. Conclusions: This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. Lay summary: Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes. (c) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials.gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death - termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD - patients in this group rarely require hospital admission and have a much lower 1-year mortality risk

Time from diagnosis to treatment has no impact on survival in newly diagnosed acute myeloid leukemia treated with venetoclax-based regimens

In newly diagnosed acute myeloid leukemia, immediate initiation of treatment is standard of care. However, deferral of antileukemic therapy may be indicated to assess comorbidities or pre-therapeutic risk factors. We explored the impact of time from diagnosis to treatment on outcomes in newly diagnosed acute myeloid leukemia undergoing venetoclax-based therapy in two distinct cohorts. By querying the Study Alliance Leukemia database and the global health network TriNetX, we identified 138 and 717 patients respectively with an average age of 76 and 72 years who received venetoclax-based firstline therapy. When comparing patients who started treatment earlier or later than 10 days after initial diagnosis, no significant difference in median overall survival was observed - neither in the SAL cohort (7.7 vs. 9.6 months, p=.42) nor in the TriNetX cohort (7.5 vs. 7.2 months, p=.41). Similarly, severe infections, bleeding, and thromboembolic events were equally observed between early and later treatments, both in the overall patient groups and specific subgroups (age ≥75 years or leukocytes ≥20x109/L). This retrospective analysis indicates that delaying the start of venetoclax-based therapy in newly diagnosed acute myeloid leukemia might be a safe option for selected patients, provided that close clinical monitoring is performed

The SIB Swiss Institute of Bioinformatics' resources: focus on curated databases

The SIB Swiss Institute of Bioinformatics (www.isb-sib.ch) provides world-class bioinformatics databases, software tools, services and training to the international life science community in academia and industry. These solutions allow life scientists to turn the exponentially growing amount of data into knowledge. Here, we provide an overview of SIB's resources and competence areas, with a strong focus on curated databases and SIB's most popular and widely used resources. In particular, SIB's Bioinformatics resource portal ExPASy features over 150 resources, including UniProtKB/Swiss-Prot, ENZYME, PROSITE, neXtProt, STRING, UniCarbKB, SugarBindDB, SwissRegulon, EPD, arrayMap, Bgee, SWISS-MODEL Repository, OMA, OrthoDB and other databases, which are briefly described in this article

Grenzenlose Karrieren? Hochqualifiziertes Personal und Top-Führungskräfte in Ökonomie und Medizin

Ziel des Beitrags ist es, die These „grenzenloserMobilität“ von Hochqualifizierten zu prüfen, die davon ausgeht, dass es im Zuge der Globalisierung zu einer internationalen Verteilung und zu transnationalen Rekrutierungsstrukturen des hochqualifizierten Personals komme. Wir betrachten auf der Basis eigener empirischer Untersuchungen und der Sekundärauswertung weiterer Studien die Wanderungsdynamik Hochqualifizierter in zwei institutionellen Feldern: Ökonomie und Medizin näher und kommen zu dem Ergebnis, dass sich diese „starke“ Globalisierungsthese nicht halten lässt.Wir sprechen daher von „Internationalisierung light“ und verorten die Gründe dafür auf der Ebene organisationaler Karrieremechanismen