Why should stakeholders consider the effect of tensions in collaborative innovation in healthcare—lessons learned from surveying integrated care projects in Germany

Introduction The German Innovation Fund supports projects that aim to improve healthcare through integration and intersectoral collaboration. As is typical for collaborative innovation projects, partners often pursue different objectives, which can create tensions and affect outcomes. The study aims to explore the causes and effects of tensions in integrated care projects and how frameworks, processes, and management should be designed to deal with tensions and achieve their productive effects. Methods In an online survey we asked participants about the causes, effects, and management of tensions and their implications for integrated care projects (n = 58 completed questionnaires). We applied bivariate descriptive statistics to analyse the quantitative data. Results Tensions between stakeholders, caused by deep-seated differences and the design of the project frameworks, often affect the course and outcome of innovative integrated care projects. However, through appropriate conflict management and negotiation processes such tensions can be managed constructively and lead to better outcomes. Discussion Tension is usually seen as something unpleasant to be avoided and/or overcome. In fact, tensions can have positive effects, the importance of which remains little understood. Developing appropriate frameworks for managing and integrating different perspectives are key factors in unlocking the positive potential of tensions in integrated care projects

Quality of Postoperative Pain Management After Maxillofacial Fracture Repair

Background: Effective pain management is an essential component in the perioperative care of surgical patients. However, post-operative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail. Materials and Methods: In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients’ characteristics and pain- related parameters. Results: Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021). Conclusions: Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine

Differential expression of immunoregulatory cytokines in adipose tissue and liver in response to high fat and high sugar diets in female mice

A comprehensive understanding of how dietary components impact immunoregulatory gene expression in adipose tissue (AT) and liver, and their respective contributions to metabolic health in mice, remains limited. The current study aimed to investigate the metabolic consequences of a high-sucrose diet (HSD) and a high-fat diet (HFD) in female mice with a focus on differential lipid- and sucrose-induced changes in immunoregulatory gene expression in AT and liver. Female C57BL/6 J mice were fed a purified and macronutrient matched high fat, high sugar, or control diets for 12 weeks. Mice were extensively phenotyped, including glucose and insulin tolerance tests, adipose and liver gene and protein expression analysis by qPCR and Western blot, tissue lipid analyses, as well as histological analyses. Compared to the control diet, HSD- and HFD-fed mice had significantly higher body weights, with pronounced obesity along with glucose intolerance and insulin resistance only in HFD-fed mice. HSD-fed mice exhibited an intermediate phenotype, with mild metabolic deterioration at the end of the study. AT lipid composition was significantly altered by both diets, and inflammatory gene expression was only significantly induced in HFD-fed mice. In the liver however, histological analysis revealed that both HSD- and HFD-fed mice had pronounced ectopic lipid deposition indicating hepatic steatosis, but more pronounced in HSD-fed mice. This was in line with significant induction of pro-inflammatory gene expression specifically in livers of HSD-fed mice. Overall, our findings suggest that HFD consumption in female mice induces more profound inflammation in AT with pronounced deterioration of metabolic health, whereas HSD induced more pronounced hepatic steatosis and inflammation without yet affecting glucose metabolism

EEG-Meta-Microstates: Towards a More Objective Use of Resting-State EEG Microstate Findings Across Studies.

Over the last decade, EEG resting-state microstate analysis has evolved from a niche existence to a widely used and well-accepted methodology. The rapidly increasing body of empirical findings started to yield overarching patterns of associations of biological and psychological states and traits with specific microstate classes. However, currently, this cross-referencing among apparently similar microstate classes of different studies is typically done by "eyeballing" of printed template maps by the individual authors, lacking a systematic procedure. To improve the reliability and validity of future findings, we present a tool to systematically collect the actual data of template maps from as many published studies as possible and present them in their entirety as a matrix of spatial similarity. The tool also allows importing novel template maps and systematically extracting the findings associated with specific microstate maps from ongoing or published studies. The tool also allows importing novel template maps and systematically extracting the findings associated with specific microstate maps in the literature. The analysis of 40 included sets of template maps indicated that: (i) there is a high degree of similarity of template maps across studies, (ii) similar template maps were associated with converging empirical findings, and (iii) representative meta-microstates can be extracted from the individual studies. We hope that this tool will be useful in coming to a more comprehensive, objective, and overarching representation of microstate findings

Unverhältnismäßige Kosten nach EG-Wasserrahmenrichtlinie: Praxistest zweier Verfahren zur Begründung weniger strenger Umweltziele

Aktualisierte Fassung des Endberichts des F+E-Vorhabens aus dem Länderfinanzierungsprogramm 2016 O 8.16 im Auftrag der Bund/Länderarbeitsgemeinschaft Wasser. Laufzeit: 01.06.2016 - 30.11.2017, Stand August 2018

Soziopolitische und administrative Determinanten der Mobilisierung kommunaler Eigeneinnahmen: Einblicke aus Mosambik

Obwohl in den meisten Entwicklungsländern das Einnahmenpotential auf subnationaler Ebene bescheiden ist, bestehen gute Gründe für verstärkte Bemühungen von Gebern und Entwicklungspartnern in diesem Bereich. Einerseits können lokal generierte Einnahmen – selbst wenn diese verglichen mit Einnahmen auf nationaler Ebene geringfügig sind – eine Erweiterung des finanziellen Spielraums der Kommunen durchaus begünstigen. Des Weiteren hoffen Geber durch eine starke Mobilisierung von Einnahmen auf lokaler Ebene neben zusätzlichen Finanzressourcen auch auf eine „Governance Dividende“. Die Mobilisierung von Eigeneinahmen auf lokaler Ebene stellt daher nicht nur aus finanzieller Sicht, sondern auch aus einer umfassenderen Governance-Perspektive ein relevantes Thema dar. Demzufolge ist eine stärkere Mobilisierung des lokalen Steuerpotentials kein Selbstzweck, sondern auch ein Mittel zur Förderung guter Regierungsführung. Damit diese positiven Wirkungen auch erreicht werden können, benötigen Geber und Entwicklungspartner ein besseres Verständnis der Wirkungen soziopolitischer und administrativer Faktoren in diesem Bereich. Im vorliegenden Papier werden die Ergebnisse einer Studie zu den Wirkungen dieser Faktoren auf die Mobilisierung von Eigeneinnahmen in mosambikanischen Kommunen zusammengefasst. Damit leisten wir einen Beitrag zu einer sich rasant entwickelnden Literatur zum Effekt dieser Faktoren auf unterschiedliche Aspekte der Öffentlichen Finanzen auf subnationaler Ebene. Die Ergebnisse zeigen erstens, dass administrative Schwächen zu einer starken Abhängigkeit von verwaltungstechnisch weniger anspruchsvollen Einnahmeninstrumenten führen. Diese Erkenntnisse unterstreichen auch den systemischen Charakter des Prozesses der Einnahmenerhebung: Eine mangelhafte oder fehlende Kapazität im Hinblick auf nur einen Schritt hat bereits starke Auswirkungen auf die Effektivität und Effizienz des gesamten Erhebungssystems. Zweitens zeigen Kommunen, in denen die auf nationaler Ebene regierende Partei nicht an der Macht ist, mehr Bemühungen zur Steigerung der Eigeneinnahmen als Kommunen, in denen die Regierungspartei mit der Partei an der Macht auf nationaler Ebene übereinstimmt. Dies zeigt, wie politische Faktoren auf lokaler Ebene, insbesondere in der Interaktion mit anderen Regierungsebenen, die Anreize für Kommunen stark beeinflussen können, ihr Einnahmenpotential auszuschöpfen. Drittens scheint die Stärke der Zivilgesellschaft auf lokaler Ebene keine Auswirkungen auf das finanzpolitische Verhalten der kommunalen Regierungen zu haben. In diesem Zusammenhang ist festzustellen, dass, besonders auf lokaler Ebene, die Zivilgesellschaft in Mosambik zu schwach erscheint, um Initiativen oder Prozesse im Themenbereich Öffentliche Finanzen signifikant anzustoßen, zu begleiten und zu beeinflussen – selbst wenn Unterstützung durch die Geber vorhanden ist. Aus den Ergebnissen lässt sich eine deutliche Empfehlung für Geber und Entwicklungspartner ableiten: Um zielgerichtete Maßnahmen zur Mobilisierung lokaler Eigeneinnahmen erfolgreich zu konzipieren und umzusetzen, müssen Geber und Entwicklungspartner soziopolitische und administrative Faktoren systematisch beachten. Dafür müssen Praktiker in diesem Themenbereich ihren Ansatz erweitern und noch stärker als bisher Zeit und Kapazitäten investieren, um die genannten Faktoren zu berück-sichtigen. Hemmende und fördernde Faktoren müssen identifiziert werden, um Strategien und Maßnahmen besser anpassen zu können

Determinantes sociopolíticos e administrativos dos resultados das receitas municipais: perceções de Moçambique

Embora na maior parte dos países em desenvolvimento o potencial de receitas ao nível subnacional seja modesto, existem bons motivos para os doadores e os parceiros de desenvolvimento prosseguirem e intensificarem os seus esforços neste setor. Por um lado, as receitas obtidas localmente, apesar de insignificantes quando comparadas com as receitas obtidas a nível nacional, podem fazer uma grande diferença para a margem orçamental disponível para os municípios. Por outro lado, para além da disponibilidade de mais recursos financeiros, prevê-se que uma mobilização mais forte de receitas locais venha acompanhada de «dividendos de governação». Consequentemente, a mobilização de receitas a nível local constitui um importante tópico para desenvolvimento, não apenas de um ponto de vista fiscal, mas também de uma perspetiva de governação mais lata. Por conseguinte, uma mobilização de receitas mais forte não deve ser apenas vista como um fim em si mesmo, mas também como um meio para promover a boa governação. Defendemos que a fim de se desbloquearem estes eventuais efeitos positivos, os doadores e os parceiros de desenvolvimento precisam de entender melhor os efeitos que os determinantes sociopolíticos e administrativos têm na mobilização das receitas municipais. Neste documento, sintetizamos as informações obtidas num estudo sobre como as variáveis administrativas e sociopolíticas a nível local afetam os resultados das receitas dos municípios moçambicanos. Por conseguinte, contribuímos para uma literatura em evolução salientando a relevância dos fatores locais na explicação da mobilização das receitas locais. Os resultados mostram que, em primeiro lugar, as fragilidades administrativas conduzem a uma forte dependência de determinados instrumentos de receitas fáceis de implementar que não são necessariamente aqueles com maior potencial de receitas. Além disso, os resultados salientam a natureza sistémica do processo de cobrança de receitas: a falha ou falta de capacidade relativamente a um único passo afeta profundamente a eficácia e eficiência de todo o sistema de cobrança de receitas. Em segundo lugar, os governos municipais que estão politicamente alinhados com o partido que governa a nível nacional mostram menos esforços para aumentar os resultados das receitas do que os governos não alinhados. Isso mostra de que modo as variáveis políticas a nível local, sobretudo na interação com outros níveis de go¬verno, podem afetar profundamente os incentivos para os municípios explorarem o seu potencial de receitas. Em terceiro lugar, no contexto de uma sociedade civil, em geral, frágil, as variações marginais na força organizacional não parecem afetar o comportamento fiscal dos governos locais. No mesmo sentido, consideramos que a sociedade civil a nível local em Moçambique carece das capacidades para moldar e influenciar a mobilização de receitas de uma forma significativa, mesmo quando têm apoio de doadores. Estes resultados têm implicações profundas para os doadores e parceiros de desenvolvimento. Não se considerar os efeitos sociopolíticos e os fatores administrativos nos resultados das receitas limita fortemente a capacidade de os doadores anteciparem a eficácia prospetiva das políticas e medidas destinadas a aumentar a mobilização local de receitas. Neste sentido, os profissionais precisam de alargar a sua abordagem à mobilização de receitas municipais e considerar mais siste¬maticamente o modo como as variáveis sociopolíticas e administrativas moldam as perspetivas de impactos mais fortes a alcançar

Socio-political and administrative determinants of municipal revenue performance: insights from Mozambique

While in most developing countries revenue potential at the subnational level is modest, there are good reasons for donors and development partners to continue and intensify their efforts in this sector. On the one hand, locally collected revenue, although negligible when compared with revenue collected at the national level, can make a big difference for the fiscal space available to municipalities. On other hand, beyond the availability of more financial resources, stronger local revenue mobilisation is expected to come with a “governance dividend”. As a result, the mobilisation of revenue at the local level is a relevant topic for development, not only from a fiscal point of view, but also from a broader governance perspective. Consequently, stronger revenue mobilisation should not only be seen as an end in itself, but also as a means for promoting good governance. We argue that to unlock these potential positive effects, donors and development partners need a better understanding of the effects that socio-political and administrative determinants have on municipal revenue mobilisation. In this paper, we summarise the insights gained in a study on how administrative and socio-political variables at the local level affect the revenue performance of Mozambican municipalities. Thereby, we contribute to an evolving literature highlighting the relevance of local factors in explaining local revenue mobilisation. Results show that, first, administrative weaknesses lead to strong reliance on certain easy-to-implement revenue instruments that are not necessarily those with the highest revenue potential. Moreover, the results highlight the systemic nature of the process of revenue collection: failure or lack of capacity concerning one single step strongly affects the effectiveness and efficiency of the whole revenue collection system. Second, municipal governments that are politically aligned with the party governing at the national level show fewer efforts to increase revenue performance than non-aligned governments. This shows how political variables at the local level, especially in the interaction with other levels of government can strongly affect the incentives for municipalities to exploit their revenue potential. Third, in the context of a generally weak civil society, marginal variations in organisational strength do not seem to affect the fiscal behaviour of local governments. In this line, we find that the civil society at the local level in Mozambique lacks the capabilities to shape and influence revenue mobilisation in any meaningful way, even where they have donors’ support. These results have strong implications for donors and development partners. Not considering the effects of socio-political and administrative factors on revenue performance strongly limits the capacity of donors to anticipate the prospective effectiveness of policies and measures aimed at increasing local revenue mobilisation. In this line, practitioners need to broaden their approach to municipal revenue mobilisation and more systematically consider how socio-political and administrative variables shape prospects for stronger impacts to be achieved