Defining hospital markets – an application to the German hospital sector

The correct definition of the product market and of the geographic market is a prerequisite for assessing market structures in antitrust cases. For hospital markets, both dimensions are controversially discussed in the literature. Using data for the German hospital market we aim at elaborating the need for differentiating the product market and at investigating the effects of different thresholds for the delineation of the geographic market based on patient flows. Thereby we contribute to the scarce empirical evidence on the structure of the German hospital market. We find that the German hospital sector is highly concentrated, confirming the results of a singular prior study. Furthermore, using a very general product market definition such as “acute in-patient care” averages out severe discrepancies that become visible when concentration is considered on the level of individual diagnoses. In contrast, varying thresholds for the definition of the geographic market has only impact on the level of concentration, while the correlation remains high. Our results underline the need for more empirical research concerning the definition of the product market for hospital services

Together or Not? Exploring Stakeholders in Public and Permissionless Blockchains

The emergence of blockchain projects enables new ways of collaboration between untrusted parties. Each of these projects, however , only exists because stakeholders of these projects find common ground. If this common ground is not found, blockchains are forked – organizationally and technically – which endangered major blockchain systems like Bitcoin or Ethereum. To assure the operation of such projects and, thus, to improve their governance, it is crucial to understand their stakeholders. This research conducted a literature review and a survey to (1) identify blockchain stakeholders and to (2) understand their interests as well as underlying motives for their interests. This research has two main contributions: a stakeholder map, which serves as a lens to study stakeholders of public blockchains, and exemplary insights from the application of this lens comprising of 74 survey responses. Consequently, this research provides a novel tool for stakeholder analysis in academia and practice to improve blockchain governance

Impact of surgical technique on operative morbidity and its socioeconomic benefit in thyroid surgery

Purpose: The aim of this retrospective cohort study was to evaluate the rate of complications in relation to the extent of surgery and some of its consequences. Methods: Between 1972 and 2010, a total of 5,277 consecutive thyroid gland surgeries with 7,383 nerves at risk were performed at our teaching institution. Data of all patients undergoing thyroidectomy were collected prospectively. A total of 2,867 subtotal resections (first study period from 1972 to 1990) were compared with 2,410 extended thyroid resections involving at least a hemithyroidectomy (second period from 1991 to 2010). Results: The incidence of permanent recurrent laryngeal nerve palsy in primary operations was significantly higher in the first period compared to the second period (3.6 vs. 0.9%; p < 0.001). Permanent hypoparathyroidism decreased from 3.2% in the first period to 0.8% in the second period (p < 0.001). The incidence of recurrent goiter surgery decreased from 11.1% in the first period to 8.1% in the second period (p < 0.001). No significant difference was found in permanent recurrent laryngeal nerve palsy in recurrent disease between the two periods. The socioeconomic benefits of an extended thyroid resection in our patient population are 360 preventable operations, 90 preventable permanent recurrent laryngeal nerve palsies, and 58 preventable cancers. Furthermore, 37 preventable radioiodine ablations and 15 preventable deaths were associated with more radical thyroid resection. Conclusion: Improvements in surgical technique and change in surgical strategy significantly decreased the prevalence of recurrent laryngeal nerve palsy, hypoparathyroidism, and recurrent disease as well as reduced public health costs associated with recurrent goite

The Role of A Priori Belief in the Design and Analysis of Fault-Tolerant Distributed Systems

The debate around the notions of a priori knowledge and a posteriori knowledge has proven crucial for the development of many fields in philosophy, such as metaphysics, epistemology, metametaphysics etc. We advocate that the recent debate on the two notions is also fruitful for man-made distributed computing systems and for the epistemic analysis thereof. Following a recently proposed modal and fallibilistic account of a priori knowledge, we elaborate the corresponding concept of a priori belief: We propose a rich taxonomy of types of a priori beliefs and their role for the different agents that participate in the system engineering process, which match the existing view exceedingly well and are particularly promising for explaining and dealing with unexpected behaviors in fault-tolerant distributed systems. Developing such a philosophical foundation will provide a sound basis for eventually implementing our ideas in a suitable epistemic reasoning and analysis framework and, hence, constitutes a mandatory first step for developing methods and tools to cope with the various challenges that emerge in such systems

Single molecule secondary structure determination of proteins through infrared absorption nanospectroscopy.

Funder: EC | EC Seventh Framework Programm | FP7 Health (FP7-HEALTH - Specific Programme "Cooperation": Health); doi: https://doi.org/10.13039/100011272The chemical and structural properties of biomolecules determine their interactions, and thus their functions, in a wide variety of biochemical processes. Innovative imaging methods have been developed to characterise biomolecular structures down to the angstrom level. However, acquiring vibrational absorption spectra at the single molecule level, a benchmark for bulk sample characterization, has remained elusive. Here, we introduce off-resonance, low power and short pulse infrared nanospectroscopy (ORS-nanoIR) to allow the acquisition of infrared absorption spectra and chemical maps at the single molecule level, at high throughput on a second timescale and with a high signal-to-noise ratio (~10-20). This high sensitivity enables the accurate determination of the secondary structure of single protein molecules with over a million-fold lower mass than conventional bulk vibrational spectroscopy. These results pave the way to probe directly the chemical and structural properties of individual biomolecules, as well as their interactions, in a broad range of chemical and biological systems