Mitgliedertypen und Kommunikationsstrukturen in Netzwerken : Analyse am Beispiel eines Beraterinnennetzwerks

Unternehmen haben längst erkannt: „Den Netzwerken gehört die Zukunft“ . Immer wenn ein Unternehmen eine Kooperation bekannt gibt, steigt deren Aktienkurs. Im Gesundheitsbereich werden Netzwerke immer beliebter. So fördert der Staat Ärztenetzwerke für eine bessere Effizienz und Effektivität der Versorgung. Bereits jetzt arbeiten 32% der Ärzte in Netzwerken. Im Bereich der betrieblichen Gesundheitsförderung ist ein Zusammenschluss verschiedener Disziplinen immer häufiger. Diese Zusammenschlüsse haben das Ziel, dem demographischen Wandel entgegenzuwirken. Wird der Dienstleistungssektor betrachtet, so stellen Netzwerke eine häufige Organisationsform dar. Insbesondere im produzierende Gewerbe oder dem Versicherungssektor finden sich netzwerkartige Strukturen. Netzwerke in der Gesundheitsdienstleistung, insbesondere der Ernährungsberatung, sind noch nicht häufig vertreten oder nicht für Außenstehende sichtbar. Die Forschung beschäftigte sich bislang hauptsächlich mit der Initiierung und dem Auflösen von Netzwerken. Die vorliegende Arbeit analysiert bestehende Netzwerkstrukturen. Die Gestaltungsebene bestehender Netzwerke kann als Erfolgsfaktor für Netzwerke gesehen werden, vor allem die Informationsvermittlung und die Kommunikation. Diese Schwerpunkte werden in der Analyse gesetzt. Durch eine theoretische Betrachtung der Begriffe Netzwerk und Kommunikation und deren Ausprägungen, werden die Grundpfeiler für die Analyse gelegt. Ein weiterer Schwerpunkt ist die theoretische Einordnung von Mitgliedertypen und Mitgliederrollen in Netzwerken. Mithilfe der Großgruppenmethode der Gruppendiskussion wird ein Untersuchungskollektiv betrachtet und die Kommunikationsstrukturen dessen identifiziert. Die Arbeitsform World Café wird mit dem Untersuchungskollektiv umgesetzt, um den Informationsfluss in einem Netzwerk deutlich zu machen. Durch die qualitative Herangehensweise an das Forschungsvorhaben können analytische Elemente der Hermeneutik, der Grounded Theory und der qualitativen Inhaltsanalyse eingesetzt werden. Die vorliegende Arbeit zeigt, dass die Mitgliederstruktur in Netzwerken entscheidend zum Kommunikationserfolg beiträgt. Die Mitgliederstruktur des Untersuchungskollektivs kann dargestellt und durch Charaktertypen identifiziert werden. Diese Charaktertypen sind entscheidend für die Ansprache der Netzwerkmitglieder und für das Gelingen der Kommunikation in einem Netzwerk. Es werden in der Arbeit verschiedene Dimensionen der Kommunikationsqualität dargelegt. Mithilfe eines Kommunikationsmodells kann die Kommunikation eines Netzwerks bewertet und Schwachstellen aufgezeigt werden. Das wichtigste Ergebnis der Analyse ist die Notwendigkeit für den Überblick der Netzwerkmitgliederstruktur. Das Management eines Netzwerks erfordert das Wissen über die Mitgliedertypen und deren Kommunikationsgebaren. Durch die Kenntnis dieser Punkte können ein Netzwerk und seine Kommunikation erfolgreich sein.Companies have realized it for quite a while: “The future belongs to networks.” Whenever a company announces a cooperation its stock price rises. This holds true for the health-care sector as well. Government provides financial support for networks of doctors in order to achieve a greater efficiency. Right now 32% of all doctors work in networks. Concerning the segment of workplace health promotion, alliances of different disciplines can be observed more and more frequently. These alliances aim at counteracting the effects of demographic changes. Focusing the service sector, networks are a common form of organization. Especially in the manufacturing industries as well as the insurance sector networks can be found. Concerning healthcare services but above all the field of nutritional consulting, networks often are either not existent or not visible for externals. Up to now, science has mainly worked on the initiation and the closing down of networks. This thesis analyses existing network structures. The formation level of already existing networks, especially communication as well as providing information, can be seen as major factor in being successful. The analysis focuses on these aspects. A theoretical approach to the terms network and communication as well as the terms’ manifestations serves as analytical basis. The theoretical classification of types of members as well as the members’ tasks within a network will be a further focus. By using the “large group method“ of a group discussion, an investigation sample will be observed and its communication structure will be identified. The method “world café” will be realized in order to illustrate the information flow within a network. Due to a qualitative approach, analytical elements of hermeneutics, of the grounded theory and the qualitative content analysis can be applied. With this thesis, it’s proved that member structures within networks significantly contribute to a successful communication. This structure can be visualized which provides the possibility of identifying certain characters. These types of characters are not only important for the way of addressing network members but also for a successful way of communicating within the network. Different dimensions of communication quality are presented in this thesis. With the help of a communication model it’s possible to evaluate communication within a network and to show weak points. The most important conclusion of the analysis is the necessity of being able to review the structure of network members. Managing a network requires knowledge concerning the types of members as well as their way of communicating. Only in this way a network and its communication can be successful

Hydrophobic Mycobacterial Antigens Elicit Polyfunctional T Cells in Mycobacterium bovis Immunized Cattle:Association With Protection Against Challenge?

Bovine tuberculosis (bTB), caused by Mycobacterium bovis, is a chronic disease of cattle with a detrimental impact on food quality and production. Research on bTB vaccines has predominantly been focused on proteinaceous antigens. However, mycobacteria have a thick and intricate lipid outer layer and lipids as well as lipopeptides are important for immune-evasion and virulence. In humans, lipid extracts of M. tuberculosis have been shown to elicit immune responses effective against M. tuberculosisin vitro. Chloroform-methanol extraction (CME) was applied to M. bovis BCG to obtain a hydrophobic antigen extract (CMEbcg) containing lipids and lipopeptides. CMEbcg stimulated IFN-γ+IL-2+ and IL-17A+IL-22+ polyfunctional T cells and elicited T cell responses with a Th1 and Th17 cytokine release profile in both M. bovis BCG vaccinated and M. bovis challenged calves. Lipopeptides were shown to be the immunodominant antigens in CMEbcg, stimulating CD4 T cells via MHC class II. CMEbcg expanded T cells killed CMEbcg loaded monocytes and the CMEbcg-specific CD3 T cell proliferative response following M. bovis BCG vaccination was the best predictor for reduced pathology following challenge with M. bovis. Although the high predictive value of CMEbcg-specific immune responses does not confirm a causal relationship with protection against M. bovis challenge, when taking into account the in vitro antimycobacterial phenotype of CMEbcg-specific T cells (e.g. Th1/Th17 cytokine profile), it is indicative that CMEbcg-specific immune responses could play a functional role in immunity against M. bovis. Based on these findings we conclude that lipopeptides of M. bovis are potential novel subunit vaccine candidates and that further studies into the functional characterization of lipopeptide-specific immune responses together with their role in protection against bovine tuberculosis are warranted

CD47 restricts antiviral function of alveolar macrophages during influenza virus infection

CD47 is an ubiquitously expressed surface molecule with significant impact on immune responses. However, its role for antiviral immunity is not fully understood. Here, we revealed that the expression of CD47 on immune cells seemed to disturb the antiviral immune response as CD47-deficient mice (CD47−/−) showed an augmented clearance of influenza A virus (IAV). Specifically, we have shown that enhanced viral clearance is mediated by alveolar macrophages (aMФ). Although aMФ displayed upregulation of CD47 expression during IAV infection in wildtype mice, depletion of aMФ in CD47−/− mice during IAV infection reversed the augmented viral clearance. We have also demonstrated that CD47 restricts hemoglobin (HB) expression in aMФ after IAV and severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, with HB showing antiviral properties by enhancing the IFN-β response. Our study showed a negative role for CD47 during antiviral immune responses in the lung by confining HB expression in aMФ

Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database

BackgroundPredicting complications associated with pulmonary hypertension (PH) after cardiac transplantation is an important factor when considering cardiac transplantation. The transpulmonary gradient (TPG) is recommended to quantify PH in transplant candidates. Nonetheless, PH remains a common driver of mortality. The diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) can differentiate post- from combined pre- and post-capillary PH and may improve estimation of PH-associated risks. We used a large European cohort of transplant candidates to assess whether the pulmonary pulsatility index (PAPi), improves prediction of graft failure and mortality compared to DPG and PVR.MethodsOut of all patients undergoing heart transplantation between 2009 and 2019 in Eurotransplant member states (n = 10,465), we analyzed the impact of PH (mPAP > 25 mmHg) and right heart catheter hemodynamic data on graft failure and mortality within 1–5 years.ResultsIn 1,407 heart transplant patients with PH (79% male, median age 54 years, IQR 39–69 years), the median PVR was 2.5 WU (IQR 1.6 WU) with a median mPAP (pulmonary arterial pressure) of 32 mmHg (IQR 9 mmHg). Patients with low (< 3 mmHg) DPG had a better 5 year survival than those with higher DPG (log rank p = 0.023). TPG, mPAP, PAPi, and PVR did not improve prediction of survival. Low PAPi (OR = 2.24, p < 0.001) and high PVR (OR = 2.12, p = 0.005) were associated with graft failure.ConclusionPAPI and PVR are associated with graft failure in patients with PH undergoing cardiac transplantation. DPG is associated with survival in this cohort

Is Routine Audiometric Evaluation Necessary in Gynaecologic Tumour Patients Undergoing Chemotherapy?

Background: Our objective was to assess the auditory function ofgynaecological tumour patients who had received cytotoxic agents and todetermine their associated risk of ototoxicity. Patients and Methods: 87patients who had undergone chemotherapy for gynaecological malignancieswere investigated. Of these patients, 79% had breast cancer, and 14%ovarian cancer. All of the patients had a subjective assessment of theirhearing function on a visual analogue scale. Audiometric tests wereperformed before and at 9 weeks, 18 weeks and 3 months after completionof chemotherapy. Results: The age of the patients ranged from 32 to 71years (mean age of 53.5 +/- 10.5 years). The average subjective ratingof the patients’ hearing function was 83.0 +/- 17.2 before and 84.8 +/-16.9 3 months after completion of chemotherapy. No significantaudiometric change at either the speech hearing frequency range (0.5-2KHz) or high frequencies was observed in the patients afterchemotherapy. There was also no significant difference in the hearingthreshold of the patients who had received platinum analogue-basedchemotherapy compared to non-platinum analogue-based chemotherapy.Conclusion: Hearing loss is uncommon in patients treated with thetypical gynaecological chemotherapy protocols. Hence, routineaudiometric testing in these patients is not necessary

Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy

Objectives Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. Methods Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. Results This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (>= pT2) compared to low-grade biopsy. Conclusions High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU

VACCELERATE Site Network: Real-time definition of clinical study capacity in Europe

Background: The inconsistent European vaccine trial landscape rendered the continent of limited interest for vaccine developers. The VACCELERATE consortium created a network of capable clinical trial sites throughout Europe. VACCELERATE identifies and provides access to state-of-the-art vaccine trial sites to accelerate clinical development of vaccines. Methods: Login details for the VACCELERATE Site Network (vaccelerate.eu/site-network/) questionnaire can be obtained after sending an email to. Interested sites provide basic information, such as contact details, affiliation with infectious disease networks, main area of expertise, previous vaccine trial experience, site infrastructure and preferred vaccine trial settings. In addition, sites can recommend other clinical researchers for registration in the network. If directly requested by a sponsor or sponsor representative, the VACCELERATE Site Network pre-selects vaccine trial sites and shares basic study characteristics provided by the sponsor. Interested sites provide feedback with short surveys and feasibility questionnaires developed by VACCELERATE and are connected with the sponsor to initiate the site selection process. Results: As of April 2023, 481 sites from 39 European countries have registered in the VACCELERATE Site Network. Of these, 137 (28.5 %) sites have previous experience conducting phase I trials, 259 (53.8 %) with phase II, 340 (70.7 %) with phase III, and 205 (42.6 %) with phase IV trials, respectively. Infectious diseases were reported as main area of expertise by 274 sites (57.0 %), followed by any kind of immunosuppression by 141 (29.3 %) sites. Numbers are super additive as sites may report clinical trial experience in several indications. Two hundred and thirty-one (47.0 %) sites have the expertise and capacity to enrol paediatric populations and 391 (79.6 %) adult populations. Since its launch in October 2020, the VACCELERATE Site Network has been used 21 times for academic and industry trials, mostly interventional studies, focusing on different pathogens such as fungi, monkeypox virus, Orthomyxoviridae/influenza viruses, SARS-CoV-2, or Streptococcus pneumoniae/pneumococcus. Conclusions: The VACCELERATE Site Network enables a constantly updated Europe-wide mapping of experienced clinical sites interested in executing vaccine trials. The network is already in use as a rapid-turnaround single contact point for the identification of vaccine trials sites in Europe.The VACCELERATE Site Network has received funding from the European Union’s Horizon 2020 research and innovation pro gramme (grant agreement No 101037867) and the German Federal Ministry of Education and Research (Bundesministerium für Bil dung und Forschung [BMBF]) (grant agreement No BMBF01KX2040).S

Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol

Introduction: Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. Methods and analysis: Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. Ethics and dissemination: The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. Trial registration number: Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200

Implicit Algorithms for Multi-Valued Input Support Manipulation

We present an implicit approach to solve problems arising in decomposition of incompletely specified multi-valued functions and relations. We introduce a new representation based on binaryencoded multi-valued decision diagrams (BEMDDs). This representation shares desirable properties of MDDs, in particular, compactness, and is applicable to weakly-specified relations with a large number of output values. This makes our decomposition approach particularly useful for data mining and machine learning. Using BEMDDs to represent multi-valued relations we have developed two complementary input support minimization algorithms. The first algorithm is efficient when the resulting support contains almost all initial variables; the second is efficient when it contains only a few. We propose a simple heuristic measure to choose which algorithm to use. Numerical results over a set of multi-valued benchmarks provide experimental evidence for the efficiency of our approach