Zusammenschluss von unfallchirurgischen Abteilungen zu einem regionalen TraumaNetzwerk (DGU): Eine qualitative Studie zu Auswirkungen auf Strukturen, Prozesse, Versorgungsqualität und Sozialkapital (social capital) am Beispiel des TraumaNetzwerks Ostbayern (TNO)

Hintergrund: In der heutigen Zeit gewinnt der Zusammenschluss von Kliniken zu regionalen Verbünden zunehmend an Bedeutung. Auch die Deutsche Gesellschaft für Unfallchirurgie (DGU) ist von dieser Entwicklung nicht verschont geblieben und hat im Jahre 2006 die Bildung von regionalen TraumaNetzwerken initiiert. Laut von der DGU herausgegebenem Weißbuch der Schwerverletztenversorgung sollten sich Kliniken in einem Gebiet insbesondere zur Optimierung der Versorgung von Polytraumatisierten organisieren und miteinander kooperieren und so auch eine Standardisierung und letztlich Verbesserung in der Behandlung der betroffenen Patienten erreicht werden. Ein TraumaNetzwerk beinhaltet in der Regel mindestens ein überregionales Traumazentrum, mehrere regionale Traumazentren und Kliniken der Regelversorgung, sogenannte lokale Traumazentren. Kennzeichen eines TraumaNetzwerks sind unter anderem die Formulierung von standardisierten Behandlungsabläufen und Verlegungskriterien, gemeinsame Ausbildungsprogramme und Qualitätszirkel sowie die Einrichtung von Telekommunikation. Das TraumaNetzwerk Ostbayern (TNO) ist das erste in Deutschland zertifizierte und zum Zeitpunkt der Datenerhebung – mit 26 beteiligten Kliniken – eines der größten von 49 in der Bundesrepublik und grenzüberschreitend existierenden TraumaNetzwerken. Bislang ist nicht untersucht worden, inwieweit die mit der Auditierung und Zertifizierung verbundenen strukturellen, organisatorischen oder personellen Veränderungen in den jeweiligen Kliniken aufgenommen wurden, ob es Probleme bei der Umsetzung der Vorgaben gab und wie eine möglicherweise neu entstandene Kooperation die Qualität sozialer Beziehungen innerhalb dieser Netzwerke verändert und Patientenversorgung oder Motivation der Teilnehmer beeinflusst. Letzteres lässt sich durch das Konzept des social capital erfassen; dies beschreibt die Ressourcen, die durch die Teilhabe an einem Netz sozialer Beziehungen entstehen können. Social capital ist klassischerweise in Regionen und Nachbarschaften analysiert, bislang aber nicht auf Klinikverbünde angewendet worden. Methodik: Für die Studie wurden semi-standardisierte face-to-face-Interviews mit den verantwortlichen unfallchirurgischen Ärzten von 23 der insgesamt 26 beteiligten Kliniken des TNO geführt. Erfragt wurden unter anderem intraklinische Veränderungen im Rahmen der TraumaNetzwerk-Mitgliedschaft, die Struktur der Zusammenarbeit, Entscheidungswege, die Identifikation mit dem Netzwerk, Reziprozität und Vertrauen sowie gemeinsames Agieren. Die Interviews wurden aufgezeichnet, transkribiert, anonymisiert und mittels systematischer Inhaltsanalyse ausgewertet. Ein Ethikvotum durch die Universität Regensburg war zuvor eingeholt worden. Ergebnisse: Als Ergebnisse dieser Erhebung lassen sich festhalten, dass die Teilnahme am TraumaNetzwerk die Behandlungsabläufe verändert hat, vor allem durch Einführung fester Algorithmen. Insbesondere lokale Traumazentren haben zudem eine materielle Aufrüstung erfahren. Der Austausch innerhalb des Netzwerkes findet hauptsächlich in vierteljährlichen TNO-Treffen oder Qualitätszirkeln aller Klinikvertreter statt, darüber hinaus vereinzelt in bilateralen Kontakten zwischen Kliniken. Die Entscheidungswege werden als transparent bewertet, die Mitglieder fühlen sich mehrheitlich gehört und eingebunden, was insbesondere auf den integrierenden Leitungsstil des TNO-Koordinators und das offene, von gegenseitigem Vertrauen geprägte Klima in der Gruppe zurückgeführt wird. Die meisten Interviewpartner bestätigen die Entwicklung eines gewissen Gemeinschaftsgefühls nach dem Motto ‚Wir Unfallchirurgen in Ostbayern‘, die Ausbildung eines Vertrauensverhältnisses untereinander sowie das Verfolgen gemeinsamer Ziele. Eine Kerngruppe hat sich zudem zu gemeinsamem berufspolitischem Engagement zusammengeschlossen. Nur wenige Interviewpartner geben an, medizinisch nicht zu profitieren oder sich in Versorgungsaspekten gelegentlich bevormundet zu fühlen. Nahezu alle interviewten Ärzte empfinden die Bildung eines Netzwerks subjektiv als eine Verbesserung in der Patientenversorgung, insbesondere die lokalen Kliniken, was hauptsächlich auf die Standardisierung in Abläufen und Ausbildung zurückgeführt wird. Die Verlegungspraxis habe sich insgesamt jedoch kaum geändert. Durch erleichterte Kommunikation und ein gewachsenes Zusammengehörigkeitsgefühl steige aber größtenteils die ärztliche Zufriedenheit. Diskussion: In der vorliegenden Studie konnte somit nachgewiesen werden, dass der Zusammenschluss unfallchirurgischer Kliniken zu einem regionalen TraumaNetzwerk zur Entstehung von social capital geführt hat, indem Vertrauen untereinander aufgebaut werden konnte und eine gemeinsame Kultur und Identität entstanden ist. Allerdings bleibt trotz der Kooperation eine Konkurrenz zwischen örtlich nahen Häusern bestehen. Die Ausbildung von social capital hängt dabei offensichtlich stark von der Leitung des TraumaNetzwerks ab, so dass vergleichende Untersuchungen in entsprechenden Pendants deutschland- wie weltweit sinnvoll erscheinen

MEDIATING THE TENSION BETWEEN DATA SHARING AND PRIVACY: THE CASE OF DMA AND GDPR

The Digital Markets Act (DMA) constitutes a crucial part of the European legislative framework addressing the dominance of ‘Big Tech’. It intends to foster fairness and competition in Europe’s digital platform economy by imposing obligations on ‘gatekeepers’ to share end-user-related information with business users. Yet, this may involve the processing of personal data subject to the General Data Protection Regulation (GDPR). The obligation to provide access to personal data in a GDPR-compliant manner poses a regulatory and technical challenge and can serve as a justification for gatekeepers to refrain from data sharing. In this research-in-progress paper, we analyze key tensions between the DMA and the GDPR through the paradox perspective. We argue through a task-technology fit approach how privacyenhancing technologies – particularly anonymization techniques – and portability could help mediate tensions between data sharing and privacy. Our contribution provides theoretical and practical insights to facilitate legal compliance

Mediating the Tension between Data Sharing and Privacy: The Case of DMA and GDPR

The Digital Markets Act (DMA) constitutes a crucial part of the European legislative framework addressing the dominance of 'Big Tech'. It intends to foster fairness and competition in Europe's digital platform economy by imposing obligations on 'gatekeepers' to share end-user-related information with business users. Yet, this may involve the processing of personal data subject to the General Data Protection Regulation (GDPR). The obligation to provide access to personal data in a GDPR-compliant manner poses a regulatory and technical challenge and can serve as a justification for gatekeepers to refrain from data sharing. In this research-in-progress paper, we analyze key tensions between the DMA and the GDPR through the paradox perspective. We argue through a task-technology fit approach how privacy-enhancing technologies-particularly anonymization techniques-and portability could help mediate tensions between data sharing and privacy. Our contribution provides theoretical and practical insights to facilitate legal compliance

The effects of improving hospital physicians working conditions on patient care: a prospective, controlled intervention study

Background: Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians' psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care. Methods: A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians' working conditions and patients' perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews. Results: Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients' relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work. Conclusions: This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care

Transition Pathways towards Design Principles of Self-Sovereign Identity

Society\u27s accelerating digital transformation during the COVID-19 pandemic highlighted clearly that the Internet lacks a secure, efficient, and privacy-oriented model for identity. Self-sovereign identity (SSI) aims to address core weaknesses of siloed and federated approaches to digital identity management from both users\u27 and service providers\u27 perspectives. SSI emerged as a niche concept in libertarian communities, and was initially strongly associated with blockchain technology. Later, when businesses and governments began to invest, it quickly evolved towards a mainstream concept. To investigate this evolution and its effects on SSI, we conduct design science research rooted in the theory of technological transition pathways. Our study identifies nine core design principles of SSI as deployed in relevant applications, and discusses associated competing political and socio-technical forces in this space. Our results shed light on SSI\u27s key characteristics, its development pathway, and tensions in the transition between regimes of digital identity management

The effects of improving hospital physicians working conditions on patient care: a prospective, controlled intervention study

Background: Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians' psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care. Methods: A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians' working conditions and patients' perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews. Results: Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients' relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work. Conclusions: This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care

Mediating the Tension between Data Sharing and Privacy: The Case of DMA and GDPR

The Digital Markets Act (DMA) constitutes a crucial part of the European legislative framework addressing the dominance of 'Big Tech'. It intends to foster fairness and competition in Europe's digital platform economy by imposing obligations on 'gatekeepers' to share end-user-related information with business users. Yet, this may involve the processing of personal data subject to the General Data Protection Regulation (GDPR). The obligation to provide access to personal data in a GDPR-compliant manner poses a regulatory and technical challenge and can serve as a justification for gatekeepers to refrain from data sharing. In this research-in-progress paper, we analyze key tensions between the DMA and the GDPR through the paradox perspective. We argue through a task-technology fit approach how privacy-enhancing technologies-particularly anonymization techniques-and portability could help mediate tensions between data sharing and privacy. Our contribution provides theoretical and practical insights to facilitate legal compliance

Transition Pathways towards Design Principles of Self-Sovereign Identity

Society’s accelerating digital transformation during the COVID-19 pandemic highlighted clearly that the Internet lacks a secure, efficient, and privacy-oriented model for identity. Self-sovereign identity (SSI) aims to address core weaknesses of siloed and federated approaches to digital identity management from both users’ and service providers’ perspectives. SSI emerged as a niche concept in libertarian communities, and was initially strongly associated with blockchain technology. Later, when businesses and governments began to invest, it quickly evolved towards a mainstream concept. To investigate this evolution and its effects on SSI, we conduct design science research rooted in the theory of technological transition pathways. Our study identifies nine core design principles of SSI as deployed in relevant applications, and discusses associated competing political and socio-technical forces in this space. Our results shed light on SSI’s key characteristics, its development pathway, and tensions in the transition between regimes of digital identity managemen

Unique, Gender-Dependent Serum microRNA Profile inPLS3 Gene-Related Osteoporosis

Plastin 3 (PLS3), encoded byPLS3, is a newly recognized regulator of bone metabolism, and mutations in the encoding gene result in severe childhood-onset osteoporosis. Because it is an X chromosomal gene,PLS3mutation-positive males are typically more severely affected whereas females portray normal to increased skeletal fragility. Despite the severe skeletal pathology, conventional metabolic bone markers tend to be normal and are thus insufficient for diagnosing or monitoring patients. Our study aimed to explore serum microRNA (miRNA) concentrations in subjects with defective PLS3 function to identify novel markers that could differentiate subjects according to mutation status and give insight into the molecular mechanisms by which PLS3 regulates skeletal health. We analyzed fasting serum samples for a custom-designed panel comprising 192 miRNAs in 15 mutation-positive (five males, age range 8-76 years, median 41 years) and 14 mutation-negative (six males, age range 8-69 years, median 40 years) subjects from four Finnish families with differentPLS3mutations. We identified a unique miRNA expression profile in the mutation-positive subjects with seven significantly upregulated or downregulated miRNAs (miR-93-3p, miR-532-3p, miR-133a-3p, miR-301b-3p, miR-181c-5p, miR-203a-3p, and miR-590-3p;pvalues, range .004-.044). Surprisingly, gender subgroup analysis revealed the difference to be even more distinct in female mutation-positive subjects (congruentpvalues, range .007-.086) than in males (pvalues, range .127-.843) in comparison to corresponding mutation-negative subjects. Although the seven identified miRNAs have all been linked to bone metabolism and two of them (miR-181c-5p and miR-203a-3p) have bioinformatically predicted targets in thePLS33 ' untranslated region (3 '-UTR), none have previously been reported to associate with PLS3. Our results indicate thatPLS3mutations are reflected in altered serum miRNA levels and suggest there is crosstalk between PLS3 and these miRNAs in bone metabolism. These provide new understanding of the pathomechanisms by which mutations inPLS3lead to skeletal disease and may provide novel avenues for exploring miRNAs as biomarkers in PLS3 osteoporosis or as target molecules in future therapeutic applications. (c) 2020 The Authors.Journal of Bone and Mineral Researchpublished by American Society for Bone and Mineral Research.Peer reviewe

Link between interlayer hybridization and ultrafast charge transfer in WS2-graphene heterostructures

Ultrafast charge separation after photoexcitation is a common phenomenon in various van-der-Waals (vdW) heterostructures with great relevance for future applications in light harvesting and detection. Theoretical understanding of this phenomenon converges towards a coherent mechanism through charge transfer states accompanied by energy dissipation into strongly coupled phonons. The detailed microscopic pathways are material specific as they sensitively depend on the band structures of the individual layers, the relative band alignment in the heterostructure, the twist angle between the layers, and interlayer interactions resulting in hybridization. We used time- and angle-resolved photoemission spectroscopy combined with tight binding and density functional theory electronic structure calculations to investigate ultrafast charge separation and recombination in WS2-graphene vdW heterostructures. We identify several avoided crossings in the band structure and discuss their relevance for ultrafast charge transfer. We relate our own observations to existing theoretical models and propose a unified picture for ultrafast charge transfer in vdW heterostructures where band alignment and twist angle emerge as the most important control parameters