The role of the regulatory framework for innovation activities: The EU ETS and the German paper industry

Based on a research framework which combines environmental economics and innovation studies, we explore the relevance of the regulatory framework for innovation activities in the German paper industry, with a focus on climate poli-cies. Innovation activities considered include research and development, adop-tion and organizational change. Empirically, we mainly rely on the survey data of paper producers and technology providers. Findings suggest that innovation activities are mainly governed by market factors and (as yet) are hardly affected by the European Emission Trading System and other climate policies. Also, the impact of these policies on innovation activities is lower for technology providers than for paper producers. However, the majority of companies expect the ef-fects of the regulatory climate policy framework on innovation to increase by 2020. --

Enhancing patient safety by integrating ethical dimensions to Critical Incident Reporting Systems

Background Critical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS. Methods A six-step approach combined the analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts' experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics. Results Four main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance. Conclusion The developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations' presence and effectiveness. The proposed enhancement could contribute to hospitals' ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction

Moralischer Stress bei Medizinstudierenden und ärztlichen Berufseinsteigenden

BACKGROUND The COVID-19 pandemic poses particular challenges for people working in the medical sector. Some of the medical students and young medical professionals who are starting their work in healthcare facilities during this time are confronted with extraordinary moral challenges. A~portion of them does not yet have sufficient coping skills to adequately deal with these challenges. This can lead to so-called moral distress (MoD). Permanent or intensive exposure to MoD can have serious consequences. Appropriate support services have the potential to improve the handling of MoD. OBJECTIVE This article aims to provide an overview of the current state of research on MoD among medical students and young medical professionals in order to sensitize lecturers with responsibility for education and training and doctors in leading positions to the problem. MAIN PART This article presents the scientific concept of MoD, known triggers, and options for prevention and intervention. The topic is presented with reference to the changes in patient care in the context of the COVID-19 pandemic and research needs are presented. CONCLUSION The article illustrates the necessity of a~German-language, interdisciplinary discourse on MoD among medical students and young professionals

Systematic Imaging of the anterior cerebral circulation with Transcranial Color-Coded Sonography using the Power-Mode

Zur systematischen Evaluierung der transkraniellen duplexsonographischen Darstellbarkeit der Karotisstrombahn wurden 50 gesunde Probanden mit gutem transtemporalen Schallfenster untersucht. Die konventionelle farbkodierte Duplexsonographie (TCCS) gilt im Bereich der Karotisstrombahn als eine geeignete Untersuchungsmethode zur Darstellung proximaler Gefäßabschnitte. Die Diagnose von Pathologien in distalen Gefäßsegmenten wie den M2-Segmenten der A. cerebri media, den A2-/A4-Segmenten der A. cerebri anterior und den intrakraniellen Abschnitten der A. carotis interna wird bisher mittels radiologisch-angiographischer Verfahren gestellt; der Ultraschall besitzt in diesem Bereich bisher noch einen untergeordneten diagnostischen Stellenwert bei Fehlen von Referenzwerten. Gerade in Zeiten dynamischer Betrachtungsweisen des Schlaganfalles ist der Einsatz von nichtinvasiven, real-time- Untersuchungen wie der Sonographie jedoch von enormer Bedeutung. Die vorliegenden Untersuchungen der A. cerebri media, der A. cerebri anterior sowie der intrakraniellen Abschnitte der A. carotis interna zeigen, dass die Darstellung auch distaler Abschnitte mittels TCCS im Power-Mode ohne Einsatz von Signalverstärkern bei gefäßgesunden Probanden mit ausreichend gutem Schallfenster zu einem hohen Prozentsatz möglich ist. Es wurden Verlaufsformen und Aufteilungsfiguren sowie die distalen Segmente der A.cerebri media und anterior erstmals im Ultraschall systematisch untersucht, Gefäßlängen sowie systolische und diastolische Strömungsgeschwindigkeiten bei gefäßgesunden Probanden erhoben. Ebenfalls wurde erstmalig eine funktionelle Untersuchung von linkshirnigen M2-Ästen bei den rechtshändigen Probanden basierend auf dem gut validierten sprachlichen Paradigma des word fluency tasks durchgeführt, wodurch ein erster Ansatz zur differenzierten Untersuchung spezieller kognitiver Funktionen mittels TCCS entwickelt wurde.We systematically studied the facilities of Transcranial Color-Coded Sonography (TCCS) in visualization distal vessel sections and analyzed length and flow parameters. Transtemporal TCCS in axial and coronar plane was performed in 50 subjects without detectable stenosis and complete visible M1-MCA segment

The role of the regulatory framework for innovation activities: the EU ETS and the German paper industry

Based on a research framework, which combines environmental economics and innovation studies, we explore the relevance of the regulatory framework for innovation activities in the German paper industry, with a focus on climate policies. Innovation activities considered include research and development, adoption and organisational change. Empirically, we mainly rely on the survey data of paper producers and technology providers. Findings suggest that innovation activities are mainly governed by market factors and (as yet) are hardly affected by the European emission trading system and other climate policies. Also, the impact of these policies on innovation activities is lower for technology providers than for paper producers. However, the majority of companies expect the effects of the regulatory climate policy framework on innovation to increase by 2020

Ethics in times of physical distancing: virtual training of ethical competences

Ethics teaching in medicine, nursing and other health care professions does not only consist of knowledge transfer that can be easily implemented digitally. Rather, it focuses on specific ethical competences (such as arguing and articulating one's own moral position) and attitudes (such as empathic patient orientation, critical self-reflection, and ambiguity tolerance), for whose development interactive formats are superior. Competence-oriented ethical learning goals are important for the development of professionalism, but require time, space and personal exchange. Due to contact restrictions and the widespread cancellation of (face-to-face) courses in the wake of the corona pandemic, ethics teaching was forced to keep its distance in many places, which posed great challenges. This article is based on an exchange of experiences from members of the working group ethik learning of the Academy for Ethics in Medicine about ethics teaching in times of physical distancing. Recommendations will be given on how ethical competence can be successfully taught in the context of exclusively digital teaching. Starting with the question what is at risk of being lost in digital teaching, the potentials of digital formats are explored and illustrated with concrete practical examples. Beyond ethics teaching, the article also aims to provide ideas and suggestions for other specialist and cross-sectional areas where interactive formats are central.Ethik-Lehre in Medizin, Pflege und anderen Gesundheitsberufen besteht nicht allein aus Wissensvermittlung, die digital gut umzusetzten ist. Im Mittelpunkt stehen vielmehr spezifische ethische Fertigkeiten (etwa Argumentieren und Artikulieren der eigenen moralischen Position) und Haltungen (etwa empathische Patientenorientierung, kritische Selbstreflexion und Ambiguitätstoleranz), für deren Entwicklung interaktive Formate besser geeignet sind. Kompetenzorientierte ethische Lernziele sind für die Entwicklung des professionellen Rollen- und Selbstverständnisses wichtig, erfordern jedoch Zeit, Raum und vor allem den persönlichen Austausch. Durch die Kontaktbeschränkungen und den fächendeckenden Ausfall von (Präsenz-)Lehrveranstaltungen im Zuge der Corona-Pandemie war die Ethik-Lehre vielerorts gezwungen, auf Abstand zu gehen, was grosse Herausforderungen mit sich brachte. Der Beitrag basiert auf einem Erfahrungsaustausch von Mitgliedern der Arbeitsgruppe ethik lerning der Fachgesellschaft Akademie für Ethik in der Medizin über Ethhik-Lehre in Zeiten von physical distancing. Es werden Empfehlungen gegeben, wie ethische Kompetenzvermittlung im Rahmen ausschliesslich digital stattfindender Lehre gelingen kann. Ausgehend davon, was bei digitalem Unterricht verlohren zu gehen droht, werden die Potentziale digitaler Formate ausgelotet und mit konkreten Praxisbeispielen illustriert. Über die Ethik-Lehre hinaus möchte der Beitrag auch Ideen und Anregungen für andere Fach-Querschnittsbereiche geben, bei denen interaktive Formate zentral sind.ISSN:2366-501

Clinical Priority Setting and Decision-Making in Sweden : A Cross-sectional Survey Among Physicians

Background: Priority setting in healthcare that aims to achieve a fair and efficient allocation of limited resources is a worldwide challenge. Sweden has developed a sophisticated approach. Still, there is a need for a more detailed insight on how measures permeate clinical life. This study aimed to assess physicians views regarding (1) impact of scarce resources on patient care, (2) clinical decision-making, and (3) the ethical platform and national guidelines for healthcare by the National Board of Health and Welfare (NBHW). Methods: An online cross-sectional questionnaire was sent to two groups in Sweden, 2016 and 2017. Group 1 represented 331 physicians from different departments at one University hospital and group 2 consisted of 923 members of the Society of Cardiology. Results: Overall, a 26% (328/1254) response rate was achieved, 49% in group 1 (162/331), 18% in group 2 (166/923). Scarcity of resources was perceived by 59% more often than at least once per month, whilst 60% felt less than well-prepared to address this issue. Guidelines in general had a lot of influence and 19% perceived them as limiting decision-making. 86% professed to be mostly independent in decision-making. 36% knew the ethical platform well and very well and 64% NBHWs national guidelines. 57% expressed a wish for further knowledge and training regarding the ethical platform and 51% for support in applying NBHWs national guidelines. Conclusion: There was a need for more support to deal with scarcity of resources and for increased knowledge about the ethical platform and NBHWs national guidelines. Independence in clinical decision-making was perceived as high and guidelines in general as important. Priority setting as one potential pathway to fair and transparent decision-making should be highlighted more in Swedish clinical settings, with special emphasis on the ethical platform

Stress and coping among stable-satisfied, stable-distressed and separated/divorced Swiss couples

This article presents a 5-year prospective longitudinal study exploring the effects of stress and individual and dyadic coping on relationship stability among couples in Switzerland. Stress and coping variables assessed at the beginning of the study (tl) were used as predictors for the relationship status five years later (i.e., stable-satisfied; stable-distressed; separated/divorced). At the time of first measurement, all three groups differed significantly in their stress and individual and dyadic coping profiles. On average, the stable-satisfied couples were characterized by a lower level of stress, practiced less dysfunctional individual coping strategies, and relied more frequently on interpersonal (dyadic) coping when dealing with stress. At the end of the five-year period, it was possible to classify couples with 62.1% accuracy into one of three groups-stable-satisfied, stable-distressed, or separated/divorced. On the basis of the predictor variables, 73.3% of the couples could be correctly classified as being either stable or unstable