Search

The short report provides insights into the most important results from a survey conducted in October 2022.

Childhood compared to adolescence and adulthood is characterized by high neuroplasticity represented by accelerated cognitive maturation and rapid cognitive developmental trajectories. Natural growth, biological maturation and permanent interaction with the physical and social environment fosters motor and cognitive development in children. Of note, the promotion of physical activity, physical fitness, and motor skill learning at an early age is mandatory first, as these aspects are essential for a healthy development and an efficient functioning in everyday life across the life span and second, physical activity behaviors and lifestyle habits tend to track from childhood into adulthood. The main objective of the present thesis was to optimize and deepen the knowledge of motor and cognitive performance in young children and to develop an effective and age-appropriate exercise program feasible for the implementation in kindergarten and preschool settings. A systematic review with meta-analysis was conducted to examine the effectiveness of fundamental movement skill and exercise interventions in healthy preschool-aged children. Further, the relation between measures of physical fitness (i.e., static balance, muscle strength, power, and coordination) and attention as one domain of cognitive performance in preschool-aged children was analyzed. Subsequently, effects of a strength-dominated kindergarten-based exercise program on physical fitness components (i.e., static balance, muscle strength, power, and coordination) and cognitive performance (i.e., attention) compared to a usual kindergarten curriculum was examined. The systematic review included trials focusing on healthy young children in kindergarten or preschool settings that applied fundamental movement skill-enhancing intervention programs of at least 4 weeks and further reported standardized motor skill outcome measures for the intervention and the control group. Children aged 4-6 years from three kindergartens participated in the cross-sectional and the longitudinal study. Product-orientated measures were conducted for the assessment of muscle strength (i.e., handgrip strength), muscle power (i.e., standing long jump), balance (i.e., timed single-leg stand), coordination (hopping on right/left leg), and attentional span (i.e., “Konzentrations-Handlungsverfahren für Vorschulkinder” [concentration-action procedure for preschoolers]). With regards to the scientific literature, exercise and fundamental movement skill interventions are an effective method to promote overall proficiency in motor skills (i.e., object control and locomotor skills) in preschool children particularly when conducted by external experts with a duration of 4 weeks to 5 months. Moreover, significant medium associations were found between the composite score of physical fitness and attention as well as between coordination separately and attention in children aged 4-6 years. A 10-weeks strength-dominated exercise program implemented in kindergarten and preschool settings by educated and trained kindergarten teachers revealed significant improvements for the standing long jump test and the Konzentrations-Handlungsverfahren of intervention children compared to children of the control group. The findings of the present thesis imply that fundamental movement skill and exercise interventions improve motor skills (i.e., locomotor and object control skills). Nonetheless, more high-quality research is needed. Additionally, physical fitness, particularly high performance in complex fitness components (i.e., coordination measured with the hopping on one leg test), tend to predict attention in preschool age. Furthermore, an exercise program including strength-dominated exercises, fundamental movement skills and elements of gymnastics has a beneficial effect on jumping performance with a concomitant trend toward improvements in attentional capacity in healthy preschool children. Finally, it is recommended to start early with the integration of muscular fitness (i.e., muscle strength, muscle power, muscular endurance) next to coordination, agility, balance, and fundamental movement skill exercises into regular physical activity curriculums in kindergarten settings., Das Kindesalter ist im Vergleich zum Jugend- und Erwachsenenalter durch eine hohe Neuroplastizität, charakterisiert, welche durch beschleunigte Reifungsprozesse und rasche kognitive Entwicklungsverläufe gekennzeichnet ist. Natürliches Wachstum, biologische Reifung und die permanente Auseinandersetzung mit der physischen und sozialen Umwelt unterstützen und fördern die motorische und kognitive Entwicklung von Kindern. Bemerkenswert ist, dass bereits ab dem frühen Kindesalter die Förderung von körperlicher Aktivität, motorischen Fähigkeiten und Fertigkeiten unablässig ist, da sie zum einen wesentliche Faktoren für eine gesunde Entwicklung sowie eine effiziente alltägliche Funktionstüchtigkeit im Lebensverlauf darstellen und zum anderen das Aktivitätsverhalten und die Lebensgewohnheiten des Kindesalters tendenziell ins Erwachsenenalter übernommen werden. Die Zielstellung der vorliegenden Arbeit war es, das Wissen über motorische und kognitive Leistungsfähigkeit im frühen Kindesalter zu vertiefen und effektive altersgerechte Bewegungsprogramme für die Umsetzung im Setting Kindertagesstätte zu entwickeln. Es wurde ein systematisches Review mit Metaanalyse erarbeitet, um die Effekte von Bewegungsprogrammen zur Verbesserung elementarer Bewegungsfertigkeiten bei gesunden Vorschulkindern zu untersuchen. Zudem wurden die Zusammenhänge zwischen motorischen Fähigkeiten (z.B. statisches Gleichgewicht, Maximalkraft, Schnellkraft und Koordination) und der Konzentration, als ein Bereich der kognitiven Leistungsfähigkeit, im Kindesalter analysiert. Anschließend wurde die Wirksamkeit eines kraft-orientierten Bewegungsprogramms gegenüber einem gewöhnlichen Kindergartencurriculums auf motorische Fähigkeiten, wie statisches Gleichgewicht, Maximalkraft, Schnellkraft und Koordination sowie auf kognitive Leistungsfähigkeit, wie die Konzentration, überprüft. Das systematische Review beinhaltete Studien mit gesunden jungen Kindern im Setting Kindertagesstätte, welche Bewegungsprogramme von mindestens 4 Wochen zur Verbesserung der elementaren Bewegungsfertigkeiten durchführten und Ergebnisse der Interventions- sowie Kontrollgruppen mithilfe standardisierter motorischer Tests berichteten. In der Querschnitts- und Längsschnittstudie nahmen Kinder im Alter von 4-6 Jahren aus drei Kindertagesstätten teil. Ergebnisorientierte motorische Messungen wurden durchgeführt, um die Maximalkraft (Handkraft), die Schnellkraft (Standweitsprung), das Gleichgewicht (Einbeinstand), die Koordination (einbeiniges Hüpfen rechts/links) und die Konzentrationsfähigkeit (Konzentrations-Handlungsverfahren für Vorschulkinder (KHV-VK)) zu erheben. Mit Bezug zur wissenschaftlichen Literatur stellen Bewegungsprogramme eine effektive Möglichkeit dar, motorische Fertigkeiten (lokomotorische sowie objektbezogene Fertigkeiten) bei Vorschulkindern zu fördern, vor allem, wenn sie von externen Experten durchgeführt werden und eine Dauer von 4 Wochen bis 5 Monaten haben. Darüber hinaus konnten signifikante Zusammenhänge zwischen motorischen Fähigkeiten und der Konzentration sowie insbesondere zwischen der Koordination allein und der Konzentration bei Kindern im Alter von 4-6 Jahren gefunden werden. Ein 10-wöchiges kraft-orientiertes Bewegungsprogramm, welches durch geschultes und qualifiziertes Kindergartenpersonal in Kindertagesstätten durchgeführt wurde, führte zudem zu signifikanten Verbesserungen im Standweitsprung und im KHV-VK bei Kindern der Interventionsgruppe im Vergleich zu Kontrollgruppe. Die Ergebnisse der vorliegenden Arbeit zeigen, dass Bewegungsprogramme motorische Fertigkeiten, wie lokomotorische und objektbezogenen Fertigkeiten, verbessern. Dennoch gibt es Bedarf an weiterführenden, methodisch gut designten und qualitativ hochwertigen Interventionsstudien. Motorische Fähigkeiten, besonders gut ausgebildete komplexe Fähigkeiten wie die Koordination (gemessen mit dem einbeinigen Hüpfen), scheinen die Konzentrationsfähigkeit im Vorschulalter zu beeinflussen. Zudem verbessert ein Trainingsprogramm mit kraft-orientierte Übungen, elementare Bewegungsfertigkeiten und turnerischen Elementen die Sprungleistung und scheint gleichzeitig einen Einfluss auf die Konzentrationsfähigkeit bei gesunden Vorschulkindern zu haben. Letztendlich empfiehlt es sich, bereits in jungen Jahren Kraftfähigkeiten, wie Maximal- und Schnellkraft und Kraftausdauer neben Koordination, Agilität, Gleichgewicht und elementaren Bewegungsfertigkeiten zu schulen und diese in regelmäßige Bewegungsstunden im Setting Kindertagesstätte zu integrieren.

In recent years there have been numerous technical innovations such as CGM systems or insulin pumps that have made life easier for people with type 1 diabetes. However, this also means that more and more information is available. The aim of the present study is to find out more about the daily handling of information. The following research question was asked: What information do people with type 1 diabetes use? To answer this research question, a quantitative online survey of people with type 1 diabetes was conducted by Prof. Dr. Matthias Fank at the Technical University of Cologne. The online survey mainly consisted of 25 closed questions, which were asked on a scale from 0 to 10. The responses of 1,025 people who are at least 18 years old were included in the evaluation. The most important information for type 1 diabetics is the "current value". 67.5% have this on Place 1 placed. Current glucose levels are provided by CGM systems used by 94.2% of people with type 1 diabetes. Quarterly visits to the diabetologist are important and provide important information. 30.8% “completely” agree with this statement on a scale from 0 to 10. Only 2.2% of people with type 1 diabetes are satisfied with their current diabetes management apps. There is a desire for a manufacturer-independent app. The strongest agreement with a value of 10 was chosen by almost a quarter (24.6%) of the people with type 1 diabetes. The study provides an insight into diabetes therapy and shows the need for action.

An ever-increasing number of prediction models is published every year in different medical specialties. Prognostic or diagnostic in nature, these models support medical decision making by utilizing one or more items of patient data to predict outcomes of interest, such as mortality or disease progression. While different computer tools exist that support clinical predictive modeling, I observed that the state of the art is lacking in the extent to which the needs of research clinicians are addressed. When it comes to model development, current support tools either 1) target specialist data engineers, requiring advanced coding skills, or 2) cater to a general-purpose audience, therefore not addressing the specific needs of clinical researchers. Furthermore, barriers to data access across institutional silos, cumbersome model reproducibility and extended experiment-to-result times significantly hampers validation of existing models. Similarly, without access to interpretable explanations, which allow a given model to be fully scrutinized, acceptance of machine learning approaches will remain limited. Adequate tool support, i.e., a software artifact more targeted at the needs of clinical modeling, can help mitigate the challenges identified with respect to model development, validation and interpretation. To this end, I conducted interviews with modeling practitioners in health care to better understand the modeling process itself and ascertain in what aspects adequate tool support could advance the state of the art. The functional and non-functional requirements identified served as the foundation for a software artifact that can be used for modeling outcome and risk prediction in health research. To establish the appropriateness of this approach, I implemented a use case study in the Nephrology domain for acute kidney injury, which was validated in two different hospitals. Furthermore, I conducted user evaluation to ascertain whether such an approach provides benefits compared to the state of the art and the extent to which clinical practitioners could benefit from it. Finally, when updating models for external validation, practitioners need to apply feature selection approaches to pinpoint the most relevant features, since electronic health records tend to contain several candidate predictors. Building upon interpretability methods, I developed an explanation-driven recursive feature elimination approach. This method was comprehensively evaluated against state-of-the art feature selection methods. Therefore, this thesis' main contributions are three-fold, namely, 1) designing and developing a software artifact tailored to the specific needs of the clinical modeling domain, 2) demonstrating its application in a concrete case in the Nephrology context and 3) development and evaluation of a new feature selection approach applicable in a validation context that builds upon interpretability methods. In conclusion, I argue that appropriate tooling, which relies on standardization and parametrization, can support rapid model prototyping and collaboration between clinicians and data scientists in clinical predictive modeling. Die Zahl der jährlich veröffentlichten Vorhersagemodelle in verschiedenen medizinischen Fachrichtungen nimmt stetig zu. Solche prognostischen oder diagnostischen Modelle helfen bei der medizinischen Entscheidungsfindung, indem sie zum Beispiel Vorhersagen zur Mortalität oder zum Krankheitsverlauf erlauben. Obwohl bereits Softwarewerkzeuge für die Entwicklung klinischer Vorhersagemodelle existieren, genügt der Stand der Technik noch immer nicht den Anforderungen klinischer Wissenschaftler. So kommt es, dass aktuelle Softwarewerkzeuge zur Modellentwicklung entweder 1) auf die Anforderungen von Datenwissenschaftlicher zugeschnitten sind und folglich Programmierkenntnisse voraussetzen, oder 2) zu generisch sind und somit den tatsächlichen Anforderungen klinischer Wissenschaftler nicht gerecht werden. Überdies wird die Reproduzierbarkeit der Modelle sowie die Durchführung und Validierung von Experimenten durch verteilte Datenbestände und Informationen, sogenannte Datensilos, stark eingeschränkt. Ähnlich verhält es sich bei der Akzeptanz von Modellen des maschinellen Lernens, welche ohne interpretierbare Erklärungen von Vorhersagen kaum gegeben sein dürfte. Eine auf diese Anforderungen klinischer Modellbildung ausgerichtete Softwarelösung kann dabei helfen, die identifizierten Herausforderungen bezüglich Modellentwicklung, -validierung und -interpretation zu bewältigen und die Akzeptanz und Nutzung unter Klinikern zu stärken. Um den Modellierungsprozess zu verstehen und zu eruieren, in welchem Ausmaß eine angemessene Softwarelösung den Stand der Technik voranbringen könnte, wurden im Zuge dieser Arbeit Interviews mit praktizierenden Modellierern im Gesundheitsbereich geführt. Daraus leiten sich funktionale und nichtfunktionale Anforderungen ab, die als Grundlage eines Softwareartefaktes für die Modellierung von Outcome- und Risikovorhersagen in der Gesundheitsforschung verwendet wurden. Um die Eignung meines Ansatzes zu verifizieren, habe ich den Anwendungsfall „akutes Nierenversagen“ im Bereich der Nephrologie in zwei verschiedenen Krankenhäusern betrachtet und validiert. Darüber hinaus wurde eine Nutzerevaluierung durchgeführt um herauszufinden, ob ein solcher Ansatz im Vergleich zum Stand der Technik Vorteile bietet und inwieweit klinische Praktiker davon profitieren können. Außerdem müssen praktizierende Kliniker bei der Aktualisierung von Modellen für die externe Validierung Ansätze zur Merkmalsselektion anwenden, da elektronische Gesundheitsakten in der Regel mehrere erklärende Merkmale enthalten. Aufbauend auf Methoden zur Interpretierbarkeit habe ich einen erklärungsorientierten rekursiven Eliminierungsansatz entwickelt. Dieser neue Ansatz wurde umfassend mit Standardverfahren der Merkmalsselektion verglichen. Daraus leiten sich folgende Forschungsbeiträge dieser Arbeit ab: 1) Entwurf und Entwicklung eines Softwareartefakts, welches auf die speziellen Bedürfnisse der klinischen Modellierungsdomäne zugeschnitten ist, 2) Demonstration seiner Anwendbarkeit für das konkrete Fallbeispiel „akutes Nierenversagen“ und 3) Entwicklung und Evaluierung eines neuen, auf Interpretierbarkeitsmethoden basierenden Ansatzes, zur Merkmalsselektion in einem Validierungskontext. Zusammenfassend ist zu folgern, dass ein geeignetes auf Standardisierung und Parametrisierung gestütztes Tool die schnelle prototypische Entwicklung und die Zusammenarbeit von Klinikern und Datenwissenschaftlern an klinischen Vorhersagemodellen unterstützen kann.

Educational institutions have increasing needs for professional digital communication. When selecting suitable communication tools, there is a need for appropriate information as a basis for decision-making. Messenger communication in particular is strongly integrated into people's private everyday lives. While needs for extensive data-secure communication in educational contexts are increasing, there is a lack of concepts for data-protected and privacy-preserving support of educational processes through software (Karaboga et al 2014; Digitalcourage e.V. n.d.) , as well as for mandatory training for professionals (Zorn, Tillmann, and Kaminski 2014; Imort and Niesyto 2014), and reliable information for viable software alternatives. This paper outlines the specific requirements of educational institutions when selecting suitable software, using messenger communication as an example. From these requirements, criteria for needed information are presented as a basis for software selection decisions in three categories: data protection/privacy, accessibility/low-barrier, practicability. Since no criteria and good practice suggestions were available so far, a study was conducted to elicit the characteristics of potentially suitable messenger software. To this end, the necessary criteria for the three categories mentioned were first defined and then German and well-known international messengers were tested for data protection criteria. Based on the results for conformity with the EU's General Data Protection Regulation (GDPR) as an inclusion criterion, the messengers in question were subjected to a practical test. In the process, additional practicality criteria were developed, in part iteratively. In addition to institution-internal messengers, six services were identified among the freely available provider-dependent messengers that can be used in a GDPR-compliant manner, at least for users over the age of 16. At the time of publication, this leaves only five: Threema, Wire, SID, Ginlo, Chiffry. Furthermore, provider-independent messenger systems that adhere to the international standard protocol for the exchange of chat messages (XMPP) appear to be a viable option for educational institutions. In-house or commissioned server hosting would then be possible and a corresponding agreement for commissioned data processing can be concluded with an IT service provider. The decisions to use "Wire" and "Threema Work" in the IDiT project context are explained and justified. The context was vocational training for prospective office management clerks at vocational schools and vocational training centers. Although the underlying considerations are tailored to the project context (application in the Berufsförderungswerk Köln), they can be generalized.

In C3 plants, CO2 diffuses into the leaf and is assimilated by the Calvin-Benson cycle in the mesophyll cells. It leaves Rubisco open to its side reaction with O2, resulting in a wasteful cycle known as photorespiration. A sharp fall in atmospheric CO2 levels about 30 million years ago have further increased the side reaction with O2. The pressure to reduce photorespiration led, in over 60 plant genera, to the evolution of a CO2-concentrating mechanism called C4 photosynthesis; in this mode, CO2 is initially incorporated into 4-carbon organic acids, which diffuse to the bundle sheath and are decarboxylated to provide CO2 to Rubisco. Some genera, like Flaveria, contain several species that represent different steps in this complex evolutionary process. However, the majority of terrestrial plant species did not evolve a CO2-concentrating mechanism and perform C3 photosynthesis. This thesis compares photosynthetic metabolism in several species with C3, C4 and intermediate modes of photosynthesis. Metabolite profiling and stable isotope labelling were performed to detect inter-specific differences changes in metabolite profile and, hence, how a pathway operates. The results obtained were subjected to integrative data analyses like hierarchical clustering and principal component analysis, and were deepened by correlation analyses to uncover specific metabolic features and reaction steps that were conserved or differed between species. The main findings are that Calvin-Benson cycle metabolite profiles differ between C3 and C4 species and between different C3 species, including a very different response to rising irradiance in Arabidopsis and rice. These findings confirm Calvin-Benson cycle operation diverged between C3 and C4 species and, most unexpectedly, even between different C3 species. Moreover, primary metabolic profiles supported the current C4 evolutionary model in the genus Flaveria and also provided new insights and opened up new questions. Metabolite profiles also point toward a progressive adjustment of the Calvin-Benson cycle during the evolution of C4 photosynthesis. Overall, this thesis point out the importance of a metabolite-centric approach to uncover underlying differences in species apparently sharing the same photosynthetic routes and as a valid method to investigate evolutionary transition between C3 and C4 photosynthesis., Bei C3-Pflanzen diffundiert CO2 in das Blatt und wird durch den Calvin-Benson-Zyklus in den Mesophyllzellen assimiliert. Dies l��sst Rubisco f��r seine Nebenreaktion mit O2 offen, was zu einem verschwenderischen Kreislauf f��hrt, der als Photorespiration bekannt ist. Ein starker R��ckgang der atmosph��rischen CO2-Konzentration vor etwa 30 Millionen Jahren hat die Nebenreaktion mit O2 weiter verst��rkt. Der Druck, die Photorespiration zu reduzieren, hat in ��ber 60 Pflanzengattungen zur Entwicklung eines CO2-Konzentrationsmechanismus namens C4-Photosynthese gef��hrt. In diesem Mechanismus wird CO2 zun��chst in organische C4-Kohlenstoffs��uren eingebaut, die zur B��ndelscheide diffundieren und dort decarboxyliert werden, um CO2 f��r Rubisco bereitzustellen. Einige Gattungen, wie z.B. Flaveria, enthalten mehrere Arten, die verschiedene Schritte dieses komplexen Evolutionsprozesses darstellen. Die Mehrheit der terrestrischen Pflanzenarten hat jedoch keinen CO2-Konzentrationsmechanismus entwickelt und betreibt C3-Photosynthese. Diese Arbeit vergleicht den Photosynthese-Metabolismus in mehreren Spezies mit C3-, C4- und intermedi��ren Arten der Photosynthese. Metaboliten-Profiling und stabile Isotopenmarkierung wurden durchgef��hrt, um interspezifische Unterschiede im Metabolitenprofil und damit die Funktionsweise der Stoffwechselwege zu erkennen. Die Ergebnisse wurden integrativen Datenanalysen wie hierarchischem Clustering und Hauptkomponentenanalyse unterzogen und durch Korrelationsanalysen vertieft, um spezifische metabolische Merkmale und Reaktionsschritte aufzudecken, die konserviert oder zwischen Spezies verschieden sind. Die wichtigsten Ergebnisse sind, dass sich die Metabolitenprofile des Calvin-Benson-Zyklus zwischen C3- und C4-Spezies und zwischen verschiedenen C3-Spezies unterscheiden, einschlie��lich einer sehr unterschiedlichen Reaktion auf steigende Strahlungsintensit��t bei Arabidopsis und Reis. Diese Ergebnisse best��tigen, dass der Calvin-Benson-Zyklus zwischen C3- und C4-Spezies und, h��chst unerwartet, sogar zwischen verschiedenen C3-Spezies divergiert. Dar��ber hinaus unterst��tzen die prim��ren Stoffwechselprofile das aktuelle C4-Evolutionsmodell in der Gattung Flaveria, liefern auch neue Erkenntnisse und er��ffnen neue Fragen. Die Metabolitenprofile weisen auch auf eine fortschreitende Anpassung des Calvin-Benson-Zyklus w��hrend der Evolution der C4-Photosynthese hin. Insgesamt unterstreicht diese Dissertation die Bedeutung eines metabolitenzentrierten Ansatzes, um Unterschiede in Arten aufzudecken, die anscheinend dieselben Photosynthesewege teilen, und als valide Methode zur Untersuchung des evolution��ren ��bergangs zwischen C3- und C4-Photosynthese.

Background: The characteristics of osteoporosis are decreased bone mass and destruction towards the microarchitecture of bone tissue, which raises the risk of fracture. Psychosocialstress and osteoporosis are linked by sympathetic nervous system, hypothalamic-pituitary-adrenal axis, and other endocrine factors. Psychosocial stress causes a series of effects on the organism, and this long-term depletion at the cellular level is considered to be mitochondrial allostatic load, including mitochondrial dysfunction and oxidative stress. Extracellular vesicles (EVs) are involved in the mitochondrial allostatic load process and may as biomarkers in this setting. As critical participants during cell-to-cell communications, EVs serve as transport vehicles for nucleic acid and proteins, alter the phenotypic and functional characteristics of their target cells, and promote cell-to-cell contact. And hence, they play a significant role in the diagnosis and therapy of many diseases, such as osteoporosis. Aim: This narrative review attempts to outline the features of EVs, investigate their involvement in both psychosocial stress and osteoporosis, and analyze if EVs can be potential mediators between both. Methods: The online database from PubMed, Google Scholar, and Science Direct were searched for keywords related to the main topic of this study, and the availability of all the selected studies was verified. Afterward, the findings from the articles were summarized and synthesized. Results: Psychosocial stress affects bone remodeling through increased neurotransmitters such as glucocorticoids and catecholamines, as well as increased glucose metabolism. Furthermore, psychosocial stress leads to mitochondrial allostatic load, including oxidative stress, which may affect bone remodeling. In vitro and in vivo data suggest EVs might involve in the link between psychosocial stress and bone remodeling through the transfer of bioactive substances and thus be a potential mediator of psychosocial stress leading to osteoporosis. Conclusions: According to the included studies, psychosocial stress affects bone remodeling, leading to osteoporosis. By summarizing the specific properties of EVs and the function of EVs in both psychosocial stress and osteoporosis, respectively, it has been demonstrated that EVs are possible mediators of both, and have the prospects to be useful in innovative research areas. Hintergrund: Kennzeichnend für Osteoporose sind eine verringerte Knochenmasse und die Zerstörung der Mikroarchitektur des Knochengewebes, wodurch sich das Risiko von Knochenbrüchen erhöht. Psychosozialer Stress und Osteoporose sind durch das sympathische Nervensystem, die Hypothalamus-Hypophysen-Nebennieren-Achse und andere endokrine Faktoren miteinander verbunden. Psychosozialer Stress hat eine Reihe von Auswirkungen auf den Organismus, und diese langfristige Erschöpfung auf zellulärer Ebene wird als mitochondriale allostatische Belastung angesehen, die eine mitochondriale Dysfunktion und oxidativen Stress beinhaltet. Extrazelluläre Vesikel (EVs) sind in den mitochondrialen allostatischen Belastungsprozess involviert und können in diesem Zusammenhang als Biomarker dienen. Als kritische Teilnehmer der Zell-zu-Zell-Kommunikation dienen EVs als Transportmittel für Nukleinsäuren und Proteine, verändern die phänotypischen und funktionellen Eigenschaften ihrer Zielzellen und fördern den Zell-zu-Zell-Kontakt. Daher spielen sie eine wichtige Rolle bei der Diagnose und Therapie vieler Krankheiten, wie z. B. Osteoporose. Ziel: Diese Übersichtsarbeit soll die Eigenschaften von EVs und ihre Rolle in Hinblick auf den Zusammenhang zwischen psychosozialen Stress und Osteoporose zusammenfassen. Weiterhin wird untersucht, ob EVs in dem Zusammenhang eine potenzielle Mediatorenrolle zukommt. Methoden Die Online-Datenbanken PubMed, Google Scholar und Science Direct wurden anhand thematischer Stichwörter durchsucht und die Verfügbarkeit aller ausgewählten Studien überprüft. Anschließend wurden die Ergebnisse der Artikel zusammengefasst und miteinander in Verbindung setzen. Ergebnisse: Psychosozialer Stress führt zu einer Erhöhung der Transmitterkonzentrate wie Glukokortikoide und Katecholamine sowie einen erhöhten Glukosestoffwechsel, was jeweils Einfluss auf den Knochenumbau haben kann. Darüber hinaus führt psychosozialer Stress zu mitochondrialer allostatischer Last, einschließlich oxidativem Stress, was sich ebenfalls auf den Knochenumbau auswirken kann. Sowohl in vitro- als auch in vivo-Daten deuten darauf hin, dass EVs hierbei durch ihre Übertragung von bioaktiven Messengern eine relevante Mediatorenrolle einnehmen. Es ist anzunehmen, dass sie potenzielle Vermittler des Zusammenhangs von psychosozialem Stress und osteoporotischen Veränderungen sein können. Schlussfolgerung: Entlang der eingeschlossenen Studien besteht ein Zusammenhang zwischen psychosozialem Stress, dem Knochenumbau und damit der Entstehung von Osteoporose. In der Genese des negativen Einflusses auf die Knochengesundheit scheint EVs durch ihre Aktivität als Messenger-Transporter eine relevante Mediatorenrolle zuzukommen. Dieses Wissen hat das Potenzial für zukünftige innovative Forschungskonzepte.

Even though the majority of individuals know that exercising is healthy, a high percentage struggle to achieve the recommended amount of exercise. The (social-cognitive) theories that are commonly applied to explain exercise motivation refer to the assumption that people base their decisions mainly on rational reasoning. However, behavior is not only bound to reflection. In recent years, the role of automaticity and affect for exercise motivation has been increasingly discussed. In this dissertation, central assumptions of the affective–reflective theory of physical inactivity and exercise (ART; Brand & Ekkekakis, 2018), an exercise-specific dual-process theory that emphasizes the role of a momentary automatic affective reaction for exercise-decisions, were examined. The central aim of this dissertation was to investigate exercisers and non-exercisers automatic affective reactions to exercise-related stimuli (i.e., type-1 process). In particular, the two components of the ART’s type-1 process, that are, automatic associations with exercise and the automatic affective valuation to exercise, were under study. In the first publication (Schinkoeth & Antoniewicz, 2017), research on automatic (evaluative) associations with exercise was summarized and evaluated in a systematic review. The results indicated that automatic associations with exercise appeared to be relevant predictors for exercise behavior and other exercise-related variables, providing evidence for a central assumption of the ART’s type-1 process. Furthermore, indirect methods seem to be suitable to assess automatic associations. The aim of the second publication (Schinkoeth, Weymar, & Brand, 2019) was to approach the somato-affective core of the automatic valuation of exercise using analysis of reactivity in vagal HRV while viewing exercise-related pictures. Results revealed that differences in exercise volume could be regressed on HRV reactivity. In light of the ART, these findings were interpreted as evidence of an inter-individual affective reaction elicited at the thought of exercise and triggered by exercise-stimuli. In the third publication (Schinkoeth & Brand, 2019, subm.), it was sought to disentangle and relate to each other the ART’s type-1 process components—automatic associations and the affective valuation of exercise. Automatic associations to exercise were assessed with a recoding-free variant of an implicit association test (IAT). Analysis of HRV reactivity was applied to approach a somatic component of the affective valuation, and facial reactions in a facial expression (FE) task served as indicators of the automatic affective reaction’s valence. Exercise behavior was assessed via self-report. The measurement of the affective valuation’s valence with the FE task did not work well in this study. HRV reactivity was predicted by the IAT score and did also statistically predict exercise behavior. These results thus confirm and expand upon the results of publication two and provide empirical evidence for the type-1 process, as defined in the ART. This dissertation advances the field of exercise psychology concerning the influence of automaticity and affect on exercise motivation. Moreover, both methodical implications and theoretical extensions for the ART can be derived from the results. Obwohl die meisten Menschen wissen, dass Sport gesund ist, hat ein hoher Prozentsatz Mühe, die empfohlenen Bewegungsumfänge zu erreichen. Sozial-kognitive Theorien, die üblicherweise zur Erklärung von Sportmotivation angewendet werden, stützen sich auf die Annahme, dass Menschen ihre Entscheidungen hauptsächlich auf Grund rationaler Überlegungen treffen. Unser Verhalten ist jedoch nicht immer rational. In den letzten Jahren ist die Rolle von Automatizität und Affekt für die Sportmotivation daher zunehmend diskutiert worden. In dieser Dissertation wurden zentrale Annahmen der affective–reflective theory zur Erklärung von körperlicher Inaktivität und Sporttreiben (ART; Brand & Ekkekakis, 2018), einer sportspezifischen Zwei-Prozesstheorie, die die Rolle einer momentanen automatischen affektiven Reaktion für Sportentscheidungen betont, überprüft. Das zentrale Ziel dieser Dissertation war die Untersuchung automatisch affektiver Reaktionen von Sportlern und Nicht-Sportlern auf sportbezogene Stimuli (i.e., Typ-1-Prozess). Insbesondere wurden die beiden in der ART beschrieben Komponenten dieser automatisch affektiven Reaktion, d.h. die automatischen Assoziationen zu Sport und die automatische affektive Valuation von Sport, untersucht. In der ersten Publikation (Schinkoeth & Antoniewicz, 2017) wurde die Forschung zu automatischen Assoziationen zu Sport in einem systematischen Review zusammengefasst und evaluiert. Die Ergebnisse deuteten darauf hin, dass automatische Assoziationen relevante Prädiktoren für das Sportverhalten und andere sportbezogene Variablen zu sein scheinen, was den Beweis für eine zentrale Annahme des Typ-1-Prozesses der ART lieferte. Darüber hinaus scheinen indirekte Methoden geeignet zu sein um automatische Assoziationen zu messen. Das Ziel der zweiten Publikation (Schinkoeth, Weymar, & Brand, 2019) war es, sich dem somato-affektiven Kern der automatischen Valuation von Sport mittels Analyse der Reaktivität der vagalen HRV bei Betrachtung von Sportbildern zu nähern. Die Ergebnisse zeigten, dass die HRV-Reaktivität Unterschiede im Sportumfang hervorsagen konnte. Im Licht der ART wurden diese Befunde als Hinweis auf eine interindividuelle affektive Reaktion interpretiert, die beim bloßen Gedanken an Sport hervorgerufen und durch die Sportbilder ausgelöst wurde. In der dritten Publikation (Schinkoeth & Brand, 2019, subm.) wurde versucht, die Typ-1-Prozesskomponenten der ART - automatische Assoziationen und die affektive Valuation von Sport - zu trennen und in Beziehung zueinander zu setzen. Automatische Assoziationen zu Sport wurden mit einer rekodierungsfreien Variante eines impliziten Assoziationstests (IAT) gemessen. Die Analyse der HRV-Reaktivität wurde genutzt, um sich einer somatischen Komponente der affektiven Valuation zu nähern, und Gesichtsreaktionen in einer Mimikaufgabe (GR) dienten als Indikatoren für die Valenz der automatischen affektiven Reaktion. Das Bewegungsverhalten wurde mittels Selbstbericht bewertet. Die Messung der Valenz der affektiven Valuation mit der GR-Aufgabe funktionierte in dieser Studie nicht. Es konnte aber gezeigt werden, dass die HRV-Reaktivität durch den IAT-Score hervorgesagt werden konnte und wiederum das selbstberichtete Sportverhalten statistisch vorhersagen konnte. Diese Ergebnisse bestätigen und erweitern somit die Ergebnisse der Publikation zwei und liefern empirische Evidenz für den Typ-1-Prozess, wie er in der ART definiert ist. Die Ergbenisse dieser Dissertation tragen dazu bei die Forschung Rund um den Einfluss von Automatizität und Affekt auf die Sportmotivation entscheidend voran zu treiben. Darüber hinaus lassen sich aus den Ergebnissen sowohl methodische Implikationen als auch theoretische Erweiterungen für die ART ableiten.

This paper aims to better understand the relationship between HIV knowledge and media exposure in India. We use a two-stage hurdle model to estimate the effect of media sources such as newspapers, radios and television on AIDS-related knowledge among Indian men and women using demographic health survey data. Overall, access to newspapers, radio, or television increases the likelihood of better HIV knowledge in both males and females by an order between 2% and 12%. These findings, albeit quantitatively small, suggest, even if indirectly, possible problems faced by AIDS campaigns and government programs in combating the HIV epidemic in India.

The effects of Internet education on economic growth are examined using a cross-section of 36 high-income countries. Internet usage rates are employed as a proxy for Internet education across countries. Regression results show that the frequent usage of the Internet has a positive and significant effect on economic growth. The estimated growth effect of Internet skills is also found to be greater than the growth effect of math and science skills. The results are, in general, robust across model specifications.

Recent debate on the effectiveness of tax rebates has concentrated on the degree to which they can affect economic activity, which depends on the methodology, the state of the economy, and the underlying assumptions. A better approach to assess the effectiveness of these monetary transfers is by comparing this method to alternative policies—like the traditional monetary injections through the financial intermediaries. A limited participation model calibrated to the U.S. economy is used to show that the higher the proportion of the monetary injection channeled through the consumers—instead of banks—leads to a less vigorous recovery of output but softens the detrimental effect on the utility of the representative household from the inherent inflationary pressure. This result is robust to the relative importance of the injection (utilization of resources) and alternative utility functions.

We study whether forecasts of the rate of change of the price of oil are rational. To this end, we consider a model that allows the shape of forecasters’ loss function to be studied. The shape of forecasters’ loss function may be consistent with a symmetric or an asymmetric loss function. We find that an asymmetric loss function often (but not always) makes forecasts look rational, and we also report that forecast rationality may have changed over time.

Background: Nowadays, an increasing number of discrete-choice experiments (DCEs) incorporate cost as an attribute. However, the inclusion of a cost attribute, particularly within collectively funded healthcare systems, can be challenging because health services or goods are generally not traded in a market situation and individuals are not used to paying for a service or a good at the point of consumption. Objective: To examine whether the inclusion of a cost attribute in a DCE results in different preferences regarding a surgical treatment for primary basal cell carcinoma (BCC) compared with a DCE without a cost attribute. Methods: A randomized study was performed in which the impact of a cost attribute on the general public's preferences for a surgical treatment (Mohs micrographic surgery [MMS] or standard excision [SE]) to remove BCC was examined. This was done by comparing the outcomes of two DCEs, one with a cost attribute (DCE_cost) and one without (DCE_nocost). Six attributes (recurrence, re-excision, travel time, surgical time, waiting time for surgical results, costs) and their levels were selected, based on results of a clinical trial, a cost-effectiveness study, a review and a focus group of patients who had recently received treatment for BCC. Outcomes of both DCEs were compared in terms of theoretical validity, relative importance of the attributes and the rank order of preferences. Results: A total of 615 respondents (n - 303 for DCE_nocost; n - 312 for DCE_cost) were interviewed by telephone. This gave an overall response rate of 38%. Respondents in DCE_nocost preferred a surgical treatment with a lower probability of recurrence, lower surgery time, lower waiting time and no risk for a re-excision. Respondents in DCE_cost showed the same preferences, but also preferred a treatment with less travel time and lower costs. Overall, respondents in both DCEs showed the same preference for a surgical treatment: MMS was preferred over SE. Conclusion: Results suggest that, in this population, the inclusion of a cost attribute in a DCE leads to the same preference regarding a surgical treatment to remove BCC as a DCE without a cost attribute. However, further research in different settings is needed to confirm these findings.

This article presents insights into the use of electronic health records (EHRs) by small physician practices participating in a CMS pay-for-performance demonstration. Site visits to four States reveal slow movement toward improved EHR use. Factors facilitating use of EHRs include customization of EHR products and being owned by a larger organization. Factors limiting use of EHRs include system limitations, cost, and lack of strong incentives to improve. Practices in one State were moving more vigorously toward improved EHR use than those in the other States. Many practices also increased use of medical assistants after implementing EHRs.

Senior hospital executives responding to a 2005 national telephone survey conducted for the Centers for Medicare & Medicaid Services (CMS) report that Hospital Compare and other public reports on hospital quality measures have helped to focus hospital leadership attention on quality matters. They also report increased investment in quality improvement (QI) projects and in people and systems to improve documentation of care. Additionally, more consideration is given to best practice guidelines and internal sharing of quality measure results among hospital staff. Large, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited hospitals appear to be responding to public reporting efforts more consistently than small, non-JCAHO accredited hospitals.

While most of the offshoring literature focuses on the effects on relative wages, other implications do not receive the necessary attention. This paper investigates the effects on the industries' skill ratio. It summarizes the empirical literature, discusses theoretical findings, and provides empirical evidence for Germany. As results show, effects are mainly driven by the industry where offshoring takes place. If offshoring takes place in high-skill intensive industries, the high-skill labor ratio increases (vice versa if offshoring takes place in low-skill intensive industries). Results are in line with other empirical findings, however, they seem to contradict theoretical causalities. Thus, we additionally discuss possible explanations.

Given limited research on monetary policy rules in emerging markets, this paper challenges the applicability of a nonlinear Taylor rule in characterizing the monetary policy behavior of the Brazilian Central Bank. It also investigates whether and how the process of setting interest rates has been developed in response to contingencies and special events. We extend the linear Taylor rule to a regime-switching framework, where the transition from one regime to another occurs in a smooth way, using a Logistic Smooth Transition Regression (LSTR) approach. In this sense, we empirically analyze the movement of the nominal short term interest rate of the Brazilian Central Bank using quarterly data, covering the period 1994.Q4 - 2012.Q2. We find that the nonlinear Taylor rule provides a better description of the Brazilian interest rate setting and is consistent with historical macroeconomic events. In particular, our results show that adopting a nonlinear specification, instead of the linear, leads to a costs reduction in terms of fit: 190 basis points in 1995 and 140 basis points in the mid-2002 presidential election campaign in Brazil. Moreover, the Brazilian monetary policy exhibits nonlinear patterns that better captures special events and may contain relevant information rendering it applicable to unusual conditions, i.e., a financial crisis, which require disconnection from the automatic pilot rule and use of judgement to make decision.

In this paper, the differences between two variations of proportional representation (PR), open-list PR and closed-list PR, are analyzed in terms of their ability to accurately reflect voter preference. The single nontransferable vote (SNTV) is also included in the comparison as a benchmark. We construct a model of voting equilibria with a candidate who is least preferred by voters in the sense that replacing the least-preferred candidate in the set of winners with any loser is Pareto improving, and our focus is on whether the least-preferred candidate wins under each electoral system. We demonstrate that the least-preferred candidate never wins under the SNTV, but can win under open-list PR, although this is less likely than winning under closed-list PR.

This paper estimates and decomposes multidimensional poverty in 82 natural regions in India using unit data from the Indian Human Development Survey (IHDS), 2011–12. Multidimensional poverty is measured in the dimensions of health, education, living standard and household environment using eight indicators and Alkire-Foster methodology. The unique contributions of the paper are inclusion of a direct economic variable (consumption expenditure, work and employment) to quantify the living standard dimension, decomposition of MPI across the dimensions and the indicators, and estimates of multidimensional poverty at the sub-national level. Results indicate that 43% of India’s population are multidimensional poor with large regional variations. The average intensity of poverty was 45.5% with a MPI value of 19.3. Six states in India—Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha and West Bengal who have a share of 45% of the total population—account for 58% of the multidimensional poor. Across regions, more than 70% of the population are multidimensional poor in the southern region of Chhattisgarh and the Ranchi plateau, while they comprise less than 10% in the regions of Manipur, Mizoram and Chandigarh. The economic poor have a weak association with health and household environment dimensions. The decomposition of MPI indicates that the economic dimension accounts for 22%, the health dimension accounts for 36%, the education dimension accounts for 11% and the household environment accounts for 31% of the deprivation. Based on these analyses, the authors suggest target based interventions in the poor regions to reduce poverty and inequality in India.

The global city thesis and the migration thesis concern two important dimensions of the impacts of contemporary globalization on cities. The two theses are intrinsically linked. The central question is how we should approach migration in the new context of the global city, and how we should articulate their interrelationships. To address this question, we construct an integrative analytical framework linking global city and migration, and empirically apply it to Sydney. We build a set of indexes to measure global competitiveness, global migration, and global mobility of communities across global Sydney. The findings reveal that global competitiveness—the defining capacity of Sydney as a global city—has very weak association with global migration that measures the stock of foreign born population, but has very strong association with global mobility that measures the people movement in recent years. These findings call for a redefinition of migration to incorporate people movement to better capture the interplay between global city and migration.

This report discusses what is known about low-income and at-risk LGBT people and their interactions with human services, especially services funded by ACF, and identifies important areas for further research. To provide context for the needs assessment findings, the assessment begins by describing the scope and estimated size of the LGBT population in the United States as well as factors that may contribute to social and economic disadvantages for LGBT people. The assessment then presents the framework and methods for the needs assessment and ultimately recommends potential areas for future research to enhance the knowledge base surrounding the human service needs of low-income and at-risk LGBT populations.

Well-documented racial disparities in use of medical services raise concerns about such disparities in other aspects of health care. We compare the difference in Medicaid pharmacy use between black and white dually eligible Medicare beneficiaries. Controlling for the presence of chronic illnesses, we find that black beneficiaries have significantly fewer prescriptions filled and lower pharmacy costs in 8 of the 10 States examined, despite having higher physician costs. If this disparity stems from a lack of provider or beneficiary knowledge, programs to educate providers or beneficiaries may hold the greatest promise for reducing it, whether pharmacy coverage is obtained from Medicaid or from a new Medicare benefit.

A baseline integration of commercial banks into the disequilibrium framework with behavioral traders of Charpe et al. (2011, 2012) is presented. At the core of the analysis is the impact the banking sector exerts on the interaction of real and financial markets. Potentially destabilizing feedback channels in the presence of imperfect macroeconomic portfolio adjustment and heterogeneous expectations are investigated. Given the possible financial market instability, various policy instruments have to be applied in order to guarantee viable dynamics in the highly interconnected macroeconomy. Among those are open market operations reacting to the state-of-confidence in the economy and Tobin-type capital gain taxes. The need for policy intervention is even more striking, as the banking sector is modeled in a rather stability enhancing way, fulfilling its fundamental tasks of term transformation of savings and credit granting without engaging in investment activities itself.

[Abstract] The aim of this paper is twofold. On the one hand, we attempt to find out whether Spanish households took part in a process of substituting loans for wages during the period before the beginning of the current economic crisis. On the other hand, we try to identify the consequences of such process in the evolution of income and consumption inequalities. The theoretical framework to deal with the above mentioned issues is provided by a review of the economic literature on the determinants of consumer behaviour, namely, on consumption, saving and debt. The empirical study consists of a descriptive analysis, which is focused on two fields. First, we analyze the evolution of consumer credit (both, in aggregate and by income groups) and the savings rates. Second, we compare the values and temporal evolution of income and consumption inequalities. The period under study ranges from 2000 to 2008. Our analysis provides some empirical evidence that supports the hypothesis that financial conditions led to significant effects on the distribution of consumption. This influence is especially significant in the case of consumption inequalities. These inequalities were lower than income inequalities and were kept “artificially” low and stable during the whole period.

We investigate the welfare effect of union activity in a relatively new oligopoly model, the Cournot-Bertrand model, where one firm competes in output ( a la Cournot) and the other firm competes in price ( a la Bertrand). The Nash equilibrium prices, outputs, and profits are quite diverse in this model, with the competitive advantage going to the Cournot-type competitor. A comparison of the results from the Cournot-Bertrand model with those found in the traditional Cournot and Bertrand models reveals that firms and the union have a different preference ordering over labor market bargaining. These differences help explain why the empirical evidence does not support any one model of union bargaining. We also examine the welfare and policy implications of union activity in a Cournot-Bertrand setting.

Classical power index analysis considers the individual's ability to influence the aggregated group decision by changing its own vote, where all decisions and votes are assumed to be binary. In many practical applications we have more options than either "yes" or "no". Here we generalize three important power indices to continuous convex policy spaces. This allows the analysis of a collection of economic problems like e.g. tax rates or spending that otherwise would not be covered in binary models., 31 pages, 9 tables

This article offers insight into what we term "second-generation" Medicaid managed care. In case studies of seven States, we examined three critical questions: (1) Does managed care experience facilitate program operations? (2) Can Medicaid managed care deliver on important goals? and (3) Can States extend the program beyond low-income families and children to others? The answers are encouraging but also suggest caution. Medicaid managed care is not a solution to fundamental problems facing the Medicaid program. It may be a tool to encourage better delivery of care. This requires a long-term commitment and adequate financing to develop stable partnerships with all stakeholders.

Objective: To compare the costs of 2 atypical drug therapies (olanzapine and risperidone) with one another and with a conventional antipsychotic (haloperidol) in the treatment of schizophrenia. Design and setting: The analysis is based on a simulation model with parameter values taken mainly from clinical trial data in patients with schizophrenia, and was conducted within a UK context. Results: The 3 therapies are approximately cost neutral over a 5-year period (olanzapine (L)35 701, risperidone (L)36 590 and haloperidol (L)36 653). There is evidence of greater efficacy with the atypical drugs [average percentage of 5 years with Brief Psychiatric Rating Scale (BPRS) scores

In a call for papers, for the special issue to be devoted to “Urban Economy” late in 2015, that the Economies editors issued recently, I noted the increased attention that has been given to urban economies during the past quarter century. This is concomitant with the increased importance and role in policy that cities have attained. This is, in part, due to the diminished capacity of national and sub-national governments to find the funds needed for urban projects and services, and in part to the understanding that cities are the key to the economies and societies of most if not all nations.[...]

This study found that community-dwelling individuals and nursing home residents treated by a geriatrician were less likely to use the emergency department (ED) than individuals treated by other providers. Compared with those with no geriatric care, the predicted probability of ED use in one month was 11.3 percent lower for community-dwelling individuals who had one or more office, home, or nursing home visits to a geriatrician in the previous six-month period. Results for nursing home residents were similar.

Economies (ISSN 2227-7099) is a new international, peer-reviewed open access journal for the academic fields of development economics and macroeconomics. While the latter seems to be clearly defined, development economics is not, because it is related to nearly all traditional economic sub-disciplines such as macroeconomics, international trade and finance, as well as microeconomics and public finance. Typically, academic field journals of development economics cover all those economic sub-disciplines. Economies instead focuses mainly on the macroeconomic perspective of economic development and it intends to publish academic research that is of strong macroeconomic policy relevance. In general, contributions in Economies should foster understanding of the macroeconomic process of economic development, with the process of development not exclusively being reserved to what we typically call developing countries. Also, the group of developed economies is still developing in the sense of improving their living standards further. [...]

Background:Background: Cost-effectiveness analysis of pharmaceutical and other treatments for children with autism spectrum disorders (ASDs) has the potential to improve access to services by demonstrating the value of treatment to public and private payers, but methods for measuring QALYs in children are under-studied. No cost-effectiveness analyses have been undertaken in this population using the cost-per-QALY metric. Abstract: Objective:Objective: This study describes health-related quality-of-life (HR-QOL) outcomes in children with ASDs and compares the sensitivity of two generic preference-based instruments relative to ASD-related conditions and symptoms. Abstract: Methods:Methods: The study design was cross-sectional with prospectively collected outcome data that were correlated with retrospectively assessed clinical information. Subjects were recruited from two sites of the Autism Treatment Network (ATN) in the US: a developmental centre in Little Rock, Arkansas, and an outpatient psychiatric clinic at Columbia University Medical Center in New York. Children that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for an ASD by a multidisciplinary team evaluation were asked to participate in a clinical registry. Families of children with an ASD that agreed to be contacted about participation in future research studies as part of the ATN formed the sampling frame for the study. Families were included if the child with the ASD was between 4 and 17 years of age and the family caregiver spoke English. Eligible families were contacted by mail to see if they would be interested in participating in the study with 150 completing surveys. HR-QOL outcomes were described using the Health Utilities Index (HUI) 3 and the Quality of Well-Being Self-Administered (QWB-SA) scale obtained by proxy via the family caregiver. Abstract: Results:Results: Children were diagnosed as having autistic disorder (76%), pervasive developmental disorder-not otherwise specified &lsqb;PDD-NOS&rsqb; (15%), and Asperger's disorder (9%). Average HUI3 and QWB-SA scores were 0.68 (SD 0.21, range 0.07-1) and 0.59 (SD 0.16, range 0.18-1), respectively. The HUI3 score was significantly correlated with clinical variables including adaptive behaviour (ρ - 0.52; p < 0.001) and cognitive functioning (ρ - 0.36; p < 0.001). The QWB-SA score had weak correlation with adaptive behaviour (ρ - 0.25; p < 0.001) and cognitive functioning (ρ - 0.17; p < 0.005). Change scores for the HUI3 were larger than the QWB-SA for all clinical measures. Scores for the HUI3 increased 0.21 points (95% CI 0.14, 0.29) across the first to the third quartile of the cognitive functioning measure compared with 0.05 (95% CI -0.01, 0.11) for the QWB-SA. Adjusted R values also were higher for the HUI3 compared with the QWB-SA across all clinical measures. Abstract: Conclusions:Conclusions: The HUI3 was more sensitive to clinical measures used to characterize children with autism compared with the QWB-SA score. The findings provide a benchmark to compare scores obtained by alternative methods and instruments. Researchers should consider incorporating the HUI3 in clinical trials and other longitudinal research studies to build the evidence base for describing the cost effectiveness of services provided to this important population.

Objectives: To develop and psychometrically evaluate a domain-specific questionnaire to assess subtle but clinically relevant differences in treatment experiences and satisfaction over a wide range of currently available insulin therapy regimens. The study focussed on patients with type 2 diabetes mellitus and placed particular attention on the impact of different forms of insulin therapy on diabetes self-management. Methods: The development of the Insulin Treatment Experience Questionnaire (ITEQ) was conducted in three steps: (i) a qualitative phase to generate relevant items and identify relevant domains; (ii) a pilot study to reduce the number of generated items; and (iii) a validation study to assess major psychometric properties of the final ITEQ version. Results: The final version of the questionnaire comprised 28 items with the subscales ‘leisure activities’ (four items), ‘psychological barriers’ (two items), ‘handling’ (five items), ‘diabetes control’ (six items), ‘dependence’ (five items), ‘weight control’ (three items), ‘sleep’ (two items), and one further item assessing general treatment satisfaction. The subscales’ internal consistencies (Cronbach’s alpha) ranged from 0.52 to 0.83. Motivated by the homogenous structure of inter-scale-correlations (range 0.10–0.46), a summary composite score was calculated (alpha = 0.86). Construct validity showed statistically significant correlations with other scales (ITEQ vs the Problem Areas in Diabetes [PAID] questionnaire total score −0.60, ITEQ vs the Diabetes Treatment Satisfaction Questionnaire [DTSQ] total score 0.52). Conclusion: The newly developed ITEQ displayed satisfactory to good psychometric properties, thereby allowing the assessment of everyday life experience and treatment satisfaction in patients with insulin-treated type 2 diabetes. Additional research is needed to assess test-retest reliability and sensitivity to change.

Comparative effectiveness research (CER) can provide valuable information for patients, providers and payers. These stakeholders differ in their incentives to invest in CER. To maximize benefits from public investments in CER, it is important to understand the value of CER from the perspectives of these stakeholders and how that affects their incentives to invest in CER. This article provides a conceptual framework for valuing CER, and illustrates the potential benefits of such studies from a number of perspectives using several case studies. We examine cases in which CER provides value by identifying when one treatment is consistently better than others, when different treatments are preferred for different subgroups, and when differences are small enough that decisions can be made based on price. We illustrate these findings using value-of-information techniques to assess the value of research, and by examining changes in pharmaceutical prices following publication of a comparative effectiveness study. Our results suggest that CER may have high societal value but limited private return to providers or payers. This suggests the importance of public efforts to promote the production of CER. We also conclude that value-of-information tools may help inform policy decisions about how much public funds to invest in CER and how to prioritize the use of available public funds for CER, in particular targeting public CER spending to areas where private incentives are low relative to social benefits.

Background: Two phase II trials (POWER 1 and 2) have demonstrated that darunavir co-administered with low-dose ritonavir (DRV/r) provides significant clinical benefit compared with control protease inhibitors (PIs) in highly treatment-experienced, HIV-1-infected adults, when co-administered with optimized background therapy (OBR). Objective: To determine whether DRV/r is cost effective compared with control PIs, from the perspective of Belgian, Italian, Swedish and UK reimbursement authorities, when used in treatment-experienced patients similar to those included in the POWER 1 and 2 trials. Methods: An existing Markov model containing health states defined by CD4 cell count ranges (>500, 351-500, 201-350, 101-200, 51-100 and 0-50 cells/mm) and death was adapted for use in four European healthcare settings. Baseline demographics, CD4 cell count distribution and antiretroviral drug usage reflected those reported in the POWER 1 and 2 trials. Virological/immunological response rates and matching transition probabilities over the patient's lifetime were based on results from the POWER trials and published data. After treatment failure, patients were assumed to switch to a tipranavir-containing regimen plus OBR. For each CD4 cell count range, utility values and HIV-related mortality rates were obtained from the published literature. National all-cause mortality data and published data on the increased risk of non HIV-related mortality in HIV-infected individuals were taken into account in the model. Data from observational studies conducted in each healthcare setting were used to determine resource-use patterns and costs associated with each CD4 cell count range. Unit costs were derived from official local sources; a lifetime horizon was taken and discount rates were selected based on local guidelines. Results: In the base-case analysis, quality-adjusted life-year (QALY) gains of up to 1.397 in Belgium, over 1.171 in Italy, 1.142 in Sweden and 1.091 in the UK were predicted when DRV/r-based therapy was used instead of control PI-based treatment. The base-case analyses predicted an incremental cost-effectiveness ratio (ICER) of &U20AC;11 438/QALY in Belgium, &U20AC;12 122/QALY in Italy, &U20AC;10 942/QALY in Sweden and &U20AC;16 438/QALY in the UK. Assuming an acceptability threshold of &U20AC;30 000/QALY, DRV/r-based therapy remained cost effective over all parameter ranges tested in extensive one-way sensitivity analyses. Probabilistic sensitivity analysis revealed a 95% (Belgium), 97% (Italy), 92% (Sweden) or 78% (UK) probability of attaining an ICER below this threshold. Conclusion: From four European payer perspectives, DRV/r-based antiretroviral therapy is predicted to be cost effective compared with currently available control PIs, when both are used with an OBR in treatment-experienced, HIV-1-infected adults who failed to respond to more than one PI-containing regimen.

The global prevalence of HIV infection continues to grow, as a result of increasing incidence in some countries and improved survival where highly active antiretroviral therapy (HAART) is available. Growing healthcare expenditure and shifts in the types of medical resources used have created a greater need for accurate information on the costs of treatment. The objectives of this review were to compare published estimates of direct medical costs for treating HIV and to determine the impact of disease stage on such costs, based on CD4 cell count and plasma viral load. A literature review was conducted to identify studies meeting prespecified criteria for information content, including an original estimate of the direct medical costs of treating an HIV-infected individual, stratified based on markers of disease progression. Three unpublished cost-of-care studies were also included, which were applied in the economic analyses published in this supplement. A two-step procedure was used to convert costs into a common price year (2004) using country-specific health expenditure inflators and, to account for differences in currency, using health-specific purchasing power parities to express all cost estimates in US dollars. In all nine studies meeting the eligibility criteria, infected individuals were followed longitudinally and a ‘bottom-up’ approach was used to estimate costs. The same patterns were observed in all studies: the lowest CD4 categories had the highest cost; there was a sharp decrease in costs as CD4 cell counts rose towards 100 cells/mm3; and there was a more gradual decline in costs as CD4 cell counts rose above 100 cells/mm3. In the single study reporting cost according to viral load, it was shown that higher plasma viral load level (>100 000 HIV-RNA copies/mL) was associated with higher costs of care. The results demonstrate that the cost of treating HIV disease increases with disease progression, particularly at CD4 cell counts below 100 cells/mm3. The suggestion that costs increase as the plasma viral load rises needs independent verification. This review of the literature further suggests that publicly available information on the cost of HAART by disease stage is inadequate. To address the information gap, multiple stakeholders (governments, pharmaceutical industry, private insurers and non-governmental organizations) have begun to establish and support an independent, high quality and standardized multicountry data collection for evaluating the cost of HIV management. An accurate, representative and relevant cost-estimate data resource would provide a valuable asset to healthcare planners that may lead to improved policy and decision-making in managing the HIV epidemic.

BACKGROUND: Inadequate blood pressure (BP) control remains prevalent. One proposed explanation is "clinical inertia," often defined as the failure by providers to initiate or intensify medication therapy when otherwise appropriate. However, patients could contribute to clinical inertia by signaling an unwillingness to consider medication intensification. OBJECTIVE: To explore covariates of patient attitudes regarding medication intensification. STUDY DESIGN: Cross-sectional survey. SETTING: 9 Midwestern U. S. Veterans' Administration medical facilities. PARTICIPANTS: 1,062 diabetics identified as having BP>= 140/90 mm Hg as part of a prospective cohort study of clinical inertia in hypertension treatment. MEASUREMENTS: Primary outcome was participants' indicated willingness to intensify BP medications if their provider noted elevated BP levels. Potential covariates assessed included BP control (actual and perceived), perceived importance of BP control, BP management self-efficacy, competing demands, medication factors (adherence and management issues), trust in provider, and sociodemographic factors. RESULTS: While 64% of participants reported complete willingness to intensify BP medications, 36% of participants expressed at least some unwillingness. In ordered logistic regression analysis, willingness to intensify was negatively associated with medication concerns, particularly concern about side effects (OR=0.49, 95% CI: 0.42, 0.59) and adherence or management problems (OR=0.72, 95% CI: 0.57, 0.91), and positively associated with perceived dependence of health on BP medications (OR=1.50, 95% CI: 1.26, 1.79) and trust in provider (OR=1.30, 95% CI: 1.10, 1.54). Importance of BP control had a weaker, non-significant association with willingness to intensify as well (OR=1.17, 95% CI: 0.99, 1.40). Neither competing demands, current BP control, current number of medications prescribed, nor self-efficacy was associated with willingness to intensify medications. CONCLUSIONS: Patients' willingness to consider intensification of BP medications appears primarily determined by how well patients are managing their current medications, rather than patients' perceived importance of BP control, their self-efficacy, or their prioritization of BP control versus other health demands. Greater attention to patients' pre-existing medication issues may improve providers' ability to intensify BP medication therapy when medically appropriate while simultaneously improving patient satisfaction with care.

Background: Qualitative research can inform the development of asthma patient-reported outcome (PRO) measures and user-friendly technologies through defining measurement constructs, identifying potential limitations in measurement and sources of response error, and evaluating usability. Objective: To inform the development of a comprehensive asthma PRO assessment with input from patients and clinical experts. Methods: Self-reported adult asthma patients recruited from a 3000-member New England area research panel participated in either one of three focus groups (n = 21) or individual cognitive item debriefing interviews (n = 20) to discuss how asthma impacts their health-related quality of life (HR-QOL), and provide feedback on a preliminary set of asthma impact survey items and prototype patient reports. Focus groups and cognitive interviews were conducted using traditional research principles (e.g. semi-structured interview guide, probing, and think aloud techniques). An expert advisory panel (n= 12) including asthma clinical specialists and measurement professionals was convened to review results from the focus group and cognitive interview studies, and make recommendations for final survey and report development. Results: Domains of health impacted by asthma included physical (recreation, play, competitive sports, and exercise), social (activities, family relationships), emotional (anger, upset, frustration, anxiety, worry), sleep, role (recreational/leisure activities, work), and sexual functioning. Most items in the impact survey were easily understood, covered important content, and included relevant response options. Items with contradictory examples and multiple concepts were difficult to comprehend. Suggestions were made to expand survey content by including additional items on physical and sexual functioning, sleep, self-consciousness, stigma, and finances. Reports were considered useful and participants saw value in sharing the results with their doctors. Graphic presentation of scores was not always understood; participants preferred tabular presentation of score levels with associated interpretative text. Display of inverse scores for different measures (higher scores equaling better health on one scale and worse health on another) shown on a single page was confusing. The score history section of the report was seen as helpful for monitoring progress over time, particularly for those recently diagnosed with asthma. Expert panelists agreed that displaying inverse scores in a single summary report could be confusing to patients and providers. They also stressed the importance of comprehensive interpretation guidelines for patients, with an emphasis on what they should do next based on scores. Panelists made recommendations for provider and aggregate-level reports (e.g. ‘red flags’ to indicate significant score changes or cut points of significance; identification of subgroups that have scored poorly or recently got worse). Conclusion: Incorporating input from patients, clinicians, and measurement experts in the early stages of product development should improve the construct validity of this PRO measure and enhance its practical application in healthcare.

The goal of this paper is to analyze different approaches to acquiring new knowledge. We analyze what means of knowledge acquisition are used by entrepreneurs, such as formal education process, one and more day professional development workshops, professional counselors, professional literature and information on the world wide web. When making a decision on what means to use in order to increase one’s knowledge, entrepreneurs employ different assessment criteria: time and money investment as well as pedagogical techniques used. Time shortage is the most frequently cited reason that entrepreneurs do not invest more personal resources into knowledge acquisition processes. The main hypothesis we test, postulates that entrepreneurs who invest more time and money into knowledge acquisition processes are more successful. Success is measured with an average annual degree of growth of sale, profits and number of employees in the last four years and with entrepreneur’s opinion concerning success of the company’s business. Finally, we develop the implication for public policy and educational institutions on the means that need to be employed so that entrepreneurs would invest more resources in knowledge acquisition processes.

Congress posed questions about the effectiveness of educational technology and how effectiveness is related to conditions and practices. The study identified reading and mathematics software products based on prior evidence of effectiveness and other criteria and recruited districts, schools, and teachers to implement the products. On average, after one year, products did not increase or decrease test scores by amounts that were statistically different from zero. For first and fourth grade reading products, the study found several school and classroom characteristics that were correlated with effectiveness, including student-teacher ratios (for first grade) and the amount of time products were used (for fourth grade). The study did not find characteristics related to effectiveness for sixth grade math or algebra. The study also found that products caused teachers to be less likely to lecture and more likely to facilitate, while students using reading or mathematics software products were more likely to be working on their own. The results reported here are based on schools and teachers who were not using the products in the previous school year. Whether products are more effective when teachers have more experience using them is being examined with a second year of data. The study will involve teachers who were in the first data collection (those who are teaching in the same school and at the same grade level or subject area) and a new group of students. The second-year study will also report results separately for the various products.

The editors of Economies would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2014:[...]

The motivation for launching the journal Economies (ISSN 2227-7099) is my concern regarding human sustainability [1,2]. There are two major categories of economic systems: capitalism, or free market economy and socialism, or planned economy. The last 30 years have witnessed great social change in China, for example, indicating that the free market economy has prevailed and now dominates around the World. [...]

There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation—better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys—one cohort study and one randomized clinical trial—that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.

International audience; Over the last two decades the incidence of congestive heart failure (CHF) has increased with aging of the population and in spite of the decline in age-adjusted mortality rates due to coronary heart disease. Its management has seen substantial progress, embodied in the introduction of ACE inhibitors, initially as part of triple therapy in which they complemented diuretics and digoxin, and latterly as first-line therapy. The current consensus on treatment of CHF has been based on the multiple clinical studies performed with ACE inhibitors in which these agents have been shown to prevent a new cardiovascular accident and/or progression to more severe CHF in an increasingly wide range of patients with symptomatic CHF or post-infarction left ventricular dysfunction (ejection fraction ≤ 40% in some trials or ≤ 35% in others). Not only have the results shown a marked decrease in all-cause (and especially cardiovascular) mortality, but also a great number of cost-effectiveness analyses have shown the advantages of ACE inhibitors in terms of resource allocation: they are either cost saving or convincingly cost effective compared with standard treatment with digoxin and diuretics. Other drugs require similar cost and clinical analyses before they can earn their place in an add-on strategy. To date, cost savings have been documented only for β-blockers; implantable devices are still undergoing assessment. Two trends are now competing: one is to downplay add-on strategies and to recommend first-line therapy with ACE inhibitors and β-blockers at effective doses, supplemented by a raft of non-pharmaceutical measures (specialist nurses, patient education, dietary advice, exercise) in a multidisciplinary approach to CHF; the second is, on the contrary, to prescribe up to five drugs for patients with advanced CHF. The evidence that this decreases hospital admission rates and patient cost is more than anecdotal, but conclusive proof of cost effectiveness is still lacking and the approach presupposes dedicated structures. This review argues that despite technical limitations, a combined approach of CHF therapy based on clinical trials and cost-effectiveness analyses is essential. However, improvements can be made. The absence of sufficient comparative data still makes it difficult to choose between drugs within the same class; institutional purchasers need to conduct such analyses to identify the drugs best suited to their patients' profiles and budgetary constraints.

Game theory offers a rigorous set of concepts, relationships, and models that invite myriad applications to problems of political economy. Indeed, game theory can serve as a fundamental modeling technique that can bridge microfoundations of political and economic exchanges, with developmental processes and macro implications related to growth and distribution. Applications can range from localized interactions within workplaces, firms, political organizations, and community groups; to intermediate-level market, industry, community, or inter-organizational transactions; to encompassing national, regional, population, or global interactions. At any of these levels, game models can illustrate strategic responses of economic or political actors (individuals or organizations) to specifiable conditions concerning any or all of the following: prevailing social context—notably informal institutions (such as social norms) and formal institutions (such as mutually understood laws and regulations); available information (complete or not; accessible or strategically manipulated); agents’ motivations (material and/or social); and even levels of rationality—substantive (full cognition) or bounded (limited cognition). Applicable models may operate on the basis of given institutional context and preference orientations or may explore associated developmental processes, including adaptive social learning. Of particular interest are representations of one or more of the myriad social dilemmas (or collective-action problems) that inhabit political economy, associated exercises or distributions of power, and/or representations of potential resolutions to such dilemmas—perhaps with policy implications. Accordingly, this forthcoming issue of Economies seeks game-theoretic models based on classical, evolutionary, behavioral, or epistemic game theory that can be applied to one or more problems in political economy. [...]