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The first-in-human clinical trial of the CD28-specific monoclonal antibody (mAb) TGN1412 resulted in a life-threatening cytokine release syndrome. Although TGN1412 was designed as IgG4, known for weak Fc:Fcγ receptor (FcγR) interactions, these interactions contributed to TGN1412-induced T-cell activation. Using cell lines (TFs) expressing human FcγRI, -IIa, -IIb, or -III, we show that TGN1412 and TGN1412 as IgG1 and IgG2 are bound by FcγRs as it can be deduced from literature. However, upon coculture of TGN1412-decorated T cells with TFs or human primary blood cells, we observed that binding capacities by FcγRs do not correlate with the strength of the mediated effector function. FcγRIIa and FcγRIIb, showing no or very minor binding to TGN1412, mediated strongest T cell proliferation, while high-affinity FcγRI, exhibiting strong TGN1412 binding, mediated hardly any T-cell proliferation. These findings are of biological relevance because we show that FcγRI binds TGN1412, thus prevents binding to FcγRIIa or FcγRIIb, and consequently disables T-cell proliferation. In line with this, FcγRI- FcγRII+ but not FcγRI+ FcγRII+ monocytes mediate TGN1412-induced T-cell proliferation. Collectively, by using TGN1412 as example, our results indicate that binding of monomeric IgG subclasses does not predict the FcγR-mediated effector function, which has major implications for the design of therapeutic mAbs.

Human cytomegalovirus (HCMV) is endowed with multiple highly sophisticated immune evasion strategies. This includes the evasion from antibody mediated immune control by counteracting host Fc-gamma receptor (FcγR) mediated immune control mechanisms such as antibody-dependent cellular cytotoxicity (ADCC). We have previously shown that HCMV avoids FcγR activation by concomitant expression of the viral Fc-gamma-binding glycoproteins (vFcγRs) gp34 and gp68. We now show that gp34 and gp68 bind IgG simultaneously at topologically different Fcγ sites and achieve efficient antagonization of host FcγR activation by distinct but synergizing mechanisms. While gp34 enhances immune complex internalization, gp68 acts as inhibitor of host FcγR binding to immune complexes. In doing so, gp68 induces Fcγ accessibility to gp34 and simultaneously limits host FcγR recognition. The synergy of gp34 and gp68 is compelled by the interfering influence of excessive non-immune IgG ligands and highlights conformational changes within the IgG globular chains critical for antibody effector function., eLife digest Human cytomegalovirus is a type of herpes virus that rarely causes symptoms in healthy people but can cause serious complications in unborn babies and in people with compromised immune systems, such as transplant recipients. The virus has found ways to successfully evade the immune system, and once infected, the body retains the virus for life. It deploys an arsenal of proteins that bind to antibodies, specialized proteins the immune system uses to flag virus-infected cells for destruction. This prevents certain cells of the immune system, the natural killer cells, from recognizing and destroying virus-infected cells. These immune-evading proteins are called viral Fc-gamma receptors, or vFcγRs. While it has been previously shown that these receptors are able to evade the immune system, it remained unknown how exactly they prevent natural killer cells from recognizing infected cells. Now, Kolb et al. show that the cytomegalovirus deploys two vFcγRs called gp34 and gp68, which work together to block natural killer cells. The latter reduces the ability of natural killer cells to bind to antibodies on cytomegalovirus-infected cells. This paves the way for gp34 to pull virus proteins from the surface of the infected cell, making them inaccessible to the immune system. Neither protein fully protects virus-infected cells on its own, but together they are highly effective. The experiments reveal further details about how cytomegalovirus uses two defense mechanisms simultaneously to outmaneuver the immune system. Understanding this two-part viral evasion system may help scientists to develop vaccines or new treatments that can protect vulnerable people from diseases caused by the cytomegalovirus.

Human Cytomegalovirus (HCMV) is endowed with multiple highly sophisticated immune evasion strategies. This includes the evasion from antibody mediated immune control by counteracting host Fc-gamma receptor (FcγR) mediated immune control mechanisms such as antibody-dependent cell-mediated cytotoxicity (ADCC). We have previously shown that HCMV avoids FcγR activation by concomitant expression of the viral Fc-gamma binding glycoproteins (vFcγRs) gp34 and gp68. We now show that gp34 and gp68 bind IgG simultaneously at topologically different Fcγ sites and achieve efficient antagonization of host FcγR activation by distinct but synergizing mechanisms. While gp34 enhances immune complex internalization, gp68 acts as inhibitor of host FcγR binding to immune complexes. In doing so, gp68 induces Fcγ accessibility to gp34 and simultaneously limits host FcγR recognition. The synergy of gp34 and gp68 is compelled by the interfering influence of excessive non-immune IgG ligands and highlights conformational changes within the IgG globular chains critical for antibody effector function.Graphical AbstractNK cells elicit a powerful antibody-mediated antiviral response through ADCC. gp68 (ochroid) binds IgG in a 2:1 ratio reducing, but not abolishing accessibility of immune complexes to FcγRIII+ (dark blue) immune effector cells such as NK cells. gp34 (red, natively forming a dimer (Sprague et al., 2008)) effectively internalizes immune complexes making them unavailable to surveilling FcγRIII+ effector cells but cannot compete with FcγRIII for a similar binding region on IgG. Supported by functional evaluation, we propose a model in which g34 and gp68 work in cooperation to achieve efficient antagonization of antibody-mediated effector mechanisms.

The constant region of IgG antibodies mediates antiviral activities upon engaging host Fcγ receptors (FcγRs) expressed by a variety of immune cells, such as antibody-dependent cellullar cytotoxcity (ADCC) executed by natural killer (NK)cells. Human cytomegalovirus (HCMV) is unique among viruses by encoding also an array of several Fcγ-binding glycoproteins with cell surface disposition and concomitant incorporation into the virion. Evidence is increasing that the virus-encoded Fcγ receptors differ in their Fcγ binding mode but effectively operate as adversaries of host FcγRs since they are able to prevent IgG-mediated triggering of activating host FcγRs, i.e., FcγRI, FcγRIIA, and FcγRIIIA. Here we discuss virus-encoded FcγRs as the first known HCMV inhibitors of IgG-mediated immunity which could account for the limited efficacy of HCMV hyperimmune globulin in clinical settings. A better understanding of their molecular mode of action opens up new perspectives for improving IgG therapies against HCMV disease. DFG through He 2,526/6–2 European Commission through QLRT-2001–01112 European Commission through MRTN-CT-2005–019248 Helmholtz Association through VISTRIE VH-VI-242 UCR::Vicerrectoría de Docencia::Salud::Facultad de Microbiología

communication skills represent an essential component of clinical competence. In the field of pediatrics, communication between physicians and patients' parents is characterized by particular difficulties. To investigate the effects of a parent-physician communication skills training program on OSCE performance and self-efficacy in a group control design.parallel to their daily work in the outpatient department, intervention-group experienced clinicians in practice (n=14) participated in a communication training with standardized parents. Control-group physicians (n=14) did not receive any training beyond their daily work. Performance was assessed by independent video ratings of an OSCE. Both groups rated their self-efficacy prior to and following training.regarding OSCE performance, the intervention group demonstrated superior skills in building relationships with parents (p.024) and tended to perform better in exploring parents' problems (p.081). The communication training program led to significant improvement in self-efficacy with respect to the specific training objectives in the intervention group (p.046).even in physicians with considerable experience, structured communication training with standardized parents leads to significant improvement in OSCE performance and self-efficacy. PRACTISE IMPLICATIONS: briefness and tight structure make the presented communication training program applicable even for experienced physicians in daily clinical practice.

Die vorliegende Studie pruft Zusammenhange zwischen Arbeitsintensitat, Tatigkeitsspielraum, sozialer Arbeitsumgebung (Kooperation/Kommunikation, soziale Unterstutzung, soziale Stressoren) und Stresserleben am Arbeitsplatz mit der basalen Cortisolsekretion im Speichel (Tagesprofil, Aufwachreaktion und Variation uber den Tag). Insgesamt 46 Erwerbstatige aus dem Bankwesen sammelten an zwei aufeinander folgenden Arbeitstagen je vier Speichelproben (beim Aufwachen, 30 min nach dem Aufwachen, 14 Uhr und unmittelbar vor dem Zubettgehen), aus denen die individuelle Cortisolkonzentration (Mittelwert aus den jeweils zugehorigen Proben) bestimmt wurde. Die Tatigkeitsmerkmale wurden sowohl mittels Fragebogen als auch objektiv, d.?h. unabhangig vom Arbeitsplatzinhaber, erhoben. Alter, Geschlecht, Rauchen, Body-Mass-Index, gesundheitliche Beeintrachtigungen sowie eventuelle Abweichungen bei der Probensammlung wurden als mogliche Drittvariablen berucksichtigt. Im Ergebnis zeigte sich, dass subjektiv erlebte, geringe soziale Unterstutzung und hohe soziale Stressoren mit einer erhohten Aufwachreaktion bzw. mit einer erhohten Variation uber den Tag assoziiert waren. Fur die Arbeitsintensitat, den Tatigkeitsspielraum sowie fur die objektiv erhobene Kooperation/Kommunikation waren keine Effekte nachweisbar. Die Ergebnisse lassen vermuten, dass sowohl die Belastungs- als auch deren Erhebungsart fur den Nachweis von Effekten im Hinblick auf die Cortisolsekretion bei Erwerbstatigen von Bedeutung sind. The present study examines associations between job demands, job control, social work environment (cooperation/communication, social support, social stressors), and strain at work with basal salivary cortisol (day profiles, cortisol awakening reaction, diurnal variation). Forty-six employees collected four saliva samples (immediately after waking up, 30 min after waking up, at 2 p.m. and immediately before going to bed) each on two consecutive working days. We computed the mean across the two days for each of the four saliva samples per employee. Job characteristics were assessed by self-reports as well as by objective job analysis. Analyses were controlled for possible confounding effects of age, gender, smoking, body-mass index, health impairments, and non compliance with the cortisol protocol. Results show that subjectively experienced low social support and high social stressors at work were associated with elevated cortisol awakening reaction and elevated diurnal variation. We found no effects for job demands, job control or objectively assessed cooperation/communication. Our results suggest that both the type of job characteristic as well as the type of measurement of job characteristics have to be taken into account when relating them to employees’ cortisol secretion.

OBJECTIVE To describe the lymphatic vessel density and to determine the functional and prognostic significance of tumoral lymphatic vessels in upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS The study included 65 patients who had a radical nephroureterectomy (RNU) for UTUC between 1997 and 2004. All pathological slides were re-evaluated by one reference pathologist and clinical data were reviewed. Lymphatic endothelial cells (LECs) were stained immunohistochemically using D2-40. The lymphatic vessel density (LVD) was described in representative intratumoral (ITLVD), peritumoral (PTLVD) and non-tumoral (NTLVD) areas. Random samples were selected for double-immunostaining with D2-40 and CD-34 (to distinguish blood and lymphatic vessels) and the proliferation marker Ki-67 to detect lymphangiogenesis. The primary outcome measures were disease-specific survival (DSS) and disease recurrence (urothelial and/or distant). RESULTS The median (interquartile range) PTLVD was 4.0 (3.0–6.3), and significantly higher than that for ITLVD, of 0.3 (0–1.7) (P

Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programmes are rare. We introduced a PAL programme with a focus on clinical competencies on internal medicine wards.To assess the effects of an on-ward PAL programme on self-assessed clinical competencies.A total of 168 medical students were randomly assigned to one of the seven intervention wards or one of the seven control wards. During their 5-week ward-placement, the intervention group (IG; n = 88) received 10 patient-centred tutorials lead by final year tutors: (I) history taking, (II) physical examination, (III) blood withdrawal, (IV) infusion, (V) patient files, (VI and VII) ECG, (VIII-X) chart rounds. The control group (CG; n = 80) did not take part in the PAL programme. Clinical competencies were self-assessed pre- and post-intervention.For five of the ten assessed clinical competencies, increases in self-confidence ratings were significantly higher in the IG as compared to CG.RESULTS provide preliminary evidence to suggest that PAL programmes on internal medicine wards and with final year students as peer tutors may represent a valuable additional tool within medical clerkships. However, the findings must be confirmed and clarified in further research.

Die vorliegende Studie untersuchte die im Job-Demand-Control-Support-Modell und Effort-Reward-Imbalance-Modell beschriebenen Tatigkeitsmerkmale in Bezug auf Depressivitat in einer Stichprobe von 265 Erwerbstatigen. Anhand konfirmatorischer Faktorenanalysen wurden Gemeinsamkeiten und Unterschiede beider Modelle gepruft. Anschliesend wurde die Bedeutung der nachweisbaren Tatigkeitsmerkmale fur die Vorhersage von Depressivitat getestet und untersucht, inwieweit die Effekte durch Uberforderungserleben mediiert werden. Die Analysen zeigten, dass die Modelle sowohl gemeinsame (Arbeitsintensitat bzw. berufliche Anforderungen) als auch distinkte Arbeitsmerkmale (Tatigkeitsspielraum, Arbeitsplatzsicherheit, beruflicher Status, soziale Anerkennung) erfassen. Hohe Arbeitsintensitat, geringe Arbeitsplatzsicherheit und fehlende soziale Anerkennung standen in signifikantem Zusammenhang mit Depressivitat. Anders als erwartet war der berufliche Status positiv mit Depressivitat assoziiert, wahrend fur den Tatigkeitsspielraum keine signifikanten Effekte nachweisbar waren. Das Pfadmodell bestatigte sowohl direkte als auch durch Uberforderungserleben vermittelte Zusammenhange zwischen den Tatigkeitsmerkmalen und Depressivitat (39 % Varianzaufklarung). Die Ergebnisse bieten eine Grundlage fur die Identifizierung potenzieller Risikofaktoren fur das Auftreten depressiver Symptome am Arbeitsplatz. This study examined the job characteristics in the Job-Demand-Control-Support Model and in the Effort-Reward Imbalance Model with regard to depression in a sample of 265 employees. First, we tested by means of confirmatory factor analysis similarities and differences of the two models. Secondly, job characteristics were introduced as predictors in a path model to test their relation with depression. Furthermore, we examined whether the associations were mediated by the experience of excessive demands. Our analyses showed the demand/effort component to be one common factor, while decision latitude and reward (subdivided into the three facets of job security, social recognition, and status-related reward) remained distinctive components. Employees with high job demands/effort, low job security, low social recognition, but high status-related rewards reported higher depression scores. Unexpectedly, status-related rewards were positively associated with depression, while we found no significant effects for decision latitude. The path models confirmed direct as well as mediation effects (through experienced excessive demands) between job characteristics and depression (39 % explained variance in depression). Our results could be useful to identify possible job-related risk factors for depression.

Zusammenfassung. An einer Studie zum Zusammenhang zwischen der Gesundheit von Unternehmern, deren Arbeitsmerkmalen und deren Erfolg nahmen 53 klein- und mittelstndische Unternehmer teil. Erfasste Arbeitsmerkmale waren: Handlungs-/Entscheidungs- spielraum, Arbeitsintensitt, Arbeitszeit, Konkurrenzdruck und Prognoseber die Auftragsentwicklung. Der Unternehmenserfolg wurdeber das Mitarbeiterwachstum, die Mcglichkeit des Unternehmers, von seiner Firma abwesend zu sein (Urlaubstage), und dem erlebten Unternehmenserfolg operationalisiert. Gesundheitsindikatoren waren Depression, Angst, vitale Erschcpfung, Schlafstcrun- gen und Bluthochdruck. Im Vergleich zur Gesamtbevclkerung wiesen die Unternehmer in allen untersuchten Gesundheitsvariablen hufiger Beeintrchtigungen auf. Regressionsanalysen ergaben, dass lange Arbeitszeiten und Konkurrenzdruck mit einer verzcgerten Rckstellung des systolischen Blutdrucks (SBD) in der Freizeit und Nacht einhergingen. Alle untersuchten Erfolgsmerkmale waren fr die Gesundheit prdiktiv. So war Mitarbeiterwachstum negativ mit dem SBD whrend der Arbeit sowie Schlafstcrungen assoziiert. Je mehr Unternehmenserfolg erlebt wurde, desto geringer waren die Werte fr vitale Erschcpfung und Depression. Die Urlaubsdauer war negativ mit Angst und vitaler Erschcpfung korreliert. Insgesamt hatte von den Arbeitsmerkmalen nur die Dauer der Arbeitszeit einen Effekt auf die Gesundheit von Unternehmern. Daneben existieren aber offensichtlich weitere Faktoren, die mit der Unternehmerge- sundheit in Beziehung stehen. Dies sind neben dem Konkurrenzdruck am Markt insbesondere Indikatoren des Unternehmenserfolgs. Schlsselwcrter: Gesundheit, Arbeitsbelastung, Unternehmererfolg, ambulantes Monitoring Health risks of entrepreneurs Abstract. The relationship between health and workload as well as entrepreneurial success was analyzed in 53 entrepreneurs. Work- load data (decision latitude, job demand, working time, competition, market development) were determined by using structured inter- views and Karaseks job content questionnaire. Firm success was operationalized by employee growth, the possibility of absence from the company (days of holiday), and perceived success. Health was measured by questionnaires for sleep disturbances, vital exhaustion, depression, and anxiety, and by 24 hour ambulatory blood pressure monitoring. Regression analyses showed that working time and strength of competition within the market were predictive for systolic blood pressure (SBP) during leisure time and night, but not dur- ing work. All variables measuring entrepreneurial success were predictive for health. Employee growth was related to decreasing SBP during work and to fewer sleep disturbances. The duration of holidays was negatively related to vital exhaustion and anxiety. Perceived company success was negatively related to depression and vital exhaustion. In conclusion, only the relationship between working time and bad health conformed to findings reported for the relationship between work and health in employees. However, there were addi- tional indicators, especially indicators of competition and entrepreneurial success, that affected the health of entrepreneurs.

INTRODUCTION Following the recent amendment to the Medical Education Act in Germany (Approbationsordnung 2002) and the abolition of the preliminary approbation for early residency (AiP), the discussion increasingly focuses on the restructuring of German post-graduate medical training. The training should include well-defined learning objectives and an educational concept with a central emphasis on communication skills training. In the German-speaking countries there has as yet been no publication of a structured training course for the improvement of communication skills in the context of post-graduate education. METHODS Jointly designed by the University of Heidelberg's Clinic of Internal Medicine and Clinic of Paediatrics, this study aimed to measure the effect of a training programme for handling problems and difficult situations arising in the communication with parents and patients. 28 paediatric residents took part in a randomised controlled trial using standardized patients and video-feedback (intervention group: N = 14; control group: N = 14). Upon completion of the study, the control group also received training and was subsequently evaluated. The training course consisted of four units, lasting 90 minutes each. Both the acceptance of the training units and the self-evaluation of communication skills in dealing with parents were subject to assessment. RESULTS The participating residents acknowledged the training course to be an extremely useful tool for improving their communication skills and confidence in dealing with the parents of ill children. A pre-post comparison of self-assessed communication skills revealed a significant increase in the intervention group, but not in the control group. DISCUSSION The structured training course presented in the current study proved highly effective and should serve as a model for a compulsory component of a post-graduate training.

Zusammenfassung Einfuhrung Studentisch geleitete Tutorien sind in der Medizinischen Ausbildung weit verbreitet und erwiesen sich in vielen Bereichen als sehr effektiv. Bisher existieren keine Berichte uber PJ-geleitete Tutorien auf Station zur Forderung klinisch-praktischer Fertigkeiten von Medizinstudierenden. Ziel der vorliegenden Untersuchung war es, die Akzeptanz eines PJ-Tutoren-Programmes von Seiten der Medizinstudierenden und der PJ-TutorInnen sowie die Wahrnehmung der Rollenfunktion von PJ-Studierenden von einer studentischen Interventions- und Kontrollgruppe zu evaluieren. Methode 88 Medizinstudierende (51 w, 37 m; Alter 23,6 Jahre) wurden 7 Interventionsstationen zugeteilt, auf denen jeweils 10 PJ-geleitete, patientenzentrierte Tutorien abgehalten wurden. 80 Medizinstudierende (58 w, 22 m; Alter 23,3 Jahre) waren auf 7 Kontrollstationen tatig. Die Tutorien wurden von 14 freiwilligen PJ-TutorInnen (8 w, 6 m; Alter 26,2 Jahre) abgehalten. Die Akzeptanz des Tutorenprogramms sowie die Einschatzung der Rollenfunktion von PJ-Studierenden wurden auf einer 6-Punkt Likert-Skala evaluiert (1=sehr gut, 6=ungenugend bzw. 1=stimme voll zu, 6=stimme gar nicht zu). Ergebnisse Die PJ-geleiteten Tutorien wurden von den Medizinstudierenden, die Einfuhrungsveranstaltung und das Gesamtprogramm von Seiten der PJ-TutorInnen als auserst positiv evaluiert (1,14±0,36 bis 2,34±1,15). In der Interventionsgruppe wurde die Rolle von PJ-Studierenden als Vorbild, Lehrer, Ansprechpartner und Integrationsfigur im Vergleich zur Kontrollgruppe als signifikant bedeutsamer eingeschatzt (jeweils p Diskussion Patientenzentrierte, von PJ-Studierenden geleitete Tutorien auf Station zur Vermittlung klinischer-praktischer Kompetenzen werden sowohl von den Medizinstudierenden als auch den PJ-TutorInnen als sehr positiv bewertet und ermoglichen den PJ-TutorInnen die Ubernahme wichtiger Rollenfunktionen.

Recent research provides evidence that implicit attitude formation is guided by a summation principle (Betsch, Plessner, Schwieren, & Gutig, 2001). This finding contradicts models claiming that attitudes form from the average value of stimulus information (e.g., Anderson, 1981). In this paper, we show that the application of an integration rule depends on the mode of processing (implicit vs. explicit). In three experiments, participants encode sequences of return values produced by shares on the stock market. Results jointly indicate that evaluative judgments follow an averaging principle when attitudes were formed explicitly, either on memory content (Exp. 1) or the relevant sample of information (Exp. 2). In Experiment 3, we varied the processing mode within participants. An attitude reversal effect was found by varying the mode of processing for the same set of stimuli. After implicit attitude formation, participants evaluated the share with a higher sum of return values more positively than the share with a higher average value. This pattern reversed when participants explicitly evaluated the same shares. Copyright © 2006 John Wiley & Sons, Ltd.

In a laboratory experiment, we compare the relative impact of two possible determinants of intuitive evaluative judgments: ease of recognition and total value of prior encounters with a target. Participants encode daily return values of shares on the stock market while watching videotaped ads on the computer screen. This dual-task procedure ensures that participants subsequently lack relevant event memories and thus have to rely on their intuition when evaluating the targets. In the presentation, the share appearing least frequently produced the highest sum of returns. In contrast, the share appearing most frequently produced the lowest sum of returns. Evaluative judgments reveal a preference for the share with the highest sum of returns, although, as evident from recognition latencies, it was the one that was more difficult to recognize. The results provide evidence for the value-account model of implicit attitude formation ( Betsch, Plessner, Schwieren, & Gütig, 2001 ), which predicts that intuitive evaluative judgments reflect the total value of prior encounters.

Background: Learning on the ward as a practice-oriented preparation for the future workplace plays a crucial role in the medical education of future physicians. However, students’ ward internship is partially problematic due to condensed workflows on the ward and the high workload of supervising physicians. For the first time in a German-speaking setting, students’ expectations and concerns about their internship on the ward are examined in a qualitative analysis regarding their internal medicine rotation within clinical medical education. Methods: Of a total of 168 medical students in their 6th semester at the Medical Faculty of Heidelberg, 28 students (m=8, f=20, Ø 23.6 years) took part in focus group interviews 3 to 5 days prior to their internship on the internal medicine ward within their clinical internal medicine rotation. Students were divided into four different focus groups. The protocols were transcribed and a content analysis was conducted based on grounded theory. Results: We gathered a total of 489 relevant individual statements. The students hope for a successful integration within the ward team, reliable and supportive supervisors and supervision in small groups. They expect to face the most common diseases, to train the most important medical skills, to assume full responsibility for their own patients and to acquire their own medical identity. The students fear an insufficient time frame to achieve their aims. They are also concerned they will have too little contact with patients and inadequate supervision. Conclusion: For the development and standardization of effective student internships, the greatest relevance should be attributed to guidance and supervision by professionally trained and well-prepared medical teachers, entailing a significant increase in staff and costs. A structural framework is required in order to transfer the responsibility for the treatment of patients to the students at an early stage in medical education and in a longitudinal manner. The data suggest that the development and establishment of guidelines for medical teachers associated with clearly defined learning objectives for the students’ internships are urgently needed. Based on our findings, we provide first recommendations and suggest possible solutions.

Ausstellungen sind konstitutiv für die »Ordnungen des Wissens« einer Kultur - so etwa für den Kanon der Kunstgeschichte. Im Mittelpunkt dieses Buches steht die »Documenta 11« aus dem Jahre 2002, an der sich eine Entwicklung symptomatisch ablesen lässt: Nach dem Bruch von 1989 und mit dem dominanten Einsatz fotografisch-dokumentarischer Bildmedien wurde hier ein immer noch wirkmächtiger abstrakter, modernistischer Kunst- und Bildbegriff in Frage gestellt, der auf »Werkautonomie«, »Originalität« und einer »eurozentristisch-westlichen Kunstgeschichtsschreibung« basiert. Katja Hoffmanns systematische Ausstellungsanalyse entwickelt zugleich einen innovativen Ansatz zur Untersuchung von Foto-, Film- und Videoinstallationen (u.a. von Candida Höfer, Fiona Tan, Eija-Liisa Ahtila) und knüpft an aktuelle bild- und medienwissenschaftliche Fragestellungen an.