Low-cost test rig for characterization of photocatalytic planar materials using photonically sized UV-A LED light sources.

In the presented studies, a system for the characterization of planar photocatalysts was developed and tested. In the system, reference substances can be studied online with regard to their degradability and adsorption on photocatalytic materials. In order to perform accurate calculations of the quantum and photon efficiency of the catalysts, the LED arrays used were adjusted in their spacing by simulations so that a homogeneous light field is imaged on the catalysts. The system was tested with respect to measurement accuracy and reproducibility and the photocatalytic degradation of methylene blue, methyl orange and rhodamine B was investigated. Exemplarily, the reaction kinetics, photolysis and adsorption on the tested photocatalysts were determined for these compounds and the calculation was presented in detail. The exact construction plans and circuits as well as the sensors and their programming are presented in detail and should encourage other scientists to replicate the experimental setup, since especially in the field of photocatalysis research, often the results of publications cannot be compared with each other.

[A regional comparison of outcomes quality and costs of general and specialized palliative care in Germany: a claims data analysis]. / Ergebnisqualität und Kosten der allgemeinen und spezialisierten Palliativversorgung in Deutschland im regionalen Vergleich: eine GKV-Routinedatenstudie.

BACKGROUND: The main framework conditions for palliative care are set at the regional level. The scope of the forms of care used (outpatient, inpatient, general, specialized) varies widely. What is the quality of outcomes achieved by the palliative care provided on a federal states level? What are the associated costs of care? METHOD: Retrospective observational study using BARMER claims data from 145,372 individuals who died between 2016 and 2019 and had palliative care in the last year of life. Regional comparison with regard to the following outcomes: proportion of palliative care patients who died in the hospital, potentially burdensome care in the last 30 days of life (ambulance calls, [intensive care] hospitalizations, chemotherapy, feeding tubes, parenteral nutrition), total cost of care (last three months), cost of palliative care (last year), and cost-effectiveness ratios. Calculation of patient/resident characteristic adjusted rates, costs, and ratios. RESULTS: Federal states vary significantly with respect to the outcomes (also adjusted) of palliative care. Palliative care costs vary widely, most strongly for specialized outpatient palliative care (SAPV). Across all indicators and the cost-effectiveness ratio of total cost of care to at-home deaths, Westphalia-Lippe shows favorable results. CONCLUSION: Regions with better quality and more favorable cost (ratios) can provide guidance for other regions. The extent to which the new federal SAPV agreement can incorporate the empirical findings should be reviewed. Patient-relevant outcome parameters should be given greater weight than parameters aiming at structures of care.

Assessing physician preferences on future therapeutic options and diagnostic practices in non-alcoholic steatohepatitis.

BACKGROUND & AIMS: There is currently no data on physician preferences regarding future therapies for non-alcoholic steatohepatitis (NASH); this study explores these preferences and characteristics that are relevant to physician decision-making when choosing a potential therapy for a patient with NASH. The results were compared with those from a similar patient preference survey which was conducted in parallel. METHOD: Initial exploratory 30-minute telephone interviews were conducted to inform the design of a 15-minute quantitative online specialist physicians survey, containing direct questions and a preference survey. This was based on a best-worst scaling (BWS) experiment to assess the relative importance of different treatment characteristics (attributes), followed by several paired comparison questions to understand the preference for 5 hypothetical product profiles. RESULTS: The answers come from 121 physicians from Canada (n = 31), Germany (n = 30), the UK (n = 30) and the USA (n = 30). The primary driving element in NASH treatment decision-making was efficacy (49.23%), defined as "[hypothetical product] impact on liver status" and "[slowing of] progression to cirrhosis". Physicians reported the common use of non-invasive NASH diagnostic tests and 81% reported performing liver biopsy. In 57% of cases, physicians reported that "concerns related to the available diagnostic methods" limit the number of patients with biopsy-confirmed NASH. CONCLUSIONS: This first physician preference study reveals that efficacy will be the main driver for physicians in selecting future NASH drugs. The findings also confirm the widespread use of non-invasive diagnostic tests and the reluctance to perform confirmatory liver biopsy despite guideline recommendations, mainly due to limited therapeutic options and patient refusal. LAY SUMMARY: This study explores physician preferences in relation to future therapies for non-alcoholic steatohepatitis (NASH) and characteristics that are relevant to physician decision-making when choosing a potential therapy for a patient with NASH. The results of a short online survey completed by 121 specialist physicians determined that the primary factor that influences treatment decision-making is efficacy, and that a wide range of non-invasive techniques are used to diagnose NASH, while confirmatory liver biopsy is not performed by all physicians despite guideline recommendations.

The Choice of Transcatheter Aortic Valve Implementation (TAVI): Do Patient Co-morbidity and Hospital Ownership Type Matter?

BACKGROUND: Innovative technologies challenge healthcare systems, as evidence on costs and benefits frequently usually are slow to reflect new technology. We investigated these dynamics for Germany, using the emergence of transcatheter aortic valve implementation (TAVI) as an alternative to conventional aortic valve replacements (CAVR). OBJECTIVE: We focused on the role of patient co-morbidity-which would be a medical explanation for adopting TAVI-and hospital ownership status, hypothesizing that for-profit facilities are more likely to capitalize on the favorable reimbursement conditions of TAVI. METHODS: The analysis uses claims data from the Techniker Krankenkasse, the largest health insurance fund in Germany, for the years 2009-2015, covering 2892 patients with TAVI and 9523 with CAVR. The decision on TAVI versus CAVR was estimated for patient-level data, that is, socioeconomic data as well as co-morbidity. At the hospital level, we included the ownership type. We also controlled for effects of the respective owner (rather than the type of ownership), including a random intercept. RESULTS: While the co-morbidity score of TAVI patients was much higher in the early years, over time, the score almost converged with that of CAVR patients. This is in agreement with emerging evidence that suggests the use of TAVI also leads to better patient outcomes. Our results indicate that the type of ownership does not drive the switch to TAVI. We found little, if any, effect from the respective owner, regardless of ownership type. CONCLUSION: Overall, the effects of co-morbidity suggest that providers acted responsibly when adopting TAVI while evidence was still emerging.

Out-of-pocket expenditure and financial protection in the Chilean health care system-A systematic review.

BACKGROUND: Protection against financial risk due to medical spending is an explicit health guarantee within Chile's AUGE health reform. This paper seeks to analyze the degree to which out-of-pocket expenditure still expose Chilean households to financial catastrophe and impoverishment, and to explore inequalities in financial protection. METHODS: A systematic literature review was conducted to identify empirical studies analyzing financial protection in Chile. The search included databases as well as grey literature, i.e. governmental and institutional webpages. The indicators are based on the conceptual framework of financial protection, as portrayed in the World Health Report 2013. RESULTS: We identify n=16 studies that fulfill the inclusion criteria. Empirical studies indicate that 4% of Chilean households faced catastrophic health expenditure defined as out-of-pocket expenditure exceeding 30% of household's capacity to pay, while less than 1% were pushed into poverty in 2012. In contrast to prior studies, recent data report that even publicly insured who should be fully protected from co-payments were affected by catastrophic health expenditure. Also in the private insurance system financial catastrophe is a common risk. CONCLUSION: Despite health reform efforts, financial protection is insufficient and varies to the disadvantage of the poor and vulnerable groups. More research is required to understand why current mechanisms are not as effective as expected and to enable according reforms of the insurance system.

Redistribution through social health insurance: evidence on citizen preferences.

The extent of social health insurance (SHI) and supplementary private insurance is frequently analyzed in public choice. Most of these analyses build on the model developed by Gouveia (1997), who defines the extent of SHI as consequence of a choice by self-interested voters. In this model, an indicator reflecting individuals' relative income position and relative risk of falling ill determines the voting decision. Up to now, no empirical evidence for this key assumption has been available. We test the effect of this indicator on individuals' preferences for the extent of SHI in a setting with mandatory SHI that can be supplemented by private insurance. The data is based on a DCE conducted in the field with a representative sample of 1538 German citizens in 2012. Conditional logit and latent class models are used to analyze preference heterogeneity. Our findings strongly support the assumptions of the models. Individuals likely to benefit from public coverage show a positive marginal willingness to pay (MWTP) for both a shift away from other beneficiary groups toward the sick and an expansion of publicly financed resources, and the expected net payers have a negative MWTP and prefer lower levels of public coverage.

Hospital merger control in Germany, the Netherlands and England: Experiences and challenges.

Aiming at the efficiency enhancing and quality improving effects of competition, various steps have been undertaken to foster competition in hospital markets. For these mechanisms to work, robust competition policy needs to be enacted and enforced. We compare the hospital markets in Germany, the Netherlands and England regarding their experience with competition and put a special focus on merger control and the stringency of its implementation. Elaborating on the differences in merger control practice we find that despite very similar goals the respective agencies apply very different approaches and take fundamentally different routes when balancing proclaimed benefits of mergers with potential risks of consolidated markets. While the German competition authority has a strong focus on maintaining the preconditions for competition, in the Netherlands we find over the past decade a much stronger focus on hypothesized countervailing buyer power, accepting in turn highly concentrated markets. In England we find the currently most comprehensive analysis of proposed mergers in combination with a clearly positive assessment of the effects of patient choice and competition on prices and quality. All agencies are still reluctant to implement merger simulation models or similarly advanced econometric methods in their appraisal. One very likely reason is a lack of country specific empirical evidence on these matters.

Guiding bioprocess design by microbial ecology.

Industrial bioprocess development is driven by profitability and eco-efficiency. It profits from an early stage definition of process and biocatalyst design objectives. Microbial bioprocess environments can be considered as synthetic technical microbial ecosystems. Natural systems follow Darwinian evolution principles aiming at survival and reproduction. Technical systems objectives are eco-efficiency, productivity, and profitable production. Deciphering technical microbial ecology reveals differences and similarities of natural and technical systems objectives, which are discussed in this review in view of biocatalyst and process design and engineering strategies. Strategies for handling opposing objectives of natural and technical systems and for exploiting and engineering natural properties of microorganisms for technical systems are reviewed based on examples. This illustrates the relevance of considering microbial ecology for bioprocess design and the potential for exploitation by synthetic biology strategies.

Using discrete choice experiments to understand preferences in health care.

Whenever processes are reconfigured or new products are designed the needs and preferences of patients and consumers have to be considered. Although at times neglected, this becomes more and more relevant in health care settings: Which modes of health care delivery will be accepted? What are the patients' priorities and what is the willingness to pay? To which degree are patients mobile and for which kind of services are they willing to travel? Preferences, however, are difficult to measure, as they are latent constructs. This becomes even more difficult, when no past choices can be analyzed either as the service or the product is yet to be developed or as in the past there has not been free choice for patients. In such cases, preferences cannot be surveyed directly. Asking individuals openly for their attitudes towards certain services and products, the results are likely biased as individuals are not confronted with budget constraints and trade-offs. For this reason, discrete choice experiments (DCEs) are frequently used to elicit patient preferences. This approach confronts patients with hypothetical scenarios of which only one can be chosen. Over the past few years, this tool to reveal patients' preferences for health care has become very popular in health economics. This contribution aims at introducing the principles of DCEs, highlighting the underlying theory and giving practical guidance for conducting a discrete choice experiment in health economics. Thereby we focus on three major fields of patient demand: designing health insurance, assessing patient utility of new pharmaceuticals and analyzing provider choice. By having a closer look at selected international studies, we discuss the application of this technique for the analysis of the supply and the demand of health care as well as the implications for assessing patient mobility across different health care systems.

Consolidation and concentration in the German hospital market: the two sides of the coin.

In many countries, policy makers try to increase quality and efficiency in the hospital sector by fostering competition. The German hospital market is a good example of this approach and the challenges that come with it. We focus on market concentration which is both a result of and a potential threat to more competition. This study gives a detailed account of health reform in the German hospital sector and illustrates international experience with regard to market concentration. For the first time, concentration measures are consistently calculated at hospital system level. To make the results exploitable for comparative studies, this approach is described in detail. Patient flows are analyzed using data from the German hospital census, which is augmented with external data such as an indicator for the structures of urban and rural development. Our findings indicate that just some years after hospital competition was intensified, more than one third of German hospitals are located in strongly concentrated markets. Rural areas are especially prone to this development. If system membership is not accounted for, concentration is considerably underestimated. Policy makers are strongly advised to take precautions against excessive market concentration before promoting competition, as once consolidated, structures are difficult to unbundle.

Characterization of polymer-silica nanocomposite particles with core-shell morphologies using Monte Carlo simulations and small angle X-ray scattering.

A two-population model based on standard small-angle X-ray scattering (SAXS) equations is verified for the analysis of core-shell structures comprising spherical colloidal particles with particulate shells. First, Monte Carlo simulations of core-shell structures are performed to demonstrate the applicability of the model. Three possible shell packings are considered: ordered silica shells due to either charge-dependent repulsive or size-dependent Lennard-Jones interactions or randomly arranged silica particles. In most cases, the two-population model produces an excellent fit to calculated SAXS patterns for the simulated core-shell structures, together with a good correlation between the fitting parameters and structural parameters used for the simulation. The limits of application are discussed, and then, this two-population model is applied to the analysis of well-defined core-shell vinyl polymer/silica nanocomposite particles, where the shell comprises a monolayer of spherical silica nanoparticles. Comprehensive SAXS analysis of a series of poly(styrene-co-n-butyl acrylate)/silica colloidal nanocomposite particles (prepared by the in situ emulsion copolymerization of styrene and n-butyl acrylate in the presence of a glycerol-functionalized silica sol) allows the overall core-shell particle diameter, the copolymer latex core diameter and polydispersity, the mean silica shell thickness, the mean silica diameter and polydispersity, the volume fractions of the two components, the silica packing density, and the silica shell structure to be obtained. These experimental SAXS results are consistent with electron microscopy, dynamic light scattering, thermogravimetry, helium pycnometry, and BET surface area studies. The high electron density contrast between the (co)polymer and the silica components, together with the relatively low polydispersity of these core-shell nanocomposite particles, makes SAXS ideally suited for the characterization of this system. Moreover, these results can be generalized for other types of core-shell colloidal particles.

Defining clinical assessment standards for bachelor's-prepared nurses in Switzerland.

PURPOSE: A rigorous process of collaboration among multilingual and multicultural nursing faculties throughout Switzerland to define optimized learning goals for clinical assessment education at the bachelor's level is described in the context of wider European academic harmonization. Formation of a consensus-seeking panel proved a useful strategy for disseminating knowledge among academic nursing faculties in the early years of tertiary nursing education. The process enabled representatives of competing institutions to share scarce resources and articulate the added value of a bachelor's degree in nursing. CONCLUSIONS: A consensus-building strategy has applicability for nursing faculties wishing to increase collaboration, efficiency, and effectiveness early in the process of academic nursing development. Lack of availability of learning materials written in the languages of the local clinical setting is a barrier to teaching advanced assessment skills. CLINICAL RELEVANCE: Clinical assessment education that teaches a systematic approach to data collection, analysis, and reporting is central to producing excellent clinical professionals.

[Cardiovascular preparticipation screening of competitive athletes]. / Die kardiovaskuläre Voruntersuchung im Wettkampfsport.

Cardiovascular deaths during or following sport activities repeatedly raise the question about a practicable preparticipation screening for athletes to prevent such adverse events. In Germany and most European countries, well-equipped sports medicine centers evaluate the health of the Olympic athletes through regular checkups, which include a detailed medical history and thorough physical examination as well as an ECG at rest, a stress ECG, and an echocardiography. In professional sports, guidelines for this screening differ according to the federations, however, most of them intend to follow the recommendations of the Olympic sports system. For nonprofessional competitive sports, there are no guidelines for preparticipation screening, although these athletes train at the same level of intensity as professional athletes. The main issue in this international debate is the question of cost-effectiveness and how to finance preventive measures.

Prediction of the adaptability of Pseudomonas putida DOT-T1E to a second phase of a solvent for economically sound two-phase biotransformations.

The strain Pseudomonas putida DOT-T1E was tested for its ability to tolerate second phases of different alkanols for their use as solvents in two-liquid-phase biotransformations. Although 1-decanol showed an about 10-fold higher toxicity to the cells than 1-octanol, the cells were able to adapt completely to 1-decanol only and could not be adapted in order to grow stably in the presence of a second phase of 1-octanol. The main explanation for this observation can be seen in the higher water and membrane solubility of 1-octanol. The hydrophobicity (log P) of a substance correlates with a certain partitioning of that compound into the membrane. Combining the log P value with the water solubility, the maximum membrane concentration of a compound can be calculated. With this simple calculation, it is possible to predict the property of an organic chemical for its potential applicability as a solvent for two-liquid-phase biotransformations with solvent-tolerant P. putida strains. Only compounds that show a maximum membrane concentration of less than 400 mM, such as 1-decanol, seem to be tolerated by these bacterial strains when applied in supersaturating concentrations to the medium. Taking into consideration that a solvent for a two-liquid-phase system should possess partitioning properties for potential substrates and products of a fine chemical synthesis, it can be seen that 1-decanol is a suitable solvent for such biotransformation processes. This was also demonstrated in shake cultures, where increasing amounts of a second phase of 1-decanol led to bacteria tolerating higher concentrations of the model substrate 3-nitrotoluene. Transferring this example to a 5-liter-scale bioreactor with 10% (vol/vol) 1-decanol, the amount of 3-nitrotoluene tolerated by the cells is up to 200-fold higher than in pure aqueous medium. The system demonstrates the usefulness of two-phase biotransformations utilizing solvent-tolerant bacteria.

Practical issues in the application of oxygenases.

Oxygenases carry out the regio-, stereo- and chemoselective introduction of oxygen in a tremendous range of organic molecules. This versatility has already been exploited in several commercial processes. There are, however, many hurdles to further practical large-scale applications. Here, we review various issues in biocatalysis using these enzymes, such as screening strategies, overoxidation, uncoupling, substrate uptake, substrate toxicity, and oxygen mass transfer. By addressing these issues in a systematic way, the productivity of promising laboratory scale biotransformations involving oxygenases may be improved to levels that allow industry to realise the full commercial potential of these enzymes.

The production of fine chemicals by biotransformations.

Today, biocatalysis is a standard technology for the production of chemicals. An analysis of 134 industrial biotransformations reveals that hydrolases (44%) and redox biocatalysts (30%) are the most prominent categories. Most products are chiral (89%) and are used as fine chemicals. In the chemical industry, successful product developments involve on average a yield of 78%, a volumetric productivity of 15.5 g/(L.h) and a final product concentration of 108 g/L. By contrast, the pharmaceutical industry focuses on time-to-market. The implications of this for future research and development on biocatalysis are discussed.

The use of enzymes in the chemical industry in Europe.

Many European chemical industries are in a phase of reorganization resulting in a general opening towards life sciences. Traditional chemical markets are served increasingly with products derived from bioprocesses or hybrid chemical/biocatalytic processes. Biocatalytic steps are already being used to produce a wide range of products, including agricultural chemicals, organics, drugs and plastic materials, to name but a few. Apart from the rapidly growing number of commercialized bioprocesses, a partial survey of exploratory activities points to future applications of enzymes in the European chemical industry, which will bring new products and technologies and, in some cases, replace traditional syntheses.