Structural characteristics and contractual terms of specialist palliative homecare in Germany.

BACKGROUND: Multi-professional specialist palliative homecare (SPHC) teams care for palliative patients with complex symptoms. In Germany, the SPHC directive regulates care provision, but model contracts for each federal state are heterogeneous regarding staff requirements, cooperation with other healthcare providers, and financial reimbursement. The structural characteristics of SPHC teams also vary. AIM: We provide a structured overview of the existing model contracts, as well as a nationwide assessment of SPHC teams and their structural characteristics. Furthermore, we explore whether these characteristics serve to find specifc patterns of SPHC team models, based on empirical data. METHODS: This study is part of the multi-methods research project "SAVOIR", funded by the German Innovations Fund. Most model contracts are publicly available. Structural characteristics (e.g. number, professions, and affiliations of team members, and external cooperation) were assessed via an online database ("Wegweiser Hospiz- und Palliativversorgung") based on voluntary information obtained from SPHC teams. All the data were updated by phone during the assessment process. Data were descriptively analysed regarding staff, cooperation requirements, and reimbursement schemes, while latent class analysis (LCA) was used to identify structural team models. RESULTS: Model contracts have heterogeneous contract partners and terms related to staff requirements (number and qualifications) and cooperation with other services. Fourteen reimbursement schemes were available, all combining different payment models. Of the 283 SPHC teams, 196 provided structural characteristics. Teams reported between one and 298 members (mean: 30.3, median: 18), mainly nurses and physicians, while 37.8% had a psychosocial professional as a team member. Most teams were composed of nurses and physicians employed in different settings; for example, staff was employed by the team, in private practices/nursing services, or in hospitals. Latent class analysis identified four structural team models, based on the team size, team members' affiliation, and care organisation. CONCLUSION: Both the contractual terms and teams' structural characteristics vary substantially, and this must be considered when analysing patient data from SPHC. The identified patterns of team models can form a starting point from which to analyse different forms of care provision and their impact on care quality.

[Concept-dependent and -independent care effects of site-specific care concepts using "pain" as an example]. / Konzeptabhängige und -unabhängige Versorgungseffekte standortspezifischer palliativer Versorgungskonzepte am Beispiel "Schmerz".

BACKGROUND: Structures of palliative care, cross-sectoral transitions and care pathways of patients with palliative care needs were investigated at two sites. The systematic comparison of similarities and differences using the topic of 'pain' as an example is intended to provide information on the extent to which these are related to site-specific palliative care concepts (integrated and cooperative). METHODS: The study follows a mixed-methods design. In addition to a document analysis of anonymised patient records (n = 774), expert interviews (n = 20), as well as interviews with patients, relatives (n = 60) and focus groups (n = 12), were conducted. RESULTS: The systematic comparative analysis provides evidence for concept-independent commonalities (e.g. sociodemographic distribution, aggravated pain treatment) as well as concept-dependent differences (e.g. care pathways, facilitated continuous symptom control through integrated care structures) in the context of integrated or cooperative palliative care. DISCUSSION: Commonalities and differences with regard to the topic of pain, as focused on here, and its organisational management become tangible as effects of the respective organisational structure (= concept-dependent) as well as concept-independent external influencing factors.

Palliative care as a digital working world (PALLADiUM) - A mixed-method research protocol.

BACKGROUND: In Palliative Care, actors from different professional backgrounds work together and exchange case-specific and expert knowledge and information. Since Palliative Care is traditionally distant from digitalization due to its holistically person-centered approach, there is a lack of suitable concepts enabling digitalization regarding multi-professional team processes. Yet, a digitalised information and collaboration environment geared to the requirements of palliative care and the needs of the members of the multi-professional team might facilitate communication and collaboration processes and improve information and knowledge flows. Taking this chance, the presented three-year project, PALLADiUM, aims to improve the effectiveness of Palliative Care teams by jointly sharing available inter-subjective knowledge and orientation-giving as well as action-guiding practical knowledge. Thus, PALLADiUM will explore the potentials and limitations of digitally supported communication and collaboration solutions. METHODS: PALLADiUM follows an open and iterative mixed methods approach. First, ethnographic methods - participant observations, interviews, and focus groups - aim to explore knowledge and information flow in investigating Palliative Care units as well as the requirements and barriers to digitalization. Second, to extend this body, the analysis of the historical hospital data provides quantitative insights. Condensing all findings results in a to-be work system. Adhering to the work systems transformation method, a technical prototype including artificial intelligence components will enhance the collaborative teamwork in the Palliative Care unit. DISCUSSION: PALLADiUM aims to deliver decisive new insights into the preconditions, processes, and success factors of the digitalization of a medical working environment as well as communication and collaboration processes in multi-professional teams. TRIAL REGISTRATION: The study was registered prospectively at DRKS (Deutsches Register Klinischer Studien) Registration-ID: DRKS0025356 Date of registration: 03.06.21.

Emphasizing speed or accuracy in an eye-tracking version of the Trail-Making-Test: Towards experimental diagnostics for decomposing executive functions.

The Trail-Making-Test (TMT) is one of the most widely used neuropsychological tests for assessing executive functions, the brain functions underlying cognitively controlled thought and action. Obtaining a number of test scores at once, the TMT allows to characterize an assortment of executive functions efficiently. Critically, however, as most test scores are derived from test completion times, the scores only provide a summary measure of various cognitive control processes. To address this problem, we extended the TMT in two ways. First, using a computerized eye-tracking version of the TMT, we added specific eye movement measures that deliver a richer set of data with a higher degree of cognitive process specificity. Second, we included an experimental manipulation of a fundamental executive function, namely participants' ability to emphasize speed or accuracy in task performance. Our study of healthy participants showed that eye movement measures differed between TMT conditions that are usually compared to assess the cognitive control process of alternating between task sets for action control. This demonstrates that eye movement measures are indeed sensitive to executive functions implicated in the TMT. Crucially, comparing performance under cognitive control sets of speed vs. accuracy emphasis revealed which test scores primarily varied due to this manipulation (e.g., trial duration, number of fixations), and which were still more sensitive to other differences between individuals (e.g., fixation duration, saccade amplitude). This provided an experimental construct validation of the test scores by distinguishing scores primarily reflecting the executive function of emphasizing speed vs. accuracy and those independent from it. In sum, both the inclusion of eye movement measures and of the experimental manipulation of executive functions in the TMT enabled a more specific interpretation of the TMT in terms of cognitive functions and mechanisms, which offers more precise diagnoses in clinical applications and basic research.

Working memory and active sampling of the environment: Medial temporal contributions.

Working memory (WM) refers to the ability to maintain and actively process information-either derived from perception or long-term memory (LTM)-for intelligent thought and action. This chapter focuses on the contributions of the temporal lobe, particularly medial temporal lobe (MTL) to WM. First, neuropsychological evidence for the involvement of MTL in WM maintenance is reviewed, arguing for a crucial role in the case of retaining complex relational bindings between memorized features. Next, MTL contributions at the level of neural mechanisms are covered-with a focus on WM encoding and maintenance, including interactions with ventral temporal cortex. Among WM use processes, we focus on active sampling of environmental information, a key input source to capacity-limited WM. MTL contributions to the bidirectional relationship between active sampling and memory are highlighted-WM control of active sampling and sampling as a way of selecting input to WM. Memory-based sampling studies relying on scene and object inspection, visual-based exploration behavior (e.g., vicarious behavior), and memory-guided visual search are reviewed. The conclusion is that MTL serves an important function in the selection of information from perception and transfer from LTM to capacity-limited WM.

[Patient-reported outcomes and quality of care in specialized palliative home care: a nationwide, prospective longitudinal cohort trial]. / Symptomverlauf, Betreuungsqualität und Zufriedenheit mit der spezialisierten ambulanten Palliativversorgung (SAPV) aus Patient*innenperspektive: eine bundesweite prospektive Längsschnittstudie.

INTRODUCTION: Since 2007, patients receiving palliative care have been entitled to specialised outpatient palliative care (SAPV). Until now, the quality of care of the SAPV was only regionally focussed or in relation to individual SAPV teams. A nationwide analysis of outcome quality is still awaited. The organisation and design of structures and processes vary greatly from region to region, which complicates a comparative assessment of implementation. One way to measure the quality of the heterogeneous structures and processes is to collect patient-reported outcomes. Here, it is possible to use symptom burden, quality of care and patient satisfaction with SAPV care, since patients' quality of life is a central focus of SAPV care. This article is part of the research project SAVOIR, which is funded by the G-BA Innovation Fund. METHODS: For this prospective longitudinal survey of the outcome quality of SAPV, structured data were collected at two measurement points (t1 and t2 [4-10 days after t1]). A nationwide, representative sample of SAPV teams was targeted. These teams performed consecutive recruitment of patients included in SAPV. Two questionnaire instruments were used: the IPOS (Integrated Palliative Outcome Scale) at t1 and t2, and the QUAPS (quality control in specialized palliative home care) questionnaire at t2. Patient-reported outcomes measured improvement in symptom burden, patient satisfaction, and quality of care from the patient perspective. In addition, an exploratory stepwise regression analysis of factors associated with satisfaction was conducted. RESULTS: 42 SAPV teams agreed to participate in the study. They recruited a total of 964 patients at measurement time t1 (t2: 690 patients). The analyses show that the number and intensity of symptoms from the patient perspective decreased significantly during the course of SAPV treatment, especially pain, gastrointestinal symptoms, but also psychological complaints. 74.7 % of the patients reported a high level of satisfaction with SAPV. Also, the quality of care was considered to be high by the patients. Exploratively, five factors were extracted that explain 55 % of the satisfaction with SAPV: respect for the patient's decision, quality of communication, support with practical problems, and referral to care measures as well as symptom relief between the two measurement points. CONCLUSIONS: The SAPV patients recruited from a total of nine KV regions reported a reduced symptom burden and a high level of satisfaction with SAPV and rated the quality of care provided by SAPV as high.

The desmin mutation R349P increases contractility and fragility of stem cell-generated muscle micro-tissues.

AIMS: Desminopathies comprise hereditary myopathies and cardiomyopathies caused by mutations in the intermediate filament protein desmin that lead to severe and often lethal degeneration of striated muscle tissue. Animal and single cell studies hinted that this degeneration process is associated with massive ultrastructural defects correlating with increased susceptibility of the muscle to acute mechanical stress. The underlying mechanism of mechanical susceptibility, and how muscle degeneration develops over time, however, has remained elusive. METHODS: Here, we investigated the effect of a desmin mutation on the formation, differentiation, and contractile function of in vitro-engineered three-dimensional micro-tissues grown from muscle stem cells (satellite cells) isolated from heterozygous R349P desmin knock-in mice. RESULTS: Micro-tissues grown from desmin-mutated cells exhibited spontaneous unsynchronised contractions, higher contractile forces in response to electrical stimulation, and faster force recovery compared with tissues grown from wild-type cells. Within 1 week of culture, the majority of R349P desmin-mutated tissues disintegrated, whereas wild-type tissues remained intact over at least three weeks. Moreover, under tetanic stimulation lasting less than 5 s, desmin-mutated tissues partially or completely ruptured, whereas wild-type tissues did not display signs of damage. CONCLUSIONS: Our results demonstrate that the progressive degeneration of desmin-mutated micro-tissues is closely linked to extracellular matrix fibre breakage associated with increased contractile forces and unevenly distributed tensile stress. This suggests that the age-related degeneration of skeletal and cardiac muscle in patients suffering from desminopathies may be similarly exacerbated by mechanical damage from high-intensity muscle contractions. We conclude that micro-tissues may provide a valuable tool for studying the organization of myocytes and the pathogenic mechanisms of myopathies.

Action Selection and Execution in Everyday Activities: A Cognitive Robotics and Situation Model Perspective.

We examine the mechanisms required to handle everyday activities from the standpoint of cognitive robotics, distinguishing activities on the basis of complexity and transparency. Task complexity (simple or complex) reflects the intrinsic nature of a task, while task transparency (easy or difficult) reflects an agent's ability to identify a solution strategy in a given task. We show how the CRAM cognitive architecture allows a robot to carry out simple and complex activities such as laying a table for a meal and loading a dishwasher afterward. It achieves this by using generalized action plans that exploit reasoning with modular, composable knowledge chunks representing general knowledge to transform underdetermined everyday action requests into motion plans that successfully accomplish the required task. Noting that CRAM does not yet have the ability to deal with difficult activities, we leverage insights from the situation model perspective on the cognitive mechanisms underlying flexible context-sensitive behavior with a view to extending CRAM to overcome this deficit.

[Quality of care in specialized palliative homecare from the provider perspective: A qualitative study]. / Versorgungsqualität in der spezialisierten ambulanten Palliativversorgung aus Sicht der Leistungserbringer: eine qualitative Studie.

BACKGROUND: Since its introduction in 2007, the quality of care in specialized palliative home care (SAPV) is being measured using the patients' perspective. The perception of beneficial or inhibiting factors on the quality of care from the perspective of care providers received only little attention. OBJECTIVE: To investigate the factors that promote or impede the quality of care in SAPV from the care providers' perspective. METHODS: Within the framework of a transregional qualitative study, 113 problem-centered interviews were conducted on-site at 10 SAPV providers with their staff as well as their network partners. Grounded theory methodology was used for data curation and analysis. RESULTS: The factors that are perceived as either enhancing or inhibiting the quality of care largely depends on the culture of care of the individual SAPV provider. For participating doctors, nurses and psychosocial professionals, successful performance is associated with good symptom control, participation of relatives and the achievement of certainty of action and of interpretation by means of 'good' decision-making procedures. Problematic performances are linked to a lack of time resulting in restlessness and especially in disagreement between the parties involved in the provision of care as well as to the denial of death. CONCLUSIONS: The results of the study show that the perceived strategies, interpretations and evaluation categories, which are associated with good quality of care, are very heterogenous. On the basis of qualitative data, they do, however, follow three typical patterns in terms of cultures of care: proceduralism, holism and dualism.

Differentiating Progressive Supranuclear Palsy and Parkinson's Disease With Head-Mounted Displays.

Background: Progressive supranuclear palsy (PSP) is a neurodegenerative disorder that, especially in the early stages of the disease, is clinically difficult to distinguish from Parkinson's disease (PD). Objective: This study aimed at assessing the use of eye-tracking in head-mounted displays (HMDs) for differentiating PSP and PD. Methods: Saccadic eye movements of 13 patients with PSP, 15 patients with PD, and a group of 16 healthy controls (HCs) were measured. To improve applicability in an inpatient setting and standardize the diagnosis, all the tests were conducted in a HMD. In addition, patients underwent atlas-based volumetric analysis of various brain regions based on high-resolution MRI. Results: Patients with PSP displayed unique abnormalities in vertical saccade velocity and saccade gain, while horizontal saccades were less affected. A novel diagnostic index was derived, multiplying the ratios of vertical to horizontal gain and velocity, allowing segregation of PSP from PD with high sensitivity (10/13, 77%) and specificity (14/15, 93%). As expected, patients with PSP as compared with patients with PD showed regional atrophy in midbrain volume, the midbrain plane, and the midbrain tegmentum plane. In addition, we found for the first time that oculomotor measures (vertical gain, velocity, and the diagnostic index) were correlated significantly to midbrain volume in the PSP group. Conclusions: Assessing eye movements in a HMD provides an easy to apply and highly standardized tool to differentiate PSP of patients from PD and HCs, which will aid in the diagnosis of PSP.

A low-cost uniaxial cell stretcher for six parallel wells.

Cells in the lungs, the heart, and numerous other organs, are constantly exposed to dynamic forces and deformations. To mimic these dynamic mechanical loading conditions and to study the resulting cellular responses such as morphological changes or the activation of biochemical signaling pathways, cells are typically seeded on flexible 2D substrates that are uniaxially or biaxially stretched. Here, we present an open-source cell stretcher built from parts of an Anet A8 3D printer. The cell stretcher is controlled by a fully programmable open-source software using GCode and Python. Up to six flexible optically clear substrates can be stretched simultaneously, allowing for comparative multi-batch biological studies including microscopic image analysis. The cell yield from the cell culture area of 4 cm2 per substrate is sufficient for Western-blot protein analysis. As a proof-of-concept, we study the activation of the Yes-associated protein (YAP) mechanotransduction pathway in response to increased cytoskeletal tension induced by uniaxial stretching of epithelial cells. Our data support the previously observed activation of the YAP transcription pathway by stretch-induced increase in cytoskeletal tension and demonstrate the suitability of the cell stretcher to study complex mechano-biological processes.

Nanostructured Carbonated Hydroxyapatite Associated to rhBMP-2 Improves Bone Repair in Rat Calvaria.

Many biomaterials are used for Bone Morphogenetic Proteins (BMPs) delivery in bone tissue engineering. The BMP carrier system's primary function is to hold these growth factors at the wound's site for a prolonged time and provide initial support for cells to attach and elaborate the extracellular matrix for bone regeneration. This study aimed to evaluate the nanostructured carbonated hydroxyapatite microspheres (nCHA) as an rhBMP-2 carrier on rats calvaria. A total of fifteen male Wistar rats were randomly divided into three groups (n = 5): clot (control group), rhBMP-2 associated with collagen membrane (COL/rhBMP-2) or associated with the microspheres (nCHA/rhBMP-2). After 45 days, the calvaria defect samples were evaluated through histological, histomorphometric, and SR-µCT analyses to investigate new-formed bone and connective tissue volume densities. The descriptive histological analysis showed that nCHA/rhBMP-2 improved bone formation compared to other groups. These results were confirmed by histomorphometric and SR-µCT analysis that showed substantially defect area filling with a higher percentage of newly formed (36.24 ± 6.68) bone than those with the COL/rhBMP-2 (0.42 ± 0.40) and Clot (3.84 ± 4.57) (p < 0.05). The results showed that nCHA is an effective carrier for rhBMP-2 encouraging bone healing and an efficient alternative to collagen membrane for rhBMP-2 delivery.

[Palliative care at the end of life in Germany : Utilization and regional distribution]. / Palliativversorgung am Lebensende in Deutschland : Inanspruchnahme und regionale Verteilung.

BACKGROUND: Palliative care supply increased in Germany in recent years. But how many people use which forms of palliative care and how does this differ between regions? METHOD: Retrospective cohort study with claims data from insured persons who died in 2016: Based on services billed at least once in the last six months of life, we determined the use of primary palliative care (PPC), specialized palliative homecare (SPHC), as well as inpatient palliative and hospice care, using regional billing codes for PPC and SPHC services for the first time. RESULTS: Of the 95,962 deceased in the study population, 32.7% received palliative care nationwide, with variations from 26.4% in Bremen to 40.8% in Bavaria. PPC services were billed at 24.4% (16.9% in Brandenburg to 34.1% in Bavaria). SPHC services received 13.1% (6.3% in Rhineland-Palatinate to 18.9% in Brandenburg and 22.9% in Westphalia-Lippe with different SPHC practices). Inpatient palliative care was received by 8.1% (6.7% in Schleswig-Holstein/Hesse to 13.0% in Thuringia); 3.3% (1.6% in Bremen to 5.6% in Berlin) with hospice services. CONCLUSION: SPHC is used more frequently than previously reported, while PPC is declining. Utilization seems to be based less on objective needs than on region-specific framework conditions. Besides needs criteria, further development of palliative care should be oriented more towards outcomes and relevant framework conditions.

High-Force Magnetic Tweezers with Hysteresis-Free Force Feedback.

Magnetic tweezers based on a solenoid with an iron alloy core are widely used to apply large forces (∼100 nN) onto micron-sized (∼5 µm) superparamagnetic particles for mechanical manipulation or microrheological measurements at the cellular and molecular level. The precision of magnetic tweezers, however, is limited by the magnetic hysteresis of the core material, especially for time-varying force protocols. Here, we eliminate magnetic hysteresis by a feedback control of the magnetic induction, which we measure with a Hall sensor mounted to the distal end of the solenoid core. We find that the generated force depends on the induction according to a power-law relationship and on the bead-tip distance according to a stretched exponential relationship. Combined, they describe with only three parameters the induction-force-distance relationship, enabling accurate force calibration and force feedback. We apply our method to measure the force dependence of the viscoelastic and plastic properties of fibroblasts using a protocol with stepwise increasing and decreasing forces. We group the measured cells in a soft and a stiff cohort and find that softer cells show an increasing stiffness but decreasing plasticity with higher forces, indicating a pronounced stress stiffening of the cytoskeleton. By contrast, stiffer cells show no stress stiffening but an increasing plasticity with higher forces. These findings indicate profound differences between soft and stiff cells regarding their protection mechanisms against external mechanical stress. In summary, our method increases the precision, simplifies the handling, and extends the applicability of magnetic tweezers.

Oculomotor capture by search-irrelevant features in visual working memory: on the crucial role of target-distractor similarity.

When searching for varying targets in the environment, a target template has to be maintained in visual working memory (VWM). Recently, we showed that search-irrelevant features of a VWM template bias attention in an object-based manner, so that objects sharing such features with a VWM template capture the eyes involuntarily. Here, we investigated whether target-distractor similarity modulates capture strength. Participants saccaded to a target accompanied by a distractor. A single feature (e.g., shape) defined the target in each trial indicated by a cue, and the cue also varied in one irrelevant feature (e.g., color). The distractor matched the cue's irrelevant feature in half of the trials. Nine experiments showed that target-distractor similarity consistently influenced the degree of oculomotor capture. High target-distractor dissimilarity in the search-relevant feature reduced capture by the irrelevant feature (Experiments 1, 3, 6, 7). However, capture was reduced by high target-distractor similarity in the search-irrelevant feature (Experiments 1, 4, 5, 8). Strong oculomotor capture was observed if target-distractor similarity was reasonably low in the relevant and high in the irrelevant feature, irrespective of whether color or shape were relevant (Experiments 2 and 5). These findings argue for involuntary and object-based, top-down control by VWM templates, whereas its manifestation in oculomotor capture depends crucially on target-distractor similarity in relevant and irrelevant feature dimensions of the search object.

micrObs - A customizable time-lapse camera for ecological studies.

Camera traps for motion-triggered or continuous time-lapse recordings are readily available on the market. For demanding applications in ecology and environmental sciences, however, commercial systems often lack flexibility to freely adjust recording time intervals, suffer from mechanical component wear, and can be difficult to combine with auxiliary sensors such as GPS, weather stations, or light sensors. We present a robust time-lapse camera system that has been operating continuously since 2013 under the harsh climatic conditions of the Antarctic and Subantarctic regions. Thus far, we have recorded over one million images with individual cameras. The system consumes 122 mW of power in standby mode and captures up to 200,000 high-resolution (16 MPix) images without maintenance such as battery or image memory replacement. It offers time-lapse intervals between 2 s and 1 h, low-light or night-time power saving, and data logging capabilities for additional inputs such as GPS and weather data.

Task-Irrelevant Features in Visual Working Memory Influence Covert Attention: Evidence from a Partial Report Task.

Selecting a target based on a representation in visual working memory (VWM) affords biasing covert attention towards objects with memory-matching features. Recently, we showed that even task-irrelevant features of a VWM template bias attention. Specifically, when participants had to saccade to a cued shape, distractors sharing the cue's search-irrelevant color captured the eyes. While a saccade always aims at one target location, multiple locations can be attended covertly. Here, we investigated whether covert attention is captured similarly as the eyes. In our partial report task, each trial started with a shape-defined search cue, followed by a fixation cross. Next, two colored shapes, each including a letter, appeared left and right from fixation, followed by masks. The letter inside that shape matching the preceding cue had to be reported. In Experiment 1, either target, distractor, both, or no object matched the cue's irrelevant color. Target-letter reports were most frequent in target-match trials and least frequent in distractor-match trials. Irrelevant cue and target color never matched in Experiment 2. Still, participants reported the distractor more often to the target's disadvantage, when cue and distractor color matched. Thus, irrelevant features of a VWM template can influence covert attention in an involuntarily object-based manner when searching for trial-wise varying targets.

Study protocol for a multi-methods study: SAVOIR - evaluation of specialized outpatient palliative care (SAPV) in Germany: outcomes, interactions, regional differences.

BACKGROUND: Since 2007, the German statutory health insurance covers Specialized Outpatient Palliative Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive disease, complex symptoms and life expectancy limited to days, weeks or months. The introduction of SAPV is ruled by a directive (SAPV directive). Within this regulation, SAPV delivery models can and do differ regarding team structures, financing models, cooperation with other care professionals and processes of care. The research project SAVOIR is funded by G-BA's German Innovations Fund to evaluate the implementation of the SAPV directive. METHODS: The processes, content and quality of SAPV will be evaluated from the perspectives of patients, SAPV teams, general practitioners and other care givers and payers. The influence of different contracts, team and network structures and regional and geographic settings on processes and results including patient-reported outcomes will be analyzed in five subprojects: [1] structural characteristics of SAPV and their impact on patient care, [2] quality of care from the perspective of patients, [3] quality of care from the perspective of SAPV teams, hospices, ambulatory nursing services, nursing homes and other care givers, content and extent of care from [4] the perspective of General Practitioners and [5] from the perspective of payers. The evaluation will be based on different types of data: team and organizational structures, treatment data based on routine documentation with electronic medical record systems, prospective assessment of patient-reported outcomes in a sample of SAPV teams, qualitative interviews with other stakeholders like nursing and hospice services, a survey in general practitioners and a retrospective analysis of claims data of all SAPV patients, covered by the health insurance fund BARMER in 2016. DISCUSSION: Data analysis will allow identification of variables, associated with quality of SAPV. Based on these findings, the SAVOIR study group will develop recommendations for the Federal Joint Committee for a revision of the SAPV directive. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00013949 (retrospectively registered, 14.03.2018), DRKS00014726 (14.05.2018), DRKS00014730 (30.05.2018). Subproject 3 is an interview study with professional caregivers and therefore not registered in DRKS as a clinical study.

Neuropsychological assessment of visual selective attention and processing capacity with head-mounted displays.

OBJECTIVE: Neuropsychological patients often suffer from impairments in visual selective attention and processing capacity components. Their assessment demands a high standardization of testing conditions, which is difficult to achieve across institutions. Head-mounted displays (HMDs) provide a solution. These virtual reality devices cover the entire visual field in a shielded way and thus keep visual stimulation constant. For neuropsychological assessment with HMDs, sufficient reliability is required. We have previously demonstrated that an early developer version of an HMD can be used to reliably measure components of visual processing capacity. However, it is unclear whether this also holds for the assessment of components of visual selective attention. Moreover, it has yet to be established whether now commercially available HMDs are capable of reliable neuropsychological assessment. METHOD: We assessed the test-retest reliabilities of several components of visual selective attention and processing capacity of healthy subjects with the commercially available HTC Vive. Using an assessment procedure (combiTVA) derived from the theory of visual attention (TVA; Bundesen, 1990), we measured attentional selectivity, lateral bias, processing speed, visual working memory capacity, and the threshold of conscious perception. We compared the reliabilities of these components measured with the HTC Vive with those of a cathode ray tube (CRT) screen, the gold standard of visual presentation in the laboratory. RESULTS: Both devices provided comparable reliabilities. CONCLUSIONS: Thus, HMDs fulfill the requirement to replace standard screens. With their inherent visual standardization and portability, they offer unprecedented opportunities for neuropsychological assessment, such as computerized bedside testing and comparisons of test values across institutions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Feature prediction across eye movements is location specific and based on retinotopic coordinates.

With each saccadic eye movement, internal object representations change their retinal position and spatial resolution. Recently, we suggested that the visual system deals with these saccade-induced changes by predicting visual features across saccades based on transsaccadic associations of peripheral and foveal input (Herwig & Schneider, 2014). Here we tested the specificity of feature prediction by asking (a) whether it is spatially restricted to the previous learning location or the saccade target location, and (b) whether it is based on retinotopic (eye-centered) or spatiotopic (world-centered) coordinates. In a preceding acquisition phase, objects systematically changed their spatial frequency during saccades. In the following test phases of two experiments, participants had to judge the frequency of briefly presented peripheral objects. These objects were presented either at the previous learning location or at new locations and were either the target of a saccadic eye movement or not (Experiment 1). Moreover, objects were presented either in the same or different retinotopic and spatiotopic coordinates (Experiment 2). Spatial frequency perception was biased toward previously associated foveal input indicating transsaccadic learning and feature prediction. Importantly, while this pattern was not bound to the saccade target location, it was seen only at the previous learning location in retinotopic coordinates, suggesting that feature prediction probably affects low- or mid-level perception.